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Zeng M, Niu L. Spatiotemporal patterns of healthy life expectancy and the effects of health financing in West African countries, 1995-2019: A Spatial Panel Modelling Study. J Glob Health 2023; 13:04123. [PMID: 37861131 PMCID: PMC10588290 DOI: 10.7189/jogh.13.04123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Background Health financing produce a broad range of healthy life expectancy (HLE) disparities. In West Africa, limited research exists on the association between health financing and HLE at ecological level during a consecutive period of time from the spatial perspectives. This study aimed to determine the existence, quantify the magnitude, and interpret the association between health financing and HLE. Methods A Dynamic Spatial Durbin model was used to explain the association between HLE and health financing level and structure during 1995-2019 in West Africa. Spatial spillover effects were introduced to interpret the direct and indirect effects caused by health financing level and structure on HLE during the long and short terms. Results Spatial dependence and clustering on HLE were observed in West Africa. Although the overall level of total health spending, government health spending, out-of-pocket health spending, and development assistance for health (DAH) increased from 1995 to 2019, government health spending per person experienced a declining trend. Out-of-pocket health spending per total health spending was the highest among other sources of health financing, decreasing from 57% during 1995-1999 to 42% during 2015-2019. Total health spending and out-of-pocket health spending affected HLE positively and negatively in the long term, respectively. Government health spending and prepaid private health spending per person had positive effects on local and adjacent country HLE in the short-term, while DAH had negative effects on the same. The short-term spatial spillover effects of government health spending, DAH, and prepaid private health spending per person were more pronounced than the long-term effects. Conclusions Spatial variations of HLE existed at country-level in West Africa. Health financing regarding government, non-government, as well as external assistance not only affected HLE disparities at local scale but also among nearby countries. Policymakers should optimise supportive health financing transition policies and narrow the national gap to reduce health disparities and increase HLE. Externalities of policy of those health financing proxies should be took into consideration to promote health equity to improve global health governance.
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Debrah AF, Adebusoye FT, Shah MH, Awuah WA, Tenkorang PO, Bharadwaj HR, Wellington J, Ghosh S, Abiy L, Fernandes C, Abdul-Rahman T, Lychko V, Volodymyrivna BT, Mykolayivna NI. Neurological disorders in pregnant women in low- and middle-income countries-Management gaps, impacts, and future prospects: A review perspective. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231210265. [PMID: 37955275 PMCID: PMC10644749 DOI: 10.1177/17455057231210265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023]
Abstract
Neurological disorders during pregnancy are a substantial threat to women's health, particularly in low- and middle-income countries. Furthermore, a critical shortage of mental health workers and neurologists exacerbates the already pressing issue, where a lack of coordination of respective healthcare among multidisciplinary teams involved in managing these conditions perpetuates the current state of affairs. Financial restrictions and societal stigmas associated with neurological disorders in pregnancy amplify the situation. Addressing these difficulties would necessitate a multifaceted approach comprising investments in healthcare infrastructure, healthcare professional education and training, increased government support for research, and the implementation of innovative care models. Improving access to specialized treatment and coordinated management of antenatal neurological diseases will precipitate improved health outcomes for women and their families in low- and middle-income countries.
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Affiliation(s)
| | | | | | | | | | | | - Jack Wellington
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | | | - Lydia Abiy
- Donetsk National Medical University, Kropyvnytskyi, Ukraine
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Jamal MH, Abdul Aziz AF, Aizuddin AN, Aljunid SM. Successes and obstacles in implementing social health insurance in developing and middle-income countries: A scoping review of 5-year recent literatures. Front Public Health 2022; 10:918188. [PMID: 36388320 PMCID: PMC9648174 DOI: 10.3389/fpubh.2022.918188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/22/2022] [Indexed: 01/22/2023] Open
Abstract
Social health insurance (SHI) is a form of health finance mechanism that had been implemented in many countries to achieve universal health care (UHC). To emulate the successes of SHI in many developed countries, many developing and middle-income countries (MICs) have attempted to follow suit. However, the SHI implementation has problems and obstacles. Many more obstacles were observed despite some successes. This scoping review aimed to study the various developments of SHI globally in its uses, implementation, successes, and obstacles within the last 5 years from 2017 to 2021. Using three databases (i.e., PubMed, EBSCO, and Google Scholar), we reviewed all forms of articles on SHI, including gray literature. The PRISMA-ScR protocol was adapted as the guideline. We used the following search terms: social health insurance, national health insurance, and community health insurance. A total of 57,686 articles were screened, and subsequently, 46 articles were included in the final review. Results showed that the majority of SHI studies were in China and African countries, both of which were actively pursuing SHI programs to achieve UHC. China was still regarded as a developing country. There were also recent experiences from other Asian countries, but only a few from South America. Implementing SHI to achieve UHC was desirable but will need to consider several factors and issues. This was especially the case in developing and MICs. Eventually, full UHC would only be possible with a combination of general taxation and SHI.
