Goal Of Universal Health Coverage Research Articles

Experiences of seeking healthcare across the border: lessons to inform upstream policies and system developments on cross-border health in East Africa

ObjectivesThis study explored the experiences of accessing care across the border in East Africa.ParticipantsFrom February to June 2018, a cross-sectional study using qualitative and quantitative methods was conducted among 279...

Effect of mobile application user interface improvements on minimum expected home visit coverage by community health workers in Mali: a randomised controlled trial

BackgroundProactive community case management (ProCCM) has shown promise to advance goals of universal health coverage (UHC). ProCCM community health workers (CHWs) face operational challenges when pursuing their goal of visiting...

Integrated and People-centred Hospital toward Universal Health Coverage in WHO- European Countries.

Background: Ensuring integrated people-centred health services (IPCHS) that offer universal access, social equity, and financial protection within a primary health care method is important toward universal health coverage and health sustainable development goals. Hospitals are part of this ambitious agenda. The purpose is to review the health system and to list and summarize hospital interventions. Methods: Document review. As part of our review, we selected health systems reports for conceptualizing IPCHS frameworks at the country level as well as those focusing on the hospital sector. Our research team collected and analyzed data including governance, financing, human resource, provision service, and reforms based on the health system report of 14 countries. Results: The review showed 26 challenges, most of which were in Eastern European countries, with 48 interventions in 3 themes and 13 subthemes. Conclusion: Due to the paradigm shift, there is a need for change. However, a much better positive view is needed to determine the role of hospitals in the service delivery system. The IPCHS framework provides guidance for countries in setting priorities, and formulating, implementing, and evaluating national policy/strategic plans for their hospital sector. Although the vision and interventions should be adapted to local context, different policy instruments may be needed to specifically tackle the most pressing local issues. Recognizing differences in countries’ contexts will help to develop realistic and applicable solutions.

How West African countries prioritize health

BackgroundThe goal of Universal Health Coverage (UHC) is to ensure that everyone is able to obtain the health services they need without suffering financial hardship. UHC remains a mirage if government health expenditure is not improved. Health priority refers to general government health expenditure as a percentage of general government expenditure. It indicates the priority of the government to spend on healthcare from its domestic public resources. Our study aimed to assess health priorities in the Economic Community of West African States (ECOWAS) using the health priority index from the WHO’s Global Health Expenditure Database.MethodWe extracted and analysed data on health priority in the WHO’s Global Health Expenditure Database across the 15 members of the ECOWAS (Benin, Burkina Faso, Cabo Verde, Cote d'Ivoire, The Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone, and Togo) from 2010 to 2018 to assess how these countries prioritize health. The data are presented using descriptive statistics.ResultsOur findings revealed that no West African country beats the cutoff of a minimum of 15% health priority index. Ghana (8.43%), Carbo Verde (8.29%), and Burkina Faso (7.60%) were the top three countries with the highest average health priority index, while Guinea (3.05%), Liberia (3.46%), and Guinea-Bissau (3.56%) had the lowest average health priority in the West African region within the period of our analysis (2010 to 2018).ConclusionOur study reiterates the need for West African governments and other relevant stakeholders to prioritize health in their political agenda towards achieving UHC.

Health Sector Resource Mapping in Malawi: Sharing the Collection and Use of Budget Data for Evidence-Based Decision Making.

