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1 | Item Type | Publication Year | Author (s) | Title | Publication Title | DOI | Url | Abstract Note | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
2 | Journal Article | 2020 | Wagstaff, Adam; Neelsen, Sven | A comprehensive assessment of universal health coverage in 111 countries: a retrospective observational study | The Lancet Global Health | 10.1016/S2214-109X(19)30463-2 | Background: The goal of universal health coverage (UHC) requires that everyone receive needed health services, and that families who get needed services do not suffer undue financial hardship. Tracking progress towards UHC requires measurement of both these dimensions, and a way of trading them off against one another. Methods: We measured service coverage by a weighted geometric average of four prevention indicators (antenatal care, full immunisation, and screening for breast and cervical cancers) and four treatment indicators (skilled birth attendance, inpatient admission, and treatment for acute respiratory infection and diarrhoea), financial protection by the incidence of catastrophic health expenditures (those exceeding 10% of household consumption or income), and a country's UHC performance as a geometric average of the service coverage index and the complement of the incidence of catastrophic expenditures. Where possible, we adjusted service coverage for inequality, penalising countries with a high level of inequality. The bulk of data used in this study were from the World Bank's Health Equity and Financial Protection Indicators database (2019 version), comprising data from household surveys. Gaps in the data were supplemented with other survey data and (where necessary) non-survey data from other sources (administrative, modelled, and imputed data). Findings: A low incidence of catastrophic expenses sometimes reflects low service coverage (often in low-income countries) but sometimes occurs despite high service coverage (often in high-income countries). At a given level of service coverage, financial protection also varies. UHC index scores are generally higher in higher-income countries, but there are variations within income groups. Adjusting the UHC index for inequality in service coverage makes little difference in some countries, but reduces it by more than 10% in others. Seven of the 12 countries for which we were able to produce trend data have increased their UHC index over time (with the greatest average yearly increases seen in Ghana [1·43%], Indonesia [1·85%], and Vietnam [2·26%]), mostly by improving both financial protection and service coverage. Some increased their UHC index, despite reductions in financial protection, by substantially increasing their service coverage. The UHC index decreased in five of 12 countries with trend data, mostly because financial protection worsened with stagnant or declining service coverage. Our UHC indicators (except inpatient admissions) are significantly and positively associated with GDP per capita, and most are correlated with the share of health spending channelled through social health insurance and government schemes. However, associations of our UHC indicators with the share of GDP spent on health and the shares of health spending channelled through non-profit and private insurance are ambiguous. Interpretation: Progress towards UHC can be tracked using an index that captures both service coverage and financial protection. Although per-capita income is a good predictor of a country's UHC index score, some countries perform better than others in the same income group or even in the income group above their own. Strong UHC performance is correlated with the share of a country's health budget that is channelled through government and social health insurance schemes. Funding: None. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
3 | Journal Article | 2018 | Van Weel, Chris; Kidd, Michael R. | Why strengthening primary health care is essential to achieving universal health coverage | CMAJ | 10.1503/cmaj.170784 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
4 | Journal Article | 2017 | Veillard, Jeremy; Cowling, Krycia; Bitton, Asaf; Ratcliffe, Hannah; Kimball, Meredith; Barkley, Shannon; Mercereau, Laure; Wong, Ethan; Taylor, Chelsea; Hirschhorn, Lisa R.; Wang, Hong | Better Measurement for Performance Improvement in Low- and Middle-Income Countries: The Primary Health Care Performance Initiative (PHCPI) Experience of Conceptual Framework Development and Indicator Selection | Milbank Quarterly | 10.1111/1468-0009.12301 | Policy Points: Strengthening accountability through better measurement and reporting is vital to ensure progress in improving quality primary health care (PHC) systems and achieving universal health coverage (UHC). The Primary Health Care Performance Initiative (PHCPI) provides national decision makers and global stakeholders with opportunities to benchmark and accelerate performance improvement through better performance measurement. Results from the initial PHC performance assessments in low- and middle-income countries (LMICs) are helping guide PHC reforms and investments and improve the PHCPI's instruments and indicators. Findings from future assessment activities will further amplify cross-country comparisons and peer learning to improve PHC. New indicators and sources of data are needed to better understand PHC system performance in LMICs. Context: The Primary Health Care Performance Initiative (PHCPI), a collaboration between the Bill and Melinda Gates Foundation, The World Bank, and the World Health Organization, in partnership with Ariadne Labs and Results for Development, was launched in 2015 with the aim of catalyzing improvements in primary health care (PHC) systems in 135 low- and middle-income countries (LMICs), in order to accelerate progress toward universal health coverage. Through more comprehensive and actionable measurement of quality PHC, the PHCPI stimulates peer learning among LMICs and informs decision makers to guide PHC investments and reforms. Instruments for performance assessment and improvement are in development; to date, a conceptual framework and 2 sets of performance indicators have been released. Methods: The PHCPI team developed the conceptual framework through literature reviews and consultations with an advisory committee of international experts. We generated 2 sets of performance indicators selected from a literature review of relevant indicators, cross-referenced against indicators available from international sources, and evaluated through 2 separate modified Delphi processes, consisting of online surveys and in-person facilitated discussions with experts. Findings: The PHCPI conceptual framework builds on the current understanding of PHC system performance through an expanded emphasis on the role of service delivery. The first set of performance indicators, 36 Vital Signs, facilitates comparisons across countries and over time. The second set, 56 Diagnostic Indicators, elucidates underlying drivers of performance. Key challenges include a lack of available data for several indicators and a lack of validated indicators for important dimensions of quality PHC. Conclusions: The availability of data is critical to assessing PHC performance, particularly patient experience and quality of care. The PHCPI will continue to develop and test additional performance assessment instruments, including composite indices and national performance dashboards. Through country engagement, the PHCPI will further refine its instruments and engage with governments to better design and finance primary health care reforms. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
