Who Needs Big Health Sector Reforms Anyway? Seychelles’ Road to UHC Provides Lessons for Sub-Saharan Africa and Island Nations

Finland is one of the donor countries that is most supportive in family planning (FP), Sexual and Reproductive Health and Rights (SRHR) and gender issues. This study examines Finnish ODA for FP and SRHR: its decision-making structure, other stakeholders and funding levels. Data consists of documents from the Ministry for Foreign Affairs (MFA) and interviews conducted at the MFA and with other experts. While Parliament decides on the overall level of ODA funding, the Minister for Foreign Trade and Development has considerable autonomy. Other stakeholders such as the All-Party Parliamentary Group on Population and Development and the Family Federation of Finland (Vestliitto) engage in advocacy work and have influenced development policy. Although the Development Policy 2007 mentions the importance of health and SRHR issues and HIV/AIDS is a cross-cutting issue, interviewees stated that the importance of health and SRHR in ODA has declined and that the implementation of cross-cutting issues is challenging. Multilateral funding for UNFPA, UNAIDS and GFATM, and thus the proportion of SRHR funding within the health sector, is however currently rising. Funding for population-related activities has increased and represented 4.8% of Finlands total ODA in 2009. Almost all of this funding is directed towards basic reproductive health and HIV/AIDS issues and the majority is directed through multilateral channels (78% in 2009), mainly UNFPA and UNAIDS. IPPF, Ipas and Marie Stopes International also receive support.

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A Narrative Synthesis Review of Out-of-Pocket Payments for Health Services Under Insurance Regimes: A Policy Implementation Gap Hindering Universal Health Coverage in Sub-Saharan Africa

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2021.38 ◽

2021 ◽

Author(s):

Abigail Nyarko Codjoe Derkyi-Kwarteng ◽

Irene Akua Agyepong ◽

Nana Enyimayew ◽

Lucy Gilson

Keyword(s):

Policy Implementation ◽

Universal Health Coverage ◽

Health Sector ◽

Sub Saharan Africa ◽

Narrative Synthesis ◽

Health Coverage ◽

Implementation Gap ◽

Street Level ◽

Sub Saharan ◽

Universal Health

Background: "Achieve universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all" is the Sustainable Development Goal (SDG) 3.8 target. Although most high-income countries have achieved or are very close to this target, low- and middle-income countries (LMICs) especially those in sub-Saharan Africa (SSA) are still struggling with its achievement. One of the observed challenges in SSA is that even where services are supposed to be "free" at point-of-use because they are covered by a health insurance scheme, out-of-pocket fees are sometimes being made by clients. This represents a policy implementation gap. This study sought to synthesise the known evidence from the published literature on the ‘what’ and ‘why’ of this policy implementation gap in SSA. Methods: The study drew on Lipsky’s street level bureaucracy (SLB) theory, the concept of practical norms, and Taryn Vian’s framework of corruption in the health sector to explore this policy implementation gap through a narrative synthesis review. The data from selected literature were extracted and synthesized iteratively using a thematic content analysis approach. Results: Insured clients paid out-of-pocket for a wide range of services covered by insurance policies. They made formal and informal cash and in-kind payments. The reasons for the payments were complex and multifactorial, potentially explained in many but not all instances, by coping strategies of street level bureaucrats to conflicting health sector policy objectives and resource constraints. In other instances, these payments appeared to be related to structural violence and the ‘corruption complex’ governed by practical norms. Conclusion: A continued top-down approach to health financing reforms and UHC policy is likely to face implementation gaps. It is important to explore bottom-up approaches – recognizing issues related to coping behaviour and practical norms in the face of unrealistic, conflicting policy dictates.

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A spatial database of health facilities managed by the public health sector in sub Saharan Africa

Scientific Data ◽

10.1038/s41597-019-0142-2 ◽

2019 ◽

Vol 6 (1) ◽

Cited By ~ 29

Author(s):

Joseph Maina ◽

Paul O. Ouma ◽

Peter M. Macharia ◽

Victor A. Alegana ◽

Benard Mitto ◽

...

