Goal Of Universal Health Coverage Research Articles

An appraisal of the contextual drivers of successful antimicrobial stewardship implementation in Nigerian health care facilities

Antimicrobial resistance (AMR) is a consequence of inappropriate actions, including irrational antimicrobial prescribing and use. Antimicrobial resistance remains an emergent and significant public health threat, particularly in low and middle-income countries (LMICs), including Nigeria. Optimizing antimicrobial (AM) use through functional hospital antimicrobial stewardship (AMS) programs is one of the strategies to control the spread of AMR. Literature is replete with evidence, but few studies examined the contextual factors limiting AMS functionality at the facility levels. This study explored the intrinsic contextual factors shaping AMS practice at the three-tiered levels of care. This was a qualitative case study with a purposeful sample size of 30 participants drawn from two primary, two secondary, and two tertiary health facilities in Nigeria. Data were coded and categorized for thematic analysis. Emergent themes include lack of AMS programs, inadequate guidelines, lack of modern equipment and incorrect diagnosis, absence of continuous medical education, imbalance of power among professionals, and pervasive external influence of pharmaceutical marketing companies. These findings demonstrate that the AMS program is lacking or poorly implemented at the three-tiered level of care. We recommended that health facilities establish AMS programs in line with the World Health Organization's stepwise approach. These challenges, if addressed, will promote the successful performance of the AMS program, contributing to rational AM use at all levels of care. Since primary health centres constitute 85.4% of all health facilities, customizing the AMS core elements at this level will contribute to achieving the goals of universal health coverage.

Role of publicly funded health insurance in financial protection of the elderly from hospitalisation expenditure in India-findings from the longitudinal aging study

BackgroundThe elderly face a greater burden of illnesses than other age groups and have a more frequent need of healthcare, including in-patient hospitalisations. Catastrophic expenditure on hospitalisation of the elderly poses a significant challenge to India’s aim of achieving Universal Health Coverage (UHC). India has implemented a policy of Publicly Funded Health Insurance (PFHI) to provide free inpatient care by empanelling private and public hospitals. The existing studies have examined the performance of PFHI in financial protection of the elderly.MethodsThis study utilised the Longitudinal Ageing Study in India (LASI) Wave 1, conducted in 2017–18. LASI is a large-scale nationally representative survey collecting data on elderly health including illness burden, healthcare use and out of pocket expenditure (OOPE). It covered a sample 72,250 individuals aged 45 or above. Financial Protection was measured in terms of Catastrophic Health Expenditure (CHE). Multivariate analysis was conducted to find effect of PFHI on OOPE—quantile and logistic models were applied for OOPE and CHE respectively. For robustness, Propensity Score Matching (PSM) model was applied.ResultsOf the hospitalisations, 35% had taken place in public hospitals. The mean OOPE for a hospitalisation in public sector was Indian Rupees (INR) 8276, whereas it was INR 49,700 in private facilities. Incidence of CHE was several times greater for using private hospitals as compared to public hospitals. Multi-variate analyses showed that enrolment under PFHI was not associated with lower OOPE or CHE. PSM model also confirmed that PFHI-enrolment had no effect on OOPE or CHE. Use of private facilities was a key determinant of OOPE, irrespective of enrolment under PFHI.ConclusionsThis was the first study in India to examine the performance of PFHI in the context of catastrophic hospitalisation expenditure faced by the elderly. It found that PFHI was not effective in financial protection of the elderly. The ongoing reliance on a poorly regulated private sector seems to be a key limitation of PFHI policy. Governments need to find more effective ways of protecting the elderly from catastrophic health expenditure if the goal of UHC has to be realized.

Supporting each other: Pacific emergency care clinicians navigate COVID-19 pandemic challenges through collaboration

Supporting each other: Pacific emergency care clinicians navigate COVID-19 pandemic challenges through collaboration

Mental health stigma and discrimination in Ethiopia: evidence synthesis to inform stigma reduction interventions

