scholarly journals Towards universal health coverage: what are the system requirements for effective large-scale community health worker programmes?

2019 ◽  
Vol 4 (Suppl 9) ◽  
pp. e001046 ◽  
Author(s):  
Uta Lehmann ◽  
Nana A Y Twum-Danso ◽  
Jennifer Nyoni
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Large Scale ◽  
Scale Up ◽  
Health Systems Strengthening ◽  
Local Context ◽  
Extensive Literature ◽  
Health Coverage ◽  
Universal Health

Against the background of efforts to strengthen health systems for universal health coverage and health equity, many African countries have been relying on lay members of the community, often referred to as community health workers (CHWs), to deliver primary healthcare services. Growing demand and great variability in definitions, roles, governance and funding of CHWs have prompted the need to revisit CHW programmes and provide guidance on the implementation of successful programmes at scale. Drawing on the synthesised evidence from two extensive literature reviews, this article determines foundational elements of functioning CHW programmes, focusing in particular on the systems requirements of large-scale programmes. It makes recommendations for the effective development of large-scale CHW programmes. The key foundational elements of successful CHW programmes identified are (1) embeddedness, connectivity and integration into the larger system of healthcare service delivery; (2) cadre differentiation and role clarity in order to maintain clear scopes of work and accountability; (3) sound programme design based on local contextual factors and effective people management; and (4) ongoing monitoring, learning and adapting based on accurate and timely local data in order to ensure optimal fit to local context since one size does not fit all. We conclude that CHWs are an investment in health systems strengthening and community resilience with enormous potential for contributing to universal health coverage and the sustainable development goals if well designed and managed. While the evidence base is uneven and mixed, it provides extensive insight and knowledge to strengthen, scale up and sustain CHW programmes throughout Africa.

scholarly journals A Health Systems Strengthening Approach to Female Genital Fistula in Kenya

2018 ◽  
Vol 13 (2) ◽  
Author(s):  
Elizabeth Wala ◽  
Meggie Mwoka ◽  
Dan Okoro
Keyword(s):  
Health Systems ◽  
Universal Health Coverage ◽  
Social Impact ◽  
Health Systems Strengthening ◽  
Entry Point ◽  
Health Coverage ◽  
Insurance Cover ◽  
Genital Fistula ◽  
Universal Health ◽  
Female Genital

Aims: To contribute to Universal Health Coverage by strengthening the capacity of the health system in Kenya to address female genital fistula using NHIF as an entry point. Methods: This involves a revolving fund model using NHIF rebates from an initial donor funded payment of NHIF premiums for 3 years for as part of FGF management. USD 180 will be paid for NHIF subscription per patient. This will cover the woman and her dependents for 3 years. NHIF in return will pay a rebate of USD 600 per patient. The rebates will be used by County Governments for facility improvement especially on reproductive health services. This will be done with support from UNFPA who will provide technical guidance, capacity building, support of repair services and resource materials. Results: The expected results of this innovative approach include: Contribution to Universal Health Coverage through increased uptake of NHIF; increased knowledge of health workers on RMNCH and FGF management; insurance cover for fistula champion and her dependents; and strengthening policies and legislation around facility improvement funds. Conclusions: Addressing FGF will require a concentrated and coordinated effort at the national and local levels of different stakeholders under the leadership of the Ministry of Health (MOH) and county government to provide centralized coordination to ensure that quality services are available. Using NHIF as an entry point, the domino effect is health systems strengthening around FGF management and social health protection for household. This is a shift from the previous patient-focused management of fistula that had individual and not social impact.

scholarly journals Universal Health Coverage- A Case Study of Indian Healthcare System during COVID-19 Pandemic

2021 ◽  
pp. 1-6
Author(s):  
Rashika Nandwani
Keyword(s):  
Healthcare System ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Building Blocks ◽  
Health Systems Strengthening ◽  
World Health ◽  
Health Coverage ◽  
The World ◽  
The Government ◽  
Universal Health

Aim: The main purpose of this paper is to look at the Indian healthcare system during the COVID-19 pandemic and how COVID-19 acts as barrier and also presents some opportunities towards the road of Universal Health Coverage (UHC). Background: COVID-19 has exposed the vulnerability of health systems across the world and India is no exception. The World Health Organization (WHO) has kept the definition of UHC very flexible and has left on the country which is implementing it as to how much of the population and which services should be included in the scheme.  Discussion: India already has a unique flagship program Ayushman Bharat where it is trying to cover her most vulnerable population against catastrophic expenditure of health. This paper further investigates the progress of India towards UHC and how COVID-19 is acting as an impediment for India to progress towards it. On the other hand, it also poses some opportunities which had not been explored in the past. Health Systems Strengthening is the path towards the achievement of UHC and due to COVID-19, India has touched upon all the six building blocks which are needed to strengthen our system towards the achievement of UHC. Recommendations and Conclusion: It recommends that Indian system should be more proactive than reactive; it also suggests following a systems-based approach and to not target the problem in silos. It also suggests increasing the government funding as well as establishment of proper public health cadre. To conclude, this paper also suggests that the government should include outpatient expenses into their scheme, and they should also concentrate towards building adequate infrastructure in order to face future pandemics like COVID-19.