In 2011, the Ministry of Health in Malawi developed and institutionalized a resource-tracking process, known as resource mapping (RM), to collect information on planned funding flows across the health sector to support resource allocation and mobilization decisions. We analyze the RM process and tools and describe key uses of the data for health financing decision making to achieve universal health coverage (UHC). We applied a case study approach, written as a collaboration between policy makers who have led the RM process in Malawi and the implementation team who have developed tools, collected data, and reported results over the period. It draws on our experiences in conducting RM in Malawi to document the RM process and data, key uses of data, implementation challenges, and lessons learned. We conducted a gray literature review to understand rounds of RM in which we did not participate. Finally, we conducted a search of published literature to situate our work in the international health resource-tracking literature. The RM exercise in Malawi is iteratively designed around the needs of the end users and policy priorities of the government, which in turn drives institutionalization of the exercise. We describe 4 ways in which RM data has been used, including national and district planning and budgeting; prioritization and coordination of existing funds by estimating resource availability; mobilization of new resources by conducting financial gap analysis against costed national strategic plans; and generation of evidence to support the national response to the coronavirus disease 2019 pandemic. To achieve UHC goals in Malawi, RM has equipped the government and development partners with critical data used for resource mobilization and coordination decisions. Lessons learned from RM in Malawi may be applicable to other countries starting or refining their own health resource-tracking exercise.

Disparities in end-of-life outcomes among advanced cancer patients in Sri Lanka: Results from the APPROACH study.

A Universal Health Coverage goal is to provide access to affordable palliative care to reduce disparities in end-of-life (EOL) outcomes. To assess progress toward this goal in Sri Lanka, our primary aim was to systematically assess differences in patients' physical, psychological, social and spiritual outcomes, and their perceived quality of care by their socioeconomic status (SES). As part of the multi-country APPROACH (Asian Patient Perspectives Regarding Oncology Awareness, Care and Health) study, we surveyed 199 patients with a stage IV solid malignant tumor and aged >21 years from the largest government cancer hospital in Sri Lanka. We assessed their physical (physical and functional well-being, symptom burden), psychological (anxiety, depression, emotional well-being), social (social well-being), and spiritual outcomes and perceived quality of care (physician communication, nursing care, and coordination/responsiveness). Low SES patients reported significantly lower physical and functional well-being, emotional well-being, spiritual well-being including meaning/peace and faith; and significantly higher symptom burden, anxiety and depressive symptoms compared with patients from high SES (p < 0.05 for all outcomes). Results have implications regarding reducing barriers in access to appropriate palliative care and EOL care services to stage IV cancer patients from low SES in Sri Lanka.

Using the workload indicators of staffing need method to determine the staffing requirements for primary healthcare service delivery in Nigeria

Background Weak health governance mechanisms and inequitable distribution of health investments exist in Nigeria, and this is negatively affecting the health system, and health workforce availability and performance. This is evident at the primary level of care and necessitates the need to ensure that staffing levels are informed by workloads. Methods This study applied the workload indicators of staffing need (WISN) method to determine the staffing requirements for nurses, midwives, community health officers (CHO), community health extension workers (CHEWS), and junior community health extension workers (JCHEWS). It was conducted in 11 purposefully selected primary-level health facilities in two local government areas in Cross River State, Nigeria. Results Eighteen health service activities were identified for the primary level of care across the life course. Whilst nurses, midwives, CHO and CHEWS perform all the activities, the JCHEWS performed 10 of these functions. The staffing requirement findings for the facilities in Calabar Municipal indicated that there were staffing shortages for nurses and midwives in 4 of the 5 sampled facilities, three facilities had sufficient or excess numbers of CHO/CHEWS, and 4 facilities had sufficient or excess numbers of JCHEWS. In Calabar South local government area, the calculated requirement showed a cumulative shortage of 5 nurses/midwives and 26 CHO/CHEW, and appropriate staffing of JCHEWS in 4 facilities. Conclusions The results of this study illustrate the staffing needs of nurses, midwives, CHO, CHEWS and JCHEWS in the sampled facilities and indicate the need for using evidence for staffing decisions. This is pertinent considering it ultimately contribute to improvements in service delivery and health indices. The evidence from the application of the WISN tool and the scale-up of its application has the potential of contributing to the achievement of national goals as well as universal health coverage and sustainable development goals.

