Goal Of Universal Health Coverage Research Articles

Contested and nervous spaces: exploring the environment of healthcare provision for international migrants in the Gauteng province of South Africa

ABSTRACT Background Notwithstanding the global goal of inclusive universal health coverage, and the notion of migrant-sensitive health systems, limited healthcare access or the exclusion of migrants from national health systems persists. South Africa has a rights-based constitution, but there is an inability or a failure of the health system to recognise and address the health needs of migrants. Objective To explore the intersection of the environment of healthcare provision for migrants and the everyday practices and behaviours of health workers and patients in the Gauteng province of South Africa. Methods The conceptual frameworks of health system responsiveness and social exclusion informed this institutional ethnographic study at 13 healthcare facilities in Gauteng province. We developed an observation guide to explore the intersection of culture and environment and its influence on healthcare provision to patients, especially migrants. Following ethics approval, we observed the facilities for 234 person-days. We used thematic analysis to analyse the data. Results Busy, frantic or nervous spaces, and contestations between patients and health workers, and among health workers formed part of the social and cultural environment of healthcare provision. The presence of migrant patients during busy periods served as a detonator for rude or discriminatory remarks, exacerbated by staff shortages and language barriers. Simultaneously, migrants exercised their agency by rebutting or confronting rude health workers. We also observed encouraging examples of kindness, caring and professionalism of health workers. Conclusion The study has implications for achieving a migrant-sensitive health system in South Africa.

Health policy analysis for stewardship of rehabilitation services

Background and aimThere have been a growing interest in investigating the effect of stewardship on other functions of rehabilitation service delivery. Effective stewardship of rehabilitation services can ensure that these services are of high quality, accessible, affordable, and sustainable, and can help achieve the goals of universal health coverage. The purpose of this study was to identify and analyze the policies adopted in the field of rehabilitation services in Iran and in the international arena, and finally to identify policy gaps, areas for improvement, and areas that have been overlooked.MethodThis research is a policy analysis, carried out through document analysis and Dalglish et al.’s READ approach. Data were analyzed and interpreted using qualitative methodology and directed content analysis. For this purpose, Veillard et al.‘s health system stewardship framework was used to analyze the stewardship of rehabilitation services. The dimensions of the stewardship framework, were: Defining the vision for health and strategies and policies to achieve better health; influencing all sectors and advocating for better health; ensuring good governance in line with prevailing values; ensuring the alignment of system design with health system goals; improving existing legal and regulatory instruments; and compiling, disseminating, and applying information. Scott’s four criteria were used to assess the authenticity, credibility, representativeness, and meaning of the documents. Those that did not meet even one of the Scott’s criteria were excluded from content analysis.FindingsA total of 16 documents were identified, all of which met Scott’s criteria and none were excluded from the study. A total of six themes and 56 subthemes were extracted. The contents of all the documents were extracted under six themes of Veillard et al.‘s health system stewardship framework. Overall, the results show that national documents place greater emphasis on the development of preventive healthcare and health promotion. Documents often focus on engaging NGOs and the families of people with disabilities and on intersectoral collaboration for knowledge production and the development of intersectoral knowledge networks. In terms of health system governance in line with prevailing values, documents are mainly focused on health system stewardship by the Ministry of Health and on evidence-based decision-making with the participation of target groups. Also, documents place more emphasis on upgrading the national infrastructure and increasing access to rehabilitation services.ConclusionIn some areas of rehabilitation services, there is a gap between national documents, which reflects differences in priorities, approaches, resources, and instruments available to strengthen rehabilitation services at the national and international levels.

