scholarly journals Balancing Equity and Efficiency in the Allocation of Health Resources—Where Is the Middle Ground?

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1257
Author(s):  
James Avoka Asamani ◽  
Samuel Anongiba Alugsi ◽  
Hamza Ismaila ◽  
Juliet Nabyonga-Orem
Keyword(s):  
Healthcare Delivery ◽  
Health Resources ◽  
Health Service Delivery ◽  
The Other ◽  
Health Coverage ◽  
Middle Ground ◽  
Middle Income ◽  
Equity In Health ◽  
Equity And Efficiency ◽  
Development Goals

The notion of equity in health service delivery has been embodied in several of the Global Sustainable Development Goals (SDGs), especially the aspiration for universal health coverage (UHC). At the same time, escalating healthcare costs amidst dwindling resources continue to ignite discussions on the efficiency aspect of healthcare delivery at both operational and system levels. Therefore, health planners and managers have had to grapple with balancing the two, given limited resources and sophisticated population health needs. Undoubtedly, the concepts of equity and efficiency have overarching importance in healthcare. While efficiency dictates an ‘economical’ use of the limited healthcare resources, equity advocates their fair and ethical use. Some have leaned on this to argue that one has to be forgone in search of the other. In search of a ‘middle ground’, this paper explores the conceptual underpinnings of equity and efficiency in the context of healthcare resource allocation with some empirical examples from high-income and low- and middle-income settings. We conclude by arguing that equity and efficiency are, and ought to be, treated as complementary rather than conflicting considerations in distributing health resources. Each could be pursued without necessarily compromising the other—what matters is an explicit criterion of what will be ‘equitable’ in ensuring efficient allocation of resources, and on the other hand, what options will be considered more ‘efficient’ when equity objectives are pursued. Thus, equity can be achieved in an efficient way, while efficiency can drive the attainment of equity.

Universal healthcare in our lifetime? All teach, all learn

2019 ◽  
pp. 144-152
Author(s):  
Mark Britnell
Keyword(s):  
Health Coverage ◽  
National Elections ◽  
Middle Income ◽  
Universal Healthcare ◽  
Middle Income Countries ◽  
The World ◽  
Global Movement ◽  
Development Goals ◽  
The Caribbean ◽  
Universal Health

The United Nation’s Sustainable Development Goals of achieving universal health coverage (UHC) by 2030 have energized many governments to devise bold strategies and make big investments in their health systems. The global movement around UHC has gathered momentum at blistering speed. Within a few years it has transformed the focus of healthcare in low- and middle-income countries from a few diseases to a comprehensive vision of affordable, accessible, and acceptable care for all. In this chapter, Mark Britnell looks at how Philippines, Vietnam, Kenya, India, Indonesia, Columbia, Costa Rica, Panama, Nigeria, South Africa, Cyprus, islands across the Caribbean, and many others have announced significant UHC reforms since the development goals were passed in 2014, and UHC has been a headline issue in a number of national elections. He analyses UHC across the world, and looks to at the future of healthcare globally.

scholarly journals Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: a county-level case study in Kenya

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Joshua Munywoki ◽  
Nancy Kagwanja ◽  
Jane Chuma ◽  
Jacinta Nzinga ◽  
Edwine Barasa ◽  
...  
Keyword(s):  
Service Delivery ◽  
Human Resources ◽  
Priority Setting ◽  
Human Resources For Health ◽  
Health Sector ◽  
Health Service Delivery ◽  
County Level ◽  
Health Coverage ◽  
Middle Income

Abstract Background Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH. Methods We used a mixed methods case study design to examine health sector priority setting practices and outcomes at county level in Kenya. We used three sources of data. First, we reviewed all relevant national and county level policy and guidelines documents relating to HRH management. We then accessed and reviewed county records of HRH recruitment and distribution between 2013 and 2018. We finally conducted eight key informant interviews with various stakeholder involved in HRH priority setting within our study county. Results We found that HRH numbers in the county increased by almost two-fold since devolution. The county had two forms of HRH recruitment: one led by the County Public Services Board as outlined by policy and guidelines and a parallel, politically-driven recruitment done directly by the County Department of Health. Though there were clear guidelines on HRH recruitment, there were no similar guidelines on allocation and distribution of HRH. Since devolution, the county has preferentially staffed higher level hospitals over primary care facilities. Additionally, there has been local county level innovations to address some HRH management challenges, including recruiting doctors and other highly specialized staff on fixed term contract as opposed to permanent basis; and implementation of local incentives to attract and retain HRH to remote areas within the county. Conclusion Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country’s efforts for promoting service delivery equity as a key goal – both for the devolution and the country’s quest towards Universal Health Coverage (UHC).

scholarly journals Monitoring Frameworks for Universal Health Coverage: What About High-Income Countries?

