Universal Health Coverage Research Articles

Transformation in Human Well-Being for Sustainable Development

The current assessment by scientists and experts suggests that no country will be able to reach the United Nations Sustainable Development Goals (SGDs) by 2030 due to various challenges each state faces. The Global Sustainable Development Report 2023 proposes strategic and effective approaches based on scientific evidence for member states to address the barriers impeding attaining such goals. This report builds on the organizing framework of six entry points for transformation and describes key shifts across the different entry points to accelerate progress toward the SGDs. One of these transformations is health and well-being, in which interventions include universal health care, healthy behaviors, and social determinants. The intermediate output of this transformation is universal health coverage, which requires a publicly financed health system that integrates prevention, therapeutic, and palliative services, integrated information systems, and disease surveillance and control. A whole-of-nation and whole-of-society approach is critical to achieving significant gains and transformation in health, which will eventually contribute to economic and social development

ONE HEALTH APPROACHES TO TACKLING ANTIMICROBIAL RESISTANCE

Antimicrobial resistance (AMR) is a significant and growing threat to human health. A recent United Nations General Assembly declaration highlights that those in need must have sustained access to effective treatments. In the absence of a reliable supply of new drugs, pressure on existing drugs can be reduced by minimising demand. Routes to reducing demand include: promotion of WASH (access to clean water, sanitation and hygiene) and Universal Health Coverage; improved infection control in health care settings; and continued efforts to curtail drug use in agriculture. This is a One Health strategy, requiring coordinated action across the human, livestock and environmental sectors.

Projected health workforce requirements and shortage for addressing the disease burden in the WHO Africa Region, 2022–2030: a needs-based modelling study

IntroductionAn adequate health workforce (HWF) is essential to achieving the targets of the Sustainable Development Goals (SDG), including universal health coverage. However, weak HWF planning and constrained fiscal space for...

The role of primary care practitioners in cancer control in South Africa: a systems-based case study

Aim Cancer care has largely been the domain of oncology specialists. With increased awareness of the importance of primary care in the context of universal health coverage, there has been a shift to explore the role of primary care in comprehensive cancer management. This includes health promotion, screening, diagnosing, referral to oncology services, and longitudinal care that includes co-ordination of care, survivorship, and palliative care. This paper focuses on the role of primary care practitioners in health promotion, early detection and care co-ordination. Nurses and doctors who work in primary care are included as primary care practitioners. Methods Using a patient vignette narrative tool, the triad of patient empowerment in the form of enhanced health literacy, clinical competence, and system effectiveness, are discussed as the basis for early cancer detection. A complex intervention to improve primary-level cancer care and the implications thereof for the important role of care co-ordination undertaken by primary care practitioners, is also presented. Findings For effective patient assessment, primary care practitioners must be trained in screening and diagnostic techniques as part of their clinical competencies as generalists. These competencies include risk identification, counselling skills, expert clinical examination, interpretation of basic x-rays, minor surgical skills, interpreting blood tests, and point-of-care ultrasound. Against a backdrop of ongoing budget constraints, consumables and equipment needed for diagnosis should be readily available and referral pathways for patients and specimens should be clearly defined and resourced. Conclusions Primary care practitioners in community-based facilities are well-placed to engage with the psychosociocultural dimensions of care. The SA health system places primary care at the point of closest contact with communities. Efficient care pathways are needed by primary care practitioners to adopt the role of care co-ordinator when patients with suspected or confirmed cancer enter these pathways. When considered alongside the overburdened primary care patient-load and the ever-increasing mix of co-morbidities, the complexity of primary care is appreciated. Understanding the complexities of primary care in the context of cancer control is an important component of a holistic cancer control programme.