scholarly journals Optimising the performance of frontline implementers engaged in the NTD programme in Nigeria: lessons for strengthening community health systems for universal health coverage

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Akinola Oluwole ◽  
Laura Dean ◽  
Luret Lar ◽  
Kabiru Salami ◽  
Okefu Okoko ◽  
...  
Keyword(s):  
Social Support ◽  
Community Health ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Neglected Tropical Diseases ◽  
Technical Support ◽  
Health Interventions ◽  
Health Coverage ◽  
Problems And Solutions ◽  
Universal Health

Abstract Background The control and elimination of Neglected Tropical Diseases (NTDs) is dependent on mass administration of medicines (MAM) in communities and schools by community drug distributers (CDDs) who are supported and supervised by health facility staff (FLHF) and teachers. Understanding how to motivate, retain and optimise their performance is essential to ensure communities accept medicines. This study aimed to capture and translate knowledge, problems and solutions, identified by implementers, to enhance NTD programme delivery at the community level in Nigeria. Methods Qualitative data was collected through participatory stakeholder workshops organised around two themes: (i) identification of problems and (ii) finding solutions. Eighteen problem-focused workshops and 20 solution-focussed workshops were held with FLHF, CDDs and teachers in 12 purposively selected local government areas (LGA) across two states in Nigeria, Ogun and Kaduna States. Result The problems and solutions identified by frontline implementers were organised into three broad themes: technical support, social support and incentives. Areas identified for technical support included training, supervision, human resource management and workload, equipment and resources and timing of MAM implementation. Social support needs were for more equitable drug distributor selection processes, effective community sensitisation mechanisms and being associated with the health system. Incentives identified were both non-financial and financial including receiving positive community feedback and recognition and monetary remuneration. The results led to the development of the ‘NTD frontline implementer’s framework’ which was adapted from the Community Health Worker (CHW) Generic Logic Model by Naimoli et al. (Hum Resour Health 12:56, 2014). Conclusion Maximising performance of frontline implementers is key to successful attainment of NTD goals and other health interventions. As NTDs are viewed as a ‘litmus test’ for universal health coverage, the lessons shared here could cut across programmes aiming to achieve equitable coverage. It is critical to strengthen the collaboration between health systems and communities so that together they can jointly provide the necessary support for frontline implementers to deliver health for all. This research presents additional evidence that involving frontline implementers in the planning and implementation of health interventions through regular feedback before, during and after implementation has the potential to strengthen health outcomes.

scholarly journals 20.F. Workshop: Dental care – coverage and access across countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Oral Health ◽  
North America ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Dental Care ◽  
Financial Protection ◽  
Health Coverage ◽  
Universal Health

Abstract Oral health is a central element of general health with significant impact in terms of pain, suffering, impairment of function and reduced quality of life. Although most oral disease can be prevented by health promotion strategies and routine access to primary oral health care, the GBD study 2017 estimated that oral diseases affect over 3.5 billion people worldwide (Watt et al, 2019). Given the importance of oral health and its potential contribution to achieving universal health coverage (UHC), it has received increased attention in public health debates in recent years. However, little is known about the large variations across countries in terms of service delivery, coverage and financing of oral health. There is a lack of international comparison and understanding of who delivers oral health services, how much is devoted to oral health care and who funds the costs for which type of treatment (Eaton et al., 2019). Yet, these aspects are central for understanding the scope for improvement regarding financial protection against costs of dental care and equal access to services in each country. This workshop aims to present the comparative research on dental care coverage in Europe, North America and Australia led by the European Observatory on Health Systems and Policies. Three presentations will look at dental care coverage using different methods and approaches. They will compare how well the population is covered for dental care especially within Europe and North America considering the health systems design and expenditure level on dental care, using the WHO coverage cube as analytical framework. The first presentation shows results of a cross-country Health Systems in Transition (HiT) review on dental care. It provides a comparative review and analysis of financing, coverage and access in 31 European countries, describing the main trends also in the provision of dental care. The second presentation compares dental care coverage in eight jurisdictions (Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States) with a particular focus on older adults. The third presentation uses a vignette approach to map the extent of coverage of dental services offered by statutory systems (social insurance, compulsory insurance, NHS) in selected countries in Europe and North America. This workshop provides the opportunity of a focussed discussion on coverage of dental care, which is often neglected in the discussion on access to health services and universal health coverage. The objectives of the workshop are to discuss the oral health systems in an international comparative setting and to draw lessons on best practices and coverage design. The World Conference on Public Health is hence a good opportunity for this workshop that contributes to frame the discussion on oral health systems in a global perspective. Key messages There is large degree of variation in the extent to which the costs of dental care are covered by the statutory systems worldwide with implications for oral health outcomes and financial protection. There is a need for a more systematic collection of oral health indicators to make analysis of reliable and comparable oral health data possible.

scholarly journals Strengthening health systems for universal health coverage and sustainable development

2017 ◽  
Vol 95 (7) ◽  
pp. 537-539 ◽  
Author(s):  
Marie Paule Kieny ◽  
Henk Bekedam ◽  
Delanyo Dovlo ◽  
James Fitzgerald ◽  
Jarno Habicht ◽  
...  
Keyword(s):  
Sustainable Development ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Universal Health
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