Forced displacement and the healthcare workforce crisis: Venezuelan healthcare workers in Peru

Abstract Background The migration of healthcare workforces tends to be economically based benefiting high income countries, while draining lower-income countries of workers and skills. However, national instability or civil conflict may also have the effect of forcing out health workers. Few articles focus on the experiences of these types of migrants. This study aims to close a gap in the migration debate by exploring the capacity of integrating displaced healthcare workers in middle-to-low resourced health systems, using Peru as a case study. Methods The study draws on a policy analysis, statistical data and expert information from Peru. Results Peru has become the second largest Latin American destination for Venezuelan forced displaced migrants, a number of which are healthcare workers. While the exact numbers of these workers is unknown, it is estimated that 4,000 and 3,000 physicians and about 2,500 nurses and health technicians from Venezuela reside in Peru. These workers find entry into the heath system difficult due to bureaucratic and costly registration and qualification validation procedures. However, during Covid-19 the conditions were relaxed, and a large number of these workers entered the healthcare workforce. They were primarily physicians and worked in urban medical facilities, though there was some distribution across the country’s departments. This avenue to the healthcare workforce allowed the mobilisation of dormant health skills and assisted to lift density numbers. Conclusions Peru’s experiences bring into focus the potential benefits of mobilising new resources through integrating displaced healthcare worker migrants. It is too early to assess the sustainability of these policies on the country’s healthcare workforce and its Universal Health Coverage goals, yet there seem to be some positive experiences. Speakers/Panelists Tomas Zapata WHO/Europe, Copenhagen, Denmark

Contextual success and pitfalls of mHealth service for maternal and child health in Africa: An Intervention, Context, Actors, Mechanism, and Outcome (ICAMO) framework guided systematic review of qualitative evidence

IntroductionMobile health (mHealth) interventions have shown potential to improve maternal and child health outcomes in Africa, but their effectiveness depends on specific interventions, context, and implementation quality. Challenges such as limited infrastructure, low digital literacy, and sustainability need to be addressed. Further evaluation studies are essential to summarize the impact of mHealth interventions. Thus, this synthesis focuses on qualitative evidence of the impact of mHealth on maternal and child health in Africa to summarize such evidence to help policy decisions.MethodsA qualitative systematic review guided by the concepts of Intervention, Context, Mechanism, and Outcome (ICAMO) was employed in this study. The GRADE CERQual assessment and methodological constraints tools were utilized in the review to ascertain the level of confidence in the evidence and to examine the methodological limitations. The JBI checklist for qualitative research appraisal was also consulted during the review.ResultsThe current review contains 32 eligible studies from databases such as CINAHL, EMBASE, MEDLINE, Scopus, Web of Science, HINARI, and Cochrane Library. The review demonstrated substantial improvements in the HCP-woman relationship, communication system, maternal and child healthcare uptake, health-seeking behavior, and HCP skills. Economic capacities, maternal education, and the low quality of existing services challenged participants.ConclusionmHealth significantly improves maternal and child health outcomes in Africa. This review showed it can improve healthcare access, empower women, and contribute to the region's goal of universal health coverage. However, the challenges such as low partner support, high costs for services, and poor quality of current care as narrated by women need commitment from health authorities in the continent. The evidence from this review suggests that mHealth can be implemented to improve maternal and child health in Africa.Trial registrationPROSPERO: CRD42023461425.

Regulation of health professions education and the growth of schools in Somalia.

Health professions education, encompassing training programs for medicine and surgery, nursing, midwifery, medical laboratory sciences,, and public health, along with their regulations, are pivotal to achieving universal health coverage and Sustainable Development Goals, contributing significantly to health outcomes and public trust in the healthcare workforce. However, low- and middle-income countries, especially in sub-Saharan Africa, face challenges, such as inadequate resources, outdated curricula, and weak governance. Somalia in particular grapples with a fragmented health system and a critical shortage of skilled health professionals, exacerbated by decades of civil war and political instability. This study employed a mixed-method approach that incorporated both qualitative and quantitative data collection and analysis. A comprehensive literature review was conducted along with semi-structured interviews with 44 key informants, including representatives from professional health schools and officials from the Ministry of Health. Additionally, five focus group discussions were held with young professionals and an online survey was administered to students enrolled in professional health courses. The data analysis employed descriptive for quantitative data, and thematic analysis for qualitative data, guided by the human resources for health (HRH) maturity model framework. This study identified 112 health professions schools across Somalia, with a significant concentration in urban areas, particularly in Benadir. The health workforce analysis revealed a pronounced urban-rural disparity and a density of health professionals below the WHO's recommended threshold. The focus group discussions and surveys highlighted the employment challenges faced by young physicians and students' perceptions of their training and future employment opportunities. The proliferation of health professions schools without adequate quality control, the critical shortage and maldistribution of skilled health professionals, and the absence of a comprehensive regulatory framework are significant challenges facing Somalia's healthcare system. The establishment of the National Health Professionals' Council (NHPC) Act in 2020 marks a step towards addressing these issues. This study emphasizes the need for accreditation of health professions schools, capacity building of HRH teams, and collaboration among stakeholders to improve healthcare workforce development and regulation. Addressing urban-rural disparities and combating professional misconduct are also crucial for achieving universal health coverage and improving health outcomes in Somalia.