Distributed Opioids in Morphine Equivalent: A Global Measure of Availability for Palliative Care

ContextEstimates of serious health-related suffering (SHS) demonstrate immense unmet need for palliative care, predominately in low- and middle-income countries (LMICs). Because opioids are essential medicines in palliative care (PC), measuring their availability can be used to evaluate the capacity of health systems to meet need. ObjectivesPresent the methodology for calculating Distributed Opioids in Morphine Equivalents (DOME)— introduced in the Lancet Commission on Global Access to Palliative Care and Pain Relief report - and how it can be used as a simple indicator to quantify unmet pain relief and PC need. MethodsUsing International Narcotics Control Board (INCB) data, DOME applies relative potency estimates to convert the annualized quantities of clinically appropriate opioids procured by a country to oral morphine equivalent milligrams. To quantify unmet need, an expert group proposed health condition-specific estimates for opioid need and used available data on the burden of SHS to posit the annual opioid quantity required by country for symptomatic treatment of pain or breathlessness. Comparing this to DOME generates DOME%SHSNEED, the proportion of opioids needed for palliative care that can be fulfilled by the opioid procured by a country during a year. ResultsDOME and DOME%SHSNEED can be used to measure, over time, the capacity of countries to meet PC need, as a key component of universal health coverage. Identifying access gaps disproportionately impacting LMICs can promote better health system performance and guide countries and institutions in policy making. ConclusionDOME and DOME%SHSNEED can be used to monitor health system progress to redress disparities and promote access to medically indicated opioid therapy in palliative care.

Building sustainable capacity to adopt, adapt or develop child health guidelines, Malawi, Nigeria and South Africa.

Many national child health guidelines in Malawi, Nigeria and South Africa are outdated and score poorly on rigorous methods and stakeholder participation. In line with the World Health Organization's (WHO) emphasis on local guideline contextualization, the Global Evidence-Local Adaptation (GELA) project supported multistakeholder processes to adapt evidence-informed recommendations for child health in Malawi, Nigeria and South Africa. The GELA project team convened national steering groups, which conducted structured, iterative priority-setting exercises to identify priority topics. We identified appropriate source guidelines by systematically searching and screening available guidelines. We then matched recommendations in potential source guidelines to the relevant questions, and assessed the guidelines for timeliness and quality. Drawing on WHO's guideline process, we applied the GRADE-ADOLOPMENT process to develop contextualized recommendations from existing guidelines. If no source guideline or reviews were identified, we conducted new evidence syntheses. Malawi, Nigeria and South Africa are countries with varying health priorities and systems, all transitioning to universal health coverage. Guideline structures differ between countries, with processes largely led from national health ministries. National guideline groups, supported by GELA researchers and government-academic partners, developed five contextually-tailored child health recommendations. For most of these recommendations, additional evidence was required to inform contextually appropriate national decision-making. Formal capacity-building and on-the-job learning enhanced the competencies of national contributors and researchers in evidence-informed decision-making. Developing context-relevant recommendations requires considerable resources and time. Further investment in strengthening local capacity is needed for sustainable national guideline development.

Aligning the World Health Organization's (WHO) package of interventions for rehabilitation for cancer with the mission of the International Psycho-Oncology Society's: promoting psychosocial care for all people affected by cancer

Abstract The number of people living with and beyond cancer continues to increase worldwide, bringing significant attention to their rehabilitation needs. Globally, psychosocial services are largely inadequate, with many cancer survivors experiencing unmet psychosocial needs. The World Health Organization (WHO) recognizes rehabilitation as an essential component of universal health coverage to prevent disease-related conditions, while also improving physical and mental functioning and overall well-being. The Package of Interventions for Rehabilitation (PIR) was developed by the WHO to address the global need for rehabilitation across 20 conditions with high prevalence and high levels of associated disability, including cancer. Many aspects of the WHO PIR align with the mission and focus of the International Psycho-Oncology Society (IPOS). This commentary describes the WHO PIR for Cancer and proposes opportunities to advance cancer rehabilitation research, policy, and practice as they align with recent and ongoing initiatives of IPOS.

