Attainment Of Universal Health Coverage Research Articles

High-level policy and governance stakeholder perspectives on health sector reform within a developing country context

Background: Health sector reform is a government-guided sustained process of structural change in programs and institutions of the health sector. Many developing countries like Nigeria have instituted various reforms in the health sector. However, issues in provision of quality healthcare persist. Hence this study explored high level stakeholders’ perspectives on health reform in Nigeria. Methods: The study was a descriptive case study using qualitative key informant interviews with purposively selected high-level government stakeholders in the Nigerian healthcare system comprising the Federal Ministry of Health and its agencies and institutes. Key aspects of health reform as identified by the World Health Organization were captured and used to develop a semi-structured interview guide. Seven Key Informant Interviews were carried out and recordings were transcribed verbatim and manually analyzed using standard techniques of thematic content analysis. Results: The emerging themes showing why reform has not led to improvement in the quality of healthcare include maladministration of the healthcare system, lack of an evidence-based engagement process and situation analysis involving all stakeholders, human resource shortages, weak health insurance, neglected primary healthcare system, poor financing, and weak political will. Conclusions: The study assessed policy and governance stakeholders’ views and perspectives on health sector reform in Nigeria. Findings showed various reasons why reform has not worked in Nigeria including poor stakeholder engagement and not following an evidence-based approach. Addressing these challenges by implementing some stakeholder perspectives including decentralizing the reform process and capturing the opinion of the people the reform is meant for can improve current and ongoing health reform policies. This could lead to an improved health system which can drive the attainment of Universal Health Coverage in Nigeria.

Dignity and respectful maternity care as an essential step towards universal health coverage

Most women experience disrespect and abuse in delivery rooms instead of support, and respect. Disrespect and abuse of women seeking maternity care are becoming an urgent problem and creating a growing community of concern that spans the domains of healthcare research, quality, and education; human rights; and civil rights advocacy. Deprivation of respectful mother care is an important cause of traumatic childbirth experiences as much as inadequate care make mothers feel that they are forced to be in the delivery bed, exposed, and left with no help. Good communication between parturient and care provider is associated with higher patient satisfaction with care and safety. All maternity care personnel should take cognizance of the issue of respectful maternity care and take appropriate corrective measures. By providing respectful maternity care we will take a concrete step ahead toward the attainment of universal health coverage.

Role of digital health insurance management systems in scaling health insurance coverage in low- and Middle-Income Countries: A case study from Nigeria

BackgroundIncreasing global commitment to Universal Health Coverage (UHC) in the past decade has triggered UHC-inspired reforms and investments to expand health service coverage in many Low- and Middle-Income Countries (LMICs). UHC aims to ensure that all people can access quality health services, safeguard them from public health risks and impoverishment from out-of-pocket payments for healthcare when household members are sickAimThis paper reviews the role of health insurance as a policy tool to address health financing as a contributory mechanism for accelerating the achievement of UHC in LMICs. We focus on Nigeria's legal framework for health insurance coverage for its whole population and the role of technology in facilitating enrollment to health insurance schemes.MethodsFrom May to July 2022, we adopted a cross-sectional case study design combining: (i) a literature review of the effects of UHC with (ii) document analysis of health insurance systems in Nigeria, and (iii) secondary analysis of health insurance datasets to understand experiences of deploying MedStrat, a locally-developed digital health insurance management system, and its features that support the administration of health insurance schemes in multiple states of Nigeria. We drew on contemporary technology adoption models to triangulate diverse data analyzed from literature and documents reviews and from health insurance datasets to identify: (i) enablers of adoption of digital insurance schemes, (ii) the contribution of digital technology to expanding access to health insurance, and (iii) further scalability of digital insurance intervention.ResultsPreliminary findings suggests that digital insurance management systems can help to increase the number of enrollees for insurance especially among poor households. Three contextual enablers of adoption of digital insurance schemes were a favourable policy environment, public-private-partnerships, and sustained stakeholder engagement and training.Discussion and conclusionKey elements for successful scaling of digital health insurance schemes across Nigeria and similar contexts include: (i) ease of use, (ii) existing digital infrastructure to support electronic insurance systems, and (iii) trust manifested via data encryption, maintaining audit trails for all data, and in-built fraud prevention processes. Our findings affirm that digital health technology can play a role in the attainment of UHC in LMICs.

