Strengthening the Health System as a Strategy to Achieving a Universal Health Coverage in Underprivileged Communities in Africa: A Scoping Review

Universal health coverage (UHC) is defined as people having access to quality healthcare services (e.g., treatment, rehabilitation, and palliative care) they need, irrespective of their financial status. Access to quality healthcare services continues to be a challenge for many people in low- and middle-income countries (LMICs). The aim of this study was to conduct a scoping review to map out the health system strengthening strategies that can be used to attain universal health coverage in Africa. We conducted a scoping review and qualitatively synthesized existing evidence from studies carried out in Africa. We included studies that reported interventions to strengthen the health system, e.g., financial support, increasing work force, improving leadership capacity in health facilities, and developing and upgrading infrastructure of primary healthcare facilities. Outcome measures included health facility infrastructures, access to medicines, and sources of financial support. A total of 34 studies conducted met our inclusion criteria. Health financing and developing health infrastructure were the most reported interventions toward achieving UHC. Our results suggest that strengthening the health system, namely, through health financing, developing, and improving the health infrastructure, can play an important role in reaching UHC in the African context.

The Impact of Contracting on the Portuguese National Health System

All treatments, materials, instruments, exams, vaccines, tests, hospitalizations, surgeries, human resources, investigations, medicines, autopsies, among many other services provided by the National Health System (SNS). Therefore, funding is required, and the external services and supplies to which the SNS must constantly update its technologies and the necessary and continuous training and essential maintenance and cleaning expenses. Moreover, health financing has been a matter of great concern, both nationally and internationally, as health expenditures are growing faster than economic growth. Over the years, efficiency in resource allocation has always been a desirable objective, but one that is not easy to achieve. The truth is that there is much waste in allocating resources. Thereby, this study analyzes the impact of the contractualization process to which Portugal has adhered, which is most similar to a privatization model; that is, we sought to understand whether the contractualization of the SNS has a favorable effect on the economic level. However, after the entire process and development of the work, it is concluded that the contracting had a negligible impact. The repercussion that it had on the economic performance of Portuguese Hospitals was in a negative sense. In the statistical analyses it was used tests of differences between averages, to check the behavior of the economic performance of hospitals towards the contracting process. It was taken data of reports and accounts from a sample of fifteen Portuguese Hospitals S.A. that went through this contracting process from 2003 to 2017, in order to calculate the four indicators, such as: Return On Assets (ROA); Return On Equity (ROE); Economic Value Added (EVA) and the Market Value Added (MVA). For each of these indicators, were analyzed and compared the resulted effects between the period of two years before and two years after the contracting process. From the obtained results, we can conclude that contracting process had little impact on the economic performance of Portuguese Hospitals and the resulting impact was not favorable.

Study on the Factors Influencing Total Health Cost Based on Multiple Regression Model

In recent years, China's social economy and income level of residents have increased rapidly, the total cost of health has increased rapidly, and the level of medical expenditure of residents has been increasing. This paper establishes a multivariate linear regression model using data from 1996 to 2020, and analyzes several important influencing factors that affect overall health expenditure. The aim is to formulate a health financing policy suitable for the coordinated development of China's social economy, and to provide a basis for adapting to the needs of economic development, structural adjustment and institutional transformation.

COVID-19 financing strategies for refugees and migrants in the Eastern Mediterranean Region

Background: The COVID-19 pandemic has had devastating consequences on health care systems worldwide. While the world was slowly moving towards achieving health for all, the pandemic destroyed progress made over the past 25 years and exposed the vulnerability of health care systems and health insurance schemes as well as their lack of resilience. Heath care systems failed to respond in a timely and efficient manner, lives have been, and continue to be, lost and vulnerable populations, especially refugees and migrants, are more at risk than ever as many are left out of country vaccination programmes. Aims: The Eastern Mediterranean region hosts 13 million internally displaced persons and 12 million refugees as of 2018. Thus, adopting inclusive health financing mechanisms is crucial to addressing the crisis and protecting indigenous and displaced populations. Methods: By looking at regional best practices and the response of the United Nations, we outline possible financing tools for including refugees and migrants in health insurance schemes for COVID 19 and introduce novel solutions for addressing gaps in funding. Results: Among the suggested solutions are the inclusion of refugees and migrants in national health care systems, setting up community-based health insurance for migrant and refugee populations, as well as introducing a catastrophe bond financing scheme. Conclusions: While COVID-19 is far from over, many countries in the EMR have included migrants in their COVID-19 vaccine rollout plans. While this is not the first instance of inclusion in some countries, many others are unable or do not prioritize migrants in their health systems, to the detriment of the entire country. This paper, therefore, tackles the possible health financing measures which curb or prevent migrants from accessing such systems and presents possible solutions to change the status quo.

