Realization Of Universal Health Coverage Research Articles

Phytochemical Profiling of Ethanolic Extracts from the Bark and Tuber of Colocasia Esculenta (L) Schott, Identification and Quantification of Compounds Present in Kenya

Bacterial infections are the major cause of morbidity and mortality, with high financial impacts among human beings globally. Antibiotics are used in the treatment of bacterial infections. They eliminate or prevent bacteria from reproducing and spreading. Since they do so at different rates, some bacteria may mutate with an under-dose and resist antibiotic treatment through natural selection. The bacteria develop acquired antimicrobial resistance to several drugs due to increased use and misuse of antibiotics. This has resulted in increased interest in the use of medicinal plants in the treatment of bacterial infections. The plants serve as resistance modifying agents from the metabolites that they produce. Previous studies show that metabolites such as tannins, alkaloids and polyphenols may have antimicrobial and resistance-modifying properties. They destroy the microorganisms and interfere with the crucial events in the pathogenic process, reducing the bacteria's ability to develop resistance to botanicals.
 Colocasia esculenta (L) Schott leaves were previously tested against Pseudomonas aeruginosa and the extracts showed higher activity against bacterial infections compared to the use of the antibiotic drug Clarithromycin. Leaves of aqueous and ethanolic extracts of Colocasia esculenta in previous studies were found to contain steroids, Flavonoids, saponins, terpenoids, Anthroquinones and Alkaloids. The extracts were found to have anti-diabetic activity and anti-helminthic activity compared to the standard drug, Piperazine citrate. This study determined phytochemicals present in ethanolic extracts of the bark and tuber of Colocasia esculenta (L) Schott in Kenya. A qualitative research design was adopted in this study. Colocasia esculenta plant samples used in this study were purposely obtained from Kaimosi Friends University farm in Vihiga County. They were taken to the laboratory of Botany at Maseno University, where they were washed with sterile distilled water, separated into bark and tuber, dried, crushed into powder, packed separately in airtight plastic containers, labelled and stored for later use. Plant ethanolic extracts were prepared separately (from powders) in triplicate for use in experiments. Screening for the presence of phytochemicals was done using standard methods. Qualitative analysis of the plant samples was used to check for the presence of flavonoids, saponins, steroids, tannins, alkaloids, glycosides, phenolic compounds and anthraquinones. Data were collected and then analyzed. Results were presented in the form of a table as the presence or absence of the specific phytochemicals. Results showed that Saponins, steroids, tannins, alkaloids, glycosides and phenolic compounds were present in both the tuber and bark ethanolic extracts of Colocasia esculenta. Interestingly, the bark extract had more saponins and tannins than the tuber extract. The results of this study can be used to further determine the antibacterial activity of the extracts on selected sidearm bacteria. The findings could be of commercial interest to both the Kenya Ministry of Health and pharmaceutical companies in the world in the production of new antibacterial drugs. Policymakers may help reduce the increasing mortality due to bacterial infections by using results from this study. The results can also support Kenya's Vision 2030 of ensuring adequate health care for all by integrating traditional healthcare practices into the national healthcare system for the realization of universal health coverage.

The HIV/AIDS responses pre and during the COVID-19 pandemic in sub-Saharan Africa: A basis for sustainable health system strengthening post–COVID-19

In May 2023, the World Health Organization announced that COVID-19 was no longer a global emergency. The impact of COVID-19 on the provision of HIV/AIDS services was not that severe due to the reprogramming of key resources. For health systems in sub-Saharan Africa to become resilient to future pandemics, lessons should be learned from the successful HIV/AIDS response in the region, and how the HIV/AIDS services were successfully adapted to the COVID-19 pandemic. In this article, we reviewed the 6 World Health Organization health system building blocks on how the best practices from the provision of HIV/AIDS services and the services’ response to the COVID-19 pandemic can be used as a basis for restoring and strengthening health systems to offer universal access to quality essential health services. The success of the leadership and governance for universal access to anti-retroviral therapy can be a blueprint for the realization of universal health coverage. Significant efficiencies that resulted in the reduction in anti-retroviral therapy costs can be leveraged to ensure cheaper essential drugs while differentiated service delivery models can be used to improve health service accessibility. New technologies that have proven to be successful in HIV/AIDS care can also be used in the care of other diseases, including disease outbreaks. The strong health information systems developed for HIV programs can be used as a foundation for developing health information systems for the whole health sector while the healthcare professionals trained for the provision of HIV/AIDS services can be trained to provide services for a variety of other conditions.