Academic service-learning nursing partnerships in the Americas: a scoping review

BackgroundAcademic service-learning nursing partnerships (ASLNPs) integrate instruction, reflection, and scholarship with tailored service through enriched learning experiences that teach civic responsibility and strengthen communities, while meeting academic nursing outcomes. Objective: This scoping review aimed to identify, appraise, and synthesize evidence of community focused ASLNPs that promote primary health care throughout the Americas region.MethodsA systematic search of PubMed, CINAHL, Scopus, Google Scholar, and LILACS English-language databases was performed in accordance with PRISMA guidelines. Full-text articles published since 2010 were reviewed using an inductive thematic approach stemming from the “Advancing Healthcare Transformation: a New Era for Academic Nursing Report” and the Pan American Health Organization “Strategic Directions for Nursing.”ResultsA total of 51 articles were included with the vast majority 47 (92.1 %) representing North America. Structured, established relationships between an academic nursing institution or program and one or more community serving entities resulted in high levels of effectiveness and innovation across settings. Five themes emerged: (a) sustaining educational standards and processes - improving academic outcomes (25.5 %), (b) strengthening capacity for collaborative practice and interprofessional education (13.7 %), (c) preparing nurses of the future (11.8 %), (d) enhancing community services and outcomes (21.6 %), and (e) conceptualizing or implementing innovative academic nursing partnerships (27.4 %). A synthesis of conceptual frameworks and models revealed six focus areas: communities/populations (26.2 %), nursing (26.2 %), pedagogy (19 %), targeted outreach (14.3 %), interprofessional collaboration (11.9 %), and health determinants (9.5 %). A proliferation in US articles, triggered by nursing policy publications, was confirmed.ConclusionsASLNPs serve as mechanisms for nurses and faculty to develop and lead change across a wide variety of community settings and healthcare systems, develop scholarship, as well as for students to apply the knowledge and skills learned. Given the lack of geographically broad evidence, successes and challenges across U.S. partnerships should be viewed cautiously. Nevertheless, ASLNPs can play a critical role towards meeting the goal of universal health access and coverage through partnering with the education sector. Further investigation of grey literature as well as Spanish and Portuguese language literature from Latin American and Caribbean countries is highly recommended.

Individual and Contextual Factors Associated With Maternal and Child Health Essential Health Services Indicators: A Multilevel Analysis of Universal Health Coverage in 58 Low- and Middle-Income Countries.

Universal health coverage (UHC) is part of the global health agenda to tackle the lack of access to essential health services (EHS). This study developed and tested models to examine the individual, neighbourhood and country-level determinants associated with access to coverage of EHS under the UHC agenda in low- and middle-income countries (LMICs). We used datasets from the Demographic and Health Surveys (DHSs) of 58 LMICs. Suboptimal and optimal access to EHS were computed using nine indicators. Descriptive and multilevel multinomial regression analyses were performed using R and STATA. The prevalence of suboptimal and optimal access to EHS varies across the countries, the former ranging from 5.55% to 100%, and the latter ranging from 0% to 90.36% both in Honduras and Colombia, respectively. In the fully adjusted model, children of mothers with lower educational attainment (relative risk ratio [RRR] 2.11, 95% credible interval [CrI] 1.92 to 2.32) and those from poor households (RRR 1.79, 95% CrI 1.61 to 2.00) were more likely to have suboptimal access to EHS. Also, those with health insurance (RRR 0.72, 95% CrI 0.59 to 0.85) and access to media (RRR 0.59, 95% CrI 0.51 to 0.67) were at lesser risk of having suboptimal EHS. Similar trends, although in the opposite direction, were observed in the analysis involving optimal access. The intra-neighbourhood and intra-country correlation coefficients were estimated using the intercept component variance; 57.50%% and 27.70% of variances in suboptimal access to EHS are attributable to the neighbourhood and country-level factors. Neighbourhood-level poverty, illiteracy, and rurality modify access to EHS coverage in LMICs. Interventions aimed at achieving the 2030 UHC goals should consider integrating socioeconomic and living conditions of people.

Future Challenges of Nursing in Health System of Iran.

