More health workers needed for universal health coverage

Abstract Background Primary Health Centres (PHCs) are acknowledged key to the achievement of Universal Health Coverage (UHC) owing to their closeness to the grass-root and the constant patronage by low- and middle-income class citizens. An impediment to the efficiency of PHCs is the nature of politics on-going in its operation beginning from its physical construction, employment of staff, among others. This study provides evidence of politicking marring the efficiency of PHCs as well as possible solutions to the issue. Method The study was carried out in eight purposively selected PHC facilities drawn from three local government areas in Enugu State, southeast Nigeria. Data were collected using in-depth interviews (IDIs) and focus group discussions (FGDs). The IDIs involved sixteen participants that cut across frontline health workers, heads and supervisors of health units at the local governments, and chairpersons of the health facility committees (HFCCs). In addition, four FGDs were held with male and female service users of the facilities. Findings It was discovered that certain powerful community members influenced the locations of PHCs, even when the general community is disfavoured by such decision. Powerful group of persons equally influence the recruitment and sanctioning of healthcare staff. The consequences include weak patronage of the facilities and poor healthcare delivery. Of the several solutions, obtaining localised support from powerful persons in the community to enforce fairness featured strongly. Conclusions The politics around primary healthcare is a threat to the achievement of UHC, since it discourages patronage and encourages inefficiency of healthcare staff. To overcome this, there is the need to facilitate genuine participation of community members and implementing local actions and policies in the facilitation of PHCs, and also, rapidly addressing the excesses of powerful groups and individuals. Key words: Primary Health Centre; Politicking; Universal Health Coverage; Power; Politics

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Health workers and universal health coverage

The Lancet ◽

10.1016/s0140-6736(12)61939-4 ◽

2012 ◽

Vol 380 (9854) ◽

pp. 1643 ◽

Cited By ~ 2

Author(s):

Carolyn Miller ◽

Louise Holly

Keyword(s):

Universal Health Coverage ◽

Health Workers ◽

Health Coverage ◽

Universal Health

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In search of universal health coverage – highlighting the accessibility of health care to students with disabilities in Ghana: a qualitative study

10.21203/rs.2.16285/v3 ◽

2020 ◽

Author(s):

Eric Abodey ◽

Irene Vanderpuye ◽

Isaac Mensah ◽

Eric Badu

Keyword(s):

Health Care ◽

Health Insurance ◽

Students With Disabilities ◽

Universal Health Coverage ◽

Access To Health Care ◽

Health Workers ◽

Policy Formulation ◽

Health Coverage ◽

The Government ◽

Universal Health

Abstract Background: Accessibility of health care to students with disabilities is a global concern. This is no less important in Ghana, however, to date, no study has been undertaken regarding access to health care to students with disabilities. This study, therefore, aims to explore the accessibility of health care to students with disabilities, in the quest of achieving universal health coverage in Ghana. Methods: Qualitative methods, involving in-depth interviews were employed to collect data from 54 participants (29 students with disabilities, 17 health workers and 8 school mothers), selected through purposive sampling. Thematic analysis was used to analyze the data. Results : The study identified three themes – accessibility, adequacy, and affordability. The study findings highlighted that universal health coverage for students with disabilities has not been achieved due to barriers in accessing health care. The barriers faced by students with disabilities were unfriendly physical environments, structures, equipment, limited support services and poor health insurance policy to finance health care. Conclusion : The study concludes that the government should prioritize disability-related issues in health policy formulation, implementation and monitoring. The current provisions and requirements in the disability act should be prioritized, enforced and monitored to ensure adequate inclusion of disability issues in health services. Further, the current exemption policy under the National Health Insurance Scheme should be revised to adequately address the needs of people with disabilities.

