scholarly journals Realist evaluation of the role of the Universal Health Coverage Partnership in strengthening policy dialogue for health planning and financing: a protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e022345 ◽  
Author(s):  
Emilie Robert ◽  
Valery Ridde ◽  
Dheepa Rajan ◽  
Omar Sam ◽  
Mamadou Dravé ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Low Income ◽  
Expert Knowledge ◽  
Health Planning ◽  
Realist Evaluation ◽  
Low Income Countries ◽  
Policy Dialogue ◽  
Health Coverage ◽  
Support Policy ◽  
Universal Health

IntroductionIn 2011, WHO, the European Union and Luxembourg entered into a collaborative agreement to support policy dialogue for health planning and financing; these were acknowledged as core areas in need of targeted support in countries’ quest towards universal health coverage (UHC). Entitled ‘Universal Health Coverage Partnership’, this intervention is intended to strengthen countries’ capacity to develop, negotiate, implement, monitor and evaluate robust and integrated national health policies oriented towards UHC. It is a complex intervention involving a multitude of actors working on a significant number of remarkably diverse activities in different countries.Methods and analysisThe researchers will conduct a realist evaluation to answer the following question: How, in what contexts, and triggering what mechanisms, does the Partnership support policy dialogue for health planning and financing towards UHC? A qualitative multiple case study will be undertaken in Togo, Liberia, Democratic Republic of Congo, Cape Verde, Burkina Faso and Niger. Three steps will be implemented: (1) formulating context–mechanism–outcome explanatory propositions to guide data collection, based on expert knowledge and theoretical literature; (2) collecting empirical data through semistructured interviews with key informants and observations of key events, and analysing data; (3) specifying the intervention theory.Ethics and disseminationThe primary target audiences are WHO and its partner countries; international and national stakeholders involved in or supporting policy dialogues in the health sector, especially in low-income countries; and researchers with interest in UHC, policy dialogue, evaluation research and/or realist evaluation.

scholarly journals Challenges to achieving universal health coverage through community-based health planning and services delivery approach: a qualitative study in Ghana

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e024845 ◽  
Author(s):  
Abraham Assan ◽  
Amirhossein Takian ◽  
Moses Aikins ◽  
Ali Akbarisari
Keyword(s):  
Qualitative Study ◽  
Universal Health Coverage ◽  
Low Income ◽  
Health Planning ◽  
National Level ◽  
Health Coverage ◽  
Community Based ◽  
Services Delivery ◽  
Universal Health ◽  
Local Levels

ObjectiveCommunity-based initiatives have enormous potential to facilitate the attainment of universal health coverage (UHC) and health system development. Yet key gaps exist and threaten its sustainability in many low-income and middle-income countries. This study is first of its kind (following the launch of the Sustainable Developments Goal [SDG]) and aimed to holistically explore the challenges to achieving UHC through the community-based health planning and service (CHPS) initiative in Ghana.DesignA qualitative study design was adopted to explore the phenomenon. Face-to-face indepth interviews were conducted from April 2017 until February 2018 through purposive and snowball sampling techniques. Data were analysed using inductive and deductive thematic analysis approach.SettingData were gathered at the national level, in addition to the regional, district and subdistrict/local levels of four regions of Ghana. Sampled regions were Central Region, Greater Accra Region, Upper East Region and Volta Region.ParticipantsIn total, 67 participants were interviewed: national level (5), regional levels (11), district levels (9) and local levels (42). Interviewees were mainly stakeholders—people whose actions or inactions actively or passively influence the decision-making, management and implementation of CHPS, including policy makers, managers of CHPS compound and health centres, politicians, academics, health professionals, technocrats, and community health management committee members.ResultsBased on our findings, inadequate understanding of CHPS concept, major contextual changes with stalled policy change to meet growing health demands, and changes in political landscape and leadership with changed priorities threaten CHPS sustainability.ConclusionUHC is a political choice which can only be achieved through sustainable and coherent efforts. Along countries’ pathways to reach UHC, coordinated involvement of all stakeholders, from community members to international partners, is essential. To achieve UHC within the time frame of SDGs, Ghana has no choice but to improve its national health governance to strengthen the capacity of existing CHPS.