BackgroundPeople with mental illnesses are at an increased risk of experiencing human rights violations, stigma and discrimination. Even though mental health stigma and discrimination are universal, there appears to be a higher burden in low- and middle-income countries. Anti-stigma interventions need to be grounded in local evidence. The aim of this paper was to synthesize evidence on mental health stigma and discrimination in Ethiopia to inform the development of anti-stigma interventions.MethodsThis evidence synthesis was conducted as a part of formative work for the International Study of Discrimination and Stigma Outcomes (INDIGO) Partnership research program. Electronic searches were conducted using PubMed for scientific articles, and Google Search and Google Scholar were used for grey literature. Records fulfilling eligibility criteria were selected for the evidence synthesis. The findings were synthesized using a framework designed to capture features of mental health stigma to inform cultural adaptation of anti-stigma interventions.ResultsA total of 37 records (2 grey literature and 35 scientific articles) were included in the evidence synthesis. Some of these records were described more than once depending on themes of the synthesis. The records were synthesized under the themes of explanatory models of stigma (3 records on labels and 4 records on symptoms and causes), perceived and experienced forms of stigma (7 records on public stigma, 6 records on structural stigma, 2 records on courtesy stigma and 4 records on self-stigma), impact of stigma on help-seeking (6 records) and interventions to reduce stigma (12 records). Only two intervention studies assessed stigma reduction— one study showed reduced discrimination due to improved access to effective mental health care, whereas the other study did not find evidence on reduction of discrimination following a community-based rehabilitation intervention in combination with facility-based care.ConclusionThere is widespread stigma and discrimination in Ethiopia which has contributed to under-utilization of available mental health services in the country. This should be addressed with contextually designed and effective stigma reduction interventions that engage stakeholders (service users, service providers, community representatives and service developers and policy makers) so that the United Nations universal health coverage goal for mental health can be achieved in Ethiopia.

Active stewardship in healthcare: Lessons from China's health policy reforms

AbstractGovernments across the globe have made repeated attempts to reform their health systems in recent decades with the purpose of improving access while containing costs. What is the role of government in contemporary health policy in achieving these somewhat contradictory goals? This paper conceptualises this role as one of “active stewardship” wherein the government is a central actor steering and coordinating the sector through a portfolio of diverse policy tools. In this conceptualisation, the government is not a passive participant—in merely financing, delivering, or regulating the sector—but a steersman at the helm that sets policy objectives and actively pursues them. We argue that active stewardship is central to achieving contemporary health policy priorities of universal healthcare. We apply this conceptualisation to China's recent healthcare forms and show that the role of the government in governing the sector has changed substantially over time, particularly since 2009, and the changes are showing promising results. China's experience suggests that governments need to more actively guide and shape the behaviour of both public and private players in order to achieve the goals of universal health coverage. It also suggests that a high degree of policy capacity is essential if active stewardship is to be effective.

Technical efficiency of health production in Africa: A stochastic frontier analysis

Background: Inefficiency is widespread in health systems all over the world. The World Health Organization (WHO) estimates that 20%-40% of the global health spending is wasted. In African countries, inefficiency of this magnitude will seriously hamper progress towards achieving universal health coverage and other health system goals. It is thus, significant to assess the efficiency of health systems over time in order to set the ground for identifying the contextual factors leading to inefficiency and design appropriate efficiency-enhancing measures.Methods: Using panel data for the years 2000, 2005, 2010, and 2015, the study employs a time-variant stochastic frontier production function to assess efficiency. The input measure used is current expenditure per capita in purchasing power parity (Int$) terms and the measure of output is health-adjusted life expectancy (HALE). Moreover, mean years of schooling, GDP per capita in Int$, and out-of-pocket payment as a share of current expenditure on health were used as technical inefficiency effect variables. Data were analyzed using Frontier Version 4.1.Results: The mean technical efficiency scores were 79.3% in 2000, 81% in 2005, 85.6% in 2010 and 88.3% in 2015. Over the four periods of time, Cabo Verde registered the highest technical efficiency scores, while Eswatini and Sierra Leone had the lowest. The minimum technical efficiency scores were 58.7% (in 2000), 59.1% (2005), 67.4% (2010) and 71.8% (2015). These indicate that despite improvements, there is a significant degree of technical inefficiency. Most of the countries among those in the bottom 10% efficiency scores are countries in Southern Africa, which in 2015 had a very high prevalence of HIV among adults, compared to the top 10%, which had prevalence rates of less than 0.1%.The mean efficiency score increased progressively over time – a nine percentage point increase between 2000 and 2015. The elasticity of current health expenditure was positive (0.06) and statistically significant. All the technical inefficiency variables had no statistically significant effect.Conclusions: Over the period of time covered in this study, there was some improvement in the average technical efficiency scores. However, there was also marked inefficiency in many countries, which is likely to hamper their progress towards universal health coverage and other health system goals. In a context where health spending is too low to provide needed services, it is imperative to address the causes of technical inefficiency and produce more health for the money. Furthermore, low-performing health systems should learn from their relatively high-performing peers.