5 | Journal Article | 2021 | Ssennyonjo, Aloysius; Van Belle, Sara; Titeca, Kristof; Criel, Bart; Ssengooba, Freddie | Multisectoral action for health in low-income and middle-income settings: How can insights from social science theories inform intragovernmental coordination efforts? | BMJ Global Health | 10.1136/bmjgh-2020-004064 | There is consensus in global health on the need for multisectoral action (MSA) to address many contemporary development challenges, but there is limited action. Examples of issues that require coordinated MSA include the determinants of health conditions such as nutrition (malnutrition and obesity) and chronic non-communicable diseases. Nutrition, tobacco control and such public health issues are regulated separately by health, trade and treasury ministries. Those issues need to be coordinated around the same ends to avoid conflicting policies. Despite the need for MSA, why do we see little progress? We investigate the obstacles to and opportunities for MSA by providing a government perspective. This paper draws on four theoretical perspectives, namely (1) the political economy perspective, (2) principal-agent theory, (3) resource dependence theory and (4) transaction cost economics theory. The theoretical framework provides complementary propositions to understand, anticipate and prepare for the emergence and structuring of coordination arrangements between government organisations at the same or different hierarchical levels. The research on MSA for health in low/middle-income countries needs to be interested in a multitheory approach that considers several theoretical perspectives and the contextual factors underlying coordination practices. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
6 | Journal Article | 2018 | Sood, Neeraj; Wagner, Zachary | Social health insurance for the poor: Lessons from a health insurance programme in Karnataka, India | BMJ Global Health | 10.1136/bmjgh-2017-000582 | Life-saving technology used to treat catastrophic illnesses such as heart disease and cancer is often out of reach for the poor. As life expectancy increases in poor countries and the burden from chronic illnesses continues to rise, so will the unmet need for expensive tertiary care. Understanding how best to increase access to and reduce the financial burden of expensive tertiary care is a crucial task for the global health community in the coming decades. In 2010, Karnataka, a state in India, rolled out the Vajpayee Arogyashree scheme (VAS), a social health insurance scheme focused on increasing access to tertiary care for households below the poverty line. VAS was rolled out in a way that allowed for robust evaluation of its causal effects and several studies have examined various impacts of the scheme on poor households. In this analysis article, we summarise the key findings and assess how these findings can be used to inform other social health insurance schemes. First, the evidence suggests that VAS led to a substantial reduction in mortality driven by increased tertiary care utilisation as well as use of better quality facilities and earlier diagnosis. Second, VAS significantly reduced the financial burden of receiving tertiary care. Third, these benefits of social health insurance were achieved at a reasonable cost to society and taxpayers. Several unique features of VAS led to its success at improving health and financial well-being including effective outreach via health camps, targeting expensive conditions with high disease burden, easy enrolment process, cashless treatment, bundled payment for hospital services, participation of both public and private hospitals and prior authorisation to improve appropriateness of care. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
7 | Journal Article | 2021 | Sheikh, Kabir; Ghaffar, Abdul | PRIMASYS: a health policy and systems research approach for the assessment of country primary health care systems | Health Research Policy and Systems | 10.1186/s12961-021-00692-3 | For the renewed global impetus on primary health care (PHC) to translate into action at a country level, it will be important to strengthen existing ways of understanding and assessing country PHC systems. The architecture and performance of primary care systems are widely acknowledged to be crucial determinants of the health of populations in high-income countries as well as in low- and middle-income countries. There is no one-size-fits-all model of a country-level PHC system, and countries have implemented diverse models, adapted to and conditioned by their respective social, economic and political contexts. This paper applies advances in the field of health policy and systems research (HPSR) to propose an approach to the assessment of country PHC systems, using a compendium of 70 elements of enquiry requiring mixed quantitative and qualitative assessment. The approach and elements of enquiry were developed based on a review of policy and guidance documents and literature on PHC and HPSR and were finalized as part of a consultation of experts on PHC. Key features of the approach include sensitivity to context, flexibility in allowing for in-depth enquiry where necessary, systems thinking, a learning emphasis, and complementarity with existing frameworks and efforts. Implemented in 20 countries to date, the approach is anticipated to have further utility in a single country as well as in comparative assessments of PHC systems. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
8 | Journal Article | 2019 | Sharma, Atul; Prinja, Shankar; Aggarwal, Arun Kumar | Comprehensive measurement of health system performance at district level in India: Generation of a composite index | International Journal of Health Planning and Management | 10.1002/hpm.2895 | There have been limited attempts at measurement of health system performance at decentralized levels in low- and middle-income countries. This study was undertaken to develop a composite indicator to measure health system performance at district level in India. Primary data were collected from 377 public health facilities in 21 districts of Haryana state in India using health facility surveys. In addition, 1700 health care providers and 800 clients visiting health facilities were interviewed. Routine health management information system data at district and state level were also analyzed. These data were used for computing 67 input and process indicators covering six health system building blocks. Indicators were normalized and aggregated to generate domain-specific and overall composite health system performance index (HSPI) for each district. Several sensitivity analyses were performed to assess robustness of results. Overall, Panchkula and Ambala districts were found to be the best performing in the state (with HSPI scores of 0.64 and 0.62 out of 1), while Mewat, Faridabad, and Palwal districts had the poorest performance (with HSPI scores of 0.46, 0.49, and 0.48 out of 1). Significant variation in performance was observed for each health system building block. Sensitivity analyses results showed that study findings were robust to variations in methods of aggregation of indicators. Our study provides a framework and methods to measure health system performance at district level in a comprehensive manner. The composite indicator provides a summary snapshot to benchmark performance, while building block and domain scores provide critical information for programmatic action. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
