scholarly journals The long walk to universal health coverage: patterns of inequities in the use of primary healthcare services in Enugu, Southeast Nigeria

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Ijeoma L Okoronkwo ◽  
Obinna E Onwujekwe ◽  
Francis O Ani
Keyword(s):  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Healthcare Services ◽  
Health Coverage ◽  
Universal Health

scholarly journals “Living long in India”– India’s progress towards Universal Health Coverage

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Balraj ◽  
H Brand
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Indian Population ◽  
Healthcare Services ◽  
Fiscal Year ◽  
Health Coverage ◽  
Indian States ◽  
Universal Health

Abstract Issue There are multiple small health insurance schemes throughout India. However, high out-of-pocket (OOP) expenditures, unaffordable and inequitable access to healthcare services still persist. In an attempt to address these issues and achieve Universal Health Coverage (UHC), India launched the healthcare scheme ‘Ayushman Bharat’ (“long live India”) in 2018. Description The Ayushman Bharat (AB) scheme has two components which include 1) transforming the existing primary healthcare centers (PHC) under the control of State Governments and 2) the National Health Protection Scheme (NHPS) also known as “ModiCare” - a health insurance. The scheme aims to transform nearly 150.000 PHCs to deliver comprehensive primary healthcare services across the country by 2022. NHPS covers the costs of almost all secondary and many tertiary care procedures of about 40% of the total Indian population. The coverage will be approximately €6.400 per year per beneficiary family; 60% of the costs are borne by the Centre and 40% by the States. Results Approximately €127 million have already been allocated by the Centre towards the AB scheme for the fiscal year 2018-19. Till date, around 29 million health insurance cards have been issued, approximately 1,8 million beneficiaries have been admitted and around 15.291 hospitals have been empaneled under NHPS. However, there is no data available validating the usage of the health services yet. Few Indian states are yet to implement the AB scheme. Lessons For the first time, attempts have been made to provide affordable healthcare services to the Indian population under a single common initiative. However, the AB scheme fails to cover outpatient health services, which are an important part of OOP expenses in India. Main message The effort to launch Ayushman Bharat in a big, democratic and diverse country like India has to be lauded, which not only aims to make healthcare services affordable but also aligns itself to the concept of UHC.

scholarly journals Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya

2020 ◽  
Author(s):  
Peter O. Otieno ◽  
Elvis Omondi Achach Wambiya ◽  
Shukri M Mohamed ◽  
Martin Kavao Mutua ◽  
Peter M Kibe ◽  
...  
Keyword(s):  
Primary Care ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Associated Factors ◽  
Healthcare Services ◽  
Urban Slums ◽  
Health Coverage ◽  
Ordinal Logistic Regression Analysis ◽  
Access To Primary Care ◽  
Universal Health

Abstract Background: Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage (UHC) policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. Methods: The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recoded into tertiles with categories labeled as poor, moderate and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios and 95 percent confident intervals were used to interpret the strength of associations. Results : The odds of being in the lowest versus combined moderate and highest access tertile were significantly higher for female than male-headed households (AOR 1.91 [95% CI 1.03-3.54]; p < .05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥$30 had significantly lower odds of being in the lowest versus combined moderate and highest access tertile compared to those spending ≤ $5 quarterly (AOR 0.33 [95% CI 0.50-1.90]; p< .001). Households that sought care from private facilities had significantly higher odds of being in the lowest versus combined moderate and highest access compared to the public facilities (AOR 3.77 [95% CI 2.16-6.56]; p < .05). Conclusion : In Nairobi slums in Kenya, living in a female-headed household and seeking care from private facilities are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize the regulation of private health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare. Keywords: Access to primary healthcare, Universal health coverage, Urban slums, Penchansky and Thomas’s model.

scholarly journals Strengthening health systems to achieve Universal Health Coverage: Lessons from four Latin American countries.

2020 ◽  
Author(s):  
Ramiro Gilardino ◽  
Rifkin Susan B ◽  
Pilar Valanzasca
Keyword(s):  
Health Systems ◽  
Latin American ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Healthcare Services ◽  
Financial Protection ◽  
Health Coverage ◽  
Service Coverage ◽  
Latin American Countries ◽  
Universal Health