Keyword(s):

Public Health ◽

Spatial Database ◽

Health Sector ◽

Health Facilities ◽

Sub Saharan Africa ◽

The Public ◽

Public Health Sector ◽

Sub Saharan

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Dynamic inference of healthcare expenditure on economic growth in Sub-Saharan Africa: a dynamic heterogenous panel data analysis

Journal of Economic and Administrative Sciences ◽

10.1108/jeas-03-2021-0049 ◽

2022 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Idris Abdullahi Abdulqadir ◽

Bello Malam Sa'idu ◽

Ibrahim Muhammad Adam ◽

Fatima Binta Haruna ◽

Mustapha Adamu Zubairu ◽

...

Keyword(s):

Economic Growth ◽

Healthcare Expenditure ◽

Health Sector ◽

Sub Saharan Africa ◽

Marginal Effect ◽

Health Crisis ◽

Content Type ◽

Interaction Terms ◽

Sub Saharan ◽

The Impact

PurposeThis article investigates the dynamic implication of healthcare expenditure on economic growth in the selected ten Sub-Saharan African countries over the period 2000–2018.Design/methodology/approachThe study methodology included dynamic heterogenous panel, using mean group and pooled mean group estimators. The investigation of the healthcare expenditure and economic growth nexus was achieved while controlling the effects of investment, savings, labor force and life expectancy via interaction terms.FindingsThe results from linear healthcare expenditure have a significant positive impact on economic growth, while the nonlinear estimates through the interaction terms between healthcare expenditure and investment have a negative statistically significant impact on growth. The marginal effect of healthcare expenditure evaluated at the minimum and maximum level of investment is positive, suggesting the impact of health expenditure on growth does not vary with the level of investments. This result responds to the primary objective of the article.Research limitations/implicationsIn policy terms, the impact of investment on healthcare is essential to addressing future health crises. The impact of coronavirus disease 2019 (COVID-19) can never be separated from the shortages or low prioritization of health against other sectors of the economy. The article also provides an insight to policymakers on the demand for policy reform that will boost and make the health sector attractive to both domestic and foreign direct investment.Originality/valueGiven the vulnerability of SSA to the health crisis, there are limited studies to examine this phenomenon and first to address the needed investment priorities to the health sector infrastructure in SSA.

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Regional Overview on the Double Burden of Malnutrition and Examples of Program and Policy Responses: African Region

Annals of Nutrition and Metabolism ◽

10.1159/000503671 ◽

2019 ◽

Vol 75 (2) ◽

pp. 127-130 ◽

Cited By ~ 4

Author(s):

Adelheid W. Onyango ◽

Juddy Jean-Baptiste ◽

Betty Samburu ◽

Tshimi Lynn Moeng Mahlangu

Keyword(s):

Age Groups ◽

Health Sector ◽

Lifestyle Changes ◽

Sub Saharan Africa ◽

World Health ◽

Noncommunicable Diseases ◽

African Region ◽

Double Burden ◽

Double Burden Of Malnutrition ◽

Sub Saharan

Sub-Saharan Africa is experiencing the double burden of malnutrition (DBM) with high levels of undernutrition and a growing burden of overweight/obesity and diet-related noncommunicable diseases (NCDs). Undernourishment in sub-Saharan Africa increased between 2010 and 2016. Although the prevalence of chronic undernutrition is decreasing, the number of stunted children under 5 years of age is increasing due to population growth. Meanwhile, overweight/obesity is increasing in all age groups, with girls and women being more affected than boys and men. It is increasingly recognized that the drivers of the DBM originate outside the health sector and operate across national and regional boundaries. Largely unregulated marketing of cheap processed foods and nonalcoholic beverages as well as lifestyle changes are driving consumption of unhealthy diets in the African region. Progress toward the goal of ending hunger and malnutrition by 2030 requires intensified efforts to reduce undernutrition and focused action on the reduction of obesity and diet-related NCDs. The World Health Organization is developing a strategic plan to guide governments and development partners in tackling all forms of malnutrition through strengthened policies, improved service delivery, and better use of data. It is only through coordinated and complementary efforts that strides can be made to reduce the DBM.