Influence of contextual factors on strengthening key strategic and operational levers of primary healthcare to achieve universal health coverage: a protocol for a realist review

IntroductionExisting scoping reviews on the link between primary healthcare (PHC) and universal health coverage (UHC) have not sufficiently addressed the underlying causal mechanisms in which key strategic and operational PHC...

Evolution of health sector strategic planning in Tanzania: What have we learnt and how can we improve?

Progressive realization of Universal Health Coverage is inevitable given resource constraints. The incremental approach must be reflected in health sector strategic plans which serve as roadmaps. Using a matrix based on the health systems building blocks to extract data, we reviewed three successive sector strategies to assess priority issues addressed. We undertook a thematic synthesis to draw lessons and conclusion reported in this paper. Our review shows good practice as well as areas desiring attention if health sector strategic plans are to serve the intended purpose. Although all strategies were aligned to global and national development aspirations, were developed in a participatory manner they did not reflect the required incremental approach. The challenges to be addressed and the priorities remained largely the same over a 15-year period. The strategies and key results areas to be implemented in the different strategies were numerous with funding gaps. Improving the utility of strategic plans requires improving both the process and content. Implied in this approach is the need for prioritised and affordable strategic plans that reflect incremental efforts to attaining long term targets coupled with strong trend analysis and monitoring. Additionally, we advocate for strategic plan with a longer timeframe perhaps 10 years with adjustments at regular intervals.

COVID-19 Aftermath: Direction Towards Universal Health Coverage in Low-Income Countries Comment on "Health Coverage and Financial Protection in Uganda: A Political Economy Perspective".

Progressive realization of universal health coverage (UHC) requires health systems capacity to provide quality service and financial risk protection which supports access to services without financial hardship. Government health spending in low-income countries (LICs) has been low and heavily relied on external donor resources and out-of-pocket payment. This has resulted in high prevalence of catastrophic health spending or foregone care by those who cannot afford. Under fiscal constraints posed by pandemic, reforms in LICs should focus on efficiency through health resource waste reduction. Targeting the poor even with low level of health spending can make a significant health gain. Investment in primary healthcare and health workforce is the foundation for realizing UHC which cannot be postponed. Innovative tax on health hazardous products, conditional debt relief can increase fiscal space for health; while international collaboration to accelerate coronavirus disease 2019 (COVID-19) vaccine coverage can bring LICs out of acute phase of pandemic.

Estimating the threshold of health workforce densities towards universal health coverage in Africa

BackgroundThere have been past efforts to develop benchmarks for health workforce (HWF) needs across countries which have been helpful for advocacy and planning. Still, they have neither been country-specific nor...

A Systematic Review of Medicinal Plants of Kenya used in the Management of Bacterial Infections.

Kenya's vision 2030 partly aims at ensuring adequate health care for all, and the integration of traditional healthcare practices into the national healthcare system would present a more rapid alternative towards the realization of universal health coverage in Kenya. Currently, research on Kenyan medicinal plants with potential antibacterial activity remains vastly fragmented across numerous literature studies and databases; thus, it is imperative to collate and appraise these data for the ease of future research and possible clinical application. Objective. This review aims at exploring and compiling research evidence on medicinal plants used in the management of bacterial infections in Kenya, with a focus on their efficacy and safety. Methodology. A comprehensive web-based systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was executed to highlight the Kenyan medicinal plants used for the management of bacterial infections in Kenya. This review includes studies published until January 2021 from the PubMed, Science Direct, AJOL, and Google Scholar databases. Results. A total of 105 Kenyan medicinal plants belonging to 43 families have their in vitro activity against various human pathogenic bacteria evaluated. Plants from the Lamiaceae, Rutaceae, and Fabaceae families were the most commonly studied. Aloe secundiflora, Toddalia asiatica, Senna didymobotrya, Warbugia ugandensis, Tithonia diversifolia, Fuerstia africana, Olea africana, and Harrisonia abyssinica were the plants frequently evaluated within Kenya. The plants with the strongest antimicrobial activities were Toddalia asiatica, Hagenia abyssinica, Ocimum gratissimum, Harrisonia abyssinica, Senna didymobotrya, Olea Africana, Camellia sinensis, and Tarmarindus indica. Conclusion. Based on a published work, it is evident that traditional medicine is seemingly an acceptable and efficient system among Kenyan communities in the management of bacterial infections. Kenya's rich biodiversity with diverse secondary metabolites presents a promising source of new therapeutic alternatives with possibly different mechanisms of action against bacteria.