Purpose: Nursing development is considered as one of the most important ways to achieve the universal health coverage and sustainable development goals in different countries. Nursing in Iran has the potential to provide services at all levels of universal health coverage. Therefore, planning for nursing in Iran needs to recognize the future challenges. This study aims to explore the future challenges of nursing in the health system of Iran from the perspective of nursing experts.Methods: In this qualitative study, 11 semi-structured interviews were conducted with nursing experts by purposive sampling in 2017–2018. Interviews were recorded and transcribed and framework analysis method was used to analysis the data.Results: The results showed that a favorable future requires planning in three areas of nursing “governance challenges” including centralized nursing stewardship, policy-making and legislation, monitoring and evaluation, and cooperation and communication with other institutions, “inadequacy of professional development with social demands” including community-based nursing, nursing upgrades with disease patterns, expanding home care, expanding care centers, and use of technology, “human resource challenges “including nursing education tailored to the needs of the community, empowering nursing managers, recruiting and retaining nurses, and specialized nursing.Conclusions: A favorable future requires a coherent nursing government, professional development of nursing based on social demands, and enhancing human resources in line with the emerging needs of the future.

Achieving Universal Health Coverage as a Goal of Vietnam’s Socio-Economic Development

Aim.The presented study aims to analyze and identify the “bottlenecks” Vietnam may face on the way to achieving the goal of universal health coverage of the country’s population.Tasks.The authors analyze the situation regarding the implementation of sustainable development goals in terms of ensuring the availability of health services; assess the situation regarding the availability of health services in Vietnam; assess the potential of health insurance to achieve universal health coverage as a goal of Vietnam’s socio-economic development.Methods.This study uses statistical, empirical, and comparative analysis.Results.Achieving the goal of universal health coverage in the country requires more than just financing health care. It reflects the importance of ensuring equal access to quality health services and enforcing the right to health, especially for vulnerable groups. The authors analyze population coverage, the organization of the financing system, and the cost of medical care for households. Funding for health programs in Vietnam is increasing. However, due to the enduring poverty in the country, households spending a large share of their own funds on health services, and the number of challenges associated with the COVID-19 new coronavirus pandemic, there is still a risk of not achieving the goal of universal coverage in the near term.Conclusions.To achieve the set goal, Vietnam needs to introduce effective mechanisms of compulsory and voluntary health insurance (VHI). This additional financial protection is seen as a way to enable more people to use the necessary services without the risk of catastrophic health care costs, thus effectively approaching the goal of universal health coverage for the citizens of the Socialist Republic of Vietnam (SRV).

Performance assessment of the county healthcare systems in Kenya: a mixed-methods analysis

IntroductionA well performing public healthcare system is necessary for Kenya to continue progress towards universal health coverage (UHC). Identifying actionable measures to improve the performance of the public healthcare system...

PNS72 Charting the Progress of HTA in Asia: Are We Ready for Evidence Based Decision-Making?

This paper provides an update on the growing use of HTA in Asia and lessons for other countries seeking to advance HTA. This paper builds upon the research by Chootipongchaivat et al and the World Health Organization (WHO) identifying 18 “factors conducive to the development of HTA in Asia”. These factors were used to create a balanced scorecard to assess the progress of HTA. The authors scored the progress against each of the factors made in China, India, Indonesia, Malaysia, Philippines, South Korea, Taiwan, Thailand, and Vietnam. A scoring system on a scale of 1 to 5 was used wherein: 1=No progress on milestone; 2=milestone at early stages, ad hoc HTA use; 3=progress on milestone, routine HTA but limited impact; 4 = significant progress on milestone, routine HTA use but limited remit; and 5 = significant progress on milestone, routine HTA use that informs several decisions. Total scores indicated progress of HTA while milestone scores provided contextual insights within countries. A literature review and expert interviews were used to complete scorecards. South Korea and Thailand had highest scores of 73 and 71 points respectively, while Vietnam scored lowest at 28.5. Advanced HTA programs, such as Thailand and South Korea, have independent HTA agencies with a broad remit, explicit process and methods, network of researchers, and routine use of HTA. Countries like Taiwan and Malaysia fall in a middle tier, with established HTA programs with limited remit. The final tier consists of countries like China, India, Indonesia, Philippines, and Vietnam, emerging HTA processes. Universal Health Coverage (UHC) goals have catalyzed expansion of HTA. However, political will, technical expertise, and sustained financing remain challenges for sustainable HTA programs. While legislation supporting HTA is helpful, political will is key. Authors provide recommendations on areas for additional investments and opportunities for regional collaboration.

