Social Health Protection Research Articles

Response to health inequity: the role of social protection in reducing poverty and achieving equity.

Health inequities are determined by multiple factors within the health sector and beyond. While gaps in social health protection coverage and effective access to health care are among the most prominent causes of health inequities, social and economic inequalities existing beyond the health sector contribute greatly to barriers to access affordable and acceptable health care.

Regulação sanitária: inclusão e proteção à saúde

theme has as its starting point the caring of people, groups, thinkers who have reflected on the overall functioning of Brazilian Especially after 1985, with the replacement of the military regime by a democratic regime, which became known as the New Republic. Analyzing the last (almost) 30 years, a social scientist said: The dismantling of the New Republic ... is clearly being experienced early this century millennium ... The institutions political parties .. . entered ... sharp collapse in a gale of popular demonstrations ... and lost ties with society. These words become the subject of a question: how to operate the national government institutions, in particular the health authorities, has served the social inclusion health protection?

The role of medical staff in providing patients rights.

ABSTRACTAmong the priority basic human rights, without a doubt, are the right to life and health-social protection. The process of implementation of human rights in the everyday life of an ordinary citizen in the post-war recovery of Bosnia and Herzegovina faces huge objective and subjective difficulties. Citizens need to be affordable adequate healthcare facilities that will be open to all on equal terms. The term hospital activity implies a set of measures, activities and procedures that are undertaken for the purpose of treatment, diagnosis and medical rehabilitation of patients in the respective health institutions. Principles of hospital care should include Comprehensiveness (Hospital care is available to all citizens equally); Continuity (Provided is continuous medical care to all users); Availability (Provided approximately equal protection of rights for all citizens). Education of health professionals: The usual threats to patient safety include medical errors, infections occurred in the hospital, unnecessary exposure to high doses of radiation and the use of the wrong drug. Everyday continuing education in the profession of a doctor is lifelong.

Health workforce benchmarks for universal health coverage and sustainable development

Universal health coverage (UHC) includes the guarantee that everyone will be protected over the entire life-cycle by a defined set of essential health services fulfilling four interrelated criteria, as set out in Social Protection Floors Recommendation, 2012 (202) of the International Labour Organization (ILO): availability, accessibility, acceptability and quality. 1 Insofar as it furthers health, which is essential to human productivity and economic progress, UHC – and the health workforce needed to attain it – serves as a foundation to sustainable development. Gaps in the health workforce – in number, distribution and skills – undermine service availability, acceptability, accessibility and quality. Such gaps can also create financial barriers and impoverish people when they have to seek care without being covered by a social health protection system or scheme. Access to quality services is vitally dependent on the existence of a health workforce that is able to meet needs and enjoys decent working conditions, characterized by training opportunities, attractive employment, good career prospects, fair remuneration, adequate social protection, a safe work environment and access to dispute settlement mechanisms, as described in the ILO Nursing Personnel Convention No. 149. 2 Service accessibility is further compromised by factors external to the health sector that influence the financing of health and of the health workforce. Of particular relevance are the socioeconomic contexts in which people live and work. Poverty, unemployment and low wages affect a household’s ability to pay for needed health care, be it through taxes, employee contributions, premiums or out-of-pocket expenditure. At the national level, high poverty rates and the existence of large informal economies often result in tax revenues that are insufficient for adequate funding of health care and that challenge governments’ technical capacity to supply services in areas where unregistered workers and their families live. In highly vulnerable countries, defined by the ILO 3 as those where most people work in the informal economy and most of the population is poor, health care is accessible to much fewer people than in countries with low poverty rates and small informal economies. 4 Furthermore, in such countries most health care is financed by out-of-pocket payments that can reach catastrophic levels and plunge families into dire poverty or bar their access to needed care. According to the ILO, over 1.5 billion people in the world are living and working in socioeconomic contexts that challenge adequate financing of UHC and the attainment of sustainable development, so critically dependent on the presence of a healthy population. Any health workforce benchmark for measuring sustainable progress towards UHC must reflect the above-mentioned aspects, including the basic socioeconomic causes of UHC gaps beyond the health sector. 5 One such benchmark is the

