Attainment Of Universal Health Coverage Research Articles

Essential Drugs Inadequacy is an Impediment to Utilization of Universal Health Coverage; the Case of Seme Sub-County in Kisumu County, Kenya

Introduction: Many countries have been putting more effort in Universal Health Coverage through strengthening health systems to provide affordable, safe and high quality care. The Kenya government prioritized attainment of Universal Health Coverage which aimed at cushioning citizens against out of pocket expenditure on health services, though faced with challenges of staffing and inadequate medical supplies for proper implementation. Aim: This was a descriptive cross sectional study design which examined the factors influencing utilization of Universal Health Coverage utilization in Seme Sub County. Subject and Methods: The study targeted both community members and health facility managers. The health facilities were stratified according to their levels of care and randomly selected. The catchment population was stratified by administrative locations and a proportionate sampling technique applied giving a computed sample size of 377 participants, determined by Fischer’s formula. The descriptive statistics were organized and summarized using tables and charts, while logistic regression analysis determined relationship between variables. Results: The study revealed that availability of essential drugs in health facilities contributed positively in utilization of UHC as the availability of drugs in health facility is 2.52 times more likely to make people solely use UHC (OR=2.52, 95%CI=1.36- 4.69, p<0.05). Conclusion: Essential drugs have direct significant influence on utilization of UHC services by community members. Considerable progress will only to materialize through improved supply of adequate essential drugs and procurement of essential medical equipment in the government health facilities in Kisumu County.

Monitoring Quality of Care in the WHO Africa Region-A study design for measurement and tracking, towards UHC attainment

ABSTRACT This paper reports on the design of a study to generate a quality of care index for countries in the World Health Organization Africa Region. Quality of care, for all people at all times, remains pivotal to the advancement of the 2030 agenda and the attainment of Universal Health Coverage. We present a study protocol for deriving a quality of care index, hinged on indicators and data elements currently monitored through routine information systems and institutionalized facility assessments in the World Health Organization Africa Region. This paper seeks to offer more insight into options in the Region for strengthening monitoring processes of quality of care, as a step towards generating empirical evidence which can galvanize action towards an improved care process. The methodology proposed in this study design has broad implications for policymaking and priority setting for countries, emphasizing the need for robust empirical measures to understand the functionality of health systems for the delivery of quality essential services. Application of this protocol will guide policymaking, as countries work to increasingly improve quality of care and adopt policies that will best facilitate their advancement towards Universal Health Coverage.

Impact of COVID-19 pandemic on the attainment of universal health coverage and sustainable development goals

Impact of COVID-19 pandemic on the attainment of universal health coverage and sustainable development goals

Field-testing of primary health-care indicators, India.

ObjectiveTo develop a primary health-care monitoring framework and health outcome indicator list, and field-test and triangulate indicators designed to assess health reforms in Kerala, India, 2018–2019.MethodsWe used a modified Delphi technique to develop a 23-item indicator list to monitor primary health care. We used a multistage cluster random sampling technique to select one district from each of four district clusters, and then select both a family and a primary health centre from each of the four districts. We field-tested and triangulated the indicators using facility data and a population-based household survey.FindingsOur data revealed similarities between facility and survey data for some indicators (e.g. low birth weight and pre-check services), but differences for others (e.g. acute diarrhoeal diseases in children younger than 5 years and blood pressure screening). We made four critical observations: (i) data are available at the facility level but in varying formats; (ii) established global indicators may not always be useful in local monitoring; (iii) operational definitions must be refined; and (iv) triangulation and feedback from the field is vital.ConclusionWe observe that, while data can be used to develop indices of progress, interpretation of these indicators requires great care. In the attainment of universal health coverage, we consider that our observations of the utility of certain health indicators will provide valuable insights for practitioners and supervisors in the development of a primary health-care monitoring mechanism.

Doctor Retention in Ireland - What It May Mean for the Global Health Workforce Reform Agenda Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle".

The study of healthcare personnel migration in Ireland reports that most medical graduates plan to leave the country’s health system. It may be possible to address this challenge by understanding and addressing the reasons why young doctors plan to leave. Future studies should contribute to the retention of early career doctors in highincome countries such as Ireland. This will help reduce the migration of doctors from low- and middle-income countries in order to address the global health workforce crisis and its impact on the attainment of universal health coverage in all health systems.

