scholarly journals Reinforcing locally led solutions for universal health coverage: a logic model with applications in Benin, Namibia and Uganda

2021 ◽  
Vol 6 (2) ◽  
pp. e004273
Author(s):  
Joël Arthur Kiendrébéogo ◽  
Andrea Thoumi ◽  
Keith Mangam ◽  
Cheickna Touré ◽  
Seyni Mbaye ◽  
...  
Keyword(s):  
Global Health ◽  
International Development ◽  
Universal Health Coverage ◽  
Low Income ◽  
Development Assistance ◽  
Health Financing ◽  
Health Coverage ◽  
Global Health Community ◽  
Health Community ◽  
Universal Health

Development assistance for health programmes is often characterised as donor-led models with minimal country ownership and limited sustainability. This article presents new ways for low-income and middle-income countries to gain more control of their development assistance programming as they move towards universal health coverage (UHC). We base our findings on the experience of the African Collaborative for Health Financing Solutions (ACS), an innovative US Agency for International Development-funded project. The ACS project stems from the premise that the global health community can more effectively support UHC processes in countries if development partners change three long-standing paradigms: (1) time-limited projects to enhancing long-lasting processes, (2) fly-in/fly-out development support to leveraging and strengthening local and regional expertise and (3) static knowledge creation to supporting practical and co-developed resources that enhance learning and capture implementation experience. We assume that development partners can facilitate progress towards UHC if interventions follow five action steps, including (1) align to country demand, (2) provide evidence-based and tailored health financing technical support, (3) respond to knowledge and learnings throughout activity design and implementation, (4) foster multi-stakeholder collaboration and ownership and (5) strengthen accountability mechanisms. Since 2017, the ACS project has applied these five action steps in its implementing countries, including Benin, Namibia and Uganda. This article shares with the global health community preliminary achievements of implementing a unique, challenging but promising experience.

scholarly journals Analyzing efforts to synergize the global health agenda of universal health coverage, health security and health promotion: a case-study from Ethiopia

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Amare Worku Tadesse ◽  
Kassu Ketema Gurmu ◽  
Selamawit Tesfaye Kebede ◽  
Mahlet Kifle Habtemariam
Keyword(s):  
Health Promotion ◽  
Global Health ◽  
Health System ◽  
Universal Health Coverage ◽  
World Health ◽  
Health Coverage ◽  
Health Security ◽  
Universal Health ◽  
Health Agenda

Abstract Background Evidence exists about synergies among universal health coverage, health security and health promotion. Uniting these three global agendas has brought success to the country’s health sector. This study aimed to document the efforts Ethiopia has made to apply nationally synergistic approaches uniting these three global health agendas. Our study is part of the Lancet Commission on synergies between these global agendas. Methods We employed a case study design to describe the synergistic process in the Ethiopian health system based on a review of national strategies and policy documents, and key informant interviews with current and former policymakers, and academics. We analyzed the “hardware” (using the World Health Organization’s building blocks) and the “software” (ideas, interests, and power relations) of the Ethiopian health system according to the aforementioned three global agendas. Results Fragmentation of health system primarily manifested as inequities in access to health services, low health workforce and limited capacity to implementation guidelines. Donor driven vertical programs, multiple modalities of health financing, and inadequate multisectoral collaborations were also found to be key features of fragmentation. Several approaches were found to be instrumental in fostering synergies within the global health agenda. These included strong political and technical leadership within the government, transparent coordination, and engagement of stakeholders in the process of priority setting and annual resource mapping. Furthermore, harmonization and alignment of the national strategic plan with international commitments, joint financial arrangements with stakeholders and standing partnership platforms facilitated efforts for synergy. Conclusions Ethiopia has implemented multiple approaches to overcome fragmentation. Such synergistic efforts of the primary global health agendas have made significant contributions to the improvement of the country’s health indicators and may promote sustained functionality of the health system.

scholarly journals Employment based health financing does not support gender equity in universal health coverage

BMJ ◽  
2020 ◽  
pp. m3384 ◽  
Author(s):  
Lavanya Vijayasingham ◽  
Veloshnee Govender ◽  
Sophie Witter ◽  
Michelle Remme
Keyword(s):  
Gender Equity ◽  
Universal Health Coverage ◽  
Health Financing ◽  
Health Coverage ◽  
Universal Health

scholarly journals The Legal Determinants of Health: How Can We Achieve Universal Health Coverage and What Does it Mean?