Public-Private Partnership Supported Health Facilities and Progress towards Attainment of Universal Health Coverage in Kilimanjaro, Tanzania

BackgroundPublic-Private-Partnership-supported health facilities have been operational in Tanzania, and specifically, in Kilimanjaro since 1990s. This study provides a snapshot of the contribution of PPP-supported health facilities’ operations towards attainment of Universal Health Coverage (UHC) in Kilimanjaro region.MethodsAdopting a cross-sectional research design, samples of 384 households and 30 health facilities were selected through a multi-stage and purposive sampling approaches, respectively. Questionnaires and key informant interviews (KIIs) were administered (June 2020 - February 2021). Using IBM-SPSS v.23, chi-square was used to compare PPP-supported and government health facilities’ service delivery quality and affordability. Content analysis was done on KIIs.ResultsWith PPP-support unweighted mean index score for service availability (SA) was 46.59% and 29.14% without PPP-supported health facilities. With PPP-support, the GSR index score was 87% while it was 82% without PPP-support. This implies, with PPP-support, progress towards UHC attainment can be accelerated. There was no significant association between accessing services in PPP-supported or government health facilities by perceived service delivery quality and service affordability.ConclusionPPP-supported and government health facilities co-existence is essential at hastening the progress towards UHC in the study area. The government should strengthen policies and regulations to promote more PPPs in improving health facilities’ operations.Rwanda J Med Health Sci 2022;5(2):216-232

Sub-national variations in general service readiness of primary health care facilities in Ghana: Health policy and equity implications towards the attainment of Universal Health Coverage.

BackgroundService availability and readiness are critical for the delivery of quality and essential health care services. In Ghana, there is paucity of literature that describes general service readiness (GSR) of primary health care (PHC) facilities within the national context. This study therefore assessed the GSR of PHC facilities in Ghana to provide evidence to inform heath policy and drive action towards reducing health inequities.MethodsWe analysed data from 140 Service Delivery Points (SDPs) that were part of the Performance Monitoring and Accountability 2020 survey (PMA2020). GSR was computed using the Service Availability and Readiness Assessment (SARA) manual based on four out of five components. Descriptive statistics were computed for both continuous and categorical variables. A multivariable binary logistic regression model was fitted to assess predictors of scoring above the mean GSR. Analyses were performed using Stata version 16.0. Significance level was set at p<0.05.ResultsThe average GSR index of SDPs in this study was 83.4%. Specifically, the mean GSR of hospitals was 92.8%, whereas health centres/clinics and CHPS compounds scored 78.0% and 64.3% respectively. The least average scores were observed in the essential medicines and standard precautions for infection prevention categories. We found significant sub-national, urban-rural and facility-related disparities in GSR. Compared to the Greater Accra Region, SDPs in the Eastern, Western, Upper East and Upper West Regions had significantly reduced odds of scoring above the overall GSR. Majority of SDPs with GSR below the average were from rural areas.ConclusionOverall, GSR among SDPs is appreciable as compared to other settings. The study highlights the existence of regional, urban-rural and facility-related differences in GSR of SDPs. The reality of health inequities has crucial policy implications which need to be addressed urgently to fast-track progress towards the achievement of the SDGs and UHC targets by 2030.

Attainment of universal health coverage in the occupied Palestinian territory assessed by a general equilibrium approach: is informality an irreversible hurdle for universality?