Strengthening Local Governance in Health Financing in China: A Text-Mining Analysis of Policy Changes between 2009 and 2020

In the last two decades, developing countries have increasingly engaged in improving the governance of their health systems and promoting policy design to strengthen their health governance capacity. Although many well-designed national policy strategies have been promulgated, obstacles to policy implementation and compliance among localities may undermine these efforts, particularly in decentralized health systems. Studies on health governance have rarely adopted a central-local analysis to investigate in detail local governments’ distinct experiences, orientations, and dynamics in implementing the same national policy initiative. This study examines the policy orientations of prefectural governments in strengthening governance in health financing in China, which has transitioned from emphasizing the approach of fiscal resource input to that of marketization promotion and cost-containment regulation enforcement at the national level since 2009. Employing text-mining methodologies, we analyzed health policy documents issued by multi-level governments after 2009. The analysis revealed three salient findings. First, compared to higher-level authorities, prefectural governments generally opted to use fiscal resource input over marketization promotion and cost-containment regulation enforcement between 2009 and 2020. Second, policy choices of prefectural governments varied considerably in terms of enforcing cost-containment regulations during the same period. Third, the extent of the prefectural government’s orientation toward marketization promotion or cost-containment regulation enforcement was not only determined by the top-down orders of higher-level authorities but was also incentivized by the government’s fiscal dependency and the policy orientations of peer governments. These findings contribute to the health governance literature by providing an overview of local discretion in policy choices, and the political and fiscal dynamics of local policy orientations in promoting health governance in a decentralized health system.

A Qualitative Study on the Feasibility and Acceptability of Establishing Health Technology Assessment (HTA) in a Low Income Country Setting: The Case of Malawi

BackgroundThe objective of this study was to assess the feasibility and acceptability of institutionalizing Health Technology Assessment (HTA) in Malawi focusing on the form, scope, capacity and financing requirements for a limited resource setting such as Malawi.MethodsThis study employed a desk review and qualitative research methods. An extensive literature review was conducted on relevant key policy documents, reports and publications to understand the status of HTA in Malawi. The study included one focus group discussion with 7 participants and 12 key informant interviews with key stakeholders selected purposely based on their knowledge and expertise in HTA. ResultsThe study found that partial or informal HTA processes exist and that HTA is practiced without a standardized framework. The partial HTA processes are executed through three structures; Ministry of Health Senior Management Team, Technical Working Groups and Pharmacy and Medicines Regulatory Authority (PMRA) with varying levels of effectiveness. The results revealed that lack of an institutional HTA creates severe shortfalls. This includes partial HTA mechanisms, limited evidence use, especially concerning cost-effectiveness, lack of a standardized framework for technology adoption, donor pressure, lack of resources for the HTA process and technology acquisition, laws and practices that undermine cost-effectiveness considerations. ConclusionInstitutionalizing HTA in Malawi is acceptable and feasible. The results suggest that any HTA institutionalization in the short to medium term could involve strengthening the capacity of PMRA to appraise Cost-effectiveness Analysis (CEAs) within academia and MOH health financing division. Furthermore, rather than creating new HTA institutions, country-specific assessments should precede any specific recommendations for new technology adoptions. A technical capacity in Academic institutions such as Health Economics and Policy Unit (HEPU) at Kamuzu University of Health Sciences (KuHes) can be developed either as “offshore” HTA capacity fully aligned to MOH and executing HTA evidence and knowledge management function in a sub-contractor capacity.Running HeadHealth technology assessment in Malawi

Factors Associated with Out-of-Pocket Health Expenditure in Polish Regions

Out-of-pocket (OOP) payments are perceived as the most regressive means of health financing. Using the panel-data approach and region-aggregated data from Statistics Poland, this research investigated associations between socio-economic factors and OOP health spending in 16 Polish regions for the period 1999–2019. The dependent variable was real (inflation-adjusted) monthly OOP health expenditure per person in Polish households. Potential independent variables included economic, labour, demographic, educational, health, environmental, and lifestyle measures based on previous research. A set of panel-data estimators was used in regression models. The factors that were positively associated with OOP health spending were disposable income, the proportions of children (aged 0–9) and elderly (70+ years) in the population, healthcare supply (proxied by physicians’ density), air pollution, and tobacco and alcohol expenditure. On the other hand, the increased unemployment rate, life expectancy at age 65, mortality rate, and higher sports participation were all related to lower OOP health spending. The results may guide national strategies to improve health-care allocations and offer additional financial protection for vulnerable groups, such as households with children and elderly members.

