scholarly journals Universal Health Coverage

2020 ◽  
Vol 7 (4) ◽  
pp. p14
Author(s):  
Alfred A. Osoro ◽  
Edwine B. Atitwa ◽  
John K. Moturi

Universal Health Coverage has attracted global attention as an ideal vehicle that will drive health care services to the individuals, families, and communities globally. Good health systems are capable of serving the needs of entire populations, including the availability of infrastructure, human resources, health technologies, and medicines. This study seeks to identify the barriers and challenges which have hindered the provision of basic health care to communities and suggest ways of addressing some of them. Literature search reviewed 40 materials which were more relevant. Results revealed that there have been disparities in the provision of healthcare. Challenges in service provision include; lack of political commitment, weak health system resulting from limited financial allocation and poor leadership, lack of adequate number of skilled human resources, equipment and supplies and poor infrastructures. For UHC to be successful, an effective and well-functioning Primary Health Care (PHC) system is essential. Thus health systems can be strengthened through financial allocation; training of skilled and well-motivated healthcare workers. Also provision of right equipment and supplies, equity in resource distribution, improvement of infrastructures to meet the needs of the people is fundamental.

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
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Abstract Oral health is a central element of general health with significant impact in terms of pain, suffering, impairment of function and reduced quality of life. Although most oral disease can be prevented by health promotion strategies and routine access to primary oral health care, the GBD study 2017 estimated that oral diseases affect over 3.5 billion people worldwide (Watt et al, 2019). Given the importance of oral health and its potential contribution to achieving universal health coverage (UHC), it has received increased attention in public health debates in recent years. However, little is known about the large variations across countries in terms of service delivery, coverage and financing of oral health. There is a lack of international comparison and understanding of who delivers oral health services, how much is devoted to oral health care and who funds the costs for which type of treatment (Eaton et al., 2019). Yet, these aspects are central for understanding the scope for improvement regarding financial protection against costs of dental care and equal access to services in each country. This workshop aims to present the comparative research on dental care coverage in Europe, North America and Australia led by the European Observatory on Health Systems and Policies. Three presentations will look at dental care coverage using different methods and approaches. They will compare how well the population is covered for dental care especially within Europe and North America considering the health systems design and expenditure level on dental care, using the WHO coverage cube as analytical framework. The first presentation shows results of a cross-country Health Systems in Transition (HiT) review on dental care. It provides a comparative review and analysis of financing, coverage and access in 31 European countries, describing the main trends also in the provision of dental care. The second presentation compares dental care coverage in eight jurisdictions (Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States) with a particular focus on older adults. The third presentation uses a vignette approach to map the extent of coverage of dental services offered by statutory systems (social insurance, compulsory insurance, NHS) in selected countries in Europe and North America. This workshop provides the opportunity of a focussed discussion on coverage of dental care, which is often neglected in the discussion on access to health services and universal health coverage. The objectives of the workshop are to discuss the oral health systems in an international comparative setting and to draw lessons on best practices and coverage design. The World Conference on Public Health is hence a good opportunity for this workshop that contributes to frame the discussion on oral health systems in a global perspective. Key messages There is large degree of variation in the extent to which the costs of dental care are covered by the statutory systems worldwide with implications for oral health outcomes and financial protection. There is a need for a more systematic collection of oral health indicators to make analysis of reliable and comparable oral health data possible.


2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
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Abstract Very often, important health system reforms are delayed, rendered ineffective or they simply go badly wrong. All too often this happens not because of a lack of money, health workers or health care facilities but because we adopt unfit ideas and decision and/or implement them insufficiently. The incapacity to develop, adopt and implement good decision is quintessentially the definition of bad governance. If we are to develop our health systems towards Universal Health Coverage and health systems performance improvement, we will need to strengthen our health system governance. Governance is vitally important to health systems reform and refers to how decisions are made and implemented - everything from the ability of policy-makers to take evidence-based and relevant decisions to their ability to implement policies and create alignment between different actors. In this workshop we will share experiences from a governance spring course for policy makers from Eastern Europe and Central Asia. Connected to this we will also share preliminary results of a study on National Level Health Systems Governance. The panelists will address five key issues The contribution of governance to Universal Health Coverage. This contribution will focus on a) the concept of governance defined as the way societies make and implement collective decisions and b) its 5 main domains including transparency, accountability, participation, integrity and capacity. (S Greer)Governance improvement needs in Eastern Europe and Central Asia: experiences from working with policy makers including countries like Azerbaijan, Georgia, Kyrgyzstan, Moldova Tajikistan, Ukraine and Uzbekistan. For purpose of peer-learning and contrasting experiences we have paired these countries with policy makers from Austria, Finland and Ireland (G Pastorino)Stakeholder participation in decision making and implementation: Very often, powerful stakeholders, like the medical profession, is over-represented and exerts immense veto power, while the voice of other professions, patients, and citizens remained unheard. What are the governance strategies and instruments to harness those underrepresented stakeholders for Universal Health Coverage? (G Fattore)Governing centralized and decentralized budgets in primary, social and hospital care: population-based health care in larger countries requires decentralization of part of the health care budget. What are the accountability lines and instruments that ensure that regional and local budget holders aligning with national policies for Universal Health Coverage? (L Hawkins)Governance contribution addressing corruption: According to surveys health systems are perceived prone to corruption. What is the contribution of governance to heal corruption and make the system work according to rules? (D Clarke) Key messages If we are to make progress towards Universal Health Coverage, we will need to strengthen health systems governance. Without strengthening health systems governance we will fail to manage stakeholders, budgets and corruption.