BackgroundAchieving universal health coverage (UHC) has recently received attention in response to calls from international organisations to expand health coverage to hard-to-reach segments of the population (eg, informal workers, and unemployed and poor people). Despite the strong commitment to achieving UHC, its implementation continues to spark vigorous debate among policy makers, scholars, and the international health community. Much of the recent debate has focused on the macro-fiscal challenges that many developing countries face in implementing and sustaining UHC-oriented reforms, and there has also been debate in relation to challenges of the micro-behavioural sphere (at the level of the individual). Some of these challenges pertain to the structure of the labour market in developing countries, which is characterised by the large size of non-contributory segments of the population, mainly informal workers and unemployed individuals. This raises the important policy questions of the feasibility of expanding health coverage to the informal sector and the unemployed on a contributory basis. MethodsWe assessed the feasibility of UHC using a dynamic general equilibrium approach while accounting for heterogeneity across households in terms of their employment and socioeconomic status. The model was calibrated using the Palestinian Expenditures and Consumption Survey (PECS, 2011), and the Social Accounting Matrix (SAM, 2011). We assessed alternative health insurance designs proposed to target the informal workers. Fiscal sustainability of the reforms was examined using the debt-to-GDP ratio and the microeconomic impact was assessed using the concept of consumption equivalent variation (CEV), defined as the amount of additional consumption a household would give up to move from the pre-insurance to the post-insurance level of welfare. A positive CEV value indicates that individuals are willing to pay for the health insurance. The higher the CEV value, the higher the gains of health insurance. FindingsA simultaneous expansion of UHC coverage of the population and health-care costs would enhance welfare for all households. However, such an expansion would reduce government expenditure that is allocated to other sectors; for example, it was estimated that the reduction would have been approximately 10% in 2020. To finance this UHC-driven debt, we examined the impact of a tax-financed UHC-oriented reform and a low-premium, low-coverage government-sponsored health insurance that targets informal workers. Although both policies would generate additional revenues to serve the UHC debt, government-sponsored health insurance targeting informal workers seems to be more feasible in terms of its impact on household welfare. That is, the informal workers would be better off under the government-sponsored health insurance scheme. InterpretationIn the absence of precise information on the ability to pay of informal workers, which in some cases might be comparable to that of formal workers, it is reasonable for the government to charge better-off informal workers rather than naively exempting them. The findings corroborate previous evidence suggesting that informal workers are willing to join health insurance schemes that charge them lower premiums for a slightly less generous benefit package than the health insurance schemes of formal workers. This health insurance might be deemed equitable in terms of the degree of financial protection that informal workers can obtain compared with the scenario in which they are left to bear high out-of-pocket health-care costs. FundingThe A*MIDEX project (number ANR-11-IDEX-0001-02).

Predicting Universal Healthcare Through Health Financial Management for Sustainable Development in BRICS, GCC, and AUKUS Economic Blocks.

The majority of the world's population is still facing difficulties in getting access to primary healthcare facilities. Universal health coverage (UHC) proposes access to high-quality, affordable primary healthcare for all. The 17 UN sustainable development goals (SDGs) are expected to be executed and achieved by all the 193 countries through national sustainable development strategies and multi-stakeholder partnerships. This article addresses SDG 3.8—access to good quality and affordable healthcare and two subindicators related to societal impact (SDG 3.8.1 and 3.8.2) through two objectives. The first objective is to determine whether health expenditure indicators (HEIs) drive UHC, and the second objective is to analyze the importance of key determinants and their interactions with UHC in three economic blocks: emerging Gulf Cooperation Council (GCC); developing Brazil, Russia, India, China, and South Africa (BRICS) vis-à-vis the developed Australia, UK, and USA (AUKUS). We use the WHO Global Health Indicator database and UHC periodical surveys to evaluate the hypotheses. We apply state-of-the-art machine learning (ML) models and ordinary least square (traditional—OLS regression) methods to see the superiority of artificial intelligence (AI) over traditional ones. The ML Random Forest Tree method is found to be superior to the OLS model in terms of lower root mean square error (RMSE). The ML results indicate that domestic private health expenditure (PVT-D), out-of-pocket expenditure (OOPS) per Capita in US dollars, and voluntary health insurance (VHI) as a percentage of current health expenditure (CHE) are the key factors influencing UHC across the three economic blocks. Our findings have implications for drafting health and finance sector public policies, such as providing affordable social health insurance to the weaker sections of the population, making insurance premiums less expensive and affordable for the masses, and designing healthcare financing policies that are beneficial to the masses. UHC is an important determinant of health for all and requires an in-depth analysis of related factors. Policymakers are often faced with the challenge of prioritizing the economic needs of sectors such as education and food safety, making it difficult for healthcare to receive its due share. In this context, this article attempts to identify the key components that may influence the attainment of UHC and enable policy changes to address them more effectively and efficiently.