'It was quite a shock': A qualitative study of the impact of organisational and personal factors on newly qualified nurses' experiences.

To explore how newly qualified nurses' work experiences are constructed through the interplay between self, workplace and home-life influencing their retention. Nurses are critical to achieving the goal of universal health coverage. However, shortages of nursing staff are endemic. Of particular concern, newly qualified nurses are more likely to leave the nursing workforce. The point of transition to working as a newly qualified nurse is a time of vulnerability. Most studies attempt to discover why nurses leave. This study uses the concept of job embeddedness to examine the experience of this transition and first two years of practice to understand what might help newly qualified nurses stay. Qualitative approach using semi-structured telephone interviews. Self-selecting sample of nurses (n=23) who participated 1-year (n=12) and 2 years (n=11) post-qualification. Participants were part of a larger longitudinal cohort (n=867) study which has followed them since September 2013 when they entered nurse education in two Scottish universities. Thematic analysis was used to understand the interplay between organisation/workplace and the individual. Three themes were developed: transition shock; workplace factors and work/life balance. Two further subthemes were developed: experience of support and belonging; and feeling unsupported and alienated. Eight participants had changed job or left, and two were looking to leave nursing. This study highlights how the experience of transition shock can be positively or negatively impacted by the workplace environment, and how in turn this impacts the home environment. Ultimately, this impacts retention of newly qualified nurses. Having adequate support resources, such as staffing, supportive team morale, professional development and family-friendly work environment, can create a work environment where they feel the purpose and meaningfulness of working as a nurse. This 'job embeddedness' can potentially enhance nurse retention. Reporting follows the COREQ checklist.

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.

Managing Health at District Level: A Framework for Enhancing Programme Implementation in India

COVID-19 pandemic has brought to the fore the need for a strong health system for the social protection of people and to improve health programme implementation in the coming years. India has made great progress in health over the past 50 years; however, despite the progress made, it is faced with several challenges. While infectious diseases remain an unfinished agenda, chronic non-communicable diseases (NCDs) are rising and are now the leading cause of mortality in the country. This is further compounded by the prevailing inequalities in access to quality health care among population groups including those living in remote rural areas. To achieve Universal Health Coverage and Sustainable Development Goals by 2030, India in 2017 revised its National Health Policy and committed itself to attain the highest possible level of good health and well-being, through preventive and promotive health interventions. While policies are enunciated and plans are formulated, the implementation at ground level is at best tardy and lack lustre As an administrative unit for programme implementation, a district has a key role to play in implementing national programmes and in delivery of basic health services to the people. They are strategically placed to plan, organise and lead efforts meant to deliver primary health care services through better management of existing resources and by fully engaging all relevant stakeholders in contributing towards achievement of national health goals and in responding to a public health emergency such as Covid-19. Planning and managing health problems need an improved and responsive health governance. Strategic planning, monitoring and evaluation require integration and coordination of various health programmes including dealing with health crises, fostering inter-sectoral involvement and engagement of the community as a key actor. Efforts are needed to ensure that services reach the most vulnerable and marginalised sections of the society. Adequate governance support at district level through a whole-of-society approach is essential to bridge the health inequities and ensure equitable access to health services.

Towards universal health coverage in the WHO African Region: assessing health system functionality, incorporating lessons from COVID-19

The move towards universal health coverage is premised on having well-functioning health systems, which can assure provision of the essential health and related services people need. Efforts to define ways...

