Universal Health Coverage Agenda Research Articles

Private hospitals in low- and middle-income countries: a typology using the cluster method, the case of Morocco

BackgroundThe private healthcare sector has become an essential component of healthcare systems globally. This interest has increased with the universal health coverage agenda. However, in most low- and middle-income countries, few classificatory studies of the private hospital sector were carried out.MethodsThis study describes the private hospital sector in a developing country setup and propose a typology that could facilitate the identification of its categories and the understanding of its organizational and strategic characteristics.ResultsAll private hospitals in Morocco as of December 31, 2021 including 397 facilities are included. Most hospitals are for-profit, poly-disciplinary, independent, commercial societies, have fewer than 30 beds or between 30 and 99 beds and are located in urban areas. Private hospitals have a median turnover of 9.8 million MAD and a median capital value of 2 million MAD. The clustering method identifies three main categories of private hospitals: for-profit hospitals with medium size and turnover, spread across the country but with a high concentration in large regions; not-for-profit hospitals, with medium to large size, high turnover, located in large regions and including university hospitals; and small for-profit hospitals with low turnover, independent ownership and wide distribution over the country. Three criteria have the most significant discriminatory power: ownership, size (beds, turnover) and mode of governance.ConclusionsPrivate hospitals in Morocco are organized into three types according to three similarity criteria including ownership, size and governance. These criteria might be used as the basis for a common typology of private hospitals in Morocco and possibly in other low- and middle-income countries with similar contexts.

Examining inequalities in spatial access to national health insurance fund contracted facilities in Kenya.

Kenya aims to achieve universal health coverage (UHC) by 2030 and has selected the National Health Insurance Fund (NHIF) as the 'vehicle' to drive the UHC agenda. While there is some progress in moving the country towards UHC, the availability and accessibility to NHIF-contracted facilities may be a barrier to equitable access to care. We estimated the spatial access to NHIF-contracted facilities in Kenya to provide information to advance the UHC agenda in Kenya. We merged NHIF-contracted facility data to the geocoded inventory of health facilities in Kenya to assign facility geospatial locations. We combined this database with covariates data including road network, elevation, land use, and travel barriers. We estimated the proportion of the population living within 60- and 120-minute travel time to an NHIF-contracted facility at a 1-x1-kilometer spatial resolution nationally and at county levels using the WHO AccessMod tool. We included a total of 3,858 NHIF-contracted facilities. Nationally, 81.4% and 89.6% of the population lived within 60- and 120-minute travel time to an NHIF-contracted facility respectively. At the county level, the proportion of the population living within 1-hour of travel time to an NHIF-contracted facility ranged from as low as 28.1% in Wajir county to 100% in Nyamira and Kisii counties. Overall, only four counties (Kiambu, Kisii, Nairobi and Nyamira) had met the target of having 100% of their population living within 1-hour (60min) travel time to an NHIF-contracted facility. On average, it takes 209, 210 and 216min to travel to an NHIF-contracted facility, outpatient and inpatient facilities respectively. At the county level, travel time to an NHIF-contracted facility ranged from 10min in Vihiga County to 333min in Garissa. Our study offers evidence of the spatial access estimates to NHIF-contracted facilities in Kenya that can inform contracting decisions by the social health insurer, especially focussing on marginalised counties where more facilities need to be contracted. Besides, this evidence will be crucial as the country gears towards accelerating progress towards achieving UHC using social health insurance as the strategy to drive the UHC agenda in Kenya.