2019 ◽  
Vol 8 (7) ◽  
pp. 387-393 ◽  
Author(s):  
Nicole Bergen ◽  
Arne Ruckert ◽  
Ronald Labonté
Keyword(s):  
Universal Health Coverage ◽  
High Income ◽  
World Health ◽  
Future Research ◽  
Health Coverage ◽  
Middle Income ◽  
The Sustainable Development ◽  
Development Goals ◽  
Health Organization ◽  
Universal Health

Implementing universal health coverage (UHC) is widely perceived to be central to achieving the Sustainable Development Goals (SDGs), and is a work program priority of the World Health Organization (WHO). Much has already been written about how low- and middle-income countries (LMICs) can monitor progress towards UHC, with various UHC monitoring frameworks available in the literature. However, we suggest that these frameworks are largely irrelevant in high-income contexts and that the international community still needs to develop UHC monitoring framework meaningful for high-income countries (HICs). As a first step, this short communication presents preliminary findings from a literature review and document analysis on how various countries monitor their own progress towards achieving UHC. It furthermore offers considerations to guide meaningful UHC monitoring and reflects on pertinent challenges and tensions to inform future research on UHC implementation in HIC settings.

Setting up Community Health Programmes in Low and Middle Income Settings

2019 ◽  
Keyword(s):  
Health Care ◽  
Community Health ◽  
Health Workers ◽  
Health Coverage ◽  
Middle Income ◽  
Postgraduate Students ◽  
Development Goals ◽  
Field Workers ◽  
Health Programmes ◽  
Low And Middle Income

The central role of the community and its place in both healthcare planning and service delivery is increasingly seen as a vital foundation for global health. The fourth edition of Setting up Community Health Programmes in Low and Middle Income Settings provides a practical introductory guide to the initiation, management, and sustaining of health care programmes in developing countries. The book has been fully revised to take into account the Millennium Development Goals, Sustainable Development Goals, and Universal Health Coverage. Taking an evidence-based approach the book provides rationales and contextualized examples of health at the community level. Key topics include non-communicable diseases, disability, addiction, abuse and mental health. This book provides a practical guide for community health workers including field workers, programme managers, medical professionals involved in front line health care, administrators, health planners and postgraduate students

scholarly journals Globalization of national surgical, obstetric and anesthesia plans: the critical link between health policy and action in global surgery

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Paul Truché ◽  
Haitham Shoman ◽  
Ché L. Reddy ◽  
Desmond T. Jumbam ◽  
Joanna Ashby ◽  
...  
Keyword(s):  
Financial Burden ◽  
Surgical Care ◽  
Obstetric Care ◽  
Global Surgery ◽  
Health System Strengthening ◽  
Health Coverage ◽  
Middle Income ◽  
Middle Income Countries ◽  
Private And Public ◽  
Development Goals

AbstractEfforts from the developed world to improve surgical, anesthesia and obstetric care in low- and middle-income countries have evolved from a primarily volunteer mission trip model to a sustainable health system strengthening approach as private and public stakeholders recognize the enormous health toll and financial burden of surgical disease. The National Surgical, Obstetric and Anesthesia Plan (NSOAP) has been developed as a policy strategy for countries to address, in part, the health burden of diseases amenable to surgical care, but these plans have not developed in isolation. The NSOAP has become a phenomenon of globalization as a broad range of partners – individuals and institutions – help in both NSOAP formulation, implementation and financing. As the nexus between policy and action in the field of global surgery, the NSOAP reflects a special commitment by state actors to make progress on global goals such as Universal Health Coverage and the United Nations Sustainable Development Goals. This requires a continued global commitment involving genuine partnerships that embrace the collective strengths of both national and global actors to deliver sustained, safe and affordable high-quality surgical care for all poor, rural and marginalized people.

scholarly journals Allocating resources to support universal health coverage: policy processes and implementation in Malawi

2020 ◽  
Vol 5 (8) ◽  
pp. e002766 ◽  
Author(s):  
Pakwanja Twea ◽  
Gerald Manthalu ◽  
Sakshi Mohan
Keyword(s):  
Resource Allocation ◽  
Low Income ◽  
Health Sector ◽  
Health Resources ◽  
Health Coverage ◽  
Middle Income ◽  
Middle Income Countries ◽  
Distribution Of Resources ◽  
The Government ◽  
Limited Health

Optimising the use of limited health resources in low-income and middle-income countries towards the maximisation of health outcomes requires efficient distribution of resources across health services and geographical areas. While technical research exists on how efficiencies can be achieved in resource allocation, there is limited guidance on the policy processes required to convert these technical inputs into practicable solutions. In this article, we discuss Malawi’s experience in 2019 of revising its resource allocation formula (RAF) for the geographical distribution of the government health sector budget to the decentralised units in-charge of delivering primary and secondary healthcare. The policy process to revise the RAF in Malawi was initiated by district assemblies seeking a more equitable distribution of government resources, with the Ministry of Health and Population (MOHP) leading the technical and deliberative work. This article discusses all the steps undertaken by MOHP, Malawi to date as well as the steps necessary looking forward to legally establish the newly developed RAF and to start implementing it. We highlight the practical and political considerations in ensuring the acceptability and implementation feasibility of a revised RAF. It is hoped that this discussion will serve as guidance to other countries undergoing a revision of their resource allocation frameworks.