Envisaging patient safety in health-care settings

The concept of patient safety came into existence owing to the complexity attributed to the health systems and the rising incidence of patient harms in health care facilities. It won't be wrong to say that patient harm in healthcare is intolerable, especially the ones resulting because of the error in the diagnosis, prescription or the use of medicines. The need of the hour is to establish a culture that fosters linkage with patients, boosts reporting and learning from mistakes and establishes a safe environment wherein health professionals are empowered and well-trained to minimize their errors. In conclusion, patient safety during health care delivery is an essential prerequisite to accomplish health system strengthening and move forward towards the attainment of universal health coverage. The time has come when patient safety has to be regarded as one of the global health priorities and focused actions are taken to achieve improved health outcomes.

Examining purchasing reforms towards universal health coverage by the National Hospital Insurance Fund in Kenya

BackgroundKenya has prioritized the attainment of universal health coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fund (NHIF). In 2015, the NHIF introduced reforms in premium contribution rates, benefit packages, and provider payment methods. We examined the influence of these reforms on NHIF’s purchasing practices and their implications for strategic purchasing and health system goals of equity, efficiency and quality.MethodsWe conducted an embedded case study with the NHIF as the case and the reforms as embedded units of analysis. We collected data at the national level and in two purposively selected counties through 41 in-depth interviews with health financing stakeholders, facility managers and frontline providers; 4 focus group discussions with 51 NHIF members; and, document reviews. We analysed the data using a Framework approach.ResultsThe new NHIF reforms were characterized by weak purchasing actions. Firstly, the new premium contribution rates were inadequately communicated and unaffordable for certain citizen groups. Secondly, while the new benefit packages were reported to be based on service needs, preferences and values of the population, they were inadequately communicated and unequally distributed across different citizen groups. In addition, the presence of service delivery infrastructure gaps in public healthcare facilities and the pro-urban and pro-private distribution of contracted health facilities compromised delivery of, and access to, these new services. Lastly, the new provider payment methods and rates were considered inadequate, with delayed payments and weak links to financial accountability mechanisms which compromised their ability to incentivize equity, efficiency and quality of healthcare delivery.ConclusionWhile NHIF sought to expand population and service coverage and reduce out-of-pocket payments with the new reforms, weaknesses in the reforms’ design and implementation limited NHIF’s purchasing actions with negative implications for the health system goals of equity, efficiency and quality. For the reforms to accelerate the country’s progress towards UHC, policy makers at the NHIF and, national and county government should make deliberate efforts to align the design and implementation of such reforms with strategic purchasing actions that are aimed at improving health system goals.

Evidence-based policy: nursing now and the importance of research synthesis.

This study explores how scholarship relating to meta-analytical studies and systematic and integrative reviews can inform nursing's contribution to universal health coverage. As nursing globally embraces the 200th anniversary of the birth of Florence Nightingale, the Nursing Now social movement has called for the profession to improve universal health coverage through increasing nursing's policy voice. In determining how the Nursing Now social movement could pursue the aim of this study, researchers undertook a comparative bibliometric analysis of scholarship relating to the systematic curation of evidence. This study uses a mixed-method analysis of the bibliometric data available through extracting and synthesizing information from one of the commercially produced indexing and citation databases. Generally, medicine has contributed far more synthesized contributions than nursing, except in the case of integrative reviews. Co-occurrence analysis of nursing literature through examination of key terms yielded a complex visualization of 11 specific clusters of scholarship (Care of the Older Person, Nurse Education, Emergency and Critical Care, Occupational Health and Safety, Rural Services, Anxiety and Depression, Measurement, Newborn and Post-natal Health, Cardiovascular Disease, Preventative Health and Cancer Care). Bibliometric analysis of curated evidence demonstrates that there is ample nursing-relevant material to inform evidence-based policy change directed towards the attainment of universal health coverage and several of the Sustainable Development Goals. Nursing literature is available to support policy change directed towards the pursuit of universal health coverage and sustainable development goals. Leveraging existing networks of research collaboration to increase research capacity through communities of scholarship or by twinning experienced and neophyte contributors is possible. Further work is needed to equip nurses with the competencies to navigate the policy environment and develop and deliver impactful policy messaging.