Are Public Oral Care Services Evenly Distributed?-Nation-Wide Assessment of the Provision of Oral Care in Japan Using the National Database of Health Insurance Claims.

The provision of oral health care services is one of the global challenges under the realization of universal health coverage in many countries. Despite the increasing importance of oral health care in an aging society, the disparities in the provision of oral care in Japan have not been clarified. Therefore, this study investigated the status of oral and dental care provision using the National Database of Health Insurance Claims and Specific Health Checkups (NDB) at the level of prefectures and secondary medical care areas. Additionally, a multiple regression model was applied to identify the influence of human resources in oral care services and economic factors on the standardized claims data ratio (SCR) of total dental receipts. The results showed that the total amount of oral care provided tended to be higher in metropolitan areas, with bimodal peaks in children aged 5–9 and adults in their 70s. The SCR for dental caries showed little difference nationally, but SCR for periodontal disease tended to be higher in prefectures including metropolitan areas. In a multiple regression model, the number of dentists and prefectural income per capita influenced the SCR of total dental receipts. In secondary medical care areas, some depopulated areas are supplemented by adjacent areas. These results suggest that oral health care services in the national health insurance system are generally well provided; however, they are likely to be influenced by human resources and economic disparities, and regional differences may occur in the care of periodontal diseases.

Governance factors that affect the implementation of health financing reforms in Tanzania: an exploratory study of stakeholders’ perspectives

The development of effective and inclusive health financing reforms is crucial for the progressive realisation of universal health coverage in low-income and middle-income countries. Tanzania has been reforming health financing...

PSY6-4 Regulatory aspect of regional collaboration for medical products development in Asia

It's been a while since access to medicines and other essential medical products was recognized as one of the important agenda in global health. COVID-19 pandemic has been affecting every parts of the world and never before has international concord to facilitate development and to achieve access to new medical products been requested to tackle this ongoing threat regardless of development stage of each country. Regulatory authorities play a key role to assure quality, safety and efficacy of medical products. ICH and IMDRF composing of regulatory authorities including US FDA, EMA and MHLW/PMDA have long been leading global harmonization activities that minimize regulatory deviation among regulatory authorities and enable to develop medical products on a common ground. APEC's Regulatory Harmonization Steering Committee under the Life Sciences Innovation Forum further promotes it in Asia pacific region, making full use of deliverables of those initiatives. In addition to PMDA's participation in those global and regional initiatives, PMDA has been contributing to implementation of regulatory harmonization and reliance principle by providing training programs to regulators through Asia Training Center for Pharmaceuticals and Medical Devices Regulatory Affairs (PMDA-ATC) established in 2016. Moreover, with a recognition that access to medical products particularly in Asian region is essential for the realization of Universal Health Coverage (UHC), which is regarded as an integral part of Japan's contribution in global health, the Headquarters for the Healthcare Policy of Japan approved the Grand Design for Asian Pharmaceutical and Medical Devices Regulatory Harmonization in 2019 aiming at concretizing regulatory harmonization to contribute to the health of people in Asia. In accordance with the Grand Design, PMDA reorganized Office of International Programs and further contributes to regulatory harmonization in Asian region through multi- and bilateral cooperation.

Intersection of class, caste, gender and unmet healthcare needs in India: Implications for health policy

Despite renewed policy priorities to universalise health coverage, unmet need for healthcare is long-standing concern in India. The recent data suggests the unmet healthcare need amounts to a notable share of twelve per cent. While studies have examined inequalities in healthcare utilisation in single axes of social power, there was no consensus on the role of the intersectionality between class, caste and gender in shaping the unmet health need. Utilising data from National Sample survey 75th round (2017–18), this paper identifies the factors contributing to such unmet need and investigate the intersectionality of class with caste and gender in determining unmet need. The contribution of socioeconomic factors was assessed by the decomposition method & multivariate logistic regression was used to measure inter and intra-class differentials in unmet need.The analysis informs that class inequality is fundamental to having unmet need with limited role of gender and caste. Economic class however, interacting with caste and gender unfolds wider gaps in access to healthcare. While inter-class differences in unmet need are observed across caste as well as gender, intra-class differences intensify more by caste inequalities. The findings indicate the significance of the intersectional approach in identifying the sources of health inequity and special recognition to the income-poor and socially marginalised in policy agenda. Eliminating the barriers to health care access therefore needs a multidimensional construct of identifying combination of attributes to be focused towards realization of universal health coverage. These observations should aid in formulation and restructuring of the existing healthcare interventions to achieve equity in healthcare provision.

