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Adamu AA, Jalo RI, Muhammad ID, Essoh TA, Ndwandwe D, Wiysonge CS. Sustainable financing for vaccination towards advancing universal health coverage in the WHO African region: The strategic role of national health insurance. Hum Vaccin Immunother 2024; 20:2320505. [PMID: 38414114 PMCID: PMC10903629 DOI: 10.1080/21645515.2024.2320505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
There is a growing political interest in health reforms in Africa, and many countries are choosing national health insurance as their main financing mechanism for universal health coverage. Although vaccination is an essential health service that can influence progress toward universal health coverage, it is not often prioritized by these national health insurance systems. This paper highlights the potential gains of integrating vaccination into the package of health services that is provided through national health insurance and recommends practical policy actions that can enable countries to harness these benefits at population level.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ibrahim D. Muhammad
- Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Téné-Alima Essoh
- Agence de Médecine Préventive, Regional Office for Africa, Abidjan, Cote d’Ivoire
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Cockcroft A, Belaid L, Omer K, Ansari U, Aziz A, Gidado Y, Mudi H, Mohammed R, Sale R, Andersson N. The Equity Impact of Universal Home Visits to Pregnant Women and Their Spouses in Bauchi State, Nigeria: Secondary Analysis From a Cluster Randomised Controlled Trial. Community Health Equity Res Policy 2024:2752535X241249893. [PMID: 38676402 DOI: 10.1177/2752535x241249893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
BACKGROUND Socio-economically disadvantaged women have poor maternal health outcomes. Maternal health interventions often fail to reach those who need them most and may exacerbate inequalities. In Bauchi State, Nigeria, a recent cluster randomised controlled trial (CRCT) showed an impressive impact on maternal health outcomes of universal home visits to pregnant women and their spouses. The home visitors shared evidence about local risk factors actionable by households themselves and the program included specific efforts to ensure all households in the intervention areas received visits. PURPOSE To examine equity of the intervention implementation and its pro-equity impact. RESEARCH DESIGN AND STUDY SAMPLE The overall study was a CRCT in a stepped wedge design, examining outcomes among 15,912 pregnant women. ANALYSIS We examined coverage of the home visits (three or more visits) and their impact on maternal health outcomes according to equity factors at community, household, and individual levels. RESULTS Disadvantaged pregnant women (living in rural communities, from the poorest households, and without education) were as likely as those less disadvantaged to receive three or more visits. Improvements in maternal knowledge of danger signs and spousal communication, and reductions in heavy work, pregnancy complications, and post-natal sepsis were significantly greater among disadvantaged women according to the same equity factors. CONCLUSIONS The universal home visits had equitable coverage, reaching all pregnant women, including those who do not access facility-based services, and had an important pro-equity impact on maternal health.
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Affiliation(s)
- Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centro de Investigácion de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Loubna Belaid
- École Nationale d'Administration Publique, Montreal, Canada
| | - Khalid Omer
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Umaira Ansari
- Centro de Investigácion de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Amar Aziz
- Centro de Investigácion de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Yagana Gidado
- Federation of Muslim Women's Associations of Nigeria (FOMWAN), Bauchi, Nigeria
| | - Hadiza Mudi
- Federation of Muslim Women's Associations of Nigeria (FOMWAN), Bauchi, Nigeria
| | - Rilwanu Mohammed
- Bauchi State Primary Health Care Development Agency, Bauchi, Nigeria
| | - Rakiya Sale
- Bauchi State College of Nursing and Midwifery, Bauchi, Nigeria
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centro de Investigácion de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
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Miranda J, Miller S, Alfieri N, Lalonde A, Ivan-Ortiz E, Hanson C, Steinholt M, Palshetkar N, Suharjono H, Gebhardt S, Dossou JP, Pascali-Bonaro D, Jacobsson B, Okong P. Global health systems strengthening: FIGO's strategic view on reducing maternal and newborn mortality worldwide. Int J Gynaecol Obstet 2024. [PMID: 38651311 DOI: 10.1002/ijgo.15553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To demonstrate that successful health systems strengthening (HSS) projects have addressed disparities and inequities in maternal and perinatal care in low-income countries. METHODS A comprehensive literature review covered the period between 1980 and 2022, focusing on successful HSS interventions within health systems' seven core components that improved maternal and perinatal care. RESULTS The findings highlight the importance of integrating quality interventions into robust health systems, as this has been shown to reduce maternal and newborn mortality. However, several challenges, including service delivery gaps, poor data use, and funding deficits, continue to hinder the delivery of quality care. To improve maternal and newborn health outcomes, a comprehensive HSS strategy is essential, which should include infrastructure enhancement, workforce skill development, access to essential medicines, and active community engagement. CONCLUSION Effective health systems, leadership, and community engagement are crucial for a comprehensive HSS approach to catalyze progress toward universal health coverage and global improvements in maternal and newborn health.
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Affiliation(s)
- Jezid Miranda
- Department of Obstetrics and Gynecology, Grupo de Investigación en Cuidado Intensivo y Obstetricia (GRICIO), Universidad de Cartagena, Cartagena de Indias, Colombia
- Centro Hospitalario Serena del Mar y Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California, USA
| | - Nikita Alfieri
- Department of Obstetrics and Gynecology, San Paolo Hospital Medical School, University of Milano, Milano, Italy
| | - Andre Lalonde
- FIGO International Childbirth Initiative and Working Group, Ottawa, Ontario, Canada
| | - Edgar Ivan-Ortiz
- Department of Obstetrics and Gynecology, Universidad del Valle, Cali, Colombia
| | - Claudia Hanson
- Public Health Sciences - Global Health - Health Systems and Policy, Karolinska Institute, Stockholm, Sweden
| | - Margit Steinholt
- Helgeland Hospital Trust, Sandnessjøen, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Nandita Palshetkar
- Department of Reproductive Medicine, Patil Medical College, Mumbai, India
| | - Harris Suharjono
- Department of Obstetrics and Gynaecology, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Stefan Gebhardt
- Department of Obstetrics and Gynaecology, Stellenbosch University, Stellenbosch, South Africa
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin
| | - Debra Pascali-Bonaro
- International Childbirth Consultant, Trainer, and Speaker, River Vale, New Jersey, USA
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Genetics and Bioinformatics, Domain of Health Data and Digitalization, Institute of Public Health, Oslo, Norway
| | - Pius Okong
- Department of Obstetrics and Gynecology, St Francis Hospital Nsambya, Kampala City, Uganda
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Godwin-Akpan TG, McCollum R, Kollie J, Berrian H, Seekey-Tate W, Smith JS, Zaizay FZ, Chowdhury S, Kollie KK, Rogers EJ, Parker CBMC, Zawolo GVK, Wickenden A, Dean L, Theobald S. Key lessons from Liberia for successful partnerships toward universal health coverage in low-resource settings. Int Health 2024:ihae028. [PMID: 38606990 DOI: 10.1093/inthealth/ihae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
| | | | - Jerry Kollie
- University of Liberia Pacific Institute for Research and Evaluation - UL-PIRE, University of Liberia, Monrovia, Liberia
| | - Hannah Berrian
- University of Liberia Pacific Institute for Research and Evaluation - UL-PIRE, University of Liberia, Monrovia, Liberia
| | - Wede Seekey-Tate
- University of Liberia Pacific Institute for Research and Evaluation - UL-PIRE, University of Liberia, Monrovia, Liberia
| | - John S Smith
- University of Liberia Pacific Institute for Research and Evaluation - UL-PIRE, University of Liberia, Monrovia, Liberia
| | | | | | - Karsor K Kollie
- Neglected Tropical Diseases Program, Ministry of Health, Oldest Congo Town, Monrovia, Liberia
| | - Emerson J Rogers
- Neglected Tropical Diseases Program, Ministry of Health, Oldest Congo Town, Monrovia, Liberia
| | | | - Georgina V K Zawolo
- University of Liberia Pacific Institute for Research and Evaluation - UL-PIRE, University of Liberia, Monrovia, Liberia
- WaterAid Liberia, Sinkor, Monrovia, Liberia
| | - Anna Wickenden
- Liverpool School of Tropical Medicine, Liverpool, UK
- Effect Hope, Markham, Ontario, Canada
| | - Laura Dean
- Liverpool School of Tropical Medicine, Liverpool, UK
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Gaffar B, Schroth RJ, Foláyan MO, Ramos-Gomez F, Virtanen JI. A global survey of national oral health policies and its coverage for young children. Front Oral Health 2024; 5:1362647. [PMID: 38645574 PMCID: PMC11026553 DOI: 10.3389/froh.2024.1362647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Background There is no accessible information on countries with oral health policies. The purpose of this study was to identify World Dental Federation (FDI) member countries with oral health policies and their scope and extent of coverage of oral health care for young children. Methods This international survey recruited chief dental officers, oral health advisors to national ministries of health, and other key informants of the 158 FDI member countries between December 2020 and December 2021. The survey tool was administered online to the study participants. Key questions explored the following outcome measures: countries with oral health policies; the thrusts of the oral health policies; policy thrusts targeting young children; and dental care plans as a component of a universal health care plan. Descriptive statistics were conducted to determine the number of countries with any of the study outcome measures and coverage per country. Results Sixty (38%) of the 158 FDI member-countries responded to the survey. Forty-eight (55.2%) of the 60 countries had a national oral health policy document or position statement on oral health; 54 (62.1%) countries had plans on universal health care, and 42 (48.3%) included dental care within their universal health care plan. The most common policy thrusts addressing the oral health needs of children were the promotion of oral hygiene (71.7%), provision of fluoride products for children (53.3%), collaboration with primary care providers (35%), and prenatal oral health education (50%). There were differences in the scope of oral health care coverage and the coverage for young children between continents as well as between countries. Europe had many countries with children-friendly oral health policy coverage. Conclusions About half of the surveyed countries had a national oral health policy. There were variations in the scope of oral health care coverage, particularly for young children, both between continents and among individual countries. These findings underscore the importance of understanding the landscape of oral health policies globally. Such insights can help inform targeted interventions to enhance oral health policies, thereby contributing to improved oral health outcomes on a global level.
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Affiliation(s)
- Balgis Gaffar
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Robert J. Schroth
- Departments of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry and Departments of Pediatrics & Child Health and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, MB, Canada
| | | | - Francisco Ramos-Gomez
- UCLA Center for Children’s Oral Health (UCCOH), University of California, Los Angeles, Los Angeles, CA, United States
| | - Jorma I. Virtanen
- Faculty of Medicine, University of Bergen, Bergen, Norway
- Institute of Dentistry, University of Turku, Turku, Finland
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Fuentes-Alabi S. Navigating the economic challenges in childhood cancer control in low- and middle-income countries: Insights from the CC-BRIDGE tool and the global initiative for childhood cancer. Cancer 2024; 130:1025-1027. [PMID: 38240557 DOI: 10.1002/cncr.35209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The increasing incidence of childhood cancer in low- and middle-income countries (LMICs) presents significant economic and logistical challenges, affecting health care provision and equitable treatment access. This editorial explores the economic barriers to pediatric oncology care in LMICs, highlighting resource scarcity, socioeconomic inequities, and health care complexities. It emphasizes the need for detailed cost analysis within health systems complicated by inadequate data and variable treatment protocols. Central to the discussion is the "Childhood Cancers Budgeting Rapidly to Incorporate Disadvantaged Groups for Equity (CC-BRIDGE) Tool" from the manuscript by Nancy Bolous et al., who proposed an innovative method to estimate the cost of integrating childhood cancer services into National Cancer Control Plans. This tool aligns with the World Health Organization's Global Initiative for Childhood Cancer to enhance survival rates and advocate for universal health coverage in pediatric oncology. The CC-BRIDGE tool's methodological rigor provides a structured framework for cost analysis. Yet, it is recognized as an initial step requiring further enhancements for comprehensive economic forecasting and societal cost assessments. In conclusion, the editorial highlights the tool's critical role in incorporating childhood cancer care into national strategies in LMICs, contributing to the broader fight against cancer and advocating for comprehensive, equitable health care. It signifies a vital stride toward addressing pediatric oncology's economic challenges and supporting universal health coverage for childhood cancer care.