scholarly journals AI for Improving Children’s Health: A Community Case Study

2021 ◽  
Vol 3 ◽  
Author(s):  
Aakash Ganju ◽  
Srini Satyan ◽  
Vatsal Tanna ◽  
Sonia Rebecca Menezes
Keyword(s):  
Health Care ◽  
Digital Health ◽  
Healthcare Delivery ◽  
Health Resources ◽  
Heterogeneous Data ◽  
Mobile App ◽  
Children's Health ◽  
Children’S Health ◽  
Middle Income ◽  
Predictive Algorithms

The Indian health care system lacks the infrastructure to meet the health care demands of the country. Physician and nurse availability is 30 and 50% below WHO recommendations, respectively, and has led to a steep imbalance between the demand for health care and the infrastructure available to support it. Among other concerns, India still struggles with challenges like undernutrition, with 38% of children under the age of five being underweight. Despite these challenges, technological advancements, mobile phone ubiquity and rising patient awareness offers a huge opportunity for artificial intelligence to enable efficient healthcare delivery, by improved targeting of constrained resources. The Saathealth mobile app provides low-middle income parents of young children nflwith interactive children’s health, nutrition and development content in the form of an entertaining video series, a gamified quiz journey and targeted notifications. The app iteratively evolves the user journey based on dynamic data and predictive algorithms, empowering a shift from reactive to proactive care. Saathealth users have registered over 500,000 sessions and over 200 million seconds on-app engagement over a year, comparing favorably with engagement on other digital health interventions in underserved communities. We have used valuable app analytics data and insights from our 45,000 users to build scalable, predictive models that were validated for specific use cases. Using the Random Forest model with heterogeneous data allowed us to predict user churn with a 93% accuracy. Predicting user lifetimes on the mobile app for preliminary insights gave us an RMSE of 25.09 days and an R2 value of 0.91, reflecting closely correlated predictions. These predictive algorithms allow us to incentivize users with optimized offers and omni-channel nudges, to increase engagement with content as well as other targeted online and offline behaviors. The algorithms also optimize the effectiveness of our intervention by augmenting personalized experiences and directing limited health resources toward populations that are most resistant to digital first interventions. These and similar AI powered algorithms will allow us to lengthen and deepen the lifetime relationship with our health consumers, making more of them effective, proactive participants in improving children’s health, nutrition and early cognitive development.

scholarly journals Sustainable development goals, universal health coverage and equity in health systems: the Orang Asli commons approach

2016 ◽  
Vol 1 ◽  
Author(s):  
Y. S. Wong ◽  
P. Allotey ◽  
D. D. Reidpath
Keyword(s):  
Sustainable Development ◽  
Health System ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Sustainable Development Goals ◽  
Participant Observation ◽  
Health Coverage ◽  
Equity In Health ◽  
Development Goals ◽  
Universal Health

Universal health coverage is a key health target in the Sustainable Development Goals (SDGs) that has the means to link equitable social and economic development. As a concept firmly based on equity, it is widely accepted at international and national levels as important for populations to attain ‘health for all’ especially for marginalised groups. However, implementing universal coverage has been fraught with challenges and the increasing privatisation of health care provision adds to the challenge because it is being implemented in a health system that rests on a property regime that promotes inequality. This paper asks the question, ‘What does an equitable health system look like?’ rather than the usual ‘How do you make the existing health system more equitable?’ Using an ethnographic approach, the authors explored via interviews, focus group discussions and participant observation a health system that uses the commons approach such as which exists with indigenous peoples and found features that helped make the system intrinsically equitable. Based on these features, the paper proposes an alternative basis to organise universal health coverage that will better ensure equity in health systems and ultimately contribute to meeting the SDGs.

Doctor Retention in Ireland - What it may mean for the Global Health Workforce Reform Agenda Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

2020 ◽  
Author(s):  
Bernard Hope Taderera
Keyword(s):  
Global Health ◽  
Health Workforce ◽  
Cross Sectional Study ◽  
Early Career ◽  
Healthcare Personnel ◽  
Health Coverage ◽  
Cross Sectional ◽  
Middle Income ◽  
Reform Agenda ◽  
Medical Graduates

The study of healthcare personnel migration in Ireland reports that most medical graduates plan to leave the country’s health system. It may be possible to address this challenge by understanding and addressing the reasons why young doctors plan to leave. Future studies should contribute to the retention of early career doctors in highincome countries such as Ireland. This will help reduce the migration of doctors from low- and middle-income countries in order to address the global health workforce crisis and its impact on the attainment of universal health coverage in all health systems.

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