Achieving Universal Health Coverage Research Articles

Provincial inequality of China's progress towards universal health coverage: An empirical analysis in 2016-21.

Achieving universal health coverage (UHC) is a crucial target shared by the Sustainable Development Goals (SDGs). As UHC levels are influenced by factors such as the regional economy and resource allocation, subnational evidence in China is urgently needed. This study aimed to monitor provincial progress from 2016 to 2021, thereby informing the development of region-specific strategies. Based on the UHC monitoring framework proposed by the World Health Organization, a UHC index was constructed comprising the service coverage dimension (16 indicators) and financial protection dimension (four indicators). In this observational study, routinely collected health data from 25 provinces (autonomous regions and municipalities) in mainland China were obtained from statistical yearbooks, relevant literature, and nationally representative surveys. The indices were calculated using geometric means. Socioeconomic inequalities among provinces were quantified using the slope index of inequality (SII) and relative index of inequality (RII). From 2016 to 2021, China made laudable progress towards achieving UHC, with the index rising from 56.94 in 2016 to 63.03 in 2021. Most provinces demonstrated better performance in service coverage. Western provinces generally presented faster rates of progress, which were attributed to more substantial increases in financial protection. Despite significant disparities, with the UHC index ranging from 77.94 in Shanghai to 54.61 in Fujian in 2021, the overall equity of UHC has improved across the 25 provinces. SII decreased from 17.78 (95% confidence interval (CI) = 11.64, 23.93) to 12.25 (95% CI = 5.86, 18.63) and RII from 1.38 (95% CI = 1.29, 1.46) to 1.22 (95% CI = 1.16, 1.29). However, the non-communicable disease (NCD) domain experienced a drop in both index score and equity, underscoring the need for prioritised attention. In the context of SDGs and the 'Healthy China 2030' initiative, China has made commendable progress towards UHC, and inter-provincial equity has improved. However, substantial differences persisted. The equitable realisation of UHC necessitates prioritising the enhancement of service capacity and financial protection in less developed regions, particularly by addressing shortages in the general practitioner workforce and mitigating catastrophic payments. Developed regions should focus on preventing NCDs through effective interventions targeting key risk factors. This study provides insights for other countries to adopt comprehensive monitoring frameworks, identify subnational disparities, and introduce targeted policy initiatives.

Mind the data gaps: Comparing the quality of data sources for maternal health services in Cameroon

BackgroundNumerous sources of routine data exist but there is limited information on how they relate or complement each other to improve data availability and the quality of data collected. This paper compares data coverage and completeness on selected maternal health service indicators between (1) a performance-based financing(PBF) database, (2) the national health information system, and (3) health facility registers in selected districts in Cameroon. MethodData on antenatal care, skilled birth delivery and family planning were collected from 2010 to 2020 in three purposively selected districts (Buea, Limbe and Tiko) in the southwest region of Cameroon. The coverage and completeness of data from the performance-based financing database, the district health information system (dhis2, a national system) and health facility registers were compared. Data sources for the performance-based financing database and the district health information system are based on data generated from health facilities. ResultsAmong the 90 health facilities in the three districts, 13 (14.5 %) facilities could not be accessed due to ongoing political conflict. Therefore, data were collected from 77 health facilities. Of the 77 facilities, half were public, a third private, and the remainder para-public (13 %) or confessional (5 %). Approximately seven registers at each health facility included data on maternal and child health. Problems of these data included incomplete coverage, misplacement of records, and incomplete data in the records identified. There was inconsistency across all sources. dhis2 collected antenatal care only for the first and fourth visits and PBF collected data for any antenatal care visits without specifying the visit number and health facility collected data for all antenatal care visits. ConclusionThe introduction of dhis2 and PBF programs has strengthened the availability of data in electronic format. Generally, we noted important gaps and heterogeneity in data reporting as well as incomplete data across health sectors and districts. There is need to transform the way data are collected at health facilities and there is also need for capacity building and better data governance to improve data quality and use. This will ensure that reliable, consistent, accurate, and actionable data are available to inform policy towards achieving Universal Health Coverage.