Economic development trends and aspects of healthcare reform in Russia under COVID-2019 pandemic

The article is aimed at studying the state of the Russian economy and health care system before and after the COVID-2019 pandemic, identifying the main trends in the economy and health care, regardless of the pandemic, as well as its impact on the socioeconomic development of the country. The interrelation and mutual influence of the levels of development of the economy and health care of the country is noted. An analysis of the state of the economy and health care system in Russia for 2017–2019 is presented, problems and achievements in the pre-pandemic period are identified. The COVID-2019 pandemic is considered not only from the point of view of a medical manifestation but as a powerful trigger that provoked large-scale socioeconomic changes in the world, as a bifurcation point in world development, requiring states to objectively assess the state of the economy and healthcare, revise the current coordinate system, getting out of the state of uncertainty and choosing promising areas of socioeconomic development. A cross-country analysis of the response of various health systems to the COVID-19 pandemic has shown the advantages of countries with centralized management, health financing, and subordinate sanitary and epidemiological services. Along with the achievements of Russia in the fight against COVID-19, the existing specific problems of the domestic health care system are noted, which negatively affected the preparedness for a pandemic. Analyzed the consequences of the COVID-2019 pandemic for the socio-economic state of countries at the global level. The change in socio-economic indicators in Russia in 2020 compared to 2019 is presented as a result of the consequences of the COVID-2019 pandemic. The main results of the study are to identify the main trends in the development of the economy and the healthcare system in Russia in the context of the ongoing COVID-2019 pandemic, defining the directions of reforming the national healthcare, trajectories of increasing the level of socioeconomic development of the country

Political economy analysis of universal health coverage and health financing reforms in low- and middle-income countries: the role of stakeholder engagement in the research process

Background Progress towards universal health coverage (UHC) is an inherently political process. Political economy analysis (PEA) is gaining momentum as a tool to better understand the role of the political and economic dimensions in shaping and achieving UHC in different contexts. Despite the acknowledged importance of actors and stakeholders in political economy considerations, their role in the PEA research process beyond “study subjects” as potential cocreators of knowledge and knowledge users has been overlooked so far. We therefore aimed to review the approaches with reference to stakeholder engagement during the research process adopted in the current published research on the political economy of UHC and health financing reforms, and the factors favouring (or hindering) uptake and usability of PEA work. Methods We reviewed the literature to describe whether, when and how stakeholders were involved in the research process of studies looking at the political economy of UHC and health financing reforms, and to identify challenges and lessons learned on effective stakeholder engagement and research uptake. We used a standardized search strategy with key terms across several databases; we screened and included articles that focused on PEA and UHC. Additionally, we conducted a short survey of the authors of the included studies to complement the information retrieved. Results Fifty articles met the inclusion criteria and were included in the analysis. We found overall little evidence of systematic engagement of stakeholders in the research process, which focused mostly on the data collection phase of the research (i.e., key informant interviews). Our study identifies some reasons for the varying stakeholder engagement. Challenges include PEA requiring specific skills, a focus on sensitive issues, and the blurriness in researchers’ and stakeholders’ roles and the multiple roles of stakeholders as research participants, study subjects and research users. Among the approaches that might favour usability of PEA work, we identified early engagement, coproduction of research questions, local partners and personal contact, political willingness, and trust and use of prospective analysis. Conclusions Stakeholder engagement and research uptake are multifaceted concepts and complex processes, particularly when applied to PEA. As such, stakeholder engagement in the research process of PEA of UHC and health financing reforms is limited and underreported. Despite the challenges, however, stakeholder engagement remains key to ensuring relevance, usability and research uptake of PEA studies. More efforts are required to ensure engagement at different stages of the research process and better reporting in published articles.