Lessons for the Implementability and Sustainability of the SURG-Africa Model of Malawi in Colombia Comment on "Improving Access to Surgery Through Surgical Team Mentoring - Policy Lessons From Group Model Building With Local Stakeholders in Malawi".

The development of models that allow improving the quality to achieve person-centered care is a challenge for any health system, especially in low- and middle-income countries, due to the economic difficulties inherent to the countries and to the cost involved in its implementation, which should be assumed by the states, avoiding that the economic burden is assumed by the population, and approaching the goal of universal health coverage. The availability of human talent and efficiency in the use of basic and specialized human talent is a necessity to improve safe access to health services, in this sense, the model proposed by SURG-Africa and whose sustainability in Malawi was evaluated, is an important reference for the establishment and sustainability of these models with other specialties and in other countries. Through this article, the elements of education, care model and financing for the implementation of the strategy in family medicine in the Colombian health system are explored.

Advanced Practice Nursing Roles, Regulation, Education, and Practice: A Global Study.

Background and Objectives:Several subgroups of the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN) have periodically analyzed APN (nurse practitioner and clinical nurse specialist) development around the world. The primary objective of this study was to describe the global status of APN practice regarding scope of practice, education, regulation, and practice climate. An additional objective was to look for gaps in these same areas of role development in order to recommend future initiatives.Methods:An online survey was developed by the research team, and included questions on APN practice roles, education, regulation/credentialing, and practice climate. The study was launched in August 2018 at the 10th Annual ICN NP/APNN Conference in Rotterdam, Netherlands. Links to the survey were provided there and via multiple platforms over the next year.Results:Survey results from 325 respondents, representing 26 countries, were analyzed through descriptive techniques. Although progress was reported, particularly in education, results indicated the APN profession around the world continues to struggle over titling, title protection, regulation development, credentialing, and barriers to practice.Conclusions and Practice/Policy Relevance:APNs have the potential to help the world reach the Sustainable Development Goal of universal health coverage. Several recommendations are provided to help ensure APNs achieve these goals.

Missing Middle: Extending Health Insurance Coverage in India

Abstract: In India’s stride towards achieving its goal of Universal Health Coverage, an important and sometimes neglected aspect is that of health insurance. The pandemic has served to highlight the state of healthcare infrastructure along with the impact of government spending on the healthcare sector. However, in the current Union Health Budget (2022-23) there has been only a marginal increase of 0.2 percent over the revised estimates of 2021-22 which clearly indicates that the financial protection extended by the government does not amount too much. Consequently, the public is directed towards the private sector which results in high out-of-pocket expenditures. Though the government schemes include insurance coverage for the ultra-poor, and there is a portion of the population that is covered by private and voluntary insurance, that leaves 30% of the population devoid of any insurance. They have been referred to as the “missing middle.” This paper looks at the health insurance landscape of countries like the USA, China, and Canada. We also look at the data regarding coverage of different schemes and took inputs from hospitals and private insurance providers to gain a perspective on how health insurance coverage in India can be expanded and be made more inclusive. Factors determining demand and supply are analyzed. We recommend that both the private and public sectors need to collaborate to achieve this outcome. Keywords: Universal Health Coverage, Missing Middle, Health Insurance, Employee State Insurance Corporation (ESIC), Private Health Insurance, Pradhan Mantri Jan Arogya Yojna (PMJAY).

Predictors of the utilisation of continuum of maternal health care services in India.

BackgroundUtilisation of continuum of maternal health care services is crucial for a healthy pregnancy and childbirth and plays an important role in attaining Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) related to maternal and child health. This paper aims to assess the percentage of dropouts across various stages of utilization of continuum of maternal health services (CMHS) in India and also investigates the factors hindering the utilization of these services.MethodsWe used recent data from National Family Health Survey(NFHS) encompassing a total sample of 1,70,937 pregnant women for the period 2015–16. The percentage of women dropping out while seeking maternal health care is measured using descriptive statistics. While, the factors impeding the utilization of maternal health services is estimated using a Multinomial Logistic Regression Model, where dependent variable (CMHS) is defined as complete care, incomplete care and no care.ResultsOnly17% of pregnant women availed the utilisation of complete care and 83% either did not seek any care or dropped after seeking one or two services. For instance, it is found that 79% of women who registered for antenatal care services (ANC) did not avail the same adequately. An empirical investigation of determinants of inadequate utilization of CMHS revealed that factors like individual characteristics, for instance- access to media (RRR: 2.06) and mother’s education play (RRR: 3.61) a vital role in the uptake of CMHS. It is also found that the interaction between wealth index and place of residence plays a pivotal role in seeking complete care. Lastly, the results revealed that male participation (RRR: 2.69) and contacting multi-purpose worker (MPW) (RRR: 2.33) are also at play.ConclusionThe study suggests that the major determinants of utilisation of CMHS are access to media, mother’s education, affordability barriers and male participation. Hence, policy recommendations should be oriented towards strengthening these dimensions and the utilisation of adequate ANC has to be considered as the need of the hour.

