Abstract
Many countries rely on standard recipes for accelerating progress toward universal health coverage (UHC). With limited generalizable empirical evidence, expert confidence and consensus plays a major role in shaping country policy choices. This article presents an exploratory attempt conducted between April and September 2016 to measure confidence and consensus among a panel of global health experts in terms of the effectiveness and feasibility of a number of policy options commonly proposed for achieving UHC in low- and middle-income countries, such as fee exemptions for certain groups of people, ring-fenced domestic health budgets, and public-private partnerships. To ensure a relative homogeneity of contexts, we focused on French-speaking sub-Saharan Africa. We initially used the Delphi method to arrive at expert consensus, but since no consensus emerged after 2 rounds, we adjusted our approach to a statistical analysis of the results from our questionnaire by measuring the degree of consensus on each policy option through 100 (signifying total consensus) minus the size of the interquartile range of the individual scores. Seventeen global health experts from various backgrounds, but with at least 20 years' experience in the broad region, participated in the 2 rounds of the study. The results provide an initial "mapping" of the opinions of a group of experts and suggest interesting lessons. For the 18 policy options proposed, consensus emerged only on strengthening the supply of quality primary health care services (judged as being effective with a confidence score of 79 and consensus score of 90), and on fee exemptions for the poorest (judged as being fairly easy to implement with a confidence score of 66 and consensus score of 85). For none of the 18 common policy options was there consensus on both potential effectiveness and feasibility, with very diverging opinions concerning 5 policy options. The lack of confidence and consensus within the panel seems to reflect the lack of consistent evidence on the proposed policy options. This suggests that experts' opinions should be framed within strengthened inclusive and "evidence-informed deliberative processes" where the trade-offs along the 3 dimensions of UHC-extending the population covered against health hazards, expanding the range of services and benefits covered, and reducing out-of-pocket expenditures-can be discussed in a transparent and contextualized setting.
Highlights
That is why we intended to assess the degree of confidence among a sample of global health experts on the potential effectiveness and feasibility of a set of common policy options, to allow us to move toward universal health coverage (UHC) in typical African contexts
Based on the World Health Report 2010 on health systems financing,[2] we identified a number of policy options recommended on the path to UHC and grouped them along the 3 dimensions of the UHC “cube.” We selected the most frequently recommended and implemented in French-speaking sub-Saharan Africa based on our field experience (Table 1)
To limit variability of contexts and ensure coherence, we focused the study on typical con- This article texts of French-speaking sub-Saharan African attempts to countries; and to limit ideological biases, we measure global selected a number of global health experts work- health experts' ing in various types of organizations who had experience in this feasibility of policy broad region
Summary
Global Health: Science and Practice 2018 | Volume 6 | Number 2 covered by a mechanism of financial protection against health hazards; (2) expanding the range of services and benefits covered; and (3) reducing out-of-pocket expenditure for the services and benefits that are provided.[1,2,3] evidence on the impact of specific UHC design features is scarce and inconclusive,[4] and it is acknowledged that there is no one-size-fits-all approach to achieving UHC.[2,5,6,7,8] the choice between the dimension(s) of UHC to be privileged in the first place and the policy options to implement to achieve that implies trade-offs and requires a contextdependent balancing act.[6]. The influence of global health experts may be very important in this respect. This article presents exploratory research attempting to measure global health experts' confidence in, and possible consensus on, the effectiveness and feasibility of a number of policy options commonly proposed for achieving UHC in low- and middle-income countries (LMICs). We first present our objectives and the methodological approach we used, and draw general lessons from our results
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