scholarly journals Social exclusion and universal health coverage: health care rights and citizen-led accountability in Guatemala and Peru

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Jeannie Samuel ◽  
Walter Flores ◽  
Ariel Frisancho
Keyword(s):  
Health Care ◽  
Social Exclusion ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Health Care Services ◽  
Health Coverage ◽  
Care Services ◽  
Socially Excluded ◽  
Accountability Initiatives ◽  
Universal Health

Abstract Background While equity is a central concern in promoting Universal Health Coverage (UHC), the impact of social exclusion on equity in UHC remains underexplored. This paper examines challenges faced by socially excluded populations, with an emphasis on Indigenous peoples, to receive UHC in Latin America. We argue that social exclusion can have negative effects on health systems and can undermine progress towards UHC. We examine two case studies, one in Guatemala and one in Peru, involving citizen-led accountability initiatives that aim to identify and address problems with health care services for socially excluded groups. The case studies reveal how social exclusion can affect equity in UHC. Methods In-depth analysis was conducted of all peer reviewed articles published between 2015 and 2019 on the two cases (11 in total), and two non-peer reviewed reports published over the same period. In addition, two of the three authors contributed their first-hand knowledge gathered through practitioner involvement with the citizen-led initiatives examined in the two cases. The analysis sought to identify and compare challenges faced by socially excluded Indigenous populations to receive UHC in the two cases. Results Citizen-led accountability initiatives in Guatemala and Peru reveal very similar patterns of serious deficiencies that undermine efforts towards the realization of Universal Health Coverage in both countries. In each case, the socially excluded populations are served by a dysfunctional publicly provided health system marked by gaps and often invisible barriers. The cases suggest that, while funding and social rights to coverage have expanded, marginalized populations in Guatemala and Peru still do not receive either the health care services or the protection against financial hardship promised by health systems in each country. In both cases, the dysfunctional character of the system remains in place, undermining progress towards UHC. Conclusions We conclude that efforts to promote UHC cannot stop at increasing health systems financing. In addition, these efforts need to contend with the deeper challenges of democratizing state institutions, including health systems, involved in marginalizing and excluding certain population groups. This includes stronger accountability systems within public institutions. More inclusive accountability mechanisms are an important step in promoting equitable progress towards UHC.

scholarly journals Roles and reimbursement of pharmacists as South Africa transitions towards Universal Health Coverage (UHC): An online survey-based study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257348
Author(s):  
Vivian Naidoo ◽  
Fatima Suleman ◽  
Varsha Bangalee
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Universal Health Coverage ◽  
Health Care Services ◽  
Online Survey ◽  
Health Coverage ◽  
Care Services ◽  
Primary Health ◽  
Comprehensive Service ◽  
Universal Health

Background The implementation of Universal Health Coverage in SA has sought to focus on promoting affordable health care services that are accessible to all citizens. In this regard, pharmacists are expected to play a pivotal function in the revitalization of primary health care (PHC) during this transition by the expansion of their practice roles. Objectives To assess the readiness and perceptions of pharmacists to expand their roles in an integrated health care system. To determine the availability and pricing of primary health care services currently provided within a community pharmacy environment and to evaluate suitable reimbursement for the provision of such services by a community pharmacist. Methods Community pharmacists’ across SA were invited to participate in an online survey-based study. The survey consisted of both open- and closed-ended questions. Descriptive statistics for closed-ended questions were generated and analysed using Microsoft Excel® and Survey Monkey®. Responses for the open-ended questions were transcribed, analysed, and reported as emerging themes. Results Six hundred and sixty-four pharmacists’ responded to the online survey. Seventy-five percent of pharmacists’ reported that with appropriate training, a transition into a more patient-centered role might be beneficial in the re-engineering of the PHC system. However, in order to adopt these new roles, appropriate reimbursement structures are required. The current fee levied by pharmacists in community pharmacies that offered these PHC services was found to be lower to that recommended by the South African Pharmacy Council; this disparity is primarily due to a lack of information and policy standardisation. Therefore, in order to ensure that fees levied are fair, comprehensive service package guidelines are required. Conclusions This study provides baseline data for policy makers on pharmacists’ readiness to transition into expanded roles. Furthermore, it can be used as a foundation to establish appropriate reimbursement frameworks for pharmacists providing PHC services.