The challenges of payment for performance under Brazil's PMAQ

In 2020, the Brazilian Unified Health System (Sistema Único de Saúde; SUS) celebrated 30 years. However, adequate government funding allocation to continue supporting SUS's universal health coverage goal remains a challenge to be addressed.1 Payment for performance (P4P) was the strategy proposed to strengthen primary health care with the implementation of Brazil's National Programme for Improving Primary Care Access and Quality (PMAQ), a federal public policy that started in 2011, with three rounds completed in 2019.

Optimizing Myanmar\u2019s community-delivered malaria volunteer model: a qualitative study of stakeholders\u2019 perspectives

BackgroundIn parallel with the change of malaria policy from control to elimination and declines in the malaria burden in Greater Mekong Sub-region, the motivation and social role of malaria volunteers has declined. To address this public health problem, in Myanmar, the role and responsibilities of malaria volunteers have been transformed into integrated community malaria volunteers (ICMV), that includes the integration of activities for five additional diseases (dengue, lymphatic filariasis, tuberculosis, HIV/AIDS and leprosy) into their current activities. However, this transformation was not evidence-based and did not consider inputs of different stakeholders. Therefore, qualitative stakeholder consultations were performed to optimize future malaria volunteer models in Myanmar.MethodsSemi-structured interviews were conducted with key health stakeholders from the Myanmar Ministry of Health and Sports (MoHS) and malaria implementing partners to obtain their perspectives on community-delivered malaria models. A qualitative descriptive approach was used to explore the experiences of the stakeholders in policymaking and programme implementation. Interview topic guides were used during the interviews and inductive thematic data analysis was performed.ResultsWhile ICMVs successfully provided malaria services in the community, the stakeholders considered the ICMV model as not optimal and suggested that many aspects needed to be improved including better training, supervision, support, and basic health staff’s recognition for ICMVs. Stakeholders believe that the upgraded ICMV model could contribute significantly to achieving malaria elimination and universal health care in Myanmar.Discussion and conclusionIn the context of high community demand for non-malaria treatment services from volunteers, the integrated volunteer service package must be developed carefully in order to make it effective in malaria elimination programme and to contribute in Myanmar’s pathway to universal health coverage (UHC), but without harming the community. An evidenced-based, community-delivered and preferred model, that is also accepted by the MoHS, is yet to be developed to effectively contribute to achieving malaria elimination and UHC goals in Myanmar by 2030.

Community demand for comprehensive primary health care from malaria volunteers in South-East Myanmar: a qualitative study

BackgroundMalaria volunteers have contributed significantly to malaria control achieving a reduction of annual parasite incidence to pre-elimination levels in several townships across Myanmar. However, the volunteers’ role is changing as Myanmar transitions from a malaria control to elimination programme and towards the goal of universal health coverage. The aim of the study is to explore the perspectives of community leaders, members and malaria volunteers in South-East Myanmar on community-delivered models to inform an optimal design that targets malaria elimination in the context of primary health care in Myanmar.MethodsQualitative methods including focus group discussions (FGDs) with community members and current or ex-malaria volunteers, and participatory workshops with community leaders were conducted. All data collection tools were pilot tested with similar participants. The FGDs were stratified into male and female participants in consideration of diverse gender roles among the ethnic groups of Myanmar. Data saturation was the key cut-off point to cease recruitment of participants. Inductive thematic analysis was used.ResultsCommunity members were willing to be tested for malaria because they were concerned about the consequences of malaria although they were aware that malaria prevalence is low in their villages. Malaria volunteers were the main service providers for malaria and other infectious diseases in the community. Apart from malaria, the community identified common health problems such as the flu (fever, sneezing and coughing), diarrhoea, skin infections and tuberculosis as priority diseases in this order. Incorporating preventive, and whenever possible curative, services for those diseases into the current malaria volunteer model was recommended.Discussion and conclusionThere was a gap between the communities’ expectations of health services and the health services currently being delivered by volunteers in the community that highlights the need for reassessment and reform of the volunteer model in the changing context. An evidence-based, community preferred, pragmatic community-delivered integrated model should be constructed based on the context of malaria elimination and progressing towards universal health coverage in Myanmar.