Part Of Universal Health Coverage Research Articles

Is economic growth enough to propel rehabilitation expenditures? An empirical analysis of country panel data and policy implications

PurposeRehabilitation is a set of services designed to increase functioning and improve wellbeing across the life course. Despite being a core part of Universal Health Coverage, rehabilitation services often receive limited public expenditure, especially in lower income countries. This leads to limited service availability and high out of pocket payments for populations in need of care. The purpose of this research was to assess the association between macroeconomic conditions and rehabilitation expenditures across low-, middle-, and high-income countries and to understand its implications for overall rehabilitation expenditure trajectory across countries.Materials and methodsWe utilized a panel data set from the World Health Organization’s Global Health Expenditure Database comprising the total rehabilitation expenditure for 88 countries from 2016 to 2018. Basic macroeconomic and population data served as control variables. Multiple regression models were implemented to measure the relationship between macroeconomic conditions and rehabilitation expenditures. We used four different model specifications to check the robustness of our estimates: pooled data models (or naïve model) without control, pooled data models with controls (or expanded naïve model), fixed effect models with all controls, and lag models with all controls. Log-log specifications using fixed effects and lag-dependent variable models were deemed the most appropriate and controlled for time-invariant differences.ResultsOur regression models indicate that, with a 1% increase in economic growth, rehabilitation expenditure would be associated with a 0.9% and 1.3% increase in expenditure. Given low baseline levels of existing rehabilitation expenditure, we anticipate that predicted increases in rehabilitation expenditure due to economic growth may be insufficient to meet the growing demand for rehabilitation services. Existing expenditures may also be vulnerable during periods of economic recession.ConclusionThis is the first known estimation of the association between rehabilitation expenditure and macroeconomic conditions. Our findings demonstrate that rehabilitation is sensitive to macroeconomic fluctuations and the path dependency of past expenditures. This would suggest the importance of increased financial prioritization of rehabilitation services and improved institutional strengthening to expand access to rehabilitation services for populations.

Global oral health initiative: World Health Organization strategic action plan.

Dentistry today is a profession which is facing several challenges: -Oral health is less good than thirty years ago, especially in thelow social-economic level countries and emerging countries. -A reduced or poorly distributed number of professionals, which necessarily implies unequal access to care. -Multiple social determinants which are more and more impacting oral health. To tackle these challenges, WHO launched the WHO Global Oral Health strategy which it goal is to guide Member States to: -develop ambitious national responses to promote oral health -reduce oral diseases, other oral conditions and oral health inequalities -strengthen efforts to address oral diseases and conditions as part of universal health coverage; and consider the development of targets and indicators, based on national and subnational contexts, building on the guidance to be provided by the WHO global action plan 2023-2030 on oral health.

Service guidelines, models, and protocols for integrating rehabilitation services in primary healthcare in Brazil, Russia, India, China, and South Africa: a scoping review

Purpose The WHO emphasises that rehabilitation services must be integrated into primary healthcare as an inherent part of universal health coverage. However, there is limited research on the integration of rehabilitation services in primary healthcare in low- and middle-income countries. The purpose of this paper is to identify and describe the literature on service guidelines, models, and protocols that support the integration of rehabilitation services in primary healthcare in the BRICS countries (Brazil, Russia, India, China, and South Africa). Methods A scoping review guided by Arksey and O’Malley’s framework was conducted. Structured database and website searches identified published and unpublished records from 2010, which were subjected to eligibility criteria. Mendeley, JBI SUMARI, and Microsoft Excel were used to extract and synthesise the data. Results The search strategy identified 542 records. Thirty-two records met the inclusion criteria. Shared care and community-based rehabilitation were the most reported practice models, and the implementation of the models, guidelines, and protocols was mostly described in mental health services. Conclusion This review discusses BRICS countries’ rehabilitation service guidelines, models, and protocols for primary healthcare integration and implementation challenges. Rehabilitation professionals should rethink, realign, and apply existing models because of the lack of primary healthcare integration directives.