Planning human resources and facilities to achieve Sustainable Development Goals: a decision-analytical modelling approach to predict cancer control requirements in Indonesia

ObjectivesIndonesia aims to achieve universal health coverage (UHC) and Sustainable Development Goals (SDGs), including SDG 3 target 4, which focuses on cancer control, by 2030. This study aimed to forecast...

Strategies to Promote Health System Strengthening and Global Health Security at the Subnational Level in a World Changed by COVID-19.

<h3>Key Messages</h3> Achieving strong, resilient health systems that reach both global health security and universal health coverage goals requires a unified approach to how we work across the system. We propose the following 3 key overarching approaches: Strengthen comprehensive district planning (i.e., to be successful, district planners must understand how various public health programs come together within their communities, the range of stakeholders who have a role to play in health efforts, and how public and private funding and information systems can be leveraged at the local level to achieve their objectives). Support flexibility of district health systems to break the silos of vertical programs and take on new roles as circumstances warrant. Use the ongoing roll-out of COVID-19 interventions as an opportunity to address management, coordination, and integration challenges at the district level.

Building evidence and capacity in global health palliative care.

To achieve universal health coverage goals, access to quality palliative care must be rapidly scaled up in low and middle-income countries. By 2060, people living with cancer at the end of life will be the major contributors to serious health-related suffering. Major developments have occurred in the science of palliative care research in low- and middle-income countries (LMIC), from the development and validation of outcome measures to the delivery of randomised controlled trials. While the evidence has demonstrated context-specific needs among patients and families facing life-limiting illness, there are also many commonalities. Specific areas of leadership in the field have emerged from LMIC in HIV palliative care and in care for children. These innovations offer enormous potential for adaptation in high income countries. International partnerships in research, founded on mutually beneficial learning and capacity building, are central to achieving universal health coverage goals.

Health technology assessment: a tool for evidence-based decisions for quality health care in India

Health technology assessment is widely used methodology internationally for optimization of healthcare resource allocation. It is a multidisciplinary process that gathers policy relevant evidence about the clinical effectiveness, cost effectiveness, ethical and social issues related to the use of a health intervention in a systematic, comprehensive, transparent and robust manner to help policy makers in decision making while formulating policies for incorporating or excluding health interventions from the health system. In order to achieve the ultimate goal of universal health coverage, Government of India has set up health technology assessment in India under the department of health research, ministry of health and family welfare. The health technology assessment framework in India must utilize its entire capacity to guide government and policy makers in explicit priority setting that ensures that available health budgets are spent after weighing all options, and coming to a fair and just conclusion.