Progressive Realisation of Universal Health Coverage in Low- and Middle-Income Countries: Beyond the "Best Buys".

Background: World Health Organization Choosing Interventions that are Cost-Effective (WHO CHOICE) has been a programme of the WHO for 20 years. In this latest update, we present for the first time a cross-programme analysis of the comparative cost-effectiveness of 479 intervention scenarios across 20 disease programmes and risk factors. Methods: This analysis follows the standard WHO CHOICE approach to generalized cost-effectiveness analysis applied to two regions, Eastern sub-Saharan Africa and Southeast Asia. The scope of the analysis is all interventions included in programme specific WHO CHOICE analyses, using WHO treatment guidelines for major disease areas as the foundation. Costs are measured in 2010 international dollars, and benefits modelled beginning in 2010, or the nearest year for which validated data was available, both for a period of 100 years. Results: Across both regions included in the analysis, interventions span multiple orders of magnitude in terms of cost-effectiveness ratios. A health benefit package optimized through a value for money lens incorporates interventions responding to all of the main drivers of disease burden. Interventions delivered through first level clinical and non-clinical services represent the majority of the high impact cost-effective interventions. Conclusion: Cost-effectiveness is one important criterion when selecting health interventions for benefit packages to progress towards universal health coverage (UHC), but it is not the only criterion and all calculations should be adapted to the local context. To support country decision-makers, WHO CHOICE has developed a downloadable tool to support the development of data for this criterion.

COMMUNITY PHARMACY ROLE IN UNIVERSAL HEALTH COVERAGE IN MOMBASA COUNTY

Community pharmacy role in universal health coverage was a qualitative study that entailed close contact to the role played by community pharmacies in healthcare provision. As a "small healthcare" in provision of pharmaceutical services, community pharmacies are required to be included in realization of Universal Health Coverage in Mombasa since it is among the Big 4 Agenda of the national government (MOH, 2013). The objective of the study was to determine community pharmacy role in universal health coverage. A descriptive cross sectional study design was used to collect both qualitative and quantitative data and the design estimate the prevalence of the outcome of interest commonly for the purpose of public health planning. A sample size of 196 was calculated using fishers formula. Data was collected using in-depth interviews and structured questionnaire were administered on a target population of community pharmacies health providers and clients seeking services respectively. The collected data was analysed using SPSS version 20 and interpreted using tables and pie charts. On community pharmacy practitioners respondents; 58% were male, 90.3% diploma holders in pharmacy, 39.8% registered with PPB and 65% had practised for less than two years. 78% of the respondents agree that community pharmacy has a role in UHC and there was 74% affordability of community pharmacy medicines. Bivariate analysis findings show that training and inspection on UHC (P=0.003) Covid 19 (p=0.000) and inspection fee (p=0.000). Accessibility; location of community pharmacies (p=0.000) and doctors attitudes (p=0.000). Essential medicines; acyclovir 200mg tablets (p=0.000), chlorpromazine 100mg tablets (p=0.000) and tetanus toxoid vaccine (p=0.000). Key determinants of community pharmacy role in UHC were diploma (AOR 666.7; CI 129.6-3429.5), Erythromycin 125mg suspension (AOR 120.3; CI 15.4-940.8), Acyclovir 200mg tablets (AOR 46.823; CI 17.7-124.1) and Occupation (AOR 45.271; CI 15.363-133.404. The study recommends reduction of tax on essential medicines, MOH revise the UHC policy to incorporate community pharmacies and empowerment on management of controlled drugs and vaccines in order to realize effective and efficient UHC in Kenya

Social exclusion and universal health coverage: health care rights and citizen-led accountability in Guatemala and Peru