Abstract Background: During the 1990s, health systems within several Latin American countries changed to expand service coverage and reach more people. These changes are considered the antecedent of the Universal Health Coverage (UHC). Seven years after the United Nations’ call for UHC, healthcare services in Argentina, Brazil, Colombia, Mexico are generally accessible and affordable. However, these countries increasingly struggle to meet their populations’ growing health needs while also addressing rising health care costs. This research aims to describe measures taken by these four countries to commit by UHC, addressing their barriers and challenges. Methods: This study examined literature review data, supplemented with survey data collected from regional stakeholders. Data were analyzed within an ad-hoc matrix.Results: These four countries increased healthcare services coverage by strengthening their primary healthcare systems. They also expanded coverage for non-communicable diseases, provided community outreach, and increased the number of skilled healthcare workers. New pharmaceutical support programs provided access to treatments for chronic conditions at zero cost, while high-costs drugs and cancer treatments were partially guaranteed. However, these measures did not achieve full financial protection to all, leaving citizens exposed to possible catastrophic expenditures, despite increased service coverage. UHC is funded primarily through taxes and polling resources, and these four countries still struggle to find mechanisms that could increase pooling mechanisms capable of increasing service coverage, while reducing financial inequities among people. Conclusions: Argentina, Brazil, Colombia, and Mexico have made progress towards UHC. Nevertheless, additional mechanisms to sustain financial protection are urgently required. The decentralization of the primary healthcare system, the development of public-private partnerships, and the implementation of progressive financing mechanisms like conditional cash transfers are potential manners to improve service delivery and financial protection contributing to effective UHC.

scholarly journals Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya

2019 ◽  
Author(s):  
Peter O. Otieno ◽  
Elvis Omondi Achach Wambiya ◽  
Shukri M Mohamed ◽  
Martin Kavao Mutua ◽  
Peter M Kibe ◽  
...  
Keyword(s):  
Primary Care ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Associated Factors ◽  
Healthcare Expenditure ◽  
Healthcare Services ◽  
Urban Slums ◽  
Health Coverage ◽  
Access To Primary Care ◽  
Universal Health

Abstract Background: Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. Methods: The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recoded into tertiles with categories labeled as poor, moderate and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios and 95 percent confident intervals were used to interpret the strength of associations. Results : The odds of being in the lowest versus combined moderate and highest access tertile were significantly higher for female than male-headed households (AOR 1.91 [95% CI 1.03-3.54]; p < .05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥$30 had significantly lower odds of being in the lowest versus combined moderate and highest access tertile compared to those spending ≤ $5 quarterly (AOR 0.33 [95% CI 0.50-1.90]; p< .001). Households that sought care from private facilities had significantly higher odds of being in the lowest versus combined moderate and highest access compared to the public facilities (AOR 3.77 [95% CI 2.16-6.56]; p < .05). Conclusion : In Nairobi slums in Kenya, the gender of the household head, out of pocket healthcare expenditure, and source of primary care are significantly associated with access to primary care. Therefore, the universal health coverage program in this setting should be designed with an equity lens so that the most vulnerable groups within the community can have access.

scholarly journals An Analysis of The National Health Insurance Policy Implementation in 2014 (Presidential Regulation No. 12 And 111/2013 on Health Insurance) from The Regulator’s Position

2016 ◽  
Vol 1 (2) ◽  
Author(s):  
Muhammad Arief Hasan ◽  
Puput Oktamianti ◽  
Dumilah Ayuningtyas
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
Healthcare Services ◽  
Regional Government ◽  
Health Coverage ◽  
Healthcare Facilities ◽  
Road Map ◽  
Universal Health

Abstract. JKN (National Health Insurance) is a government program that aims to provide health assurance for all Indonesian citizens for a healthy, productive, and prosperous life. In the two years after JKN was implemented, various problems occurred. This research used the qualitative approach with the Edward II implementation theory. Results of the research indicated that there were problems in communication, stemming from the lack of socialization and inharmonic regulations, there was also the problem of the lack of healthcare resources. From the disposition side, the policy makers often obstructs the implementation preparation, this is evident from the information on determining the premium size. From the organization structure, all the stakeholders have been well coordinated. We conclude that we are not ready to implement the JKN. We recommend that mass and effective socialization program to be performed using various methods of communication and involve the community. To reduce the disparity of healthcare services, we recommend that the regional government to establish various healthcare facilities to accelerate health development. There should also be regulations that allocates healthcare staff in every corner of the country to achieve Universal Health Coverage in 2019, as stated in the National Health Insurance Road Map. Keywords: policy analysis, national health insurance, universal health coverage

scholarly journals Access to and Quality of Primary Healthcare: a Multi-Country Qualitative Case Study in West and East Africa

2020 ◽  
Author(s):  
Soter Ameh ◽  
Bolarinwa Oladimeji Akeem ◽  
Caleb Ochimana ◽  
Abayomi Olabayo Oluwasanu ◽  
Shukri F Mohamed ◽  
...  
Keyword(s):  
East Africa ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Qualitative Case Study ◽  
Financial Burden ◽  
Cost Of Care ◽  
Health Coverage ◽  
Universal Health