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Affiliation(s)
- Soad Fuentes-Alabi
- Centro Medico Ayudame a Vivir, National Children's Hospital Benjamin Bloom, San Salvador, El Salvador
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Offosse MJ, Yameogo P, Ouedraogo AL, Traoré Z, Banke-Thomas A. Has the Gratuité policy reduced inequities in geographic access to antenatal care in Burkina Faso? Evidence from facility-based data from 2014 to 2022. Front Glob Womens Health 2024; 5:1345438. [PMID: 38585342 PMCID: PMC10996443 DOI: 10.3389/fgwh.2024.1345438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Background Evidence shows that user fee exemption policies improve the use of maternal, newborn, and child health (MNCH) services. However, addressing the cost of care is only one barrier to accessing MNCH services. Poor geographic accessibility relating to distance is another. Our objective in this study was to assess the effect of a user fee exemption policy in Burkina Faso (Gratuité) on antenatal care (ANC) use, considering distance to health facilities. Methods We conducted a cross-sectional study with sub-analysis by intervention period to compare utilization of ANC services (outcome of interest) in pregnant women who used the service in the context of the Gratuité user fee exemption policy and those who did not, in Manga district, Burkina Faso. Dependent variables included were socio-demographic characteristics, obstetric history, and distance to the lower-level health facility (known as Centre de Santé et Promotion Sociale) in which care was sort. Univariate, bivariate, and multivariate analyses were performed across the entire population, within those who used ANC before the policy and after its inception. Results For women who used services before the Gratuité policy was introduced, those living 5-9 km were almost twice (OR = 1.94; 95% CI: 1.17-3.21) more likely to have their first ANC visit (ANC1) in the first trimester compared to those living <5 km of the nearest health facility. After the policy was introduced, women living 5-9 km and >10 km from the nearest facility were almost twice (OR = 1.86; 95% CI: 1.14-3.05) and over twice (OR = 2.04; 95% CI: 1.20-3.48) more likely respectively to use ANC1 in the first trimester compared to those living within 5 km of the nearest health facility. Also, women living over 10 km from the nearest facility were 1.29 times (OR = 1.29; 95% CI: 1.00-1.66) more likely to have 4+ ANC than those living less than 5 km from the nearest health facility. Conclusions Insofar as the financial barrier to ANC has been lifted and the geographical barrier reduced for the populations that live farther away from services through the Gratuité policy, then the Burkinabé government must make efforts to sustain the policy and ensure that benefits of the policy reach the targeted and its gains maximized.
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Affiliation(s)
| | - Pierre Yameogo
- Technical Secretariat for Health Financing Reforms, Ministry of Health, Ouagadougou, Burkina Faso
| | - André Lin Ouedraogo
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Zanga Traoré
- Country Office, ThinkWell Institute, Ouagadougou, Burkina Faso
| | - Aduragbemi Banke-Thomas
- Country Office, ThinkWell Institute, Ouagadougou, Burkina Faso
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Abu El Kheir-Mataria W, Khadr Z, El Fawal H, Chun S. COVID-19 vaccine intercountry distribution inequality and its underlying factors: a combined concentration index analysis and multiple linear regression analysis. Front Public Health 2024; 12:1348088. [PMID: 38577285 PMCID: PMC10993910 DOI: 10.3389/fpubh.2024.1348088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/21/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Inequitable access to COVID-19 vaccines among countries is a pressing global health issue. Factors such as economic power, political power, political stability, and health system strength contribute to disparities in vaccine distribution. This study aims to assess the inequality in vaccine distribution among countries based on these factors and identify their relationship with COVID-19 vaccine distribution. Methods A Concentration Index (CI) analysis was conducted to evaluate inequalities in the distribution of COVID-19 vaccines among countries based on four separate variables: GDP per capita, political stability (PS), World Power Index (WPI), and Universal Health Coverage (UHC). Additionally, Multiple Linear Regression (MLR) analysis was employed to explore the relationship between vaccine distribution and these independent variables. Two vaccine distribution variables were utilized for result reliability. Results The analysis revealed significant inequalities in COVID-19 vaccine distribution according to the countries' GDP/capita, PS, WPI, and UHC. However, the multiple linear regression analysis showed that there is no significant relationship between COVID-19 vaccine distribution and the countries' GDP/capita and that UHC is the most influential factor impacting COVID-19 vaccine distribution and accessibility. Discussion The findings underscore the complex interplay between economic, political, and health system factors in shaping vaccine distribution patterns. To improve the accessibility to vaccines in future pandemics, Global Health Governance (GHG) and countries should consider working on three areas; enhance political stabilities in countries, separate the political power from decision-making at the global level and most importantly support countries to achieve UHC.
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Affiliation(s)
| | - Zeinab Khadr
- The Social Research Center, The American University in Cairo, New Cairo, Egypt
- Department of Statistics, Faculty of Economics and Political Sciences, Cairo University, Giza, Egypt
| | - Hassan El Fawal
- Institute of Global Health and Human Ecology, The American University in Cairo, New Cairo, Egypt
| | - Sungsoo Chun
- Institute of Global Health and Human Ecology, The American University in Cairo, New Cairo, Egypt
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Barnawi NA, Al-Otaibi H, Alkhudairy AI, Alajlan MA, Alajlan RA, Alay SM, Alqahtani SM, Bushnak IA, Abolfotouh MA. Awareness, Knowledge, Attitude, and Skills (AKAS) of Telemedicine and Its Use by Primary Healthcare Providers. Int J Gen Med 2024; 17:1047-1058. [PMID: 38532847 PMCID: PMC10964027 DOI: 10.2147/ijgm.s452641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Background This study aimed to determine the rate of telemedicine (TM) use and the levels of awareness, knowledge, attitude, and skills of TM among primary healthcare (PHC) providers. Methods In a cross-sectional study, 104 PHC providers were subjected to a validated AKAS scale via Survey Monkey. The tool consists of 4 parameters that users can respond to using a 4-point Likert scale to assess their awareness (12 statements), knowledge (11 statements), attitude (11 statements), and skills (13 statements) on TM. Total and percentage mean scores (PMS) were calculated for each parameter. Participants were categorized in each parameter into three categories: low (≤ 49% score), average (50-70% score), and high (≥ 71% score) levels. The association of AKAS levels with personal characteristics and TM use was investigated. The significance was set at p<0.05. Results One-half of participants (51%) reported current use of TM, and two-thirds (63.5%) reported a high level of AKAS, with a PMS of 72.9±14.7, 95% CI: 70.1-75.7. There were significant associations between the following: years of experience and levels of knowledge (Χ2LT = 6.77, p= 0.009) and skills (Χ2LT = 4.85, p = 0.028), respectively; and total household income and levels of skills (Χ2LT = 6.91, p= 0.009). The rate of TM use was significantly associated with awareness levels (Χ2LT = 6.14, p = 0.013). Lack of training ranked as the first barrier (45.5%), followed by connection problems and tools' unavailability (35.1% each). The participants recommended providing TM training (41.1%) and stabilization of connection and networking signals (30.1%). Conclusion Despite their high level of TM awareness, the rate of TM use by PHC providers is less than satisfactory. Establishing standardized TM training and supporting the network signals are recommended. A large-scale study on the impact of TM integration with PHC services is necessary.
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Affiliation(s)
- Najla A Barnawi
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Hazza Al-Otaibi
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Abdulaziz I Alkhudairy
- College of Medicine, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Mohammed A Alajlan
- College of Medicine, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | - Renad A Alajlan
- College of Medicine, Imam Muhammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Saeed M Alay
- College of Pharmacy, King Saud Bin Abdul-Aziz University for Health Science (KSAU-HS), Riyadh, Saudi Arabia
| | | | - Ibraheem A Bushnak
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mostafa A Abolfotouh
- King Abdullah International Medical Research Center (KAIMRC)/King Saud Bin Abdulaziz University for Health Sciences/Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Rahmawati T, Hsieh HM. Appraisal of universal health insurance and maternal health services utilization: pre- and post-context of the Jaminan Kesehatan Nasional implementation in Indonesia. Front Public Health 2024; 12:1301421. [PMID: 38550326 PMCID: PMC10972875 DOI: 10.3389/fpubh.2024.1301421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/29/2024] [Indexed: 04/02/2024] Open
Abstract
Introduction The Indonesian government introduced universal health insurance through the National Social Security System (JKN) in 2014 to enhance overall healthcare. This study compares maternal health care (MHC) service utilization before and after JKN implementation in Indonesia. Method Using 2012 and 2017 data from Indonesia Demographic and Health Surveys (DHS), we conducted a two-period cross-sectional design study following the Anderson model. We assessed how the JKN policy and population characteristics influenced healthcare utilization for women aged 15-49 who had given birth in the last 5 years. Multivariable logistic regression models were used to assess the impact of the JKN policy and related factors. Result In two waves of Indonesia DHS with 14,782 and 15,021 subjects, this study observed a significant increase in maternal healthcare service utilization post-JKN implementation. Women were more likely to have at least four antenatal care visits (adjusted odds ratio, AOR = 1.17), receive skilled antenatal care (AOR = 1.49), obtain skilled birth assistance (AOR = 1.96), and access facility-based delivery (AOR = 2.45) compared with pre-JKN implementation. Conclusion This study revealed a significant positive impact of JKN on enhancing MHS utilization. The introduction of universal health insurance coverage likely reduced financial barriers for specific demographics, resulting in increased service utilization. Our study may offer valuable insights for Asian countries with similar demographics and health insurance implementations.
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Affiliation(s)
- Tati Rahmawati
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Azmat SK, Thom EM, Arshad M, Hamza HB, Aabroo A, Balal A, Awan MA, Rifaq F, Hemachandra N, Qudsia U. A study protocol for integrating outpatient services at the primary health care level as part of the universal health coverage benefit package within the national health insurance program of Pakistan through private health facilities. Front Public Health 2024; 12:1293278. [PMID: 38532967 PMCID: PMC10964903 DOI: 10.3389/fpubh.2024.1293278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Introduction and aim Pakistan has a mixed-health system where up to 60% of health expenditures are out of pocket. Almost 80% of primary healthcare (PHC) facilities are in the private sector, which is deeply embedded within the country's health system and may account for the unaffordability of healthcare. Since 2016, the existing national health insurance program or Sehat Sahulat Program (SSP), has provided invaluable coverage and financial protection to the millions of low-income families living in Pakistan by providing inpatient services at secondary and tertiary levels. However, a key gap is the non-inclusion of outpatient services at the PHC in the insurance scheme. This study aims to engage a private provider network of general practitioners in select union councils of Islamabad Capital Authority (ICT) of Pakistan to improve access, uptake, and satisfaction and reduce out-of-pocket expenditure on quality outpatient services at the PHC level, including family planning and reproductive health services. Methods and analysis A 24-month research study is proposed with a 12-month intervention period using a mixed method, two-arm, prospective, quasi-experimental controlled before and after design with a sample of 863 beneficiary families from each study arm, i.e., intervention and control groups (N = 1726) will be selected through randomization at the selected beneficiary family/household level from four peri-urban Union Councils of ICT where no public sector PHC-level facility exists. All ethical considerations will be assured, along with quality assurance strategies. Quantitative pre/post surveys and third-party monitoring are proposed to measure the intervention outcomes. Qualitative inquiry with beneficiaries, general practitioners and policymakers will assess their knowledge and practices. Conclusion and knowledge contribution PHC should be the first point of contact for accessing health services and appears to serve as a programmatic engine for universal health coverage (UHC). The research aims to study a service delivery model which harnesses the private sector to deliver an essential package of health services as outpatient services under SSP, ultimately facilitating UHC. Findings will provide a blueprint referral system to reduce unnecessary hospital admissions and improve timely access to healthcare. A robust PHC system can improve population health, lower healthcare expenditure, strengthen the healthcare system, and ultimately make UHC a reality.
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Affiliation(s)
- Syed Khurram Azmat
- Marie Stopes Society, Karachi, Pakistan
- AIPH - AAPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | - Hasan Bin Hamza
- Ministry of National Health Services, Regulations, and Coordination, Islamabad, Pakistan
| | - Atiya Aabroo
- Ministry of National Health Services, Regulations, and Coordination, Islamabad, Pakistan
| | | | - Muhammad Ali Awan
- Marie Stopes Society, Karachi, Pakistan
- AIPH - AAPNA Institute of Public Health, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Faisal Rifaq
- Federal Sehat Sahulat Program, Islamabad, Pakistan
| | | | - Uzma Qudsia
- World Health Organization, Islamabad, Pakistan
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Rai E, Varghese E, Yaddanapudi S, Iyer RS. Advancing pediatric perioperative care in India: A contemporary overview. Paediatr Anaesth 2024. [PMID: 38462924 DOI: 10.1111/pan.14871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND In the last 30 years, significant advances have been made in pediatric medical care globally. However, there is a persistent urban-rural gap which is more pronounced in low middle-income countries than high-income countries, similar urban-rural gap exists in India. While on one hand, health care is on par or better than healthier nations thriving international medical tourism industry, some rural parts have reduced access to high-quality care. AIM With this background, we aim to provide an overview of the present and future of healthcare in India. METHODOLOGY With the cumulative health experience of the authors or more than 100 years, we have provided our experience and expertise about healthcare in India in this narrative educational review. This is supplemented by the government plans and non government plans as appropriate. References are used to justify as applicable. RESULTS With the high percentage of pediatric population like other low to middle-income countries, India faces challenges in pediatric surgery and anesthesia due to limited resources and paucity of specialized training, especially in rural areas. Data on the access and quality of care is scarce, and the vast rural population and uneven resource distribution add to the challenges along with the shortage of pediatric surgeons in these areas of specialized care . Addressing these challenges requires a multi faceted strategy that targets both immediate and long-term healthcare needs, focusing on improving the facilities and training healthcare professionals. Solutions could include compulsory rural service, district residency programs, increasing postgraduate or residency positions, and safety courses offered by national and international organizations like Safer Anesthesia from Education Pediatrics, Vital Anesthesia Simulation Training, and World Federation of Society of Anesthesiologists pediatric fellowships. CONCLUSION India has achieved great strides in perioperative health care and safety. It has become the major international medical industry due to high-quality care, access and costs. Crucially, India needs to establish local hubs for pediatric perioperative care training to enhance healthcare delivery for children.