Universal Access to Healthcare in Cameroon: Financing Sources

Purpose: The research aims to identify sustainable sources of funding the implementation of Universal Health Coverage (UHC) in Cameroon, in response to the current situation where households finance 70% of healthcare costs, and healthcare is largely unaffordable for many social groups. Material and Methods : The study used an exploratory qualitative approach in the Bangue Health District in the Littoral Region of Cameroon. Fifteen people participated in this study during ten days. Participants were selected using the purposive sampling method. Data were collected by means of a semi-structured interview guide. A general inductive approach was used to analyse the collected data. Findings: The main findings indicated that the identified funding sources are primarily based on local resources, including: 1) the State, through the budget allocated to healthcare; 2) the implementation of a health tax based on different sectors of activity; 3) contributions from the Diaspora; and 4) assistance from external and internal partners. Resource mobilisation could be carried out by decentralised government departments, with management overseen by an autonomous UHC body created for the project. Implications to Theory, Practice and Policy : Considering the findings, the State should : 1) Raise public awareness and provide training on UHC ; 2) Equip healthcare facilities with adequate human and material resources ; 3) Decentralise the structures for collecting UHC-related funds ; 4) Ensure the security of the collected funds to operationalise UHC effectively.

Analyzing stroke burden and risk factors in India using data from the Global Burden of Disease Study.

Stroke remains a critical global health issue, significantly impacting India with substantial contributions to mortality and disability. This study comprehensively analyses stroke incidence, mortality, and disability-adjusted life years (DALYs) across India from 1990 to 2021, using the latest Global Burden of Disease (GBD) 2021 data. We evaluate how Universal Health Coverage (UHC), health expenditure, human development index (HDI), and gross national income (GNI) influence stroke outcomes. Our findings reveal significant regional disparities, with higher stroke rates in urban areas and states like Goa and Kerala. Higher health expenditure and HDI are linked to lower stroke rates, while higher GNI per capita correlates with increased stroke incidence, likely due to lifestyle changes. Risk factors include air pollution, tobacco use, dietary risks, and high blood pressure. Air pollution notably impacts stroke mortality in Bihar and Jharkhand, while tobacco use is a major risk factor in Mizoram and Manipur. Dietary risks and hypertension are prevalent in Maharashtra and Jammu & Kashmir. The study highlights the need for targeted public health strategies addressing regional disparities and socioeconomic factors. Policymakers should focus on lifestyle modification programs, public awareness campaigns, and enhanced access to quality stroke care to reduce stroke-related morbidity and mortality effectively.

Revisiting a decade of inequality in healthcare financial burden in Cambodia, 2009–19: trends, determinants and decomposition

BackgroundOut-of-pocket healthcare expenditure (OOPHE) without adequate social protection often translates to inequitable financial burden and utilization of services. Recent publications highlighted Cambodia’s progress towards Universal Health Coverage (UHC) with reduced incidence of catastrophic health expenditure (CHE) and improvements in its distribution. However, departing from standard CHE measurement methods suggests a different storyline on trends and inequality in the country.ObjectiveThis study revisits the distribution and impact of OOPHE and its financial burden from 2009–19, employing alternative socio-economic and economic shock metrics. It also identifies determinants of the financial burden and evaluates inequality-contributing and -mitigating factors from 2014–19, including coping mechanisms, free healthcare, and OOPHE financing sources.MethodsData from the Cambodian Socio-Economic Surveys of 2009, 2014, and 2019 were utilized. An alternative measure to CHE is proposed: Excessive financial burden (EFB). A household was considered under EFB when its OOPHE surpassed 10% or 25% of total consumption, excluding healthcare costs. A polychoric wealth index was used to rank households and measure EFB inequality using the Erreygers Concentration Index. Inequality shifts from 2014–19 were decomposed using the Recentered Influence Function regression followed by the Oaxaca-Blinder method. Determinants of financial burden levels were assessed through zero-inflated ordered logit regression.ResultsBetween 2009–19, EFB incidence increased from 10.95% to 17.92% at the 10% threshold, and from 4.41% to 7.29% at the 25% threshold. EFB was systematically concentrated among the poorest households, with inequality sharply rising over time, and nearly a quarter of the poorest households facing EFB at the 10% threshold. The main determinants of financial burden were geographic location, household size, age and education of household head, social health protection coverage, disease prevalence, hospitalization, and coping strategies. Urbanization, biased disease burdens, and preventive care were key in explaining the evolution of inequality.ConclusionMore efforts are needed to expand social protection, but monitoring those through standard measures such as CHE has masked inequality and the burden of the poor. The financial burden across the population has risen and become more unequal over the past decade despite expansion and improvements in social health protection schemes. Health Equity funds have, to some extent, mitigated inequality over time. However, their slow expansion and the reduced reliance on coping strategies to finance OOPHE could not outbalance inequality.