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Affiliation(s)
- Mohammad Husni Jamal
- University of Cyberjaya, Cyberjaya, Malaysia,Academy of Family Physicians of Malaysia, Kuala Lumpur, Malaysia
| | - Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Azimatun Noor Aizuddin
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Malaysia,International Centre for Casemix and Clinical Coding, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, Cheras, Malaysia,*Correspondence: Azimatun Noor Aizuddin
| | - Syed Mohamed Aljunid
- Department of Health Policy and Management, College of Public Health, Kuwait University, Kuwait City, Kuwait
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Jaca A, Malinga T, Iwu-Jaja CJ, Nnaji CA, Okeibunor JC, Kamuya D, Wiysonge CS. Strengthening the Health System as a Strategy to Achieving a Universal Health Coverage in Underprivileged Communities in Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:587. [PMID: 35010844 PMCID: PMC8744844 DOI: 10.3390/ijerph19010587] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 12/13/2022]
Abstract
Universal health coverage (UHC) is defined as people having access to quality healthcare services (e.g., treatment, rehabilitation, and palliative care) they need, irrespective of their financial status. Access to quality healthcare services continues to be a challenge for many people in low- and middle-income countries (LMICs). The aim of this study was to conduct a scoping review to map out the health system strengthening strategies that can be used to attain universal health coverage in Africa. We conducted a scoping review and qualitatively synthesized existing evidence from studies carried out in Africa. We included studies that reported interventions to strengthen the health system, e.g., financial support, increasing work force, improving leadership capacity in health facilities, and developing and upgrading infrastructure of primary healthcare facilities. Outcome measures included health facility infrastructures, access to medicines, and sources of financial support. A total of 34 studies conducted met our inclusion criteria. Health financing and developing health infrastructure were the most reported interventions toward achieving UHC. Our results suggest that strengthening the health system, namely, through health financing, developing, and improving the health infrastructure, can play an important role in reaching UHC in the African context.
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Affiliation(s)
- Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Cape Town 8000, South Africa; (T.M.); (C.A.N.); (C.S.W.)
| | - Thobile Malinga
- Cochrane South Africa, South African Medical Research Council, Cape Town 8000, South Africa; (T.M.); (C.A.N.); (C.S.W.)
| | - Chinwe Juliana Iwu-Jaja
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa;
| | - Chukwudi Arnest Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town 8000, South Africa; (T.M.); (C.A.N.); (C.S.W.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 8000, South Africa
| | | | - Dorcas Kamuya
- Department of Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Nairobi 43640-00100, Kenya;
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town 8000, South Africa; (T.M.); (C.A.N.); (C.S.W.)
- School of Public Health and Family Medicine, University of Cape Town, Cape Town 8000, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 8000, South Africa
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Gillio AM, Li HW, Bhatia MB, Chepkemoi E, Rutto EJ, Carpenter KL, Saruni SI, Keung CH, Hunter-Squires JL. Gender Differences in Insurance, Surgical Admissions and Outcomes at a Kenyan Referral Hospital. J Surg Res 2021; 268:199-208. [PMID: 34340011 DOI: 10.1016/j.jss.2021.06.014] [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: 03/12/2021] [Revised: 05/28/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Gender is an important factor in determining access to healthcare resources. Women face additional barriers, especially in low- and middle-income countries. Surgical costs can be devastating, which can exacerbate engendered disparities. Kenya's National Hospital Insurance Fund (NHIF) aims to achieve universal coverage and protect beneficiaries from catastrophic health expenditures. We examine gender differences in NHIF coverage, health-seeking behavior, and surgical outcomes at a tertiary care hospital in Eldoret, Kenya. MATERIALS AND METHODS All patients ≥13 years admitted to the general surgery service at Moi Teaching and Referral Hospital from January 2018-July 2018 were enrolled. Health records were retrospectively reviewed for demographic data, clinical parameters, NHIF enrollment, and cost information. Descriptive analyses utilized Wilcoxon Rank Sum, Pearson's Chi-square, and Fisher's Exact tests. RESULTS 366 patients were included for analysis. 48.6% were enrolled in NHIF with significant female predominance (64.8% versus 37.9%, P < 0.0001). Despite differing coverage rates, male and female patients underwent surgery and suffered in-hospital mortality at similar rates. However, women only comprised 39.6% of admissions and were significantly more likely to delay care (median 60 versus 7 days, P < 0.0001), be diagnosed with cancer (26.6% versus 13.2%, P = 0.0024), and require a palliative procedure for cancer (44.1% versus 13.0%, P = 0.013). CONCLUSION Many financial and cultural barriers exist in Kenya that prevent women from accessing healthcare as readily as men, persisting despite higher rates of NHIF coverage amongst female patients. Investigation into extra-hospital costs and social disempowerment for women may elucidate key needs for achieving health equity.
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Affiliation(s)
- Anna M Gillio
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND.
| | - Helen W Li
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND
| | - Manisha B Bhatia
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND
| | | | | | - Kyle L Carpenter
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND
| | - Seno I Saruni
- Moi Teaching and Referral Hospital, Kesses, Eldoret, Kenya
| | - Connie H Keung
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND
| | - JoAnna L Hunter-Squires
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IND; Moi University, Kesses, Eldoret, Kenya
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Suchman L, Verde Hashim C, Adu J, Mwachandi R. Correction to: Seeking care in the context of social health insurance in Kenya and Ghana. BMC Public Health 2020; 20:945. [PMID: 32539707 PMCID: PMC7296631 DOI: 10.1186/s12889-020-09076-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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