An examination of the structural linkages between households and community health services in realization of accelerated primary healthcare delivery in Kisumu County, Kenya: a systematic review

Background The provision of community health services (CHS) is critical in accelerating primary health care delivery to vulnerable and deprived populations. This systematic review study has been conducted to interrogate the interrelationship between households and community health services in accelerating primary healthcare delivery synthesizing the available empirical studies. The findings are to inform a primary research on structural linkages between households and CHS in Kisumu County, Kenya. Methods This study applied a descriptive approach using a systematic review technique to provide context and substance to the two main research questions: (1) how does the interaction between households and CHWs affect utilization of CHS to promote equity and right to health? (2) How do health-seeking behaviours of households influence their decision-making regarding choices of CHS? We screened the literature from Google scholar, JSTOR, SAGE and EBSCO based on our inclusion criteria, resulting in 21 studies. These studies were assessed for quality and eligibility and data extracted based on relevance to the research study. Results Households place primacy on trust and confidentiality in the interaction with CHWs and this affects uptake of CHS. The social determinants of health are also critical in influencing the health-seeking behaviour of households and individuals and their choice of CHS. The successful models of CHS share the characteristic of community ownership and participation and provides for comprehensive health care teams. Conclusion CHS are critical for the acceleration of primary health care delivery. It forms an important pathway for the achievement of universal health coverage, which is an outcome required for Sustainable Development Goal 3 on health.

Data for health system comparison and assessment in the African Region: A review of 63 indicators available in international databases.

Achieving universal health coverage in the African region requires health systems strengthening. Assessing and comparing health systems contributes to this process, but requires internationally comparable data. The European Observatory on Health Systems and Policies has produced Health Systems in Transition (HiT) reviews in Europe, Asia, North America and the Caribbean with a standardised template. This study explores data availability in international databases for the quantitative health and health system indicators in the HiT template for the WHO African region. We identified ten databases which contained data for 40 of the 80 original HiT indicators and an additional 23 proxy indicators to fill some gaps. We then assessed data availability for the resulting 63 indicators by country and time, i.e. first/last year of data, years of data available overall and since 2000, and we explored for each indicator (1) against the country with the greatest availability overall and (2) against annual availability for all years since 2000. Overall data availability was greatest in South Africa (93.0% of possible total points) and least in South Sudan (59.5%). Since 2000, Uganda (60.4%) has had the highest data availability and South Sudan (37.2%) the lowest. By topic, data availability was the highest for health financing (91.4%; median start/end date 2000/2019) and background characteristics (88.5%; 1990/2020) and was considerably lower for health system performance (54.5%; 2000/2018) and physical and human resources (44.8%; 2004/2013). Data are available for different years in different countries, and at irregular intervals, complicating time series analysis. No data are available for service provision indicators. Gaps in data in international databases across time, countries, and topics undermine systematic health systems comparisons and assessments, regional health systems strengthening, and efforts to achieve universal health coverage. More efforts are needed to strengthen national data collection and management and integrate national data into international databases to support cross-country assessments, peer learning, and planning. In tandem, more research is needed to understand the specific historical, cultural, administrative, and technological determinants influencing country data availability, as well as the facilitators and barriers of data sharing between countries and international databases, and the potential of new technologies to increase timeliness of data.

Engagement of private healthcare sector in addressing noncommunicable diseases at primary care level in the Eastern Mediterranean Region.

The private healthcare sector is a critical stakeholder in the provision of health care services, including noncommunicable diseases (NCDs), and engagement with the sector is increasingly being advocated in efforts to achieve Universal Health Coverage. This study was conducted to explore the role of the private health sector in delivering NCD-related primary care services in selected countries of the WHO Eastern Mediterranean Region (EMR): Jordan, Oman, Pakistan, Sudan, and the Syrian Arab Republic. We adapted the analytical framework for this study from the "Framework for action to implement the United Nations political declaration on noncommunicable diseases". We conducted a desk review to gather evidence, identify gaps and provide direction for the subsequent stakeholder interviews. Key informant interview respondents were selected using the snowball sampling method. Data from the interviews were analysed using MAXQDA, version 2020. We reviewed 26 documents and interviewed 19 stakeholders in Jordan, Oman, Pakistan, Sudan and the Syrian Arab Republic. Our results indicated increasing advocacy at the regional and national levels to align the private and public health sectors, just as there were efforts to reduce the risk factors for NCDs by implementing tobacco laws, introducing food labelling guidelines, increasing taxes on soft drinks, and promoting the healthy cities approach. NCDs health information systems varied widely among the countries, from being organized and developed to having poor recordkeeping. The private health sector is the predominant provider of care at primary level in most of the EMR countries. Increased collaboration between the public and private sectors is essential for better management of NCDs in the EMR. Governments need to strengthen regulation and defragment the private health sector and harness the sector's strengths as part of efforts to achieve national health targets, NCD goals and Universal Health Coverage.

