Noncommunicable disease control program of Bangladesh: current status and future direction to achieve universal health coverage (Preprint)

2020 ◽  
Author(s):  
Khaleda Islam ◽  
Rumana Huque ◽  
K.M. Saif-Ur Rahman ◽  
AHM Enayet Hussain
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Universal Health Coverage ◽  
Noncommunicable Disease ◽  
Health Coverage ◽  
Electronic Database ◽  
Policy Documents ◽  
Management Protocol ◽  
Key Policy ◽  
Universal Health

BACKGROUND Bangladesh is having 572,600 (67%) estimated deaths caused by noncommunicable diseases annually with 22% probable premature deaths. OBJECTIVE This study aimed to have a closer look into the overall readiness of Bangladesh to address NCDs, explore the barriers and suggest the best possible ways of reaching the target. METHODS The study reviewed relevant policy documents, NCDs related reports, publications, observed NCD service delivery at Upazila Health Complexes (UzHC) and validated the findings of desk review through discussion with key policy and program personnel. RESULTS NCDs are highlighted and prioritized in key policy documents, however, implementation of the policies remains weak with several gaps in service delivery systems. The operation plan (OP) indicators, which are the guiding factors of OP implementation, focus mostly on process not outcome or impact. Health system at primary health care facilities is not yet fully ready to deliver the NCD care, and mental health at primary care is rarely available. Health workforce (HWF) are getting oriented on national NCD management protocol though there is reluctance to follow the protocol. Record keeping is poor as it is manual. District health information software 2 (DHIS2) is not yet updated to capture the monthly service provision and tracking of indicators. CONCLUSIONS Weak health system is hampering delivery of NCD care at PHC, and tracking of indicators is difficult due to lack of electronic database. Implementation of NCD management protocol, ensuring availability of drugs, maintaining electronic database, and monitoring program and indicators are the way forward to achieve universal health coverage for NCD.

scholarly journals Towards universal health coverage for people with stroke in South Africa: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e049988
Author(s):  
Sjan-Mari van Niekerk ◽  
Sureshkumar Kamalakannan ◽  
Gakeemah Inglis-Jassiem ◽  
Maria Yvonne Charumbira ◽  
Silke Fernandes ◽  
...  
Keyword(s):  
South Africa ◽  
Service Delivery ◽  
Health System ◽  
Universal Health Coverage ◽  
Scoping Review ◽  
Stroke Care ◽  
Government Support ◽  
Health Coverage ◽  
Diverse Range ◽  
Universal Health

ObjectivesTo explore the opportunities and challenges within the health system to facilitate the achievement of universal health coverage (UHC) for people with stroke (PWS) in South Africa (SA).SettingSA.DesignScoping review.Search methodsWe conducted a scoping review of opportunities and challenges to achieve UHC for PWS in SA. Global and Africa-specific databases and grey literature were searched in July 2020. We included studies of all designs that described the healthcare system for PWS. Two frameworks, the Health Systems Dynamics Framework and WHO Framework, were used to map data on governance and regulation, resources, service delivery, context, reorientation of care and community engagement. A narrative approach was used to synthesise results.ResultsFifty-nine articles were included in the review. Over half (n=31, 52.5%) were conducted in Western Cape province and most (n=41, 69.4%) were conducted in urban areas. Studies evaluated a diverse range of health system categories and various outcomes. The most common reported component was service delivery (n=46, 77.9%), and only four studies (6.7%) evaluated governance and regulation. Service delivery factors for stroke care were frequently reported as poor and compounded by context-related limiting factors. Governance and regulations for stroke care in terms of government support, investment in policy, treatment guidelines, resource distribution and commitment to evidence-based solutions were limited. Promising supporting factors included adequately equipped and staffed urban tertiary facilities, the emergence of Stroke units, prompt assessment by health professionals, positive staff attitudes and care, two clinical care guidelines and educational and information resources being available.ConclusionThis review fills a gap in the literature by providing the range of opportunities and challenges to achieve health for all PWS in SA. It highlights some health system areas that show encouraging trends to improve service delivery including comprehensiveness, quality and perceptions of care.

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 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.

scholarly journals Human Resource Requirement Under the Context of Universal Health Coverage (UHC) in Bangladesh: Current Situation and Future Challenges

2017 ◽  
Vol 6 (2) ◽  
pp. 34-39
Author(s):  
Md Humayun Kabir Talukder ◽  
Md Mahfuzar Rahman ◽  
Md Nuruzzaman
Keyword(s):  
Health System ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Resource Requirement ◽  
Medical College ◽  
Future Challenges ◽  
Disease Pattern ◽  
Rapid Transition ◽  
Universal Health ◽  
Overall Health Status

