scholarly journals The influential factors for achieving universal health coverage in Iran: a multimethod study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naser Derakhshani ◽  
Mohammadreza Maleki ◽  
Hamid Pourasghari ◽  
Saber Azami-Aghdash
Keyword(s):  
Systematic Review ◽  
Universal Health Coverage ◽  
Influential Factors ◽  
World Health ◽  
Cochrane Library ◽  
Round Table Discussion ◽  
Health Coverage ◽  
Regulation And Supervision ◽  
Universal Health ◽  
The Way

Abstract Background The initial purpose of healthcare systems around the world is to promote and maintain the health of the population. Universal Health Coverage (UHC) is a new approach by which a healthcare system can reach its goals. World Health Organization (WHO) emphasized maximum population coverage, health service coverage, and financial protection, as three dimensions of UHC. In progress for achieving UHC, recognizing the influential factors allows us to accelerate such progress. Therefore, this study aimed to identify the influential factors to achieve UHC in Iran. Methods This is a multi-method study was conducted in four phases: First, a systematic review of the literature was conducted to identify the factors in PubMed, Web of Science, Embase, Scopus, ProQuest, Cochrane library, and Science Direct databases, and hand searching google scholar search engine. For recognizing the unmentioned factors, a qualitative study consisting of one session of Focus Group Discussion (FGD) and five semi-structured interviews with experts was designed. The extracted factors were merged and categorized by round table discussion. Finally, the pre-categorized factors were refined and re-categorized under the health system’s control knobs framework during three expert panel sessions. Results Finally, 33 studies were included. Eight hundred two factors were extracted through systematic review and 96 factors through FGD and interviews (totally, 898). After refining them by the experts’ panel, 105 factors were categorized within the control knob framework (financing 19, payment system7, Organization 23, regulation and supervision 33, Behavior 11, and Others 12). The majority of the identified factors were related to the “regulation and supervision” dimension, whilst the “payment system” entailed the fewest. The political commitment during political turmoil, excessive attention to the treatment, referral system, paying out of pocket(OOP) and protection against high costs, economic growth, sanctions, conflict of interests, weakness of the information system, prioritization of services, health system fragmented, lack of managerial support and lack of standard benefits packages were identified as the leading factors on the way to UHC. Conclusion Considering the distinctive role of the context in policymaking, the identification of the factors affecting UHC accompanying by the countries’ experiences about UHC, can boost our speed toward it. Moreover, adopting a long-term plan toward UHC based on these factors and the robust implementation of it pave the way for Iran to achieve better outcomes comparing to their efforts.

scholarly journals Health financing for universal health coverage in Sub-Saharan Africa: a systematic review

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Susan C. Ifeagwu ◽  
Justin C. Yang ◽  
Rosalind Parkes-Ratanshi ◽  
Carol Brayne
Keyword(s):  
Systematic Review ◽  
Health Services ◽  
Universal Health Coverage ◽  
Health Financing ◽  
Sub Saharan Africa ◽  
World Health ◽  
Cochrane Library ◽  
Health Coverage ◽  
Sub Saharan ◽  
Universal Health

Abstract Background Universal health coverage (UHC) embedded within the United Nations Sustainable Development Goals, is defined by the World Health Organization as all individuals having access to required health services, of sufficient quality, without suffering financial hardship. Effective strategies for financing healthcare are critical in achieving this goal yet remain a challenge in Sub-Saharan Africa (SSA). This systematic review aims to determine reported health financing mechanisms in SSA within the published literature and summarize potential learnings. Methods A systematic review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. On 19 to 30 July 2019, MEDLINE, EMBASE, Web of Science, Global Health Database, the Cochrane Library, Scopus and JSTOR were searched for literature published from 2005. Studies describing health financing approaches for UHC in SSA were included. Evidence was synthesised in form of a table and thematic analysis. Results Of all records, 39 papers were selected for inclusion. Among the included studies, most studies were conducted in Kenya (n = 7), followed by SSA as a whole (n = 6) and Nigeria (n = 5). More than two thirds of the selected studies reported the importance of equitable national health insurance schemes for UHC. The results indicate that a majority of health care revenue in SSA is from direct out-of-pocket payments. Another common financing mechanism was donor funding, which was reported by most of the studies. The average quality score of all studies was 81.6%, indicating a high appraisal score. The interrater reliability Cohen’s kappa score, κ=0.43 (p = 0.002), which showed a moderate level of agreement. Conclusions Appropriate health financing strategies that safeguard financial risk protection underpin sustainable health services and the attainment of UHC. It is evident from the review that innovative health financing strategies in SSA are needed. Some limitations of this review include potentially skewed interpretations due to publication bias and a higher frequency of publications included from two countries in SSA. Establishing evidence-based and multi-sectoral strategies tailored to country contexts remains imperative.