Disability and sexual and reproductive health service utilisation in Uganda: an intersectional analysis of demographic and health surveys between 2006 and 2016

BackgroundThe United Nations through universal health coverage, including sexual and reproductive health (SRH), pledges to include all people, leaving no one behind. However, people with disabilities continue to experience multiple barriers in accessing SRH services. Studies analysing the impacts of disability in conjunction with other social identities and health determinants reveal a complex pattern in SRH service use. Framed within a larger mixed methods study conducted in Uganda, we examined how disability, among other key social determinants of health (SDH), was associated with the use of SRH services.MethodsWe analysed data from repeated cross-sectional national surveys, the Uganda Demographic and Health Surveys (DHS) of 2006, 2011, and 2016. The three outcomes of interest were antenatal care visits, HIV testing, and modern contraception use. Our main exposure of interest was the type of disability, classified according to six functional dimensions: seeing, hearing, walking/climbing steps, remembering/concentrating, communicating, and self-care. We performed descriptive and multivariable logistic regression analyses, which controlled for covariates such as survey year, sex, age, place of residence, education, and wealth index. Interaction terms between disability and other factors such as sex, education, and wealth index were explored. Regression analyses were informed by an intersectionality framework to highlight social and health disparities within groups.ResultsFrom 2006 to 2016, 15.5-18.5% of study participants lived with some form of disability. Over the same period, the overall prevalence of at least four antenatal care visits increased from 48.3 to 61.0%, while overall HIV testing prevalence rose from 30.8 to 92.4% and the overall prevalence of modern contraception use increased from 18.6 to 34.2%. The DHS year, highest education level attained, and wealth index were the most consistent determinants of SRH service utilisation. People with different types of disabilities did not have the same SRH use patterns. Interactions between disability type and wealth index were associated with neither HIV testing nor the use of modern contraception. Women who were wealthy with hearing difficulty (Odds Ratio (OR) = 0.15, 95%CI 0.03 – 0.87) or with communication difficulty (OR = 0.17, 95%CI 0.03 – 0.82) had lower odds of having had optimal antenatal care visits compared to women without disabilities who were poorer.ConclusionThis study provided evidence that SRH service use prevalence increased over time in Uganda and highlights the importance of studying SRH and the different disability types when examining SDH. The SDH are pivotal to the attainment of universal health coverage, including SRH services, for all people irrespective of their social identities.

Citizen Participation in Health Budget Process: Trends and Patterns with Particular Reference to Enugu State of Nigeria

This study looked at Citizen Participation in Health Budget Process: Trends and Patterns in Enugu state of Nigeria. The study's objectives included exploring citizens’ perception of the factors that influence the release of funds in the State, their level of participation, and knowledge about the goals of citizen participation in the budget process. Respondents were 398 in number (198 males and 200 females), inclusive of 40 civil and public servants. The two sets of questionnaire were used to collect data (One set for the public and civil servants; and the other set for the general public. Results reveal that the factors that influence the release of funds include, among others, poor allocation and release of funds from federal sources and weak political commitment. The results also reveal that citizens are not openly and substantially involved in the health budget process, and their level of knowledge regarding the government’s goal in citizen participation in the budget process is poor. The findings from this study will inform the development of advocacy packages to the government towards greater and meaning engagement of the citizens in the budget process. The advocacy packages might give the necessary voice to the people, which are required to strengthen efforts towards the attainment of Universal Health Coverage, as well as generate useful data which will serve as a guide for future interventions.

The Medical Nemesis of Primary Health Care Implementation: Evidence From Ghana.

Primary Health Care (PHC), based on the Alma Ata declaration, calls for the movement of responsibility, resources, and control away from medical systems and curative measures toward health promotion. However, PHC implementation in practice appears to be heavily influenced by medical systems with its own attendant effects on the attainment of PHC goals. This study therefore examines the extent and effects of medical systems influence on PHC implementation in Ghana. The study uses the thematic framework approach to qualitative data analysis to analyze data collected from PHC managers through interviews. Ethical clearance for the study was obtained from the Noguchi Memorial Institute for Medical Research. Findings suggest that PHC in practice is tied to the apron-strings of medical systems. While this has catalyzed successes in disease control programs and other medicine-based interventions, it has swayed PHC from its intended shift toward health promotion. Community ownership, participation, and empowerment in PHC is therefore lost in the maze of medical systems which reserves power over PHC decision making and implementation to medical professionals while focusing attention on treatment and curative services. Ultimately, PHC has gradually metamorphosed into mini-clinics instead of the revolutionary community-driven promotive services espoused by Alma Ata with concomitant effects on the attainment of Universal Health Coverage. Further, findings show how gradually, the primary in PHC is being used as a descriptor of the first or basic level of hospital-based care instead of a first point of addressing existing health problems using preventive, promotive, and other community driven approaches. Without a reorientation of health systems, significant efforts and resources are channeled toward empowering health workers instead of local communities with significant effects on the long term sustainability of health efforts and the attainment of UHC. The study recommends further studies toward practical means of reducing the influence of medical systems.

