Achieving Universal Health Coverage Research Articles

Strengthening Primary Healthcare in Jordan for Achieving Universal Health Coverage: A Need for Family Health Team Approach.

Achieving Universal Health Coverage (UHC) is a strategic objective of the Jordanian government and has been prioritized in its strategies and plans. However, there are several challenges affecting primary healthcare in Jordan and the health system in general that prevent Jordan from achieving UHC. This paper highlights the importance of team-based care in the form of Family Health Teams (FHTs) to realize Jordan's goal of achieving UHC. FHTs are a team-based approach that brings together diverse professionals to provide a comprehensive, efficient, patient-centered primary care system that meets the changing needs of Jordan's population and refugees. However, the implementation of FHT may encounter obstacles, including individual, organizational, institutional, and external barriers. To overcome such obstacles, several actions and processes need to be taken, including political commitment and leadership, implementing good governance and policy frameworks, allocating resources and funding, multisectoral collaboration, and engagement of communities and stakeholders. The successful implementation of FHTs requires participation from government officials, parliamentarians, civil society, and influential community, religious, and business leaders. A strategic policy framework, effective oversight, coalition building, regulation, attention to system design, and accountability are also essential. In conclusion, adopting the FHT approach in Jordan's Primary Healthcare system offers a promising path towards achieving UHC, improving healthcare access, quality, and efficiency while addressing the unique challenges faced by the country's healthcare system.

The Role of HTA for Essential Health Benefit Package Design in Low or Middle-Income Countries

ABSTRACT This Commentary explores the relationship between Health Technology Assessment (HTA) and Health Benefits Package (HBP) design to achieve Universal Health Coverage (UHC) in low- and middle-income countries. It emphasizes that while HTA evaluates individual healthcare interventions, HBP reform aims to create comprehensive service sets considering overall population health needs and available resources. Challenges in LMICs include limited local data and technical capacity, leading to reliance on cost-effectiveness estimates from other settings. We suggest a practical approach by combining HTA and HBP elements through a hybrid or compartmentalized method. This approach sets differentiated cost-effectiveness thresholds for specific healthcare platforms or programs (e.g., primary care or essential surgery), aligning priority-setting with organizational considerations, ethics, and implementation strategies. Strong institutions and academic support are vital for evidence-informed priority-setting processes. In summary, HTA can play a pivotal role in designing HBPs for UHC in LMICs, and a compartmentalized approach can enhance priority-setting while considering budget constraints and equity.

Anti-malarial and haematological evaluation of the ethanolic, ethyl acetate and aqueous fractions of Chromolaena odorata

Malaria is a global health challenge with endemicity in sub-Saharan Africa, where there are multiple drug-resistant strains and limited access to modern health care facilities, especially in rural areas. Studies indicate that African traditional medicine could make a substantial contribution to the reduction of malaria-related deaths and achievement of universal health coverage (UHC), particularly in these regions. Thus, this study evaluated the curative antimalarial effects of Chromolaena odorata leaf extract using mouse model. Forty-five (45) albino mice weighing between 18 and 22 g were grouped into nine groups of 5 animals each. Animals in groups 2–9 were infected with the chloroquine-resistant strain of Plasmodium berghei, while animals in groups 3–9 were subsequently treated with 10 mg/kg chloroquine, a combination of 1.4 mg/kg artemether and 8.75 mg/kg lumefantrine (Coartem), and varying concentrations of the fraction from the aqueous leaf extract of C. odorata at day 3 post-infection. The findings from this study indicate that treatment with 400 mg/kg of the ethanolic fraction of the crude extract resulted in a significant decrease in parasite load (97.6%), which was comparable to the activities of the conventional drugs chloroquine (98.6%) and Coartem (98.8%). The ethyl acetate and ethanolic fractions at 400 mg/kg also ameliorated the significant alterations in the red blood cells, white blood cells, and platelets of the infected animals. The high antimalarial activity displayed by the ethanolic fraction could be due to the presence of quercetin and kaempferol, as detected by high performance liquid chromatography (HPLC) analysis. The findings suggest that the fractions from C. odorata could serve as an alternative source of malaria therapy, particularly in sub-Saharan Africa.