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Affiliation(s)
- Ekta Rai
- Department of Anaesthesiology, Christian Medical College, and Hospital, Vellore, India
| | - Elsa Varghese
- Department of Anesthesiology, Kasturba Medical College, and Hospital, Manipal, India
| | - Sandhya Yaddanapudi
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev S Iyer
- Associate Division Chief for Quality and Safety, General Anesthesiology, Department of Anaesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Sukhampha R. Diffusion of global health norms through a national medical professional movement in the universal healthcare of Thailand. Front Public Health 2024; 12:1249497. [PMID: 38515593 PMCID: PMC10956689 DOI: 10.3389/fpubh.2024.1249497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024] Open
Abstract
Commonly, research investigations on social policy reform primarily examine the national processes at the core of policy formation rather than considering their global context. Concerns are raised regarding the diffusion and influence of global health norms on Thai universal health coverage policymaking. The findings demonstrate that global health ideas and actors have an impact on national policymaking and that they can share ideas in a variety of ways, including glocalization, vernacularization, policy learning, and policy entrepreneur intervention, in setting the agenda for national universal health coverage. Global and universal health coverage (UHC) concepts have existed for decades; success would not be possible without the efforts of policy entrepreneurs such as the Rural Doctor Movement, who localize and vernacularize global concepts for implementation. These concepts must be compatible with the national and local sociopolitical contexts in which they exist. The Thai case contributed to a better understanding of the influences of global ideas and actors on transnational health policy transfer, as well as the intervention of the national medical professional movement as policy entrepreneurs in healthcare policymaking and policy change for equity in health.
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Affiliation(s)
- Rangsan Sukhampha
- Faculty of Sociology, Bielefeld University, Bielefeld, Germany
- Department of Public Administration, Faculty of Humanities and Social Sciences, Valaya Alongkorn Rajabhat University, Pathum Thani, Thailand
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Aladegboye MK, Olowokere AE. Healthcare Service Needs of Orphans and Vulnerable Children in Orphanages and Barriers Caregivers face in meeting their Healthcare Service Needs: A Mixed Method Research. PSYCHOL HEALTH MED 2024; 29:670-681. [PMID: 37450470 DOI: 10.1080/13548506.2023.2236024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
Poor health and well-being among orphans and vulnerable children (OVC) in orphanages has been documented in literature, and evidence has shown an association between access to healthcare and well-being among this population. This study assessed the healthcare service needs of OVC and explored the barriers their caregivers face in meeting their healthcare service needs using a mixed method research approach. The study utilized a multi-stage sampling technique in selecting 384 OVC and 14 caregivers that participated in the study. Data were collected using pre-tested questionnaire and interview guide. The quantitative data were analyzed using Statistical Product and Service Solutions (SPSS) version 23, while the qualitative data were analyzed using thematic and content analysis. The result of the study shows that regular health assessment while in the orphanage tops the list of health services needed by OVC; this was followed by health assessment before or during admission into orphanages and facility visits for management of common illness by health professionals while health education for the children and caregivers ranked third. Mental healthcare was the least need reported by the children. From the caregivers' perspectives, financial, structural and psychological barriers emerged as major themes for barriers faced in meeting the healthcare service needs of OVC. The study concluded that OVC are mainly in need of regular health assessment and treatment of common ailments during facility visits by health professionals. The study further shows that caregivers face significant barriers in meeting the healthcare service needs of OVC.
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Affiliation(s)
- Mercy K Aladegboye
- Department of Community Health Nursing, Faculty of Nursing Sciences, University of Medical Science, Ondo, Nigeria
| | - Adekemi E Olowokere
- Department of Nursing Science, Faculty of Basic Medical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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15
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Zhu D, Shi X, Chen S, Ye X, Nicholas S, He P. The role of primary health care in improving health status, financial protection and health equity in the context of China's health system reform. Int J Health Plann Manage 2024; 39:311-328. [PMID: 37915063 DOI: 10.1002/hpm.3722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/15/2022] [Accepted: 10/14/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Stronger primary health care (PHC) is critical to achieving the United Nations' Sustainable Development Goals. However, there is scarce evidence on the impact of PHC on health system performance in developing countries. Since 2009, China has implemented an ambitious health system reform, among which PHC has received unprecedented attention. This study investigates the role of PHC resource in improving health status, financial protection and health equity. METHODS We obtained province-level and individual-level data to conduct a longitudinal study across the period of China's health system reform. The dependent variables included health outcomes and financial protection. The independent variables were the number of PHC physicians and share of PHC physicians in all physicians. Mixed-effect models were used for adjusted associations. RESULTS From 2003 to 2017, the number of PHC physicians slightly increased by 31.75 per 100,000 persons and the share of PHC physicians in all physicians increased by 3.62 percentage points. At the province level, greater PHC physician density was positively associated with life expectancy, negatively associated with age-standardized excess mortality, infectious disease mortality, perinatal mortality low birth weight, as well as the share of health expenses in total consumption expenses. At the individual and household level, greater PHC physician density was positively associated with self-assessed health, and negatively associated with incidence of catastrophic health expenditures. Compared to other quintiles, the poorest quintile benefited more from PHC physician density. CONCLUSIONS In China, an increased PHC physician supply was associated with improved health system performance. While China's PHC system has been strengthened in the context of China's health system reforms, further effective incentives should be developed to attract more qualified PHC workers.
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Affiliation(s)
- Dawei Zhu
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Siyuan Chen
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Xin Ye
- China Centre for Health Development Studies, Peking University, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, New South Wales, Australia
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangdong, China
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, New South Wales, Australia
| | - Ping He
- China Centre for Health Development Studies, Peking University, Beijing, China
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Sarkar S, Wangmo S, Flora MS, Uddin SMJ, Sultan M, Grundy J. Assessing public health sector performance in Bangladesh: Implications for health systems strengthening and universal health coverage - A secondary data analysis. Int J Health Plann Manage 2024; 39:164-174. [PMID: 37904303 DOI: 10.1002/hpm.3724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023] Open
Abstract
The Ministry of Health and Family Welfare has established a health systems strengthening initiative for measuring the performance of public sector health facilities in Bangladesh. The objective of the performance management initiative is to establish routine systems for measuring and scoring health facility performance and promote best practices in public health service management. The performance initiative includes a set of assessments conducted across the four tiers of the public health sector. The findings of assessments demonstrate improvements in the quality of health services and a sharp increase in the utilisation of services across all tiers during the period 2017-2019. The performance management initiative has also identified areas for improvement in the supply-side health system readiness, including ensuring an adequate supply of human resources, essential medicines, and functioning medical equipment and technologies. This initiative outlines the need to systematically address the issue of high health workforce vacancy rates through effective human resource planning and management strategies. The reporting of these ongoing health systems successes and challenges through the performance management initiative in Bangladesh provides an opportunity to develop evidence-based policy reforms for strengthening supply-side health systems. The initiative results, particularly in the context of growing public demand for services, also justifies a monitoring and evaluation mechanism focusing on the quality and coverage of frontline health facilities and the development of more integrated health systems. The performance management initiative will facilitate the maintenance of essential health services while addressing emergency health needs and tracking progress towards achieving the Universal Health Coverage goal.
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Affiliation(s)
- Shila Sarkar
- World Health Organization, Country Office, Dhaka, Bangladesh
| | - Sangay Wangmo
- World Health Organization, Country Office, Dhaka, Bangladesh
| | - Meerjady Sabrina Flora
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Shah Md Jashim Uddin
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Murad Sultan
- World Health Organization, Country Office, Dhaka, Bangladesh
| | - John Grundy
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
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Acharya S, Mathur MR, Tadakamadla SK, Brand A. Assessing the status of oral health integration in South East Asian Regional Office countries' Universal Health Coverage-A scoping review. Int J Health Plann Manage 2024; 39:262-277. [PMID: 38169038 DOI: 10.1002/hpm.3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Oral diseases affect close to 3.5 billion people worldwide and there has been a call by the World Health Organization (WHO) to integrate oral health into the Universal Health Coverage (UHC) agenda. OBJECTIVES To collate and synthesise information regarding the status of integration of oral health into the health systems covered by UHC across the 11 countries in the South East Asian Regional Office. METHODS Drawing on the framework of the six building blocks of health systems as devised by WHO, we compared the public dental care coverage models, with a focus on outpatient dental care in these countries. We gathered this information from publicly available resources, databases and peer-reviewed publications to populate the template guided by the WHO Health System Building Blocks. RESULTS We found a poor access to oral health care, lopsided distribution of manpower, rickety health information systems, and private sector domination and inadequate or absent financing mechanisms for outpatient procedures. The private sector was dominant in all countries except Thailand and Srilanka. Financing was absent in most countries and deficient in Thailand and Indonesia. Dental workforce was deficient in most countries except India, Srilanka, and Thailand. Health information systems were weak with no dental items under price control. Better UHC indicators did not guarantee a lower oral disease burden. CONCLUSIONS Our review highlighted the close connection between service quality and human resources, governance, and finance. There is a need to establish standardised dental treatment guidelines that are uniformly adopted across countries, integrate oral health into national health and development programs, push for functional oral health research through collecting robust surveillance, economic, and social impact data and the development of cost-effective strategies tailored to each country's unique needs.
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Affiliation(s)
- Shashidhar Acharya
- Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, India
- Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Manu Raj Mathur
- Bart's and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | | | - Angela Brand
- Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (UNU-MERIT), Maastricht, The Netherlands
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18
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Agwu P, Odii A, Orjiakor C, Ogbozor P, Mbachu C, Onwujekwe O. Implications of absenteeism of health workers on achieving universal health coverage in Nigeria: exploring lived experiences in primary healthcare. Int J Qual Health Care 2024; 36:mzae015. [PMID: 38421029 DOI: 10.1093/intqhc/mzae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
Primary healthcare facilities are the bedrock for achieving universal health coverage (UHC) because of their closeness to the grassroots and provision of healthcare at low cost. Unfortunately, in Nigeria, the access and quality of health services in public primary healthcare centres (PHCs) are suboptimal, linked with persistent occurrence of absenteeism of health workers. We used a UHC framework developed by the World Health Organization-African Region to examine the link between absenteeism and the possible achievement of UHC in Nigeria. We undertook a qualitative study to elicit lived experiences of healthcare providers, service users, chairpersons of committees of the health facilities, and policymakers across six PHCs from six local government areas in Enugu, southeast Nigeria. One hundred and fifty participants sourced from the four groups were either interviewed or participated in group discussions. The World Health Organization-African Region UHC framework and phenomenological approach were used to frame data analysis. Absenteeism was very prevalent in the PHCs, where it constrained the possible contribution of PHCs to the achievement of UHC. The four indicators toward achievement of UHC, which are demand, access, quality, and resilience of health services, were all grossly affected by absenteeism. Absenteeism also weakened public trust in PHCs, resulting in an increase in patronage of both informal and private health providers, with negative effects on quality and cost of care. It is important that great attention is paid to both availability and productivity of human resources for health at the PHC level. These factors would help in reversing the dangers of absenteeism in primary healthcare and strengthening Nigeria's aspirations of achieving UHC.
