Role of non-governmental organizations in moving toward universal health coverage: A case study in Iran

Universal health coverage-Exploring the what, how, and why using realist review

Universal health coverage (UHC) is a critical target in many health system strategies to achieve 'good health and wellbeing'. Evidence on the meaning and scope of UHC and the strategies required to achieve it are needed, as variations in its understanding and implementation have risen. This realist review was conducted to fill the knowledge gap by synthesising evidence on the meaning, components, significance, and strategies of UHC. A review of evidence was conducted based on realist synthesis. We searched PubMed, EMBASE, Scopus, and Web of Science for published materials and websites for grey literature. We have followed some steps: define the scope of the review and develop initial programme theory, search for evidence, data extraction, and synthesise evidence. This review revealed that universal coverage, universal health, universal healthcare, universal access, and insurance coverage are used interchangeably with UHC. It is a legal notion that embodies a human rights-based and collaborative approach to ensure fair and comprehensive health care services. Universal health coverage is relevant for three macro reasons: first, it prevents and reduces the impact of diseases; second, it addresses inequality and promotes equity; and third, it is key for global health security. Various mechanisms are involved to implement UHC, such as health insurance, social health protection, digital financing systems, value-based care, private sectors, civil societies, partnerships, primary health care, and reciprocal health care systems. In conclusion, universal health coverage is a multifaceted concept that various terms can express in different contexts. Universal health coverage is a political and ethical imperative that aims to promote health equity and protect human dignity across different levels of society. It is essential in preventing diseases and crucial to global health security. Practically, UHC is not truly universal, as it does not include all services under its scheme and varies across countries. This requires consistent advocacy, strategic and operational research, and political will to ensure UHC.

Improving NGOs' participation in implementing HIV preventive interventions: a case of adolescents with high-risk behaviors in Iran

BACKGROUND

The study aimed to identify the obstacles that NGOs face in their participation in implementing HIV preventive interventions among adolescents with high-risk behaviors in Iran and to propose interventions to enhance their involvement.

METHODS

The study employed a qualitative approach in three phases to identify barriers and solutions to NGOs' participation in HIV preventive interventions. First, 56 semi-structured interviews, four focus group discussions (FGDs), and a document review were conducted with diverse stakeholders, using a purposive sampling strategy combining maximum variation sampling with a snowballing approach. Participants were sampled from relevant backgrounds in health policymaking, public participation, or communicable disease. Data from interviews and FGDs were audio-recorded, transcribed, and analyzed using an inductive content analysis. Second, a scoping review was performed, utilizing databases such as PubMed, Web of Science, ProQuest, and Google Scholar. A policy brief from the first two phases informed a one-day multi-stakeholder policy dialogue with 16 selected policy actors. This session was audio-recorded, transcribed, and analyzed through content analysis.

RESULTS

We identified various challenges faced by NGOs, including those related to the unique features of HIV services, such as difficulty in case finding and constant provision of preventive care. Severe challenges included weak NGOs' performance, insufficient capabilities, and insufficient support from the government, resulting in undesirable constructive collaboration. Tailored strategies were developed, such as the empowerment of NGOs, enhancing public health literacy, modifying the process of identifying eligible NGOs, clarifying key processes for NGOs' involvement, response to COVID-19, increasing adolescent engagement, advocating for removing the stigma from active NGOs, increasing support for active NGOs, organizing communication networks and collaboration, and strengthening governance arrangements.

CONCLUSIONS

NGOs' participation in HIV prevention can facilitate the alignment of interventions with the specific needs of at-risk populations. However, there are obstacles to full NGOs' participation from both NGO and government perspectives, necessitating several measures to address these challenges. These measures are imperative for fostering constructive and sustained collaboration between NGOs and the government. The significance of this study lies in its emphasis on such collaboration, particularly in low-resource settings, which is crucial for nations committed to authentically realizing the goal of 'health for all, by all,' alongside genuine community participation.