Social Health Protection for the Poor: Insights on the Philippines

Social Health Protection for the Poor: Insights on the Philippines

Servicio social en medicina en México. Una reforma urgente y posible

One third of the primary care units in the public system keeps being covered exclusively by interns. It is shown that with the resources available in the System for Social Protection in Health it is possible to hire graduate health personnel for all Ministry of Health rural units. It is necessary to modify the current legislation to impede an intern to be located in units without supervision of a graduate doctor. There is an urgent need for a reform of social service in medicine that responds both to the institutional modernization and to the increased capacity of the newly insured to demand high-quality services.

Revisiting policies to achieve progress towards universal health coverage in low‐income countries: Realizing the pay‐offs of national social protection floors

AbstractDespite progress on extending social health protection coverage, most low‐income countries are still far from achieving universal health coverage and thus key objectives related to improvements in health, such as those aimed at by the Millennium Development Goals (MDGs), will almost certainly not be realized by 2015. Principally affected are the most vulnerable populations: the rural and urban poor and workers in the informal economy and their families. It is of particular concern that progress might not only remain limited but even be reversed if policies continue to fail to address the root causes of gaps and deficits in health coverage. This article provides evidence that these causes lie both within and beyond the health sector and are strongly related to poverty and other forms of vulnerability. It argues that sustainable progress towards universal health coverage can only be achieved in an adequate time frame when focusing simultaneously on i) extending health coverage and improving access to needed health care; ii) providing income security through income support to those in need; iii) addressing limitations, or the inability to participate, in income generation from work; and iv) implementing coherent policies within and across the social, economic and health sectors that set priorities on poverty alleviation. Such policies can best be implemented in the context of national social protection floors (SPF) that focus on access to at least essential health care and on providing at least basic income security over the life cycle to all in need. Implementing SPFs may result in breaking the mutual linkages between ill health, poverty and other vulnerabilities and achieving sustainable progress towards universal health coverage and other social protection objectives.

Differences in social health protection between wage earners and the self–employed: Comparative analysis in European and Latin American countries

Esta investigacion analiza las diferencias en la proteccionsocial de la salud de trabajadores dependientes eindependientes en paises europeos y latinoamericanos.Historicamente, solo los trabajadores dependientes y susfamiliares han gozado de proteccion social de la salud enlos paises latinoamericanos; de hecho, hoy los independientesgozan de un grado inferior de proteccion socialde la salud en comparacion con los dependientes. Por elcontrario, los paises europeos proveen prestaciones de saludbasados en el principio de residencia, por lo que estandestinados a cubrir a toda la poblacion, sin tener en cuentasi los beneficiarios son dependientes o independientes.Las diferencias de trato identificadas en esta investigacionno pueden ser justificadas y deben ser eliminadas. Estanen abierto conflicto con el objetivo de luchar contra la exclusionsocial e inequidad, en la medida en que la proteccionde la salud es fundamental para lograr la integracionsocial.

Strengthening institutional and organizational capacity for social health protection of the informal sector in lesser-developed countries: A study of policy barriers and opportunities in Cambodia

Reaching out to the poor and the informal sector is a major challenge for achieving universal coverage in lesser-developed countries. In Cambodia, extensive coverage by health equity funds for the poor has created the opportunity to consolidate various non-government health financing schemes under the government's proposed social health protection structure. This paper identifies the main policy and operational challenges to strengthening existing arrangements for the poor and the informal sector, and considers policy options to address these barriers. Conducted in conjunction with the Cambodian Ministry of Health in 2011–12, the study reviewed policy documents and collected qualitative data through 18 semi-structured key informant interviews with government, non-government and donor officials. Data were analysed using the Organizational Assessment for Improving and Strengthening Health Financing conceptual framework. We found that a significant shortfall related to institutional, organisational and health financing issues resulted in fragmentation and constrained the implementation of social health protection schemes, including health equity funds, community-based health insurance, vouchers and others. Key documents proposed the establishment of a national structure for the unification of the informal-sector schemes but left unresolved issues related to structure, institutional capacity and the third-party status of the national agency. This study adds to the evidence base on appropriate and effective institutional and organizational arrangements for social health protection in the informal sector in developing countries. Among the key lessons are: the need to expand the fiscal space for health care; a commitment to equity; specific measures to protect the poor; building national capacity for administration of universal coverage; and working within the specific national context.