PANGERAN DIPONEGORO: The Effectiveness Of Achieving 100% UHC In The City Of Semarang Through Public Service Innovation

Health services play an important role in people's lives and are the basic right of every individual. Equal and quality access to health services is crucial for people's welfare. This study aims to analyze the effectiveness of public service innovation in achieving 100% UHC in Semarang City, with a focus on PANGERAN DIPONEGORO’s inspirational contribution, in order to provide insight regarding the implementation of the health insurance program and its impact on UHC. The method used in this research is qualitative using the Double Diamond approach with primary data collection through documentation and innovation supporting literature studies and secondary data collection through literature studies and Focus Group Discussions. The results of the study show that the "PANGERAN DIPONEGORO" innovation succeeded in having a significant positive impact in achieving Universal Health Coverage (UHC) in Semarang City. There has been an increase in community participation, accessibility and quality of health services, as well as a competitive advantage that is rarely possessed by other agencies. There have been many studies using public service objects. However, little has been discussed about the contribution and innovation of public services, especially those that focus on the health sector

Access to maternal health services for Indigenous women in low- and middle-income countries: an updated integrative review of the literature from 2018 to 2023.

Ninety-seven per cent of Indigenous Peoples live in low-and middle-income countries (LMICs). A previous systematic integrative review of articles published between 2000 and 2017 identified numerous barriers for Indigenous women in LMICs in accessing maternal healthcare services. It is timely given the aim of achieving Universal Health Coverage in six years' time, by 2030, to undertake another review. This article updates the previous review exploring the recent available literature on Indigenous women's access to maternal health services in LMICs identifying barriers to services. An integrative review of literature published between 2018 and 2023 was undertaken. This review followed a systematic process using Whittemore and Knafl's five-step framework for integrative reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 944 articles were identified from six databases: Academic Search Premier, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycInfo, CINAHL Plus with Full Text and APA PsycArticles (through EBSCOhost). The search was undertaken on 16 January 2023. After screening of the title/abstract and the full text using inclusion and exclusion criteria 26 articles were identified. Critical appraisal resulted in 24 articles being included in the review. Data were extracted using a matrix informed by Penchansky and Thomas's taxonomy, extended by Saurman, which focused on six dimensions of access to health care: affordability, accessibility, availability, accommodation, acceptability and awareness. Ten studies took place in Asia, 10 studies were from the Americas and four studies took place in the African region. Seventeen articles were qualitative, two were quantitative and five were mixed methods. The methods for the integrative review were prespecified in a protocol, registered at Open Science Framework. Barriers identified included affordability; community awareness of services including poor communication between providers and women; the availability of services, with staff often missing from the facilities; poor quality services, which did not consider the cultural and spiritual needs of Indigenous Peoples; an overreliance on the biomedical model; a lack of facilities to enable appropriate maternal care; services that did not accommodate the everyday needs of women, including work and family responsibilities; lack of understanding of Indigenous cultures from health professionals; and evidence of obstetric violence and mistreatment of Indigenous women. Barriers to Indigenous women's access to maternal health services are underpinned by the social exclusion and marginalisation of Indigenous Peoples. Empowerment of Indigenous women and communities in LMICs is required as well as initiatives to challenge the stigmatisation and marginalisation that they face. The importance of community involvement in design and interventions that support the political and human rights of Indigenous Peoples are required. Limitations of this review include the possibility of missing articles as it was sometimes unclear from the articles whether a particular group was from an Indigenous community. More research on access to services in the postnatal period is still needed, as well as quality quantitative research. There is also a lack of research on Indigenous groups in North Africa, and in sub-Saharan Africa - especially hunter-gatherer groups - as well as the impact of COVID-19 on access to services.