Five Years of National Health Policy in India: Critical Analysis of the Public Health Expenditure from 2017 to 2022 and Way Forward

This retrospective study assesses the impact of India’s National Health Policy (NHP) 2017 on public health expenditure and its implications for achieving Universal Health Coverage (UHC) and Sustainable Development Goal 3 (SDG-3). Using secondary data analysis from government sources, we observed health budget trends relative to GDP from 2017 to 2022. The study found a marginal increase in public health expenditure from 0.9% to 1.6% of GDP, which is below the NHP’s target of 2.5%. The results underscore the challenge of high out-of-pocket expenses, which remain a barrier to UHC. The COVID-19 pandemic has further highlighted the inadequacies of the current funding levels. We conclude that a substantial increase in health budget allocations is crucial for India to make significant strides toward UHC and meet SDG-3 targets. The study also calls for strategic enhancements in healthcare infrastructure and services to address the persistent gaps in healthcare delivery and financing. The findings advocate for a more aggressive approach to public health investment to ensure that quality healthcare services are accessible, affordable, and equitable for all citizens, thereby advancing India’s progress toward comprehensive health coverage.

Equity and trends in the allocation of health human resources in China from 2012 to 2021

BackgroundAs the second most populous country in the world, China has a huge demand for health human resources. Over the past decade, the Chinese government has continuously increased investment in the health sector and implemented relevant policies and systems in an attempt to enhance the overall quantity and equity of health human resources. This study aims to analyze the equity and developmental trends in the allocation of health human resources in China from 2012 to 2021, providing reference and theoretical support for the government’s further optimization of health human resources allocation.MethodsThis study collected health human resources data from 31 provinces, municipalities, and autonomous regions in China from 2012 to 2021. The methods employed included Lorenz curves, Gini coefficients, and agglomeration degree analysis, which examined the developmental trends and equity of health human resources from the perspectives of population and geographical.ResultsThis study found that over the past decade, there has been a significant increase in the total quantity of health human resources in China, accompanied by an improvement in equity, although disparities still exist. There are notable variations in the distribution of health human resources based on geographical area, with disparities between different regions. Relative shortages of health human resources are observed in western regions, while some areas in the eastern and central regions exhibit an abundance or surplus of health human resources.ConclusionOverall, health human resources in China have experienced stable development, with an incremental improvement in allocation equity, yet there remains considerable room for progress. It is imperative to continue strengthening policy guidance and regulation to facilitate the rational flow of health human resources, narrow regional disparities, and achieve the goal of universal health coverage.

Un/met: a mixed-methods study on primary healthcare needs of the poorest population in Khyber Pakhtunkhwa province, Pakistan

BackgroundAccess of all people to the healthcare they need, without financial hardship is the goal of Universal Health Coverage (UHC). As UHC initiatives expand, assessing the needs of vulnerable populations can reveal gaps in the system which may be covered by relevant policies. In this study we (i) identify the met and unmet primary healthcare needs of the poorest population of Khyber Pakhtunkhwa province (KP), Pakistan, and (ii) explore why the gaps exist.MethodsWe used Leveque’s Framework of Patient-centred Access to Healthcare to examine unmet primary healthcare (PHC) needs and their underlying causes for the poorest population in four districts of Khyber Pakhtunkhwa province, Pakistan. Using a triangulation mixed methods design, we analysed data from a quantitative household survey of744 households, 17 focus group discussions with household members and, 11 interviews with healthcare providers.ResultsOur results show that indicate that despite service utilization, PHC needs were not met, primarily due to prohibitively high costs at each stage of access. Furthermore, gaps in outreach and information (approachability), and varying availability of medicines and diagnostics at facilities (appropriateness) the supply side as well as difficulties in navigating the system (inability to perceive) and adhering to prescriptions (inability to engage) on the demand side, also led to unmet PHC needs. Going beyond utilization, our findings highlight that engagement with care is an important determinant of met needs for vulnerable populations.ConclusionSocial health protection policies can contribute to advancing UHC for primary care. However, in our setting, enhancing communication and outreach, addressing gender and age disparities, and improving quality of care and health infrastructure are necessary to fully meet the needs of the poorest populations.