9 | Journal Article | 2019 | Scott, Kerry; George, Asha S.; Ved, Rajani R. | Taking stock of 10 years of published research on the ASHA programme: Examining India's national community health worker programme from a health systems perspective | Health Research Policy and Systems | 10.1186/s12961-019-0427-0 | Background: As India's accredited social health activist (ASHA) community health worker (CHW) programme enters its second decade, we take stock of the research undertaken and whether it examines the health systems interfaces required to sustain the programme at scale. Methods: We systematically searched three databases for articles on ASHAs published between 2005 and 2016. Articles that met the inclusion criteria underwent analysis using an inductive CHW-health systems interface framework. Results: A total of 122 academic articles were identified (56 quantitative, 29 mixed methods, 28 qualitative, and 9 commentary or synthesis); 44 articles reported on special interventions and 78 on the routine ASHA program. Findings on special interventions were overwhelmingly positive, with few negative or mixed results. In contrast, 55% of articles on the routine ASHA programme showed mixed findings and 23% negative, with few indicating overall positive findings, reflecting broader system constraints. Over half the articles had a health system perspective, including almost all those on general ASHA work, but only a third of those with a health condition focus. The most extensively researched health systems topics were ASHA performance, training and capacity-building, with very little research done on programme financing and reporting, ASHA grievance redressal or peer communication. Research tended to be descriptive, with fewer influence, explanatory or exploratory articles, and no predictive or emancipatory studies. Indian institutions and authors led and partnered on most of the research, wrote all the critical commentaries, and published more studies with negative results. Conclusion: Published work on ASHAs highlights a range of small-scale innovations, but also showcases the challenges faced by a programme at massive scale, situated in the broader health system. As the programme continues to evolve, critical comparative research that constructively feeds back into programme reforms is needed, particularly related to governance, intersectoral linkages, ASHA solidarity, and community capacity to provide support and oversight. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
10 | Journal Article | 2020 | Sacks, Emma; Schleiff, Meike; Were, Miriam; Chowdhury, Ahmed Mushtaque; Perry, Henry B. | Communities, universal health coverage and primary health care | Bulletin of the World Health Organization | 10.2471/BLT.20.252445 | Universal health coverage (UHC) depends on a strong primary health-care system. To be successful, primary health care must be expanded at community and household levels as much of the world’s population still lacks access to health facilities for basic services. Abundant evidence shows that community-based interventions are effective for improving health-care utilization and outcomes when integrated with facility-based services. Community involvement is the cornerstone of local, equitable and integrated primary health care. Policies and actions to improve primary health care must regard community members as more than passive recipients of health care. Instead, they should be leaders with a substantive role in planning, decision-making, implementation and evaluation. Advancing the science of primary health care requires improved conceptual and analytical frameworks and research questions. Metrics used for evaluating primary health care and UHC largely focus on clinical health outcomes and the inputs and activities for achieving them. Little attention is paid to indicators of equitable coverage or measures of overall well-being, ownership, control or priority-setting, or to the extent to which communities have agency. In the future, communities must become more involved in evaluating the success of efforts to expand primary health care. Much of primary health care has taken place, and will continue to take place, outside health facilities. Involving community members in decisions about health priorities and in community-based service delivery is key to improving systems that promote access to care. Neither UHC nor the Health for All movement will be achieved without the substantial contribution of communities. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
11 | Journal Article | 2019 | Sacks, Emma; Morrow, Melanie; Story, William T; Shelley, Katharine D; Shanklin, D; Rahimtoola, Minal; Rosales, Alfonso; Ibe, Ochiawunma; Sarriot, Eric | Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all | BMJ Global Health | 10.1136/bmjgh-2018-001384 | Achieving ambitious health goals—from the Every Woman Every Child strategy to the health targets of the sustainable development goals to the renewed promise of Alma-Ata of ‘health for all’—necessitates strong, functional and inclusive health systems. Improving and sustaining community health is integral to overall health systems strengthening efforts. However, while health systems and community health are conceptually and operationally related, the guidance informing health systems policymakers and financiers—particularly the well-known WHO ‘building blocks’ framework—only indirectly addresses the foundational elements necessary for effective community health. Although community-inclusive and community-led strategies may be more difficult, complex, and require more widespread resources than facility-based strategies, their exclusion from health systems frameworks leads to insufficient attention to elements that need ex-ante efforts and investments to set community health effectively within systems. This paper suggests an expansion of the WHO building blocks, starting with the recognition of the essential determinants of the production of health. It presents an expanded framework that articulates the need for dedicated human resources and quality services at the community level; it places strategies for organising and mobilising social resources in communities in the context of systems for health; it situates health information as one ingredient of a larger block dedicated to information, learning and accountability; and it recognises societal partnerships as critical links to the public health sector. This framework makes explicit the oft-neglected investment needs for community health and aims to inform efforts to situate community health within national health systems and global guidance to achieve health for all. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
12 | Journal Article | 2020 | Rifkin, Susan B. | Paradigms, policies and people: The future of primary health care | BMJ Global Health | 10.1136/bmjgh-2019-002254 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