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Affiliation(s)
- Prince Agwu
- Department of Social Work, University of Nigeria, Nsukka, Enugu 410001, Nigeria
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Enugu 400241, Nigeria
- School of Humanities, Social Sciences, and Law, University of Dundee, Dundee, Scotland DD1 4HN, United Kingdom
| | - Aloysius Odii
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Enugu 400241, Nigeria
- Department of Sociology and Anthropology, University of Nigeria, Nsukka, Enugu 410001, Nigeria
| | - Charles Orjiakor
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Enugu 400241, Nigeria
- Department of Psychology, University of Nigeria, Nsukka, Enugu 410001, Nigeria
- Department of Psychology, University of Toronto, Scarborough, Ontario, M1C 1A4, Canada
| | - Pamela Ogbozor
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Enugu 400241, Nigeria
- Department of Psychology, Enugu State University of Science and Technology, Enugu, Enugu 01660, Nigeria
| | - Chinyere Mbachu
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Enugu 400241, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria Enugu, Enugu 400241, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Enugu 400241, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu-Campus, Enugu, Enugu 400241, Nigeria
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Khalid F, Afzal S, Shirazi A, Quick I, Mataria A. Coordinating external assistance for UHC: Pakistan's early experience of the SDG3 GAP. Health Policy Plan 2024; 39:247-251. [PMID: 37978855 PMCID: PMC11020300 DOI: 10.1093/heapol/czad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
Pakistan is a lower middle-income setting. External assistance for health and development partners play an important role in health sector development. The federal system and health care delivery as a devolved provincial subject warrant regular and effective coordination among federating units and partners. Pakistan was selected as a priority country in 2019 for the implementation of the Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP). Given the ongoing universal health coverage (UHC) reforms, the country prioritized two SDG3 GAP accelerators, related to primary health care (PHC) and sustainable financing for health (SFH). Eight partner agencies representing PHC and SFH accelerators jointly planned and conducted a 'PHC for UHC mission' to Pakistan in 2021. This mission paved the way for setting up an SDG3 GAP Coordination Committee and a 'PHC Service Delivery and Financing working group', which have been regularly coming together through in-person and virtual meetings; the latter was relatively uncommon previously and this new way of working provided a chance to build rapport, share workplans, identify duplications in technical assistance and jointly gauge governments' priorities. This has shifted the focus of reforms deliberations from 'what' to 'how', enabling joint strategic planning and implementation. The joint work by SDG3 GAP partners with the Ministry of National Health Services Regulation & Coordination linked discussions on health financing and service delivery reforms for the first time, and has contributed to advocacy, analysis, strategic policy dialogue, institutional strengthening and implementation of UHC reforms, with a focus on PHC. Even though joint work by SDG3 GAP partners undoubtedly shows the potential for better alignment and collaboration, translation of the commitment to better collaboration into concrete impact has been the result of committed and engaged staff members, rather than institutionalized change, which will require strong incentives for collaboration.
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Affiliation(s)
- Faraz Khalid
- Universal Health Coverage/Health Systems, World Health Organization , Regional Office for the Eastern Mediterranean, Monazamet El Seha El Alamia Street Extension of Abdel Razak El Sanhouri Street, Nasr City, Cairo 7608, Egypt
| | - Sabeen Afzal
- Health Wing, Ministry of National Health Services, Regulation and Coordination, Pakistan Secretariat, Islamabad 44020, Pakistan
| | - Ali Shirazi
- Health Systems Cluster, World Health Organization, Pakistan Country Office, Park Road, Chak Shahzad, Islamabad 45500, Pakistan
| | - Isadora Quick
- Secretariat of the Global Action Plan for Healthy Lives and Well-being for All, Office of the Director-General, World Health Organization Headquarters, Avenue Appia 20, Geneva 1211, Switzerland
| | - Awad Mataria
- Universal Health Coverage/Health Systems, World Health Organization , Regional Office for the Eastern Mediterranean, Monazamet El Seha El Alamia Street Extension of Abdel Razak El Sanhouri Street, Nasr City, Cairo 7608, Egypt
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20
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Guerra S, Roope LS, Tsiachristas A. Assessing the relationship between coverage of essential health services and poverty levels in low- and middle-income countries. Health Policy Plan 2024; 39:156-167. [PMID: 38300510 PMCID: PMC10883664 DOI: 10.1093/heapol/czae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 02/02/2024] Open
Abstract
Universal health coverage (UHC) aims to provide essential health services and financial protection to all. This study aimed to assess the relationship between the service coverage aspect of universal health coverage and poverty in low- and middle-income countries (LMICs). Using country-level data from 96 LMICs from 1990 to 2017, we employed fixed-effects and random-effects regressions to investigate the association of eight service coverage indicators (inpatient admissions; antenatal care; skilled birth attendance; full immunization; cervical and breast cancer screening rates; diarrhoea and acute respiratory infection treatment rates) with poverty headcount ratios and gaps at the $1.90, $3.20 and $5.50 poverty lines. Missing data were imputed using within-country linear interpolation or extrapolation. One-unit increases in seven service indicators (breast cancer screening being the only one with no significant associations) were associated with reduced poverty headcounts by 2.54, 2.46 and 1.81 percentage points at the $1.90, $3.20 and $5.50 lines, respectively. The corresponding reductions in poverty gaps were 0.99 ($1.90), 1.83 ($3.20) and 1.89 ($5.50) percentage points. Apart from cervical cancer screening, which was only significant in one poverty headcount model ($5.50 line), all other service indicators were significant in either the poverty headcount or gap models at both $1.90 and $3.20 poverty lines. In LMICs, higher service coverage rates are associated with lower incidence and intensity of poverty. Further research is warranted to identify the causal pathways and specific circumstances in which improved health services in LMICs might help to reduce poverty.
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Affiliation(s)
- Stefanny Guerra
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, United Kingdom
- Department of Population Health Sciences, King’s College London, Guy’s Campus, Great Maze Pond, London SE1 1UL, United Kingdom
| | - Laurence Sj Roope
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, United Kingdom
| | - Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom
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Alegre JC, Sharma S, Cleghorn F, Avila C. Strengthening primary health care in low- and middle-income countries: furthering structural changes in the post-pandemic era. Front Public Health 2024; 11:1270510. [PMID: 38419816 PMCID: PMC10899890 DOI: 10.3389/fpubh.2023.1270510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/06/2023] [Indexed: 03/02/2024] Open
Abstract
Strengthening primary health care (PHC) is the most cost-effective approach in low- and middle-income countries (LMICs) to achieve sustainable universal health coverage (UHC), protect against health shocks, and promote health and wellbeing for all people. It has been 45 years since PHC was put on the global agenda followed by multiple efforts to advocate for more funding and improved performance of PHC. Yet, investment in PHC is still insufficient and overall performance of PHC systems is weak in LMICs, resulting in increased vulnerability and poor health outcomes especially among marginalized populations. As countries recover from the COVID-19 pandemic, which exposed the fragility of PHC platforms, it is imperative to go beyond advocacy for PHC investments and make systemic changes to strengthen PHC as the foundation of resilient and equitable health systems. We propose five gamechangers to facilitate structural changes for strengthening PHC through a focused health systems approach: (i) integration of client-centered health services at PHC level; (ii) digitization of PHC services; (iii) efficiency gains invested in essential health services; (iv) strengthening management practices for PHC at district and facility levels; and (v) advancing community engagement for PHC. To be successful, the implementation of the gamechangers must be contextualized and focus on achieving sustainable health outcomes, and therefore use implementation approaches that link essential health services to health outcomes. Through this way countries will maximize the possibility of achieving UHC and attaining the ambitious health targets of the Sustainable Development Goals (SDGs) by 2030.
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Affiliation(s)
- J. C. Alegre
- The Palladium Group, Washington, DC, United States
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Tancred T, Falkenbach M, Raven J, Caffrey M. How can intersectoral collaboration and action help improve the education, recruitment, and retention of the health and care workforce? A scoping review. Int J Health Plann Manage 2024. [PMID: 38319787 DOI: 10.1002/hpm.3773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 02/08/2024] Open
Abstract
Inadequate numbers, maldistribution, attrition, and inadequate skill-mix are widespread health and care workforce (HCWF) challenges. Intersectoral-inclusive of different government sectors, non-state actors, and the private sector-collaboration and action are foundational to the development of a responsive and sustainable HCWF. This review presents evidence on how to work across sectors to educate, recruit, and retain a sustainable HCWF, highlighting examples of the benefits and challenges of intersectoral collaboration. We carried out a scoping review of scientific and grey literature with inclusion criteria around intersectoral governance and mechanisms for the HCWF. A framework analysis to identify and collate factors linked to the education, recruitment, and retention of the HCWF was carried out. Fifty-six documents were included. We identified a wide array of recommendations for intersectoral activity to support the education, recruitment, and retention of the HCWF. For HCWF education: formalise intersectoral decision-making bodies; align HCWF education with population health needs; expand training capacity; engage and regulate private sector training; seek international training opportunities and support; and innovate in training by leveraging digital technologies. For HCWF recruitment: ensure there is intersectoral clarity and cooperation; ensure bilateral agreements are ethical; carry out data-informed recruitment; and learn from COVID-19 about mobilising the domestic workforce. For HCWF retention: innovate around available staff, especially where staff are scarce; improve working and employment conditions; and engage the private sector. Political will and commensurate investment must underscore any intersectoral collaboration for the HCWF.
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Affiliation(s)
- Tara Tancred
- Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
| | | | - Joanna Raven
- Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
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Kesale AM. Do community health committees participate in governing health workers in primary healthcare facilities under fiscal decentralization?-An explanatory qualitative study from Tanzania. Health Sci Rep 2024; 7:e1866. [PMID: 38361807 PMCID: PMC10867382 DOI: 10.1002/hsr2.1866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
Background Decentralization is implemented at the local level to increase community participation in improving service delivery. Majority of developing countries are implementing Fiscal decentralization in primary healthcare through various approaches such as Direct Health Facility Financing, among other things, to empower Community governance structures to govern Primary Health Facility operations to improve the responsiveness of health service delivery and achieve Universal Health Coverage. One of the primary functions of these governance committees is to oversee health workers in their health facilities. Aims This aimed at assessing how empowered governance committees govern health workers in their facilities under fiscal decentralization. Methods To collect data for this study, an explanatory qualitative design with phenomenology traditions was used. To select the area of study, health facilities, and participants, a purposeful sampling procedure was used. Data were gathered through interviews and Focus Group Discussions to explore committee participation in governing health workers in primary care. Thematic analysis was used to analyze the collected data. Result The findings of the study suggest that community governance committees' participation in governing health workers under fiscal decentralization remains limited. Majority of the committees have found to have low limited participation in governing different aspects of health workers. The majority of the committees have discovered that hiring casual workers such as security guards and cleaners is more important than other functions. Conclusion The study implies that lower and middle-income countries' willingness to implement fiscal reforms at the local level and empower communities to take the lead in governing health workers still there are very limited specific powers granted to them to govern health workers. Therefore, capacity building to the governance actors is critical if we are to achieve the benefit of fiscal decentralization.
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Affiliation(s)
- Anosisye Mwandulusya Kesale
- Department of Local Government Management, School of Public Administration and ManagementMzumbe UniversityMorogoroTanzania
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Braithwaite J, Fisher G. Beyond the aspirational: creating the future of health care in Australia. Intern Med J 2024; 54:342-347. [PMID: 37926972 DOI: 10.1111/imj.16286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
The context of health care in Australia is shifting very rapidly; more chronic diseases, budgetary stress and the constant threat of the next pandemic and climate change mean that patterns of disease and care are changing, and the workforce is under pressure. Health systems have learned to respond as best they can, but there are many challenges and opportunities for the Australian health care system to plan and implement an evidence-based and sustainable approach to health care delivery in the next decade. To support this approach, many peak bodies and authoritative agencies, such as the Australian government in their 2022 Strengthening Medicare Taskforce Report, have described laudable visions for health care, but no one has laid out a tangible blueprint for whole-of-system change. Here, we outline nine strategies that span principles of integrated, value-based care, with a focus on prevention and quality, the development of a skilled workforce and health-literate population and the use of emerging technologies such as genomics and artificial intelligence. These strategies form a potential path for the Australian health care system to meet the changing requirements of the current decade and take the aspirational visions of the future of health care into an improved, patient-based health system that delivers care in line with best practices.