Utilization of Proximate Healthcare Facilities and Children’s Wait Times in Senegal: An IV-Tobit Analysis

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.

The heterogeneous effects of China's hierarchical medical system reforms on health service utilisation and health outcomes among elderly populations: a longitudinal quasi-experimental study

BackgroundSystem-wide, comprehensive, primary health care (PHC)-oriented health reforms are infrequently introduced in low-income and middle-income countries and often poorly studied. China initiated a large-scale reform in 2015 that included multiple policies: partial gatekeeping, a family physician scheme, and increased system integration. These policies aimed to build a PHC-oriented health system and improve primary care utilisation. This study assessed the heterogeneous effects of the reforms on health service utilisation and health outcomes across regions and over time. MethodsIn this longitudinal quasi-experimental study, we used longitudinal data (2011–18) from a national survey on elderly populations and governmental yearbooks. This study exploits the staggered rollout of the reforms at the city level identified using web-scrapping. We employed an event study design to assess reform effects on (1) visits to PHC facilities, (2) admissions to hospital, (3) out-of-pocket expenditures (OOPEs), and (4) self-reported health. Models were adjusted for city and time fixed effects, along with demographic and socioeconomic characteristics at individual and provincial levels. Analysis was separated into rural and urban populations. Findings18 988 Chinese individuals aged 45 and older (mean age 60·4 years [SD 10·3], 9990 [52·6%] women, 8998 [47·4%] men) were included in the analysis. The reform was associated with increasing odds of visiting PHC facilities among rural populations, which became stronger in the 2 years after the reform (adjusted odd ratio [aOR] 1·35, 95% CI 1·02–1·84, p=0·0374; absolute effect sizes [probability] 3%) before it faded. Meanwhile, urban populations were unaffected (from aOR 1·22, 0·82–1·81 to 0·89, 0·50–1·57). The reform did not have a significant effect on admission to hospital (rural: from 0·97, 0·72–1·31 to 1·47, 0·85–2·55; urban: from 1·00, 0·69–1·43 to 1·59, 0·76–3·30) or OOPEs (rural: from 260·32 Chinese Yuan, 95% CI –6·34 to 526·97, to 693·07 Chinese Yuan, –102·96 to 1489·09; urban: from 235·37 Chinese Yuan, –405·10 to 875·83, to 859·93 Chinese Yuan, –199·02 to 1918·88). Urban populations reported higher self-reported health after the reforms than the year before the reforms (1·50, 1·12–2·01, p=0·0002; 5%). InterpretationSystem-wide PHC-oriented reforms might contribute to short-term increases in primary care utilisation in elderly populations with implications for urban–rural inequalities. Effects on financial protection and health inequality were limited. Efforts in improving the accessibility and quality of primary care in deprived areas are indispensable to addressing the persistent inverse care law and to achieving Universal Health Coverage for all countries. FundingNone.

Implementing Health Policy in Nigeria: The Basic Health Care Provision Fund as a Catalyst for Achieving Universal Health Coverage?

ABSTRACTIn 2014, Nigeria adopted a new law for its healthcare system, which mandated the establishment of a novel health‐financing mechanism, the Basic Health Care Provision Fund (BHCPF). The BHCPF was created to provide sustainable funding with a view to fast‐tracking Universal Health Coverage (UHC) and improving health outcomes in Nigeria. This article places Nigeria's UHC reform process in the broader context of social policy implementation in Africa to illustrate the extent to which interactions between different agents, contextual factors such as Nigeria's federal character, as well as changing conceptualizations of social policy at a global level, shape views on how best to implement UHC. The article is based on the careful examination of three different versions of implementation guidelines for the BHCPF combined with qualitative data collected during fieldwork. It argues that there is a discrepancy between the Nigerian government rhetoric of putting into place a system that improves access to healthcare and the actual practice of implementing UHC via the BHCPF. In reality, a range of controversies surround the ongoing operationalization of the BHCPF, contributing to the perpetuation of a social policy environment that allows poor health outcomes and significant health inequities in Nigeria to persist.