Universal Health Coverage; A Way Forward

Universal health coverage means every person has access to quality health care without suffering financial hardships. The basis of universal health coverage lies in the primary health care concept, which was envisioned way back in 1978, as mentioned in Alma Ata Declaration1. The "World Health Report" published by the World Health Organization (WHO) in 2008 structures primary health care reforms in four groups. One of the crucial reforms was universal coverage reform to improve health equity2. WHO and UNICEF in 2018 documented how primary health care will be in the 21st century? The approach was towards universal health coverage and sustainable development goals. Sustainable development goals were to be achieved by 2030, and they were a continuation of millennium development goals 2000–20153. The resolution on Transforming our world: the 2030 Agenda for Sustainable Development adopted the target of universal health coverage by 2030, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all4. Currently, many developing nations do not have access to health services. About 100 million people are pushed into extreme poverty each year because of out-of-pocket spending on health. To make health for all, we need individuals and communities to have high-quality health services to take care of their families health. Skilled health workers providing quality, people-centred care and policy-makers should be committed to investing in universal health coverage. Universal health coverage should be based on intense, people-centred primary health care. Good health systems are rooted in the communities they serve. They focus not only on preventing and treating disease and illness but also on helping to improve well-being and quality of life5. Pakistan, the developing country, is struggling to provide good quality health services, mostly availed from the out-of-pocket expenditure.&#x0D; Both private and public sector hospitals were trying to deliver health services, but poor people failed to have access to many services due to poverty. To overcome this obstacle and address indicator 3.8 of SDGs, the current government developed a five-year program to improve the targeted population's health by increasing their access to quality health services. The initiative will also reduce poverty, as the government will cover most of their health budget through the "Sehat Sahulat Program". The program was part of the National vision to ensure Universal Health Coverage (UHC) for all Pakistani families. No one is denied quality healthcare services only because of financial constraints. Initially, it was piloted in selected four districts of Khyber Pakhtunkhwa, which was later extended to all over the province. Currently, 7.2 million families are getting free in-patient health care services, and the program's annual cost is 18 billion. It was a bold initiative of the current government, which helped improve access to UHC, thus addressing one of the sustainable development goals6,7.

Universal health insurance in Africa: a narrative review of the literature on institutional models

IntroductionSeveral African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries...

Strengths and Weaknesses of Strategic Health Purchasing for Universal Health Coverage in Rwanda

ABSTRACT In the context of scarce resources and increasing health care costs, strategic purchasing is viewed as a key mechanism to spur countries’ progress toward universal health coverage (UHC), by using limited resources more effectively. We applied the Strategic Health Purchasing Progress Tracking Framework to examine the health purchasing arrangements in three health financing schemes in Rwanda—the Community Based Health Insurance (CBHI) scheme, the Rwanda Social Security Board (RSSB) medical scheme, and performance-based financing (PBF). Data were collected from secondary and primary sources between September 2020 and March 2021.The objective of the study was to identify areas of progress in strategic purchasing that can be built on, and to identify areas of overlap, duplication, or conflict that limit progress in strategic purchasing to advance UHC goals. This study found that Rwanda has made progress in many areas of strategic purchasing and has a strong foundation for building further. However, some overlaps and duplication of functions weaken the power of purchasers to improve resource allocation, incentives for providers, and accountability. In addition, some of the policies within the purchasing functions could be made more strategic. In particular, open-ended fee-for-service payment in the CBHI scheme not only threatens the scheme’s financial sustainability but also imposes a high administrative burden. Better alignment and integration of contracting, incentives, and information system design to provide timely and relevant information for purchasing decisions would contribute to more strategic health purchasing and ensure that Rwanda’s health sector achievements are sustained and expanded.

Commentary: Telerehabilitation during COVID-19 pandemic - A boon for visually challenged.