TRIAL REGISTRATION

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The involvement of non-governmental organisations in achieving health system goals based on the WHO six building blocks: A scoping review on global evidence

BACKGROUND

Non-governmental organisations (NGOs) have the potential to make a significant contribution to improving health system goals through the provision of resources, health services and community participation. Therefore, this paper examines the role of NGOs in achieving health system goals, based on the six building blocks of a health system framework, and identifies strategies to enhance NGO involvement in achieving health system goals.

METHODS

A scoping systematic review methodology was used to map and synthesise the existing literature on the topic, following the latest JBI six-stage framework. Four databases and one search engine including PubMed, Web of Science (ISI), EMBASE, Scopus and Google Scholar were searched from January 2000 to January 2024. The results were synthesised using a directed content analysis approach, and the findings were categorised according to the dimensions of the six building blocks.

RESULTS

NGO involvement in health system goals can effectively address gaps in service delivery, strengthen the health workforce, improve health information systems, increase access to essential medicines, mobilise resources and promote good governance. In addition, six key strategies were identified, including joint planning, policy development, capacity building, resource allocation, developing collaboration, and improving the quality of health care, to enhance NGO participation in achieving health system goals.

CONCLUSION

NGOs can play a critical role in achieving health system goals, alongside government and other key health stakeholders. Governments need to use evidence-based policies and interventions to support NGOs to realise their potential in achieving health system goals.

Quality of newborn care and associated factors: An analysis of the 2022 Kenya demographic and health survey

Kenya one of the African countries has pledged to reduce neonatal death as per the 2030 World Health Organization target. Providing high-quality newborn care is critical in minimizing neonatal mortality. This study aimed to determine the factors that influence the quality of newborn care in Kenya. Secondary data from 11,863 participants of the 2022 Kenya Demographic and Health Survey (KDHS) were analyzed. The participants were chosen using two-stage stratified sampling. The quality of newborn care was operationalized as receiving all components of newborn care after childbirth, as reported by the mother. Using SPSS (version 29), univariate and multivariable logistic regression analyses were used to analyse the data. In this study, 32.7% (95% confidence interval [CI]: 31.0%-34.5%) of the mothers reported that their newborns had received all components of quality neonatal care after childbirth. Mothers who spent an average of one hour accessing the health facilities compared with those who spent less than half an hour were 1.33 (95%CI: 1.01-1.75) times more likely to report that their newborns had received quality newborn care. Mothers who gave birth in a non-government organization health facility were 30.37 (95%CI: 2.69-343.20) times more likely to report that their newborns had received quality newborn care compared with those who delivered from a faith-based organization. On the contrary, in terms of regions, mothers who lived in Nyanza, Eastern, and Rift Valley provinces compared with those who lived in the coastal regions were 0.53 (95%CI: 0.34-0.82), 0.61 (95%CI: 0.39-0.94), and 0.62 (95%CI: 0.41-0.93) times less likely to report that their newborns had received quality newborn care, respectively. Mothers who subscribed to other religions or faith (0.28 (95%CI: 0.10-0.76) compared with those from the Christian faith, were less likely to report that their newborns had received quality newborn care. Finally, mothers who gave birth through cesarean section were 0.44 (95%CI: 0.32-0.61) times less likely to report that their newborns had received quality newborn care than mothers who gave birth through spontaneous vaginal delivery. The study indicates that about a third of the neonates received quality newborn care and that facility-related and parental social factors were associated with receiving quality newborn care. Stakeholders need to pay more attention to newborn babies whose mothers come from certain regions of Kenya where the quality of newborn care was found to be low, minority religious faith denominations, and those who delivered by ceasearen section. Stakeholders also should focus on strengthening collaborations with NGO health facilities and achieving universal health coverage to improve the quality of newborn care provided in health facilities.

A qualitative exploration of experts' views about multi-dimensional aspects of hookah smoking control in Iran

BACKGROUND

The related literature has primarily addressed cigarette smoking control. It seems that researchers have failed to explore the determinants of hookah smoking (HS) control. In an attempt to fill this gap, the present study explores experts' views about aspects of HS control in Bandar Abbas, a city in the south of Iran.