BackgroundWhile equity is a central concern in promoting Universal Health Coverage (UHC), the impact of social exclusion on equity in UHC remains underexplored. This paper examines challenges faced by socially excluded populations, with an emphasis on Indigenous peoples, to receive UHC in Latin America. We argue that social exclusion can have negative effects on health systems and can undermine progress towards UHC. We examine two case studies, one in Guatemala and one in Peru, involving citizen-led accountability initiatives that aim to identify and address problems with health care services for socially excluded groups. The case studies reveal how social exclusion can affect equity in UHC.MethodsIn-depth analysis was conducted of all peer reviewed articles published between 2015 and 2019 on the two cases (11 in total), and two non-peer reviewed reports published over the same period. In addition, two of the three authors contributed their first-hand knowledge gathered through practitioner involvement with the citizen-led initiatives examined in the two cases. The analysis sought to identify and compare challenges faced by socially excluded Indigenous populations to receive UHC in the two cases.ResultsCitizen-led accountability initiatives in Guatemala and Peru reveal very similar patterns of serious deficiencies that undermine efforts towards the realization of Universal Health Coverage in both countries. In each case, the socially excluded populations are served by a dysfunctional publicly provided health system marked by gaps and often invisible barriers. The cases suggest that, while funding and social rights to coverage have expanded, marginalized populations in Guatemala and Peru still do not receive either the health care services or the protection against financial hardship promised by health systems in each country. In both cases, the dysfunctional character of the system remains in place, undermining progress towards UHC.ConclusionsWe conclude that efforts to promote UHC cannot stop at increasing health systems financing. In addition, these efforts need to contend with the deeper challenges of democratizing state institutions, including health systems, involved in marginalizing and excluding certain population groups. This includes stronger accountability systems within public institutions. More inclusive accountability mechanisms are an important step in promoting equitable progress towards UHC.

Global health and human rights in the time of COVID-19: Response, restrictions, and legitimacy

Policy responses to the COVID-19 pandemic have impacted a range of human rights, with the pandemic being used to justify police violence, authoritarian power grabs, and corruption. Health systems in high- and low-income countries have struggled to provide adequate COVID-19 testing, tracing, and treatment, with non-COVID-19 healthcare-restricted, vulnerable populations at high risk of infection and negative health and social impacts, and lockdowns exacerbating poverty, domestic violence, and mental health problems. If underresourced health systems are overwhelmed by COVID-19, and individuals are forced to bear testing and treatment costs, there is a stronger likelihood of health system failures, for higher mortality from a range of causes, and for people to be pushed further into poverty and insecurity. COVID-19 thus underscores the urgent need for clearer rules about legitimate restrictions of the right to health in responding to the pandemic, and for safeguarding global health policy initiatives in its aftermath. This article focuses on key right-to-health challenges, including realization of universal health coverage, and potential challenges in access to future COVID-19 therapies and vaccines. We conclude with reflections on what the pandemic may mean for the evolution of human rights, and the right to health in particular.

Factors associated with the perceived barriers of health care access among reproductive-age women in Ethiopia: a secondary data analysis of 2016 Ethiopian demographic and health survey

BackgroundHealth care access is the timely use of personal health services to achieve the best health outcomes. Problems in accessing health care among reproductive-age may lead to various adverse health outcomes like death and disabilities. Therefore, this study aimed to identify factors associated with the perceived barriers of healthcare access among reproductive-age women in Ethiopia.MethodThis study was based on secondary data sources from the 2016 Ethiopia Demography and Health Survey. The individual women record (IR) file was used to extract about 15, 683 women for the final analysis from the largest dataset. A composite variable of health care access was created from four questions used to rate health care access problems among women of reproductive age. To identify factors associated with the perceived barriers of health care access among reproductive-age women, generalized estimating equation (GEE) model was fitted. Crude and adjusted odds ratio (AOR) with a 95% confidence interval (CI) computed to assess the strength of association between independent and outcome variables.ResultsThis study revealed that the magnitude of perceived barriers of healthcare access among reproductive-age women was 69.9% with 95%CI (69.3 to 70.7) to at least one or more of the four reasons. Rural resident (AOR = 2.13, 95%CI: 1.79 to 2.53), age 35–49 years (AOR = 1.24, 95%CI: 1.09 to 1.40), divorced/separated (AOR = 1.34, 95%CI: 1.17 to 1.54), had no health insurance coverage (AOR = 1.19, 95%CI: 1.01 to 1.45), poorer (AOR = 2.09,95%CI: 1.86 to 2.35) and middle wealth (AOR = 1.57,95%CI:1.38 to 1.79), no education (AOR = 2.30, 95%CI:1.95 to 2.72), primary education (AOR = 1.84, 95%CI: 1.58 to 2.15) and secondary education (AOR = 1.31, 95%CI: 1.13 to 1.51) were factors associated with the perceived barriers of health care access.ConclusionA significant proportion of women of reproductive age faced barriers to healthcare access, of which money and distance were the most frequently perceived barriers. Divorced/separated marital status, old age, rural dwelling, no health insurance coverage, low economic situation, and level of education were factors associated with perceived barriers. These findings suggest further strengthening and improving health care access to those women with low socio-economic status for the realization of universal health coverage.

