Achieving Universal Health Coverage Research Articles

Do private health providers help achieve Universal Health Coverage? A scoping review ofthe evidence from low-income countries.

Universal Health Coverage (UHC) is the dominant paradigm in health systems research, positing that everyone should have access to a range of affordable health services. Although private providers are an integral part of world health systems, their contribution to achieving UHC is unclear, particularly in low-income countries (LICs). We scoped the literature to map out the evidence on private providers' contribution to UHC progress in LICs. Literature searches of PubMed, Scopus and Web of Science were conducted in 2022. A total of 1049 documents published between 2002 and 2022 were screened for eligibility using predefined inclusion criteria, focusing on formal as well as informal private health sectors in 27 LICs. Primary qualitative, quantitative and mixed-methods evidence was included, as well as original analysis of secondary data. The Joanna Briggs Institute's critical appraisal tool was used to assess the quality of the studies. Relevant evidence was extracted and analysed using an adapted UHC framework. We identified 34 papers documenting how most basic health care services are already provided through the private sector in countries such as Uganda, Afghanistan and Somalia. A substantial proportion of primary care, mother, child and malaria services are available through non-public providers across all 27 LICs. Evidence exists that while formal private providers mostly operate in well-served urban settings, informal and not-for-profit ones cater for underserved rural and urban areas. Nonetheless, there is evidence that the quality of the services by informal providers is suboptimal. A few studies suggested that the private sector fails to advance financial protection against ill-health, as costs are higher than in public facilities and services are paid out of pocket. We conclude that despite their shortcomings, working with informal private providers to increase quality and financing of their services may be key to realizing UHC in LICs.

Peranan Program Jaminan Kesehatan Nasional (JKN) Dalam Mendorong Sustainable Development Goals (SDGs) di Indonesia

The National Health Insurance has received great attention in the Sustainable Development Goals, where one of the main targets is to guarantee a healthy life and promote welfare for all people at all ages or later called Universal Health Coverage (UHC). The National Health Insurance is a social security program based on Law Number 40 of 2004 which aims to provide comprehensive health insurance coverage for every Indonesian so that Indonesians can live healthy, productive and prosperous lives. Whereas Universal Health Coverage is a health system that ensures that every citizen in the population has equitable access to quality promotive, preventive, curative and rehabilitative health services at affordable costs. In this study, in its implementation, there was an increase in the Community Health Development Index which was marked by an increase in health service efforts with cross-sector, central and regional synergy towards achieving Universal Health Coverage. The problem found in this study is that there are still many problems found regarding mothers, babies and toddlers. The nutritional status of the people who have a double burden, as well as problems regarding the quality and access to basic and referral health services which include fulfilling the conditions and facilities for basic and referral health services, fulfilling the availability of facilities and infrastructure for health service facilities both medical and non-medical, and not yet covering guarantee services national health as a whole. The purpose of this study was to find out the planning for the implementation of the National Health Insurance (JKN) program in Encouraging Sustainable Development Goals (SDGs) in Indonesia, especially in Medan City. This research is a descriptive qualitative research. The process of monitoring and evaluating the implementation of activities is carried out according to their duties and functions and in accordance with the procedures and provisions of the 1945 Constitution, Law Number 40 of 2004 concerning the National Social Security System
 Keywords: Role, National Health Insurance, SDGs

Using the integration of human resource management strategies at district level to improve workforce performance: analysis of workplan designs in three African countries