Evaluation of Drug Pricing in Nigeria: A Focus on Affordability and Availability of Essential Medicines in Federal Capital Territory Abuja

Critical to the success of a country’s healthcare delivery services is the affordability, availability, and accessibility of essential medicines to the populace irrespective of their income status. The price of medicines is an important determinant of medicines affordability and accessibility. Due to seeming inefficient health insurance programs, medicine financing in Nigeria is generally out-of-pocket. In Nigeria, drug prices are set mostly by market forces, with government tariffs, taxes, and distribution mark-ups accounting for a significant proportion of the final price.The following thematic areas of interest to were the focus in evaluating the current situation of drug pricing: National Drug Policy and Drug Pricing; National Drug Distribution Guideline and Drug Pricing; National Policy Framework on Drug Revolving Fund and Drug Pricing; Nigerian Pharmaceutical Market and Drug Pricing.The study evaluated drug pricing in Nigeria by comparing the availability and prices of various brands of a chosen set of essential medicines in different parts of the health sector and different types of health facilities in the Federal Capital Territory Abuja to assess the availability and affordability of these medicines.The study design used a questionnaire format data collection tool based on the 2nd edition of the World Health Organization (WHO) and Health Action International manual for measuring medicine prices, availability, affordability, and price components. The survey was carried out within the Federal Capital Territory Abuja at both public and private health facilities, including community pharmacies. A total of 145 facilities were enumerated and 20% were successfully surveyed. Key data collected included; percentage availability, price of originator brand and generics, price ratio to the international reference price, and the economic effect of current drug prices on the populace.The results showed varied and fantastic outcome, on inferential statistics in comparative analysis; Firstly, for the Public hospital vs Private hospital Medicines’ Prices, there was a significant difference (P&lt;0.05) between the price of medicines in private hospital and the median price of medicines in public hospitals. Also, price of medicines in private hospital was 2.9 times higher than the median price of medicine in public hospital ( p=0.013, t=2.9); Secondly, for the Innovator brand vs Most sold generic brand in community pharmacy, there was a significant difference between the median price of innovator brands of medicines and the median price of the most sold generics. The median price of the innovator brands was approximately 5 times the median price of the most sold generics (p=0.000291, t=4.689); Thirdly, for the Price of medicines across community pharmacies (innovator brand), there was no significant difference (p&gt;0.05) in the prices of innovator brands across the community pharmacies assessed. (p=0.459); Fourthly, for the Price of medicines across community pharmacies (Most sold generic), there was no significant difference (p&gt;0.05) in the prices of the most sold generic brands of medicines across community pharmacies assessed (P=0.915); Fifthly, for the Price of medicine across public hospitals, there was no significant difference (p&gt;0.05) between the prices of medicines across the public hospitals assessed. (p=0.877).There exists a huge price disparity between public and private health facilities, hence there is an overarching need to regulate drug prices in the health sector so as to ensure affordability and availability of essential medicines and other healthcare commodities. There is poor availability of some essential medicines particularly in the public health pharmacies, it is imperative that appropriate measures be put in place to ensure medicine availability. Improving access to medicines is key to attainment of Universal Health Coverage and Patients’ satisfaction of the healthcare delivery system. Keywords: Drug Pricing, Essential Medicines, Affordability, Availability, Nigeria, FCT Abuja DOI: 10.7176/JHMN/97-01 Publication date: January 31 st 2022

Respectful maternity care in the achievement of universal health coverage.

The attainment of universal health coverage (UHC) is incomplete without achieving respectful maternity care (RMC). While planning for UHC, the need and importance of RMC should be considered. In India, the government has started a health scheme on UHC, namely the Ayushman Bharat Scheme. RMC being an important component of UHC, if not achieved, will result in failure to achieve UHC in the true sense.