Primary health care preparedness to integrate diabetes care in Blantyre, Malawi: A mixed methods study.

There is limited access to diabetes care services at primary care facilities in Malawi. Assessing the capacity of facilities to provide diabetes care is an initial step to integrating services at primary care. To assess the preparedness for delivering diabetes services at primary care level within the Blantyre District Health Office (DHO) to support the response to NCD epidemic in Malawi. Blantyre DHO primary care facilities. A mixed methods approach nested in a national needs assessment for NCD response in Malawi was used. Fourteen primary healthcare facilities from Blantyre DHO were assessed. A tool adapted from the WHO rapid assessment questionnaire was used to identify human resource, equipment, supplies, and medication needed for comprehensive diabetes care. Descriptive statistics were done to analyze the quantitative data. Fisher's exact test was used to assess if there was a statistically significant difference between urban and rural facilities. Seventeen health care workers from the selected facilities participated in key informant interviews. Framework analysis method guided the qualitative data analysis. The quantitative and qualitative data were merged and displayed jointly. The quantitative assessment showed that none of the facilities assessed had capacity to provide all the interventions recommended by WHO for diabetes care at primary level. Eight (57%) of the facilities had the capacity to diagnose diabetes, monitor glucose, prevent limb amputations and manage hypoglycemia and hyperglycemia. Four themes emerged from the qualitative data: differences in level of preparedness and implementation of diabetes care; disparities in resources between urban and rural facilities; low utilization of diabetes services; and strategy and policy recommendations for improvement of diabetes care. Inadequate health financing resulted in significant disparities in the available resources between the rural and urban facilities to offer diabetes care services. There is need to develop national policies and guidelines for diabetes care to strengthen the capacity of primary care facilities to facilitate achievement of universal health coverage.

"For a man to go to hospital, then that would be his last option": A qualitative study exploring men's experiences, perceptions and healthcare needs in the implementation of Universal Health Coverage in Kenya.

The achievement of Universal Health Coverage (UHC) requires equitable access and utilization of healthcare services across all population groups, including men. However, men often face unique barriers that impede their engagement with health systems which are influenced by a myriad of socio-cultural, economic, and systemic factors. Therefore, understanding men's perspectives and experiences is crucial to identifying barriers and facilitators to their healthcare-seeking behaviour under UHC initiatives. This qualitative study sought to explore men's perceptions, experiences, healthcare needs and potential strategies to inform an impartial implementation of Universal Health Coverage (UHC) in Kenya. The study employed a qualitative research design to investigate men's healthcare experiences in 12 counties across Kenya. Thirty focus group discussions involving 296 male participants were conducted. Men were purposively selected and mobilized through the support of health facility-in-charges, public health officers, and community health extension workers. Data was coded according to emergent views and further categorized thematically into three main domains (1) Perspectives and experiences of healthcare access (2) Socio-cultural beliefs and societal expectations (3) Desires and expectations of health systems. Findings revealed complex sociocultural, economic, and health system factors that influenced men's healthcare experiences and needs which included: masculinity norms and gender roles, financial constraints and perceived unaffordability of services, lack of male-friendly and gender-responsive healthcare services, confidentiality concerns, and limited health literacy and awareness about available UHC services. Our study has revealed a disconnect between men's needs and the current healthcare system. The expectations concerning masculinity further exacerbate the problem and exclude men further hindering men's ability to receive appropriate care. This data provides important considerations for the development of comprehensive and gender-transformative approaches challenging harmful masculine norms, pushing for financial risk protection mechanisms and gender-responsive healthcare delivery attuned to the unique needs and preferences of men.