Inequalities in oral health service utilisation in Ireland: results from the Healthy Ireland Survey

Abstract Background Good oral health is important for overall health and wellbeing; poor oral health disproportionately affects disadvantaged groups and is associated with various non-communicable diseases, many of which have shared risk factors, including diabetes and cardiovascular disease. Regular dental attendance with risk assessment optimises oral health. Due to an ageing dentate population, demands on oral health services are predicted to increase in Ireland. This cross-sectional assessment of oral health service utilisation aimed to inform equitable national resource allocation. Methods Secondary analysis of the Healthy Ireland Survey 2022, a telephone-delivered survey of a representative sample of the Irish public aged ≥15 years, was conducted. Prevalence of dental attendance in the preceding year was measured with 95% Confidence Intervals (CIs). Logistic regression determined factors associated with dental attendance using Adjusted Odds Ratios (aORs). Results Response rate was 40.4% (N = 7,455). Most participants (81.3%) self-reported good or very good overall oral health; 49.3% had attended dental services in the previous year. Compared to comparative counterparts those of higher educational level (aOR 1.28 95% CI 1.09-1.50), those with private health insurance (aOR 1.66 95% CI 1.48-1.86) and those with no missing teeth (aOR 2.91 95% CI 2.19-3.85) were significantly more likely to have attended dental services in the previous year. Conversely, compared to those aged 25-34 years, those aged 65+ had significantly lower odds of dental attendance in the previous year. Conclusions Disparities in oral healthcare utilisation identified in this study suggest potential unmet population oral health needs. Combined with population ageing and a growing scarcity of dentists available to provide care to disadvantaged groups such coverage gaps are key considerations for Irish oral healthcare planning, namely implementation of Ireland's National Oral Health Policy ‘Smile agus Sláinte’ 2019. Key messages • In this nationally representative cross-sectional survey of Irish adults notable disparities in oral health service utilisation were evident, especially among older adults. • Aligning with the universal health coverage agenda, suggested unmet population oral health needs are key considerations for national and international oral healthcare planning and resource allocation.

Interconnection between reproductive and migrant health rights.

SynopsisCritical policies are needed, in line with the universal health coverage agenda, for the inclusion of migrant women recently impacted by restrictions in accessing abortion care.

The importance of wage loss in the financial burden of illness: Longitudinal evidence from India

BackgroundA key aim of Universal Health Coverage (UHC) is to protect individuals and households against the financial risk of illness, and large-scale health insurance expansions are a central focus of the UHC agenda. Importantly, however, health insurance does not protect against a key dimension of financial risk associated with illness: forgone wage income. In this paper, we quantify the economic burden of illness in India attributable – separately – to wage loss and to medical care spending, as well as differences in them across the socio-economic distribution. MethodsWe use data from two longitudinal Indian household surveys: (i) the Village Dynamics in South Asia (VDSA) survey (1300 households surveyed every month for 60 months between 2010 and 2015) and (ii) the Indian Human Development Survey (IHDS) (more than 40,000 households surveyed in 2005 and again in 2011). Our regression models include a series of fixed effects that account for time-invariant household- (or individual-) level and time-varying unobservables common across households. FindingsWe find that, in the VDSA sample, wage loss accounts for more than 80% of the total economic burden of illness among the poorest households, but only about 20% of the economic burden of illness among the most affluent. Estimates from the IHDS sample confirm that this socio-economic gradient is present in the Indian population generally. ConclusionsWage loss accounts for a substantial share of the total economic burden of illness in India – and disproportionately so among the poorest households. Our findings imply that if UHC is to achieve its objective of protecting households against the financial risk of illness – particularly poor households, the inclusion of wage loss insurance or another illness-related income replacement benefit is needed.

Ensuring the right to health along the life course

The concept of health throughout the life course derives from the varied health needs at the different stages in life. Jones and colleagues1 assert that developmental and structural perspectives rooted in social disparities impact health along the life course. Thus, varied health needs should be reflected in health policies, service delivery models, and resource allocation. Relatedly, monitoring and evaluation methods need to embody a similar approach. The universal health coverage agenda that was embraced by countries engendered a holistic approach to health service provision.