BackgroundThere is a worldwide shortage of health workers against WHO recommended staffing levels to achieve Universal Health Coverage. To improve the performance of the existing health workforce a set of integrated human resources (HR) strategies are needed to address the root causes of these shortages. The PERFORM2Scale project uses an action research approach to support district level management teams to develop appropriate workplans to address service delivery and workforce-related problems using a set of integrated human resources strategies. This paper provides evidence of the feasibility of supporting managers at district level to design appropriate integrated workplans to address these problems.MethodsThe study used content analysis of documents including problem trees and 43 workplans developed by 28 district health management teams (DHMT) across three countries between 2018 and 2021 to identify how appropriate basic planning principles and the use of integrated human resource and health systems strategies were used in the design of the workplans developed. Four categories of HR strategies were used for the analysis (availability, direction, competencies, rewards and sanctions) and the relationship between HR and wider health systems strategies was also examined.ResultsAbout half (49%) of the DHMTs selected service-delivery problems while others selected workforce performance (46%) or general management (5%) problems, yet all workplans addressed health workforce-related causes through integrated workplans. Most DHMTs used a combination of strategies for improving direction and competencies. The use of strategies to improve availability and the use of rewards and sanctions was more common amongst DHMTs in Ghana; this may be related to availability of decision-space in these areas. Other planning considerations such as link between problem and strategy, inclusion of gender and use of indicators were evident in the design of the workplans.ConclusionsThe study has demonstrated that, with appropriate support using an action research approach, DHMTs are able to design workplans which include integrated HR strategies. This process will help districts to address workforce and other service delivery problems as well as improving ‘health workforce literacy' of DHMT members which will benefit the country more broadly if and when any of the team members is promoted.

Strategy to Optimize Access to Health Service Financing for the Poor through the UHC Program in Bondowoso Regency

This study aims to determine the Bondowoso district government's strategy for optimizing health service financing for low-income people in the Bondowoso district.
 The method used in compiling this paper is a qualitative descriptive approach using direct field observations, interviews with related parties, and supporting documents, focusing on strategic efforts to achieve Universal Health Coverage (UHC) in Bondowoso Regency as part of accelerating the achievement of the Sustainable Development Goals. or the Sustainable Development Goals (SDGs), as well as an effort to ensure the fulfillment of citizens' rights to health, especially people with low incomes.
 The sustainable synergy of implementing the UHC program in Bondowoso district is inseparable from the close ties of communication and collaboration across related sectors, namely, among others, the Bondowoso District Health Office as executor in administration and also as supervisor, Bondowoso Regency Government through the Regional Development Planning Agency as well as the Regional Finance and Asset Management Agency in terms of budget, BPJS Health in terms of management of claims and premium contributions and cooperation with First Level Health Facilities and Referral/Advanced Level Facilities as a provider of public health services, the Social Service and the Tape Manis Post as parties that recommend targets who can receive the Health insurance program and the Population and Civil Registration Office in terms of synchronizing population data.
 In the implementation of the UHC Program in Bondowoso district, there are still several obstacles in terms of technical performance related to updating and synchronizing population data, human resources, technical financing, and supporting infrastructure so that the Government of Bondowoso Regency continues to evaluate and make improvements in terms of technical implementation and policies related to the performance of the UHC program, to optimize the achievement of UHC.

Pandemic preparedness with 20/20 vision: Applying an intersectional equity lens to health workforce planning.

Human resource for health (HRH) is considered critical for achieving Universal Health Coverage, and the crisis surrounding HRH is now established as a global emergency. Their vital role has been central in the pandemic response. Yet, the discussions and deliberations on the recent pandemic treaty circumscribe HRH discussions to their capacities and protection, and address discrimination mainly in relation to gender. While this paper endorses the case for prioritisation of HRH in global pandemic preparedness planning, it re-frames the HRH crisis in relation to the institutional and structural factors driving HRH shortage, maldistribution and skills-needs misalignment. We critique the supply-and-demand framing of HRH crisis as one that obliviates the systematic inequalities within health systems that underpin health workforce motivations, distribution, satisfaction and performance. We propose an intersectional equity lens to redefine the HRH challenges, understand their underlying drivers and accordingly integrate in the global pandemic preparedness plans.

Reimagining Health Systems for Healthier Lives and Social Justice: New Social Contract Through Abia State Health Insurance Scheme to Achieve Universal Health Coverage in Nigeria.

Reimagining Health Systems for Healthier Lives and Social Justice: New Social Contract Through Abia State Health Insurance Scheme to Achieve Universal Health Coverage in Nigeria.