Ghana: health system review 2021

Abstract A health system review provides a detailed description of a health care system and of reform and policy initiatives in progress or under development. The health system review of Ghana serves as an effort to also assess the system's performance towards the attainment of universal health coverage (UHC). A workshop was organized in 2018 to develop a template for writing the health system review of Ghana. This serves as a pilot study to test the feasibility of using a template somewhat like that of the WHO European Observatory on Health Systems and Policies for writing health system reviews of African countries. The health system review of Ghana is the first to be written for an African country modelled after the HiT reviews by the European Observatory. One key characteristics of the health system of Ghana is the introduction and reform of the national health insurance scheme (NHIS) in 2003 and 2012 respectively. About 40% of the population are enrolled and 60% enrolled are exempted from premium payments. Ghana has since 2010 scaled-up a national telemedicine programme, becoming one of the first adopters and innovators in Africa to integrate digital health technologies into mainstream health care system. Since 2018, Ghana has implemented the NHIS mobile renewal service, which allows payment of health insurance coverage using mobile money technologies. Ghana is one of the first countries to introduce a nationwide health insurance in Africa. The NHIS is one significant effort towards health systems strengthening and achieving UHC. Enrolment in in the NHIS contributes to better access to health care and improved financial protection. However, not only is population coverage low, but there is a serious concern about the system's financial sustainability. A promising approach is to improve the mobile-money based intervention through the high mobile-phone penetration rates in Ghana to enable more effective household saving arrangements towards UHC. Key messages Ghana presents important lessons, including the introduction of a national health insurance. This contributes to better access to health care and improved financial protection. Ghana is exploiting the use of mobile phone technologies and has become one of the first adopters and innovators in Africa to integrate digital health technologies into mainstream health care system.

Strengthening Rural Medical Education in the Undergraduate Training Period

The equal distribution of the health workforce has been identified as one of the key determinants for the attainment of health-related goals. The purpose of the current review is to identify the existing practices of rural medical education and to recommend strategies for the strengthening of the same. An extensive search of all materials related to the topic was carried out on the PubMed search engine. Keywords used in the search include rural medical education and undergraduate medical curriculum in the title alone (viz. rural medical education [ti]; rural [ti] AND undergraduate medical curriculum [ti]). Relevant research articles focusing on rural medical education and undergraduate medical curriculum published in the period 2002–2020 were included in the review. A total of 21 studies similar to the current study objectives were identified initially, and those were screened for eligibility. However, two articles were excluded owing to the unavailability of the complete version of the articles. In the current review, the articles published in only the English language were enrolled for the review. Overall, 19 articles were selected based on the suitability with the current review objectives. In general, the people living in rural settings are a vulnerable section, as they have access to the limited resources and health-care facilities. Thus, from the perspective of the rural population, the exposure of medical students to rural settings simultaneously enhances their accessibility to health-care services, which, in turn, takes us forward toward the attainment of universal health coverage. In conclusion, the provision of medical education to the undergraduate students in rural settings is the need of the hour both for producing a competent medical graduate and for meeting the health-related needs of the vulnerable rural population. It becomes the responsibility of the medical institutions to ensure that all the medical students are posted in rural settings as a part of their training and are encouraged to serve the rural population.

Management of chronic lung diseases in Sudan and Tanzania: how ready are the country health systems?

BackgroundChronic lung diseases (CLDs), responsible for 4 million deaths globally every year, are increasingly important in low- and middle-income countries where most of the global mortality due to CLDs currently occurs. As existing health systems in resource-poor contexts, especially sub-Saharan Africa (SSA), are not generally oriented to provide quality care for chronic diseases, a first step in re-imagining them is to critically consider readiness for service delivery across all aspects of the existing system.MethodsWe conducted a mixed-methods assessment of CLD service readiness in 18 purposively selected health facilities in two differing SSA health system contexts, Tanzania and Sudan. We used the World Health Organization’s (WHO) Service Availability and Readiness Assessment checklist, qualitative interviews of key health system stakeholders, health facility registers review and assessed clinicians’ capacity to manage CLD using patient vignettes. CLD service readiness was scored as a composite of availability of service-specific tracer items from the WHO service availability checklist in three domains: staff training and guidelines, diagnostics and equipment, and basic medicines. Qualitative data were analysed using the same domains.ResultsOne health facility in Tanzania and five in Sudan, attained a CLD readiness score of ≥ 50 % for CLD care. Scores ranged from 14.9 % in a dispensary to 53.3 % in a health center in Tanzania, and from 36.4 to 86.4 % in Sudan. The least available tracer items across both countries were trained human resources and guidelines, and peak flow meters. Only two facilities had COPD guidelines. Patient vignette analysis revealed significant gaps in clinicians’ capacity to manage CLD. Key informants identified low prioritization as key barrier to CLD care.ConclusionsGaps in service availability and readiness for CLD care in Tanzania and Sudan threaten attainment of universal health coverage in these settings. Detailed assessments by health systems researchers in discussion with stakeholders at all levels of the health system can identify critical blockages to reimagining CLD service provision with people-centered, integrated approaches at its heart.