The rapidly evolving COVID-19 pandemic has challenged human lives and emerged as a threat to the global community.[1] On the one hand, it opened doors for innovations[2] and opportunities for many and on the other hand, it impacted many lives. Patients with low vision and blindness were also affected as they faced numerous challenges in accessing hospital-based eye care and fulfilling their daily needs.[3] Thus, there was a need to “think out of the box” and make eye care accessible to these patients at their homes to minimize the delay in beginning low-vision rehabilitative services once diagnosed. This gave birth to the concept of telerehabilitation as an alternative eye care model. Telerehabilitation or e-rehabilitation delivers rehabilitative services through telecommunication platforms. It allows health service providers to communicate with patients remotely, assess patients, and provide treatment. The telerehabilitative services can include physical, visual, speech, occupational, psychological, and audio therapy. These services can be communicated at an individual or community level. In general, rehabilitation service aims to improve functioning and reduce disability in patients with health issues in accordance with their surrounding environment through targeted interventions.[4] Visual rehabilitation cannot be neglected as it is a vital component of universal health coverage and sustainable development goal 3 (SDG). The goal is to “ensure healthy lives and promote well being for all ages.” There are approximately 300 million people with low vision globally. Low vision affects their daily survival and quality of living. As per the literature review, COVID-19 impacted rehabilitative services in approximately 70% of the countries globally.[5] Carolyn Ihrig[6] started telerehabilitation services at VA Western New York Healthcare System, Buffalo low-vision clinics and showed that patients with low vision living in rural communities and having limited access to eyecare due to transport issues and lockdown were able to procure telerehabilitation services effectively at home. Beula and Jill,[7] in their article, proposed varied initiatives and strategies to improve telerehabilitation for the visually disabled. The various proposed initiatives were counseling of patients with low vision for mental well-being and upliftment; providing them information and resources for COVID-19 preventive measures; financial supplies beyond the ex gratia amount of INR 1000 with the help of volunteers; and therapeutic interventions for pediatric patients with multiple disabilities for visual, cognitive, social and physical upliftment. The other measures implemented were video call-basedcounselling of parents for the supervision and guidance of their children; training programs for young patients through apps and social media platforms; and talent hunt of children with visual disabilities through various recreational activities such as singing, dancing, painting, and writing. A helpline number has been generated for patients with visual disabilities for any mental or physical help in these challenging times. The digital library has been a great source of information and has helped educate low-vision patients. Tinelli et al. described an innovative approach of telerehabilitation of hemianopia patients based on multisensory human brain inputs through audio-visual stimulation training. In the current article,[8] the authors, as collaborative partners of the WHO, have shared valuable insights regarding the impact of virtual rehabilitation through the results of 305 patients analyzed from this model of care. The article also highlights the importance of the collaborative effort of low-vision consultants (n = 2), rehabilitation consultants, speech therapists, physiotherapists, special educators, helpline counselors, computer instructors, digital library coordinators, and central coordinators in uplifting the telerehabilitation services during these demanding times. Intricate analysis reveals that most patients in need were pediatric low-vision patients (42%), and out of the total, most had severe vision impairment or blindness (51%). Telerehabilitation is imperative as they are closely dependent on their first-degree relatives for daily activities, perfect coordination, and required therapy. Telerehabilitation has been a boon for these patients during the COVID-19 pandemic. As no telerehabilitation guidelines exist for visual rehabilitation, the authors have initially used the general guidelines for physiotherapy and then developed their eye care model. This highlights the challenges faced by the authors during telerehabilitation and their innovative mindset for improving the services for the needy. To summarize, the telerehabilitation initiative has come as a boon for the blind and the disabled. It is a practical, repeatable, cost-effective, time-saving, and accepted service modality for the needy in this digital era. Large-scale studies will help to elucidate better the practical challenges and benefits of implementing this strategy. The future for telerehabilitation seems promising not only in these COVID-19 times but also in the long run. Implementing this innovative technology not only allows easy access to rehabilitation facilities from home but the ease of conversation, reduced carbon footprint, and helps them achieve regular motivation without dependency on others for follow-up visits. There is a need shortly to formulate telerehabilitation-specific guidelines to surpass this challenge.

EMERGING CHALLENGES IN IMPLEMENTING UNIVERSAL HEALTH COVERAGE DUE TO COVID-19 IN INDONESIA

The goal of Universal Health Coverage (UHC) means a situation in which all individuals and communities have access to health services, whenever and wherever they need them, without financial barriers to obtaining them. UHC covers a wide range of essential health services, from promotion, prevention, treatment, care, rehabilitation, and palliative care for patients with chronic diseases. On the other hand, the COVID-19 Pandemic is devastating national health systems in countries that have strived to provide UHC, hampering their efforts to fulfill the ethos of universal health coverage, which is to "leave no one behind." As mentioned in the World Economic Forum 2021, this issue is interesting because an estimated 400 million people worldwide lack access to essential health services. Approximately 100 million people fall into poverty each year due to not paying their health costs. This number has increased with COVID-19 and will continue to up as people lose their jobs, health insurance, and health spending rise due to COVID-19-related spending on testing, treatment, and vaccines.

Gordon McVie: his legacy as a blueprint for cancer advocates as we strive towards the 2030 global health and sustainable development goals.

Cancer prevention and control services worldwide must actively rebuild and contribute to improved health systems resilience alongside and beyond the COVID-19 (SARS-CoV-2 coronavirus disease) pandemic, especially in low- and middle-income countries. Cancer advocacy groups should respond to this unprecedented challenge as an opportunity to bolster community and patient involvement in research and clinical practice that is adjusted to local needs and circumstances. This short communication provides a synthesis of these critical challenges and, stemming from the pioneering activities of Gordon McVie on patient empowerment, urges policy makers and researchers to develop new implementation strategies that start from the social, economic and health consequences of the COVID-19 pandemic to overcome roadblocks in the access to cancer care. We propose that developing the domain of collaborative implementation research in national cancer control plans will be the key to consolidate patient-centred services with both an equity lens and a focus on integration of new technologies as all countries drive towards the 2030 goals of universal health coverage.