2020 ◽  
Author(s):  
Lawrence O. Gostin
Keyword(s):  
Public Health ◽  
Global Health ◽  
Social Determinants ◽  
Universal Health Coverage ◽  
Good Health ◽  
Essential Medicines ◽  
Health Coverage ◽  
Public Health Services ◽  
The Right ◽  
Universal Health

How can we keep people – wherever they live – healthy and safe? Among all global health initiatives, universal health coverage (UHC) has garnered most political attention. But can UHC (as important as it is) actually achieve the two fundamental aspirations of the right to health: keeping people healthy and safe, while leaving no one behind? There is a universal longing for health and security, but also a deep-seated belief in fairness and equity. Can UHC achieve both health and equity, or what I have called, "global health with justice?" What makes a population healthy and safe? Certainly, universal and affordable access to healthcare is essential, including clinical prevention, treatment, and essential medicines. But beyond medical care are public health services, including surveillance, clean air, potable water, sanitation, vector control, and tobacco control. The final and most important factor in good health are social determinants, including housing, employment, education, and equity. If we can provide everyone with these three essential conditions for good health (healthcare, public health and social determinants), it would vastly improve global health. But we also need to take measures to leave no one behind. To achieve equity, we need to plan for it, and here I propose national health equity programs of action. Society’s highest obligation is to achieve global health, with justice.

scholarly journals Narrowing the Gap of Inequity in the Indonesia’s National Social Health Insurance Scheme, 2014-2018

2021 ◽  
Author(s):  
Hasbullah Thabrany ◽  
Ryan R. Nugraha ◽  
Ery Setiawan ◽  
Farah Purwaningrum
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
Universal Health Coverage ◽  
Low Income ◽  
National Health Insurance Scheme ◽  
Income Group ◽  
Health Insurance Scheme ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Universal Health

Abstract Background. Indonesia is nearing its 7-year implementation of its national health insurance scheme, or the Jaminan Kesehatan Nasional (JKN), as a facilitator for achieving universal health coverage (UHC). Despite its long-running system, it is contentious as to whether JKN has been narrowing the gap of inequity in its delivery. This paper aims to explore on whether the national health insurance scheme in Indonesia have been promoting equity of access towards health services.Methods. This study analyzes findings from JKN statistic data of 2014-2018 published by Government of Indonesia. Using a retrospective design, this study identified membership and utilization of health services within JKN, based on different membership enrollment groups as proxy for income.Results. JKN has been expanding its enrollment significantly within 5 years, during year 2014 to 2018. Moreover, the study concludes that there was increased access for outpatient in all membership groups. Inpatient care was increased in low-income group, but not in high-income group. Result also showed inpatient access was correlated with adequate supply side intervention, particularly hospital beds.Conclusion. JKN has been successful in narrowing the inequity gap, particularly by serving the low-income group better in terms of access. Going forward, equity needs to be incorporated into JKN achievement indicator, particularly to accelerate Indonesia’s effort to realize universal health coverage.

scholarly journals People’s Voice and Civil Society Participation as a Core Element of Universal Health Coverage Reforms: Review of Experiences in Iran

2021 ◽  
Author(s):  
Dheepa Rajan ◽  
Mohammad Hadi Ayazi ◽  
Maziar Moradi-Lakeh ◽  
Narges Rostamigooran ◽  
Maryam Rahbari ◽  
...  
Keyword(s):  
Civil Society ◽  
International Development ◽  
Universal Health Coverage ◽  
Health Sector ◽  
Civil Society Organizations ◽  
Health Coverage ◽  
Health Governance ◽  
Core Element ◽  
Governance Challenges ◽  
Universal Health

Health governance challenges can make or break universal health coverage (UHC) reforms. One of the biggest health governance challenges is ensuring meaningful participation and adequately reflecting people’s voice in health policies and implementation. Recognizing this, Iran’s Health Transformation Plan (HTP) lays out the country’s blueprint for UHC with an explicit emphasis on the ‘socialization of health.’ ‘Socialization’ is seen as a key means to contribute to HTP objectives, meaning the systematic and targeted engagement of the population, communities, and civil society in health sector activities. Given its specific cultural and historical context, we sought to discern what notions such as ‘civil society,’ ‘non-governmental organization,’ etc mean in practice in Iran, with the aim of offering policy options for strengthening and institutionalizing public participation in health within the context of the HTP. For this, we reviewed the literature and analysed primary qualitative data. We found that it may be more useful to understand Iranian civil society through its actions, ie, defined by its motivation and activities rather than the prevailing international development understanding of civil society as a structure which is completely independent of the state. We highlight the blurry boundaries between the different types of civil society organizations (CSOs) and government institutions and initiatives, as well as high levels of overlaps and fragmentation. Reducing fragmentation as a policy goal could help channel resources more efficiently towards common HTP objectives. The National Health Assembly (NHA) model which was first launched in 2017 offers a unique platform for this coordination role, and could be leveraged accordingly.