"Human resources" have been described as "the heart of the health system in any country". The fact of health worker shortage in Bangladesh is well documented and regarded as one of the major challenges of the country's health system as mentioned in the national health policy 2011 and also in the strategic plan for health, population and nutrition sector development programme (HPNSDP 2011-2016). Universal Health Coverage (UHC) has got immense attention around the world. This is true that Bangladesh has been able to achieve remarkable progresses on the overall health status. However, considering the growing needs of the health system and rapid transition in the disease pattern (e.g. from communica ble to non communicable), long way to go towards a responsive, competent and equity based health system.Anwer Khan Modern Medical College Journal Vol. 6, No. 2: July 2015, P 34-39

scholarly journals 31.F. Workshop: Health system (performance) assessment: working towards a common approach

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health System ◽  
Performance Assessment ◽  
Health Systems ◽  
Universal Health Coverage ◽  
System Performance ◽  
Health System Performance ◽  
Health Coverage ◽  
Health System Performance Assessment ◽  
Health Systems Performance ◽  
Universal Health

Abstract Since the publication of the World Health Report 2000, which aimed at assessing health systems performance globally, a number of health systems performance assessment (HSPA) frameworks and tools, designed for various purposes, have emerged. In 2017, the joint Universal Health Coverage 2030 Technical Working Group on Health Systems Assessment (TWG), consisting of health policy makers and global actors, such as the WHO, World Bank, USAID, Unicef, European Commission, OECD, etc., was formed with the aim to align the existing tools and develop a common approach to understanding and measuring health systems performance globally. As part of this work, the European Observatory on Health Systems and Policies (OBS) has developed a Health Systems Performance Assessment framework for Universal Health Coverage (HSPA Framework for UHC), that allows to evaluate health system performance, largely by drawing on the information available in the existing tools or through global data collection initiatives. Suggested approach is based on the detailed assessment of the four health system functions (governance, financing, resource generation and service delivery) and their sub-functions, the interaction of which jointly leads to the successes and failures in the achievement of health system goals. We propose distinct assessment areas for specific functions and sub-functions as a way to identify potential strengths and weaknesses, which can then be related to actions or responsibilities of specific actors within a health system, or linkages to other sectors. The objective of the workshop is to introduce the background, rationale, methods and process of developing of the HSPA framework for UHC; present a systematic approach to assessing various functions of health system and their interactions; relate the assessment areas of specific functions and sub-functions to the final health system goals; and, finally, to test the use of the framework in practice. The workshop is structured as follows: the workshop will start from the four 10-minute presentations (outlined below), followed by an interactive session with the audience to discuss the content of the framework and elaborate on its potential use for HSPA and applications globally. Key messages The HSPA framework for UHC is an approach that allows to bring together existing HSPA efforts and moves towards a more systematic and universally applicable health system performance assessment. The approach assesses performance through attribution of various health system outcomes to specific functions and sub-functions, allowing to identify strengths and weaknesses that affect performance.

scholarly journals Influence of Organizational Change on Public Health Maternal Health Care Service Delivery in Kitui County (A Survey of Level 4 Hospitals in Kitui County)

2021 ◽  
Vol 5 (2) ◽  
pp. 84-100
Author(s):  
Marinah Syovinya Muteti
Keyword(s):  
Public Health ◽  
Health Care ◽  
Maternal Health ◽  
Service Delivery ◽  
Universal Health Coverage ◽  
Health Care Service ◽  
Maternal Health Care ◽  
Health Coverage ◽  
Universal Health ◽  
Health Care Service Delivery

The County Governments in Kenya are faced with poor service delivery especially in the provision of maternal health care services. Maternal health care services in public hospitals are not meeting up to the quality standard as outlined by the Ministry of Health in Kenya. The paper sought to determine the influence of leadership and universal health coverage on public health maternal health care in Kitui County. This study was guided by Transformational Leadership Theory and Theory X & Y. The study focused on 11 public hospitals providing maternity services in Kitui County. The target population of the study was 203 health officers that include 26 doctors, 10 specialists, 41 clinical officers and 126 nurses across the 13 level 4 hospitals providing maternity services in Kitui County. Data was collected by use of structured closed ended questionnaire. Data analysis was conducted using SPSS Version 25.0 Software. Pearson Correlation showed that leadership and universal health coverage have a positive correlation with public health maternal health care service delivery. Model summary results indicated that leadership and universal health coverage explain 52.1 percent of public health maternal health care service delivery. Coefficient regression revealed that coefficient of leadership has appositive and significant influence (β=.203, p=.001<0.05) on and public health maternal health care service delivery. It was also found that coefficient of Universal Health Coverage and public health maternal health care service delivery have a positive and significant relationship (β=.662, p=.000<0.05). The study concludes that leadership is one of the key health systems factors affecting the performance of maternal health services at facility level. Conclusion can be made further that universal health coverage improves public health maternal health care service delivery. The study recommends for the need of maternal health care providers to review their leadership guidelines and styles with aim of enhancing quality of leadership in the management of hospitals. Though universal health coverage is on trial, the study recommends for the need to adequately support the implementation of universal health coverage.

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

2019 ◽  
Vol 18 (1) ◽  
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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