Digital health in your hands: A narrative review of exploring Ayushman Bharat's digital revolution

Background: “The Ayushman Bharat Digital Mission (ABDM)” is a revolutionary initiative started in India in September 2021 that aims to digitalize the country's healthcare industry. Initiatives like Ayushman Bharat Digital Mission, CoWIN App, Aarogya Setu, e-Sanjeevani, and e-Hospital provide healthcare services and facilities that reach every corner of India. This narrative review focuses on the mission's goals, objectives, innovations, significant features, progress, and worldwide scenery for digital health practices—India's healthcare scene by delivering universal health coverage and improving health outcomes. The assessment finds that ABDM is an important step toward a digitalized healthcare system that requires attention and assistance to overcome obstacles and reach its full potential. Methods: The research utilized various databases including Research Gate, PubMed, Google Scholar, and government portals to conduct a comprehensive literature review. This review article provides a critical analysis and offers essential suggestions, ideas, and recommendations for the effective and rapid implementation of the Ayushman Bharat Program. Furthermore, it includes information about the program's ability to transform India's healthcare sector and achieve universal health coverage. Conclusion: The revolutionary Ayushman Bharat Digital Mission (ABDM) aims to digitalize India's healthcare industry. It has made major achievements in improving healthcare access, increasing system effectiveness, improving care quality, and promoting teamwork amongst stakeholders in the healthcare system. By implementing strong data privacy and security protocols and developing infrastructure for India's diverse population, ABDM can play a key role in achieving national health coverage and improving health outcomes. ABDM may be vital in attaining national health coverage and greatly enhancing health outcomes with persistent work and strategic assistance.

Assessment of the compliance with minimum quality standards by public primary healthcare facilities in Nigeria

Achieving universal health coverage (UHC) and the Sustainable Development Goals (SDG) by 2030 relies on the delivery of quality healthcare services through effective primary healthcare (PHC) systems. This necessitates robust infrastructure, adequately skilled health workers and the availability of essential medicines and commodities. Despite the critical role of minimum standards in benchmarking PHC quality, no global consensus on these standards exists. Nigeria has established minimum standards to enhance healthcare accessibility and quality, including the Revised Ward Health System Strategy (RWHSS) by the National Primary Health Care Development Agency (NPHCDA). This paper outlines the evolution of PHC minimum standards in Nigeria, evaluates compliance with RWHSS standards across all public PHC facilities, and examines the implications for ongoing PHC revitalization efforts. The study used a cross-sectional descriptive design to assess compliance across 25 736 public PHC facilities in Nigeria. Data collection involved a national survey using a standardized assessment tool focussing on infrastructure, staffing, essential medicines and service delivery. Compliance with RWHSS minimum standards was found to be below 50% across all facilities, with median compliance scores of 40.7%. Outreach posts had a median compliance of 32.6%, level 1 facilities 31.5% and level 2+ facilities 50.9%. Key findings revealed major gaps in health infrastructure, human resources and availability of essential medicines and equipment. Compliance varied regionally, with the North-west showing the highest number of facilities but varied performance across standards. The lessons learned underscore the urgent need for targeted interventions and resource allocation to address the identified deficiencies. This study highlights the critical need for regular, comprehensive compliance assessments to guide policy-makers in identifying gaps and strengthening PHC systems in Nigeria. Recommendations include enhancing monitoring mechanisms, improving resource distribution and focussing on infrastructure and human resource development to meet UHC and SDG targets. Addressing these gaps is essential for advancing Nigeria’s healthcare system and ensuring equitable, quality care for all.

Does younger children's social health insurance alleviate household impoverishment due to illness?

