A review of prospective pathways and impacts of COVID-19 on the accessibility, safety, quality, and affordability of essential medicines and vaccines for universal health coverage in Africa

Abstract Background The ongoing pandemic of coronavirus disease 2019 (COVID-19) has the potential to reverse progress towards global targets. This study examines the risks that the COVID-19 pandemic poses to equitable access to essential medicines and vaccines (EMV) for universal health coverage in Africa. Methods We searched medical databases and grey literature up to 2 October 2020 for studies reporting data on prospective pathways and innovative strategies relevant for the assessment and management of the emerging risks in accessibility, safety, quality, and affordability of EMV in the context of the COVID-19 pandemic. We used the resulting pool of evidence to support our analysis and to draw policy recommendations to mitigate the emerging risks and improve preparedness for future crises. Results Of the 310 records screened, 134 were included in the analysis. We found that the disruption of the international system affects more immediately the capability of low- and middle-income countries to acquire the basket of EMV. The COVID-19 pandemic may facilitate dishonesty and fraud, increasing the propensity of patients to take substandard and falsified drugs. Strategic regional cooperation in the form of joint tenders and contract awarding, joint price negotiation and supplier selection, as well as joint market research, monitoring, and evaluation could improve the supply, affordability, quality, and safety of EMV. Sustainable health financing along with international technology transfer and substantial investment in research and development are needed to minimize the vulnerability of African countries arising from their dependence on imported EMV. To ensure equitable access, community-based strategies such as mobile clinics as well as fees exemptions for vulnerable and under-served segments of society might need to be considered. Strategies such as task delegation and telephone triage could help reduce physician workload. This coupled with payments of risk allowance to frontline healthcare workers and health-literate healthcare organization might improve the appropriate use of EMV. Conclusions Innovative and sustainable strategies informed by comparative risk assessment are increasingly needed to ensure that local economic, social, demographic, and epidemiological risks and potentials are accounted for in the national COVID-19 responses.

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COMMUNITY PHARMACY ROLE IN UNIVERSAL HEALTH COVERAGE IN MOMBASA COUNTY

EPRA International Journal of Multidisciplinary Research (IJMR) ◽

10.36713/epra5722 ◽

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

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The Legal Determinants of Health: How Can We Achieve Universal Health Coverage and What Does it Mean?

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.64 ◽

2020 ◽

Author(s):

Lawrence O. Gostin

Keyword(s):

Public Health ◽

Global Health ◽

Social Determinants ◽

Universal Health Coverage ◽

Good Health ◽

Essential Medicines ◽

Health Coverage ◽

Public Health Services ◽

The Right ◽

Universal Health

How can we keep people – wherever they live – healthy and safe? Among all global health initiatives, universal health coverage (UHC) has garnered most political attention. But can UHC (as important as it is) actually achieve the two fundamental aspirations of the right to health: keeping people healthy and safe, while leaving no one behind? There is a universal longing for health and security, but also a deep-seated belief in fairness and equity. Can UHC achieve both health and equity, or what I have called, "global health with justice?" What makes a population healthy and safe? Certainly, universal and affordable access to healthcare is essential, including clinical prevention, treatment, and essential medicines. But beyond medical care are public health services, including surveillance, clean air, potable water, sanitation, vector control, and tobacco control. The final and most important factor in good health are social determinants, including housing, employment, education, and equity. If we can provide everyone with these three essential conditions for good health (healthcare, public health and social determinants), it would vastly improve global health. But we also need to take measures to leave no one behind. To achieve equity, we need to plan for it, and here I propose national health equity programs of action. Society’s highest obligation is to achieve global health, with justice.

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Essential medicines for universal health coverage

The Lancet ◽

10.1016/s0140-6736(16)31599-9 ◽

2017 ◽

Vol 389 (10067) ◽

pp. 403-476 ◽

Cited By ~ 169

Author(s):

Veronika J Wirtz ◽

Hans V Hogerzeil ◽

Andrew L Gray ◽

Maryam Bigdeli ◽

Cornelis P de Joncheere ◽

...

Keyword(s):

Universal Health Coverage ◽

Essential Medicines ◽

Health Coverage ◽

Universal Health

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Implementing health technology assessment in Ghana to support universal health coverage: building relationships that focus on people, policy, and process

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462319000795 ◽

2019 ◽

Vol 36 (1) ◽

pp. 8-11 ◽

Cited By ~ 5

Author(s):

Samantha Hollingworth ◽

Martha Gyansa-Lutterodt ◽

Lydia Dsane-Selby ◽

Justice Nonvignon ◽

Ruth Lopert ◽

...