scholarly journals In Madagascar, Use Of Health Care Services Increased When Fees Were Removed: Lessons For Universal Health Coverage

2017 ◽  
Vol 36 (8) ◽  
pp. 1443-1451 ◽  
Author(s):  
Andres Garchitorena ◽  
Ann C. Miller ◽  
Laura F. Cordier ◽  
Ranto Ramananjato ◽  
Victor R. Rabeza ◽  
...  
Keyword(s):  
Health Care ◽  
Universal Health Coverage ◽  
Health Care Services ◽  
Health Coverage ◽  
Care Services ◽  
Universal Health ◽  
Use Of Health Care

scholarly journals Multi-criteria decision analysis as a tool for evaluation of unmet needs in health care

2018 ◽  
Vol 51 ◽  
pp. 02001
Author(s):  
Diana Araja
Keyword(s):  
Health Care ◽  
Decision Analysis ◽  
Universal Health Coverage ◽  
Health Care Services ◽  
Unmet Needs ◽  
Health Coverage ◽  
Medical Needs ◽  
Care Services ◽  
Unmet Medical Needs ◽  
Universal Health

The United Nations Sustainable Development Goals appoint that all Member States have agreed to try to achieve Universal Health Coverage by 2030. This includes financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines for all. The World Health Organisation has defined the Universal Health Coverage as a priority, which means that all people can use the preventive, curative, rehabilitative and palliative health care services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. The classic approach of the unmet medical needs is defined as the total self-reported unmet needs for medical care for the following three reasons: financial barriers, waiting times, too far to travel. According to the Eurostat data, overall range of unmet medical needs in Latvia is the highest of the European Union countries, however, the accessibility of health services depends on a multitude of factors that relate to the health system and also to the patients themselves. Therefore the Multi-criteria decision analysis approach could be acceptable for assessment of the unmet medical needs. The data on unmet medical needs for Latvia should be additionally evaluated, taking into account the “therapeutic need”, which refers to the need for a better treatment than the treatment currently reimbursed, from the perspective of the patient. Apart from therapeutic need, the concept of societal need should be investigated, which refers to the need for a better treatment than the currently available treatment for societal reasons.

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 Assessing health services accessibility in Colombia: Beyond universal health coverage

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Arrivillaga
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Care Services ◽  
Right To Health ◽  
Primary Data ◽  
Pilot Test ◽  
Health Coverage ◽  
Human Right ◽  
Care Services ◽  
Universal Health

Abstract Background Colombia has an insurance-based, private and public health care system, with the intermediation of health insurance agencies that control the resources. At present, the Universal Health Coverage (UHC) is around 97%. However, there is wide scientific evidence that criticizes the structure and operation of the system due to the persistent differences between the UHC indicator and real accessibility to health services. This study aimed to analyze the concept of accessibility of health services in order to design and validate alternatives instruments for its assessment beyond UHC. Methods A mixed methods approach with concurrent design in three phases was conducted between 2014 and 2017: 1) systematic review of literature and documentary research; 2) design, content validation with experts and pilot test of instruments to assess health care accessibility and 3) definition of a route to assess accessibility. Results The reviewed literature revealed five conceptual logics to define accessibility: decent minimum of health care, health care market, factors and multicausality, needs and, social justice and human right to health. A Household Survey on Accessibility to Health Care Services and a Health Care Services Availability Questionnaire was designed and validated with experts and pilot test in representative samples of households and care centers in three cities in Colombia was conducted. Those instruments were designed under the conceptual logic of human right to health. Finally, an alternative route to assess accessibility in Colombia was proposed. Conclusions The route for assessing accessibility with primary data, territorial approach and without intermediation of health insurance agencies allow obtaining an overview of the real situation beyond the UHC indicator. The instruments included in this assessing process can be useful to monitor progress in guaranteeing the human right to health, declared in Colombia and other countries. Key messages The UHC indicator is not enough to assess real accessibility to health services. This study presents an alternative route and two validated instruments for its assessment with primary data and territory-based approach, applicable to countries with public-private health systems.