Healthcare Access and Financing: A Legal and Public Health Perspective

The welfare provisions of the current Constitution centre on healthcare. The Indian Constitution's Article 42 declares that the state has an obligation to take all reasonable steps to promote public health. Additionally, Article 47 of the Indian Constitution, another article containing Directive Principles of State Policy, mandates that the state carry out its primary duties to improve public health by raising the standard of living, improving nutrition, and improving public health. In particular, the state must work to outlaw the use of drugs and alcohol, unless prescribed, as these substances are harmful to health. It follows that welfare regulations clearly place an obligation on the state to increase its assistance in promoting the health of those individuals who are unable to pay for the expensive medical care needed to treat their illnesses. In light of the urgency and importance of the issue, the World Health Organisation designated Universal Health Coverage (UHC) as its top goal. Ensuring that everyone has access to necessary health services of adequate quality and is shielded from the financial burden of medical expenses is the goal of universal health coverage. In underdeveloped nations, financial security against medical expenses is just as important as access to healthcare.

First-aid training for primary Healthcare providers on a remote Island: a mixed-methods study

BackgroundEnsuring ongoing first-aid training for primary healthcare providers (PHPs) is one of the critical strategies for providing quality health services and contributing to achieving universal health coverage. However, PHPs have received insufficient attention in terms of training and capacity building, especially in the remote areas of low-to-middle-income countries. This study evaluated the effectiveness of a first-aid training program for PHPs on a Vietnamese island and explored their perspectives and experiences regarding first-aid implementation.MethodsA mixed-methods study was conducted among 39 PHPs working in community healthcare centers. The quantitative method utilized a quasi-experimental design to evaluate participants’ first-aid knowledge at three time points: pre-training, immediately post-training, and three months post-training. Sixteen of the PHPs participated in subsequent semi-structured focus group interviews using the qualitative method. Quantitative data were analyzed using repeated measures analysis of variance (ANOVA), while qualitative data were subjected to thematic analysis.ResultsThe quantitative results showed a significant improvement in both the overall mean first-aid knowledge scores and the subdimensions of the first-aid knowledge scores among healthcare providers post-training. There was a statistically significant difference between the baseline and immediate posttest and follow-up knowledge scores (p < 0.001). However, the difference in knowledge scores between the immediate posttest and three-month follow-up was not significant (p > 0.05). Three main themes emerged from the focus group discussions: perception of first-aid in remote areas, facilitators and barriers. Participants identified barriers, including infrastructure limitations, shortage of the primary healthcare workforce, inadequate competencies, and insufficient resources. Conversely, receiving considerable support from colleagues and the benefits of communication technologies in implementing first aid were mentioned as facilitators. The training bolstered the participants’ confidence in their first-aid responses, and there was a desire for continued education.ConclusionsImplementing periodic first-aid refresher training for PHPs in a nationwide resource-limited setting can contribute significantly to achieving universal health coverage goals. This approach potentially enhances the preparedness of healthcare providers in these areas to deliver timely and effective first aid during emergencies, which may lead to more consistent primary healthcare services despite various challenges.