Socioeconomic characteristics, cancer mortality, and universal health coverage: A global analysis

Achieving universal health coverage (UHC) involves all individuals attaining accessible health interventions at an affordable cost. We examined current patterns and temporal trends of cancer mortality and UHC across sociodemographic index (SDI) settings, and quantified these association. We used data from the Global Burden of Disease Study 2019 and Our World in Data. The UHC effective coverage index was obtained to assess the potential population health gains delivered by health systems. The estimated annual percentage change (EAPC) with a 95% confidence interval (CI) was calculated to quantify the trend of cancer age-standardized mortality rate (ASMR). A generalized linear model was applied to estimate the association between ASMR and UHC. The high (EAPC= -0.9% [95% CI, -1.0%, -0.9%]) and high-middle (-0.9% [-1.0%, -0.8%]) SDI regions had the fastest decline in ASMR (per 100,000) for total cancers from 1990 to 2019. The overall UHC effective coverage index increased by 27.9% in the high-SDI quintile to 62.2% in the low-SDI quintile. A negative association was observed between ASMR for all-cancer (adjusted odds ratio [OR]= 0.87 [0.76, 0.99]), stomach (0.73 [0.56, 0.95]), breast (0.64 [0.52, 0.79]), cervical (0.42 [0.30, 0.60]), lip and oral cavity (0.55 [0.40, 0.75]), and nasopharynx (0.42 [0.26, 0.68]) cancers and high UHC level (the lowest as the reference). Our findings strengthen the evidence base for achieving UHC to improve cancer outcomes. This work is funded by the China National Natural Science Foundation and Chinese Academy of Medical Sciences Innovation Fund for Medical Science.

Regulation and participation of the private sector in the pursuit of universal health coverage: Challenges and strategies for health systems.

This paper focuses on the role of the private sector (including for-profit and non-profit organizations) in achieving Universal Health Coverage (UHC). It examines their involvement in the management, service delivery, resource investment and financing of primary health care (PHC) within the sustainable development goals (SDGs). The study covers a review of health systems, emphasizing the influence of private institutions on public health, and evaluates how private sector experiences contribute to system functions and progress towards UHC. The findings indicate the crucial role of the private sector in global health systems, notably expanded in several countries. Private actors are essential to improve access and coverage, particularly in countries with low health indicators. The article highlights the importance of primary care physicians understanding these dynamics since their management is vital in implementing public policies for UHC.

The Role of Private Practitioners in Bridging the Healthcare Gap and Achieving Universal Health Coverage in India

abstract In a mixed Healthcare System such as India, private practitioners or private sector Health care providers play a significant role in providing health care to the community. This is especially true in settings where public healthcare systems are overburdened and face challenges in providing universal and timely access to medical services. The availability of ample private healthcare options allows patients to receive the medical care they receive where individuals can select the provider that aligns with their preferences, timings and needs and enhance overall patient satisfaction. Although private practitioners have the potential to bridge healthcare gaps, there are also challenges faced by the private healthcare sector. A proper balance and cooperation between the public and private sectors are a must for achieving Universal Health Coverage (UHC). Integrating private practitioners into UHC should be tailored to each country’s context and demand. When private practitioners collaborate with public healthcare, they can collectively bridge gaps, improve general access and improve service quality.

Exploring the inequalities experienced by health and care workforce and their bases - A scoping review protocol.

Planning for investment in human resources for health (HRH) is critical to achieve Universal Health Coverage (UHC) and establish a sustainable health system. Informed planning warrants a better understanding of the health labour market (HLM) to tackle a variety of health and care workforce challenges: from addressing critical supply shortage, to ensuring optimal skills mix and distribution, and addressing motivation and performance challenges. Scant evidence around the overall role of socioeconomic and cultural factors like gender, race, marital status, citizenship (migrant) status, workplace hierarchy etc. in determining workforce composition, deployment, distribution, retention, un- and underemployment, sub-optimal work environments and other factors in the 'HRH crisis' warrants further exploration. This scoping review protocol aims to map and present the available evidence on inequalities experienced by health and care workforce, the socio-economic, cultural and other bases of these inequalities, and their outcomes/ consequences. PubMed, Web of Science, CINAHL and SCOPUS will be used to identify relevant literature. All types of published study designs in English language will be included if they discuss any inequality experienced by any category of health and care workers. Elaborate keyword categories for health and care workers and inequalities context have been developed, tested and reduced to the near-final search string. Eligible articles will be charted using the Joanna Briggs Institute checklist. The sample data extraction chart in JBI manual will be used as a basic skeleton with fields added to it to serve the needs of the scoping review. Descriptive analysis will be performed, depicting basic frequencies. While no further analysis has been advised in the JBI and PRISMA protocol, thematic analysis will be undertaken; following the Braun and Clarke's method with some modification and open coding as suggested by Maquire and Delahunt.

