scholarly journals How is equity approached in universal health coverage? An analysis of global and country policy documents in Benin and Senegal

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Elisabeth Paul ◽  
Céline Deville ◽  
Oriane Bodson ◽  
N’koué Emmanuel Sambiéni ◽  
Ibrahima Thiam ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Health Coverage ◽  
African Countries ◽  
Policy Documents ◽  
Guiding Principle ◽  
Country Level ◽  
Gender Based ◽  
And Gender ◽  
Universal Health ◽  
Country Specific

Abstract Background Equity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it. We explore how the multidimensional concept of equity has been approached in key global UHC policy documents, as well as in country-level UHC policies. Methods We analysed a purposeful sample of UHC reports and policy documents both at global level and in two Western African countries (Benin and Senegal). We manually searched each document for its use and discussion of equity and related terms. The content was summarised and thematically analysed, in order to comprehend how these concepts were understood in the documents. We distinguished between the level at which inequity takes place and the origin or types of inequities. Results Most of the documents analysed do not define equity in the first place, and speak about “health inequities” in the broad sense, without mentioning the dimension or type of inequity considered. Some dimensions of equity are ambiguous – especially coverage and financing. Many documents assimilate equity to an overall objective or guiding principle closely associated to UHC. The concept of equity is also often linked to other concepts and values (social justice, inclusion, solidarity, human rights – but also to efficiency and sustainability). Regarding the levels of equity most often considered, access (availability, coverage, provision) is the most often quoted dimension, followed by financial protection. Regarding the types of equity considered, those most referred to are socio-economic, geographic, and gender-based disparities. In Benin and Senegal, geographic inequities are mostly pinpointed by UHC policy documents, but concrete interventions mostly target the poor. Overall, the UHC policy of both countries are quite similar in terms of their approach to equity. Conclusions While equity is widely referred to in global and country-specific UHC policy documents, its multiple dimensions results in a rather rhetorical utilisation of the concept. Whereas equity covers various levels and types, many global UHC documents fail to define it properly and to comprehend the breadth of the concept. Consequently, perhaps, country-specific policy documents also use equity as a rhetoric principle, without sufficient consideration for concrete ways for implementation.

Implementing health technology assessment in Ghana to support universal health coverage: building relationships that focus on people, policy, and process

2019 ◽  
Vol 36 (1) ◽  
pp. 8-11 ◽  
Author(s):  
Samantha Hollingworth ◽  
Martha Gyansa-Lutterodt ◽  
Lydia Dsane-Selby ◽  
Justice Nonvignon ◽  
Ruth Lopert ◽  
...  
Keyword(s):  
Resource Allocation ◽  
Health Technology Assessment ◽  
Universal Health Coverage ◽  
Technology Assessment ◽  
Health Technology ◽  
Health Coverage ◽  
African Countries ◽  
Allocation Decisions ◽  
Universal Health ◽  
Resource Allocation Decisions

AbstractGhana is one of the few African countries to enact legislation and earmark significant funding to establish universal health coverage (UHC) through the National Health Insurance Scheme, although donor funds have declined recently. Given a disproportionate level of spending on medicines, health technology assessment (HTA) can support resource allocation decisions in the face of highly constrained budgets, as commonly found in low-resource settings. The Ghanaian Ministry of Health, supported by the International Decision Support Initiative (iDSI), initiated a HTA study in 2016 to examine the cost-effectiveness of antihypertensive medicines. We aimed to summarize key insights from this work that highlights success factors beyond producing purely technical outputs. These include the need for capacity building, academic collaboration, and ongoing partnerships with a broad range of experts and stakeholders. By building on this HTA study, and with ongoing interactions with iDSI, HTAi, WHO, and others, Ghana will be well positioned to institutionalize HTA in resource allocation decisions and support progress toward UHC.

Noncommunicable disease control program of Bangladesh: current status and future direction to achieve universal health coverage (Preprint)

2020 ◽  
Author(s):  
Khaleda Islam ◽  
Rumana Huque ◽  
K.M. Saif-Ur Rahman ◽  
AHM Enayet Hussain
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Universal Health Coverage ◽  
Noncommunicable Disease ◽  
Health Coverage ◽  
Electronic Database ◽  
Policy Documents ◽  
Management Protocol ◽  
Key Policy ◽  
Universal Health