Universal Health Coverage for Undocumented Migrants. The Spanish Case

2018 ◽  
Vol 25 (2) ◽  
pp. 283-299
Author(s):  
María Dalli
Keyword(s):  
Health Care ◽  
Universal Health Coverage ◽  
Access To Health Care ◽  
Health Care Services ◽  
Universal Coverage ◽  
Right To Health ◽  
Undocumented Migrants ◽  
Health Coverage ◽  
The Right ◽  
Universal Health

Implementation of the universal right to health, along with the UN’s goal to achieve universal health coverage (UHC), face common challenges to ensuring universal health care entitlement. One of these difficulties is health care restrictions for undocumented migrants. A recent example is the Spanish health care regulation that places universal coverage at risk by restricting access to it by this group. The work herein examines the right to health and UHC’s regulations with the aim of determining if access to health care services for undocumented migrants is indeed recognized and if this recognition could therefore be valid to limit those kinds of measures. The UHC proposal does not sufficiently deal with this problem. Regarding the right to health, even though there are some limitations within international human rights laws regarding protection for this group, it can be concluded that the right to health is also applicable to undocumented migrants.

21.G. Round table: Strengthening national level health systems governance

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health Care ◽  
Health System ◽  
Eastern Europe ◽  
Health Systems ◽  
Universal Health Coverage ◽  
National Level ◽  
Health Coverage ◽  
Policy Makers ◽  
Universal Health ◽  
Health Systems Governance

Abstract Very often, important health system reforms are delayed, rendered ineffective or they simply go badly wrong. All too often this happens not because of a lack of money, health workers or health care facilities but because we adopt unfit ideas and decision and/or implement them insufficiently. The incapacity to develop, adopt and implement good decision is quintessentially the definition of bad governance. If we are to develop our health systems towards Universal Health Coverage and health systems performance improvement, we will need to strengthen our health system governance. Governance is vitally important to health systems reform and refers to how decisions are made and implemented - everything from the ability of policy-makers to take evidence-based and relevant decisions to their ability to implement policies and create alignment between different actors. In this workshop we will share experiences from a governance spring course for policy makers from Eastern Europe and Central Asia. Connected to this we will also share preliminary results of a study on National Level Health Systems Governance. The panelists will address five key issues The contribution of governance to Universal Health Coverage. This contribution will focus on a) the concept of governance defined as the way societies make and implement collective decisions and b) its 5 main domains including transparency, accountability, participation, integrity and capacity. (S Greer)Governance improvement needs in Eastern Europe and Central Asia: experiences from working with policy makers including countries like Azerbaijan, Georgia, Kyrgyzstan, Moldova Tajikistan, Ukraine and Uzbekistan. For purpose of peer-learning and contrasting experiences we have paired these countries with policy makers from Austria, Finland and Ireland (G Pastorino)Stakeholder participation in decision making and implementation: Very often, powerful stakeholders, like the medical profession, is over-represented and exerts immense veto power, while the voice of other professions, patients, and citizens remained unheard. What are the governance strategies and instruments to harness those underrepresented stakeholders for Universal Health Coverage? (G Fattore)Governing centralized and decentralized budgets in primary, social and hospital care: population-based health care in larger countries requires decentralization of part of the health care budget. What are the accountability lines and instruments that ensure that regional and local budget holders aligning with national policies for Universal Health Coverage? (L Hawkins)Governance contribution addressing corruption: According to surveys health systems are perceived prone to corruption. What is the contribution of governance to heal corruption and make the system work according to rules? (D Clarke) Key messages If we are to make progress towards Universal Health Coverage, we will need to strengthen health systems governance. Without strengthening health systems governance we will fail to manage stakeholders, budgets and corruption.