IJCM_262A: Digital Health Boon or Bane: From Community Health Worker’s Perspective in an Aspirational District

Background: Digital health technologies are pivotal for achieving Universal Health Coverage (UHC) and Sustainable Development Goal 3. This study investigates Community Health Workers (CHWs) perspectives on digital health platforms in an aspirational district in India, aligning with the World Health Organization’s emphasis on fostering an enabling environment for digital health adoption. Objectives: To assess CHWs’ current practices and knowledge of digital health applications/platforms and to understand their perceptions regarding the need and use of digital health platforms in the public health system. Methodology: A mixed-methods approach was utilized, involving 95 CHWs in quantitative surveys and 30 CHWs in qualitative interviews and focus group discussions. The study was conducted in Muzaffarpur, Bihar, India’s most populated aspirational district, using stratified random sampling and purposive sampling methods. Results: Findings reveal varied app usage patterns among CHWs, with challenges like non-functional government-provided devices. Qualitative insights highlight the importance of peer support and training quality alongside concerns about device accessibility and app rationalization. Despite government provision of smartphones, CHWs face obstacles in utilizing digital health tools effectively. Conclusion: This research illuminates the availability and utilization of digital health applications among CHWs, emphasizing the need to address challenges and tailor digital tools to enhance healthcare delivery in aspirational districts.

Barriers and facilitators to health insurance enrolment among people working in the informal sector in Morogoro, Tanzania

Background Health insurance is a crucial pathway towards the achievement of universal health coverage. In Tanzania, health-financing reforms are underway to speed up universal health coverage in the informal sector. Despite improved Community Health Fund (iCHF) rollout, iCHF enrolment remains a challenge in the informal sector. This study aimed to explore the perspectives of local women food vendors (LWFV) and Bodaboda (motorcycle taxi) drivers on factors that challenge and facilitate their enrolment in iCHF. Methods A qualitative study was conducted in Morogoro Municipality through in-depth interviews with LWFV (n=24) and Bodaboda drivers (n=26), and two focus group discussions with LWFV (n=8) and Bodaboda drivers (n=8). Theory of planned behaviour (TPB) constructs (attitude, subjective norms, and perceived control) provided a framework for the study and informed a thematic analysis focusing on the barriers and facilitators of iCHF enrolment. Results The views of LWFV and Bodaboda drivers on factors that influence iCHF enrolment converged. Three main barriers emerged: lack of knowledge about the iCHF (attitude); negative views from friends and families (subjective norms); and inability to overcome challenges, such as the quality and range of health services available to iCHF members and iCHF not being accepted at non-government facilities (perceived control). A number of facilitators were identified, including opinions that enrolling to iCHF made good financial sense (attitude), encouragement from already-enrolled friends and relatives (subjective norms) and the belief that enrolment payment is affordable (perceived control). Conclusions Results suggest that positive attitudes supported by perceived control and encouragement from significant others could potentially motivate LWFV and Bodaboda drivers to enroll in iCHF. However, more targeted information about the scheme is needed for individuals in the informal sector. There is also a need to ensure that quality health services are available, including coverage for non-communicable diseases (NCDs), and that non-government facilities accept iCHF.

Factors influencing inequality in government health expenditures within African regional economic communities