13 | Journal Article | 2011 | Reddy, K. Srinath; Patel, Vikram; Jha, Prabhat; Paul, Vinod K.; Kumar, A. K.Shiva; Dandona, Lalit | Towards achievement of universal health care in India by 2020: A call to action | The Lancet | 10.1016/S0140-6736(10)61960-5 | To sustain the positive economic trajectory that India has had during the past decade, and to honour the fundamental right of all citizens to adequate health care, the health of all Indian people has to be given the highest priority in public policy. We propose the creation of the Integrated National Health System in India through provision of universal health insurance, establishment of autonomous organisations to enable accountable and evidence-based good-quality health-care practices and development of appropriately trained human resources, the restructuring of health governance to make it coordinated and decentralised, and legislation of health entitlement for all Indian people. The key characteristics of our proposal are to strengthen the public health system as the primary provider of promotive, preventive, and curative health services in India, to improve quality and reduce the out-of-pocket expenditure on health care through a well regulated integration of the private sector within the national health-care system. Dialogue and consensus building among the stakeholders in the government, civil society, and private sector are the next steps to formalise the actions needed and to monitor their achievement. In our call to action, we propose that India must achieve health care for all by 2020. © 2011 Elsevier Ltd. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
14 | Journal Article | 2011 | Rao, Mohan; Rao, Krishna D.; Kumar, Ak Shiva; Chatterjee, Mirai; Sundararaman, Thiagarajan | Human resources for health in India | The Lancet | 10.1016/S0140-6736(10)61888-0 | India has a severe shortage of human resources for health. It has a shortage of qualified health workers and the workforce is concentrated in urban areas. Bringing qualified health workers to rural, remote, and underserved areas is very challenging. Many Indians, especially those living in rural areas, receive care from unqualified providers. The migration of qualified allopathic doctors and nurses is substantial and further strains the system. Nurses do not have much authority or say within the health system, and the resources to train them are still inadequate. Little attention is paid during medical education to the medical and public health needs of the population, and the rapid privatisation of medical and nursing education has implications for its quality and governance. Such issues are a result of underinvestment in and poor governance of the health sector - two issues that the government urgently needs to address. A comprehensive national policy for human resources is needed to achieve universal health care in India. The public sector will need to redesign appropriate packages of monetary and non-monetary incentives to encourage qualified health workers to work in rural and remote areas. Such a policy might also encourage task-shifting and mainstreaming doctors and practitioners who practice traditional Indian medicine (ayurveda, yoga and naturopathy, unani, and siddha) and homoeopathy to work in these areas while adopting other innovative ways of augmenting human resources for health. At the same time, additional investments will be needed to improve the relevance, quantity, and quality of nursing, medical, and public health education in the country. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
15 | Journal Article | 2012 | Rao, M Govinda; Choudhury, Mita | Health Care Financing Reforms in India | 2012-100 | This chapter analyzes public spending on health care in India. The second section presents the salient features of the health care system in India and the health status of the population. The third section examines the impact of low levels of public expenditures on the state of health infrastructure in India. The fourth section discusses recent reforms for increasing allocation to health. The fifth section discusses the transfer system and analyses expenditure needs of States to provide essential health infrastructure. It also analyzes the fiscal space for health care in terms of stimulation and substitution effects of central transfers for health to states. The final section summarizes the main findings. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
16 | Journal Article | 2017 | Rasanathan, Kumanan; Bennett, Sara; Atkins, Vincent; Beschel, Robert; Carrasquilla, Gabriel; Charles, Jodi; Dasgupta, Rajib; Emerson, Kirk; Glandon, Douglas; Kanchanachitra, Churnrurtai; Kingsley, Pete; Matheson, Don; Mbabu, Rees Murithi; Mwansambo, Charles; Myers, Michael; Paul, Jeremias; Radebe, Thulisile; Smith, James; Solar, Orielle; Soucat, Agnès; Ssennyonjo, Aloysius; Wismar, Matthias; Zaidi, Shehla | Governing multisectoral action for health in low- and middle-income countries | PLoS Medicine | 10.1371/journal.pmed.1002285 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
17 | Journal Article | 2020 | Rasanathan, Kumanan; Evans, Tim G. | Primary health care, the declaration of astana and COVID-19 | Bulletin of the World Health Organization | 10.2471/BLT.20.252932 | Four decades after the Declaration of Alma-Ata, its vision of health for all and strategy of primary health care are still an inspiration to many people. In this article we evaluate the current status of primary health care in the era of the Declaration of Astana, the sustainable development goals, universal health coverage and the coronavirus disease 2019 pandemic. We consider how best to guide greater application of the primary health care strategy, reflecting on tensions that remain between the political vision of primary health care and its implementation in countries. We also consider what is required to support countries to realize the aspirations of primary health care, arguing that national needs and action must dominate over global preoccupations. Changing contexts and realities need to be accommodated. A clear distinction is needed between primary health care as an inspirational vision and set of values for health development, and primary health care as policy and implementation space. To achieve this vision, political action is required. Stakeholders beyond the health sector will often need to lead, which is challenging because the concept of primary health care is poorly understood by other sectors. Efforts on primary health care as policy and implementation space might focus explicitly on primary care and the frontline of service delivery with clear links and support to complementary work on social determinants and building healthy societies. Such efforts can be partial but important implementation solutions to contribute to the much bigger political vision of primary health care. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
18 | Journal Article | 2017 | Prinja, Shankar; Gupta, Rakesh; Bahuguna, Pankaj; Sharma, Atul; Kumar Aggarwal, Arun; Phogat, Amit; Kumar, Rajesh | A composite indicator to measure universal health care coverage in India: way forward for post-2015 health system performance monitoring framework | Health Policy and Planning | 10.1093/heapol/czw097 | https://academic.oup.com/heapol/article-lookup/doi/10.1093/heapol/czw097 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
19 | Journal Article | 2017 | Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh | Impact of publicly financed health insurance schemes on healthcare utilization and financial risk protection in India: A systematic review | PLoS ONE | 10.1371/journal.pone.0170996 | Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or higher financial risk protection. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