Health outcomes of the G7 Hiroshima Summit: breaking the cycle of panic and neglect and achieving UHC

Health outcomes of the G7 Hiroshima Summit: breaking the cycle of panic and neglect and achieving UHC

Inclusive innovation: World health organization (WHO) task-shifting principles in community health workers living with disabilities through women’s cancer screening in the EMPOWER Program.

e22512 Background: The W.H.O estimates that people with disabilities make up 15% of the world’s population. In the Horn of Africa (Djibouti, Kenya, Ethiopia & Uganda) there have been several disability inclusion programs in Education, livelihoods and empowerment through the Development Response to Displacement Impacts Project (DRDIP). In Kenya, the Government has continued to leverage on the private sector to accelerate progress towards inclusion. A strategic partnership with Safaricom enabled provision of Assistive devices and medical cover exceptional approval to a tune of USD 223,000 to Persons with Disabilities in the formal and informal economy in Kenya. Women CHVs were selected to reduce cultural barriers because many women in the communities are more comfortable being screened by a fellow woman. Objectives: To identify and deploy women living with disabilities as community health volunteers in the county EMPOWER Clinics; To build capacity of women living with disabilities and enable them to accurately screen for breast and cervical cancer. Methods: A total of 25 women living with disabilities and 7 able-bodied women from Meru and Kisumu counties were selected for the training program through county disability coordinators. The training program consisted of a basic community health volunteer (CHV) module and focused on Breast and cervical cancer awareness topics. The CHVs were equipped with mobile phones with assistive technology (AT) features such as braille keyboards, magnifiers, and text-to-speech technology. The training was delivered through Amref Health Innovations' (AHI) LEAP platform in collaboration with 5 county community health assistants. The CHVs' understanding of the material was evaluated through performance tracking on the LEAP platform. The CHVs were also given regular feedback on their progress, and any areas of difficulty were addressed through additional support and guidance. Results: The trained CHVs demonstrated an increased understanding of breast and cervical cancer screening, as well as the skills necessary to perform medical tactile breast exams. The trained CHVs were then commissioned to be integrated into the community health workforce, with a focus on breast and cervical cancer screening and awareness. Conclusions: The deployment of inclusion-centered learning for women Community Health Volunteers (CHVs) living with disabilities is a promising approach for improving access to health services for this marginalized group. This program provides a model for promoting disability inclusion in health services and underscores the need for continued investment in disability-inclusive programs. The findings of this program can inform the development of similar programs in other regions and contribute to the achievement of universal health coverage and health for all.

The Potentials of Big Data in Achieving Universal Health Coverage in Iran

Big data refers to large and complex data sets that cannot be easily processed, managed, or analyzed using traditional data processing tools and techniques. The role of big data in health encompasses a wide range of applications that leverage large and complex data sets to improve health outcomes and healthcare delivery. The goal of universal health coverage (UHC) is to ensure that everyone has access to the health services they need when and where they need them, without financial barriers or catastrophic health expenditures that can lead to poverty. Big data in Iran’s health system has the potential to significantly improve healthcare delivery, enhance patient outcomes, and reduce healthcare costs. Moreover, big data can assist in ongoing monitoring and evaluating the progress toward achieving UHC goals in Iran.

Peran Puskesmas Untuk Mencapai Universal Health Coverage di Indonesia: Literature Review

Universal Health Coverage (UHC) is a health insurance system where every citizen has access to health services, both promotive, preventive, curative, rehabilitative, and palliative. Universal Health Coverage (UHC) not only provides protection for health services, but also provides financial protection to the community. Puskesmas is an effort to realize this, which provides health services with the main program of mandatory health efforts. However, health services at puskesmas still require a lot of leverage in achieving Universal Health Coverage (UHC). The purpose of this study is to analyze the role of puskesmas to achieve Universal Health Coverage (UHC). This research uses the Literature Review literature study method with Search engines used in literature searches, namely Google Scholar and journal databases such as Researchgate with the keywords Indonesia, Puskesmas, Universal Health Coverage (UHC). The criteria for articles used were based on publications published between 2019 and 2023. The results showed that the health service efforts of puskesmas in Indonesia still have to be improved to realize quality services in order to realize universal health coverage (UHC). Efforts to increase community empowerment are carried out through community empowerment in the independence of healthy living, maintaining, and improving health status. The conclusion of this study shows that improving services at puskesmas continues to be carried out through several capacity building, infrastructure and system improvements or updates as well as several programs with preventive, promotive, and community empowerment to achieve Universal Health Coverage (UHC).