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Calibration of the Epilepsy Questionnaire for Use in a Low-Resource Setting

Journal of Environmental and Public Health ◽

10.1155/2020/5193189 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Joseph O. Yaria ◽

Adesola Ogunniyi

Keyword(s):

Health Sector ◽

Sub Saharan Africa ◽

Health Providers ◽

Good Test ◽

Retest Reliability ◽

Low Resource ◽

Resource Setting ◽

Low Resource Setting ◽

Sub Saharan ◽

Test Retest Reliability

Background. Burden of epilepsy in sub-Saharan Africa is huge in the midst of shortage of human resource in its health sector. Using skilled staff to supervise and support lower level healthcare workers providing frontline primary healthcare is a pragmatic coping solution. But, lower level health providers face enormous challenges due to absent clinical algorithms or pragmatic rapid diagnostic tests. Objective. This study aimed to determine if the use of an epilepsy questionnaire in a traditional clinical setting would improve semiological details obtained and diagnostic accuracy. Methods. A prospective study was conducted involving patients diagnosed with epilepsy each with an eye witness who had regularly witnessed the seizures. Routine seizure history from clinical documentation and an interviewer-based questionnaire were compared. The data obtained were assessed for content, accuracy, intermethod and test-retest reliability. Results. Sixty-seven patients with a median age of 24 years were recruited. Routine seizure history had obtained less semiological details with inadequate description of nonmotor manifestations and lateralizing motor details. The questionnaire-obtained history showed higher accuracy for generalized onset seizure (0.83 vs. 0.56) and focal onset seizures (0.79 vs. 0.59). The questionnaire-obtained history also had good test-retest reliability for various semiological domains except automatisms. Conclusions. Routine seizure histories are not standardized. The use of a questionnaire goes a long way in improving semiology description in a low-resource setting and guides the health provider on what details to focus on. The use of epilepsy questionnaires should, therefore, be considered to improve semiology, especially in nonspecialist settings.

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Trends and drivers of government health spending in sub-Saharan Africa, 1995–2015

BMJ Global Health ◽

10.1136/bmjgh-2018-001159 ◽

2019 ◽

Vol 4 (1) ◽

pp. e001159 ◽

Cited By ~ 8

Author(s):

Angela E Micah ◽

Catherine S Chen ◽

Bianca S Zlavog ◽

Golsum Hashimi ◽

Abigail Chapin ◽

...

Keyword(s):

Purchasing Power Parity ◽

Good Governance ◽

Health Sector ◽

National Income ◽

Health Spending ◽

Sub Saharan Africa ◽

African Countries ◽

Individual Country ◽

Government Health ◽

Sub Saharan

IntroductionGovernment health spending is a primary source of funding in the health sector across the world. However, in sub-Saharan Africa, only about a third of all health spending is sourced from the government. The objectives of this study are to describe the growth in government health spending, examine its determinants and explain the variation in government health spending across sub-Saharan African countries.MethodsWe used panel data on domestic government health spending in 46 countries in sub-Saharan Africa from 1995 to 2015 from the Institute for Health Metrics and Evaluation. A regression model was used to examine the factors associated with government health spending, and Shapley decomposition was used to attribute the contributions of factors to the explained variance in government health spending.ResultsWhile the growth rate in government health spending in sub-Saharan Africa has been positive overall, there are variations across subgroups. Between 1995 and 2015, government health spending in West Africa grew by 6.7% (95% uncertainty intervals [UI]: 6.2% to 7.0%) each year, whereas in Southern Africa it grew by only 4.5% (UI: 4.5% to 4.5%) each year. Furthermore, per-person government health spending ranged from $651 (Namibia) in 2017 purchasing power parity dollars to $4 (Central African Republic) in 2015. Good governance, national income and the share of it that is government spending were positively associated with government health spending. The results from the decomposition, however, showed that individual country characteristics made up the highest percentage of the explained variation in government health spending across sub-Saharan African countries.ConclusionThese findings highlight that a country’s policy choices are important for how much the health sector receives. As the attention of the global health community focuses on ways to stimulate domestic government health spending, an understanding that individual country sociopolitical context is an important driver for success will be key.

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