20 | Journal Article | 2016 | Panda, Bhuputra; Thakur, Harshad P. | Decentralization and health system performance - a focused review of dimensions, difficulties, and derivatives in India | BMC Health Services Research | 10.1186/s12913-016-1784-9 | Introduction: One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of 'decision space' at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of 'trust', 'convenience' and 'mutual benefits' to explain, define and measure components of governance in health. In the emerging 'continuum of health services' model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc.) through the prism of decentralization in the first place, and in establishing directed relationships among them. Methods: This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers) were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives. Results: Evaluation of local decision making and its effect on health system performance has been studied in a compartmentalized manner. There is sparse evidence about innovations attributable to decentralization. We observed that in India, there is very scant evaluative study on the subject. We didn't come across a single study examining the perception and experiences of local decision makers about the opportunities and challenges they faced. The existing body of evidences may be inadequate to feed into sound policy making. The principles of management hinge on measurement of inputs, processes and outputs. In the conceptual framework we propose three levels of functions (health systems functions, management functions and measurement functions) being intricately related to inputs, processes and outputs. Each level of function encompasses essential elements derived from the synthesis of information gathered through literature review and non-participant observation. We observed that it is difficult to quantify characteristics of governance at institutional, system and individual levels except through proxy means. Conclusion: There is an urgent need to sensitize governments and academia about how best more objective evaluation of 'shared governance' can be undertaken to benefit policy making. The future direction of enquiry should focus on context-specific evidence of its effect on the entire spectrum of health system, with special emphasis on efficiency, community participation, human resource management and quality of services. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
21 | Journal Article | 2024 | Oyugi, Boniface; Nizalova, Olena; Kendall, Sally; Peckham, Stephen | Does a free maternity policy in Kenya work? Impact and cost–benefit consideration based on demographic health survey data | European Journal of Health Economics | 10.1007/s10198-023-01575-w | This paper evaluates the overall effect of the Kenyan free maternity policy (FMP) on the main outcomes (early neonatal and neonatal deaths) and intermediate outcomes (delivery through Caesarean Section (CS), skilled birth attendance (SBA), birth in a public hospital and low birth weight (LBW)) using the 2014 Demographic Health Survey. We applied the difference-in-difference (DID) approach to compare births (to the same mothers) happening before and after the start of the policy (June 2013) and a limited cost–benefit analysis (CBA) to assess the net social benefit of the FMP. The probabilities of birth resulting in early neonatal and neonatal mortality are significantly reduced by 17–21% and 19–20%, respectively, after the FMP introduction. The probability of birth happening through CS reduced by 1.7% after implementing the FMP, while that of LBW birth is increased by 3.7% though not statistically significant. SBA and birth in a public facility did not moderate the policy’s effects on early neonatal mortality, neonatal mortality, and delivery through CS. They were not significant determinants of the policy effects on the outcomes. There is a significant causal impact of the FMP in reducing the probability of early neonatal and neonatal mortality, but not the delivery through CS. The FMP cost-to-benefit ratio was 21.22, and there were on average 4015 fewer neonatal deaths in 2013/2014 due to the FMP. The net benefits are higher than the costs; thus, there is a need to expand and sustainably fund the FMP to avert more neonatal deaths potentially. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
22 | Journal Article | 2020 | Noh, Kamaliah Mohamad; Mahmud, Siti Haniza; Ismail, Mohd Safiee; Ujang, Izzatur Rahmi Mohd; Rahman, Rusdi Abd; Chai, Koh Kar; Rashid, Rima Marhayu Abd; Mohamed, Nur Ezdiani; Othman, Akmal Aida; Ya’kub, Zurriyati; Hussein, Rozita Halina | Evaluation of primary health care (PHC)-universal health coverage (UHC) alignment using modified self-assessment tool in Malaysia | International Journal of Pharmaceutical Research | 10.31838/ijpr/2020.12.04.151 | In Malaysia, the provisions of healthcare are totally separated between the public and private sectors. The main provider of health services for the population has been the Ministry of Health (MOH). In the case of outpatient services, the people used both public and private service providers almost equally. Most of the services provided by the public sector are free of charge or heavily subsidised through public funding but the private sector sources of finance are household out-of-pocket payments. This study aimed to evaluate the PHC-UHC alignment using a modified self-assessment tool for PHC with UHC in Malaysia. A cross-sectional study was conducted from August to November 2014. Both quantitative and qualitative approaches were used in different parts of this study. A combination of purposive and convenient sampling of top-level managers from Ministry of Health technical and financial personnel, public and private providers as well as representatives from the Ministry of Finance and Economic Planning Unit were done and the tool applied through a combination of face-to-face interview and self-administered approach. The modified tool had successfully assessed the interaction between the financial institution and the factors influencing the delivery of PHC. The tool captured the alignment and misalignments pertaining to areas of priority setting, financing policies, payment policies, regulation and communications, and monitoring and evaluation. There is a significant dichotomy between public and private providers in Malaysia in terms of financing, payment and regulation. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