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Affiliation(s)
- Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Georgia Fisher
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Maseko LJ, Adams F, Myezwa H. Perceptions of integrated rehabilitation service delivery in a metropolitan district. Afr J Prim Health Care Fam Med 2024; 16:e1-e10. [PMID: 38299544 PMCID: PMC10839198 DOI: 10.4102/phcfm.v16i1.4069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND There is a recognised need for rehabilitation services at primary health care (PHC) level. In addition, there are clear policies (international and national) and guidelines for use by healthcare planners in South Africa to implement rehabilitation services. Although rehabilitation services are provided on the primary platform, its operationalisation has not been in an integrated manner. Clarity on the level of integration within existing PHC rehabilitation service delivery is required for its inclusion in a reengineered PHC. AIM The study explored the extent to which rehabilitation services are integrated into PHC service delivery based on the expressed reality of rehabilitation professionals. SETTING The Johannesburg Metropolitan District of Gauteng, South Africa. METHODS In-depth interviews with 12 PHC rehabilitation professionals were completed to elicit their experiences with PHC rehabilitation services. RESULTS The theme the current state of rehabilitation services - 'this is the reality; you need to do what you need to do' along with its two subcategories, was generated from this study. The theme describes the expressed reality of suboptimal, underdeveloped and poorly integrated rehabilitation services within the Johannesburg Metropolitan District. Rehabilitation service providers have adapted service delivery by including isolated components of rehabilitation integration models, but this has not yielded an integrated service. CONCLUSION Rehabilitation services although recognised as a crucial service in PHC must be critically analysed and adapted to develop integrated service delivery models. There should be a shift from selected coping mechanisms to targeted, integrated services.Contribution: The study describes PHC rehabilitation services and explores best practice models for integrated service planning and delivery.
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Affiliation(s)
- Lebogang J Maseko
- Department of Occupational Therapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg.
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Bellizzi S, Severoni S. Refugees and migrants at the heart of the synergies between universal health coverage, health security and health promotion. J Travel Med 2024; 31:taad137. [PMID: 37883458 DOI: 10.1093/jtm/taad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 10/28/2023]
Abstract
Responding to the health need of refugees and migrants is key to accommodate universal health coverage, health security and health promotion to guarantee the well-being and protection of populations. This is in line with the human rights agenda as well as with the adoption of a coherent efficient comprehensive health system.
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Affiliation(s)
- Saverio Bellizzi
- WHO Health Emergencies Programme, WHO Jordan Country Office, Amman 11118, Jordan
| | - Santino Severoni
- Health and Migration Programme (PHM), World Health Organization, Geneva, CH-1211, Switzerland
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Castano R, Prada SI, Maldonado N, Soto V. Managed competition in Colombia: convergence of public and private insurance and delivery. Health Econ Policy Law 2024:1-15. [PMID: 38251683 DOI: 10.1017/s1744133123000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The Colombian health system has made a deep transition into managed competition since a major reform in 1993. A market for insurers was created, the consumer has free choice of insurer and a national-level equalisation fund distributes revenues via a per-capita payment. Fully subsidised insurance for the poor and informal, and a comprehensive standardised benefit package for subsidised and contributory schemes (both schemes covering 98 per cent of the population), has led to a low level of out-of-pocket expenses and high financial protection, as well as to reduced gaps in equity in access. The preconditions for managed competition are largely met, but improving health care providers' organisation towards integrated care, to enable them to deliver more value, is a necessary step to achieve the expected results of managed competition in terms of efficiency and quality. Although the current system is likely to be reformed in the coming months, the nature and extent of those reforms are not defined yet, so our analysis is based on the current system.
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Affiliation(s)
- Ramon Castano
- School of Medicine, Universidad El Bosque, Bogotá, Colombia
| | - Sergio I Prada
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali, Colombia
- Universidad ICESI, Centro PROESA, Cali, Colombia
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Wahdi AE, Sutanto E, Setyawan A, Astrini YP, Adani N, Mardani H, Maulana N, Pattnaik A, Trihono T, Wilopo SA. National health insurance contribution to family planning program funding in Indonesia: A fund flow analysis. Gates Open Res 2024; 7:105. [PMID: 38605912 PMCID: PMC11006955 DOI: 10.12688/gatesopenres.14642.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 04/13/2024] Open
Abstract
Background Launched in 2014, Indonesia's national health insurance system (JKN) aimed to provide universal health coverage, including contraceptive services, to its population. We aim to evaluate the contribution of JKN to the overall spending for the family planning program in Indonesia. Methods Data from the Indonesian Demographic Health Survey, Survey on Financial Flows for Family Planning, Indonesia Motion Tracker Matrix, World Population Prospect, and Indonesian ministries' budget accountability reports were entered into the CastCost Contraceptive Projection Tool to define budgetary allocation and spending for the family planning program at the national level in 2019. Results Indonesia's family planning program in 2019 was financed mostly by the national budget (64.0%) and out-of-pocket payments (34.6%). There were three main ministries responsible for family planning financing: the National Population and Family Planning Board (BKKBN) (35.8%), the Ministry of Finance (26.2%), and the Ministry of Health (2.0%). Overall, JKN contributed less than 0.4% of the funding for family planning services in Indonesia in 2019. The majority of family planning spending was by public facilities (57.3%) as opposed to private facilities (28.6%). Conclusion JKN's contribution to funding Indonesia's family planning programs in 2019 was low and highlights a huge opportunity to expand these contributions. A coordinated effort should be conducted to identify possible opportunities to realign BKKBN and JKN roles in the family planning programs and lift barriers to accessing family planning services in public and private facilities. This includes a concerted effort to improve integration of private family planning providers into the JKN program.
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Affiliation(s)
- Amirah Ellyza Wahdi
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Edward Sutanto
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Althaf Setyawan
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Yufan Putri Astrini
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
| | - Nadhila Adani
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Halimah Mardani
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Nirwan Maulana
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Anooj Pattnaik
- ThinkWell, 1519 York Road, Lutherville, Maryland, 21093, USA
| | - Trihono Trihono
- ThinkWell, Central Jakarta, Jakarta Special Capital District, 10350, Indonesia
| | - Siswanto Agus Wilopo
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health & Nursing, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
- Center for Reproductive Health, Universitas Gadjah Mada, Sleman, Special Region of Yogyakarta, 55281, Indonesia
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Croke K, Ogbuoji O. Health reform in Nigeria: the politics of primary health care and universal health coverage. Health Policy Plan 2024; 39:22-31. [PMID: 37978878 PMCID: PMC10775211 DOI: 10.1093/heapol/czad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/12/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
Over the past decade, Nigeria has seen major attempts to strengthen primary health care, through the Saving One Million Lives (SOML) initiative, and to move towards universal health care, through the National Health Act. Both initiatives were successfully adopted, but faced political and institutional challenges in implementation and sustainability. We analyse these programmes from a political economy perspective, examining barriers to and facilitators of adoption and implementation throughout the policy cycle, and drawing on political settlement analysis (PSA) to identify structural challenges which both programmes faced. The SOML began in 2012 and was expanded in 2015. However, the programme's champion left government in 2013, a key funding source was eliminated in 2015, and the programme did not continue after external funding elapsed in 2021. The National Health Act passed in 2014 after over a decade of advocacy by proponents. However, the Act's governance reforms led to conflict between health sector agencies, about both reform content and process. Nine years after the Act's passage, disbursements have been sporadic, and implementation remains incomplete. Both programmes show the promise of major health reforms in Nigeria, but also the political and institutional challenges they face. In both cases, health leaders crafted evidence-based policies and managed stakeholders to achieve policy adoption. Yet political and institutional challenges hindered implementation. Institutionally, horizontal and vertical fragmentation of authority within the sector impeded coordination. Politically, electoral cycles led to frequent turnover of sectoral leadership, while senior politicians did not intervene to support fundamental institutional reforms. Using PSA, we identify these as features of a 'competitive clientelist' political settlement, in which attempts to shift from clientelist to programmatic policies generate powerful opposition. Nonetheless, we highlight that some policymakers sought to use health reforms to change institutions at the margin, suggesting future avenues for governance-oriented health reforms.
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Affiliation(s)
- Kevin Croke
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Osondu Ogbuoji
- Center for Policy Impact in Global Health, Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA
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Eze P, Idemili CJ, Lawani LO. Evaluating health systems' efficiency towards universal health coverage: A data envelopment analysis. Inquiry 2024; 61:469580241235759. [PMID: 38456456 PMCID: PMC10924553 DOI: 10.1177/00469580241235759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/21/2024] [Accepted: 02/12/2024] [Indexed: 03/09/2024]
Abstract
To estimate the technical efficiency of health systems toward achieving universal health coverage (UHC) in 191 countries. We applied an output-oriented data envelopment analysis approach to estimate the technical efficiency of the health systems, including the UHC index (a summary measure that captures both service coverage and financial protection) as the output variable and per capita health expenditure, doctors, nurses, and hospital bed density as input variables. We used a Tobit simple-censored regression with bootstrap analysis to observe the socioeconomic and environmental factors associated with efficiency estimates. The global UHC index improved from the 2019 estimates, ranged from 48.4 (Somalia) to 94.8 (Canada), with a mean of 76.9 (std. dev.: ±12.0). Approximately 78.5% (150 of 191) of the studied countries were inefficient (ϕ < 1.0) with respect to using health system resources toward achieving UHC. By improving health system efficiency, low-income, lower-middle-income, upper-middle-income, and high-income countries can improve their UHC indices by 4.6%, 5.5%, 6.8%, and 4.1%, respectively, by using their current resource levels. The percentage of health expenditure spent on primary health care (PHC), governance quality, and the passage of UHC legislation significantly influenced efficiency estimates. Our findings suggests health systems inefficiency toward achieving UHC persists across countries, regardless of their income classifications and WHO regions, as well as indicating that using current level of resources, most countries could boost their progress toward UHC by improving their health system efficiency by increasing investments in PHC, improving health system governance, and where applicable, enacting/implementing UHC legislation.
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Affiliation(s)
- Paul Eze
- Penn State University, University Park, PA, USA
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31
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Naidoo V, Suleman F, Bangalee V. Medical Insurance Representatives Perceptions on National Health Insurance Primary Healthcare Re-Engineering in South Africa: A Qualitative Study. J Prim Care Community Health 2024; 15:21501319241237044. [PMID: 38571364 PMCID: PMC10993667 DOI: 10.1177/21501319241237044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 04/05/2024] Open
Abstract
The South African government is moving toward universal health coverage (UHC) with the passing of the National Health Insurance (NHI) Bill. Access to quality primary healthcare (PHC) is the cornerstone of UHC principles. The South African governmental health department have begun focusing efforts on improving the efficiency and functionality of this system; that includes the involvement of private healthcare professionals and medical insurance companies. This study sought to explore perceptions of medical insurance company personnel on PHC re-engineering as part of NHI restructuring. A qualitative research design was adopted in this study. Semi-structured interviewed were conducted on 10 participants. Their responses were audio recorded and transcribed utilizing Microsoft Word® documents. Nvivo® was used to facilitate the analysis of data. A thematical approach was used to categories codes into themes. Although participants were in agreement with the current healthcare reform in South Africa. The findings of this study have highlighted several gaps in the NHI Bill at the current point in time. In order to achieve standardized quality of care at a primary level; it is imperative that reimbursement frameworks with clearly detailed service provision and accountability guidelines are developed.
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Connolly E, Mohan S, Twea P, Msuku T, Kees A, Sharma L, Heung S, Nkhoma D, Manthalu G. Revision of Malawi's Health Benefits Package: A Critical Analysis of Policy Formulation and Implementation. Value Health Reg Issues 2024; 39:84-94. [PMID: 38041898 DOI: 10.1016/j.vhri.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 10/03/2023] [Accepted: 10/30/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES Health benefits packages (HBPs), which define specific health services that can be offered for free or at a reduced cost to fit within public revenues, have been recommended for over 30 years to maximize population health in resource-limited settings. However, there remain gaps in defining and operationalizing HBPs. We propose a combination of design and prioritization methods along with practical strategies to improve the implementation of future iterations of the HBP in Malawi. METHODS For HBP development for Malawi's Third Health Sector Strategic Plan, we combined cost-effectiveness analysis with a quantitative, consultative multicriteria decision analysis. Throughout the process of development, we documented challenges and opportunities to improve HBP design and application. RESULTS The primary and secondary HBP included 115 interventions. However, the definition of an HBP is just one step toward focusing limited resources, with functional operationalization as the most critical component. Full implementation of previous HBPs has been limited by challenges in aid coordination with the misalignment of nonfungible vertical donor funding for the HBP without accounting for the complexity and interconnectedness of the health system. Opportunities for improved application include creation of a complementary minimum health service package to guide overall resource inputs through an integrative approach. CONCLUSIONS We believe that expanded participatory HBP methods that consider value, equity, and social considerations, along with a shift to providing integrated health service packages at all levels of care, will improve the efficiency of using scarce resources along the journey to universal health coverage.