Improving Sustainable Financing for Universal Health Coverage in Bhutan: Exploring Policy Options and Financial Strategies

AbstractDeeply rooted in its developmental philosophy of gross national happiness (GNH), Bhutan's healthcare system strives towards achieving a shared goal of universal health coverage (UHC). Despite being primarily financed by the government, the health system faces a plethora of challenges. To overcome these hurdles and achieve UHC goals, expanding the fiscal space for health and improving operational efficiency are crucial. This article aims to address Bhutan's evolving healthcare landscape and advance the achievement of UHC through two policy options. The first policy option focuses on the dual objective of improving health outcomes and promoting financial sustainability by leveraging health taxes, whereas the second option emphasizes reinforcing a systematic health technology assessment (HTA) in the Bhutanese health system. First, drawing lessons from global experiences, the policy brief recommends leveraging health taxes to reduce societal and healthcare costs and enhance financial sustainability in the health sector. Considering Bhutan's high prevalence of tobacco and alcohol consumption, and taking opportunity from the ongoing Goods and Services Tax (GST) reform, continued advocacy on health taxes is essential, and soft earmarking the health taxes may be considered to finance a broader array of public health programmes, particularly focusing on the promotion of healthy lifestyle, health screening and outreach public health activities. Second, the integration of HTA into policymaking and decision‐making processes is essential for effective resource allocation in UHC. Nurturing and strengthening the existing HTA governance structure under the Ministry of Health (MoH) and establishing a dedicated multidisciplinary HTA Committee will ensure informed decision‐making and resource optimization. HTA evidence should inform the revision of health service standards, clinical guidelines development, procurement decisions and healthcare priorities. These policy options can assist the country in improving financial sustainability, enhancing effective resource allocation and utilization and improving healthcare delivery, aligning with its vision of GNH and ultimately accelerating progress towards achieving UHC.

Transforming Lives Through Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (ABPMJAY): A Review

Background: The Pradhan Mantri Jan Arogya Yojana (PMJAY) program was created in line with the global goal of Universal Health Coverage (UHC), and aims to ensure everyone has access to quality healthcare services without suffering financial difficulties. In India, over 60% of healthcare spending is still borne by households, and a significant portion of the population lacks any form of health protection coverage. Discussion: The High-Level Expert Group (HLEG) recommended a shift from supply-side healthcare financing to demand-side financing, leading to the introduction of government-sponsored health insurance schemes. To achieve Universal Health Coverage (UHC), the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY) was launched following the recommendations of the National Health Policy 2017. The PMJAY program is the world's largest publicly sponsored social health insurance program, delivering comprehensive healthcare services covering primary, secondary, and tertiary care levels. The scheme covers approximately 12 crore households, including more than 50 crore beneficiaries, offering healthcare coverage of up to Rs. 5 lakh per family annually. PMJAY operates nationwide in India, covering all states and union territories except for a few.. Conclusion: To move forward, PMJAY can play a transformative role in the healthcare landscape, integrate with primary healthcare, contribute to economic development, and expand its scope to include more healthcare services.

Influence of nursing services and facilities on the satisfaction level of BPJS Patients in the inpatient ward of Wajo health Center

Overview: The research conducted at the Wajo Health Center in Baubau City in 2023 aims to evaluate the impact of nursing services and facilities on the satisfaction of BPJS patients. Using an analytical cross-sectional approach, this study involved 42 patients selected through accidental sampling. Primary data were collected through survey questionnaires, while secondary data were obtained from the health center's medical records. Body of Knowledge: This study evaluates the influence of nursing services and health facilities on BPJS patient satisfaction as a key indicator of the effectiveness of the National Health Insurance. The research highlights the importance of improving service quality and health infrastructure to achieve equitable health coverage in line with the WHO's Universal Health Coverage goals. Methods: The study employed an analytical cross-sectional design at the Wajo Health Center in Baubau City from May to June 2023. Out of a population of 55 patients, 42 were selected via accidental sampling. Primary data were gathered through questionnaires and analyzed using univariate, bivariate, and Chi-Square statistical methods. Ethical considerations were maintained by ensuring informed consent, anonymity, and data confidentiality. Results: The majority of respondents were female (81%), predominantly aged 20-29 years (54.8%), and had a high school education (57.1%). Most were housewives (66.7%). There was a high level of satisfaction with nursing care (71.4%) and health facilities (81%). Bivariate analysis showed a significant relationship between satisfaction with nursing services (X² = 10.438, p = 0.005) and health facilities (X² = 12.101, p = 0.003) and BPJS patient satisfaction. Recommendation: It is recommended to enhance service quality through regular training for medical personnel to improve interpersonal and clinical skills. Periodic evaluations of health infrastructure are necessary to ensure reliability. Continuous support from management is required for ongoing improvements, ensuring that health service standards meet BPJS patient expectations.

