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Worede DT, Tariku MK, Asresie MB, Shibesh BF. Household satisfaction and associated factors with community-based health insurance scheme in Ethiopia: systematic review and meta-analysis. Glob Health Res Policy 2023; 8:41. [PMID: 37710337 PMCID: PMC10503176 DOI: 10.1186/s41256-023-00325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Community-based health insurance (CBHI) schemes are crucial for households to avoid financial hardship, improve healthcare quality, and engage in health policies. Household satisfaction is a key indicator for assessing healthcare quality and identifying service gaps. However, research on household satisfaction with CBHI in Ethiopia is limited. Therefore, this study aimed to evaluate household satisfaction and associated factors with CBHI schemes in Ethiopia. METHODS A comprehensive search of relevant literature was conducted using multiple databases, including PubMed, Google Scholar, Africa Journal Online, and Ethiopian Universities' institutional open-access online repositories. The search was carried out between January 25, 2023, and February 28, 2023. Twelve primary studies, including eight published and four unpublished, were identified and included in the analysis with a total sample size of 5311 participants. A protocol with the registration number CRD20531345698 is recorded on the Prospero database. Two authors, DT and MK, independently extracted the required data using a standardized form. The extracted data were then analyzed using STATA version 17 software. Heterogeneity was assessed using the Cochrane Q-test and I2 tests. Finally, a random-effect model was employed to calculate the overall household satisfaction with CBHI and to determine the associated factors. RESULTS The meta-analysis showed that the overall household satisfaction with CBHI in Ethiopia was 62.26% (95% CI 53.25-71.21%). The study found regional variations in household satisfaction, with 63.40% in Oromia, 64.01% in Amhara, 49.58% in Addis Ababa, and 66.76% in SNNPs. The study identified several factors associated with household satisfaction and the CBHI scheme, including the availability of drugs (OR 2.13, 95% CI 1.47-2.78), friendly services (OR 3.85, 95% CI 1.60-6.10), affordability of premium (OR 2.80, 95% CI 1.97-3.63), and knowledge/awareness of CBHI (OR 2.52, 95% CI 1.73-3.33). CONCLUSIONS The study provides valuable insights into household satisfaction with CBHI in Ethiopia, with a considerable proportion of enrolees being satisfied. The finding highlights regional variations in household satisfaction and underscores the need for tailored interventions and monitoring to enhance CBHI sustainability and effectiveness. The results suggest that healthcare providers and policymakers should prioritize the availability of drugs, friendly services, affordable premiums, and education to improve household satisfaction with CBHI schemes.
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Affiliation(s)
- Daniel Tarekegn Worede
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, 269, Debre Markos, Ethiopia.
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, 79, Bahir Dar, Ethiopia.
| | - Mengistie Kassahun Tariku
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, 269, Debre Markos, Ethiopia
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, 79, Bahir Dar, Ethiopia
| | - Melash Belachew Asresie
- Department of Reproductive and Population Health School of Public Health, College of Medicine and Health Science, Bahir Dar University, 79, Bahir Dar, Ethiopia
| | - Belayneh Fentahun Shibesh
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Bahir Dar University, 79, Bahir Dar, Ethiopia
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Mangoya D, Barham L, Moyo E, Moyo P, Dzinamarira T. The Use of Economic Evaluation Tools in Essential Health Benefits Package Selection for Universal Health Coverage. Value Health Reg Issues 2023; 36:1-9. [PMID: 36934592 DOI: 10.1016/j.vhri.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/15/2023] [Accepted: 01/28/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES The sustainable development goals launched in 2015 are a follow-up commitment to the successful Millennium Development Goals. Goal number 3 of ensuring "good health and well-being" is a target to ensure universal health coverage. Universal health coverage means the provision of quality services that meet the needs of populations without risking financial impoverishment in the process. The guaranteed minimum health services in every health system constitute the health benefits package (HBP), which should be explicit and be composed of services that represent the best value for money and guarantee the best return on investment. The objective of this study was to review the application of cost-effectiveness analysis (CEA) and budget impact analysis in the development of HBP in low-to-middle income countries across the world. METHODOLOGY A literature review using a systematic approach was used. A search of PubMed, Google Scholar, World Health Organization, and World Bank databases was made for articles outlining the development of HBP in low- and middle-income countries, and a narrative synthesis was used for analysis. RESULTS Results from processes in Armenia, Ethiopia, Kyrgyz Republic, Lebanon, and Malawi showed CEA and budget impact analysis as 2 criteria used in HBP development in a limited number of countries with either no reference to the two or no reporting from the others. Local CEA estimates and cost data limitations were the biggest challenges to efforts to use robust methods. CONCLUSION Sustained efforts are needed to understand and address the challenges to the use of economic evaluation in the development of HBPs.