Strengthening WASH facilities for the general population to accomplish universal access by 2030

The provision of drinking water, sanitation, and hygiene (WASH) facilities has been identified as one of the important goals required for the attainment of universal health coverage. However, billions of people across the globe are having poor access to water, sanitation, and hygiene (WASH). It is important to note that significant progress has been observed in ensuring access to WASH facilities since the start of the current century; nevertheless, massive gaps and inequalities persist in the field with regard to access, availability, and the quality of the offered services. Another important aspect is that ensuring mere access to these facilities is not enough. The time has come wherein all the concerned stakeholders should commit themselves toward the realization of this essential and fundamental human right. In conclusion, the need of the hour is to minimize the inequality gaps in WASH facilities and that will essentially require a concerted and well-coordinated response from all the stakeholders, including the general population.

Advancing alternative health care financing through effective community partnership: A necessity for universal health coverage in Nigeria

This paper sought to advance alternative health care financing for the attainment of universal health coverage (UHC) in Nigeria considering the widening inequality, dwindling government spending, and non-inclusive health insurance scheme in the country. An adoptive narrative review of existing literature and authors’ experiences and observations of health care financing system was used to develop an overview of health care financing system in Nigeria. The results showed that Nigeria has a long way to go in attaining universal health coverage considering her high burden of disease and low health care expenditure, especially in comparison with Africa and similar countries across the globe. The results further showed that out-of-pocket spending dominates health care expenditure in Nigeria, and that the only way to curb heavy reliance on unsustainable and inequitable health care financing is to encourage risk-pooling of resources. This article therefore argues that alternative health care financing through effective community partnership is a necessity to achieving health for all. This understanding could inform health policies by annexing necessary connections with the promise of extending primary health care to all, especially the vulnerable groups, in a rapidly changing but highly unequal society.

How Can Digital Health Technologies Contribute to Sustainable Attainment of Universal Health Coverage in Africa? A Perspective.

Background: Innovative strategies such as digital health are needed to ensure attainment of the ambitious universal health coverage in Africa. However, their successful deployment on a wider scale faces several challenges on the continent. This article reviews the key benefits and challenges associated with the application of digital health for universal health coverage and propose a conceptual framework for its wide scale deployment in Africa.Discussion: Digital health has several benefits. These include; improving access to health care services especially for those in hard-to-reach areas, improvements in safety and quality of healthcare services and products, improved knowledge and access of health workers and communities to health information; cost savings and efficiencies in health services delivery; and improvements in access to the social, economic and environmental determinants of health, all of which could contribute to the attainment of universal health coverage. However, digital health deployment in Africa is constrained by challenges such as poor coordination of mushrooming pilot projects, weak health systems, lack of awareness and knowledge about digital health, poor infrastructure such as unstable power supply, poor internet connectivity and lack of interoperability of the numerous digital health systems. Contribution of digital health to attainment of universal health coverage requires the presence of elements such as resilient health system, communities and access to the social and economic determinants of health.Conclusion: Further evidence and a conceptual framework are needed for successful and sustainable deployment of digital health for universal health coverage in Africa.

Global governmental and nongovernmental action on dementia

The number of people with dementia is increasing globally, especially in scarce-resource countries. Health-care systems are in danger of becoming overwhelmed by the costs of caring for people with dementia and supporting their family carers. Health professionals including psychiatrists and neurologists in countries across the world have a significant role in the network of health and social services that support dementia care. Dementia care is an integral part of general health care and public health and the attainment of universal health coverage. Support for community workers, family carers and those living with dementia is becoming a priority in high-income as well as scarce-resource countries. In May 2017, the World Health Assembly endorsed the Global action plan on the public health response to dementia 2017–2025. It is a guide for action – for policy-makers, international, regional and national partners, and WHO – in areas such as: increasing awareness of dementia and establishing dementia-friendly initiatives; reducing the risk of dementia; diagnosis, treatment and care; research and innovation; and support for dementia carers. The Lancet Commission on dementia (July 2017) calls on governments to generate updated action plans for dementia along these lines to tackle the impending dementia crisis. Psychiatrists, neurologists and health professionals make an essential contribution to each area of action in the national and local plans, with an emphasis on working in partnerships. They contribute either directly in their clinical consultations with families and those living with dementia, or indirectly through advocacy and partnerships with primary health care and community workers and civil society groups. The presentation will consider how professional associations can best support health professionals in different parts of the world in the needed focus on community-oriented care.

