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 Synergies and Fragmentation in Country Level Policy and Program Agenda Setting, Formulation and Implementation for Global Health Agendas: A Case Study of Health Security, Universal Health Coverage, and Health Promotion in Ghana and Sierra Leone

2020 ◽  
Author(s):  
Irene Akua Agyepong ◽  
Fredline A.O. M’Cormack-Hale ◽  
Hannah Brown-Amoakoh ◽  
Abigail N.C. Derkyi-Kwarteng ◽  
Theresa Ethel Darkwa ◽  
...  
Keyword(s):  
Health Promotion ◽  
Global Health ◽  
Sierra Leone ◽  
Agenda Setting ◽  
Structural Constraints ◽  
Health Coverage ◽  
Health Security ◽  
Country Level ◽  
Universal Health

Abstract Background: Global health agendas have in common the goal of contributing to population health outcome improvement. In theory therefore, whenever possible, country level policy and program agenda setting, formulation and implementation towards their attainment should be synergistic such that efforts towards one agenda promote efforts towards the other agendas. Observation suggests that this is not what happens in practice. Potential synergies are often unrealized and fragmentation is not uncommon. In this paper we present findings from an exploration of how and why synergies and fragmentation occur in country level policy and program agenda setting, formulation and implementation for the global health agendas of Universal Health Coverage (UHC), Health Security (HS) and Health Promotion (HP) in Ghana and Sierra Leone. Our study design was a two country case study. Data collection involved document reviews and Key Informant interviews with national and sub-national level decision makers in both countries between July and December 2019. Additionally, in Ghana a stakeholder workshop in December 2019 was used to validate the draft analysis and conclusions. This study is part of a series of country case studies to inform the Lancet Commission on synergies between UHC, HS and HP.Results: National and global context, country health systems leadership and structure including resources were drivers of synergies and fragmentation. How global as well as country level actors mobilized power and exercised agency in policy and program agenda setting and implementation processes within country were also important drivers. Conclusions: There is potential in both countries to pull towards synergies and push against fragmentation in agenda setting, formulation and implementation of global health agendas despite the resource and other structural constraints. It however requires political and bureaucratic prioritization of synergies, as well as skilled leadership. It also requires considerable mobilization of country level actor exercise of agency to counter sometimes daunting contextual, systems and structural constraints.

scholarly journals Synergies and fragmentation in country level policy and program agenda setting, formulation and implementation for Global Health agendas: a case study of health security, universal health coverage, and health promotion in Ghana and Sierra Leone

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Irene Akua Agyepong ◽  
Fredline A. O. M’Cormack-Hale ◽  
Hannah Brown Amoakoh ◽  
Abigail N. C. Derkyi-Kwarteng ◽  
Theresa Ethel Darkwa ◽  
...  
Keyword(s):  
Health Promotion ◽  
Global Health ◽  
Sierra Leone ◽  
Agenda Setting ◽  
Structural Constraints ◽  
Health Coverage ◽  
Health Security ◽  
Country Level ◽  
Universal Health

Abstract Background Global health agendas have in common the goal of contributing to population health outcome improvement. In theory therefore, whenever possible, country level policy and program agenda setting, formulation and implementation towards their attainment should be synergistic such that efforts towards one agenda promote efforts towards the other agendas. Observation suggests that this is not what happens in practice. Potential synergies are often unrealized and fragmentation is not uncommon. In this paper we present findings from an exploration of how and why synergies and fragmentation occur in country level policy and program agenda setting, formulation and implementation for the global health agendas of Universal Health Coverage (UHC), Health Security (HS) and Health Promotion (HP) in Ghana and Sierra Leone. Our study design was a two country case study. Data collection involved document reviews and Key Informant interviews with national and sub-national level decision makers in both countries between July and December 2019. Additionally, in Ghana a stakeholder workshop in December 2019 was used to validate the draft analysis and conclusions. Results National and global context, country health systems leadership and structure including resources were drivers of synergies and fragmentation. How global as well as country level actors mobilized power and exercised agency in policy and program agenda setting and implementation processes within country were also important drivers. Conclusions There is potential in both countries to pull towards synergies and push against fragmentation in agenda setting, formulation and implementation of global health agendas despite the resource and other structural constraints. It however requires political and bureaucratic prioritization of synergies, as well as skilled leadership. It also requires considerable mobilization of country level actor exercise of agency to counter sometimes daunting contextual, systems and structural constraints.