Institutional design and organizational practice for universal coverage in lesser-developed countries: Challenges facing the Lao PDR

There is now widespread acceptance of the universal coverage approach, presented in the 2010 World Health Report. There are more and more voices for the benefit of creating a single national risk pool. Now, a body of literature is emerging on institutional design and organizational practice for universal coverage, related to management of the three health-financing functions: collection, pooling and purchasing. While all countries can move towards universal coverage, lower-income countries face particular challenges, including scarce resources and limited capacity. Recently, the Lao PDR has been preparing options for moving to a single national health insurance scheme. The aim is to combine four different social health protection schemes into a national health insurance authority (NHIA) with a single national fund- and risk-pool. This paper investigates the main institutional and organizational challenges related to the creation of the NHIA. The paper uses a qualitative approach, drawing on the World Health Organization's institutional and Organizational Assessment for Improving and Strengthening health financing (OASIS) conceptual framework for data analysis. Data were collected from a review of key health financing policy documents and from 17 semi-structured key informant interviews. Policy makers and advisors are confronting issues related to institutional arrangements, funding sources for the authority and government support for subsidies to the demand-side health financing schemes. Compulsory membership is proposed, but the means for covering the informal sector have not been resolved. While unification of existing schemes may be the basis for creating a single risk pool, challenges related to administrative capacity and cross-subsidies remain. The example of Lao PDR illustrates the need to include consideration of national context, the sequencing of reforms and the time-scale appropriate for achieving universal coverage.

Family, Poverty and Inequalities in Latin America and the Caribbean

This article adopts the concept of development as freedom and the relationship between income and capabilities to analyze and compare macroeconomic, demographic and poverty trends and inequalities in Latin American and the Caribbean countries, and the responses from governments to promote the inclusion of the poorest and marginalized population groups in development and policies. Differences in population structures indicate that poverty and gender, generational and race inequalities fragment societies. Policies oriented to reduce poverty have been implemented with a set of combined programs such as cash transfers articulated with actions in nutrition, health, education, day-care programs for poor children, civil registration and other programs to promote poverty reduction and the conciliation of domestic and work life for poor women and social protection. Some good practices are discussed, particularly in Brazil and Mexico. During the last 15 years, the Conditioned Cash Transfers programs raised public support and political consensus, guaranteeing continuity in their implementation, development and integration with other social protection programs. Currently there are 18 countries implementing such programs, covering approximately 25 million households and over 133 million people, representing 19% of the Latin American and Caribbean. Policies to reduce poverty, in combination with income distribution and social protection in nutrition, health, education, civil registration and day-care for children, have contributed to human development, and also promoted internal market of consumers, even in rural areas, mobilizing local economies and promoting the return of investments to development. Despite the economic crisis in 2008-2009, Latin America had a relatively good performance in the world economy, demonstrating that social and economic inclusion can be compatible with development. That positive balance is fundamental to guarantee the inclusion of rural, indigenous, women and youth in access to services, as well as to reducing poverty and inequalities in the region.

Regularización laboral de trabajadores de la salud pagados con recursos del Seguro Popular en México

The process of regularization of workers paid by the Social Protection Health System of Mexico is described and analyzed. Primary and secondary data collected by the external evaluation of the Mexican System for Social Protection in Health in 2009 were used. The regularization clearly improved the labor conditions of workers contracted by the system but a broader systemic implication of regularization does not seem to be necessarily positive. It is important to consider the need to guarantee that this type of changes in the contractual conditions of workers benefit all actors, particularly the insured population.