Advancing the World Health Assembly's landmark Resolution on Strengthening Rehabilitation in Health Systems: unlocking the Future of Rehabilitation.

In May 2023, the historic Resolution on Strengthening Rehabilitation in Health Systems was adopted unanimously by the 194 Member States of the World Health Assembly (WHA), the highest health policy-setting body. The resolution aims to scale up and integrate rehabilitation into health systems as part of Universal Health Coverage (UHC) to address the growing rehabilitation needs due to the global ageing population, the increasing prevalence of non-communicable diseases, and the emergence of new infectious diseases such as COVID-19. Globally, data extracted from the Global Burden of Disease Study in 2019 showed that one out of three people could benefit from rehabilitation, while more than half of the population in many countries is not receiving essential rehabilitation services. This special article highlights the global challenges in meeting rehabilitation needs and emphasizes the importance of affordable, accessible, and quality rehabilitation services for vulnerable populations. The resolution's path, which started in 2017 with the "Rehabilitation 2030: a Call for Action" initiative by the World Health Organization (WHO), is outlined. We summarize the key aspects of the WHA resolution, including its requests for Member States, international organizations, and the WHO Director-General. Finally, we discuss the way forward towards implementation, involving advocacy and concrete actions by all stakeholders, with the support of the newly established World Rehabilitation Alliance. The goal is to integrate rehabilitation into health systems worldwide, thus improving the well-being and socio-economic participation of those in need.

Developing Standard Treatment Workflows-way to universal healthcare in India.

Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80-90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC.

Healthier mind builds healthier nation under ABArK

Background: The State of Karnataka launched a scheme called “Arogya Karnataka” as a part of universal health coverage following the Karnataka Integrated Public Health Policy 2017 and Karnataka Vision 2025 document. With the goal of achieving universal health coverage (UHC), Karnataka, a national leader in healthcare, launched the Arogya Karnataka scheme in March 2018. It was later integrated with the government of India's national health protection scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana(AB-PMJAY) to help with financial protection. Mental health, as defined by the World Health Organization (WHO), refers to “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. Methods: A cross-sectional analysis of data collected from the State Health Agency, Suvarna Arogya Suraksha Trust (SAST) portal. The study was conducted for a period 12 months from January to December 2022. Results: The study included 7292 mental disorder patients, majority of were male (70.95%), having age group of 31-45 years (45.41%), and belonged to the Below poverty line (BPL) (94.54%). Majority of cases were psychoactive substance use (64%) followed by Schizophrenia (22%) and Mental Retardation (14%). Conclusions: Ayushman Bharat –PM-JAY Arogya Karnataka (AB-PMJAY ArK) has potential to reduce the out of pocket expenditure, distress financing and reduce catastrophic health expenditure which will lead to significant impact on health indices.

Identifying Patient Perceptions of Inequality in Public Health Care Services: Evidence From a Single Indian Administrative District.

Assessment of patient experiences is an essential step to revamp patient-centered care and identify systemic effectiveness as part of universal health coverage. This paper analyzes the variation of health care at different levels of the public health care system in India by measuring patients' experience with the care they have received in the Alipurduar district of India. From May 2021 to April 2022, stratified sampling technique was applied to collect primary data from 450 patients having different health problems from different levels of the public health care system. In addition, Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results were used to evaluate patient experience, with the reliability of questions measured by Cronbach's alpha. Collected data were categorized with the help of exploratory factor analysis; after which, analysis of variance and post-hoc tests were applied to understand specific variations in patient experiences. This study identified that the services delivered in the health centers were not suitable (6.160 out of 10) to fulfill the needs of the patients. Among the three domains of health care services - namely, proficiency, tangibility, and information - the experience of patients significantly varied (P<0.001) when comparing primary, secondary, and tertiary levels of the public health care system. Patients receiving services from the centers under the tertiary level have expressed lesser satisfaction than those patients who have received care at primary or secondary levels because of excessive patient load, inadequate manpower, and other infrastructure deficits at the tertiary level.

A Financing Strategy to Expand Surgical Health Care.