BACKGROUND Bangladesh is having 572,600 (67%) estimated deaths caused by noncommunicable diseases annually with 22% probable premature deaths. OBJECTIVE This study aimed to have a closer look into the overall readiness of Bangladesh to address NCDs, explore the barriers and suggest the best possible ways of reaching the target. METHODS The study reviewed relevant policy documents, NCDs related reports, publications, observed NCD service delivery at Upazila Health Complexes (UzHC) and validated the findings of desk review through discussion with key policy and program personnel. RESULTS NCDs are highlighted and prioritized in key policy documents, however, implementation of the policies remains weak with several gaps in service delivery systems. The operation plan (OP) indicators, which are the guiding factors of OP implementation, focus mostly on process not outcome or impact. Health system at primary health care facilities is not yet fully ready to deliver the NCD care, and mental health at primary care is rarely available. Health workforce (HWF) are getting oriented on national NCD management protocol though there is reluctance to follow the protocol. Record keeping is poor as it is manual. District health information software 2 (DHIS2) is not yet updated to capture the monthly service provision and tracking of indicators. CONCLUSIONS Weak health system is hampering delivery of NCD care at PHC, and tracking of indicators is difficult due to lack of electronic database. Implementation of NCD management protocol, ensuring availability of drugs, maintaining electronic database, and monitoring program and indicators are the way forward to achieve universal health coverage for NCD.

scholarly journals A review of prospective pathways and impacts of COVID-19 on the accessibility, safety, quality, and affordability of essential medicines and vaccines for universal health coverage in Africa

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Floriano Amimo ◽  
Ben Lambert ◽  
Anthony Magit ◽  
Masahiro Hashizume
Keyword(s):  
Universal Health Coverage ◽  
Regional Cooperation ◽  
International System ◽  
Grey Literature ◽  
Essential Medicines ◽  
International Technology Transfer ◽  
Health Coverage ◽  
Equitable Access ◽  
African Countries ◽  
Universal Health

Abstract Background The ongoing pandemic of coronavirus disease 2019 (COVID-19) has the potential to reverse progress towards global targets. This study examines the risks that the COVID-19 pandemic poses to equitable access to essential medicines and vaccines (EMV) for universal health coverage in Africa. Methods We searched medical databases and grey literature up to 2 October 2020 for studies reporting data on prospective pathways and innovative strategies relevant for the assessment and management of the emerging risks in accessibility, safety, quality, and affordability of EMV in the context of the COVID-19 pandemic. We used the resulting pool of evidence to support our analysis and to draw policy recommendations to mitigate the emerging risks and improve preparedness for future crises. Results Of the 310 records screened, 134 were included in the analysis. We found that the disruption of the international system affects more immediately the capability of low- and middle-income countries to acquire the basket of EMV. The COVID-19 pandemic may facilitate dishonesty and fraud, increasing the propensity of patients to take substandard and falsified drugs. Strategic regional cooperation in the form of joint tenders and contract awarding, joint price negotiation and supplier selection, as well as joint market research, monitoring, and evaluation could improve the supply, affordability, quality, and safety of EMV. Sustainable health financing along with international technology transfer and substantial investment in research and development are needed to minimize the vulnerability of African countries arising from their dependence on imported EMV. To ensure equitable access, community-based strategies such as mobile clinics as well as fees exemptions for vulnerable and under-served segments of society might need to be considered. Strategies such as task delegation and telephone triage could help reduce physician workload. This coupled with payments of risk allowance to frontline healthcare workers and health-literate healthcare organization might improve the appropriate use of EMV. Conclusions Innovative and sustainable strategies informed by comparative risk assessment are increasingly needed to ensure that local economic, social, demographic, and epidemiological risks and potentials are accounted for in the national COVID-19 responses.

scholarly journals Reflections on Japan’s G20 Presidency in 2019 and The Lessons for Future Political Commitment to Universal Health Coverage

2020 ◽  
Author(s):  
Maaya Kita Sugai ◽  
Aya Ishizuka ◽  
Mina Chiba ◽  
Hiroyasu Iso ◽  
Yasushi Katsuma
Keyword(s):  
Global Health ◽  
Universal Health Coverage ◽  
Vulnerable Groups ◽  
Health Coverage ◽  
Political Commitment ◽  
Pharmaceutical Sector ◽  
Expert Meeting ◽  
And Gender ◽  
Multi Stakeholder ◽  
Universal Health