scholarly journals Successes, Challenges and Opportunities Towards Universal Health Coverage for Maternal and Child Health in South East Asian Countries: A Systematic Review

2020 ◽  
Author(s):  
Upuli Amaranganie Pushpakumari perera ◽  
Charles Gilks ◽  
Yibeltal Alemu
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Universal Health Coverage ◽  
East Asian ◽  
Health Care Facilities ◽  
Cash Transfer ◽  
World Health ◽  
Health Coverage ◽  
Challenges And Opportunities ◽  
Universal Health

Abstract Background: Sustainable Development Goal 3 (SDG-3) aims to ensure healthy lives and promote wellbeing for all. Universal Health Coverage (UHC) assures delivering health services to all who need without suffering from financial hardships. This paper aims to identify the successes, challenges and opportunities towards achieving UHC for maternal and childcare in countries in the World Health Organization, South East Asian Region (SEAR). Methods: We conducted a systematic review of the literature. We searched PubMed, Embase, Scopus, CINAHL, PsycINFO, WHO research portal and Google scholar for studies published in English from 2010 to 2020. We included studies conducted in maternal and childcare focusing on challenges, opportunities or successes towards UHC in countries in SEAR. Data was synthesized and presented as a narrative description, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results: We identified 62 studies with different study designs from eight SEAR countries , majority were from India. We observed successes or opportunities in access and quality in MCH with government cash transfer schemes and private sector contribution in India, Bangladesh and Indonesia. Politically prioritized MCH care was identified as an opportunity in a state of India. Inadequate healthcare infrastructure including trained human resources, medical products and other supplies were identified as the main challenges in the region. Facilities are overcrowded in Bangladesh and Indonesia. From provider perspective, health care workers’ knowledge and skills as well as attitudes and behaviors were also identified as issues in the region. Lack of health literacy, misconceptions and cultural barriers are identified as challenges from clients’ side. Difficulties in geographical distribution and transport were contributing to poor healthcare access in four countries. Deficiencies in government policies and administration were identified in some fields. Poverty was detected as an overarching barrier.Conclusions: SEAR countries have demonstrated improvements in access, quality and equity on MCH towards UHC. There are, however, challenges related to human and other resources, health care facilities and socio-economic determinants of health. Regional bodies as well as authorities in individual countries should work on these issues to address challenges to achieve UHC.Registration: PROSPERO: CRD42020166404

scholarly journals Analyzing efforts to synergize the global health agenda of universal health coverage, health security and health promotion: a case-study from Ethiopia

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Amare Worku Tadesse ◽  
Kassu Ketema Gurmu ◽  
Selamawit Tesfaye Kebede ◽  
Mahlet Kifle Habtemariam
Keyword(s):  
Health Promotion ◽  
Global Health ◽  
Health System ◽  
Universal Health Coverage ◽  
World Health ◽  
Health Coverage ◽  
Health Security ◽  
Universal Health ◽  
Health Agenda

Abstract Background Evidence exists about synergies among universal health coverage, health security and health promotion. Uniting these three global agendas has brought success to the country’s health sector. This study aimed to document the efforts Ethiopia has made to apply nationally synergistic approaches uniting these three global health agendas. Our study is part of the Lancet Commission on synergies between these global agendas. Methods We employed a case study design to describe the synergistic process in the Ethiopian health system based on a review of national strategies and policy documents, and key informant interviews with current and former policymakers, and academics. We analyzed the “hardware” (using the World Health Organization’s building blocks) and the “software” (ideas, interests, and power relations) of the Ethiopian health system according to the aforementioned three global agendas. Results Fragmentation of health system primarily manifested as inequities in access to health services, low health workforce and limited capacity to implementation guidelines. Donor driven vertical programs, multiple modalities of health financing, and inadequate multisectoral collaborations were also found to be key features of fragmentation. Several approaches were found to be instrumental in fostering synergies within the global health agenda. These included strong political and technical leadership within the government, transparent coordination, and engagement of stakeholders in the process of priority setting and annual resource mapping. Furthermore, harmonization and alignment of the national strategic plan with international commitments, joint financial arrangements with stakeholders and standing partnership platforms facilitated efforts for synergy. Conclusions Ethiopia has implemented multiple approaches to overcome fragmentation. Such synergistic efforts of the primary global health agendas have made significant contributions to the improvement of the country’s health indicators and may promote sustained functionality of the health system.