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Affiliation(s)
| | - Leela Barham
- Faculty of Life Science and Education, Learna, Cardiff, Wales, UK
| | - Enos Moyo
- Medical Centre Oshakati, Oshakati, Namibia.
| | | | - Tafadzwa Dzinamarira
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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Appiah-Agyekum NN, Sakyi EK, Kayi EA, Otoo DD, Appiah-Agyekum J. The Medical Nemesis of Primary Health Care Implementation: Evidence From Ghana. Health Serv Insights 2022; 15:11786329221115040. [PMID: 35898350 PMCID: PMC9309768 DOI: 10.1177/11786329221115040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/03/2022] [Indexed: 11/17/2022] Open
Abstract
Primary Health Care (PHC), based on the Alma Ata declaration, calls for the movement of responsibility, resources, and control away from medical systems and curative measures toward health promotion. However, PHC implementation in practice appears to be heavily influenced by medical systems with its own attendant effects on the attainment of PHC goals. This study therefore examines the extent and effects of medical systems influence on PHC implementation in Ghana. The study uses the thematic framework approach to qualitative data analysis to analyze data collected from PHC managers through interviews. Ethical clearance for the study was obtained from the Noguchi Memorial Institute for Medical Research. Findings suggest that PHC in practice is tied to the apron-strings of medical systems. While this has catalyzed successes in disease control programs and other medicine-based interventions, it has swayed PHC from its intended shift toward health promotion. Community ownership, participation, and empowerment in PHC is therefore lost in the maze of medical systems which reserves power over PHC decision making and implementation to medical professionals while focusing attention on treatment and curative services. Ultimately, PHC has gradually metamorphosed into mini-clinics instead of the revolutionary community-driven promotive services espoused by Alma Ata with concomitant effects on the attainment of Universal Health Coverage. Further, findings show how gradually, the primary in PHC is being used as a descriptor of the first or basic level of hospital-based care instead of a first point of addressing existing health problems using preventive, promotive, and other community driven approaches. Without a reorientation of health systems, significant efforts and resources are channeled toward empowering health workers instead of local communities with significant effects on the long term sustainability of health efforts and the attainment of UHC. The study recommends further studies toward practical means of reducing the influence of medical systems.
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Affiliation(s)
- Nana Nimo Appiah-Agyekum
- Department of Public Administration and Health Services Management, University of Ghana Business School, University of Ghana, Legon, Ghana
| | - Emmanuel Kojo Sakyi
- Department of Public Administration and Health Services Management, University of Ghana Business School, University of Ghana, Legon, Ghana
| | - Esinam Afi Kayi
- Department of Adult Education and Human Resource Studies, School of Continuing and Distance Education, University of Ghana, Legon, Ghana
| | - Desmond Dzidzornu Otoo
- Department of Public Administration and Health Services Management, University of Ghana Business School, University of Ghana, Legon, Ghana
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Jeet G, Masaki E, Vassall A, Prinja S. Costing of Essential Health Service Packages: A Systematic Review of Methods From Developing Economies. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1700-1713. [PMID: 34711371 DOI: 10.1016/j.jval.2021.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/08/2021] [Accepted: 05/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Although an increasing number of countries are adopting essential health service packages (EHSPs) and undertaking their cost assessment, standardization of the costing methods and their reporting are imperative to instill confidence in the use of findings of EHSPs as evidence for decision making and resource allocation. This review was conducted to synthesize the EHSP costing reports, focusing on the key costing methods and their reporting standards. METHODS A systematic review of English language literature (peer-reviewed as well as gray) was conducted. PubMed, Embase, Scopus, NHS Economic Evaluation Database, Google Scholar, and websites of key institutions were reviewed (2000-2020). Publication characteristics, costing methods, valuation sources, quality, transparency, and reporting standards were assessed and synthesized. RESULTS A total of 29 studies from 19 countries were included. Most studies were government reports (69%) and reported the use of "bottom-up" approach (76%), OneHealth tool (38%), had international funding (79%), and reported both normative and empirical cost estimates (41%). Six studies (21%) scored "excellent" in conduct and reporting. Stand-alone costing of EHSP had higher mean quality score (80). The projected increase in government budget to implement EHSP ranged from 17% to 117%. Limited availability of reliable data on resources, prices, and coverage of interventions were identified as major limitations for costing of EHSPs. CONCLUSIONS Substantial differences in the costing methods and reporting standards of EHSPs made comparisons across countries difficult. Existing costing guidelines and checklists should be adapted for EHSPs with more specific methodological guidance to allow harmonization of methods and reporting.