Neighbourhood effect and inequality in access to essential health services among mother–child paired samples: a decomposition analysis of data from 58 low- and middle-income countries

IntroductionNeighbourhood effect on health outcomes is well established, but little is known about its effect on access to essential health services (EHS). Therefore, this study aimed to assess the contributing factors to access to EHS in slum versus non-slum settings.MethodologyThe most recent data from 58 Demographic and Health Surveys (DHS) conducted between 2011 and 2018 were used, including a total of 157,000 pairs of currently married women aged 15–49 and their children aged 12–23 months. We used meta-analysis techniques to examine the inequality gaps in suboptimal access to EHS between mother-children pairs living in slums and non-slums. Blinder-Oaxaca decomposition technique was used to identify the factors contributing to the inequality gaps in each low- and middle-income country (LMIC) included.ResultThe percentage of mother–child pairs living in slums ranged from 0.5% in Egypt to 63.7% in Congo. Meta-analysis of proportions for the pooled sample revealed that 31.2% [27.1, 35.5] of slum residents and 20.0% [15.3, 25.2] among non-slum residents had suboptimal access to EHS. We observed significant pro-slum inequalities in suboptimal access to EHS in 28 of the 52 LMICs with sufficient data. Of the 34 African countries included, 16 showed statistically significant pro-slum inequality in suboptimal access to EHS, with the highest in Egypt and Mali (2.64 [0.84–4.44] and 1.76 [1.65, 1.87] respectively). Findings from the decomposition analysis showed that, on average, household wealth, neighbourhood education level, access to media, and neighbourhood-level illiteracy contributed mostly to slum & non-slum inequality gaps in suboptimal access to EHS.ConclusionThe study showed evidence of inequality in access to EHS due to neighbourhood effects in 26 LMICs. This evidence suggests that increased focus on the urban poor might be a important for increasing access to EHS and achieving the universal health coverage (UHC) goals.

Advocacy, experience sharing and action planning toward raising additional financing for primary health care: spending more and spending better towards universal health coverage.

Reallocation of funding to respond the covid-19 pandemic, against a backdrop of longstanding underfunded health systems and high out of pocket expenditures for health, affected access to health services for households, especially those without social protection. These highlighted the urgency in curbing the impact of disruptions on progress towards Universal Health Coverage (UHC) goals. Strategic investments in Primary Health Care (PHC) can help spur the necessary momentum. Under the collaborative platform of the Harmonization for Health in Africa's Health Financing Technical Working Group; UNICEF Regional Office for East and Southern Africa and WHO Regional Office for Africa convened the first PHC financing forum for 21 countries across the Eastern and Southern Africa Region. The three-day forum engaged key health and financing decision makers in constructive dialogue to identify practical actions and policy changes needed to accelerate delivery of UHC through improvements in PHC financing mechanisms and arrangements. The forum was attended by over 130 senior policy makers and technicians from governments, United Nations agencies and nonstate actors drawn from within country, regional and affiliating headquarter institutions. The Regional Forum engaged participants in meaningful, and constructive discussions. Five themes emerged (1) regular measurement and monitoring of PHC services and spending (2) increasing investments in PHC (3) enhancing efficiency, effectiveness, and equity of PHC spending, (4) ensuring an enabling environment to invest more and better in PHC, and (5) better partnerships for the realization of commitments. An outcome statement summarizing the main recommendations of the meeting was approved at the end of the forum, and action plans were developed by 14 government delegations to improve PHC financing within country-specific context and priorities. The aims of this meeting in augmenting the political will created through the Africa Leadership Meeting (ALM), by catalyzing technical direction for increased momentum for improved health financing across all African countries was achieved. Peer exchanges offered practical approaches countries can take to improve health financing in ways that are suited to regional context providing a channel for incremental improvements to health outcomes in the countries.

Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study

BackgroundKenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)),...