From idea to systems solution: enhancing access to primary care in Malawi

Malawi, like many other countries, faces challenges in providing accessible, affordable, and quality health services to all people. The Malawian policy framework recognizes the value of communities and citizens, as co-creators of health and leaders of localized and innovative initiatives, such as social innovations.Social innovations involve and include communities and citizens, as well as bring about changes in the institutions responsible for care delivery. In this article, we describe the institutionalization process of a citizen-initiated primary care social innovation, named Chipatala Cha Pa Foni, focused on extending access to health information and appropriate service-seeking behavior.An interdisciplinary multi-method qualitative case study design was adopted, drawing on data collected from key informant interviews, observations, and documents over an 18-month period. A composite social innovation framework, informed by institutional theory and positive organizational scholarship, guided the thematic content analysis. Institutional-level changes were analyzed in five key dimensions as well as the role of actors, operating as institutional entrepreneurs, in this process.A subset of actors matched the definition of operating as Institutional Entrepreneurs. They worked in close collaboration to bring about changes in five institutional dimensions: roles, resource flows, authority flows, social identities and meanings. We highlight the changing role of nurses; redistribution and decentralization of health information; shared decision-making, and greater integration of different technical service areas.From this study, the social innovation brought about key institutional and socio-cultural changes in the Malawi health system. These changes supported strengthening the system’s integrity for achieving Universal Health Coverage by unlocking and cultivating dormant human-based resources. As a fully institutionalized social innovation, Chipatala Cha Pa Foni has enhanced access to primary care and especially as part of the Covid-19 response.

The notion of access to health care in a large-scale social health protection initiative: a case study of ‘Sehat Sahulat Programme’ at Khyber Pakhtunkhwa, Pakistan

Background Sehat Sahulat Programme (SSP), a health insurance initiative, was launched by the Government of Khyber Pakhtunkhwa (GoKP) in Pakistan to improve access to quality health services. In this paper, we describe the notion of access under SSP, present stakeholders’ views on access-related challenges, and suggest ways forward to realise SSP’s access-related objective in the broader context of its contribution towards Pakistan’s drive to achieve Universal Health Coverage (UHC). Methods We employed a case study design approach using three data sources. We used official GoKP programme documents to capture the chronology of events (policy interventions), in-depth interviews to explore the drivers behind the events and non-participant observations to understand the decision-making and implementation processes. We employed maximum variation sampling. Access to documents and observation sites was gained through the SSP director. We recruited interviewees through direct and indirect approaches and conducted thematic analysis. Findings GoKP engaged the State Life Insurance Corporation (SLIC) of Pakistan as a purchaser. SLIC purchased services from public and private hospitals for SSP patients, up to 600,000 Pakistani Rupees (PKR) per family per year. Considering this insurance coverage, GoKP officials claimed SSP made health care accessible, which the development partners contested. Instead of the narrow finance-centric definition by GoKP, the development partners highlighted the broader dimensions of access, including the services’ acceptability and availability. Tensions existed between the interpretation of the stakeholders on different dimensions of access. For instance, GoKP and SLIC claimed that including private hospitals in SSP improved services’ availability, but development partners noted an under-supply of private providers in remote districts of the province. Bridging such an undersupply, SLIC made inter-district referrals, which the patient advocates noted led to travel costs and geographical barriers. Similarly, GoKP officials claimed SSP had good acceptability. The providers noted that SSP’s acceptability was damaged by limited patient choice, low package rates, and delayed claims payments. Conclusions This analysis suggests that SSP had challenges with the acceptability and geographical dimensions of access which GoKP needed to address. A key transferrable lesson is that demand-side intervention (insurance) might not improve access with a weak supply side. Therefore, countries contemplating improving access to services enroute to achieving UHC need to address both supply and demand-side considerations.