Moving towards social inclusion: Engaging rural voices in priority setting for health.

Achieving universal health coverage (UHC) in the context of limited resources will require prioritising the most vulnerable and ensuring health policies and services are responsive to their needs. One way of addressing this is through the engagement of marginalised voices in the priority setting process. Public engagement approaches that enable group level deliberation as well as individual level preference capturing might be valuable in this regard, but there are limited examples of their practical application, and gaps in understanding their outcomes, especially with rural populations. To address this gap, we implemented a modified priority setting tool (Choosing All Together-CHAT) that enables individuals and groups to make trade-offs to demonstrate the type of health services packages that may be acceptable to a rural population. The paper presents the findings from the individual choices as compared to the group choices, as well as the differences among the individual choices using this tool. Participants worked in groups and as individuals to allocate stickers representing the available budget to different health topics and interventions using the CHAT tool. The allocations were recorded at each stage of the study. We calculated the median and interquartile range across study participants for the topic totals. To examine differences in individual choices, we performed Wilcoxon rank sum tests. The results show that individual interests were mostly aligned with societal ones, and there were no statistically significant differences between the individual and group choices. However, there were some statistically significant differences between individual priorities based on demographic characteristics like age. The study demonstrates that giving individuals greater control and agency in designing health services packages can increase their participation in the priority setting process, align individual and community priorities, and potentially enhance the legitimacy and acceptability of priority setting. Methods that enable group level deliberation and individual level priority setting may be necessary to reconcile plurality. The paper also highlights the importance of capturing the details of public engagement processes and transparently reporting on these details to ensure valuable outcomes. The facilitator of the CHAT groups was a member from the community and underwent training from the research team. The fieldworkers were also from the community and were trained and paid to capture the data. The participants were all members of the rural community- the study represents their priorities.

8.M. Pro/con workshop: Moving towards primary health care-oriented health systems: Insights from the PHC Primer

Abstract Primary health care (PHC) has been the focus of intense global attention over the past few years. It has been acknowledged as having a key role in achieving Universal Health Coverage, in advancing health equity and in enabling health system resilience. PHC as a whole-of-society approach translates the fundamental human right to health, the central role of people in co-creating their health and the responsibility of governments to enable the maintenance and restoration of health for all. The PHC approach aims to maximize the level and distribution of health and well-being through the three PHC components as endorsed in the Astana Declaration: (a) primary care and essential public health functions as the core of integrated health services; (b) multisectoral policy and action; and (c) empowered people and communities. A ‘PHC-oriented health system’ is composed of ‘models of care’ and core ‘health system levers’ that support UHC and access to services that are acceptable and affordable to the population and enhance equity. This session will present the comprehensive PHC approach that is enshrined in the understanding that fragmented approaches focusing on single diseases do not deliver on the goal of improving health for all. It will outline different models of care (MoC) that are reoriented around the values of PHC, namely solidarity, community empowerment and equity and show how different MoC components can operationalise the PHC principles. This session will further outline how countries implement the PHC approach across the WHO European region and highlight their trajectories. In particular, it will demonstrate Slovenia's experience in its transition towards comprehensive, integrated, people-centred PHC. More specifically, the session aims to: • summarize the evidence-informed contemporary theoretical and political rationale for PHC to guide its implementation in the 21st century, • cultivate a common understanding of the concept, with a focus on developments in the global and public health arena in the last 20 years, • provide a grounding in a thorough conceptual and practical comprehension of the possibilities and challenges of PHC to advance its implementation. This workshop presents results from a global publication on primary health care, the PHC Primer, that is jointly produced by the World Health Organization and the European Observatory on Health Systems and Policies. The PHC Primer collects latest evidence on primary health care and current approaches and developments adopted by countries to transform health systems towards more person-centred, holistic systems. Key messages • The development of strong PHC-oriented health systems requires a multi-pronged approach and policies in all operational levers. • PHC oriented model of care should extend beyond integrated health services to facilitate engagement with communities and multisectoral action. Speakers/Panelists Luke Allen LSHTM, London, UK Erica Barbazza University of Amsterdam, Amsterdam, Netherlands Toni Dedeu WHO European Centre for Primary Health Care, Almaty, Kazakhstan Pia Vracko NIJZ, Ljubljana, Slovenia