Towards Universal Health Coverage

This paper explores the universal health coverage (UHC) in Kenya through the lens of its potential to progressively realize the constitutional promise of the right to the highest attainable standard of health. The health sector in Kenya has experienced tremendous changes since the government piloted the UHC program in four counties that led to the abolition of all fees, more than 200 community health units launched, 7700 community health volunteers with over 700 health workers recruited (MOH, 2020). Still, the government is in the process of scaling up UHC, reforming the national hospital insurance fund (NHIF) to establish a mandatory universal health coverage scheme. This paper sought to examine the framing of UHC; assess the healthcare system between 2017 -2020; investigate the challenges faced in the implementation of UHC in Kenya. The researcher utilized documents analysis to collect the relevant data using a coding schedule. A purposive search was undertaken to identify key policy documents and relevant documents. 18 documents were sampled. The findings reveal that Kenya’s healthcare facilities index stands at 59%, with a density of 2.2 per 10,000 population, the workforce density is at 15.6/10,000. Four counties including Tharaka Nithi (33.8), Nyeri (31.0), Uasin Gishu (28.2), and Nairobi (26.3) have achieved well above the WHO target. Several strategies and programs such as Afya Care, abolished maternity fees for mothers delivering at public facilities, and expansion of the National Health Insurance Fund, has been initiated to drive the UHC agenda. The Ministry of Health’s (MoH) budget also continues to rise, in 2018/19 the MoH received its largest allocation. Kenya, now more than ever, has an opportunity to accelerate progress towards equitable access to healthcare.

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.

Digital Health in East Africa: Innovation, Experimentation and the Market

AbstractAcross East Africa, mobile phones and tablets are increasingly sitting in the hands of community health workers, clinicians, managers and patients. They are being used for a widening range of functions from diagnostics to health insurance to treatment advice, generating hopes for new healthcare futures and establishing the region as an emerging hub of experimentation in digital health. Drawing on our on‐going ethnographic and anthropological research in Kenya and Tanzania, this article explores the dynamic, varied, experimental, and increasingly financialised terrain of formal digital health projects. While innovation in digital health is a growing feature of healthcare across the globe, in East Africa it is entering into a region already long characterised by NGOised, fragmented and vertical healthcare systems and heavy dependence on foreign capital. This presents challenges to efforts, including the WHO’s Universal Health Coverage agenda, to foster national and equitable public healthcare systems. In exploring these issues, we recognise the power, and often deleterious effects, of financial capital that foregrounds markets in global digital health, but we also open space for a (still critical) recognition of East African‐led digital and data technology movements.

Results Based Financing in Zambia: Performance Evaluation and Exploration of Opportunities in Health System Adoption

Background–Results Based Financing has strategically fit into discussions of the Universal Health Coverage agenda at global level with the aim of meeting the Sustainable Development Goals. It has been viewed that Results Based Financing is a potent financing model and can be used as a strategic tool for remodeling the health systems in many developing countries as suggested by prior studies which argued that Results Based Financing implementation requires: (i) a strong management support and political will; (ii) maximum innovative efficiencies and willingness for change; and (iii) strengthened health management information and reporting systems. Therefore, this study aimed at understanding how Results Based Financing approaches can be scaled-up by exploring the Successes, Challenges and Opportunities of adopting it into the health system from its project form.Methods -A case study design was used for this research with a quantitativedata collection approach. Data was analyzed using SPSS version 22.Results-The Results Based Financingprogramme improved all the indicators targeted in Lunte District Health facilities. The successes of the project included improved quality of health care services and strengthened health system. A notable challenge for Results BasedFinancing implementers was poor performance of non-incentivized indicators compared with the incentivized. However, an opportunity was seen with the project in that other financing models were discussed to either mimic or simply use Results Based Financing tools, pool funds in one basket and apply the concept. Results Based Financing improved efficiency and effectiveness based on results that health facilities learnt how to manage funds, shown by 67% of respondents, and commitment to re-investment 60% of their bonuses back into the system.Conclusion-Results based financing can be regarded as a model for harmonizing other donor funds and drive forward the financial sustainability of being a successful financing strategy for the health sector

Politics of success stories in the path towards Universal Health Coverage: The case of Turkey