Abstract Background: The Group of 20 (G20) Osaka Summit 2019 was a large step forward for global health diplomacy to build consensus on universal health coverage (UHC). To strengthen multi-stakeholder UHC partnership, Japan involved the research and policy advice network for G20 (Think 20: T20), civil society (Civil 20: C20), private initiatives of medical professional groups (H20), and the pharmaceutical sector. We attempted to identify UHC-related issues addressed and left unaddressed at the G20 Osaka, to bring lessons for the G20 Riyadh Leaders’ Summit 2020. Methods: We reviewed the G20 Osaka Leaders’ Declaration, policy-related statements, and voices of the relevant G20 engagement groups and sectors. In 2019 July, after the G20 Osaka Leaders’ Summit, we organized an expert meeting convening Japan-based UHC-related key global health stakeholders. The main findings were presented in form of classifying the voices expressed in the meeting by UHC-related topics, and then definitional ranges of UHC were summarized.Results: The T20, H20, and the pharmaceutical sector noted during our expert meeting that the ministerial-level health -finance collaboration was one of the key agendas suggested at the G20. T20 and C20 called for a recognition of health needs of refugees, migrants and other vulnerable groups in achieving UHC. Sexual and reproductive health and rights (SRHR) with a human rights-based approach through UHC was raised by the C20 as an issue unaddressed in G20 Osaka. Variation in operative purposes between global health stakeholders led to a definitional difference in the scope of UHC. Discussion: The definitional difference could delay progress of UHC attainment. Addressing migrant and refugee health and SRHR within the context of UHC is further needed. Understanding perspectives of various stakeholders will become increasingly important to well-coordinate multi-actor cooperation with adequate social responsibility and transparency in UHC achievement and public-private partnership. Conclusions: At the G20 Riyadh, for UHC there is need of 1) ensuring an integrated yet comprehensive multi-stakeholder approach towards UHC; 2) incorporating important dimensions such as the marginalized population and gender; and 3) ensuring adequate investments toward health information systems and governance to track health data for the vulnerable population and gender-responsive financing.

Individual and Contextual Factors Associated With Maternal and Child Health Essential Health Services Indicators: A Multilevel Analysis of Universal Health Coverage in 58 Low & Middle-Income Countries

2021 ◽  
Author(s):  
Seun S. Anjorin ◽  
Abimbola A. Ayorinde ◽  
Oyinlola Oyebode ◽  
Olalekan A. Uthman
Keyword(s):  
Health Services ◽  
Universal Health Coverage ◽  
Demographic And Health Surveys ◽  
Health Coverage ◽  
Multinomial Regression ◽  
Middle Income ◽  
Middle Income Countries ◽  
Country Level ◽  
Low Middle Income Countries ◽  
Universal Health

Background: Universal health coverage (UHC) is part of the global health agenda to tackle the lack of access to essential health services (EHS). This study developed and tested models to examine the individual, neighbourhood and country-level determinants associated with access to coverage of EHS under the UHC agenda in low- and middle-income countries (LMICs). Methods: We used datasets from the Demographic and Health Surveys of 58 LMICs. Suboptimal and optimal access to EHS were computed using nine indicators. Descriptive and multilevel multinomial regression analyses were performed using R & STATA. Result: The prevalence of suboptimal and optimal access to EHS varies across the countries, the former ranging from 5.55% to 100%, and the latter ranging from 0% to 90.36% both in Honduras and Colombia, respectively. In the fully adjusted model, children of mothers with lower educational attainment (RRR 2.11, 95% credible interval [CrI] 1.92 to 2.32) and those from poor households (RRR 1.79, 95%CrI 1.61 to 2.00) were more likely to have suboptimal access to EHS. Also, those with health insurance (RRR 0.72, 95% CrI 0.59 to 0.85) and access to media (RRR 0.59, 95% CrI 0.51 to 0.67) were at lesser risk of having suboptimal EHS. Similar trends, although in the opposite direction, were observed in the analysis involving optimal access. The intra-neighbourhood and intra-country correlation coefficients were estimated using the intercept component variance; 57.50%% and 27.70% of variances in suboptimal access to EHS are attributable to the neighbourhood and country-level factors. Conclusion: Neighbourhood-level poverty, illiteracy, and rurality modify access to EHS coverage in LMICs. Interventions aimed at achieving the 2030 UHC goals should consider integrating socioeconomic and living conditions of people.

scholarly journals Developing a specialist children’s nursing workforce in sub-Saharan Africa: a descriptive programme evaluation

BMC Nursing ◽  
2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Jennifer Ruthe ◽  
Natasha North
Keyword(s):  
Nursing Education ◽  
Workforce Development ◽  
Universal Health Coverage ◽  
Course Completion ◽  
Programme Evaluation ◽  
Nursing Workforce ◽  
Health Coverage ◽  
African Countries ◽  
Sub Saharan ◽  
Universal Health