Despite an evolving need to provide surgical health care globally, few health systems, particularly in low-income and middle-income countries (LMICs), can sufficiently provide such care. The vast majority of the world's people-an estimated 5 billion-are unable to access safe and affordable surgical health care when they need it. This is a significant concern for global public health because the demand for these services is rising with the epidemiological and demographic transitions occurring worldwide. A principal driver of weak surgical health care services is a lack of adequate health system financing for surgical health care. This article examines the financing of surgical health care by analyzing global trends in health system financing, approaches to expand fiscal space for health, and empirical perspectives on the design, introduction, and scale-up of policies to improve surgical systems. We describe a surgical health care financing strategy, together with broader political and economic considerations, to provide policy recommendations to fund the expansion of surgical health care and an essential surgical package as part of universal health coverage in LMICs.

Indicators of integrating oral health care within universal health coverage and general health care in low-, middle-, and high-income countries: a scoping review

BackgroundThe World Health Organization (WHO) has recently devoted special attention to oral health and oral health care recommending the latter becoming part of universal health coverage (UHC) so as to reduce oral health inequalities across the globe. In this context, as countries consider acting on this recommendation, it is essential to develop a monitoring framework to measure the progress of integrating oral health/health care into UHC. This study aimed to identify existing measures in the literature that could be used to indicate oral health/health care integration within UHC across a range of low-, middle- and high-income countries.MethodsA scoping review was conducted by searching MEDLINE via Ovid, CINAHL, and Ovid Global Health databases. There were no quality or publication date restrictions in the search strategy. An initial search by an academic librarian was followed by the independent reviewing of all identified articles by two authors for inclusion or exclusion based on the relevance of the work in the articles to the review topic. The included articles were all published in English. Articles concerning which the reviewers disagreed on inclusion or exclusion were reviewed by a third author, and subsequent discussion resulted in agreement on which articles were to be included and excluded. The included articles were reviewed to identify relevant indicators and the results were descriptively mapped using a simple frequency count of the indicators.ResultsThe 83 included articles included work from a wide range of 32 countries and were published between 1995 and 2021. The review identified 54 indicators divided into 15 categories. The most frequently reported indicators were in the following categories: dental service utilization, oral health status, cost/service/population coverage, finances, health facility access, and workforce and human resources. This study was limited by the databases searched and the use of English-language publications only.ConclusionsThis scoping review identified 54 indicators in a wide range of 15 categories of indicators that have the potential to be used to evaluate the integration of oral health/health care into UHC across a wide range of countries.

The roles and experiences of informal carers providing care to people with advanced cancer in Africa-A systematic review and critical interpretive analysis.

There is an increasing prevalence of cancer in Africa with approximately 80% of cancers diagnosed at an advanced stage. High out-of-pocket healthcare costs and overstretched health systems lead to heavy reliance on informal carers for cancer care. This study aims to explore the roles and experiences of informal carers including the impact of cancer care on individuals and communities and support available for carers. We carried out a systematic review following PRISMA reporting guidelines and used critical interpretative synthesis to identify themes and develop an informal carers' experience framework. We searched nine databases and screened 8,123 articles from which 31 studies were included in the review. Most studies were from Sub-Saharan Africa (29/31, 94%), particularly Uganda (9, 29%). Carers were mostly women, aged 30-40 years, and siblings, spouses, or children. Caring roles included care coordination, fundraising, and emotional support. Caring was time-consuming with some carers reporting 121 hours/week of caring, associated with the inability to pursue paid work and depression. Four themes demonstrated carers' experiences: 1) intrapersonal factors: strong sense of familial obligation, and grappling with gender roles, 2) interpersonal factors: impact of a cancer diagnosis on households, changing social and sexual relationships, 3) community factors: navigating cultural norms on nature and location of care, and 4) health system influences: barriers to accessing healthcare services, and tensions between traditional and biomedical medicine. These themes aligned with Bronfenbrenner's social ecological model which aided our development of a framework for understanding informal carers' experiences'. Our review highlights multifaceted roles and experiences of informal carers in Africa, amidst cultural and community impacts. Carers experience a strong obligation and willingly undertake the role of carer, but at the expense of their social, economic, and psychological wellbeing. Support for carers, including flexible working hours/ carers' allowance, should be incorporated as part of universal health coverage.