AbstractMotivationTurkey has been acknowledged as a “successful” example of Universal Health Coverage (UHC) reforms and has recently gained donor “darling status.” While the literature on UHC and health reforms in various countries has increased significantly in recent years, there is still little research on the political dynamics of the rise of UHC in national and global development agendas.PurposeThis study examines the politics of UHC in Turkey’s Health Transformation Program (HTP). It investigates how various policy actors, such as international organizations, policy experts and national political leaders, use UHC framing for different purposes.Approach & MethodsThe article develops an interdisciplinary conceptual framework that combines elements of ideational scholarship and critical policy analysis. The analysis is based on a review of the secondary literature and primary sources. Qualitative content analysis is used to identify major themes and analyse patterns of interactions across the various policy levels.FindingsThe article’s main findings demonstrate the ways in which international actors and national policy‐makers engage in policy work and use their relationships, global policy ideas and experiences to build legitimacy and support for their respective agendas. Reforms in Turkey were proposed and implemented before the rise of UHC in the global agenda, suggesting an ex post facto rebranding of its reforms as UHC. For Turkey’s policy‐makers, rebranding worked to tie their policy solutions, summarized in the HTP, to UHC as a widely accepted cultural symbol. The Ministry of Health’s deliberate strategy to encourage data collection and monitoring was also a key part of its efforts to construct a success narrative in collaboration with global policy actors. For the global‐level advocates of UHC, Turkey provided evidence that UHC works. Before it became a target under the health‐related Social Development Goals (SDGs), advocates needed to demonstrate that they had the right framing and metrics for a UHC agenda. After 2015, successful examples have served as strategic tools for building support and political momentum as the agenda was diffused, and as these diverse agendas and interests overlapped.Policy ImplicationsThis article contributes to the current debates on policy diffusion, translation and implementation of the UHC agenda. It unpacks the use of success stories to navigate the political dynamics among national governments and global policy communities. Success stories, alongside an emphasis on country ownership, may serve to encourage the co‐production of policy across local, national and global levels.

Can minimal intervention dentistry help in tackling the global burden of untreated dental caries?

The latest estimates from the Global Burden of Disease study show that dental caries remains a neglected global health issue, with over two billion people suffering the consequences of this highly preventable disease globally. The two main goals of a national health system are to improve population health and reduce health inequalities, which are often achieved through prevention and promotion for everyone, as well as treatment and rehabilitation for the sick. Oral health promotion should be integrated with national policies for the prevention of non-communicable diseases, especially those targeting the intake of free sugars. The ongoing debate on universal health coverage (UHC) offers a unique opportunity to align dental care with essential health services, which all countries are expected to provide. Minimal intervention dentistry (MID) protocols for management of carious lesions, such as the atraumatic restorative technique, silver diamine fluoride and the Hall Technique, could help tackle the global burden of untreated caries as they are cost-effective in the long run. However, the successful implementation in primary dental care and training the new cadre of dentists adequately are pending issues if MID is to facilitate the inclusion of dental care as part of the UHC agenda.

Primary health care and nutrition.

Globally, dietary factors are responsible for about one in five deaths. In many low- and middle-income countries different forms of malnutrition (including obesity and undernutrition) can co-exist within the same population. This double burden of malnutrition is placing a disproportional strain on health systems, slowing progress towards universal health coverage (UHC). Poor nutrition also impedes the growth of local economies, ultimately affecting the global economy. In this article, we argue that comprehensive primary health care should be used as a platform to address the double burden of malnutrition. We use a conceptual framework based on human rights and the Astana Declaration on primary health care to examine existing recommendations and propose guidance on how policy-makers and providers of community-oriented primary health care can strengthen the role of nutrition within the UHC agenda. Specifically, we propose four thematic areas for action: (i) bridging narratives and strengthening links between the primary health care and the nutrition agenda with nutrition as a human rights issue; (ii) encouraging primary health-care providers to support local multisectoral action on nutrition; (iii) empowering communities and patients to address unhealthy diets; and (iv) ensuring the delivery of high-quality promotive, preventive, curative and rehabilitative nutrition interventions. For each theme we summarize the available strategies, policies and interventions that can be used by primary health-care providers and policy-makers to strengthen nutrition in primary health care and thus the UHC agenda.