Priority setting for health system strengthening in low income countries. A qualitative case study illustrating the complexities

ABSTRACT Health systems are critical to the realisation of Universal Health Coverage. There has been insufficient attention to the evaluation of priority setting for health system strengthening within low income countries, including evaluation of the local capacity to implement priorities. This study evaluated the extent to which health system strengthening was prioritized in Uganda. The Kapiriri & Martin framework was used to evaluate health system priority setting from 2005–2015. A document analysis was triangulated with interview data (n = 67) from global, national and subnational stakeholders and analysed using content analysis. Health system strengthening was perceived to be circumvented by a lack of resources as well as influential actors with disease focused, rather than system-oriented, interests. There were defined processes with explicit criteria for identifying priorities and evidence was highly valued. But sub-optimal transparency and weak accountability often compromised the integrity of priority setting and contributed to stalling progress on health system strengthening and achieving health system outcomes. The strengths in the current planning processes should be harnessed. In addition, a systematic approach to priority setting, potentially through the establishment of an independent body, and stronger oversight mechanisms, would strengthen health system planning in this setting.

Baseline Assessment of Primary Healthcare Delivery Through Subcenters of Northern India.

BackgroundOur study assessed the status of facilities and services available at the subcenter level and identified the gaps that deter the realization of universal health coverage.MethodsA cross-sectional observational study design was used for assessing the subcenters of the Ambala district, Haryana, India with a predesigned, semi-structured tool containing 88 items marked on an ordinal scale. The subcenters were assessed and scored as per their functioning and delivery of various services, their coverage, and quality in terms of various national health programs.ResultsWe found that the essential infrastructure of most of the buildings was average. The types of equipment for antenatal examination, vital medicines, and prominent display boards in the local language were present in all subcenters. The majority of the health workers (n = 27; 93%) successfully demonstrated proper handwashing techniques; 65% correctly measured blood pressure during an objective structured clinical examination (OSCE), and 48% could correctly estimate hemoglobin with a hemoglobinometer. Sound knowledge regarding maternal and child healthcare practices and guidelines was noted in 89% of the health workers.ConclusionsThe health system of Haryana has scope for improvement in terms of health centers. It is pertinent for the realization of universal health coverage. Therefore, internal audits similar to what we performed must be planned and executed as a regular activity within the framework of existing health systems.

Developing the health workforce for universal health coverage.

Optimizing the management of the health workforce is necessary for the progressive realization of universal health coverage. Here we discuss the six main action fields in health workforce management as identified by the Human Resources for Health Action Framework: leadership; finance; policy; education; partnership; and human resources management systems. We also identify and describe examples of effective practices in the development of the health workforce, highlighting the breadth of issues that policy-makers and planners should consider. Achieving success in these action fields is not possible by pursuing them in isolation. Rather, they are interlinked functions that depend on a strong capacity for effective stewardship of health workforce policy. This stewardship capacity can be best understood as a pyramid of tools and factors that encompass the individual, organizational, institutional and health system levels, with each level depending on capacity at the level below and enabling actions at the level above. We focus on action fields covered by the organizational or system-wide levels that relate to health workforce development. We consider that an analysis of the policy and governance environment and of mechanisms for health workforce policy development and implementation is required, and should guide the identification of the most relevant and appropriate levels and interventions to strengthen the capacity of health workforce stewardship and leadership. Although these action fields are relevant in all countries, there are no best practices that can simply be replicated across countries and each country must design its own responses to the challenges raised by these fields.

Other considerations than: how much will universal health coverage cost?

Globally, countries have agreed to pursue the progressive realization of universal health coverage (UHC) and there is now a high level of political commitment to providing universal coverage of essential health services while ensuring that individuals are financially protected against high health spending. The aim of this paper is to help policy-makers think through the progressive realization of UHC. First, the pitfalls of applying global normative expenditure targets in estimating the national revenue required for UHC are discussed. Then, several recommendations on estimating national revenue are made by moving beyond the question of how much UHC will cost and focusing instead on the national health-care reforms and policy choices needed to progress towards UHC. In particular, costing exercises are recommended as a tool for comparing different service delivery options and investment in data infrastructure is recommended for improving the information needed to identify the best policies. These recommendations are intended to assist health policy-makers and international and national agencies who are developing country plans for the progressive realization of UHC.