&lt;i&gt;Corrigendum to&lt;/i&gt;: Is Australia&amp;#x2019;s lack of national clinical leadership hampering efforts with the oral health policy agenda?

The landmark 2021 Resolution on Oral Health by the 74th World Health Assembly has elevated the importance of oral health into the global health policy agenda. This has led to the development and adoption of the World Health Organization (WHO) Global Strategy on Oral Health in 2022. It acknowledged the need to integrate oral health as part of universal health coverage (UHC), which is supported by national clinical leadership for oral health. Although Australia is a signatory WHO member state, it is yet to appoint a Commonwealth Chief Dental Officer to provide national clinical leadership. This commentary provides a background on the current issues on population oral health in Australia, an insight into the Australian oral healthcare system, and explores some of the challenges and learnings related to previous Commonwealth dental programs. This paper highlights why expertise in dental public health is required to steer national oral health policy that is focused on prevention and early intervention. A population oral health approach for UHC should be informed by evidence, prioritise and address oral health inequities, and be co-ordinated by national clinical leadership for oral health.

Is Australia's lack of national clinical leadership hampering efforts with the oral health policy agenda?

The landmark 2021 Resolution on Oral Health by the 74th World Health Assembly has elevated the importance of oral health into the global health policy agenda. This has led to the development and adoption of the World Health Organization (WHO) Global Strategy on Oral Health in 2022. It acknowledged the need to integrate oral health as part of universal health coverage (UHC), which is supported by national clinical leadership for oral health. Although Australia is a signatory WHO member state, it is yet to appoint a Commonwealth Chief Dental Officer to provide national clinical leadership. This commentary provides a background on the current issues on population oral health in Australia, an insight into the Australian oral healthcare system, and explores some of the challenges and learnings related to previous Commonwealth dental programs. This paper highlights why expertise in dental public health is required to steer national oral health policy that is focused on prevention and early intervention. A population oral health approach for UHC should be informed by evidence, prioritise and address oral health inequities, and be co-ordinated by national clinical leadership for oral health.

To ensure universal eye health coverage to accelerate progress towards the achievement of sustainable development goals

The United Nations signed "Vision for Everyone-Accelerating Action to Achieve the Sustainable Development Goals (A/RES/75/310)" at the 75th UN sessions, committing to great efforts to improve eye health globally and address the increasing impact of vision loss on sustainable development. It is the first agreement designed to tackle preventable sight loss to be adopted at the United Nations and to enshrine eye health as an integral part of universal health coverage. The resolution summarized the lessons learned from previous global eye health practices, set a target of eye care for all by 2030-with countries set to ensure full access to eye care services for their populations, and, to support global efforts, to make eye care part of their nation's journey to achieving the Sustainable Development Goals (SDG). This global initiative will also have a significant impact on eye health in China, and we should implement this United Nations General Assembly Resolution to promote the continued development of eye health in China.

Rehabilitation - is an Essential Part of Universal Health Coverage

Rehabilitation, like promotion of good health, disease prevention, treatment, and palliative care, is an important aspect of universal health coverage. Rehabilitation enables a child, adult, or elderly person to be as self-sufficient as possible in daily activities, allowing them to participate in education, job, recreation, and meaningful life tasks such as caring for family members. An estimated 2.4 billion people worldwide suffer from a health condition that could benefit from rehabilitation. Changes in population health and features are expected to increase the demand for rehabilitation services around the world. People are living longer, for example, but with more chronic disease and incapacity. The requirement for rehabilitation is now largely unmet. More than half of people in several low- and middle-income nations do not obtain the rehabilitation services they require. The COVID-19 pandemic has wreaked havoc on rehabilitation programmes, as well as other health services1.

Impact of disasters on blood donation rates and blood safety: A systematic review and meta-analysis.