Exploring effectiveness of different health financing mechanisms in Nigeria; what needs to change and how can it happen?

BackgroundVarious attempts to examine health financing mechanisms in Nigeria highlight the fact that there is no single mechanism that fits all contexts and people. This paper sets out findings of an in-depth assessment of different health financing mechanisms in Nigeria.MethodsThe study was undertaken in the Federal Capital territory of Nigeria and two States (Niger and Kaduna). Data were collected through review of government documents, and in-depth interviews of purposively selected respondents. Data analysis was guided by a conceptual framework which draws from various approaches for assessing health financing mechanisms. Data was examined for current practices, what needs to change and how the change can happen.ResultsHealth financing mechanisms in Nigeria do not operate optimally. Allocation and use of resources are neither evidence-based nor results-driven. Resources are not allocated equitably or in a manner that minimizes wastage and improves efficiency. None of the mechanisms effectively protects individuals/households from catastrophic health expenditure. Issues with social health insurance cut across legal frameworks and use of Health Maintenance Organisations (HMOs) as purchasers. The concomitant effect is that attainment of Universal Health Coverage is greatly compromised. In order to improve efficiency of health financing mechanisms, government needs to allocate more funds for purchasing health services; this spending must be based on evidence (strategic), and appropriately tracked. The legislation that established National Health Insurance Scheme should be amended such that social health insurance becomes mandatory for all citizens. Implementation of the latter should be complemented by revision of benefit package, strict oversight and regulation of HMOs.ConclusionIn order to improve health financing in the country, legal and regulatory frameworks need to be revised. Efficient utilization of resources could be improved through strategic purchasing arrangements and strict oversight.

Moving Forward Toward the Attainment of Universal Health Coverage

Moving Forward Toward the Attainment of Universal Health Coverage

Assessing the quality of primary healthcare in seven Chinese provinces with unannounced standardised patients: protocol of a cross-sectional survey

IntroductionPrimary healthcare (PHC) serves as the cornerstone for the attainment of universal health coverage (UHC). Efforts to promote UHC should focus on the expansion of access and on healthcare quality....

Challenges to achieving universal health coverage through community-based health planning and services delivery approach: a qualitative study in Ghana

ObjectiveCommunity-based initiatives have enormous potential to facilitate the attainment of universal health coverage (UHC) and health system development. Yet key gaps exist and threaten its sustainability in many low-income and...

Loss of productivity interfering with the attainment of universal health coverage in African nations

Loss of productivity interfering with the attainment of universal health coverage in African nations

Nonfarm enterprise participation and healthcare expenditure among farm households in rural Ghana

PurposeRural poverty remains high in many developing countries, Ghana inclusive. This has implications for healthcare affordability and utilization, and thus the attainment of universal health coverage. Nonfarm diversification is seen as a means by which rural farm households can increase incomes and smooth consumption including healthcare. The purpose of this paper is to investigate the impact of nonfarm enterprise participation on healthcare expenditure among farm households in rural Ghana.Design/methodology/approachUsing nationally representative household data from the sixth round of the Ghana Living Standards Survey (GLSS 6), the paper employs endogenous switching regression and propensity score matching techniques to account for potential selectivity bias.FindingsResults indicate that households that participate in nonfarm enterprises earn higher incomes and expend more on healthcare. Total household income and region of residence are significant determinants of healthcare expenditure among farm households in rural Ghana. In addition, while in nonfarm enterprise nonparticipating households the marital status of the head of household is important, for participating households the head having at least secondary education significantly influences healthcare expenditure.Practical implicationsPromoting nonfarm activities and hence raising the incomes of households in rural areas of Ghana has the potential of increasing health capital through increased investments in health. It will also positively impact access to and utilization of healthcare and ultimately contribute towards increased farm and non-farm productivity.Originality/valuePrevious studies have only examined the determinants of nonfarm enterprise participation or its impact on household welfare, poverty, inequality, food security and agricultural investments. While evidence abounds on the positive impact of rural nonfarm enterprise participation on household income, which in turn has implications for household health expenditure, the potential positive link between rural nonfarm enterprise participation and household healthcare expenditure remains unexamined.