The ambitious expansion of social health insurance in China has played a crucial role in preventing and alleviating poverty caused by illness. However, there is no government-sponsored health insurance program specifically for younger children and inequities are more pronounced in healthcare utilization, medical expenditure, and satisfaction in some households with severely ill children. This study assessed the effectiveness of child health insurance in terms of alleviating poverty caused by illness. Data were collected from two rounds of follow-up surveys using the China Family Panel Studies 2016 and 2018 child questionnaires to investigate the relationship between child health insurance and household medical impoverishment (MI). Impoverishing health expenditure (IHE) and catastrophic health expenditure (CHE) were measured to quantify "poverty due to illness" in terms of absolute and relative poverty, respectively. Propensity score matching with the difference-in-differences (PSM-DID) method, robustness tests, and heterogeneity analysis were conducted to address endogeneity issues. Social health insurance for children significantly reduced household impoverishment due to illness. Under the shock of illness, the incidences of IHE and CHE were significantly lower in households with insured children. The poverty alleviation mechanism transmitted by children enrolled in social health insurance was primarily driven by hospitalization reimbursements and the proportion of out-of-pocket medical payments among the total medical expenditure for children. Children's possession of social health insurance significantly reduced the likelihood of household poverty due to illness. The poverty-reducing effect of social medical insurance is most significant in rural areas, low-income families, no-left-behind children, and infants. Targeted poverty alleviation strategies for marginalized groups and areas would ensure the equity and efficiency of health system reforms, contributing to the goal of universal health insurance coverage in China.

Scaling Up Departmental Health Insurance Units in Senegal: A Mixed-Method Study

ABSTRACT In response to the failure of community-based health insurance (CBHI) at the municipal level, some African countries are implementing district or departmental CBHIs to improve universal health coverage. After creating two CBHIs at the departmental level in 2014, Senegal launched a campaign to disseminate the model in 2022. This article presents the stakeholders’ perspectives on the factors and challenges of scaling up CBHI departmentalization in Senegal. The study uses a mixed-methods approach, utilizing concept mapping and a focus group to examine scaling up departmentalization. The sample size consists of 22 individuals involved in the process. The quantitative analysis includes hierarchical cluster analysis, multidimensional scaling analysis, and the Pearson coefficient test. The qualitative analysis involves content analysis to triangulate the findings. Participants identified 125 factors to consider for the departmentalization of CBHI. They were categorized into nine clusters according to their degree of importance (I) and ease to organize (F): service package (I: 4.07; F: 2,26), communication (I: 4.05; F: 2.96), governance (I: 3.96; F: 2,94), human and logistical resources (I: 3.94; F: 2,82), financing (I: 3.90; F: 2,31), involvement of the authorities (I: 3.82; F: 2.75), community involvement (I: 3.81; F: 2.76), membership (I: 3.70; F: 2.24, strategic planning and implementation (I: 3.57; F: 2,62). The main challenges faced were a process perceived as precipitous and vertical and needing more negotiation and consultation. The conditions for accompaniment and public funding availability need to be sufficiently considered. The study proposes avenues for action to promote the scaling up of CBHI departmentalization in Senegal.

Sustaining Current Policies and Introducing New Initiatives: Strategic Five-year Plan for the Government of India

A review of key documents, including political manifestos and reports from NITI Aayog and WHO, outlines healthcare priorities for 2024-2029, aligned with Viksit Bharat 2047 and the UN SDGs. Key actions include expanding Universal Health Coverage through Ayushman Bharat, improving rural healthcare, addressing medical staff shortages, and leveraging digital health, telemedicine, and interoperable records. National missions targeting disease prevention, mental health, and non-communicable diseases aim to promote healthier lifestyles. Strengthening public health preparedness and health information systems, while promoting traditional medicine, is also essential. Expanding maternal and child health programs, increasing access via AB-PMJAY, ensuring quality through NQAS, and driving innovation with R&D funding are vital. Enhanced tobacco control through COTPA, higher taxes, and NTCP campaigns, along with investments in WASH infrastructure through Swachh Bharat and Jal Jeevan Missions, will improve health outcomes. Geriatric care, digitalisation, digital health, mental health, community health workers, and partnerships are critical. Initiatives like healthcare innovation hubs, mobile clinics, and health equity programs will build a resilient, inclusive healthcare system and improve national health.