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In search of universal health coverage – highlighting the accessibility of health services for students with disabilities in Ghana: a qualitative study

10.21203/rs.2.16285/v1 ◽

2019 ◽

Author(s):

Eric Abodey ◽

Irene Vanderpuye ◽

Isaac Mensah ◽

Eric Badu

Keyword(s):

Health Services ◽

Students With Disabilities ◽

Universal Health Coverage ◽

Health Workers ◽

Policy Formulation ◽

Health Coverage ◽

Access To Health Services ◽

Accessibility Of Health Services ◽

The Government ◽

Universal Health

Abstract Background: Accessibility to health services for students with disabilities is a global concern. This is no less important in Ghana, however, to date, no study has been undertaken regarding access to health services for students with disabilities. This study, therefore, aims to explore the accessibility of health services for students with disabilities, in the quest of achieving universal health coverage in Ghana. Methods: Qualitative methods, involving in-depth interviews were employed to collect data from 54 participants (29 students with disabilities, 17 health workers and 8 school mothers), selected through purposive sampling. Thematic analysis was used to analyze the data. Results : The study identified three themes – accessibility, adequacy, and affordability. The study findings highlighted that universal health coverage for students with disabilities has not been achieved due to barriers in accessing health services. The barriers faced by students with disabilities are unfriendly physical environments, structures, equipment, limited support services and poor health insurance policy to finance health services. Conclusion : The study concludes that the government should prioritize disability-related issues in health policy formulation, implementation and monitoring. The current provisions and requirements in the disability act should be prioritized, enforced and monitored to ensure adequate inclusion of disability issues in health services. Further, the current exemption policy under the NHIS scheme should be revised to adequately address the needs of people with disabilities.

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Achieving universal health coverage in small island states: could importing health services provide a solution?

BMJ Global Health ◽

10.1136/bmjgh-2017-000612 ◽

2018 ◽

Vol 3 (1) ◽

pp. e000612 ◽

Cited By ~ 5

Author(s):

Mariyam Suzana ◽

Helen Walls ◽

Richard Smith ◽

Johanna Hanefeld

Keyword(s):

Health Services ◽

Universal Health Coverage ◽

Economies Of Scale ◽

Health Workers ◽

Health Indicators ◽

Small Island ◽

Health Coverage ◽

Access To Health Services ◽

Medical Travel ◽

Universal Health

BackgroundUniversal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health services, rather than focus on domestic production. This paper provides empirical analysis of the potential impact of this option.MethodsAnalysis was based on publicly accessible data for 14 SIDS, covering health-related travel and health indicators for the period 2003–2013, together with in-depth review of medical travel schemes for the two highest importing SIDS—the Maldives and Tuvalu.FindingsMedical travel from SIDS is accelerating. The SIDS studied generally lacked health infrastructure and technologies, and the majority of them had lower than the recommended number of physicians in a country, which limits their capacity for achieving UHC. Tuvalu and the Maldives were the highest importers of healthcare and notably have public schemes that facilitate medical travel and help lower the out-of-pocket expenditure on medical travel. Although different in approach, design and performance, the medical travel schemes in Tuvalu and the Maldives are both examples of measures used to increase access to health services that cannot feasibly be provided in SIDS.InterpretationOur findings suggest that importing health services (through schemes to facilitate medical travel) is a potential mechanism to help achieve universal healthcare for SIDS but requires due diligence over cost, equity and quality control.

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Health workers and health systems

Oxford Textbook of Global Health of Women, Newborns, Children, and Adolescents ◽

10.1093/med/9780198794684.003.0008 ◽

2018 ◽

pp. 40-43

Author(s):

Kate Mandeville ◽

Ingrid Wolfe

Keyword(s):

Health System ◽

Health Systems ◽

Universal Health Coverage ◽

Health Workers ◽

Critical Role ◽

Good Health ◽

Health Coverage ◽

Historical Factors ◽

Equity Of Access ◽

Universal Health

This chapter describes the critical role that health workers and strong health systems play in improving maternal and child health. A strong health system should deliver improved health, financial protection, equity of access, and a responsive service. Delivering these goals relies on strengthening all parts of the health system, in the context of social, political, and historical factors. There are many lessons to be learned from country experiences, including the importance of universal health coverage and investment in health workers. Universal health coverage is vital for ensuring good health for all; however, both establishing and expanding such coverage is fraught with challenges. Health workforces need to be aligned to a country’s population and disease burden, with retention of health workers given as much priority as increased production. Strengthening health systems is an essential part of the global effort to safeguard health for mothers and children, now and in the future.

