Abstract
Universal health coverage (UHC) is part of the global health agenda to tackle the lack of access to essential health services (EHS). This study developed and tested models to examine the individual, neighbourhood and country-level determinants associated with access to coverage of EHS under the UHC agenda in low- and middle-income countries (LMICs). We used datasets from the Demographic and Health Surveys (DHSs) of 58 LMICs. Suboptimal and optimal access to EHS were computed using nine indicators. Descriptive and multilevel multinomial regression analyses were performed using R and STATA. The prevalence of suboptimal and optimal access to EHS varies across the countries, the former ranging from 5.55% to 100%, and the latter ranging from 0% to 90.36% both in Honduras and Colombia, respectively. In the fully adjusted model, children of mothers with lower educational attainment (relative risk ratio [RRR] 2.11, 95% credible interval [CrI] 1.92 to 2.32) and those from poor households (RRR 1.79, 95% CrI 1.61 to 2.00) were more likely to have suboptimal access to EHS. Also, those with health insurance (RRR 0.72, 95% CrI 0.59 to 0.85) and access to media (RRR 0.59, 95% CrI 0.51 to 0.67) were at lesser risk of having suboptimal EHS. Similar trends, although in the opposite direction, were observed in the analysis involving optimal access. The intra-neighbourhood and intra-country correlation coefficients were estimated using the intercept component variance; 57.50%% and 27.70% of variances in suboptimal access to EHS are attributable to the neighbourhood and country-level factors. Neighbourhood-level poverty, illiteracy, and rurality modify access to EHS coverage in LMICs. Interventions aimed at achieving the 2030 UHC goals should consider integrating socioeconomic and living conditions of people.
Highlights
The concept of expanding health service coverage to everyone and providing financial protection has been in existence since the 20th century.[1,2] The German social health insurance scheme, founded in 1978, and the British National Health Service, founded in 1948, were the founding models; more countries, especially in Europe, adapted different models to design their health systems years after.[3,4] The concept gained more attention in 2005 when the World Health Organization (WHO) mobilised all its member states to commit to advancing the concept in their respective countries.[5]
Figure provided a graphical representation of variation in suboptimal access to essential health services (EHS) across the 58 low- and middle-income countries (LMICs)
We found that mother-child pairs living in LMICs with high Human development index (HDI) have suboptimal access increased by only 0.27 times and increased optimal access to universal health coverage (UHC) by 1.83 times
Summary
The concept of expanding health service coverage to everyone and providing financial protection has been in existence since the 20th century.[1,2] The German social health insurance scheme, founded in 1978, and the British National Health Service, founded in 1948, were the founding models; more countries, especially in Europe, adapted different models to design their health systems years after.[3,4] The concept gained more attention in 2005 when the World Health Organization (WHO) mobilised all its member states to commit to advancing the concept in their respective countries.[5]. UHC has emerged as one of the most critical post2015 global health priorities; it is termed the most potent strategy to deal with public health issues and forms part of Sustainable Development Goal (SDG) indicators.[7,8] this concept has enjoyed massive support from global development agencies such as The World Bank, WHO and the United Nations. They have received funding and technical support from these agencies to design and implement interventions to advance progress towards UHC; the global coverage of health services is it the highest of all times in history
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