Enhancing global health accountability through results-oriented monitoring: EC/WHO collaboration

Abstract Issue Governments and organizations must demonstrate accountability and delivery of results. Results-Oriented Monitoring is a European Commission mechanism to enhance internal control and management. The Health System Strengthening for Universal Health Coverage program - the largest Commission grant to the World Health Organization - provides support towards achieving Universal Health Coverage through policy dialogue in 119 countries. Description We employ a Results-Oriented Monitoring review of the program conducted in October 2021- April 2022 as a case study to examine the question: what is the value of the Commission's Results-Oriented Monitoring system as a tool to enhance accountability of large Global Health interventions?. We conducted 87 face-to-face/remote interviews to engage stakeholders in assessing specific criteria such as relevance, efficiency, effectiveness, sustainability and human rights, in 12 purposively selected countries including Timor Leste, Colombia, the Democratic Republic of Congo, Zambia, Burkina Faso, Nigeria, Uzbekistan, the Philippines, Mongolia, Egypt, Jordan and Morocco. Results The Health System Strengthening for Universal Health Coverage program is a relevant intervention that responds to the needs of target groups because it is demand driven, flexible, and well-integrated within national health plans/regional frameworks. The absence of robust Monitoring and Evaluation frameworks for Universal Health Coverage at country level is a missed opportunity to pull the case for continued investment in health systems strengthening. Co-developing country level monitoring and evaluation frameworks could enhance multi-stakeholder policy dialogues anchored in the Universal Health Coverage concept. Lessons Our innovative adaptation of Results-Oriented Monitoring approaches to assess a large Global Health intervention (+100 countries) provided critical data to inform program implementation and fostered consensus building over subsequent steps. Key messages • The European commission’s results-oriented monitoring system is a valuable instrument to assess large scale global health interventions. • Co-developing monitoring and evaluation frameworks at country level could serve as a tool to facilitate multi-stakeholder policy dialogues and to track progress towards universal health coverage.

Behavioural Sciences for Better Health: WHO Resolution and Action Framework

Abstract Behavioural factors are important contributors to increasing trends in communicable and non-communicable diseases and their risk factors, injuries, and health emergency risks as well as other health challenges that pose a significant challenge to health systems and increase disease burden globally. The World Health Organization (WHO) has recommended the adoption of a Resolution on Behavioural Sciences for Better Health to the Seventy-sixth World Health Assembly #WHA76, held in Geneva, Switzerland on 21-30 May 2023. Brief summary of the resolution The resolution recognizes that behavioural science is a multidisciplinary scientific approach that deals with human action, its psychological, social, and environmental drivers, determinants and influencing factors. It acknowledges the contribution of behavioural science in achieving improved health outcomes and the value of high-quality data about behaviours in guiding the health sector. It also recognizes that no single discipline can provide a complete understanding of how to support individuals to enact healthier behaviours to achieve improved health outcomes. The resolution notes that behavioural science can facilitate the understanding of how behavioural influences and communications guide decision-making. It highlights the contribution of behavioural science in achieving Universal Health Coverage (UHC) and in strengthening prevention of, preparedness, and response to public health emergencies. It also recognizes the importance of building capacity to systematically adopt evidence, including evidence from behavioural science and implementation studies. Finally, it urges member states to mainstream behavioural science approaches in health policies and to advocate for necessary structural considerations including behavioural science teams, units or functions, and for the allocation of sufficient funding and human resources.

