scholarly journals Assessing the Efficiency of Iran Health System in Making Progress Towards Universal Health Coverage: A Comparative Panel Data Analysis

2020 ◽  
Author(s):  
Haniye Sadat Sajadi ◽  
Zahra Goodarzi ◽  
Amirhossein Takian ◽  
Efat Mohamadi ◽  
Alireza Olyaeemanesh ◽  
...  
Keyword(s):  
Panel Data ◽  
Health System ◽  
Universal Health Coverage ◽  
Health Expenditure ◽  
Malmquist Productivity Index ◽  
Health Coverage ◽  
System Efficiency ◽  
Per Capita ◽  
Health System Efficiency ◽  
Universal Health

Abstract Background: Building upon decades of continuous reforms, Iran has been implementing various initiatives to reach universal health coverage (UHC). Improving efficiency is a crucial intermediate policy objective for UHC. Therefore, this article aimed to measure the efficiency and productivity changes of the Iranian health system in making progress towards UHC during 2010-2015 in comparison with 36 selected other upper-middle-income countries.Methods: We used panel data to measure the variations in technical efficiency (TE) and total factor productivity (TFP) through an extended data envelopment analysis (EDEA) and Malmquist productivity index, respectively. General Government Health Expenditure (GGHE) per capita (International dollar) was selected as the input variable. Service coverage of diphtheria, tetanus and pertussis; family planning; antiretroviral therapy; skilled attendants at birth; Tuberculosis treatment success rate; and GGHE as % of Total Health Expenditure (THE) were considered as output variables. The data for each indicator were taken from the Global Health Observatory data repository and World Development Indicator database, for six years (2010-2015). Results: The TE scores of Iran’s health system were 0.75, 0.77, 0.74, 0.74, 0.97, and 0.84 in the period 2010-2015, respectively. TFP improved in 2011 (1.02), 2013 (1.01), and 2014 (1.30, generally). The overall efficiency and TFP increased in 2014. Changes made in CCHE per capita and GGHE/THE attributed to the increase of efficiency. Conclusion: There is a growing demand for efficiency improvements in the health systems to achieve UHC. While there are no defined set of indicators or precise methods to measure health system efficiency, EDEA helped us to draw the picture of health system efficiency in Iran. Our findings highlighted the essential need for targeted and sustained interventions, i.e., allocation of enough proportion of public funds to the health sector, to improve universal financial coverage against health costs aiming to enhance the future performance of Iran’s health system, ultimately. Such tailored interventions may also be useful for settings with similar context to speed up their movement towards improving efficiency, which in turn might lead to more resources to reach UHC. Trial registration: NA

scholarly journals Title of Manuscript: Health System Performance Towards Universal Health Coverage in Iran: A Comparative Panel Data Analysis

2020 ◽  
Author(s):  
Haniye Sadat Sajadi ◽  
Zahra Goudarzi ◽  
Amirhossein Takian ◽  
Efat Mohamadi ◽  
Alireza Olyaeemanesh ◽  
...  
Keyword(s):  
Panel Data ◽  
Health System ◽  
Universal Health Coverage ◽  
Health Expenditure ◽  
Malmquist Productivity Index ◽  
Productivity Index ◽  
Health Coverage ◽  
System Efficiency ◽  
Per Capita ◽  
Universal Health