The gender gap in outpatient care for non-communicable diseases in Mexico between 2006 and 2022.

Equitable health service utilization is key to health systems' optimal performance and universal health coverage. The evidence shows that men and women use health services differently. However, currentanalyses have failed to explore these differences in depth and investigate how such gender disparities vary by service type. This study examined the gender gap in the use of outpatient health services by Mexican adults with non-communicable diseases (NCDs) from 2006 to 2022. A cross-sectional population-based analysis of data drawn from National Health and Nutrition Surveysof 2006, 2011-12, 2020, 2021, and 2022 was performed. Information was gathered from 300,878 Mexican adults aged 20years and older who either had some form of public health insurance or were uninsured. We assessed the use of outpatient health services provided by qualified personnel for adults who reported having experienced an NCD and seeking outpatient care in the 2 weeks before the survey. Outpatient service utilization was disaggregated into four categories: non-use, use of public health services from providers not corresponding to the user's health insurance, use of public health services from providers not corresponding to the user's health insurance, and use of private services. This study reported the mean percentages (with 95% confidence intervals [95% CIs]) for each sociodemographic covariate associated with service utilization, disaggregated by gender. The percentages were reported for each survey year, the entirestudyperiod, the types of serviceuse, and the reasons for non-use, according to the type of health problem. The gender gap in healthservice utilization was calculated using predictive margins by gender, type of disease, and survey year, and adjusted through a multinomial logistic regression model. Overall, we found that women were less likely to fall within the "non-use" category than men during the entire studyperiod (21.8% vs. 27.8%, P < 0.001). However, when taking into account the estimated gender gap measured by incremental probability and comparing health needs caused by NCDs against other conditions,compared with women, men had a 7.4% lower incremental likelihood of falling within the non-use category (P < 0.001), were 10.8% more likely to use services from providers corresponding to their health insurance (P < 0.001), and showed a 12% lower incremental probability of using private services (P < 0.001). Except for the gap in privateservice utilization, which tended to shrink, the others remained stable throughout the period analyzed. Over 16years of outpatient service utilization by Mexican adults requiring care for NCDs has been characterized by the existence of gender inequalities. Women are more likely either not to receive care or resort to using private outpatient services, often resulting in catastrophic out-of-pocket expenses for them and their families. Such inequalities are exacerbated by the segmented structure of the Mexican health system, which provides health insurance conditional on formal employment participation. These findings should be considered as a key factor in reorienting NCD health policies and programs from a gender perspective.

Evaluation of the Implementation of the National Community Health Policy in the Bembèrèkè-Sinendé Health District, 2023

In a context shaped by the Sustainable Development Goals and the pursuit of Universal Health Coverage, the National Community Health Policy (NCHP) stands as a crucial pillar to achieve these goals by redirecting healthcare systems towards primary healthcare. The aim of this study was to assess the implementation of the NCHP in the Bembèrèkè-Sinendé health district (BSHD). This was an evaluative cross-sectional observational study with an analytical approach. A census of all active healthcare facilities in the two municipalities of the health district was conducted. A total of 28 health establishments, were included. Activity coverage rates ranged from high for home visits (46.9%) to low for other activities. Awareness raising (89.3%) and educational discussions (100%) are well conducted, while practical demonstrations and home visits encounter challenges. No significant association was found between the independent variables and the quality of the activities implemented. The results of this study provide valuable insight into the implementation of the NCHP in the BSHD. They highlight the need to strengthen the training of heads of posts. In addition, they point to the neglect of home visits in the delivery of community health care.