The Impact of the Pharmaceutical Ecosystem in Achieving Universal Health Coverage in Sub-Saharan Africa

Background: The purpose of universal health coverage (UHC) is to provide equitable access to health services to people without financial hardship. Nevertheless, despite the diverse measures in place to accomplish this goal, there are still obstacles including access to affordable essential medicines. Specifically, low and middle-income regions like Sub-Saharan Africa and South Asian countries are the most affected due to regional disparities in achieving UHC. Citizens in financially vulnerable positions in these nations rely on their governments to provide essential medicines at little or no cost. However, government health systems are plagued with the unavailability of necessary medicines and services, forcing citizens to resort to more expensive private options and placing them at greater financial risk. The pharmaceutical ecosystem is responsible for the research, development, manufacturing, distribution, regulation, and safe use of these medicines. This study reviewed the impact of the pharmaceutical ecosystem in achieving universal health coverage in Sub-Saharan Africa. Method: A narrative review of published peer-reviewed articles and grey literature was executed to examine how the pharmaceutical ecosystems have impacted universal access to the use of medicines thus achieving universal health coverage. Conclusion: The pharmaceutical ecosystem sector is complex and crucial in achieving Universal Health Coverage as it directly affects the accessibility of safe, effective, and affordable essential medicines. Pharmacists are the major drivers of this ecosystem and should build their capacity in this area for positive results to be achieved in improving access to medicines and reducing the global disease burden. In Sub-Saharan Africa, due to the lack of government structures and enforcement, sectors of this ecosystem operate sub-optimally, and players and actors have taken advantage of its weaknesses and disorganization. Therefore, further research is imperative to identify ways to progress and improve the pharmaceutical ecosystem.

The Barriers to Universal Health Coverage in India and the Strategies to Address Them: A Key Informant Study.

India has adopted several policies toward improving access to healthcare and has been an enthusiastic signatory to several global health policies to achieve Universal Health Coverage (UHC). However, despite these policy commitments, there has been limited success in realizing these goals. The COVID-19 pandemic has highlighted the urgent need for health system re-design and amplified the calls for such reforms. We seek to understand the views of a diverse group of policy actors in India to address the following research questions: what are the (i) conceptualizations of UHC, (ii) main barriers to realizing UHC, and (iii) policy strategies to address these barriers. We collected data through in-depth interviews with 38 policy actors from diverse backgrounds and analyzed using the Framework Method to develop themes both inductively and deductively using the Control Knob Framework of health systems. There was congruence in the conceptualization of UHC by policy actors. Quality of care, equity, financial risk protection, and a comprehensive set of services were the most commonly cited features. The lack of a comprehensive systems approach to health policies, inadequate and inefficient health financing mechanisms, and fragmentation between public and private sectors were identified as the main barriers to UHC. Contrasting views about specific strategies, health financing, provider payments, organization of the delivery system, and regulation emerged as the key policy interventions to address these barriers. This is the first systematic examination of a diverse set of policy actors' problem analyses and suggestions to advance UHC goals in India. The study underscores the need to recognize the complex and interlinked nature of health system reforms and initiate a departure from path-dependent vertical interventions to bring about transformative change.

Challenges and Strategies for Enhancing eHealth Capacity Building Programs in African Nations.

eHealth applications play a crucial role in achieving Universal Health Coverage. (1) Background: To ensure successful integration and use, particularly in developing and low/middle-income countries (LMIC), it is vital to have skilled healthcare personnel. The purpose of this study was to describe challenges that hinder capacity-building initiatives among healthcare personnel in developing and LMIC and suggest interventions to mitigate them. (2) Methods: Adopted a descriptive research design and gathered empirical data through an online survey from 37 organizations. (3) Results: The study found that in developing and LMIC, policymakers and eHealth specialists face numerous obstacles integrating and using eHealth including limited training opportunities. These obstacles include insufficient funds, inadequate infrastructure, poor leadership, and governance, which are specific to each context. The study suggests implementing continuous in-service training, computer-based systems, and academic modules to address these challenges. Additionally, the importance of having solid and appropriate eHealth policies and committed leaders were emphasized. (4) Conclusions: These findings are consistent with previous research and highlight the need for practical interventions to enhance eHealth capacity-building in LMICs. However, it should be noted that the data was collected only from BETTEReHEALTH partners. Therefore, the results only represent their respective organizations and cannot be generalized to the larger population.