Abstract Background Building upon decades of continuous reforms, since 2014 under the banner of health transformation plan (HTP), Iran has been implementing various initiatives to strengthen its health system. Improving efficiency of the health system is fundamental to achieve better performance and reach universal health coverage (UHC). This article aimed to measure the efficiency and productivity changes in the Iranian health system during 2010-2015 in comparison with 36 selected other upper-middle income countries. Methods We used panel data to measure the variations in technical efficiency (TE) and total factor productivity (TFP) through an extended data envelopment analysis (EDEA) and Malmquist productivity index, respectively. General Government Health Expenditure (GGHE) per capita (International dollar) was selected as input variable. Service coverage of diphtheria, tetanus and pertussis; family planning; antiretroviral therapy; skilled attendants at birth; Tuberculosis treatment success rate; and GGHE as % of Total Health Expenditure (THE) were considered as output variables. The data for each indicator were taken from Global Health Observatory data repository and World Development Indicator database, for a period of six years (2010-2015). Results The TE scores of Iran’s health system were 0.75, 0.77, 0.74, 0.74, 0.97 and 0.84 in the period 2010-2015, respectively. TFP improved in 2011 (1.02), 2013 (1.01), and 2014 (1.30, generally). The overall efficiency and TFP increased in 2014. Changes made in CCHE per capita and GGHE/THE attributed to the increase of efficiency. ConclusionThere is a growing demand for efficiency improvements in the health systems to achieve UHC. While there are no defined set of indicators or precise methods to measure heath system efficiency, EDEA helped us to draw the picture of health system efficiency in Iran. Our findings also highlighted the essential need for targeted and sustained interventions, i.e. allocation of enough proportion of public funds to the health sector, to improve universal financial coverage against health costs aiming to enhance the future performance of Iran’s health system, ultimately. Such tailored interventions may be also useful for settings with similar context to speed up their movement towards improving efficiency, which in turn might lead to more resources to reach UHC.

scholarly journals Assessing the efficiency of Iran health system in making progress towards universal health coverage: a comparative panel data analysis

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Haniye Sadat Sajadi ◽  
Zahra Goodarzi ◽  
Amirhossein Takian ◽  
Efat Mohamadi ◽  
Alireza Olyaeemanesh ◽  
...  
Keyword(s):  
Data Analysis ◽  
Panel Data ◽  
Health System ◽  
Universal Health Coverage ◽  
Panel Data Analysis ◽  
Health Coverage ◽  
Universal Health

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 Future Challenges of Nursing in Health System of Iran

2021 ◽  
Vol 9 ◽  
Author(s):  
Salman Barasteh ◽  
Maryam Rassouli ◽  
Mohammad Reza Karimirad ◽  
Abbas Ebadi
Keyword(s):  
Professional Development ◽  
Nursing Education ◽  
Health System ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Structured Interviews ◽  
Framework Analysis ◽  
The Future ◽  
Future Challenges ◽  
Universal Health

Purpose: Nursing development is considered as one of the most important ways to achieve the universal health coverage and sustainable development goals in different countries. Nursing in Iran has the potential to provide services at all levels of universal health coverage. Therefore, planning for nursing in Iran needs to recognize the future challenges. This study aims to explore the future challenges of nursing in the health system of Iran from the perspective of nursing experts.Methods: In this qualitative study, 11 semi-structured interviews were conducted with nursing experts by purposive sampling in 2017–2018. Interviews were recorded and transcribed and framework analysis method was used to analysis the data.Results: The results showed that a favorable future requires planning in three areas of nursing “governance challenges” including centralized nursing stewardship, policy-making and legislation, monitoring and evaluation, and cooperation and communication with other institutions, “inadequacy of professional development with social demands” including community-based nursing, nursing upgrades with disease patterns, expanding home care, expanding care centers, and use of technology, “human resource challenges “including nursing education tailored to the needs of the community, empowering nursing managers, recruiting and retaining nurses, and specialized nursing.Conclusions: A favorable future requires a coherent nursing government, professional development of nursing based on social demands, and enhancing human resources in line with the emerging needs of the future.

scholarly journals Autocratisation and universal health coverage: synthetic control study

BMJ ◽  
2020 ◽  
pp. m4040 ◽  
Author(s):  
Simon Wigley ◽  
Joseph L Dieleman ◽  
Tara Templin ◽  
John Everett Mumford ◽  
Thomas J Bollyky
Keyword(s):  
Life Expectancy ◽  
Confidence Interval ◽  
Population Health ◽  
Universal Health Coverage ◽  
Freedom Of Expression ◽  
Synthetic Control ◽  
Health Coverage ◽  
Effective Coverage ◽  
Per Capita ◽  
Universal Health