scholarly journals The impact of the fragile health system on the implementation of health policies in Yemen

2020 ◽  
Author(s):  
Taha Hussein ◽  
Fekri Dureab ◽  
Raof Al-Waziza ◽  
Hanan Noman ◽  
Lisa Hennig ◽  
...  
Keyword(s):  
Health Promotion ◽  
Health System ◽  
Universal Health Coverage ◽  
Peace Building ◽  
Health Policies ◽  
Health Coverage ◽  
Health Security ◽  
The Public ◽  
The Impact ◽  
Universal Health

The on-going humanitarian crisis in Yemen is one of the worst in the world, with more than14 million people in acute need. The conflict in Yemen deteriorated the already fragile health system and lead to the collapse of more than half of the health facilities. Health system fragmentation is also a problem in Yemen, which is complicated by the existence of two health ministries with different strategies. The aim of this study is to evaluate the effect of health system fragmentation on the implementation of health policies in Yemen across the global agendas of Universal Health Coverage (UHC), Health Security (GHS) and Health Promotion (HP) in the context of WHO priorities achieving universal health coverage, addressing health emergencies and promoting healthier populations. Methods The study is qualitative research using key informant in-depth interviews and documents analysis. Results There are many health stakeholders in Yemen, including the public, private, and NGO sectors - each with different priorities and interests, which did not always align with national policies and strategies. The WHO and Ministry of Public Health and Population (MoPHP) are the main supporters to implement all policies related to the UHC, GHS and HP agendas. Interestingly, initiatives initially pursuing a health security approach to control the cholera epidemic realigned with the UHC concept and moved from an initial focus on health security, to propose a minimum health service package, a classical UHC intervention. Overall, Universal Health Coverage is the most adapted agenda, health security agendas were highly disrupted due to conflicts and health staffs were caught unprepared for emerging outbreaks. The health promotion agenda was largely ignored. Conclusion Restoring peace, building on synergies between the three health agendas through joint planning between the MoPHP and other health actors are highly recommended.

scholarly journals De la salud pública a la Cobertura Universal de Salud: el caso argentino / From public health to Universal Health Coverage: the Argentinian case

2018 ◽  
pp. 39-53
Author(s):  
Pablo Sebastián Cejas Romanelli
Keyword(s):  
Public Health ◽  
Global Health ◽  
Health System ◽  
Universal Health Coverage ◽  
National Health System ◽  
International Health ◽  
World Health ◽  
Health Coverage ◽  
Health Organization ◽  
Universal Health

La salud pública es un concepto dinámico que obligó a los operadores sanitarios a pensar en estrategias de promoción y protección de la salud humana. Con el paso del tiempo, dicho concepto evolucionó hacia el de salud internacional, y este último, al de salud global en un contexto de globalización. La Organización Mundial de la Salud (OMS) se perfiló como el ente destinado a instrumentar las políticas de salud global. En tal sentido la Cobertura Universal de Salud surgió como el resultado de la política de dicha organización que no estuvo exenta de presiones y controles de organismos no estatales. La República Argentina incorporó al sistema de salud nacional, la Cobertura Universal de Salud que, tal como se verificó en la normativa internacional que le dio nacimiento, la prioridad está puesta en la salud financiera del sistema sanitario antes que en el derecho a la salud. Public health is a dynamic concept that forced healthcare operators to think about strategies for the promotion and protection of human health. With the passage of time, this concept evolved towards international health, and the latter, to global health in a context of globalization. The World Health Organization (WHO) emerged as the entity destined to implement global health policies. In this regard, the Universal Health Coverage emerged as the result of the policy of this organization that was not exempt from pressures and controls by non-state organizations. The Argentine Republic incorporated into the national health system, the Universal Health Coverage that, as verified in the international regulations that gave birth to it, the priority is placed on the financial health of the health system rather than on the right to health.

scholarly journals Community participation and private sector engagement are fundamental to achieving universal health coverage and health security in Africa: reflections from the second Africa health forum

2019 ◽  
Vol 13 (S9) ◽  
Author(s):  
Olushayo Olu ◽  
Pamela Drameh-Avognon ◽  
Emil Asamoah-Odei ◽  
Francis Kasolo ◽  
Thomas Valdez ◽  
...  
Keyword(s):  
Public Health ◽  
Private Sector ◽  
World Health Organization ◽  
Universal Health Coverage ◽  
World Health ◽  
Health Coverage ◽  
Health Security ◽  
Cabo Verde ◽  
Health Organization ◽  
Universal Health