Background and ObjectivesTimely and adequate access to safe blood forms an integral part of universal health coverage, but it may be compromised by natural or man‐made disasters. This systematic review provides an overview of the best available scientific evidence on the impact of disasters on blood donation rates and safety outcomes.Materials and MethodsFive databases (The Cochrane Library, MEDLINE, Embase, Web of Science and CINAHL) were searched until 27 March 2020 for (un)controlled studies investigating the impact of disasters on blood donation rates and/or safety. Risk of bias and overall certainty of the evidence were assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsEighteen observational studies were identified, providing very low certainty of evidence (due to high risk of bias, inconsistency and/or imprecision) on the impact of natural (12 studies) and man‐made/technological (6 studies) disasters. The available evidence did not enable us to form any generalizable conclusions on the impact on blood donation rates. Meta‐analyses could not detect any statistically significant changes in transfusion‐transmissible infection (TTI) rates [hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV)‐1/2, human T‐lymphotropic virus I and II (HTLV‐I/II) and syphilis] in donated blood after a disaster, either in first‐time or repeat donors, although the evidence is very uncertain.ConclusionThe very low certainty of evidence synthetized in this systematic review indicates that it is very uncertain whether there is an association between disaster occurrence and changes in TTI rates in donated blood. The currently available evidence did not allow us to draw generalizable conclusions on the impact of disasters on blood donation rates.

Global status of essential medicine selection: a systematic comparison of national essential medicine lists with recommendations by WHO

ObjectivesExamining the availability of essential medicines is a necessary step to monitor country-level progress towards universal health coverage. We compared the 2017 essential medicine lists (EML) of 137 countries to...

Global public good and universal health coverage: conceptual and practical concerns in the context of COVID-19

The notion of public good has been reclaimed in recent times due to the pandemic as in many countries including the United States, the existing infrastructural, strategic and investment limitations have been realized. There is need for a debate on the notion of global public good especially with respect to health and to bring out the incommensurability of the notion. Along with these realizations and reclamations, issues related to the three A’s- accessibility, availability and affordability of health car have also been raised as a part of universal health coverage (UHC). The three A’s have become more relevant in the context of the pandemic. However, the ideological underpinnings of such conceptual reclamations and probable linkages need to be discussed. In fact, public good assumes the distribution of services equally to all members of the society which is problematic as it may not take care of equity issues in societies where some people suffer more and need special care and services. Public good is a ‘troubled’ notion which has its origin and also has been used in neo-classical and neoliberal approaches and it cannot be recommended without a proper understanding of the diverse ways in which the concept has been treated. The need for current claiming or reclaiming of such concepts started with environmental goods (although not many the so-called environmentalists realise it) to highlight destruction of global commons or resources which will result in loss of markets and therefore profits. The present reclaiming of the concept is also because of such a realisation as the pandemic has affected market interests. New approaches are evolving because of the so-called 'aid fatigue' of donors as they think that economic aids may be irrelevant at this time as the rich countries are also suffering and therefore, let them manage on their own!

Eye health indicators for universal health coverage: results of a global expert prioritisation process

IntroductionIn its recent World Report on Vision, the WHO called for an updated approach to monitor eye health as part of universal health coverage (UHC). This project sought to develop...

Eye health and the Decade of Action for the Sustainable Development Goals

Eye health and the Decade of Action for the Sustainable Development Goals

Oral health for healthy aging

During the 74th World Health Assembly, a resolution was passed aiming to achieve better oral health as part of universal health coverage, with plans to draft a global strategy and action plan. Oral diseases are a significant problem globally, with implications for older people’s health and quality of life. Oral health is important for healthy aging. Integration of oral health into primary care settings and use of a life-course approach have been shown to be effective in the 8020 campaign in Japan. Accurate data on prevalence of oral disease is required to monitor effectiveness of public health approaches, which should be segregated based on setting, sociodemographic status, and comorbidities. These public health approaches should also be adapted and tailored for implementation during the current COVID-19 pandemic. These considerations are essential to progress the agenda of oral health for healthy aging.