Review on the Reflection of National Health Financing Policy and Strategy on Nigerians towards Achieving Universal Health Coverage by 2030

Labour pain management is crucial for a comfortable childbirth experience. A range of options, including epidural anesthesia, breathing techniques, massage and positional changes, are available for managing labour pain. Factors such as maternal preference, stage of labour and medical conditions are considered when choosing the right approach. Effective labour pain management benefits both the mother and baby. This systematic review is aimed to identify best practices and gaps in managing labour pain and to provide recommendations for a comprehensive and effective capacity building program. The review analyzed relevant literature and data sources to assess the current state of midwifery education and practice in labour pain management. The results of the review indicate a need for a comprehensive and multi-faceted capacity building program that includes hands-on training, mentorship, and ongoing professional development opportunities for midwives. The study concludes that a well-designed and well-implemented capacity building program on labour pain management can improve the quality of care for mothers and newborns and enhance the competencies of midwives in Ekiti State.

Meeting the UN Sustainable Development Goals for mental health: why greater prioritization and adequately tracking progress are critical.

Meeting the UN Sustainable Development Goals for mental health: why greater prioritization and adequately tracking progress are critical.

Roles of Social Protection to Promote Health Service Coverage among Vulnerable People toward Achieving Universal Health Coverage: A Literature Review of International Organizations.

A wider range of social protection services, including social insurance and social assistance, are gaining global attention as a key driver of improved health service coverage and financial protection among vulnerable populations. However, only a few studies have investigated the associations between social protection and universal health coverage (UHC). Therefore, we conducted a literature review on relevant international organizations with respect to this topic. We found that many international organizations consider the wide range of social protection services, including social insurance and social assistance, essential for achieving UHC in 2030. In specific health programs, social protection is considered an important service to promote health service access and financial protection, especially among vulnerable populations. However, discussions about social protection for achieving UHC are not given high priority in the World Health Organization. Currently, the coverage of social protection services is low among vulnerable populations in low- and middle-income countries. To address this issue, we employed the metrics recommended by the migrant integration policy index (MIPEX). Based on our findings, a conceptual framework was developed. We expect this framework to lead synergy between social protection and health systems around the globe, resulting in healthy ageing.

Unmet chronic care needs and insufficient nurse staffing to achieve universal health coverage in China: Analysis of the Global Burden of Disease Study 2019

BackgroundAlthough China has made impressive progress towards Universal Health Coverage through the health system reform plan since 2009, chronic disease prevention and control implementations are still inadequate to meet the need at large. This study aims to quantify the acute and chronic care needs in China and examine the human resources for health and financial protection for the population to achieve Universal Health Coverage. MethodsThe data on disability-adjusted life years, years lived with disability, and years of life lost in China were disaggregated from the Global Burden of Diseases Study 2019 by age and sex based on acute care need or chronic care need. An auto-regressive integrated moving average model was deployed to predict the supply gap of physicians, nurses and midwives from 2020 to 2050. Out-of-pocket health expenditure was compared among China, Russia, Germany, the US, and Singapore to examine the current status of financial protection. ResultsIn 2019, conditions requiring chronic care accounted for 86.4% of all-cause, all-age disability-adjusted life years in China, while acute-care-need conditions accounted for 11.3%. Approximate 25.57% of disability-adjusted life years in communicable diseases and 94.32% in non-communicable diseases were caused by chronic care need conditions. Chronic care-need conditions accounted for more than 80% of both man and woman's disease burden. The proportion of disability-adjusted life years and years of life lost attributable to chronic care was greater than 90% in people aged 25 and up. The nurse and midwife supply will be in absolute shortage and unable to achieve effective universal health coverage effective coverage of 80% or 90% from 2020 to 2050, while the physician supply will be sufficient to maintain effective universal health coverage of 80% and reach 90% from 2036. The out-of-pocket health expenditure decreased with time but was still relatively higher than that of Germany, the US, and Singapore. ConclusionsThe present study demonstrates the chronic care needs outweigh those for acute care in China. Nurse supply and the financial protection for the poor were still inadequate to achieve Universal Health Coverage. Better workforce planning and concerted actions on chronic care prevention and control should be taken to meet the population's chronic care needs.