Abstract Background: Universal health coverage is one of the Sustainable Development Goal targets known to improve population health and reduce financial burden. There is little qualitative data on access to and quality of primary healthcare in West and East Africa. We elicited in-depth viewpoints of healthcare users and providers, and other stakeholders regarding access to and quality of healthcare.Methods: A qualitative case study was conducted in four communities in Nigeria, and one community each in Kenya, Uganda and Tanzania in 2018. Purposive sampling was used to recruit 155 participants for 24 focus group discussions, 24 in-depth interviews, and 12 key informant interviews. The conceptual framework in this study combined elements of the Health Belief Model, Health Care Utilisation Model, four ‘As’ of access to care, and pathway model to better understand health-seeking behaviours of the study participants. The data were analysed with MAXQDA 2018 qualitative software to identify three themes identified a priori and one emerging theme.Results: Access to primary healthcare in the seven communities was limited. Quality of care was perceived to be unacceptable in public facilities whereas cost of care was unaffordable in private facilities. Patients and health providers and stakeholders highlighted shortage of equipment, frequent drug stock-outs and long waiting times as major issues, but had varying opinions on satisfaction with care. Use of herbal medicines and other traditional treatments delayed or deterred seeking modern healthcare in Nigerian sites. Conclusions: There was a substantial gap in primary healthcare coverage and quality in the selected communities in rural and urban East and West Africa. Alternative models of healthcare delivery should be used to fill this gap and facilitate achieving universal health coverage.

scholarly journals Evaluation of the Participation of Community Pharmacists in Primary Healthcare Services in Nigeria: A Mixed-Method Survey

2020 ◽  
Author(s):  
Maduabuchi R. Ihekoronye ◽  
Kanayo P. Osemene
Keyword(s):  
Service Quality ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Financial Incentives ◽  
Weighted Average ◽  
Community Pharmacists ◽  
Health Coverage ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Universal Health

Background: Achieving universal health coverage in poorly-resourced settings like Nigeria demands optimal mobilization of all healthcare resources including community pharmacists. Such efforts are hampered by insufficient data on primary healthcare (PHC) contributions by community pharmacists. The study aimed to identify PHC services offered by community pharmacists; assess impact of technologies on PHC service quality; and evaluate factors influencing management of PHC services in Nigeria. Methods: A descriptive cross-sectional survey of 321 community pharmacies and 642 clients was undertaken between April and August, 2019. Semi-structured pre-tested questionnaires were administered on randomly-selected community pharmacists and clients. Interviews were conducted with key informants. Data were summarized using frequency and percentages while weighted averages on 5-point ordinal scales and chi-square tests were used to identify weights and associations between variables respectively at P<.050. Results: Response rates of pharmacists and clients were 74.7% (N=321) and 100% (N=642); while their median ages were 39.41 and 51.20 years respectively. Community pharmacists offered services in all eight domains of PHC, especially supply of medicines for treating of endemic diseases (mean weighted average [MWA]=4.59), and disease prevention (4.54) but least of vaccine administration (2.39). Blood glucose screening devices were the most adopted technology with significant impact on service quality (χ2 6.86, P=.030). Major challenges to management of PHC services were poor awareness of pharmacists’ roles (4.31) and lack of integration with the PHC infrastructure (4.31). Capacity constraints in finances (4.11), technologies (4.09), and human resources (3.99) were significant. However, major facilitators were pharmacists’ managerial skills (4.35), and strong client relationships (4.27). Conclusion: In Nigeria, community pharmacists offered important PHC services. Deploying technologies were associated with improved service quality. If community pharmacists are integrated in the national PHC architecture and financial incentives are provided, their competences and goodwill would enhance the achievement of universal health coverage.

scholarly journals Primary Healthcare Policy Research: Including Variables Associated With the Social Determinants of Health Matters Comment on "Universal Health Coverage for Non-communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare"

2021 ◽  
Author(s):  
Shannon Berg
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Policy Research ◽  
Communicable Diseases ◽  
Determinants Of Health ◽  
Health Coverage ◽  
Non Communicable Diseases ◽  
Universal Health

Fisher et al have provided a solid addition to health policy literature in their finding that universal health coverage supports equitable access to Australian primary healthcare (PHC), despite factors such as episodic care and poor distribution of services. Their definition of PHC was comprehensive, extending beyond medical care to include social determinants of health and public policy. However, they limited their operational definition for purposes of the study to general practice, community health and allied health. Applying a narrower definition risks lost opportunities to identify policy implications for equity beyond financial accessibility. The populations most at risk of non-communicable diseases also face significant language, culture, and individual and systemic discrimination barriers to access. Future policy research should consider using a comprehensive PHC definition in determining variables of interest and designing research methodologies, to avoid missing important knowledge that allows existing biases within primary care to continue.

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