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Affiliation(s)
- Emilia Connolly
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi; Partners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi; Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, OH, USA.
| | - Sakshi Mohan
- Center for Health Economics, University of York, York, England, UK
| | - Pakwanja Twea
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
| | - Thulasoni Msuku
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
| | - Andreas Kees
- Clinton Health Access Initiative, Lilongwe, Malawi
| | - Lalit Sharma
- Clinton Health Access Initiative, Lilongwe, Malawi
| | | | - Dominic Nkhoma
- Health Economics Policy Unit, Kamuzu University for Health Sciences, Lilongwe, Malawi
| | - Gerald Manthalu
- Department of Planning and Policy Development, Ministry of Health, Lilongwe, Malawi
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Oyediran K, Davis N. Relationship between health insurance enrolment and unintended pregnancy in Ghana. J Biosoc Sci 2024; 56:104-124. [PMID: 36852702 DOI: 10.1017/s0021932023000032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
CONTEXT The effect of health insurance coverage on sexual and reproductive health, especially unintended pregnancy, has scantly been researched. Using the 2014 Ghana Demographic and Health Survey, the study examined the links between women's health insurance enrolment on unintended pregnancy in Ghana. METHOD The sample consisted of 9,396 women aged 15-49 years, but the analysis was limited to the 4,544 women who were pregnant in the two years preceding the survey. The effects of health insurance enrolment on unintended pregnancy was examined with the propensity score matching. The health insurance enrolment was the treatment variable and unintended pregnancy as the outcome variable. RESULTS This study showed that 66.0% of all women surveyed had health insurance coverage and 31.8% of all women of childbearing age who were currently or had previously been pregnant reported having at least one unintended pregnancy. Thirty percent of insured women had an unintended pregnancy, compared to 37% of uninsured women. The results showed that education, household wealth index, religion, and type of marital union were significant predictor of health insurance coverage among Ghanaian women. The PSM split the women based on their health insurance status. After matching, the difference between the insured and uninsured women reduces significantly. Results demonstrated that, the probability of unintended pregnancy was 0.312 among insured women and 0.351 among those not insured in Ghana. This implies that having health insurance coverage will help in reducing the likelihood of women experiencing unintended pregnancy. CONCLUSIONS Results highlight the importance of the target of universal health coverage under the sustainable development goal 3 and demonstrate that expanding existing health insurance schemes within Ghana could contribute to reducing the number unintended pregnancies experienced each year.
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Affiliation(s)
| | - Nikki Davis
- Senior Research, Monitoring, and Evaluation Advisor John Snow Inc.Arlington, VA22202
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Hengel P, Blümel M, Siegel M, Achstetter K, Köppen J, Busse R. Financial risk protection in private health insurance: empirical evidence on catastrophic and impoverishing spending from Germany's dual insurance system. Health Econ Policy Law 2024; 19:3-20. [PMID: 37675511 DOI: 10.1017/s1744133123000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Financial risk protection from high costs for care is a main goal of health systems. Health system characteristics typically associated with universal health coverage and financial risk protection, such as financial redistribution between insureds, are inherent to, e.g. social health insurance (SHI) but missing in private health insurance (PHI). This study provides evidence on financial protection in PHI for the case of Germany's dual insurance system of PHI and SHI, where PHI covers 11% of the population. Linked survey and claims data of PHI insureds (n = 3105) and population-wide household budget data (n = 42,226) are used to compute the prevalence of catastrophic health expenditures (CHE), i.e. the share of households whose out-of-pocket payments either exceed 40% of their capacity-to-pay or push them (further) into poverty. Despite comparatively high out-of-pocket payments, CHE is low in German PHI. It only affects the poor. Key to low financial burden seems to be the restriction of PHI to a small, overall wealthy group. Protection for the worse-off is provided through special mandatorily offered tariffs. In sum, Germany's dual health insurance system provides close-to-universal coverage. Future studies should further investigate the effect of premiums on financial burden, especially when linked to utilisation.
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Affiliation(s)
- Philipp Hengel
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
- Berlin Centre for Health Economics Research, Berlin, Germany
| | - Miriam Blümel
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
- Berlin Centre for Health Economics Research, Berlin, Germany
| | - Martin Siegel
- Berlin Centre for Health Economics Research, Berlin, Germany
- Department of Empirical Health Economics, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
| | - Katharina Achstetter
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
- Berlin Centre for Health Economics Research, Berlin, Germany
| | - Julia Köppen
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
- Berlin Centre for Health Economics Research, Berlin, Germany
| | - Reinhard Busse
- Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623 Berlin, Germany
- Berlin Centre for Health Economics Research, Berlin, Germany
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Solanki G, Daviaud E, Fawcus S, Brijlal V, Doherty T. Models using private general practitioners to provide caesarean deliveries at five South African district public hospitals: insights for public-private contracting for obstetric care in rural areas. Glob Health Action 2023; 16:2241811. [PMID: 37552135 PMCID: PMC10411302 DOI: 10.1080/16549716.2023.2241811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Harnessing of private sector resources could play an important role in efforts to promote universal access to safe obstetric care including caesarean delivery in low- and middle-income countries especially in rural contexts but any such attempt would need to ensure that the care provided is appropriate and patterns of inappropriate care, such as high caesarean delivery rates, are not reproduced for the entire population. OBJECTIVE To examine the contracting arrangements for using private general practitioners to provide caesarean delivery services in rural district hospitals in South Africa. METHOD We utilised a mixed-method study design to examine the contracting models adopted by five rural district hospitals in the Western Cape, South Africa. Between April 2021 and March 2022, we collected routine data from delivery and theatre registers to capture the profile of deliveries and utilisation of contracted private GPs. We also conducted 23 semi-structured qualitative interviews with key stakeholders to explore perceptions of the contracting arrangements. RESULTS All five hospitals varied in the level of use of private general practitioners and the contracting models (three private in-sourcing models - via locum agencies, sessional contracts, and tender contracts) used to engage them. Qualitative interviews revealed insights related to the need for flexibility in the use of contractual models to meet local contextual needs, cost implications and administrative burden. CONCLUSION Structured appropriately, private public partnerships can fill important gaps in human resources in rural district hospitals. Policy makers should look to developing a 'contracting framework' which requires compliance with a set of underlying principles but allows for flexibility in developing context specific contracting arrangements. These underlying principles should include a 'risk' based delivery model, adherence to public sector- evidence-based protocols, time-based rather than per delivery/type of delivery remuneration models, group liability arrangements, and processes to monitor outcomes.
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Affiliation(s)
- Geetesh Solanki
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Honorary Research Associate: Health Economic Unit, University of Cape Town, Cape Town, South Africa
- NMG Consultants and Actuaries, Cape Town, South Africa
| | - Emmanuelle Daviaud
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Sue Fawcus
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
| | - Vishal Brijlal
- Clinton Health Access Initiative, Pretoria, South Africa
| | - Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Parmar D, Strupat C, Srivastava S, Brenner S, Parisi D, Ziegler S, Neogi R, Walsh C, De Allegri M. Effects of the Indian National Health Insurance Scheme (PM-JAY) on Hospitalizations, Out-of-pocket Expenditures and Catastrophic Expenditures. Health Syst Reform 2023; 9:2227430. [PMID: 37540622 DOI: 10.1080/23288604.2023.2227430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 08/06/2023] Open
Abstract
India launched one of the world's largest health insurance programs, the Pradhan Mantri Jan Arogya Yojana (PM-JAY), targeting more than 500 million economically and socially disadvantaged Indians. PM-JAY is publicly funded and covers hospitalization costs in public and private facilities. We examine how PM-JAY has affected hospitalizations and out-of-pocket expenditures (OOPE), and given the high use of private health care in India, we compare these outcomes across public and private facilities. We conducted a household survey to collect data on socioeconomic and demographic information, health status and hospitalizations for more than 57,000 PM-JAY eligible individuals in six Indian states. Using multivariate regression models, we estimated whether PM-JAY was associated with any changes in hospitalizations, OOPE and catastrophic health expenditures (CHE) and whether these differed across public and private facilities. We found that PM-JAY was not associated with an increase in hospitalizations, but it increased the probability of visiting a private facility by 4.6% points (p < .05). PM-JAY was associated with a relative reduction of 13% in OOPE (p < .1) and 21% in CHE (p < .01). This was entirely driven by private facilities, where relative OOPE was reduced by 17% (p < .01) and CHE by 19% (p < .01). This implied that PM-JAY has shifted use from public to private hospitalizations. Given the complex healthcare system with the presence of parallel public and private systems in India, our study concludes that for economically and socially disadvantaged groups, PM-JAY contributes to improved access to secondary and tertiary care services from private providers.
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Affiliation(s)
- Divya Parmar
- Department of Population Health Sciences, School of Life Course and Population Sciences, King's College London, London, UK
| | - Christoph Strupat
- Economic and Social Systems, German Institute of Development and Sustainability (IDOS), Bonn, Germany
| | - Swati Srivastava
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Stephan Brenner
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Diletta Parisi
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Susanne Ziegler
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
- Indo-German Social Security Programme (IGSSP), Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Bonn, Germany
| | - Rupak Neogi
- Social Research Division, Nielsen India Private Limited, Gurugram, India
| | - Caitlin Walsh
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Manuela De Allegri
- Health Economics and Financing, Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
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Mathenge VW, Sambaiga R, Bitebo A, Komba M, Mushashu A, Sang'anya M, Shaweji F, Mbwilo G, Mayao V, Mlembwa J, Rangi J, Onuekwe C, Kileo N, Mwengee W, Sagoe-Moses C. The development of a digital NGO mapping platform in Tanzania, as a tool to strengthen civil society engagement, in pursuit of universal health coverage. Pan Afr Med J 2023; 46:115. [PMID: 38465003 PMCID: PMC10924604 DOI: 10.11604/pamj.2023.46.115.42333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 03/12/2024] Open
Abstract
The role of civil society in economic development, improving livelihoods and in providing pathways towards achieving health for all has become increasingly evident. By mapping these organizations, the scope and scale as well as existing capacities, gaps, and opportunities are brought to light. This paper describes the implementation of a digital mapping platform for NGOs; an interactive site which collects, analyses, and visualizes data from a variety of sources about NGOs in Tanzania, through a series of interactive maps, graphs, and charts. We describe the approach and the technology used to develop the platform and its potential contribution towards improving health outcomes. A situation analysis and needs assessment exercise was conducted in February 2023. The developed system requirement specification document served as the guiding document in the design and development of new modules. Participatory techniques and agile iterative methodologies comprising regular stakeholder engagement were employed. A distributed revision control system was used to keep track of system revisions. The modules were deployed to the production server at the National Internet Data Center (NIDC) server room, followed by a system commissioning activity in October 2023. The NGO Information System, NGO Digital Mapping tool, NGO Analytic tool, NGO Search tool and NGO Opportunities module were designed, developed, and commissioned to support NGO operations in Tanzania. The platform was launched during the annual NGO Forum in Dodoma, Tanzania, on October 5, 2023. The modules are publicly accessible and are housed within the NGO Information System (NIS) platform. Investment in whole-of-society engagement to build health systems resilience for universal health coverage is crucial. Leveraging the unique positioning of NGOs draws us a step closer to the ambitious goal of achieving health for all. Through this one-stop web application system, information on the near real-time status, existing gaps, and opportunities for collaboration to serve communities is readily available for all stakeholders. Wide dissemination and enhancement of utilization of the platform across all sectors is now needed, for data to truly inform action.
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Affiliation(s)
| | | | - Ally Bitebo
- The University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Modesta Komba
- Ministry of Community Development, Gender, Women and Special Groups, Dodoma, Tanzania
| | - Abraham Mushashu
- Ministry of Community Development, Gender, Women and Special Groups, Dodoma, Tanzania
| | - Mussa Sang'anya
- Ministry of Community Development, Gender, Women and Special Groups, Dodoma, Tanzania
| | - Faki Shaweji
- Ministry of Community Development, Gender, Women and Special Groups, Dodoma, Tanzania
| | - Grace Mbwilo
- Ministry of Community Development, Gender, Women and Special Groups, Dodoma, Tanzania
| | - Vickness Mayao
- Ministry of Community Development, Gender, Women and Special Groups, Dodoma, Tanzania
| | - Jerry Mlembwa
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
| | - Jaliath Rangi
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
| | - Chima Onuekwe
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
- World Health Organization, Inter-Country Support Team - East and Southern Africa, Harare, Zimbabwe
| | - Neema Kileo
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
| | - William Mwengee
- World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
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Ogundeji Y, Abubakar H, Ezeh U, Hussaini T, Kamau N, Love E, Muñoz R, Ongboche P, Opuni M, Walker DG, Gilmartin C. An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria. Front Public Health 2023; 11:1226145. [PMID: 38239799 PMCID: PMC10794985 DOI: 10.3389/fpubh.2023.1226145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction The availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states. Methods We collected primary data from 50 health facilities (25 per state), including PHC facilities-health posts, health clinics, health centers-and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider's perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state. Results We found that average actual PHC costs per capita at PHC facilities-where most PHC services should be provided according to government guidelines-ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals-where approximately a third of PHC services are delivered in both states-the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano. Discussion Bridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.