23 | Journal Article | 2020 | Nambiar, Devaki; Sankar, Hari; Negi, Jyotsna; Nair, Arun; Sadanandan, Rajeev | Field-testing of primary health-care indicators, india | Bulletin of the World Health Organization | 10.2471/BLT.19.249565 | Objective To develop a primary health-care monitoring framework and health outcome indicator list, and field-test and triangulate indicators designed to assess health reforms in Kerala, India, 2018–2019. Methods We used a modified Delphi technique to develop a 23-item indicator list to monitor primary health care. We used a multistage cluster random sampling technique to select one district from each of four district clusters, and then select both a family and a primary health centre from each of the four districts. We field-tested and triangulated the indicators using facility data and a population-based household survey. Findings Our data revealed similarities between facility and survey data for some indicators (e.g. low birth weight and pre-check services), but differences for others (e.g. acute diarrhoeal diseases in children younger than 5 years and blood pressure screening). We made four critical observations: (i) data are available at the facility level but in varying formats; (ii) established global indicators may not always be useful in local monitoring; (iii) operational definitions must be refined; and (iv) triangulation and feedback from the field is vital. Conclusion We observe that, while data can be used to develop indices of progress, interpretation of these indicators requires great care. In the attainment of universal health coverage, we consider that our observations of the utility of certain health indicators will provide valuable insights for practitioners and supervisors in the development of a primary health-care monitoring mechanism. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
24 | Journal Article | 2020 | Lahariya, Chandrakant; Roy, Bijit; Shukla, Abhay; Chatterjee, Mirai; De Graeve, Hilde; Jhalani, Manoj; Bekedam, Henk | Community action for health in India: evolution, lessons learnt and ways forward to achieve universal health coverage | WHO South-East Asia journal of public health | 10.4103/2224-3151.283002 | The role of civil society and community-based organizations in advancing universal health coverage and meeting the targets of the 2030 Agenda for Sustainable Development has received renewed recognition from major global initiatives. This article documents the evolution and lessons learnt through two decades of experience in India at national, state and district levels. Community and civil society engagement in health services in India began with semi-institutional mechanisms under programmes focused on, for example, HIV/AIDS, tuberculosis, polio and immunization. A formal system of community action for health (CAH) started with the launch of the National Rural Health Mission in 2005. By December 2018, CAH processes were being implemented in 22 states, 353 districts and more than 200 000 villages in India. Successive evaluations have indicated improved performance on various service delivery parameters. One example of CAH is community-based monitoring and planning, which has been continuously expanded and strengthened in Maharashtra since 2007. This involves regular, participatory auditing of public health services, which facilitates the involvement of people in assessing the public health system and demanding improvements. At district level, CAH initiatives are successfully reaching "last-mile" communities. The Self-Employed Women's Association, a cooperative-based organization of women working in the informal sector in Gujarat, has developed community information hubs that empower clients to access government social and health sector services. CAH initiatives in India are now being augmented by regular activities led and/or participated in by civil society organizations. This is contributing to the democratization of community and civil society engagement in health. Additional documentation on CAH and the further formalization of civil society engagement are needed. These developments provide a valuable opportunity both to improve governance and accountability in the health sector and to accelerate progress towards universal health coverage. Lessons learnt may be applicable to other countries in South-East Asia, as well as to most low- and middle-income countries. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
25 | Journal Article | 2020 | Nambiar, Devaki; Hari Sankar, D.; Negi, Jyotsna; Nair, Arun; Sadanandan, Rajeev | Monitoring universal health coverage reforms in primary health care facilities: Creating a framework, selecting and fieldtesting indicators in Kerala, India | PLoS ONE | 10.1371/journal.pone.0236169 | In line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with "no-one left behind"are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram's monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
26 | Journal Article | 2021 | Maurya, Dayashankar; Asher, Mukul | Sustainable health financing system for India: The economic perspective | National Medical Journal of India | 10.4103/0970-258X.326759 | Health policy discussions in India have primarily centred around the low level of public health financing, ignoring that total health expenditure in India is at par with many other countries with similar economic development. India spends 3.7% of its gross domestic product (GDP) on healthcare, but the health outcomes are not commensurate with spending. We argue that simply increasing public health spending will not improve health outcomes unless inefficiencies in the existing health financing arrangements, public as well as private, are addressed. Using economic reasoning, we identify several allocative and technical inefficiencies in existing health financing arrangements. We argue that increasing resource allocation in the present pattern of financing may even worsen the situation. We give recommendations to correct inefficiencies in current health financing arrangements before more allocations are made to improve the performance of the health financing system. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
27 | Journal Article | 2016 | Lê, Gillian; Morgan, Rosemary; Bestall, Janine; Featherstone, Imogen; Veale, Thomas; Ensor, Tim | Can service integration work for universal health coverage? Evidence from around the globe | Health Policy | 10.1016/j.healthpol.2016.02.007 | Universal health coverage (UHC) is at the heart of the new 2030 Agenda for Sustainable Development. Health service integration is seen by World Health Organization as an essential requirement to achieve UHC. However, to date the debate on service integration has focused on perceived benefits rather than empirical impact. We conducted a global review in a systematic manner searching for empirical outcomes of service integration experiments in UHC countries and those on the path to UHC. Sixty-seven articles and reports were found. We grouped results into a unique integration typology with six categories - medical staff from different disciplines; patients and medical staff; care package for one medical condition; care package for two or more medical conditions; specialist stand-alone services with GP services; community locations. We showed that it is possible to integrate services in different human development contexts delivering positive outcomes for patients and clinicians without incurring additional costs. However, the improved outcomes shown were incremental rather than radical and suggest that integration is likely to enhance already well established systems rather than fundamentally changing the outcomes of care. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