Digital and Home Healthcare Survey among Nigerians: Assessing Awareness, Preferences, and Willingness to Pay for an Integrated Healthcare Ecosystem to achieve Universal Health Coverage

Introduction: The COVID-19 pandemic highlighted the need for evolving an integrated healthcare ecosystem that will connect patients to digital and home healthcare to achieve universal health coverage. The survey aims to assess perceptions and preferences about digital and home healthcare services and develop an integrated healthcare ecosystem. Methods: A survey of 254 Nigerians was conducted to assess their awareness, preferences, and willingness to pay for digital and home healthcare services using electronic questionnaires, and the data were analysed using SPSS 16.0. Results: Males constituted 70.9%, and 61.4% were aged ≤35 years. Two-third were clients, and a third were healthcare providers. Although about 71% patronized public hospitals, there was poor satisfaction (31.7%) than those attending private hospitals that were more satisfied. The male gender, private hospital utilization, and age of ≤35 years were associated with the satisfaction with OR 1.19 (95% CI 0.69-2.05), OR 1.22 (95% CI 0.73-2.04), and OR 2.41 (95% CI 1.38-4.20) respectively. Thirty minutes was the acceptable delay in receiving care by most respond-ents. Only 39.4% were aware of digital health, and 52.8% were aware of home healthcare. Male gender was associated with DH awareness, while being a healthcare provider was associated with both DH and home healthcare awareness. The respondents' median amount was willing to pay for DH and HH respondents is $1.64-$6.56 and $3.28 – $6.56, respectively. Conclusion: In response to the survey result, we designed an integrated hospital, digital, and home healthcare project named eDokta, to leapfrog the attainment of universal health coverage in Nigeria. © 2021 Ahmad;.

A Comparative Assessment of Access to Healthcare of People Living in Ekiti and Kogi States of Nigeria

Aim: To undertake a comparative assessment of healthcare access of people in Ekiti and Kogi States of Nigeria. This further provided hard data for health program development towards attainment of universal health coverage and health sustainable development goal.&#x0D; Study Design: A comparative research design was employed using questionnaire for data collection.&#x0D; Place and Duration of the Study: The study was conducted in Ekiti and Kogi States of Nigeria representing Southern and Northern parts of the nation. The fieldwork was conducted in October and December 2019.&#x0D; Methodology: Multistage sampling technique was used starting from random selection of one local government area from each of the three senatorial districts in the two states. From each of the local government areas, five political wards were randomly selected from the existing number of wards. From the selected wards, equal number of 144 sampled respondents were contacted for the structured interviews to make 856 administered copies of questionnaire.&#x0D; Results: Most of the respondents could identify available health care facilities in their environment. However about 70 percent patronized secondary health facilities in Ekiti State while tertiary health facilities were visited mostly in Kogi State. Costs of health care is higher in Kogi compared to Ekiti State. 49% of Ekiti have a challenge in paying for treatment compared to 69% in Kogi State while from the two states, only about 19% have health insurance coverage. Respondents in Ekiti State experience strike actions of health workers than those in Kogi State. On appropriateness, Ekiti state has better scores while Kogi State has better score in acceptability.&#x0D; Conclusion: Pronounced challenge to healthcare access is unaffordability of health care as a result of very low health insurance scheme coverage in the two states through Ekiti State has better indicators of quality healthcare.

The state of health research governance in Africa: what do we know and how can we improve?