Supporting the role and enabling the potential of community health workers in Bangladesh’s rural maternal and newborn health programs: a qualitative study

Background In the global journey towards Universal Health Coverage (UHC), strong primary healthcare systems are essential. This includes the frontline health workers, the bedrock of which are community health workers (CHWs). In Bangladesh, this largely female workforce plays a critical role in health promotion and linking communities with the formal health care system. With the launch of the new national strategy on CHWs, and its ambitions around the implementation of harmonized systems of financing, certification, job harmonization, performance assessment and supportive supervision, it is important to reference the perceptions, experiences, needs and aspirations of CHWs themselves. Methods This qualitative exploratory study examines three UNICEF supported maternal and newborn health (MNH) programs in rural Bangladesh, with two districts sampled for each program. In-depth interviews were conducted with CHWs, community members, other health workers, and program managers. Data were analyzed using a thematic analysis approach, with a particular focus on the voice and experience of CHWs and the programmatic features that support them in serving their communities. Results Across all three programs, CHWs function as critical local agents for health promotion and referral whose recruitment from and support by the community, enhances their effectiveness. Regular communication and collaboration between CHWs and public-sector frontline workers were perceived as important in enabling their role in increasing the coverage of essential services. Support for structured systems of training, supervision and monitoring which encompass the support of referral decisions, was also apparent. Of particular note were the needs and aspirations of CHWs regarding work-life balance, job satisfaction and desire for professional development. These concerns emphasize the importance of flexibility in how the CHW workforce is configured such that roles, responsibilities and remuneration are keyed to experience and qualifications, and the dynamic needs and aspirations of CHWs over the life course. Conclusions As Bangladesh pursues its UHC agenda, CHWs are pivotal in linking underserved communities to the formal health system. Flexibility in the scope of CHW roles and responsibilities, as well as supportive supervision, regular training and fair remuneration, will optimize their contributions towards UHC and better MNH outcomes.

Governing access to emergency care in Africa.

Emergency care not only has the potential to address a large portion of death and disability in low- and middle-income countries, it is also essential to achieving the current Universal Health Coverage agenda and fulfilling the universal human right to the highest attainable standard of health. One of six health system building blocks, governance is often neglected but nonetheless essential for guaranteeing access and strengthening emergency care systems in Africa. In this paper, we highlight key components of governance that are necessary to guaranteeing access to emergency care, describe current examples of emergency care accessibility laws and regulation in various African countries, and suggest priorities for measuring and evaluating the impact of legal guarantees for access to emergency care in Africa.

Implementing FIP's global pharmaceutical education transformation vision in Sub-Saharan African Countries.

The realization of a competent, versatile and adaptable Pharmaceutical workforce which is a key component in achieving the World Health Organization Universal Health Coverage agenda in 2030 depends on the supply of adequately trained pharmacy workforce who can improve access to quality medicines while delivering quality pharmaceutical services. Despite the rise in the density of pharmacists across all World Health Organization regions, African countries still stay considerably behind in terms of absolute capacity per capita which means that the pharmacy workforce in Africa continues to be very low and not adequate to deliver the pharmaceutical services needs of the region. The International Pharmaceutical Federation is leading the transformation of pharmacy education in Sub-Saharan African countries to bridge this gap with a spotlight on increasing academic capacity, establishing needs-based education strategies and creating an enabling practice environment through advocacy. This commentary paper seeks to discuss the strategies such as the FIP-UNITWIN Programme and the Kenya-Nottingham Partnership utilized in transforming the pharmacy education and therefore the pharmaceutical workforce within the Sub-Saharan African Countries. This paper also gives a clue on subsequent steps which can advance pharmaceutical practice and science in the region.