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Newborn health benefits or financial risk protection? An ethical analysis of a real-life dilemma in a setting without universal health coverage

Journal of Medical Ethics ◽

10.1136/medethics-2017-104438 ◽

2018 ◽

Vol 44 (8) ◽

pp. 524-530 ◽

Cited By ~ 1

Author(s):

Kristine Husøy Onarheim ◽

Ole Frithjof Norheim ◽

Ingrid Miljeteig

Keyword(s):

Universal Health Coverage ◽

Financial Risk ◽

Health Workers ◽

Health Benefits ◽

Real Life ◽

Ethical Analysis ◽

Health Coverage ◽

Financial Risk Protection ◽

Risk Protection ◽

Universal Health

IntroductionHigh healthcare costs make illness precarious for both patients and their families’ economic situation. Despite the recent focus on the interconnection between health and financial risk at the systemic level, the ethical conflict between concerns for potential health benefits and financial risk protection at the household level in a low-income setting is less understood.MethodsUsing a seven-step ethical analysis, we examine a real-life dilemma faced by families and health workers at the micro level in Ethiopia and analyse the acceptability of limiting treatment for an ill newborn to protect against financial risk. We assess available evidence and ethical issues at stake and discuss the dilemma with respect to three priority setting criteria: health maximisation, priority to the worse-off and financial risk protection.ResultsGiving priority to health maximisation and extra priority to the worse-off suggests, in this particular case, that limiting treatment is not acceptable even if the total well-being gain from reduced financial risk is taken into account. Our conclusion depends on the facts of the case and the relative weight assigned to these criteria. However, there are problematic aspects with the premise of this dilemma. The most affected parties—the newborn, family members and health worker—cannot make free choices about whether to limit treatment or not, and we thereby accept deprivations of people’s substantive freedoms.ConclusionIn settings where healthcare is financed largely out-of-pocket, families and health workers face tragic trade-offs. As countries move towards universal health coverage, financial risk protection for high-priority services is necessary to promote fairness, improve health and reduce poverty.

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Universal access to essential health information: accelerating progress towards universal health coverage and other SDG health targets

BMJ Global Health ◽

10.1136/bmjgh-2020-002475 ◽

2020 ◽

Vol 5 (5) ◽

pp. e002475

Author(s):

Geoff Royston ◽

Neil Pakenham-Walsh ◽

Chris Zielinski

Keyword(s):

Health Information ◽

Universal Health Coverage ◽

Health Workers ◽

Universal Access ◽

Health Coverage ◽

Health Targets ◽

The Sustainable Development ◽

Development Goals ◽

The Impact ◽

Universal Health

The information that people need to protect and manage their own health and the health of those for whom they are responsible is a fundamental element of an effective people-centred healthcare system. Achieving universal health coverage (UHC) requires universal access to essential health information. While it was recently recognised by the World Medical Association, universal access to essential health information is not yet reflected in official monitoring of progress on UHC for the sustainable development goals (SDGs). In this paper, we outline key features that characterise universal access to essential health information and indicate how it is increasingly achievable. We highlight the growing evidence of the impact of wider access to practical and actionable information on health for the public, carers and frontline health workers and provide illustrative, evidence-based, examples of how increasing access to essential health information can accelerate the achievement of UHC and other health targets of the SDGs. The paper ends with an assessment of reasons why universal access to essential health information has not yet been achieved, and an associated call to action to key stakeholders—such as governments, multilaterals, funding bodies, policy-makers, health professionals and knowledge intermediaries—to explicitly recognise the foundational role of universal access to essential health information for achieving UHC and the rest of the health SDGs, to include it in the relevant SDG target and associated monitoring indicators, and to incorporate actions in their own policies and programmes to promote and enable this access.

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SUPPLY SIDE READINESS FOR UNIVERSAL HEALTH COVERAGE: ASSESSING SERVICE AVAILABILITY AND BARRIERS IN REMOTE AND FRAGILE SETTING.