Moving from ideas to action - developing health financing systems towards universal coverage in Africa.

BackgroundAccelerating progress towards universal coverage in African countries calls for concrete actions that reinforce social health protection through establishment of sustainable health financing mechanisms. In order to explore possible pathways for moving past the existing obstacles, panel discussions were organized on health financing bringing together Ministers of health and Ministers of finance with the objective of creating a discussion space where the different perspectives on key issues and needed actions could meet. This article presents a synthesis of panel discussions focusing on the identified challenges and the possible solutions. The overview of this paper is based on the objectives and proceedings of the panel discussions and relies on the observation and study of the interaction between the panelists and on the discourse used.SummaryThe discussion highlighted that a large proportion of the African population has no access to needed health services with significant reliance on direct out of pocket payments. There are multiple obstacles in making prepayment and pooling mechanisms operational. The relatively strong political commitment to health has not always translated into more public spending for health. Donor investment in health in low income countries still falls below commitments. There is need to explore innovative domestic revenue collection mechanisms. Although inadequate funding for health is a fundamental problem, inefficient use of resources is of great concern. There is need to generate robust evidence focusing on issues of importance to ministry of finance. The current unsatisfactory state of health financing was mainly attributed to lack of clear vision; evidence based plans and costed strategies.DiscussionBased on the analysis of discussion made, there are points of convergence and divergence in the discourse and positions of the two ministries. The current blockage points holding back budget allocations for health can be solved with a more evidence based approach and dialogue based on a clear vision and costed strategic plan articulated by the ministry of health. Improving health in Africa is a driver for long-term economic growth and development and this is the reason why the ministries of health and finance will need to find common ground on how to create policy coherence and how to articulate their respective objectives.

Healthcare financing in Yemen

Yemen is a low-middle-income country where more than half of the population live in rural areas and lack access to the most basic health care. At US$40 per capita, Yemen's annual total health expenditure (THE) is among the lowest worldwide. This study analyses the preconditions and options for implementing basic social health protection in Yemen. It reveals a four-tiered healthcare system characterised by high geographic and financial access barriers mainly for the poor. Out-of-pocket payments constitute 55% of THE, and cost-sharing exemption schemes are not well organised. Resource-allocation practices are inequitable because about 30% of THE gets spent on treatment abroad for a small number of patients, mainly from better-off families. Against the background of a lack of social health protection, a series of small-scale and often informal solidarity schemes have developed, and a number of public and private companies have set up health benefit schemes for their employees. Employment-based schemes usually provide reasonable health care at an average annual cost of YR44 000 (US$200) per employee. In contrast, civil servants contribute to a mandatory health-insurance scheme without receiving any additional health benefits in return. A number of options for initiating a pathway towards a universal health-insurance system are discussed.

Improving access to quality care for female slum dwellers in urban Maharashtra, India: Researching the need for transformative social protection in health

Although quality health facilities in Mumbai and Pune are plenty, slum dwellers do not benefit fully from these. Next to financial barriers, low quality treatment and discrimination form major hurdles to entering public care. A lot of them prefer to buy services from ill-qualified private providers. Without social protection in health (SPH), their predicament often boils down to the uneasy choice between forgoing treatment and risking impoverishment. Currently, some SPH interventions try to protect poor urbanites and increase their access to quality care. This article provides more insight into the health service encounter experienced by female slum dwellers. Using data from focus group discussions with members of three SPH interventions and in-depth interviews with providers, challenges faced by the women during their health seeking process are discussed. By using Bourdieu's theoretical concepts on field, capitals and habitus, this study shows that a more subtle reproduction of social inequities and domination in the medical field forces slum dwellers to either forgo treatment, buy ineffective care from private providers, or passively accept the abuse in the public sector. These insights demonstrate the need for transformative SPH interventions to address the power imbalances in society that create and sustain the social vulnerability of poor people when seeking health.

