scholarly journals Identifying the poor for premium exemption: a critical step towards universal health coverage in Sub-Saharan Africa

2017 ◽  
Vol 2 (1) ◽  
Author(s):  
Chukwuemeka A. Umeh
Keyword(s):  
Universal Health Coverage ◽  
Sub Saharan Africa ◽  
Health Coverage ◽  
Critical Step ◽  
The Poor ◽  
Sub Saharan ◽  
Universal Health

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 A Narrative Synthesis Review of Out-of-Pocket Payments for Health Services Under Insurance Regimes: A Policy Implementation Gap Hindering Universal Health Coverage in Sub-Saharan Africa

2021 ◽  
Author(s):  
Abigail Nyarko Codjoe Derkyi-Kwarteng ◽  
Irene Akua Agyepong ◽  
Nana Enyimayew ◽  
Lucy Gilson
Keyword(s):  
Policy Implementation ◽  
Universal Health Coverage ◽  
Health Sector ◽  
Sub Saharan Africa ◽  
Narrative Synthesis ◽  
Health Coverage ◽  
Implementation Gap ◽  
Street Level ◽  
Sub Saharan ◽  
Universal Health

Background: "Achieve universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all" is the Sustainable Development Goal (SDG) 3.8 target. Although most high-income countries have achieved or are very close to this target, low- and middle-income countries (LMICs) especially those in sub-Saharan Africa (SSA) are still struggling with its achievement. One of the observed challenges in SSA is that even where services are supposed to be "free" at point-of-use because they are covered by a health insurance scheme, out-of-pocket fees are sometimes being made by clients. This represents a policy implementation gap. This study sought to synthesise the known evidence from the published literature on the ‘what’ and ‘why’ of this policy implementation gap in SSA. Methods: The study drew on Lipsky’s street level bureaucracy (SLB) theory, the concept of practical norms, and Taryn Vian’s framework of corruption in the health sector to explore this policy implementation gap through a narrative synthesis review. The data from selected literature were extracted and synthesized iteratively using a thematic content analysis approach. Results: Insured clients paid out-of-pocket for a wide range of services covered by insurance policies. They made formal and informal cash and in-kind payments. The reasons for the payments were complex and multifactorial, potentially explained in many but not all instances, by coping strategies of street level bureaucrats to conflicting health sector policy objectives and resource constraints. In other instances, these payments appeared to be related to structural violence and the ‘corruption complex’ governed by practical norms. Conclusion: A continued top-down approach to health financing reforms and UHC policy is likely to face implementation gaps. It is important to explore bottom-up approaches – recognizing issues related to coping behaviour and practical norms in the face of unrealistic, conflicting policy dictates.

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 Risk for COVID-19 among Migrants from different areas of the World in Spain: A population-based cohort study in a country with universal health coverage

2020 ◽  
Author(s):  
Carlos Guijarro ◽  
Elia Pérez-Fernández ◽  
Beatriz González-Piñeiro ◽  
Victoria Meléndez ◽  
Maria José Goyanes ◽  
...  
Keyword(s):  
Latin America ◽  
Universal Health Coverage ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Health Coverage ◽  
Relative Risks ◽  
Increased Risk ◽  
The World ◽  
Sub Saharan ◽  
Universal Health

AbstractObjectiveTo evaluate the COVID-19 incidence among migrants from different areas of the world as compared to Spaniards living in AlcorcónDesignPopulation-based cohort analysis of the cumulative incidence of PCR-confirmed COVID-19 cases until April 25 (2020) among adult residents at Alcorcón (Spain) attended at the only public hospital serving this city. Crude incident rates for Spaniards and migrants from different areas of the world were estimated. Age and sex-adjusted relative risks for COVID19 were estimated by negative bomial regression.SettingUniversity public Hospital at Alcorcón, Madrid, SpainParticipantsAll adult residents living in Alcorcon classified by their country and region of the world of origin.Main outcomePCR confirmed COVID-19.ResultsPCR confirmed COVID-19 cumulative incidence was 6.81 cases per 1000 inhabitants among residents of Alcorcón. The crude incidence among migrants (n=20419) was higher than among Spaniards (n=131599): 8.81 and 6.51 and per 1000 inhabitants respectively (p<0.001).By regions of the world, crude cumulative COVID-19 incidence rates were: European Union 2.38, Asia 2.01,, Northern Africa 3.59, East ern Europe 4.37, Sub-Saharan Africa 11.24, Caribbean 18.26 and Latin-America 20.77 8 per 1000 inhabitants. Migrant residents were markedly younger than Spaniards (median age 52 vs 73 years, p<0.001). By negative binomial regression, adjusted for age and sex, relative risks (RR) for COVID-19 were not significantly different from Spaniards for individuals from Europe, Asia or Northern Africa. In contrast, there was an increased risk for Sub-Saharan Africa (RR 3.66, 95% confidence interval (CI) 1.42-9.41, p=0.007), Caribbean (RR 6.35, 95% CI 3.83-10.55, p<0.001) and Latin-America (RR 6.92, 95% CI 4.49-10.67, p <0.001).ConclusionsThere was a marked increased risk for COVID-19 among migrants from Sub-Saharan Africa, Caribbean and Latin-America residing in Spain. The reasons underlying this increased risk and health and social implications deserve further attention.What is known about the topicRecent reports suggest an increased burden of COVID-19 among migrants or ethnic minorities in the United Kingdom and the USA, particularly regarding mortality. Reports have failed to dissociate clinical outcomes from differences in access to medical care or pre-existing medical conditions. There is no information regarding COVID risk for latinos in countries with universal health coverageWhat this study addMigrants from subsaharian Africa resident in Spain exhibit an increased risk for COVID-19. This risk is further increased for migrants from the Caribbean and Latin-America and cannot be attributed to unequal access to medical care. Studies in countries with universal health coverage may help to dissociate COVID burden in migrants and ethnic populations from access to health care.

scholarly journals Strengthening eHealth Systems to Support Universal Health Coverage in sub-Saharan Africa

2021 ◽  
Vol 13 (3) ◽  
Author(s):  
Adebowale Ojo ◽  
Herman Tolentino ◽  
Steven Yoon
Keyword(s):  
Information And Communication Technologies ◽  
Universal Health Coverage ◽  
Healthcare Services ◽  
Sub Saharan Africa ◽  
Strategy Development ◽  
Health Coverage ◽  
Quality Healthcare ◽  
Information And Communication ◽  
Sub Saharan ◽  
Universal Health

The aim of universal health coverage (UHC) is to ensure that all individuals in a country have access to quality healthcare services and do not suffer financial hardship in using these services. However, progress toward attaining UHC has been slow, particularly in sub-Saharan Africa. The use of information and communication technologies for healthcare, known as eHealth, can facilitate access to quality healthcare at minimal cost. eHealth systems also provide the information needed to monitor progress toward UHC. However, in most countries, eHealth systems are sometimes non-functional and do not serve programmatic purposes. Therefore, it is crucial to implement strategies to strengthen eHealth systems to support UHC. This perspective piece proposes a conceptual framework for strengthening eHealth systems to attain UHC goals and to help guide UHC and eHealth strategy development.

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