scholarly journals Healthcare System Functions in Iran and Successful Developing Countries Regarding Access to Universal Health Coverage: A Comparative Study

Background: Universal health coverage is considered a prerequisite for human health and security. Objectives: Therefore, the current study aimed to evaluate and compare the healthcare system functions in Iran with those in successful developing countries in terms of universal health coverage (UHC). Methods: In this comparative study, three developing countries, namely Turkey, Thailand, and China were selected based on former studies, and the model presented by the World Health Organization in 2000 was used to compare and analyze the data. The required information from the selected countries was collected through searching the Pub Med and Scopus databases using the following keywords: “Health system review”, “Health system transition”, “International profiles of healthcare systems”, “Financing”, “Resource generation”, “Service provision”, “Universal health coverage”, and “Health system reform”. Results: The evaluation of the healthcare system’s function in four countries showed that the public sector’s share of total health expenditures was much higher than the private sector in both Thailand and Turkey. The issues that need to be addressed include the integration of insurance funds and risk accumulation, as well as the existence of a strong buyer organization. The comparison of the payment system in the studied countries indicated that the per capita method was used in all domains of primary care, and the inpatient diagnostic group (diagnosis-related group), fee for service, and salaries and rewards were more focused in the context of hospitalization. The majority of hospitals in the studied countries were state-owned; however, the important point was the presence of different non-university public hospitals in these countries, compared to Iran. Conclusion: In general, one way to reach the UHC is to utilize the experiences of successful countries in establishing and maintaining this issue.

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Amare Worku Tadesse ◽  
Kassu Ketema Gurmu ◽  
Selamawit Tesfaye Kebede ◽  
Mahlet Kifle Habtemariam

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.


2021 ◽  
Author(s):  
Rangsan Sukhampha

Abstract Background: Universal health coverage is endorsed as the global development agenda in the 2015 SDGs for global achievement by 2030 and is expected to build national policymaking agendas. Common research often focuses on national processes in the first place. For example, accounts of Thailand's health system development mostly emphasise domestic factors and influences rather than the linkage of external/global health ideas. The paper questions how external/global health ideas influence national health policymaking and the linkage between them in achieving Thailand's universal health coverage policy.Methods: A qualitative method was employed to capture complex and historical narratives of the national medical professional movement for Thailand's health system reform through the lens of a global social policy approach for exploring external and global health ideas transfer. Moreover, the actor- and policy entrepreneur approaches would be employed to investigate national health policymaking and examine how ideas from the external and global levels have improved national equity in health. Results: The research locates the narratives on global ideas and practices that influence a national health system reform. This highlights the impact/role of global ideas on national professional movements, i.e. the rural doctor movement in Thailand mobilising the health system reform for all. The study found that national equity in health could not be achieved without external/global health ideas transfer. Such a case of national universal health coverage achievement in Thailand happened with the effort of the rural doctor movement and individual agency as policy entrepreneurs in translating external/global ideas and practices for their movement and mobilisation. The case contributed to a better understanding of the global process regarding ideas and practices that can be transferred directly and indirectly to the national level. Conclusions: Global ideas transfer can also happen in different aspects such as it can be seen the ideas transfer from developed to developed countries; from developed to developing countries. Besides, the author witnessed that the IOs ideas can also be transferred to developing countries or reverse, and again, between developing countries themselves.


Author(s):  
Rashika Nandwani

Aim: The main purpose of this paper is to look at the Indian healthcare system during the COVID-19 pandemic and how COVID-19 acts as barrier and also presents some opportunities towards the road of Universal Health Coverage (UHC). Background: COVID-19 has exposed the vulnerability of health systems across the world and India is no exception. The World Health Organization (WHO) has kept the definition of UHC very flexible and has left on the country which is implementing it as to how much of the population and which services should be included in the scheme.  Discussion: India already has a unique flagship program Ayushman Bharat where it is trying to cover her most vulnerable population against catastrophic expenditure of health. This paper further investigates the progress of India towards UHC and how COVID-19 is acting as an impediment for India to progress towards it. On the other hand, it also poses some opportunities which had not been explored in the past. Health Systems Strengthening is the path towards the achievement of UHC and due to COVID-19, India has touched upon all the six building blocks which are needed to strengthen our system towards the achievement of UHC. Recommendations and Conclusion: It recommends that Indian system should be more proactive than reactive; it also suggests following a systems-based approach and to not target the problem in silos. It also suggests increasing the government funding as well as establishment of proper public health cadre. To conclude, this paper also suggests that the government should include outpatient expenses into their scheme, and they should also concentrate towards building adequate infrastructure in order to face future pandemics like COVID-19.