Strengthening the Healthcare Workforce for Universal Health Coverage in Nigeria: Lessons and Strategies

Background: Achieving Universal Health Coverage (UHC) is a global imperative to ensure equitable access to quality healthcare services for all individuals. A pivotal factor in this endeavor is the strength and capacity of the healthcare workforce. This paper examines the intersection of a robust healthcare workforce and the goals of UHC, with a specific focus on the Nigerian context.
 Methods: The paper delves into the strengths and weaknesses of the Nigerian healthcare workforce, analyzing factors such as diversity, distribution, skill utilization, and the prevailing challenges. Insights from global approaches in the paper highlight innovative strategies, including workforce training, collaborative delivery models, and workforce motivation to enhance healthcare accessibility and quality.
 Results: The paper addresses contextual nuances such as cultural diversity, geographic challenges, and socioeconomic disparities that shape the Nigerian healthcare landscape. The relevance of tailored solutions that accommodate these nuances is emphasized. The paper underscores the potential impact of a strengthened healthcare workforce on achieving UHC, reducing health disparities, and improving overall health outcomes.
 Conclusion: The paper offers policy recommendations tailored to Nigeria's unique circumstances. The conclusion highlights the significance of continual monitoring, research, and evaluation of workforce-centric interventions for sustained progress towards UHC. The findings contribute to the broader discourse on health equity, offering insights into how a capable healthcare workforce can drive transformative change and pave the way for comprehensive healthcare coverage in Nigeria.

A Study on the Attitude and Perception of Bachelor of Medicine and Bachelor of Surgery (MBBS) Students Regarding Post-MBBS Compulsory Service Bond in Uttar Pradesh, India.

Background To increase the availability of doctors in the public healthcare delivery system, the state government of Uttar Pradesh, India, has implemented a two-year compulsory service bond since 2018. Students of the 2018 batch are going to complete their Bachelor of Medicine, Bachelor of Surgery (MBBS) in 2023 and are supposed to serve through this bond. There are many dilemmas in the minds of medical students regarding their compulsory service bond. Hence, there is a need to know their attitude and perceptions regarding the compulsory service bond. This study was conducted to assess the attitude and perception of undergraduate medical students toward compulsory service bonds. Methods This was a mixed-method study conducted in July-September 2022 among undergraduate medical students at Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India. For quantitative data, a structured questionnaire was developed using Google Forms (Google LLC, Mountain View, California, United States) and circulated via WhatsApp (Meta Platforms, Inc., Menlo Park, California, United States) through the random sampling method. Focused group discussions were carried out to collect the qualitative data. Result Regarding the compulsory service bond after MBBS, 100 (31.8%) medical students were found to be interested and 56 (17.8%) were disinterested. The majority (n=158; 50.4%) of participants were neutral, while 278 (88.6%) medical students perceived it as an opportunity to help poor people. Higher possibilities of social recognition and respectwere some noticeable perceptions of 243 (77.4%) MBBS students. Lack of confidenceto tackle serious cases without a senior doctor's supervision was perceived as an important hurdle by 286 (91%) participants. Non-availability of advanced medical facilities, issues like the safety of doctors, and the lack of availability of electricity, roads, and infrastructure were also perceived as hurdles. Conclusions and recommendations Students perceived thecompulsory service bond as an opportunity if met with certain conditions like a transparent method of posting and basic facilities or an incentive for accommodation and transportation. The compulsory service bond for addressing the shortfall of doctors in the public healthcare delivery system may be more effective if these hurdles are corrected and certain opportunities are met, as mentioned in the present study. This will help the government move smoothly towards achieving Universal Health Coverage (UHC).