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Affiliation(s)
- Gursimer Jeet
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Emiko Masaki
- Health, Nutrition and Population, World Bank, Vientiane, Laos PDR
| | - Anna Vassall
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, England, UK
| | - Shankar Prinja
- Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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Hanh TTD, Ngoc LB, Hoa LN, Gong E, Tao X, Yan LL, Minh HV. Improving prevention of cardiovascular diseases: Barriers and facilitators in primary care services in Vietnam. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1757858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Le Bich Ngoc
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Lam Ngoc Hoa
- Hanoi University of Public Health, Hanoi, Vietnam
| | - Enying Gong
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
| | - Xuanchen Tao
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
| | - Lijing L. Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, People’s Republic of China
- Global Health Institute, Duke University, Durham, NC, USA
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Brady E, Carmone AE, Das S, Hurley R, Martinez Vergara MT, Malata A. Harnessing the Power of Networks of Care for Universal Health Coverage. Health Syst Reform 2020; 6:e1840825. [PMID: 33252995 DOI: 10.1080/23288604.2020.1840825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
On the global health agenda, Universal Health Coverage has been displaced by the COVID-19 pandemic while disparities in COVID-19 outcomes have exposed stark gaps in quality, access, equity, and financial risk protection. These disparities highlight the importance of the core goals of Universal Health Coverage and the need for innovative approaches to working toward them. The newly codified concept of "Networks of Care" offers a promising option for implementation. The articles in this special issue present the Networks of Care lexicon and framework and demonstrate the development of leadership, responsibility, intra- and inter-facility cooperation, and dynamic cycles of quality improvement. These elements are associated with better access to services and better health outcomes, the ultimate goals of Universal Health Coverage. Increases in poverty, food insecurity, and deleterious impact on the status of women secondary to the COVID-19 pandemic add urgency to Universal Health Coverage, while the economic impact of pandemic mitigation may reduce availability of resources for years to come. The need for Universal Health Coverage and efficiency and flexibility in health spending, including the ability to contract directly, has become even more important. Countries where Universal Health Coverage efforts have yet to carry through to provision of good quality, accessible and equitable service delivery could potentially benefit from concurrent Networks of Care implementation. Documentation of Networks of Care in the context of Universal Health Coverage should be prioritized to understand how Networks of Care can be used to help realize the goals of Universal Health Coverage around the world.
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Affiliation(s)
- Eoghan Brady
- Health Financing Department, Clinton Health Access Initiative , Pretoria, South Africa
| | - Andy E Carmone
- Health Financing Department, Clinton Health Access Initiative , Pretoria, South Africa
| | - Sarthak Das
- Harvard TH Chan School of Public Health , Cambridge, Massachusetts, USA
| | - Raphael Hurley
- Health Financing Department, Clinton Health Access Initiative , Pretoria, South Africa
| | | | - Address Malata
- Malawi University of Science and Technology , Limbe, Malawi
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Akhnif EH, Hachri H, Belmadani A, Mataria A, Bigdeli M. Policy dialogue and participation: a new way of crafting a national health financing strategy in Morocco. Health Res Policy Syst 2020; 18:114. [PMID: 32993697 PMCID: PMC7523367 DOI: 10.1186/s12961-020-00629-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Policy dialogue for health policies has started to gain importance in recent years, especially for complex issues such as health financing. Moroccan health financing has faced several challenges during the last years. This study aims to document the Moroccan experience in developing a consolidated health financing strategy according to the policy dialogue approach. It especially considers the importance of conceptualising this process in the Moroccan context. METHOD We documented the process of developing a health financing strategy in Morocco. It concerned four steps, as follows: (1) summarising health financing evidence in preparation of the policy dialogue; (2) organising the health policy dialogue process with 250 participants (government, private sector, NGOs, civil society, parliamentarians, technical and financial partners); (3) a technical workshop to formulate the strategy actions; and (4) an ultimate workshop for validation with decision-makers. The process lasted 1 year from March 2019 to February 2020. We have reviewed all documents related to the four steps of the process through our active participation in the policy debate and the documentation of two technical workshops to produce the strategy document. RESULTS The policy dialogue approach showed its usefulness in creating convergence among all health actors to define a national shared vision on health financing in Morocco. There was a high political commitment in the process and all actors officially adopted recommendations on health financing actions. A strategy document produced within a collaborative approach was the final output. This experience also marked a shift from previous top-down approaches in designing health policies for more participation and inclusion. The evidence synthesis played a crucial role in facilitating the debate. The collaborative approach seems to work in favouring national consensus on practical health financing actions. CONCLUSION The policy dialogue process adopted for health financing in Morocco helped to create collective ownership of health financing actions. Despite the positive results in terms of national mobilisation around the health financing vision in Morocco, there is a need to institutionalise the policy dialogue with a more decentralised approach to consider subnational specificities.