Monitoring Universal Health Coverage (UHC) in high Tuberculosis burden countries: Tuberculosis mortality an important tracer of UHC service coverage

BackgroundThere is a paucity of empiric data evaluating whether Tuberculosis (TB) is a useful surrogate measure for Universal Health Coverage (UHC), despite recognition of the importance of TB control efforts as part of the broader UHC agenda. We hypothesized that indicators of TB burden and coverage are sensitive tracers of UHC, when compared to other disease-specific indicators of service provision.MethodsLinear regression models were used to determine the extent to which variability in UHC Service Coverage Index (SCI) was accounted for by (1) TB incidence rates and (2) TB mortality rates across 183 countries. Dominance analyses, stratifying countries by World Bank income criteria and TB burden, were used to determine the importance of TB treatment coverage in predicting UHC SCI scores, relative to other disease-specific indicators of service provision.ResultsAcross 183 countries, TB incidence rate and TB mortality rate were negatively correlated, with UHC SCI score, (r = -0.67 and r = -0.74, respectively). In linear regression models including all 183 countries, TB incidence rates explained 45% of the variability in SCI scores; TB mortality rate explained 55% of variability. Restricting models to the 30 highest TB burden countries, both incidence and mortality explained less of the variability in SCI score (16% and 36%, respectively). In dominance analysis, comparing 13 disease-specific indicators of service provision, TB effective treatment coverage, ranked ninth overall. In dominance analysis stratified by TB burden, the TB treatment coverage estimate was ranked ninth in the 30 high burden countries and sixth in the 153 non-high burden countries. In separate analyses stratified by world bank income status, TB coverage ranked as third most important variable in LICs and fifth in LMICs and UMICs, but was less important in analysis restricted HICs (ranked seventh).ConclusionsCompared to other disease-specific indicators of service provision, TB coverage was an important indicator of overall UHC service coverage, especially in low-income countries. These findings highlight that national-level inequities in TB-coverage may be an important tracer of universal health coverage.

Predictors of Pharmacy Students Intention to use Stimulants for Enhancing Academic Performance.

The realization of a competent, versatile and adaptable Pharmaceutical workforce which is a key component in achieving the World Health Organization Universal Health Coverage agenda in 2030 depends on the supply of adequately trained pharmacy workforce who can improve access to quality medicines while delivering quality pharmaceutical services. Despite the rise in the density of pharmacists across all World Health Organization regions, African countries still stay considerably behind in terms of absolute capacity per capita which means that the pharmacy workforce in Africa continues to be very low and not adequate to deliver the pharmaceutical services needs of the region. The International Pharmaceutical Federation is leading the transformation of pharmacy education in Sub-Saharan African countries to bridge this gap with a spotlight on increasing academic capacity, establishing needs-based education strategies and creating an enabling practice environment through advocacy. This commentary paper seeks to discuss the strategies such as the FIP-UNITWIN Programme and the Kenya-Nottingham Partnership utilized in transforming the pharmacy education and therefore the pharmaceutical workforce within the Sub-Saharan African Countries. This paper also gives a clue on subsequent steps which can advance pharmaceutical practice and science in the region.

Editorial: Positioning surgery at the core of the universal health coverage agenda

Editorial: Positioning surgery at the core of the universal health coverage agenda

Integrating Typhoid Fever Within the Sustainable Development Goals: Pragmatism or Utopia?

Several decades following the first estimates of the global burden of typhoidal salmonellosis (infections caused by Salmonella Typhi and Salmonella Paratyphi), this disorder remains a major cause of morbidity worldwide with an estimated 17 million cases annually. The risk factors for typhoid include poverty, poor living conditions with unsafe water and lack of adequate sanitation, and unsafe foods—all reasons for the disease burden being highest among such populations including urban slums. A recent review of typhoid trends globally and in specific countries suggests that the relative contributions of these risk factors to disease burden reduction as well as persistence have varied. There is also the risk of periodic outbreaks related to introduction of relatively virulent drug-resistant strains or movements of vulnerable populations, including those in conflict zones. Most countries of the world are now aligning their health and multisectoral strategies to address the Sustainable Development Goals (SDGs) and targets, which were agreed upon by all countries of the world in September 2015. Though neglected so far, there are huge opportunities for mainstreaming typhoid prevention and control strategies within the SDGs. This article reviews some of the approaches that may help elevate typhoid to a higher level of awareness in public health programs and policy and to ensure that investments in major public health preventive measures are made part of the universal health coverage agenda.