Beyond legal coverage: Assessing the performance of social health protection

A frequently used indicator to measure social health protection performance is the extent of population coverage as stipulated in national legislation. However, this indicator does not provide meaningful information on performance in terms of effective access to benefits that are available, affordable and of acceptable quality, not least for the poor and workers in informal economies. This article proposes a new approach to measuring performance by applying a set of relevant indicators in an analytical framework for assessing the performance of social health protection. The approach allows policy-makers to conclude from comparisons among groups of countries facing similar challenges. Preliminary results include comprehensive information on deficits that need to be addressed when striving for effective universal coverage. With further refinement, the suggested approach could become a standard assessment tool for measuring performance.

Los seguros de salud mexicanos: cobertura universal incierta

The Mexican health system is comprised of the Department of Health, state labor social security and the private sector. It is undergoing a reform process initiated in 1995 to achieve universal coverage and separate the regulation, financing and service functions; a reform that after fifteen years is incomplete and problematic. The scope of this paper is to assess the problems that underlie the successive reforms. Special emphasis is given to the last reform stage with the introduction of the "Insurance of the People" aimed at the population without labor social security. In the analysis, health reform is seen as part of the Reform of the State in the context of neoliberal reorganization of society. Unlike other Latin American countries, this process did not include a new Constitution. The study is based on official documents and a systematic review of the process of the implementation of the System of Social Health Protection and its impact on coverage and access to health services. The analysis concludes that it is unlikely that universal population coverage will be accomplished much less universal access to services. However, reforms are leading to the commodification of the health system even in the context of a weak private sector.

The health system of Mexico

This paper describes the Mexican health system. In part one, the health conditions of the Mexican population are discussed, with emphasis in those emerging diseases that are now the main causes of death, both in men and women: diabetes, ischaemic heart disease, cerebrovascular diseases and cancer. Part two is devoted to the description of the basic structure of the system: its main institutions, the population coverage, the health benefits of those affiliated to the different heath institutions, its financial sources, the levels of financial protection in health, the availability of physical, material and human resources for health, and the stewardship functions displayed by the Ministry of Health and other actors. This part also discusses the role of citizens in the monitorization and evaluation of the health system, as well as the levels of satisfaction with the rendered health services. In part three the most recent innovations and its impact on the performance of the health system are discussed. Salient among them are the System of Social Protection in Health and the Popular Health Insurance. The paper concludes with a brief analysis of the short- and middle-term challenges faced by the Mexican health system.

Separación de funciones en el Sistema de Protección Social en Salud, México 2009: avances y retos

To evaluate advancements and challenges in the separation of functions within Mexico's System of Social Protection in Health. A 2009 evaluation study involving nine states and the National Commission for Social Protection in Health was carried out via semi-structured interviews with key actors and literature analysis. The main advancement has been the creation of the State Regimens for Social Protection in Health (REPSS in Spanish) which act as intermediaries between users and health service providers, making these state-level entities responsible for both managing financial resources and shaping and coordinating the health care delivery network. However, most of the REPSS studied were found to be in a state of inertia, leading to inadequate compliance with legally mandated functions. Normative, technical, political and managerial obstacles persist, impeding the successful separation of functions.

Financing the Millennium Development Goals for health and beyond: sustaining the 'Big Push'

Many of the Millennium Development Goals are not being achieved in the world's poorest countries, yet only five years remain until the target date. The financing of these Goals is not merely insufficient; current evidence indicates that the temporary nature of the financing, as well as challenges to coordinating its delivery and directing it to the most needy recipients, hinder achievement of the Goals in countries that may benefit most. Traditional approaches to providing development assistance for health have not been able to address both prevalent and emergent public health challenges captured in the Goals; these challenges demand sustained forms of financial redistribution through a coordinated mechanism. A global social health protection fund is proposed to address recurring failures in the modern aid distribution mechanism. Such a Fund could use established and effective strategies for aid delivery to mitigate many financial problems currently undermining the Millennium Development Goals initiative.