Patient’s willingness to pay for improved community health insurance in Tanzania

Globally, achieving universal health coverage remains significant challenge. Health insurance coverage in low- and middle-income countries is still low with only a few African countries managed to reach 50% coverage. This study aimed to investigate the factors influencing patients’ willingness to pay (WTP) for medication and various versions of the improved Community Health Insurance Fund (iCHF) in Tanzania. A facility-based cross-sectional study was conducted in all hospitals, health centres, and eight randomly sampled dispensaries, sampling participant from the queue, one out of every three patient based on their order of entry into consultation room, and interviewed 1,748 patients in Kilombero and Same districts in Tanzania. We used multi-stage Contingent Valuation Methods exploring data collected during client exit interviews. We employed a random utility model and estimated WTP through an ordered logit model. The independent variables were; patient’s gender, age, marital status, education, employment status, Non-Communicable Disease (NCD) status, health insurance status, and the type of healthcare facility level. Our findings revealed that most patients exhibited a WTP of an amount equivalent to the current iCHF premiums and would also be willing to pay for an augmented iCHF premium inclusive of additional medication coverage. Upon adjusting for demographic characteristics, we observed that patients enrolled in an insurance program or benefiting from user fee waivers demonstrated a lower WTP for medication, while those with non-communicable diseases (NCDs) and seeking care in private facilities exhibited a higher WTP. Furthermore, patients with a secondary education level or above generally displayed higher WTP for premiums. Conversely, patients enrolled in private insurance and availing user fee waivers, along with those accessing care in public facilities, demonstrated a lowered WTP for iCHF premiums. These results highlight the need for targeted interventions to address systemic deficiencies and improve access to medicines. Our conclusions is that policies considering NCD status, education levels and income status are important when designing health insurance schemes for the informal sector in Tanzania, with the goal of increasing uptake of CHF.

Oral health approach in universal health coverage

ObjectiveThis study aimed to map how oral health is addressed within the universal health coverage (UHC).MethodsThis scoping review followed the Joanna Briggs Institute methodology. Searches included the WHO Library and PubMed, Scopus, Embase, LILACS, and Cochrane databases. Quantitative and qualitative studies were included without publication date and language restrictions.ResultsA total of 486 studies were retrieved, of which 292 were excluded in the title and abstract screening phase; 121 full-texts were assessed. After the removal of duplicates and unavailable documents, 50 studies were included in the review and categorized according to the level of scientific evidence.ConclusionFew studies discussed oral health within the UHC, mostly because this coverage does not include oral health adequately. When offered, oral health packages are limited and include specific populations. Access and use of oral health services remain guided by economic factors, exposing the theoretical financial protectionism that perpetuates health inequalities.

Healthcare delivery in Lebanon: a critical scoping review of strengths, weaknesses, opportunities, and threats

BackgroundLebanon, an Eastern Mediterranean country with a lower-middle income status, that once boasted a health care system that was functional despite its challenges and complexity. However, it has faced a series of crises—economic, an influx of refugees, political instability, and recent sanctions—that have significantly impacted its aim, principles and values that has impacted upon its ability to function. The objective of this study is to delve into the health service delivery within the Lebanese system and conduct a SWOT analysis (assessing strengths, weaknesses, opportunities, and threats).MethodsWe conducted a scoping review, examining literature related to the Lebanese health system and its performance in delivering healthcare services. We followed the Arksey and O’Malley framework, which involves six key phases: identifying the research question, identifying relevant studies, study selection, charting the data, collating, summarizing, and reporting the results, consultation.ResultsDespite Lebanon grappling with multiple crises in recent years—such as the COVID-19 pandemic and economic downturn—the health system has demonstrated resilience in service delivery. However, challenges persist. Healthcare providers, including physicians and nurses, must address these issues. Additionally, economic and political crises pose threats that have necessitated significant changes in healthcare service delivery.ConclusionIn the system of healthcare in Lebanon, there have been remarkable achievements, but continuous attention by healthcare providers and the Ministry of Public Health (MoPH) is critical. Economic and political challenges exert constant pressure on service delivery and thus reveal a need for strategic changes, most importantly in health financing if Universal Health Coverage (UHC) is to be attained. Proper resources to strategic reform and system implementation in all parts of the country to ensure equitable access and quality care that is sustained are obligatory.