Effective Cataract Surgical Coverage in Four Large Districts in Telangana, India – Results from Rapid Assessment of Visual Impairment Study

ABSTRACT Purpose To report cataract surgical coverage (CSC) and effective Cataract Surgical Coverage (eCSC) from four districts in Telangana, India. Methods Individuals aged ≥40 years were recruited from Adilabad, Mahbubnagar, Warangal and Khammam districts using two stage cluster sampling methodology. All participants had detailed eye examinations including visual acuity assessment using a standard Snellen chart at a distance of six meters, anterior segment examination and fundus imaging by trained professionals. CSC and eCSC were calculated for persons using a 6/12 visual acuity cut-off. Results Of 12,150 individuals enumerated from four districts 11,238 (92.5%) were examined. The mean (standard deviation) age of the participants was 54.1 (±11.2) years (range: 40 to 102 years) and 54.6% (n = 6137) were women. Overall, the CSC (%) was 54.2%. It ranged from a highest of 59% in Khammam followed by 57.5% in Adilabad, 51.7% in Warangal, and a least of 49.7% in Mahbubnagar district. Overall, the eCSC (%) was 39.9%. It ranged from a highest of 46.1% in Adilabad followed by 43.2% in Khammam, 36.2% in Warangal district and a least of 35.8% in the Mahbubnagar district. Conclusions CSC and eCSC varied across the districts. A significant gap between CSC and eCSC is noted suggestive of challenges with quality of services. District-wise planning of cataract surgical services with a focus on quality care is recommended to improve coverage and contribute towards achieving the goal of universal eye health coverage in the Telangana State in India

The micro-dimensions of health policy design: evidence from a comparative analysis

Policy design studies typically focus on broad policy goals and the types of tools that governments use to realize them. There is however limited scholarly understanding of how these goals and tools are operationalized “on-the-ground.” In this paper, we apply Capano and Howlett’s 2024 Framework on the Micro-Dimensions of Policy Design to understand how universal health coverage goals in the United States, Singapore, and Thailand are operationalized. The framework unpacks the “nuts and bolts” of policy design particularly the specification of policy targets and tools. A comparative analysis of three programs (Obamacare in the US, Medisave in Singapore, and Universal Coverage Scheme in Thailand) demonstrates how similar high-level policy goals are pursued through different tools and settings. Studying these micro dimensions provides insights into the actual operational ways in which high-level objectives are translated into impacts at the ground level. From an applied point of view, a comparative focus on the dimensions of the micro level of policy design is useful for generating evidence and informing health policy debates about what works or does not work on-the-ground.

"My Health, My Right:" There Is More to It than Meets the Eye.

The WHO's World Health Day 2024 slogan, "My health, my right," has been unpacked through the lens of an evolving social epidemiological understanding. The operative part of the theme merely reiterates international positions that have been established for a long and is unable to adequately incorporate advances in the understanding of the central role that structural determinants play in the production of ill-health. Given the urgency of addressing Sustainable Development Goal and Universal Health Coverage goals, the reduction of health inequities through the promotion of social justice is as much a governance imperative as moral.

IJCM_262A: Digital Health Boon or Bane: From Community Health Worker’s Perspective in an Aspirational District

Background: Digital health technologies are pivotal for achieving Universal Health Coverage (UHC) and Sustainable Development Goal 3. This study investigates Community Health Workers (CHWs) perspectives on digital health platforms in an aspirational district in India, aligning with the World Health Organization’s emphasis on fostering an enabling environment for digital health adoption. Objectives: To assess CHWs’ current practices and knowledge of digital health applications/platforms and to understand their perceptions regarding the need and use of digital health platforms in the public health system. Methodology: A mixed-methods approach was utilized, involving 95 CHWs in quantitative surveys and 30 CHWs in qualitative interviews and focus group discussions. The study was conducted in Muzaffarpur, Bihar, India’s most populated aspirational district, using stratified random sampling and purposive sampling methods. Results: Findings reveal varied app usage patterns among CHWs, with challenges like non-functional government-provided devices. Qualitative insights highlight the importance of peer support and training quality alongside concerns about device accessibility and app rationalization. Despite government provision of smartphones, CHWs face obstacles in utilizing digital health tools effectively. Conclusion: This research illuminates the availability and utilization of digital health applications among CHWs, emphasizing the need to address challenges and tailor digital tools to enhance healthcare delivery in aspirational districts.