28 | Journal Article | 2018 | Lahariya, Chandrakant | ‘Ayushman Bharat’ Program and Universal Health Coverage in India | Indian Pediatrics | 10.1007/s13312-018-1341-1 | India’s National Health Policy 2017 (NHP-2017) has its goal fully aligned with the concept of Universal health coverage. The Ayushman Bharat Program announced in the Union budget 2018–19 of the Government of India, aims to carry NHP-2017 proposals forward. The Ayushman Bharat Program has two initiatives/components – Health and Wellness Centers, and National Health Protection Scheme – aiming for increased accessibility, availability and affordability of primary-, secondary- and tertiary-care health services in India. Afterwards, the second component has been renamed as Pradhan Mantri Rashtriya Swasthya Suraksha Mission. The new program has received an unprecedented public, political and media attention; and is being attributed to have placed health higher on political agenda. This review article analyzes and provides critical reflections, suggestions and way forward for rapid and effective implementation of Ayushman Bharat Program. To be effective and impactful in achieving the desired health outcomes, there is a need for getting both design and implementation of Ayushman Bharat Program right, from the very beginning. If implemented fully and supplemented with additional interventions, the program can prove a potential platform to reform Indian healthcare system and to accelerate India’s journey towards universal health coverage. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
29 | Journal Article | 2013 | Kutzin, Joseph | Health financing for universal coverage and health system performance: concepts and implications for policy | Bulletin of the World Health Organization | 10.2471/blt.12.113985 | Unless the concept is clearly understood, "universal coverage" (or universal health coverage, UHC) can be used to justify practically any health financing reform or scheme. This paper unpacks the definition of health financing for universal coverage as used in the World Health Organization's World health report 2010 to show how UHC embodies specific health system goals and intermediate objectives and, broadly, how health financing reforms can influence these. All countries seek to improve equity in the use of health services, service quality and financial protection for their populations. Hence, the pursuit of UHC is relevant to every country. Health financing policy is an integral part of efforts to move towards UHC, but for health financing policy to be aligned with the pursuit of UHC, health system reforms need to be aimed explicitly at improving coverage and the intermediate objectives linked to it, namely, efficiency, equity in health resource distribution and transparency and accountability. The unit of analysis for goals and objectives must be the population and health system as a whole. What matters is not how a particular financing scheme affects its individual members, but rather, how it influences progress towards UHC at the population level. Concern only with specific schemes is incompatible with a universal coverage approach and may even undermine UHC, particularly in terms of equity. Conversely, if a scheme is fully oriented towards system-level goals and objectives, it can further progress towards UHC. Policy and policy analysis need to shift from the scheme to the system level. Si le concept est correctement défini, la «couverture universelle» (ou la couverture maladie universelle, CMU) peut être utilisée pour justifier pratiquement toute réforme ou tout régime du financement des soins de santé. Ce document présente la définition du financement des soins de santé pour une couverture universelle, telle qu'elle apparaît dans le Rapport sur la santé dans le monde 2010 de l'Organisation mondiale de la Santé, afin de montrer comment la CMU incarne les objectifs spécifiques et intermédiaires du système de santé et, plus généralement, comment les réformes du financement du système de santé peuvent influencer ces objectifs.Tous les pays cherchent à améliorer l'équité dans l'utilisation des services de santé, dans la qualité des services et dans la protection financière des populations. Par conséquent, la survie de la CMU reste pertinente pour tous les pays. La politique de financement des soins de santé fait partie intégrante des efforts réalisés pour faire de la CMU une réalité, mais pour que cette politique de financement permette la survie de la CMU, les réformes du système de santé doivent viser explicitement l'amélioration de la couverture santé et les objectifs intermédiaires qui y sont liés, à savoir, l'efficacité, l'équité dans la répartition des ressources de la santé, ainsi que la transparence et la responsabilisation.L'unité d'analyse de ces objectifs doit prendre en compte la population et le système de santé dans son ensemble. Ce qui importe, ce n'est pas comment un système de financement particulier affecte chacun de ses membres, mais plutôt comment il influe sur les progrès et conduit vers une CMU à l'échelle des populations. Les préoccupations autour des programmes spécifiques sont incompatibles avec une approche de couverture universelle et peuvent même nuire à la CMU, notamment en termes d'équité. Et inversement, si un régime est pleinement orienté sur des objectifs systémiques, il peut étendre les progrès réalisés à la CMU. Les analyses des politiques et les politiques elles-mêmes doivent changer d'échelle pour passer du simple régime au système. A menos que se entienda el concepto con claridad, “cobertura universal” (o cobertura sanitaria universal) se puede utilizar para justificar casi cualquier reforma o plan de financiación sanitaria. El presente documento amplía la definición de financiación de la salud para una cobertura universal, tal y como se utiliza en el Informe sobre la salud en el mundo 2010 de la Organización Mundial de la Salud, a fin de mostrar cómo la cobertura sanitaria universal abarca los objetivos concretos e intermedios relacionados con los sistemas sanitarios y, en sentido amplio, cómo pueden influir en los mismos las reformas de financiación sanitaria.Todos los países pretenden mejorar la igualdad en la utilización de los servicios sanitarios, la calidad de estos y la protección financiera de su población. Por ello, la búsqueda de una cobertura sanitaria universal es importante para cada país. La política de financiación de la salud es un elemento esencial en los esfuerzos para avanzar hacia la cobertura sanitaria universal. Sin embargo, para que las estrategias de financiación de la salud estén en línea con la procura de la cobertura sanitaria universal, las reformas del sistema sanitario deben aspirar de forma explícita a mejorar la cobertura y los objetivos intermedios relacionados con esta, a saber, la eficacia, la igualdad en la distribución de los recursos, así como la transparencia y la responsabilidad.La unidad sobre la cual se deben analizar las metas y objetivos debe ser la población y el sistema sanitario en conjunto. Lo importante no es cómo un modelo particular de financiación afecta a cada uno de sus miembros, sino cómo influye en el progreso hacia la cobertura sanitaria universal a nivel de la población. Si únicamente concierne a proyectos concretos, será incompatible con un enfoque universal e incluso podría minar la cobertura sanitaria universal, particularmente en lo que respecta a la igualdad. Por el contrario, si un plan se enfoca por completo hacia los objetivos y las metas a nivel del sistema, se puede continuar avanzando hacia la cobertura sanitaria universal. Las estrategias y los análisis de estrategias tienen que cambiar desde el nivel del plan al nivel del sistema. يمكن استخدام "التغطية الشاملة" (أو التغطية الصحية الشاملة، UHC) لتبرير أي إصلاح أو مخطط في مجال التمويل الصحي بشكل عملي، ما لم يتم فهم المفهوم بوضوح. وتشرح هذه الورقة تعريف التمويل الصحي من أجل التغطية الشاملة وفق استخدامه في التقرير الخاص بالصحة في العالم لعام 2010 الصادر عن منظمة الصحة العالمية، لإيضاح مدى اشتمال التغطية الصحية الشاملة على مرامي معينة وأغراض متوسطة للنظام الصحي، والكيفية التي يمكن أن تؤثر بها إصلاحات التمويل الصحي عليها، على نحو واسع. تسعى جميع البلدان لتحسين الإنصاف في استخدام الخدمات الصحية وجودة الخدمات والحماية المالية لسكانها. ولذا، توجد صلة لهدف التغطية الصحية الشاملة بكل بلد. وتعد سياسة التمويل الصحي جزءاً لا يتجزأ من الجهود الرامية للتوجه صوب التغطية الصحية الشاملة، ولكن لكي تتماشى سياسة التمويل الصحي مع هدف التغطية الصحية الشاملة، يجب أن تستهدف إصلاحات النظم الصحية بوضوح تحسين التغطية والأغراض المتوسطة المرتبطة بها، وتحديدًا، الكفاءة والإنصاف في توزيع الموارد الصحية والشفافية والمساءلة. يجب أن تكون وحدة التحليل للمرامي والأغراض هي السكان والنظام الصحي ككل. وما يستحق الاهتمام ليس الكيفية التي يؤثر بها مخطط تمويلي معين على أعضائه الفرديين، وإنما هو الكيفية التي يؤثر بها على التقدم صوب التغطية الصحية الشاملة على الصعيد السكاني. ولا يتوافق القلق بشأن مخططات معينة فقط مع أسلوب التغطية الشاملة بل قد يقوض التغطية الصحية الشاملة، ولاسيما الإنصاف. وفي مقابل ذلك، إذا تم توجيه أحد المخططات بشكل كامل صوب المرامي والأغراض على مستوى النظام، فإنه يستطيع إحراز مزيد من التقدم صوب التغطية الصحية الشاملة. ويتعين أن تتحول السياسات وتحليل السياسات من المخطط إلى مستوى النظام. 