scholarly journals Universal Health Coverage

2020 ◽  
Vol 7 (4) ◽  
pp. p14
Author(s):  
Alfred A. Osoro ◽  
Edwine B. Atitwa ◽  
John K. Moturi
Keyword(s):  
Health Care ◽  
Human Resources ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Political Commitment ◽  
Equipment And Supplies ◽  
Health Technologies ◽  
Financial Allocation ◽  
Universal Health

Universal Health Coverage has attracted global attention as an ideal vehicle that will drive health care services to the individuals, families, and communities globally. Good health systems are capable of serving the needs of entire populations, including the availability of infrastructure, human resources, health technologies, and medicines. This study seeks to identify the barriers and challenges which have hindered the provision of basic health care to communities and suggest ways of addressing some of them. Literature search reviewed 40 materials which were more relevant. Results revealed that there have been disparities in the provision of healthcare. Challenges in service provision include; lack of political commitment, weak health system resulting from limited financial allocation and poor leadership, lack of adequate number of skilled human resources, equipment and supplies and poor infrastructures. For UHC to be successful, an effective and well-functioning Primary Health Care (PHC) system is essential. Thus health systems can be strengthened through financial allocation; training of skilled and well-motivated healthcare workers. Also provision of right equipment and supplies, equity in resource distribution, improvement of infrastructures to meet the needs of the people is fundamental.

scholarly journals Socio-economic inequality and inequity in use of health care services in Kenya: evidence from the fourth Kenya household health expenditure and utilization survey

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Stefania Ilinca ◽  
Laura Di Giorgio ◽  
Paola Salari ◽  
Jane Chuma
Keyword(s):  
Health Care ◽  
Universal Health Coverage ◽  
Inpatient Care ◽  
Educational Achievement ◽  
Economic Inequality ◽  
Living Standards ◽  
Care Utilization ◽  
Health Coverage ◽  
Care Services ◽  
Universal Health

Abstract Background Kenya is experiencing persistently high levels of inequity in health and access to care services. In 2018, decades of sustained policy efforts to promote equitable, affordable and quality health services have culminated in the launch of a universal health coverage scheme, initially piloted in four Kenyan counties and planned for national rollout by 2022. Our study aims to contribute to monitoring and evaluation efforts alongside policy implementation, by establishing a detailed, baseline assessment of socio-economic inequality and inequity in health care utilization in Kenya shortly before the policy launch. Methods We use concentration curves and corrected concentration indexes to measure socio-economic inequality in care use and the horizontal inequity index as a measure of inequity in care utilization for three types of care services: outpatient care, inpatient care and preventive and promotive care. Further insights into the individual and household level characteristics that determine observed inequality are derived through decomposition analysis. Results We find significant inequality and inequity in the use of all types of care services favouring richer population groups, with particularly pronounced levels for preventive and inpatient care services. These are driven primarily by differences in living standards and educational achievement, while the region of residence is a key driver for inequality in preventive care use only. Pro-rich inequalities are particularly pronounced for care provided in privately owned facilities, while public providers serve a much larger share of individuals from lower socio-economic groups. Conclusions Through its focus on increasing affordability of care for all Kenyans, the newly launched universal health coverage scheme represents a crucial step towards reducing disparities in health care utilization. However in order to achieve equity in health and access to care such efforts must be paralleled by multi-sectoral approaches to address all key drivers of inequity: persistent poverty, disparities in living standards and educational achievement, as well as regional differences in availability and accessibility of care.

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