scholarly journals Burden, Access, and Disparities in Kidney Disease

2019 ◽  
Vol 48 (1) ◽  
pp. 32-39
Author(s):  
Deidra C. Crews ◽  
Aminu K. Bello ◽  
Gamal Saadi ◽  
Keyword(s):  
Kidney Disease ◽  
Universal Health Coverage ◽  
Kidney Injury ◽  
Public Health Problem ◽  
World Health ◽  
Health Coverage ◽  
Global Public Health ◽  
Health Organization ◽  
Basic Infrastructure ◽  
Universal Health

Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is a World Health Organization Sustainable Development Goal. While universal health coverage may not include all elements of kidney care in all countries, understanding what is locally feasible and important with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.

Introduction to Part 5: Health for the whole population—leaving no-one behind

2015 ◽  
Author(s):  
Francis Omaswa ◽  
Nigel Crisp
Keyword(s):  
South Africa ◽  
Global Health ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Health It ◽  
Universal Health ◽  
The Way

Chapter 16 addresses the way in which universal health coverage has become one of the most important concepts in global health. It sets the scene for the following chapters in which leaders discuss the implementation of universal health coverage in Rwanda, South Africa, and Ghana.

scholarly journals A Hybrid Decision-Making Approach for the Service and Financial-Based Measurement of Universal Health Coverage for the E7 Economies

2019 ◽  
Vol 16 (18) ◽  
pp. 3295 ◽  
Author(s):  
Xiaofeng Shi ◽  
Jianying Li ◽  
Fei Wang ◽  
Hasan Dinçer ◽  
Serhat Yüksel
Keyword(s):  
Decision Making ◽  
Universal Health Coverage ◽  
Health Spending ◽  
Poverty Line ◽  
Negative Influence ◽  
World Health ◽  
Annual Growth Rate ◽  
Health Coverage ◽  
Fuzzy Dematel ◽  
Universal Health

The aim of this study is to measure universal health coverage in Emerging 7 (E7) economies. Within this framework, five different dimensions and 14 different criteria are selected by considering the explanations of World Health Organization and United Nations regarding universal health coverage. While weighting the dimensions and criteria, the Decision-making Trial and Evaluation Laboratory (DEMATEL) is considered with the triangular fuzzy numbers. Additionally, Multi-Objective Optimization on the basis of Ratio Analysis (MOORA) approach is used to rank E7 economies regarding Universal Health Coverage (UHC) performance. The novelty of this study is that both service and financial based factors are taken into consideration at the same time. Additionally, fuzzy DEMATEL and MOORA methodologies are firstly used in this study with respect to the evaluation of universal health coverage. The findings show that catastrophic out of pocket health spending, pushed below an international poverty line and annual growth rate of real Gross Domestic Product (GDP) per capita are the most significant criteria for universal health coverage performance. Moreover, it is also concluded that Russia is the country that has the highest universal health coverage performance whereas China, India and Brazil are in the last ranks. It can be understood that macroeconomic conditions play a very significant role on the performance of universal health coverage. Hence, economic conditions should be improved in these countries to have better universal health coverage performance. Furthermore, it is necessary to establish programs that provide exemptions or lower out-of-pocket expenditures which will not prevent the use of health services. This situation can protect people against the financial risks related to health expenditures. In addition to them, it is also obvious that high population has also negative influence on the countries such as, China and India. It indicates that it would be appropriate for these countries to make population planning for this purpose.

scholarly journals Measuring the availability and geographical accessibility of maternal health services across sub-Saharan Africa

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
A. S. Wigley ◽  
N. Tejedor-Garavito ◽  
V. Alegana ◽  
A. Carioli ◽  
C. W. Ruktanonchai ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
National Level ◽  
District Level ◽  
Sub Saharan Africa ◽  
World Health ◽  
Health Coverage ◽  
Availability Analysis ◽  
Sub Saharan ◽  
Geographical Accessibility ◽  
Universal Health