scholarly journals Policy dialogue as a collaborative tool for multistakeholder health governance: a scoping study

2020 ◽  
Vol 4 (Suppl 7) ◽  
pp. e002161
Author(s):  
Emilie Robert ◽  
Dheepa Rajan ◽  
Kira Koch ◽  
Alyssa Muggleworth Weaver ◽  
Denis Porignon ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Low Income ◽  
Collaborative Governance ◽  
Development Aid ◽  
Policy Dialogue ◽  
Health Coverage ◽  
Scoping Study ◽  
Universal Health

IntroductionHealth system governance is the cornerstone of performant, equitable and sustainable health systems aiming towards universal health coverage. Global health actors have increasingly been using policy dialogue (PD) as a governance tool to engage with both state and non-state stakeholders. Despite attempts to frame PD practices, it remains a catch-all term for both health systems professionals and researchers.MethodWe conducted a scoping study on PD. We identified 25 articles published in English between 1985 and 2017 and 10 grey literature publications. The analysis was guided by the following questions: (1) How do the authors define PD? (2) What do we learn about PD practices and implementation factors? (3) What are the specificities of PD in low-income and middle-income countries?ResultsThe analysis highlighted three definitions of policy dialogue: a knowledge exchange and translation platform, a mode of governance and an instrument for negotiating international development aid. Success factors include the participants’ continued and sustained engagement throughout all the relevant stages, their ability to make a constructive contribution to the discussions while being truly representative of their organisation and their high interest and stake in the subject. Prerequisites to ensuring that participants remained engaged were a clear process, a shared understanding of the goals at all levels of the PD and a PD approach consistent with the PD objective. In the context of development aid, the main challenges lie in the balance of power between stakeholders, the organisational or technical capacity of recipient country stakeholders to drive or contribute effectively to the PD processes and the increasingly technocratic nature of PD.ConclusionPD requires a high level of collaborative governance expertise and needs constant, although not necessarily high, financial support. These conditions are crucial to make it a real driver of health system reform in countries’ paths towards universal health coverage.

scholarly journals Measuring progress towards universal health coverage: national and subnational analysis in Ethiopia

2019 ◽  
Vol 4 (6) ◽  
pp. e001843 ◽  
Author(s):  
Getachew Teshome Eregata ◽  
Alemayehu Hailu ◽  
Solomon Tessema Memirie ◽  
Ole Frithjof Norheim
Keyword(s):  
Universal Health Coverage ◽  
Low Income ◽  
Addis Ababa ◽  
Scale Up ◽  
Low Income Countries ◽  
Health Coverage ◽  
Country Level ◽  
Afar Region ◽  
Service Coverage ◽  
Universal Health

IntroductionAiming for universal health coverage (UHC) as a country-level goal requires that progress is measured and tracked over time. However, few national and subnational studies monitor UHC in low-income countries and there is none for Ethiopia. This study aimed to estimate the 2015 national and subnational UHC service coverage status for Ethiopia.MethodsThe UHC service coverage index was constructed from the geometric means of component indicators: first, within each of four major categories and then across all components to obtain the final summary index. Also, we estimated the subnational level UHC service coverage. We used a variety of surveys data and routinely collected administrative data.ResultsNationally, the overall Ethiopian UHC service coverage for the year 2015 was 34.3%, ranging from 52.2% in the Addis Ababa city administration to 10% in the Afar region. The coverage for non-communicable diseases, reproductive, maternal, neonatal and child health and infectious diseases were 35%, 37.5% and 52.8%, respectively. The national UHC service capacity and access coverage was only 20% with large variations across regions, ranging from 3.7% in the Somali region to 41.1% in the Harari region.ConclusionThe 2015 overall UHC service coverage for Ethiopia was low compared with most of the other countries in the region. Also, there was a substantial variation among regions. Therefore, Ethiopia should rapidly scale up promotive, preventive and curative health services through increasing investment in primary healthcare if Ethiopia aims to reach the UHC service coverage goals. Also, policymakers at the regional and federal levels should take corrective measures to narrow the gap across regions, such as redistribution of the health workforce, increase resources allocated to health and provide focused technical and financial support to low-performing regions.