Social Health Insurance a Key for Universal Health Coverage in Nepal

Social health insurance, which offers financial security and risk sharing for health care expenses, could be the key to achieving Universal Health Coverage (UHC) in Nepal. The social health insurance program in Nepal has advanced significantly, but many adjustments in the insurance mechanism are needed to make it truly a key to UHC.

International cooperation for nursing human resource development in Lao PDR: Investing in nursing leadership.

Strengthening nursing leadership in health systems has been identified as a priority for achieving Universal Health Coverage (UHC). We aimed to analyse the characteristics of Japanese technical assistance projects for nursing human resource development in Lao People's Democratic Republic (Lao PDR) and suggest directions for future assistance. An upgrading program, as part of human resource development, was initiated in the 1990s; it has contributed to the development of nursing leaders. Moreover, technical assistance from development partners has had synergistic effects by consistently promoting the involvement of nursing leaders in administration, education, and clinical practice to establish a functional regulatory system. In resource-limited settings, the application of both edge-pulling (leadership development) and bottom-up (quality improvement of the mass population) strategies are required. From a long-term perspective, development partners should continue to invest in increasing the number and quality of nursing leaders by upgrading the courses and leadership training programs, starting from the younger generation.

Առողջապահության ոլորտում վճարման մեթոդների տիպաբանությունը՝ որպես բժշկական ծառայությունների գների վրա ազդող գործոն / Provider payment methods typology in the health care sector as a factor influencing the cost of medical services

Achieving universal health coverage implies that all countries strive to expand or ensure coverage, coping with technological advances, aging populations, and growing expectations for quality medical care. The increase in healthcare costs is putting pressure on politicians. Governments often turn to the private sector to ensure sustainability, optimal use of resources, and expanding the choice of medical care. At the same time, the persons responsible for policy development are faced with the problem of providing resources and increasing efficiency, solving the problems of market failure and equity related to private financing of health care. In the conditions of growth of health care costs, not only the volume of reimbursed services, but also the approaches and terms of payment to medical service providers are becoming more and more important. For this purpose, many countries are introducing new approaches to financing, organizing and providing medical care. Understanding pricing methods becomes even more important as systems change rapidly with increased resource consumption and patient needs. In order to bring payments in line with costs, countries change the payment methods of service providers, moving from payments provided by the budget to payment methods for services, per day, on the diagnosis based groups, etc.

Health Financing Options for Sri Lanka: What, and Why?

The purpose of this paper is to renew and stimulate the national discourse on how to further Sri Lanka's aspirational goal of achieving Universal Health Coverage (UHC [1]) in line with the global sustainable development goals (SDG) to which Sri Lanka is a signatory. After a brief status update about UHC in Sri Lanka, the paper focuses on the financing function, justified on the basis of its central role in addressing the problems confronting the health system, in terms of its inherent inefficiencies as well as the specific context of the economic crisis which the country is currently facing. The paper argues for a well-managed prepaid, pooled health financing mechanism (such as the current tax-based system or social health insurance schemes), incorporating strategic purchasing approaches, leveraging the private sector (both for-profit and non-profit), in order to increase efficiency, equity and accountability by separating the financing and purchasing functions from service delivery.

Health financing options for Sri Lanka

The purpose of this paper is to renew and stimulate the national discourse on how to further Sri Lanka’s aspirational goal of achieving Universal Health Coverage(UHC [1]) in line with the global sustainable development goals (SDG) to which Sri Lanka is a signatory. After a brief status update about UHC in Sri Lanka, the paper focuses on the financing function, justified on the basis of its central role in addressing the problems confronting the health system, in terms of its inherent inefficiencies as well as the specific context of the economic crisis which the country is currently facing. The paper argues for a well-managed prepaid, pooled health financing mechanism (such as the current tax-based system or social health insurance schemes), incorporating strategic purchasing approaches, leveraging the private sector (both for-profit and non-profit), in order to increase efficiency, equity and accountability by separating the financing and purchasing functions from service delivery.