BackgroundThe unequal distribution of government health spending within African regional economic groupings is a significant barrier to achieving Universal Health Coverage and reaching health-related Sustainable Development targets. It also hampers the progress toward achieving the African Union’s vision of an integrated and prosperous Africa, free of its heavy disease burden. Based on panel data from 36 countries nested into eight Regional Economic Communities (RECs), this study probes the effects of countries' macro-level factors on government health expenditure disparities within eight regional economic communities from 2000 to 2019.MethodWe use the multilevel linear mixed-effect method to show whether countries' trade gains, life expectancy at birth, poverty, urbanization, information and communication technology, and population aging worsen or reduce the differences for two government health expenditure indicators.ResultsThe insignificant effect of GDP per capita suggests that in most regional economic groupings, the health sector is still not considered a high-priority sector regarding overall government expenditures. Countries' poverty levels and urbanization increase the domestic general government health expenditure disparities as a percentage of general government expenditure within the regional groupings. However, trade gains and ICT diffusion reduce these disparities. Furthermore, the results reveal that external health expenditure per capita and life expectancy at birth positively impact within-regional inequalities in the domestic general government health expenditure per capita. In contrast, GDP per capita and trade gains tend to reduce them.ConclusionsThis study enriches the research on the determinants of government health expenditure inequality in Africa. Policies that can spur growth in trade and ICT access should be encouraged. Countries should also make more efforts to reduce poverty. Governments should also develop policies promoting economic growth and planned urbanization.

Self-care for Health for All - An Utopian Vision or a Pragmatic Plan?

The World Health Organization (WHO) identified the importance of self-care interventions in achieving Universal Health Coverage in 2019. It urges every country to include self-care interventions in their policies and guidelines. To guide the countries in this process, it released guidelines in 2019 and revised them in 2022. However, implementation of new interventions is not a path free of thorns. These guidelines have their own set of strengths and limitations that will differ from country to country.

Implications of absenteeism of health workers on achieving universal health coverage in Nigeria: exploring lived experiences in primary healthcare.

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.

The Role of Supplementary Insurance in Achieving Universal Health Coverage: A Comprehensive Review.

The gradual movement towards universal health coverage (UHC) is an important issue in many countries. The aim of this study is to identify the role of supplementary health insurance in achieving universal coverage. This comprehensive review study was conducted to identify the role of supplementary health insurance in achieving universal health coverage. 4894 articles were found in the search in databases (Scopus, PubMed, and Web Science), and finally42 articles were selected. Considering the criteria of titles and abstracts, the reviewed articles were assessed, and a thematic analysis approach was used to analyze the collected data. The review showed 52 Sub dimensions in 7 dimensions. Policymakers can draw on international experiences to ensure that private health insurance contributes to achieving universal health coverage by Providing clarity within the national health financing policy framework regarding the role of private health insurance. Enhancing understanding of how supplementary health insurance impacts the performance of the healthcare system. They are improving oversight of private health insurance, regulating financial protection and consumer support, and implementing thorough market surveillance and proper allocation of health subsidies between the private and public sectors. Supplementary insurance holds promise as a complementary tool in achieving universal health coverage. Addressing gaps in primary insurance and providing additional financial protection can contribute to enhanced access, improved quality of care, and reduced financial barriers to healthcare services. However, careful attention must be given to affordability, equity, regulation, and coordination with primary insurance schemes to ensure its effective implementation and prevent unintended consequences.

An examination of the structural linkages between households and community health services in realization of accelerated primary healthcare delivery in Kisumu County, Kenya: a systematic review.

The provision of community health services (CHS) is critical in accelerating primary health care delivery to vulnerable and deprived populations. This systematic review study has been conducted to interrogate the interrelationship between households and community health services in accelerating primary healthcare delivery synthesizing the available empirical studies. The findings are to inform a primary research on structural linkages between households and CHS in Kisumu County, Kenya. This study applied a descriptive approach using a systematic review technique to provide context and substance to the two main research questions: (1) how does the interaction between households and CHWs affect utilization of CHS to promote equity and right to health? (2) How do health-seeking behaviours of households influence their decision-making regarding choices of CHS? We screened the literature from Google scholar, JSTOR, SAGE and EBSCO based on our inclusion criteria, resulting in 21 studies. These studies were assessed for quality and eligibility and data extracted based on relevance to the research study. Households place primacy on trust and confidentiality in the interaction with CHWs and this affects uptake of CHS. The social determinants of health are also critical in influencing the health-seeking behaviour of households and individuals and their choice of CHS. The successful models of CHS share the characteristic of community ownership and participation and provides for comprehensive health care teams. CHS are critical for the acceleration of primary health care delivery. It forms an important pathway for the achievement of universal health coverage, which is an outcome required for Sustainable Development Goal 3 on health.