Progress towards universal health coverage in Myanmar: a national and subnational assessment.

Attainment of universal health coverage is a global health priority. The Myanmar Government has committed to attainment of universal health coverage by 2030, but progress so far has not been assessed. We aimed to estimate national and subnational health service coverage and financial risk protection. We used nationally representative data from the Myanmar Demographic and Health Survey (2016) and the Integrated Household Living Condition Assessment (2010) to examine 26 health service indicators and explored the incidence of catastrophic health payment and impoverishment caused by out-of-pocket payments. We used logistic regression models of inequalities in, and risk factors for, indicators of universal health coverage. Nationally, the coverage of health service indicators ranged from 18·4% (95% CI 14·9-21·9) to 96·2% (95·9-96·5). Coverage of most health services indicators was below the universal health coverage target of 80%. 14·6% (95% CI 13·9-15·3) of households that used health services faced catastrophic health-care payments. 2·0% (95% CI 1·7-2·3) of non-poor households became poor because of out-of-pocket payments for health. Health service coverage and financial risk protection varied substantially by region. Although the richest quintiles had better access to health services than the poorest quintiles, they also had a higher incidence of financial catastrophe as a result of payments for health care. Of the indicators included in the study, coverage of adequate sanitation, no indoor use of solid fuels, at least four antenatal care visits, postnatal care for mothers, skilled birth attendance, and institutional delivery were the most inequitable by wealth quintile. Attainment of universal health coverage in Myanmar in the immediate future will be very challenging as a result of the low health service coverage, high financial risk, and inequalities in access to care. Health service coverage and financial risk protection for vulnerable, disadvantaged populations should be prioritised. Japanese Ministry of Health, Labour and Welfare, Ministry of Education, Culture, Sports, Science and Technology of Japan.

Proceedings of the first African Health Forum: effective partnerships and intersectoral collaborations are critical for attainment of Universal Health Coverage in Africa

BackgroundUniversal Health Coverage (UHC)is central to the health Sustainable Development Goals(SDG). Working towards UHC is a powerful mechanism for achieving the right to health and promoting human development which is a priority area of focus for the World Health Organization WHO. As a result, the WHO Regional Office for Africa convened the first-ever Africa Health Forum, co- hosted by the government of Rwanda in Kigali in June 2017 with the theme “Putting People First: The Road to Universal Health Coverage in Africa”. The Forum aimed to strengthen and forge new partnerships, align priorities and galvanize commitment to advance the health agenda in Africa in order to attain UHC and the SDGs. This paper reports the proceedings and conclusions of the forum.MethodsThe forum was attended by over 800 participants. It employed moderated panel and public discussions, and side events with political leaders, policy makers and technicians from ministries of health and finance, United Nations agencies, the private sector, the academia, philanthropic foundations, youth, women and non-governmental organizations drawn from within and outside the Region.ConclusionsThe commitment to achieve UHC was a collective expression of the belief that all people should have access to the health services they need without risk of financial hardship. The attainment of UHC will require a significant paradigm shift, including development of new partnerships especially public-private partnerships in selected areas with limited government resources, intersectoral collaboration to engage in interventions that affect health but are outside the purview of the ministries in charge of health and identification of public health issues where knowledge gaps exist as research priorities. The deliberations of the Forum culminated into a “Call-to-Action” – Putting People First: The Road to Universal Health Coverage in Africa, which pledged a renewed determination for Member States, in partnership with the private Sector, WHO, other UN Agencies and partners to support the attainment of the SDGs and UHC. There was agreement that immediate action was required to implement the call-to-action, and that the African Regional Office of WHO should develop a plan to rapidly operationalize the outcomes of the meeting.