scholarly journals COMMUNITY PHARMACY ROLE IN UNIVERSAL HEALTH COVERAGE IN MOMBASA COUNTY

2021 ◽  
pp. 331-341
Author(s):  
Kailong J. M ◽  
Aggrey A ◽  
Mulinya S
Keyword(s):  
Community Pharmacy ◽  
Universal Health Coverage ◽  
Close Contact ◽  
Health Planning ◽  
Essential Medicines ◽  
Bivariate Analysis ◽  
Community Pharmacies ◽  
Health Coverage ◽  
Controlled Drugs ◽  
Universal Health

Community pharmacy role in universal health coverage was a qualitative study that entailed close contact to the role played by community pharmacies in healthcare provision. As a "small healthcare" in provision of pharmaceutical services, community pharmacies are required to be included in realization of Universal Health Coverage in Mombasa since it is among the Big 4 Agenda of the national government (MOH, 2013). The objective of the study was to determine community pharmacy role in universal health coverage. A descriptive cross sectional study design was used to collect both qualitative and quantitative data and the design estimate the prevalence of the outcome of interest commonly for the purpose of public health planning. A sample size of 196 was calculated using fishers formula. Data was collected using in-depth interviews and structured questionnaire were administered on a target population of community pharmacies health providers and clients seeking services respectively. The collected data was analysed using SPSS version 20 and interpreted using tables and pie charts. On community pharmacy practitioners respondents; 58% were male, 90.3% diploma holders in pharmacy, 39.8% registered with PPB and 65% had practised for less than two years. 78% of the respondents agree that community pharmacy has a role in UHC and there was 74% affordability of community pharmacy medicines. Bivariate analysis findings show that training and inspection on UHC (P=0.003) Covid 19 (p=0.000) and inspection fee (p=0.000). Accessibility; location of community pharmacies (p=0.000) and doctors attitudes (p=0.000). Essential medicines; acyclovir 200mg tablets (p=0.000), chlorpromazine 100mg tablets (p=0.000) and tetanus toxoid vaccine (p=0.000). Key determinants of community pharmacy role in UHC were diploma (AOR 666.7; CI 129.6-3429.5), Erythromycin 125mg suspension (AOR 120.3; CI 15.4-940.8), Acyclovir 200mg tablets (AOR 46.823; CI 17.7-124.1) and Occupation (AOR 45.271; CI 15.363-133.404. The study recommends reduction of tax on essential medicines, MOH revise the UHC policy to incorporate community pharmacies and empowerment on management of controlled drugs and vaccines in order to realize effective and efficient UHC in Kenya

scholarly journals Narrowing the Gap of Inequity in the Indonesia’s National Social Health Insurance Scheme, 2014-2018

2021 ◽  
Author(s):  
Hasbullah Thabrany ◽  
Ryan R. Nugraha ◽  
Ery Setiawan ◽  
Farah Purwaningrum
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
Universal Health Coverage ◽  
Low Income ◽  
National Health Insurance Scheme ◽  
Income Group ◽  
Health Insurance Scheme ◽  
Health Coverage ◽  
Insurance Scheme ◽  
Universal Health

Abstract Background. Indonesia is nearing its 7-year implementation of its national health insurance scheme, or the Jaminan Kesehatan Nasional (JKN), as a facilitator for achieving universal health coverage (UHC). Despite its long-running system, it is contentious as to whether JKN has been narrowing the gap of inequity in its delivery. This paper aims to explore on whether the national health insurance scheme in Indonesia have been promoting equity of access towards health services.Methods. This study analyzes findings from JKN statistic data of 2014-2018 published by Government of Indonesia. Using a retrospective design, this study identified membership and utilization of health services within JKN, based on different membership enrollment groups as proxy for income.Results. JKN has been expanding its enrollment significantly within 5 years, during year 2014 to 2018. Moreover, the study concludes that there was increased access for outpatient in all membership groups. Inpatient care was increased in low-income group, but not in high-income group. Result also showed inpatient access was correlated with adequate supply side intervention, particularly hospital beds.Conclusion. JKN has been successful in narrowing the inequity gap, particularly by serving the low-income group better in terms of access. Going forward, equity needs to be incorporated into JKN achievement indicator, particularly to accelerate Indonesia’s effort to realize universal health coverage.

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