Reducing the Knowledge Gap in Global Health Delivery

2020 ◽  
pp. 152-165
Author(s):  
Andres Garchitorena ◽  
Megan B. Murray ◽  
Bethany Hedt-Gauthier ◽  
Paul E. Farmer ◽  
Matthew H. Bonds
Keyword(s):  
Global Health ◽  
International Development ◽  
Adaptive Systems ◽  
Care Delivery ◽  
Health Coverage ◽  
The Sustainable Development ◽  
New Era ◽  
Health Delivery ◽  
Development Goals ◽  
Universal Health

Randomized control trials (RCTs) are considered to be the gold standard for impact evaluation in international development and they are associated with a new era of evidence-based global health policies. However, there are inherent challenges in using RCTs to answer some of the most important questions in global health: why, if solutions are known, affordable at scale, and supported by existing evidence, do hundreds of millions of people lack access to essential health services? A lack of clarity on appropriate research methods for strengthening health systems has corresponded to a lack of investment in more complex and adaptive systems of integrated care delivery. This chapter reviews the use of RCTs in global health, highlighting major contributions, and addressing some pressing priorities in implementation research at a time when the Sustainable Development Goals emphasize the importance of sector-wide approaches, such as integrated primary care and universal health coverage.

scholarly journals Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Taufique Joarder ◽  
Tahrim Z. Chaudhury ◽  
Ishtiaq Mannan
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Service Management ◽  
Service Providers ◽  
Health Financing ◽  
Community Empowerment ◽  
Health Coverage ◽  
Demand Side ◽  
Implementation Barriers ◽  
Universal Health

Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage (UHC) and the challenges faced in these endeavors. This qualitative study involved document reviews (n=22) and key informant interviews (KII, n=15). Thematic analysis of texts (themes: activities around UHC, implementation barriers, suggestions) was done using the manual coding technique. We found that Bangladesh has a comprehensive set of policies for UHC, e.g., a health-financing strategy and staged recommendations for pooling of funds to create a national health insurance scheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three subdistricts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector’s implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.

Introduction to Part 5: Health for the whole population—leaving no-one behind

2015 ◽  
Author(s):  
Francis Omaswa ◽  
Nigel Crisp
Keyword(s):  
South Africa ◽  
Global Health ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Health It ◽  
Universal Health ◽  
The Way

Chapter 16 addresses the way in which universal health coverage has become one of the most important concepts in global health. It sets the scene for the following chapters in which leaders discuss the implementation of universal health coverage in Rwanda, South Africa, and Ghana.

scholarly journals Are we advancing universal health coverage through cataract services? Protocol for a scoping review

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e039458
Author(s):  
Chan Ning Lee ◽  
Jacqueline Ramke ◽  
Ian McCormick ◽  
Justine H Zhang ◽  
Ada Aghaji ◽  
...  
Keyword(s):  
Global Health ◽  
Universal Health Coverage ◽  
Scoping Review ◽  
Population Based ◽  
Financial Protection ◽  
Health Coverage ◽  
Surgical Services ◽  
Ethical Approval ◽  
Service Data ◽  
Universal Health

IntroductionUniversal health coverage (UHC) includes the dimensions of equity in access, quality services that improve health and protection against financial hardship. Cataract continues to be the leading cause of blindness globally, despite cataract surgery being an efficacious intervention. The aim of this scoping review is to map the nature, extent and global distribution of data on cataract services for UHC in terms of equity, access, quality and financial protection.Methods and analysisThe search will be constructed by an Information Specialist and undertaken in MEDLINE, Embase and Global Health databases. We will include all published non-interventional primary research studies and systematic reviews that report a quantitative assessment of access, equity, quality or financial protection of cataract surgical services for adults at the subnational, national, regional or global level from population-based surveys or routinely collected health service data since 1 January 2000 and published through to February 2020.Screening and data charting will be undertaken using Covidence systematic review software. Titles and abstracts of identified studies will be screened by two authors independently. Full-text articles of potentially relevant studies will be obtained and reviewed independently by two authors against the inclusion criteria. Any discrepancies between the authors will be resolved by discussion, and with a third author as necessary. A data charting form will be developed and piloted on three studies by three authors and amendments made as necessary. Data will be extracted by two reviewers independently and summarised narratively and using maps.Ethics and disseminationEthical approval was not sought as the scoping review will only use published and publicly accessible data. The review will be published in an open access peer-reviewed journal. A summary of the results will be developed for website posting, stakeholder meetings and inclusion in the ongoing Lancet Global Health Commission on Global Eye Health.

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