Abstract Objective To assess the relation between autocratisation—substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)—and countries’ population health outcomes and progress toward universal health coverage (UHC). Design Synthetic control analysis. Setting and country selection Global sample of countries for all years from 1989 to 2019, split into two categories: 17 treatment countries that started autocratising during 2000 to 2010, and 119 control countries that never autocratised from 1989 to 2019. The treatment countries comprised low and middle income nations and represent all world regions except North America and western Europe. A weighted combination of control countries was used to construct synthetic controls for each treatment country. This statistical method is especially well suited to population level studies when random assignment is infeasible and sufficiently similar comparators are not available. The method was originally developed in economics and political science to assess the impact of policies and events, and it is now increasingly used in epidemiology. Main outcome measures HIV-free life expectancy at age 5 years, UHC effective coverage index (0-100 point scale), and out-of-pocket spending on health per capita. All outcome variables are for the period 1989 to 2019. Results Autocratising countries underperformed for all three outcome variables in the 10 years after the onset of autocratisation, despite some improvements in life expectancy, UHC effective coverage index, and out-of-pocket spending on health. On average, HIV-free life expectancy at age 5 years increased by 2.2% (from 64.7 to 66.1 years) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 3.5% (95% confidence interval 3.3% to 3.6%, P<0.001) (from 64.7 to 66.9 years) in the absence of autocratisation. On average, the UHC effective coverage index increased by 11.9% (from 42.5 to 47.6 points) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 20.2% (95% confidence interval 19.6% to 21.2%, P<0.001) (from 42.5 to 51.1 points) in the absence of autocratisation. Finally, on average, out-of-pocket spending on health per capita increased by 10.0% (from $4.00 (£3.1; €3.4) to $4.4, log transformed) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by only 4.4% (95% confidence interval 3.9% to 4.6%, P<0.001) (from $4.0 to $4.2, log transformed) in the absence of autocratisation. Conclusions Autocratising countries had worse than estimated life expectancy, effective health service coverage, and levels of out-of-pocket spending on health. These results suggest that the noticeable increase in the number of countries that are experiencing democratic erosion in recent years is hindering population health gains and progress toward UHC. Global health institutions will need to adjust their policy recommendations and activities to obtain the best possible results in those countries with a diminishing democratic incentive to provide quality healthcare to populations.

scholarly journals Towards universal health coverage: governance and organisational change in ministries of health

2019 ◽  
Vol 4 (5) ◽  
pp. e001735 ◽  
Author(s):  
Peter Berman ◽  
Azrina Azhar ◽  
Elizabeth J Osborn
Keyword(s):  
Health System ◽  
Universal Health Coverage ◽  
Organisational Change ◽  
Health Financing ◽  
Comparative Case Study ◽  
Health Coverage ◽  
Political Commitment ◽  
Middle Income ◽  
High Level ◽  
Universal Health

Countries have implemented a range of reforms in health financing and provision to advance towards universal health coverage (UHC). These reforms often change the role of a ministry of health (MOH) in traditionally unitary national health service systems. An exploratory comparative case study of four upper middle-income and high-income countries provides insights into how these reforms in pursuit of UHC are likely to affect health governance and the organisational functioning of an MOH accustomed to controlling the financing and delivery of healthcare. These reforms often do not result in simple transfers of responsibility from MOH to other actors in the health system. The resulting configuration of responsibilities and organisational changes within a health system is specific to the capacities within the health system and the sociopolitical context. Formal prescriptions that accompany reform proposals often do not fully represent what actually takes place. An MOH may retain considerable influence in financing and delivery even when reforms appear to formally shift those powers to other organisational units. MOHs have limited ability to independently achieve fundamental system restructuring in health systems that are strongly subject to public sector rules and policies. Our comparative study shows that within these constraints, MOHs can drive organisational change through four mechanisms: establishing a high-level interministerial team to provide political commitment and reduce institutional barriers; establishing an MOH ‘change team’ to lead implementation of organisational change; securing key components of systemic change through legislation; and leveraging emerging political change windows of opportunity for the introduction of health reforms.

Sign in / Sign up

Export Citation Format

Share Document