Abstract Background Achieving Universal Health Coverage in low and lower-middle income countries requires an estimated additional five and a quarter million nurses. Despite an increasing focus on specialist nursing workforce development, the specialist children’s workforce in most African countries falls well below recommended densities. The Child Nursing Practice Development Initiative was established with the aim of building the children’s nursing workforce in Southern and Eastern Africa, and Ghana. The purpose of this evaluation was to enable scrutiny of programme activities conducted between 2008 and 2018 to inform programme review and where possible to identify wider lessons of potential interest in relation to specialist nursing workforce strengthening initiatives. Methods The study took the form of a descriptive programme evaluation. Data analysed included quantitative programme data and contextual information from documentary sources. Anonymised programme data covering student enrolments between January 2008 and December 2018 were analysed. Findings were member-checked for accuracy. Results The programme recorded 348 enrolments in 11 years, with 75% of students coming from South Africa and 25% from other sub-Saharan African countries. With a course completion rate of 94, 99% of known alumni were still working in Africa at the end of 2018. Most graduates were located at top-tier (specialist) public hospital facilities. Nine percent of known alumni were found to be working in education, with 54% of graduates at centres that offer or plan to offer children’s nursing education. Conclusion The programme has made a quantifiable, positive and sustained contribution to the capacity of the specialist clinical and educational children’s nursing workforce in nine African countries. Data suggest there may be promising approaches within programme design and delivery in relation to very high course completion rates and the retention of graduates in service which merit further consideration. Outputs from this single programme are however modest when compared to the scale of need. Greater clarity around the vision and role of specialist children’s nurses and costed plans for workforce development are needed for investment in specialist children’s nursing education to realise its potential in relation to achievement of Universal Health Coverage.

scholarly journals Towards universal health coverage: advancing the development and use of traditional medicines in Africa

2019 ◽  
Vol 4 (Suppl 9) ◽  
pp. e001517 ◽  
Author(s):  
Ossy Muganga Julius Kasilo ◽  
Charles Wambebe ◽  
Jean-Baptiste Nikiema ◽  
Juliet Nabyonga-Orem
Keyword(s):  
Universal Health Coverage ◽  
Conventional Medicine ◽  
Health Coverage ◽  
African Region ◽  
African Countries ◽  
Traditional Medicines ◽  
Policy Practice ◽  
Health Practitioners ◽  
Advance Research ◽  
Universal Health

African traditional medicine (ATM) and traditional health practitioners (THPs) could make significant contributions to the attainment of universal health coverage (UHC). Consequently, the WHO provided technical tools to assist African countries to develop ATM as a significant component of healthcare. Many African countries adopted the WHO tools after appropriate modifications to advance research and development (R&D) of ATM. An analysis of the extent of this development was undertaken through a survey of 47 countries in the WHO African region. Results show impressive advances in R&D of ATM, the collaboration between THP and conventional health practitioners, quality assurance as well as regulation, registration and THP integration into the national health systems. We highlight the various ways investment in the R&D of ATM can impact on policy, practice and the three themes of UHC. We underscore the need for frameworks for fair and equitable sharing of all benefits arising from the R&D of ATM products involving all the stakeholders. We argue for further investment in ATM as a complement to conventional medicine to promote attainment of the objectives of UHC.

scholarly journals Towards universal health coverage: reforming the neglected district health system in Africa

2019 ◽  
Vol 4 (Suppl 9) ◽  
pp. e001498 ◽  
Author(s):  
Prosper Tumusiime ◽  
Aku Kwamie ◽  
Oladele B Akogun ◽  
Tarcisse Elongo ◽  
Juliet Nabyonga-Orem
Keyword(s):  
Decision Making ◽  
Health System ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
African Countries ◽  
District Health ◽  
District Health System ◽  
The Hierarchical Structure ◽  
Sub Saharan ◽  
Universal Health

In most African countries, the district sphere of governance is a colonial creation for harnessing resources from the communities that are located far away from the centre with the assistance of minimally skilled personnel who are subordinate to the central authority with respect to decision-making and initiative. Unfortunately, postcolonial reforms of district governance have retained the hierarchical structure of the local government. Anchored to such a district arrangement, the (district) health system (DHS) is too weak and impoverished to function in spite of enormous knowledge and natural resources for a seamless implementation of universal health coverage (UHC). Sadly, the quick-fix projects of the 1990s with the laudable intention to reduce the burden of disease within a specified time-point dealt the fatal blow on the DHS administration by diminishing it to a stop-post and a warehouse for commodities (such as bednets and vaccines) destined for the communities. We reviewed the situation of the district in sub-Saharan African countries and identified five attributes that are critical for developing a UHC-friendly DHS. In this analytical paper, we discuss decision-making authority, coordination, resource control, development initiative and management skills as critical factors. We highlight the required strategic shifts and recommend a dialogue for charting an African regional course for a reformed DHS for UHC. Further examination of these factors and perhaps other ancillary criteria will be useful for developing a checklist for assessing the suitability of a DHS for the UHC that Africa deserves.

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