2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  

Abstract Universal health coverage (UHC) is part of the global WHO strategy to improve health. UHC and equity in access to care fall within the shared principles and values of EU health systems. However, as reported in 2016 by the Expert panel on effective ways of investing in health (EXPH), significant amount of unmet needs persisted both between and within EU member states. Access to health services encompasses the dimensions of affordability, user experience and availability of services with potential barriers arising at individual, providers or health systems levels. Health needs are constantly evolving as a consequence of population ageing and of health care technology development. Consequently access to care does not simply mean availability of a single component of care, but rather to an array of pertinent, coordinated, cost-effective and timely primary and specialized health and social interventions. Measuring performance in that respect is beyond the ability of commonly used “national level” indicators of access. Available research suggests that achieving ubiquitous access to optimal care across territories and populations (eg socioeconomic groups) is hard to achieve. This applies to the whole spectrum of health interventions, from preventive care such as immunizations to multidisciplinary interventions required for the management of chronic diseases. In this context, the workshop proposes to present examples of policy initiatives and results from research projects focusing on access and use of health care conducted in a variety of settings. The aims are to share knowledge about methods used in measuring variations of access, to improve understanding of their determinants and to identify avenues for improving performance. The workshop is proposed by a multidisciplinary and international group of research teams. It will start with a short introduction from the chair (5 minutes, Olivier Grimaud) followed by five presentations (10 minutes) addressing the issues of variations in access and use of care from different research teams and in a variety of settings. The first presentation will report on an innovative policy aiming at improving UHC in India. The following presentations will illustrate the challenges of providing access in high income countries, including, Scotland, France and Australia. In the last part of the workshop (30 minutes) comments from Prof Helmut Brand (former expert panel member of the EXPH) will introduce a general discussion with the audience moderated by the chair. Key messages Even when the conditions for universal health coverage are in place, providing equitable access to quality care remains a challenge. Understanding variations in access to care would help improve performance and equity.


10.36469/9869 ◽  
2013 ◽  
Vol 1 (3) ◽  
pp. 224-238
Author(s):  
Darius Erlangga ◽  
Lizheng Shi

Purpose: In 2010, the World Health Organization (WHO) released its report about health system financing and identified universal coverage as the best way to attain the right of every human being to enjoy “the highest attainable standard of health”. Over the past decade, Thailand has successfully implemented a universal health coverage scheme for its population, while its neighbor country, Indonesia, is still struggling to achieve the same goal. The purpose of this paper is to compare the health financing systems between Thailand and Indonesia. Both countries almost have similar socioeconomic conditions and suffered from severe financial crisis during the late 1990s. The objective of this study is to examine health systems in each country and to determine lessons on how health care financing can affect the health status of a population. Methods: The study is based on statistical data from various publicly available resources. For analysis, the authors followed The Health Systems Assessment Approach: A How-To Manual Version 1.0 issued by Health Systems 20/20 supported by United States Agency for International Development (USAID). The countries were compared using three groups of indicators in health systems performance and functioning: 1. Health Insurance System, 2. Amount and Sources of Financial Resources, and 3. Health Outcomes and Health Workforce Density. Results: In comparing the health financing of the two countries, we found that Thailand initiated much earlier health systems reforms in order to achieve universal health coverage. Indonesia, while on the right track, has moved at a slower pace than Thailand. Thailand and Indonesia have shown improving trends over time in all indicators, but Thailand outperformed Indonesia, especially in the groups of indicators regarding the amount and sources of financial resources. Conclusions: One important lesson identified in this study is that health care reform is unlikely to succeed without strong political support and constant pressure from the nation as a whole, which can be represented by local organizations or professional associations. However, the mere increase of available resources devoted to the health sector does not guarantee significant improvements of health outcomes of a population.