Abstract Background With universal health coverage a key component of the 2030 Sustainable Development Goals, targeted monitoring is crucial for reducing inequalities in the provision of services. However, monitoring largely occurs at the national level, masking sub-national variation. Here, we estimate indicators for measuring the availability and geographical accessibility of services, at national and sub-national levels across sub-Saharan Africa, to show how data at varying spatial scales and input data can considerably impact monitoring outcomes. Methods Availability was estimated using the World Health Organization guidelines for monitoring emergency obstetric care, defined as the number of hospitals per 500,000 population. Geographical accessibility was estimated using the Lancet Commission on Global Surgery, defined as the proportion of pregnancies within 2 h of the nearest hospital. These were calculated using geo-located hospital data for sub-Saharan Africa, with their associated travel times, along with small area estimates of population and pregnancies. The results of the availability analysis were then compared to the results of the accessibility analysis, to highlight differences between the availability and geographical accessibility of services. Results Despite most countries meeting the targets at the national level, we identified substantial sub-national variation, with 58% of the countries having at least one administrative unit not meeting the availability target at province level and 95% at district level. Similarly, 56% of the countries were found to have at least one province not meeting the accessibility target, increasing to 74% at the district level. When comparing both availability and accessibility within countries, most countries were found to meet both targets; however sub-nationally, many countries fail to meet one or the other. Conclusion While many of the countries met the targets at the national level, we found large within-country variation. Monitoring under the current guidelines, using national averages, can mask these areas of need, with potential consequences for vulnerable women and children. It is imperative therefore that indicators for monitoring the availability and geographical accessibility of health care reflect this need, if targets for universal health coverage are to be met by 2030.

scholarly journals Advancing universal health coverage in China and Vietnam: lessons for other countries

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wenhui Mao ◽  
Yuchen Tang ◽  
Tra Tran ◽  
Michelle Pender ◽  
Phuong Nguyen Khanh ◽  
...  
Keyword(s):  
Health Insurance ◽  
National Health ◽  
Universal Health Coverage ◽  
Secondary Data ◽  
World Health ◽  
Health Coverage ◽  
Political Commitment ◽  
Population Coverage ◽  
Service Coverage ◽  
Universal Health

Abstract Background China and Vietnam have made impressive progress towards universal health coverage (UHC) through government-led health insurance reforms. We compared the different pathways used to achieve UHC, to identify the lessons other countries can learn from China and Vietnam. Methods This was a mixed method study which included a literature review, in-depth interviews and secondary data analysis. We conducted a literature search in English and Chinese databases, and reviewed policy documents from internal contacts. We conducted semi-structured interviews with 16 policy makers, government bureaucrats, health insurance scholars in China and Vietnam. Secondary data was collected from National Health Statistics Reports, Health Insurance Statistical Reports and National Health Household Surveys carried out in both countries. We used population insurance coverage, insurance policies, reimbursement rates, number of households experiencing catastrophic heath expenditure (CHE) and incidence of impoverishment due to health expenditure (IHE) to measure the World Health Organization’s three dimensions of UHC: population coverage, service coverage, and financial coverage. Results China has increased population coverage through strong political commitment and extensive government financial subsidies to expand coverage. Vietnam expanded population coverage gradually, by prioritizing the poor and the near-poor in an incremental way. In China, insurance service packages varied across regions and schemes and were greatly determined by financial contributions, resulting in limited service coverage in less developed areas. Vietnam focused on providing a comprehensive and universal service packages for all enrollees thereby approaching UHC in a more equitable manner. CHE rate decreased in Vietnam but increased in China between 2003 and 2008. While Vietnam has decreased the CHE gap between urban and rural populations, China suffers from persistent disparities among population income levels and geographic location. CHE and CHE rates were still high in lower income groups. Conclusion Political commitment, sustainable financial sources and administrative capacity are strong driving factors in achieving UHC through health insurance reform. Health insurance schemes need to consider covering essential health services for all beneficiaries and providing government subsidies for vulnerable populations’ in order to help achieve health for all.

scholarly journals Making fair choices on the path to universal health coverage: a précis

2015 ◽  
Vol 11 (1) ◽  
pp. 71-77 ◽  
Author(s):  
Alex Voorhoeve ◽  
Trygve Ottersen ◽  
Ole F. Norheim
Keyword(s):  
Universal Health Coverage ◽  
World Health ◽  
Health Coverage ◽  
Ability To Pay ◽  
Trade Offs ◽  
The World ◽  
Extra Weight ◽  
Universal Health

AbstractWe outline key conclusions of the World Health Organisation's report 'Making Fair Choices on the Path to Universal Health Coverage (UHC)'. The Report argues that three principles should inform choices on the path to UHC: I. Coverage should be based on need, with extra weight given to the needs of the worse off; II. One aim should be to generate the greatest total improvement in health; III. Contributions should be based on ability to pay and not need. We describe how these principles determine which trade-offs are (un)acceptable. We also discuss which institutions contribute to fair and accountable choices.

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