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Affiliation(s)
- El Houcine Akhnif
- World Health Organization Country Office of Morocco, 3 Avenue S.A.R. Sidi Mohamed, Rabat, Morocco
| | - Hafid Hachri
- World Health Organization Country Office of Morocco, 3 Avenue S.A.R. Sidi Mohamed, Rabat, Morocco
| | - Abdelouahab Belmadani
- Ministry of Health, Directorate of Planning of Financial Resources, 335, Avenue Mohamed V, Rabat, Morocco
| | - Awad Mataria
- World Health Organization Regional Office for the Eastern Mediterranean, PO Box 7608, Nasr City, Cairo 11371 Egypt
| | - Maryam Bigdeli
- World Health Organization Country Office of Morocco, 3 Avenue S.A.R. Sidi Mohamed, Rabat, Morocco
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Hemadeh R, Hammoud R, Kdouh O. Lebanon's essential health care benefit package: A gateway for universal health coverage. Int J Health Plann Manage 2019; 34:e1921-e1936. [PMID: 31271234 DOI: 10.1002/hpm.2850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/10/2022] Open
Abstract
Recent years have demonstrated the resurgence of a global commitment toward universal health coverage (UHC). The first step toward developing a sustainable primary health care (PHC)-oriented UHC program is the creation and service delivery of an explicit essential health care benefit package (EHCP). This paper aims to describe the development, features, and progress of the EHCP in Lebanon, in addition to outlining barriers, facilitators, and next steps. Building on the investments made in the PHC network, the ministry of public health in Lebanon piloted an essential PHC package program in 2016 targeting vulnerable Lebanese and was able to enroll over 87% of targeted population to date. In order to scale up the EHCP to the national level and achieve UHC, modifications need to be made to the package entitlements, provider payment mechanisms, and implementation arrangements. The paper also notes that further advocacy and lobbying are needed in order to place UHC and the EHCP on the national agenda and stimulate public demand.
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Affiliation(s)
- Randa Hemadeh
- Primary Health Care Department, Ministry of Public Health, Beirut, Lebanon.,Global Health Team of Experts, Beirut, Lebanon
| | - Rawan Hammoud
- Primary Health Care Department, Ministry of Public Health, Beirut, Lebanon.,Global Health Team of Experts, Beirut, Lebanon
| | - Ola Kdouh
- Primary Health Care Department, Ministry of Public Health, Beirut, Lebanon.,Global Health Team of Experts, Beirut, Lebanon
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Romaniuk P, Semigina T. Ukrainian health care system and its chances for successful transition from Soviet legacies. Global Health 2018; 14:116. [PMID: 30470237 PMCID: PMC6260664 DOI: 10.1186/s12992-018-0439-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/13/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ukraine, one of the largest states formed on the rubble of the Soviet Union, is widely perceived as a country that has lost its opportunities. Being devastated by corruption, it shows incapable to modernize and enter the economic path of sustainable growth. Similarly in the health care system no deeper reform efforts have been taken in the entire post-soviet period, leaving the system in bonds of ineffective solutions taken out of the Soviet era. MAIN BODY The recent geopolitical and economic crisis seem to favor the introduction of radical solutions that might lead to a rapid change in the organizational paradigm of the economic system, as well as in health care in Ukraine. In this paper we aim to highlight the key features of the ongoing health reform in Ukraine, identify basic challenges for it, and assess rationality and feasibility of the reform. We found that the projected scope and schedule of changes in the Ukrainian health system give promising prognosis regarding its final effect. CONCLUSIONS The final success of health reform in Ukraine is dependent on a number of factors, including the financial foundation arising of economic stability of the country, balance assurance between public and private spending for health and ability to eliminate the long-lasting practices, particularly when they are connected with activities of lobbying groups occupying particular positions in the health system. A consequence of actions taken by the political decision-makers in the longer perspective are also to highly determine the reform's chances for success.
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Affiliation(s)
- Piotr Romaniuk
- School of Public Health, Department of Health Policy, Medical University of Silesia in Katowice, Ul. Piekarska 18, 41-902 Bytom, Poland
| | - Tetyana Semigina
- Academy of Labour, Social Relations and Tourism, 3A, Kiltseva Doroga, Kyiv, 03187 Ukraine
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