Abstract Background Inadequate access to quality health care services due to weak health systems and recurrent public health emergencies are impediments to the attainment of Universal Health Coverage and health security in Africa. To discuss these challenges and deliberate on plausible solutions, the World Health Organization Regional Office for Africa, in collaboration with the Government of Cabo Verde, convened the second Africa Health Forum in Praia, Cabo Verde on 26–28 March 2019, under the theme Achieving Universal Health Coverage and Health Security: The Africa We Want to See. Methods The Forum was conducted through technical sessions consisting of high-level, moderated panel discussions on specific themes, some of them preceded by keynote addresses. There were booth exhibitions by Member States, World Health Organization and other organizations to facilitate information exchanges. A Communiqué highlighting the recommendations of the Forum was issued during the closing ceremony. More than 750 participants attended. Relevant information from the report of the Forum and notes by the authors were extracted and synthesized into these proceedings. Conclusions The Forum participants agreed that the role of community engagement and participation in the attainment of Universal Health Coverage, health security and ultimately the Sustainable Development Goals cannot be overemphasized. The public sector of Africa alone cannot achieve these three interrelated goals; other partners, such as the private sector, must be engaged. Technological innovations will be a key driver of the attainment of these goals; hence, there is need to harness the comparative advantages that they offer. Attainment of the three goals is also intertwined – achieving one paves the way for achieving the others. Thus, there is need for integrated public health approaches in the planning and implementation of interventions aimed at achieving them. Recommendations To ensure that the recommendations of this Forum are translated into concrete actions in a sustainable manner, we call on African Ministers of Health to ensure their integration into national health sector policies and strategic documents and to provide the necessary leadership required for their implementation. We also call on partners to mainstream these recommendations into their ongoing support to World Health Organization African Member States.

scholarly journals Fragmented health systems in COVID-19: rectifying the misalignment between global health security and universal health coverage

The Lancet ◽  
2021 ◽  
Vol 397 (10268) ◽  
pp. 61-67
Author(s):  
Arush Lal ◽  
Ngozi A Erondu ◽  
David L Heymann ◽  
Githinji Gitahi ◽  
Robert Yates
Keyword(s):  
Global Health ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Global Health Security ◽  
Health Security ◽  
Universal Health

scholarly journals Universal Health Coverage Development in Thailand: How Global Ideas and a National Medical Professional Movement Made a Difference

2021 ◽  
Author(s):  
Rangsan Sukhampha
Keyword(s):  
Developing Countries ◽  
Global Health ◽  
Health System ◽  
National Health ◽  
Universal Health Coverage ◽  
Medical Professional ◽  
System Reform ◽  
Health Coverage ◽  
Health System Reform ◽  
Universal Health

Abstract Background: Universal health coverage is endorsed as the global development agenda in the 2015 SDGs for global achievement by 2030 and is expected to build national policymaking agendas. Common research often focuses on national processes in the first place. For example, accounts of Thailand's health system development mostly emphasise domestic factors and influences rather than the linkage of external/global health ideas. The paper questions how external/global health ideas influence national health policymaking and the linkage between them in achieving Thailand's universal health coverage policy.Methods: A qualitative method was employed to capture complex and historical narratives of the national medical professional movement for Thailand's health system reform through the lens of a global social policy approach for exploring external and global health ideas transfer. Moreover, the actor- and policy entrepreneur approaches would be employed to investigate national health policymaking and examine how ideas from the external and global levels have improved national equity in health. Results: The research locates the narratives on global ideas and practices that influence a national health system reform. This highlights the impact/role of global ideas on national professional movements, i.e. the rural doctor movement in Thailand mobilising the health system reform for all. The study found that national equity in health could not be achieved without external/global health ideas transfer. Such a case of national universal health coverage achievement in Thailand happened with the effort of the rural doctor movement and individual agency as policy entrepreneurs in translating external/global ideas and practices for their movement and mobilisation. The case contributed to a better understanding of the global process regarding ideas and practices that can be transferred directly and indirectly to the national level. Conclusions: Global ideas transfer can also happen in different aspects such as it can be seen the ideas transfer from developed to developed countries; from developed to developing countries. Besides, the author witnessed that the IOs ideas can also be transferred to developing countries or reverse, and again, between developing countries themselves.

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