10.21203/rs.2.10546/v1 ◽

2019 ◽

Author(s):

Veenapani Rajeev Verma ◽

Umakant Dash

Keyword(s):

Universal Health Coverage ◽

Health Workers ◽

Newborn Care ◽

Principal Component ◽

National Standards ◽

Service Availability ◽

Supply Side ◽

Health Coverage ◽

Absolute Poverty ◽

Universal Health

Abstract Background: The study hinged upon unravelling supply side readiness and barriers in attaining universal health coverage in a difficult setting. This district representative study is conducted in a fragile, remote, rural district of Jammu and Kashmir in India with unprecedented geographical barriers and heavy military deployment. Hilly geographical terrain, military skirmishes and sporadic militant attacks, rudimentary/absence of road network and absolute poverty are quintessential to this area. Methods: Mixed method approach was employed to triangulate quantitative and qualitative findings. Facility survey at various levels of facilities was conducted to gauge general service availability and service specific availability (depth of coverage). Compendium of checklist was designed using national standards in form of standard core questionnaire and parsimonious indices were computed by coalescing an array of tracer indicators across various domains as proposed in WHO’s Service Availability and Readiness Assesment (SARA) module. Polychoric principal component analysis was used to identify significant variables causing variation in health service delivery and generalized ordinal logistic model was employed to determine factors impacting facility readiness score. Multifarious techniques like observations, key informant interviews and focus group discussions using semi structured questionnaires on both leaders and laggards were administered for critical stakeholder’s analysis to discern qualitative information. Results: Results indicated poorest readiness for peripheral rural facilities with a composite score of 41% and 24% for subcenters and new type primary health centers respectively. Availability of basic amenities, diagnostic capacity and preparedness for emergencies and Non Communicable diseases was particularly subjacent having lowest scores. For primary care facilities; principal component was mainly characterized by basic newborn care as well as preparedness for delivery. Degree of environmental vulnerability of facilities, facility type and frequency of monitoring/supervision significantly impacted facility’s readiness. Lack of incentives for health workers in remote and shelling prone areas, unavailability of residential accommodation, absence of motorable roads, political interferences aiding internal adjustments in form of transfer/attachment of health workers, leakages in supply chain of drugs and consumables, reticence of skilled staff in serving militancy impacted areas, nonchalant attitude of policymakers were identified as major barriers for service provisioning.

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Sustaining the National Health Insurance Scheme in South Africa: The Roles and Challenges of Community Health Workers

The Open Public Health Journal ◽

10.2174/1874944501811010494 ◽

2018 ◽

Vol 11 (1) ◽

pp. 494-506 ◽

Cited By ~ 2

Author(s):

Takalani G. Tshitangano ◽

Foluke C. Olaniyi

Keyword(s):

South Africa ◽

Health Insurance ◽

Community Health ◽

Community Health Workers ◽

National Health Insurance ◽

National Health ◽

Universal Health Coverage ◽

Health Workers ◽

Health Coverage ◽

Universal Health

Background:The provision of universal health coverage is acknowledged as a priority goal for healthcare systems globally. In South Africa, the National Health Insurance system has been endorsed as a funding model for the provision of universal health coverage for South Africans. Community Health Workers have contributed to better universal health coverage outcomes in many countries. A study in India revealed that coverage of health care practices is positively correlated with the knowledge level of Community Health Workers. In South Africa, there is a difference in the duration of training of Community Health Workers in different provinces, especially in Vhembe District.Objective:This study aimed to assess Community Health Workers’ knowledge regarding their roles and describe their challenges within the context of National Health Insurance.Methods:Qualitative design was used to collect data from 33 participants who formed five focus groups comprising six to eight members each. Ethical principles of research such as permission, informed consent, voluntary participation and anonymity were observed. Data was analysed using thematic data analysis technique guided by Tesch open coding method.Results:The findings revealed that Community Health Workers lack adequate knowledge regarding the roles they are expected to play within Ward Based Outreach teams. Some of the challenges they face include transportation to clients’ homes and poor reception in households.Conclusion:A review of the South African Qualification Authority health promoter unit standards is recommended coupled with the mentorship of Community Health Workers by retired nurses to help them understand their roles better.

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