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Affiliation(s)
| | | | - Uche Ezeh
- Health Strategy and Delivery Foundation, Abuja, Nigeria
| | | | - Nelson Kamau
- Health Strategy and Delivery Foundation, Abuja, Nigeria
| | | | | | - Paul Ongboche
- Health Strategy and Delivery Foundation, Abuja, Nigeria
| | - Marjorie Opuni
- Kano State Primary Health Care Management Board, Kano, Nigeria
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Alebachew A, Abdella E, Abera S, Dessie E, Mesele T, Mitiku W, Muñoz R, Opuni M, Teplitskaya L, Walker DG, Gilmartin C. Costs and resource needs for primary health care in Ethiopia: evidence to inform planning and budgeting for universal health coverage. Front Public Health 2023; 11:1242314. [PMID: 38174077 PMCID: PMC10762776 DOI: 10.3389/fpubh.2023.1242314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/15/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction The Government of Ethiopia (GoE) has made significant progress in expanding access to primary health care (PHC) over the past 15 years. However, achieving national PHC targets for universal health coverage will require a significant increase in PHC financing. The purpose of this study was to generate cost evidence and provide recommendations to improve PHC efficiency. Methods We used the open access Primary Health Care Costing, Analysis, and Planning (PHC-CAP) Tool to estimate actual and normative recurrent PHC costs in nine Ethiopian regions. The findings on actual costs were based on primary data collected in 2018/19 from a sample of 20 health posts, 25 health centers, and eight primary hospitals. Three different extrapolation methods were used to estimate actual costs in the nine sampled regions. Normative costs were calculated based on standard treatment protocols (STPs), the population in need of the PHC services included in the Essential Health Services Package (EHSP) as per the targets outlined in the Health Sector Transformation Plan II (HSTP II), and the associated costs. PHC resource gaps were estimated by comparing actual cost estimates to normative costs. Results On average, the total cost of PHC in the sampled facilities was US$ 11,532 (range: US$ 934-40,746) in health posts, US$ 254,340 (range: US$ 68,860-832,647) in health centers, and US$ 634,354 (range: US$ 505,208-970,720) in primary hospitals. The average actual PHC cost per capita in the nine sampled regions was US$ 4.7, US$ 15.0, or US$ 20.2 depending on the estimation method used. When compared to the normative cost of US$ 38.5 per capita, all these estimates of actual PHC expenditures were significantly lower, indicating a shortfall in the funding required to deliver an expanded package of high-quality services to a larger population in line with GoE targets. Discussion The study findings underscore the need for increased mobilization of PHC resources and identify opportunities to improve the efficiency of PHC services to meet the GoE's PHC targets. The data from this study can be a critical input for ongoing PHC financing reforms undertaken by the GoE including transitioning woreda-level planning from input-based to program-based budgeting, revising community-based health insurance (CBHI) packages, reviewing exempted services, and implementing strategic purchasing approaches such as capitation and performance-based financing.
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Affiliation(s)
- Abebe Alebachew
- Breakthrough International Consultancy, Addis Ababa, Ethiopia
| | - Engida Abdella
- Breakthrough International Consultancy, Addis Ababa, Ethiopia
| | - Samuel Abera
- Strategic Affairs Executive Office, Ministry of Health, Addis Ababa, Ethiopia
| | - Ermias Dessie
- Strategic Affairs Executive Office, Ministry of Health, Addis Ababa, Ethiopia
| | - Tesfaye Mesele
- Strategic Affairs Executive Office, Ministry of Health, Addis Ababa, Ethiopia
| | - Workie Mitiku
- Breakthrough International Consultancy, Addis Ababa, Ethiopia
| | | | | | | | | | - Colin Gilmartin
- Management Sciences for Health, Arlington, VA, United States
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De Pawlikowski W, Bustamante A, Jumbam D, Ayala R. Implementing the Emergency, Critical, and Operative Care Resolution (World Health Assembly 76.2) in Peru. Can J Anaesth 2023; 70:2018-2019. [PMID: 37880553 DOI: 10.1007/s12630-023-02595-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
| | - Atenas Bustamante
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, VA, USA
| | - Desmond Jumbam
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, VA, USA
| | - Ruben Ayala
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, VA, USA
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Trisnasari, Laosee O, Rattanapan C, Janmaimool P. Assessing the Determinants of Compliance with Contribution Payments to the National Health Insurance Scheme among Informal Workers in Indonesia. Int J Environ Res Public Health 2023; 20:7130. [PMID: 38063558 PMCID: PMC10705999 DOI: 10.3390/ijerph20237130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023]
Abstract
This study aimed to investigate the determinants of compliance with contribution payments to the National Health Insurance (NHI) scheme among informal workers in Bogor Regency, West Java Province, Indonesia. Surveys of 418 informal workers in Bogor Regency from April to May 2023 were conducted. Multivariate logistic regression analyses were performed to assess the factors associated with informal workers' compliance with NHI contribution payments. The results revealed that being female, having lower secondary education or below, perceiving good health of family members, having negative attitudes toward and poor knowledge of the NHI, experiencing financial difficulties, preferring to visit health facilities other than public ones, and utilizing fewer outpatient services were significantly associated with the noncompliance of informal workers with NHI contribution payments. It was concluded that economic factors alone cannot contribute to informal workers' payment compliance and that motivational factors (knowledge, attitudes toward the insurance system, and self-related health status) also encourage them to comply with contribution payments. Improving people's knowledge, especially on the risk-sharing concept of the NHI, should be done through extensive health insurance education using methods that are appropriate for the population's characteristics.
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Affiliation(s)
- Trisnasari
- ASEAN Institute for Health Development, Mahidol University, 999 Salaya, Phuttamonthon, Nakhon Pathom 73710, Thailand; (T.)
- Social Security Administrator for Health (BPJS Kesehatan), Jakarta 10150, Indonesia
| | - Orapin Laosee
- ASEAN Institute for Health Development, Mahidol University, 999 Salaya, Phuttamonthon, Nakhon Pathom 73710, Thailand; (T.)
| | - Cheerawit Rattanapan
- ASEAN Institute for Health Development, Mahidol University, 999 Salaya, Phuttamonthon, Nakhon Pathom 73710, Thailand; (T.)
| | - Piyapong Janmaimool
- ASEAN Institute for Health Development, Mahidol University, 999 Salaya, Phuttamonthon, Nakhon Pathom 73710, Thailand; (T.)
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Khalifeh R, D’Hoore W, Saliba C, Salameh P, Dauvrin M. Healthcare bias and health inequalities towards displaced Syrians in Lebanon: a qualitative study. Front Public Health 2023; 11:1273916. [PMID: 38098832 PMCID: PMC10720425 DOI: 10.3389/fpubh.2023.1273916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction According to Lebanese official data, Lebanon hosts over 1.5 million displaced Syrians (DS). Research shows that migrants encounter barriers when accessing healthcare. The social determinants of health (SDOH) related to migration are an additional challenge for DS in Lebanon, though bias plays a significant factor in exacerbating health inequalities. This study aims to identify DS perception of healthcare biases in the Lebanese healthcare system, and its consequences on DS' accessing and receiving quality healthcare in Lebanon. Methods A qualitative analysis using in-depth, semi-structured interviews was utilized. 28 semi-structured interviews were conducted with doctors (n = 12) and nurses (n = 16) in 2021. Six group interviews were conducted with DS (n = 22) in Lebanese healthcare facilities. The recruitment of participants relied on reasoned and targeted sampling. Thematic analysis was performed to identify common themes in participants' experiences with DS accessing Lebanese healthcare. Results The findings indicated that there were barriers to accessing healthcare related to the SDOH, such as transportation and financial resources. The results also suggested that DS perceived health biases, including discriminatory behavior from Lebanese healthcare providers, stereotypes and racism leading to health inequalities. Conclusion Based on the perceptions and experiences reported by participants, the underlying causes of biases are due to the fragility of the Lebanese healthcare system when facing a humanitarian crisis as well as a collapsing infrastructure torn by past wars and the current socio-political and financial crises in the country. Global initiatives are required to provide the necessary resources needed for offering equitable health services. Such initiatives involve addressing biases, health inequities, discrimination, and the lack of a Lebanese infrastructure system for the provision of healthcare. Addressing health inequalities remains a major health objective in achieving health equity on the micro level (cultural awareness and competencies) and macro level (equitable distribution of resources, implementation of a universal health coverage) in order to guarantee quality healthcare services to DS.
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Affiliation(s)
- Riwa Khalifeh
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
- Legal Way for Advocacy and Research, Beirut, Lebanon
| | - William D’Hoore
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
| | - Christiane Saliba
- Faculty of Public Health—Section 2 (CERIPH), Lebanese University, Fanar, Lebanon
| | - Pascale Salameh
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Institut National de Santé Publique d’Épidémiologie Clinique et de Toxicologie-Liban (INSPECT LB), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Marie Dauvrin
- Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
- Belgian Health Care Knowledge Center, KCE, Brussels, Belgium
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Dkhimi F, Honda A, Hanson K, Mbau R, Onwujekwe O, Phuong HT, Mathauer I, Akhnif EH, Jaouadi I, Kiendrébéogo JA, Ezumah N, Kabia E, Barasa E. Examining multiple funding flows to public healthcare providers in low- and middle-income countries - results from case studies in Burkina Faso, Kenya, Morocco, Nigeria, Tunisia and Vietnam. Health Policy Plan 2023; 38:1139-1153. [PMID: 37971183 DOI: 10.1093/heapol/czad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 04/25/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023] Open
Abstract
Provider payment methods are traditionally examined by appraising the incentive signals inherent in individual payment mechanisms. However, mixed payment arrangements, which result in multiple funding flows from purchasers to providers, could be better understood by applying a systems approach that assesses the combined effects of multiple payment streams on healthcare providers. Guided by the framework developed by Barasa et al. (2021) (Barasa E, Mathauer I, Kabia E et al. 2021. How do healthcare providers respond to multiple funding flows? A conceptual framework and options to align them. Health Policy and Planning 36: 861-8.), this paper synthesizes the findings from six country case studies that examined multiple funding flows and describes the potential effect of multiple payment streams on healthcare provider behaviour in low- and middle-income countries. The qualitative findings from this study reveal the extent of undesirable provider behaviour occurring due to the receipt of multiple funding flows and explain how certain characteristics of funding flows can drive the occurrence of undesirable behaviours. Service and resource shifting occurred in most of the study countries; however, the occurrence of cost shifting was less evident. The perceived adequacy of payment rates was found to be the strongest driver of provider behaviour in the countries examined. The study results indicate that undesirable provider behaviours can have negative impacts on efficiency, equity and quality in healthcare service provision. Further empirical studies are required to add to the evidence on this link. In addition, future research could explore how governance arrangements can be used to coordinate multiple funding flows, mitigate unfavourable consequences and identify issues associated with the implementation of relevant governance measures.