BackgroundThe developments in global health, digital technology, and persistent health systems challenges, coupled with global commitments like attainment of universal health coverage, have elevated the role of health research in low- and middle-income countries. However, there is a need to strengthen health research governance and create a conducive environment that can promote ethics and research integrity and increase public trust in research.ObjectiveTo assess whether the necessary structures are in place to ensure health research governance.MethodsEmploying a cross-sectional survey, we collected data on research governance components from 35 Member States of the World Health Organization (WHO) African Region. Data were analysed using basic descriptive and comparative analysis.Results Eighteen out of 35 countries had legislation to regulate the conduct of health research, while this was lacking in 12 countries. Some legislation was either grossly outdated or too limiting in scope, while some countries had multiple laws. Health research policies and strategies were in place in 16 and 15 countries, respectively, while research priority lists were available in 25 countries. Overlapping mandates of institutions responsible for health research partly explained the lack of strategic documents in some countries. The majority of countries had ethical committees performing a dual role of ethical and scientific review. Research partnership frameworks were available to varying degrees to govern both in-country and north–south research collaboration. Twenty-five countries had a focal point and unit within the ministries of health (MoH) to coordinate research.ConclusionGovernance structures must be adaptive to embrace new developments in science. Further, strong coordination is key to ensuring comprehensiveness and complementarity in both research development and generation of evidence. The majority of committees perform a dual role of ethics and scientific review, and these need to ensure representation of relevant expertise. Opportunities that accrue from collaborative research need to be seized through strong MoH leadership and clear partnership frameworks that guide negotiations.

Reframing Non-Communicable Diseases and Injuries for Equity in the Era of Universal Health Coverage: Findings and Recommendations from the Kenya NCDI Poverty Commission.

Background:Kenya has implemented a robust response to non-communicable diseases and injuries (NCDIs); however, key gaps in health services for NCDIs still exist in the attainment of Universal Health Coverage (UHC). The Kenya Non-Communicable Diseases and Injury (NCDI) Poverty Commission was established to estimate the burden of NCDIs, determine the availability and coverage of health services, prioritize an expanded set of NCDI conditions, and propose cost-effective and equity-promoting interventions to avert the health and economic consequences of NCDIs in Kenya.Methods:Burden of NCDIs in Kenya was determined using desk review of published literature, estimates from the Global Burden of Disease Study, and secondary analysis of local health surveillance data. Secondary analysis of nationally representative surveys was conducted to estimate current availability and coverage of services by socioeconomic status. The Commission then conducted a structured priority setting process to determine priority NCDI conditions and health sector interventions based on published evidence.Findings:There is a large and diverse burden of NCDIs in Kenya, with the majority of disability-adjusted life-years occurring before age of 40. The poorest wealth quintiles experience a substantially higher deaths rate from NCDIs, lower coverage of diagnosis and treatment for NCDIs, and lower availability of NCDI-related health services. The Commission prioritized 14 NCDIs and selected 34 accompanying interventions for recommendation to achieve UHC. These interventions were estimated to cost $11.76 USD per capita annually, which represents 15% of current total health expenditure. This investment could potentially avert 9,322 premature deaths per year by 2030.Conclusions and Recommendations:An expanded set of priority NCDI conditions and health sector interventions are required in Kenya to achieve UHC, particularly for disadvantaged socioeconomic groups. We provided recommendations for integration of services within existing health services platforms and financing mechanisms and coordination of whole-of-government approaches for the prevention and treatment of NCDIs.

The inverse care law: implications for universal health coverage in Nigerian rural communities

Background: The inverse care law states that the availability of good healthcare tends to vary inversely with the need for it in the population served. This situation is easily observable in developing countries like Nigeria, and poses a threat to the attainment of universal health coverage (UHC) in rural communities. Objective: To examine how the inverse care law plays out in the Nigerian healthcare system, and how this may lead to a difficulty in achieving UHC in rural communities. Materials and Methods: Standard procedures were used in locating, selecting, extracting and synthesizing data. Electronic databases and internet resources such as PubMed, Google Scholar, SCOPUS and Web of Science were searched. Selection of studies was conducted by a two-stage process. Data extraction was done using data extraction forms. During data synthesis, major themes, strengths, weaknesses and critical gaps in each paper were identified. Results: There are several factors that boost the operation of the inverse care law in the Nigerian healthcare system. How this poses a threat to the attainment of UHC has also been documented. Among these are limitations in the range of services provided in rural healthcare facilities, inadequate production and maldistribution of health personnel, and low health manpower retention in rural areas. Conclusion: There is a need for concerted efforts by the government to address the factors that facilitate the inverse care law in the Nigerian healthcare system. This is necessary for the attainment of UHC specifically and the Sustainable Development Goal number three generally.