METHODS

The present qualitative study, conducted in 2022 and 2023, used a content analysis. To this aim, 30 experts in tobacco prevention and control were invited to participate in the research. Twenty seven accepted the invitation. In-depth, semi-structured, and face-to-face interviews were held with the experts. A purposive sampling was used and the data collection continued until data saturation. The interviews lasted between 18 and 65 min. MAXQDA 10.0 was used for data management and analysis.

RESULTS

The expert interviewees had a mean age of 44.77 ± 6.57 years and a mean work experience of 18.6 ± 6.8 years. A total number of six main categories were extracted from the data, including usin influential figures to control HS, controlling HS by alternative activities, changing beliefs and attitudes toward HS, taking administrative and regulatory measures, and facilitating HS cessation.

CONCLUSION

This qualitative study explored the multifaceted ways people adopt to quit HS. Using influential figures to control hookah smoking, promoting alternative activities as a means of control, changing beliefs and attitudes, enforcing administrative regulations, and facilitating quit attempts all play an important role in tackling the prevalence of hookah smoking. These findings emphasize the importance of a comprehensive and multifaceted approach to integrate various interventions to effectively address hookah smoking behavior.

Rural Zambian Oral Health Transition: A Long-Term Retrospective Examination of an Outreach Program's Progress and Impact

Objective

This study aimed to (a) describe an annual prevention-focused, community-based oral health outreach program in rural Zambia, (b) assess its oral health outcomes using demographic and oral health variables, and c) identify milestones resulting from program activities.

Methods

A retrospective analysis of demographic and oral health data from a single site between 2007-2014 and 2018-2019 was conducted. Demographic variables included sex and age, while clinical outcomes encompassed pain, untreated caries, and treatment urgency. Bivariate and multivariable analyses were performed, adjusting for sex and age categories. Information on community development was obtained from the Ministry of Health and local community representatives.

Results

Data from 5,791 subjects were analyzed. The prevalence of pain, untreated caries, and highest treatment urgency category decreased consistently across year categories. Both bivariate and multivariable analyses showed statistically significant differences in clinical outcomes between year categories (p < 0.001). In addition, the percentage of male participants and younger age categories increased during the study period. Key program milestones included the installation of two boreholes for clean water, the development of a local community oral health volunteer program, the establishment of an educational pipeline by the Dental Training School for residents, and the construction of a maternal/oral health center with district and ministry oversight.

Conclusion

The observed decrease in treatment urgency scores, presence of pain, and untreated caries are consistent with the prevention-seeking behavior of program participants. The increasing participation and changing demographic patterns over time suggest a growing demand for oral health services among males and younger individuals. The positive oral health outcomes and development of a maternal child/oral health facility exemplify a program design aligned with community needs and appropriate care delivery.

Strategies to strengthen non-governmental organizations' participation in the Iranian health system

Background

Non-governmental organizations (NGOs) added a new dimension to intersectoral action for health. Involving the NGOs in health system strengthening could lead to a more efficient, equitable, and better-governed healthcare system. This qualitative study explored effective strategies for NGO participation in the Iranian health system to achieve broader health system goals.

Method

We conducted 33 semi-structured interviews with health policymakers and planners, NGO actors at the national and provincial levels, and other key informants. The qualitative data were analyzed through a thematic analysis approach. Trustworthiness in the study was observed at all stages of the study.

Result

Four main themes- were identified: empowerment for learning leadership and management skills, creating active participation in policy-making, capacity building for participation, clarifying participation process, falling into 17 sub-themes. Along with the government and health sector policymakers, NGOs may have a significant role in improving health system goals and increasing equity, social responsiveness, financial risk protection, and efficiency.

Conclusion

The participation of NGOs in the Iranian health system is a complex process. All elements and dimensions of this process need to be considered when developing a platform for the appropriate participation of NGOs in the health system functions. Evidence-informed strategies for strengthening the participation of NGOs in the health system should be used to utilize NGOs potential to the fullest.