Health Insurance & Humanoid ROBOT-Agents: A case study

The Sustainable Development Goal (SDG) Target 3.8 has emphasized the persistence of health risks as a major challenge for emerging and developing countries. This challenge necessitates the achievement of Universal Health Coverage (UHC) by enhancing the infrastructure of the public sector. However, relying solely on public sector healthcare may not be sufficient to meet the needs of large populations, particularly in underdeveloped regions. Consequently, private sector healthcare solutions have emerged to fill service gaps, but they remain unaffordable for many low-income individuals. To the end, Health insurance can play a crucial role in making these services more accessible and affordable, but it faces several challenges including poor accessibility, low awareness, lack of skilled workforce, and corruption. The integration of Artificial Intelligence (AI) and Machine Learning (ML) technologies can offer solutions to these challenges. However, the adoption of technology in the insurance domain poses behavioral challenges that must be identified and addressed. This is particularly important in developing and emerging countries where markets are still underdeveloped, and information asymmetries are high. This study examines some of these challenges by studying people’s attitude towards humanoid agents. For this study a case study approach has ben used. Overall, addressing the challenges of health insurance and incorporating advanced technologies can provide a vital safety net against health risks to people.

Achieving Universal Health Coverage in Nigeria: Current Challenges and Recommendations

Health is a fundamental human right upon which all other rights are built. Easy access to needed and affordable healthcare service is essential towards achieving Universal Health Coverage (UHC). The achievement of UHC in middle and low-income countries of Africa such as Nigeria has however continued to pose a mirage, hence the need for a thorough re-evaluation and provision of sustainable solutions.
 This article aims at highlighting the current efforts in achieving UHC in Nigeria and the challenges facing its achievement, while proffering recommendations towards solving these challenges. 
 The Nigerian Government has made considerable efforts in promoting UHC; however a lot still needs to be done. Adequate healthcare financing has been found to be essential towards achieving universal health coverage in Nigeria; hence it is imperative that the Nigerian government and allied agencies continually create effective, achievable and sustainable policies and actions towards financing the healthcare sector, especially at the level of primary healthcare.

Understanding of the Readiness for HTA Implementation in Jordan as a Step Towards Universal Health Coverage

As Jordan strives to achieve universal health coverage, the mechanism for determining which health technologies to include in the basket of reimbursed services has become increasingly important. This study sought to understand stakeholder perspectives in the Jordanian health system regarding the readiness and need to implement health technology assessment (HTA) to support decision-making quality and transparency, ensure value for money on health system spending, and support the achievement of universal health coverage. This study used a cross-sectional survey methodology, and a quantitative analysis was conducted. A questionnaire based on the HTA implementation scorecard was administered in-person to capture responses regarding fourteen dimensions. Thirty-one responses from representatives across the Ministry of Health, regulatory authority, and other stakeholders in the national health system were collected. Most respondents were familiar with HTA and there was nearly unanimous agreement on the need for HTA implementation in Jordan. While the perspectives on how the implementation would occur were varied, careful consideration may be warranted in the areas of the legal framework for HTA, the quality of available data, financial constraints, and limited human resource capacity, as Jordan progresses towards implementing HTA on the road to universal healthcare.

Achieving Universal Health Coverage in Low- and Middle-Income Countries: Challenges for Policy Post-Pandemic and Beyond.

Achieving universal health coverage (UHC) is critical for ensuring equity, improving health, and protecting households from financial catastrophe. The COVID-19 pandemic derailed the progress made across primary health targets. This article aims to review the policy challenges to achieve UHC in a post-pandemic world. A narrative review of 118 peer reviewed and grey literature was conducted. A total of 77 published articles were identified using an electronic search in PubMed and Scopus and a bibliographic search of relevant literature. Another 41 Reports, websites, blogs, news articles, and data were manually sourced from international agencies (WHO, World Bank, IMF, FAO, etc.), government agencies, and non-government organizations. The challenges were identified and discussed under five broad findings: i) weak public health care systems ii) challenges to building resilient health systems, iii) health care financing and financial risk protection, iv) epidemiological and demographic challenges, and v) governance and leadership. LMICs in Africa and South Asia face significant challenges to achieving UHC by 2030. As countries recover from the pandemic's aftermath, significant investments and innovations are needed to ensure progress toward UHC. Efficient resource mobilization through internal accruals, international cooperation, and resource sharing is needed.