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Affiliation(s)
- Fahdi Dkhimi
- Department of Health Systems Governance and Financing, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Ayako Honda
- Research Centre for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, 2-1 Naka Kunitachi, Tokyo 186-8601, Japan
| | - Kara Hanson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - Rahab Mbau
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, PO Box 43640-00100, Nairobi, Kenya
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu 400001, Nigeria
| | - Hoang Thi Phuong
- Health Strategy and Policy Institute, Ministry of Health, 196 Alley, Ho Tung Mau, Cau Giay, Hanoi 100000, Vietnam
| | - Inke Mathauer
- Department of Health Systems Governance and Financing, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | - El Houcine Akhnif
- Morocco Country Office, World Health Organization, N3 Avenue Prince Sidi Mohamed, Suissi, Rabat 10000, Morocco
| | - Imen Jaouadi
- École Supérieure de Commerce de Tunis, Université de la Manouba, Tunis, Manouba 2010, Tunisia
| | - Joël Arthur Kiendrébéogo
- Health Sciences Training and Research Unit, Department of Public Health, University Joseph Ki-Zerbo, 04 BP 8398, Ouagadougou 04, Burkina Faso
| | - Nkoli Ezumah
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu 400001, Nigeria
| | - Evelyn Kabia
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, PO Box 43640-00100, Nairobi, Kenya
| | - Edwine Barasa
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford 01540, United Kingdom
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Kurowski C, Evans DB, Ottersen T, Gopinathan U, Dale E, Norheim OF. New strides towards fair processes for financing universal health coverage. Health Policy Plan 2023; 38:i5-i8. [PMID: 37963075 PMCID: PMC10645048 DOI: 10.1093/heapol/czad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/19/2023] [Accepted: 08/02/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Christoph Kurowski
- Health, Nutrition and Population, World Bank Group, 1818 H Street, NW, Washington, DC 20433, United States
| | - David B Evans
- Health, Nutrition and Population, World Bank Group, 1818 H Street, NW, Washington, DC 20433, United States
| | - Trygve Ottersen
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Unni Gopinathan
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Elina Dale
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Ole Frithjof Norheim
- Bergen Centre for Ethics and Priority Setting, University of Bergen (BCEPS), University of Bergen, Årstadveien 21, Bergen 5018, Norway
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45
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Ng’ambi WF, Mwase T, Zyambo C, Chigaru F, Banda AJ, Mfutso-Bengo J. Uptake of health insurance in Malawi in 2019-2020: evidence from the multiple indicator cluster survey. Pan Afr Med J 2023; 46:85. [PMID: 38314236 PMCID: PMC10837274 DOI: 10.11604/pamj.2023.46.85.38836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/12/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction although countries in sub-Sahara Africa (SSA) show progress in implementing various forms of health insurance, there is a dearth of information regarding health insurance in settings like Malawi. Therefore, we conducted this study to determine the uptake of health insurance and describe some of the factors associated with the prevailing uptake of health insurance in Malawi using the 2019-2020 Multiple Indicator Cluster Survey (MICS). Methods this was a secondary analysis of the 2019-2020 MICS data. Data were analysed using frequencies and weighted percentages in Stata v.17. Furthermore, since the number of persons with health insurance is very small, we were unable to perform multivariate analysis. Results a total of 205 (1%) of the 31259 had health insurance in Malawi in 2019-2020. Of the 205 individuals who owned health insurance, 118 (47%) had health insurance through their employers while 39 (16%) had health insurance through mutual health organizations or community-based. Men had a higher uptake of health insurance than women. The residents from urban areas were more likely to have health insurance than those in rural areas. Persons with media exposure were more likely to own health insurance as compared to their counterparts. There was an increasing trend in the uptake of health insurance by wealth of the individual with the poorest being less likely to have health insurance compared to the richest. The persons with no education were least likely to have health insurance while those with tertiary education were most likely to have health insurance. Conclusion the uptake of health insurance in Malawi was extremely low. In order to increase the uptake of health insurance, there is a need to increase insurance coverage amongst those in formal employment, and consider minimizing the geographic, economic, and demographic barriers in accessing the health insurance.
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Affiliation(s)
- Wingston Felix Ng’ambi
- Kamuzu University of Health Sciences, Department of Health Systems and Policy, Health Economics and Policy Unit, Lilongwe, Malawi
| | - Takondwa Mwase
- Kamuzu University of Health Sciences, Department of Health Systems and Policy, Health Economics and Policy Unit, Lilongwe, Malawi
| | - Cosmas Zyambo
- University of Zambia, Department of Public Health and Family Medicine, Lusaka, Zambia
| | - Farai Chigaru
- Kamuzu University of Health Sciences, Department of Health Systems and Policy, Health Economics and Policy Unit, Lilongwe, Malawi
| | | | - Joseph Mfutso-Bengo
- Kamuzu University of Health Sciences, Department of Health Systems and Policy, Health Economics and Policy Unit, Lilongwe, Malawi
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46
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Gopinathan U, Dale E, Evans DB. Procedural fairness in health financing for universal health coverage: why, what and how. Health Policy Plan 2023; 38:i1-i4. [PMID: 37963077 PMCID: PMC10645044 DOI: 10.1093/heapol/czad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Unni Gopinathan
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - Elina Dale
- Norwegian Institute of Public Health, Sandakerveien 24C, Oslo 0473, Norway
| | - David B Evans
- Health, Nutrition and Population, World Bank Group, 1818 H Street NW, Washington, DC 20433, USA
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47
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Viriyathorn S, Sachdev S, Suwanwela W, Wangbanjongkun W, Patcharanarumol W, Tangcharoensathien V. Procedural fairness in benefit package design: inclusion of pre-exposure prophylaxis of HIV in Universal Coverage Scheme in Thailand. Health Policy Plan 2023; 38:i36-i48. [PMID: 37963082 PMCID: PMC10645053 DOI: 10.1093/heapol/czad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/09/2023] [Accepted: 07/29/2023] [Indexed: 11/16/2023] Open
Abstract
Since 2002, Thailand's Universal Coverage Scheme (UCS) has adopted a comprehensive benefits package with few exclusions. A positive-list approach has gradually been applied, with pre-exposure prophylaxis (PrEP) of HIV recently being included. Disagreements resulting from competing values and diverging interests necessitate an emphasis on procedural fairness when making any decisions. This qualitative study analyses agenda setting, policy formulation and early implementation of PrEP from a procedural fairness lens. Literature reviews and in-depth interviews with 13 key stakeholders involved in PrEP policy processes were conducted. Civil society organizations (CSOs) and academia piloted PrEP service models and co-produced evidence on programmatic feasibility and outcomes. Through a broad stakeholder representation process, the Department of Disease Control proposed PrEP for inclusion in UCS benefits package in 2017. PrEP was shown to be cost-effective and affordable through rigorous health technology assessment, peer review, use of up-to-date evidence and safe-guards against conflicts of interest. In 2021, Thailand's National Health Security Board decided to include PrEP as a prevention and promotion package, free of charge, for the populations at risk. Favourable conditions for procedural fairness were created by Thailand's legislative provisions that enable responsive governance, notably inclusiveness, transparency, safeguarding public interest and accountable budget allocations; longstanding institutional capacity to generate local evidence; and implementation capacity for realisation of procedural fairness criteria. Multiple stakeholders including CSOs, academia and the government deliberated in the policy process through working groups and sub-committees. However, a key lesson from Thailand's deliberative process concerns a possible 'over interpretation' of conflicts of interest, intended to promote impartial decision-making, which inadvertently limited the voices of key populations represented in the decision processes. Finally, this case study underscores the value of examining the full policy cycle when assessing procedural fairness, since some stages of the process may be more amenable to certain procedural criteria than others.
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Affiliation(s)
- Shaheda Viriyathorn
- International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Saranya Sachdev
- International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Waraporn Suwanwela
- National Health Security Office (NHSO), The Government Complex Commemorating His Majesty the King's 80th Birthday Anniversary 5th December, B.E.2550 (2007) Building B 120 Moo 3 Chaengwattana Road, Lak Si District, Bangkok 10210, Thailand
| | - Waritta Wangbanjongkun
- International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Walaiporn Patcharanarumol
- International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand
| | - Viroj Tangcharoensathien
- International Health Policy Program (IHPP), Ministry of Public Health, Tiwanon Road, Nonthaburi 11000, Thailand
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48
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González-Pier E, Bryne IC, Cárdenas Gamboa DI, Dsane-Selby L, Kapologwe N, Radutskyi M, Sadanandan R. Policymakers' perspective on the importance of procedural fairness to implement and sustain health financing reforms. Health Policy Plan 2023; 38:i9-i12. [PMID: 37963074 PMCID: PMC10645043 DOI: 10.1093/heapol/czad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 03/20/2023] [Accepted: 07/27/2023] [Indexed: 11/16/2023] Open
Abstract
Fair process is instrumental to implementing and sustaining health financing reforms. Ensuring a fair process during the design and adoption phases can garner political capital and secure a sense of citizens' ownership. This will prove useful when reforms are contested before benefits are yet to be fully materialized. Since many well devised health financing reforms are vulnerable to being dismantled after a few years of being launched, fair process should play a more strategic role in the implementation and evaluation phases when policies get challenged and reformulated to reflect the changing political and socioeconomic landscapes and to better manage early evidence on performance.
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Affiliation(s)
| | | | | | | | - Ntuli Kapologwe
- Director of Health Services, President’s Office Regional Administration and Local Government, Tanzania
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Ssendagire S, Mohamoud SA, Bashir F, Jamal MA, Bulale M, Azad A, Warsame MY, Hassan F, Omar M, Dalmar A, Karanja MJ, Nyagah LM, Warsame A, Diriye AA, Malik SMMR. Health research prioritization in Somalia: setting the agenda for context specific knowledge to advance universal health coverage. Front Public Health 2023; 11:1202034. [PMID: 38026320 PMCID: PMC10680366 DOI: 10.3389/fpubh.2023.1202034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Despite recognition that health research is an imperative to progress toward universal health coverage, resources for health research are limited. Yet, especially in sub-Saharan Africa, more than 85% of the resources available for health research are spent on answering less relevant research questions. This misalignment is partially due to absence of locally determined health research priorities. In this study, we identified health research priorities which, if implemented, can inform local interventions required to accelerate progress toward universal health coverage in Somalia. Methods We adapted the child health and nutrition research initiative method for research priority setting and applied it in 4 major phases: (1) establishment of an exercise management team, (2) a web-based survey among 84 respondents to identify health research questions; (3) categorization of identified health research questions; and (4) a workshop with 42 participants to score and rank the identified health research questions. Ethical approval was received from ethics review committee of the London School of Hygiene and Tropical Medicine (Ref:26524) and the Somali Research and Development Institute (Ref: EA0143). Results Two hundred and thirty-one unique health research questions were identified and categorized under health systems, services and social determinants (77), communicable diseases (54), non-communicable diseases (41) and reproductive, maternal, new-born, child, adolescent health and nutrition (59). A priority score ranging from 1 to 9 was assigned to each of the questions. For each category, a list of 10 questions with the highest priority scores was developed. Across the four categories, an overall list of 10 questions with the highest priority scores was also developed. These related to bottlenecks to accessing essential health services, use of evidence in decision making, antimicrobial resistance, distribution and risk factors for non-communicable diseases, post-traumatic stress disorder and factors associated with low antenatal care attendance among others. Conclusion and recommendations The developed priority research questions can be used to focus health research and to inform appropriation of health research resources to questions that contribute to generation of local health system knowledge which is required to accelerate progress toward universal health coverage in Somalia. The Somalia national institute of health should set up a consortium for provision of technical and financial support for research addressing the identified priority research questions, establish a mechanism to continuously monitor the extent to which new health interventions in Somalia are informed by knowledge generated through conducting prioritized health research and prioritize interventions aimed at strengthening the broader national health research system for Somalia.
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Affiliation(s)
| | | | - Farah Bashir
- Somali Research and Development Institute, Mogadishu, Somalia
| | | | | | - Abdullah Azad
- World Health Organization Country Office, Mogadishu, Somalia
| | | | - Farhan Hassan
- World Health Organization Country Office, Mogadishu, Somalia
| | - Mohamed Omar
- National Institute of Health, Mogadishu, Somalia
| | | | | | | | - Abdihamid Warsame
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Oyekale AS. Utilization of Proximate Healthcare Facilities and Children's Wait Times in Senegal: An IV-Tobit Analysis. Int J Environ Res Public Health 2023; 20:7016. [PMID: 37947572 PMCID: PMC10650125 DOI: 10.3390/ijerph20217016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
Universal health coverage (UHC) defines individuals' timely access to healthcare services without suffering any health-related financial constraints. The Senegalese government has shown commitments towards achievement of UHC as a way of improving access by the population to quality healthcare services. This is very pertinent for promoting some indicators of under-five health in Senegal. Therefore, this study analyzed the factors influencing sick children's utilization of the nearest healthcare facilities and their wait times in Senegal. The data were from the Service Provision Assessment (SPA) survey, which was conducted in 2018. The instrumental Tobit regression model was used for data analysis. The results showed that 63.50% and 86.01% of the children utilized health posts and publicly owned facilities, respectively. Also, 98.46% of the children utilized urban facilities. The nearest facilities were utilized by 74.55%, and 78.19% spent less than an hour in the facilities. The likelihood of using the nearest healthcare facilities significantly reduced (p < 0.05) with caregivers' primary education, higher education, residence in some regions (Fatick, Kaokack, Saint Louis, Sediou, and Tambacounda), and use of private/NGO not-for-profit facilities, but increased with not having visited any other providers, residence in the Kaffrie region, vomiting symptoms, use of health centers, and use of health posts. Moreover, treatment wait times significantly increased (p < 0.05) with the use of nearest facilities, residence in some regions (Diourbel, Kaokack, Matam and Saint Louis), use of private for-profit facilities, use of private not-for-profit facilities, and urban residence, but decreased with secondary education, use of health centers, use of health posts, vomiting symptoms, and showing other symptoms. It was concluded that reduction in wait times and utilization of the nearest healthcare facilities are fundamental to achieving UHC in Senegal. Therefore, more efforts should be integrated at promoting regional and sectoral equities through facilitated public and private healthcare investment.
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Affiliation(s)
- Abayomi Samuel Oyekale
- Department of Agricultural Economics and Extension, North-West University Mafikeng Campus, Mmabatho 2735, South Africa
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