Author(s):  
Pablo Sebastián Cejas Romanelli

La salud pública es un concepto dinámico que obligó a los operadores sanitarios a pensar en estrategias de promoción y protección de la salud humana. Con el paso del tiempo, dicho concepto evolucionó hacia el de salud internacional, y este último, al de salud global en un contexto de globalización. La Organización Mundial de la Salud (OMS) se perfiló como el ente destinado a instrumentar las políticas de salud global. En tal sentido la Cobertura Universal de Salud surgió como el resultado de la política de dicha organización que no estuvo exenta de presiones y controles de organismos no estatales. La República Argentina incorporó al sistema de salud nacional, la Cobertura Universal de Salud que, tal como se verificó en la normativa internacional que le dio nacimiento, la prioridad está puesta en la salud financiera del sistema sanitario antes que en el derecho a la salud. Public health is a dynamic concept that forced healthcare operators to think about strategies for the promotion and protection of human health. With the passage of time, this concept evolved towards international health, and the latter, to global health in a context of globalization. The World Health Organization (WHO) emerged as the entity destined to implement global health policies. In this regard, the Universal Health Coverage emerged as the result of the policy of this organization that was not exempt from pressures and controls by non-state organizations. The Argentine Republic incorporated into the national health system, the Universal Health Coverage that, as verified in the international regulations that gave birth to it, the priority is placed on the financial health of the health system rather than on the right to health.


2021 ◽  
Vol 9 ◽  
Author(s):  
Salman Barasteh ◽  
Maryam Rassouli ◽  
Mohammad Reza Karimirad ◽  
Abbas Ebadi

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.


2019 ◽  
Vol 48 (1) ◽  
pp. 32-39
Author(s):  
Deidra C. Crews ◽  
Aminu K. Bello ◽  
Gamal Saadi ◽  

Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is a World Health Organization Sustainable Development Goal. While universal health coverage may not include all elements of kidney care in all countries, understanding what is locally feasible and important with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.


2019 ◽  
Vol 4 (5) ◽  
pp. e001735 ◽  
Author(s):  
Peter Berman ◽  
Azrina Azhar ◽  
Elizabeth J Osborn

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.


Author(s):  
Xiaofeng Shi ◽  
Jianying Li ◽  
Fei Wang ◽  
Hasan Dinçer ◽  
Serhat Yüksel

The aim of this study is to measure universal health coverage in Emerging 7 (E7) economies. Within this framework, five different dimensions and 14 different criteria are selected by considering the explanations of World Health Organization and United Nations regarding universal health coverage. While weighting the dimensions and criteria, the Decision-making Trial and Evaluation Laboratory (DEMATEL) is considered with the triangular fuzzy numbers. Additionally, Multi-Objective Optimization on the basis of Ratio Analysis (MOORA) approach is used to rank E7 economies regarding Universal Health Coverage (UHC) performance. The novelty of this study is that both service and financial based factors are taken into consideration at the same time. Additionally, fuzzy DEMATEL and MOORA methodologies are firstly used in this study with respect to the evaluation of universal health coverage. The findings show that catastrophic out of pocket health spending, pushed below an international poverty line and annual growth rate of real Gross Domestic Product (GDP) per capita are the most significant criteria for universal health coverage performance. Moreover, it is also concluded that Russia is the country that has the highest universal health coverage performance whereas China, India and Brazil are in the last ranks. It can be understood that macroeconomic conditions play a very significant role on the performance of universal health coverage. Hence, economic conditions should be improved in these countries to have better universal health coverage performance. Furthermore, it is necessary to establish programs that provide exemptions or lower out-of-pocket expenditures which will not prevent the use of health services. This situation can protect people against the financial risks related to health expenditures. In addition to them, it is also obvious that high population has also negative influence on the countries such as, China and India. It indicates that it would be appropriate for these countries to make population planning for this purpose.


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