Keyword(s):

Resource Allocation ◽

Health Technology Assessment ◽

Universal Health Coverage ◽

Technology Assessment ◽

Health Technology ◽

Health Coverage ◽

African Countries ◽

Allocation Decisions ◽

Universal Health ◽

Resource Allocation Decisions

AbstractGhana is one of the few African countries to enact legislation and earmark significant funding to establish universal health coverage (UHC) through the National Health Insurance Scheme, although donor funds have declined recently. Given a disproportionate level of spending on medicines, health technology assessment (HTA) can support resource allocation decisions in the face of highly constrained budgets, as commonly found in low-resource settings. The Ghanaian Ministry of Health, supported by the International Decision Support Initiative (iDSI), initiated a HTA study in 2016 to examine the cost-effectiveness of antihypertensive medicines. We aimed to summarize key insights from this work that highlights success factors beyond producing purely technical outputs. These include the need for capacity building, academic collaboration, and ongoing partnerships with a broad range of experts and stakeholders. By building on this HTA study, and with ongoing interactions with iDSI, HTAi, WHO, and others, Ghana will be well positioned to institutionalize HTA in resource allocation decisions and support progress toward UHC.

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Essential medicines for universal health coverage – Authors' reply

The Lancet ◽

10.1016/s0140-6736(17)31209-6 ◽

2017 ◽

Vol 389 (10082) ◽

pp. 1881-1882 ◽

Cited By ~ 2

Author(s):

Veronika J Wirtz ◽

Hans V Hogerzeil ◽

Andrew L Gray

Keyword(s):

Universal Health Coverage ◽

Essential Medicines ◽

Health Coverage ◽

Universal Health

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Health labour market policies in support of universal health coverage: a comprehensive analysis in four African countries

Human Resources for Health ◽

10.1186/1478-4491-12-55 ◽

2014 ◽

Vol 12 (1) ◽

Cited By ~ 5

Author(s):

Angelica Sousa ◽

Richard M Scheffler ◽

Grayson Koyi ◽

Symplice Ngah Ngah ◽

Ayat Abu-Agla ◽

...

Keyword(s):

Labour Market ◽

Universal Health Coverage ◽

Comprehensive Analysis ◽

Health Coverage ◽

African Countries ◽

Labour Market Policies ◽

Health Labour Market ◽

Universal Health

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Pooling arrangements in health financing systems: a proposed classification

International Journal for Equity in Health ◽

10.1186/s12939-019-1088-x ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Inke Mathauer ◽

Priyanka Saksena ◽

Joe Kutzin

Keyword(s):

Health Insurance ◽

Universal Health Coverage ◽

Grey Literature ◽

Health Spending ◽

Health Financing ◽

Policy Instrument ◽

Health Coverage ◽

Voluntary Health Insurance ◽

Financing Policies ◽

Universal Health

Abstract Objectives The function of pooling and the ways that countries organize this is critical for countries’ progress towards universal health coverage, but its potential as a policy instrument has not received much attention. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. Methods The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Findings We propose eight broad types of pooling arrangements: (1.) a single pool; (2.) territorially distinct pools; (3.) territorially overlapping pools in terms of service and population coverage; (4.) different pools for different socio-economic groups with population segmentation; (5.) different pools for different population groups, with explicit coverage for all; (6.) multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6.), (7.) fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) complementary or supplementary voluntary health insurance. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. Conclusion Pooling arrangements set the potential for redistributive health spending. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover.

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How is equity approached in universal health coverage? An analysis of global and country policy documents in Benin and Senegal

International Journal for Equity in Health ◽

10.1186/s12939-019-1089-9 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 3

Author(s):

Elisabeth Paul ◽

Céline Deville ◽

Oriane Bodson ◽

N’koué Emmanuel Sambiéni ◽

Ibrahima Thiam ◽

...

Keyword(s):

Universal Health Coverage ◽

Health Coverage ◽

African Countries ◽

Policy Documents ◽

Guiding Principle ◽

Country Level ◽

Gender Based ◽

And Gender ◽

Universal Health ◽

Country Specific

Abstract Background Equity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it. We explore how the multidimensional concept of equity has been approached in key global UHC policy documents, as well as in country-level UHC policies. Methods We analysed a purposeful sample of UHC reports and policy documents both at global level and in two Western African countries (Benin and Senegal). We manually searched each document for its use and discussion of equity and related terms. The content was summarised and thematically analysed, in order to comprehend how these concepts were understood in the documents. We distinguished between the level at which inequity takes place and the origin or types of inequities. Results Most of the documents analysed do not define equity in the first place, and speak about “health inequities” in the broad sense, without mentioning the dimension or type of inequity considered. Some dimensions of equity are ambiguous – especially coverage and financing. Many documents assimilate equity to an overall objective or guiding principle closely associated to UHC. The concept of equity is also often linked to other concepts and values (social justice, inclusion, solidarity, human rights – but also to efficiency and sustainability). Regarding the levels of equity most often considered, access (availability, coverage, provision) is the most often quoted dimension, followed by financial protection. Regarding the types of equity considered, those most referred to are socio-economic, geographic, and gender-based disparities. In Benin and Senegal, geographic inequities are mostly pinpointed by UHC policy documents, but concrete interventions mostly target the poor. Overall, the UHC policy of both countries are quite similar in terms of their approach to equity. Conclusions While equity is widely referred to in global and country-specific UHC policy documents, its multiple dimensions results in a rather rhetorical utilisation of the concept. Whereas equity covers various levels and types, many global UHC documents fail to define it properly and to comprehend the breadth of the concept. Consequently, perhaps, country-specific policy documents also use equity as a rhetoric principle, without sufficient consideration for concrete ways for implementation.

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