2015 ◽  
Vol 8 (7) ◽  
pp. 218 ◽  
Author(s):  
Timothy Chrispinus Okech ◽  
Steve Ltumbesi Lelegwe

<p>Kenya has made progress towards universal health coverage as evidenced in the various policy initiatives and reforms that have been implemented in the country since independence. The purpose of this analysis was to critically review the various initiatives that the government of Kenya has over the years initiated towards the realization of Universal Health Care (UHC) and how this has impacted on health equity. The paper relied heavly on secondary sources of information although primary data data was collected. Whereas secondary data was largely collected through critical review of policy documents and commissioned studies by the Ministry of Health and development partners, primary data was collected through interviews with various stakeholders involved in UHC including policy makers, implementers, researchers and health service providers. Key findings include commitment towards UHC; minimal solidarity in health care financing; cases of dysfunctionalilty of health care system; minimal opportunities for continuous medical training; quality concerns in terms of stock-outs of drugs and other medical supplies, dilapidated health infrastructure and inadequqte number of health workers. Other findings include governance concerns at NHIF coupled with, high operational costs, low capitation, fraud at facility levels, low pay out ratio, accreditation of facilities, and narrowness of the benefit package, among others. In lieu of these, various recommendations have been suggested. Among these include promotion of solidarty in health care financing that are reliable and economical in collecting; political will to enhance commitment towards devolution of health care, engagement of various stakeholders at both county and national government in fast tracking the enactment of Health Act; investment in health infrastructure and training of human resources; revamping NHIF into a full-fledged social health insurance scheme, and enhancing capacity of NHIF human resources, enhanced awareness amongst members, enhanced benefit package among other recommendations.</p>


2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Jeannie Samuel ◽  
Walter Flores ◽  
Ariel Frisancho

Abstract Background While equity is a central concern in promoting Universal Health Coverage (UHC), the impact of social exclusion on equity in UHC remains underexplored. This paper examines challenges faced by socially excluded populations, with an emphasis on Indigenous peoples, to receive UHC in Latin America. We argue that social exclusion can have negative effects on health systems and can undermine progress towards UHC. We examine two case studies, one in Guatemala and one in Peru, involving citizen-led accountability initiatives that aim to identify and address problems with health care services for socially excluded groups. The case studies reveal how social exclusion can affect equity in UHC. Methods In-depth analysis was conducted of all peer reviewed articles published between 2015 and 2019 on the two cases (11 in total), and two non-peer reviewed reports published over the same period. In addition, two of the three authors contributed their first-hand knowledge gathered through practitioner involvement with the citizen-led initiatives examined in the two cases. The analysis sought to identify and compare challenges faced by socially excluded Indigenous populations to receive UHC in the two cases. Results Citizen-led accountability initiatives in Guatemala and Peru reveal very similar patterns of serious deficiencies that undermine efforts towards the realization of Universal Health Coverage in both countries. In each case, the socially excluded populations are served by a dysfunctional publicly provided health system marked by gaps and often invisible barriers. The cases suggest that, while funding and social rights to coverage have expanded, marginalized populations in Guatemala and Peru still do not receive either the health care services or the protection against financial hardship promised by health systems in each country. In both cases, the dysfunctional character of the system remains in place, undermining progress towards UHC. Conclusions We conclude that efforts to promote UHC cannot stop at increasing health systems financing. In addition, these efforts need to contend with the deeper challenges of democratizing state institutions, including health systems, involved in marginalizing and excluding certain population groups. This includes stronger accountability systems within public institutions. More inclusive accountability mechanisms are an important step in promoting equitable progress towards UHC.


Author(s):  
Joia S. Mukherjee

This chapter explores the seminal topic of Universal Health Coverage (UHC), an objective within the Sustainable Development goals. It reviews the theory and definitions that shape the current conversation on UHC. The movement from selective primary health care to UHC demonstrates a global commitment to the progressive realization of the right to health. However, access to UHC is limited by barriers to care, inadequate provision of care, and poor-quality services. To deliver UHC, it is critical to align inputs in the health system with the burden of disease. Quality of care must also be improved. Steady, sufficient financing is needed to achieve the laudable goal of UHC.This chapter highlights some important steps taken by countries to expand access to quality health care. Finally, the chapter investigates the theory and practice behind a morbidity-based approach to strengthening health systems and achieving UHC.


2021 ◽  
Vol 24 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Charalampos Milionis ◽  
Maria Ntzigani ◽  
Stella Olga Milioni ◽  
Ioannis Ilias

Coronavirus disease 2019 is a respiratory infection that has evolved to a pandemic with an enormous burden both on human life and health care. States throughout the world have pursued strategies to restrict the transmission of the virus in the community. Health systems have a crucial dual role as they are at the frontline of the fight against the pathogen and at the same time they must continue to offer emergency and routine health services. The provision of health care in the context of the COVID-19 pandemic finds certain barriers. The simultaneous protection of both universal health coverage and health care efficiency is a difficult task due to conflicting challenges of these two goals. Key actions need to be decided and implemented in the fields of health policy, operation of health services, and clinical interaction between health personnel and patients, so that health care continues to perform its mission in a sustainable manner. As the scientific community prepares for the widespread production and application of effective protective and therapeutic agents against COVID-19, it is vital for the general population to remain safe and for the health systems to survive. Allocation of resources and priority setting need to be applied fairly and efficiently for the achievement of the maximum benefit.


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