除非概念非常清楚,“全面医保”(或全民健康保险,UHC)实际上可以用来证明任何医疗融资改革或计划。本文分析世界卫生组织的《2010年世界卫生报告》中使用的全面医保的卫生筹资定义,以说明UHC如何体现特定卫生系统目标和中间目标,并更广泛地说明卫生筹资改革如何影响这些目标。所有国家都追求提高其公民在使用卫生服务、服务质量和金融保护方面的公平性。因此,UHC目标对每个国家都很重要。卫生筹资政策是实现UHC的工作组成部分,但卫生筹资政策要与UHC目标看齐,卫生系统改革需要明确改善医保范围以及与其关联的中间目标,即在卫生资源分配、透明度和问责制方面的效率和公平。目的和目标的分析单位必须是整体人口与健康系统。重要的不是特定的筹资计划如何影响其个别成员,而是它如何影响群体水平上的UHC进展。只局限于具体方案的做法与合全民医保方法格格不入,甚至可能破坏UHC,在公平方面尤其如此。反之,如果计划完全面向系统层面的目标和目的,它可以进一步迈向UHC。政策和政策分析需要从计划转移到系统层面。 В отсутствие четкого понимания соответствующей концепции понятие «единая система» (или «единая система здравоохранения», ЕСЗ) может использоваться при обосновании практически любой реформы или схемы финансирования. В данной статье раскрыто понятие финансирования здравоохранения применительно к единой системе здравоохранения, которое используется в публикации «Доклад о состоянии здравоохранения в мире в 2010 году» Всемирной Организации Здравоохранения, чтобы продемонстрировать, как ЕСЗ реализует конкретные задачи системы здравоохранения и достигает ее промежуточных целей, а также показать в общих чертах, как на это могут повлиять реформы финансирования системы здравоохранения.Все государства стремятся к обеспечению равенства доступа населения к медицинским услугам, качеству обслуживания и финансовой защите. Поэтому стремление к созданию ЕСЗ свойственно каждому из них. Политика финансирования здравоохранения является составной частью усилий по продвижению к ЕСЗ, однако, чтобы она соответствовала стремлению к ЕСЗ, реформы системы здравоохранения должны быть четко направлены на улучшение охвата и достижение связанных с ним промежуточных целей, а именно, на эффективность, справедливое распределение ресурсов здравоохранения, обеспечение прозрачности и ответственности.Предметом анализа для определения целей и задач должны быть население и система здравоохранения в целом. Это подразумевает изучение не того, как конкретная схема финансирования воздействует на ее отдельных участников, а скорее того, как она влияет на продвижение к ЕСЗ на уровне населения. Интерес только к конкретным схемам несовместим с подходом, который подразумевается единой системой здравоохранения, и даже может подрывать принципы ЕСЗ, особенно в плане обеспечения справедливости. И наоборот, если схема полностью ориентирована на достижение целей и задач на уровне всей системы, она способна обеспечить дальнейшее продвижение к ЕСЗ. Политика и ее анализ должны перейти с уровня схемы на уровень системы. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
30 | Journal Article | 2015 | Kumar, Raman | Lack of social or political demand for good health care in India: Impact on unfolding universal health coverage | Journal of Family Medicine and Primary Care | 10.4103/2249-4863.152234 | The article presents the author's views on the lack of social or political demand for good health care in India. Topics discussed include a claim by the country's planning commission ex offcial that the political representatives often do not seek resources for health care, the widespread corruption in healthcare, and a proposal to have a Universal Health Coverage program. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
31 | Journal Article | 2018 | Kruk, Margaret E.; Gage, Anna D.; Arsenault, Catherine; Jordan, Keely; Leslie, Hannah H.; Roder-DeWan, Sanam; Adeyi, Olusoji; Barker, Pierre; Daelmans, Bernadette; Doubova, Svetlana V.; English, Mike; Elorrio, Ezequiel García; Guanais, Frederico; Gureje, Oye; Hirschhorn, Lisa R.; Jiang, Lixin; Kelley, Edward; Lemango, Ephrem Tekle; Liljestrand, Jerker; Malata, Address; Marchant, Tanya; Matsoso, Malebona Precious; Meara, John G.; Mohanan, Manoj; Ndiaye, Youssoupha; Norheim, Ole F.; Reddy, K. Srinath; Rowe, Alexander K.; Salomon, Joshua A.; Thapa, Gagan; Twum-Danso, Nana A.Y.; Pate, Muhammad | High-quality health systems in the Sustainable Development Goals era: time for a revolution | The Lancet Global Health | 10.1016/S2214-109X(18)30386-3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
32 | Journal Article | 2013 | Kringos, Dionne; Boerma, Wienke; Bourgueil, Yann; Cartier, Thomas; Dedeu, Toni; Hasvold, Toralf; Hutchinson, Allen; Lember, Margus; Oleszczyk, Marek; Rotar Pavlic, Danica; Svab, Igor; Tedeschi, Paolo; Wilm, Stefan; Wilson, Andrew; Windak, Adam; Van Der Zee, Jouke; Groenewegen, Peter | The strength of primary care in Europe: An international comparative study | British Journal of General Practice | 10.3399/bjgp13X674422 | Background: A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking. Aim: Evaluation of strength of primary care in Europe. Design and setting: International comparative cross-sectional study performed in 2009-2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey. Method: Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions of primary care, and primary care workforce development; and four dimensions of primary care service-delivery process: accessibility, comprehensiveness, continuity, and coordination of primary care. The primary care dimensions were operationalised by a total of 77 indicators for which data were collected in 31 countries. Data sources included national and international literature, governmental publications, statistical databases, and experts' consultations. Results: Countries with relatively strong primary care are Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK. Countries either have many primary care policies and regulations in place, combined with good financial coverage and resources, and adequate primary care workforce conditions, or have consistently only few of these primary care structures in place. There is no correlation between the access, continuity, coordination, and comprehensiveness of primary care of countries. Conclusion: Variation is shown in the strength of primary care across Europe, indicating a discrepancy in the responsibility given to primary care in national and international policy initiatives and the needed investments in primary care to solve, for example, future shortages of workforce. Countries are consistent in their primary care focus on all important structure dimensions. Countries need to improve their primary care information infrastructure to facilitate primary care performance management. ©British Journal of General Practice. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
33 | Journal Article | 2023 | Khatri, Resham B.; Erku, Daniel; Endalamaw, Aklilu; Wolka, Eskinder; Nigatu, Frehiwot; Zewdie, Anteneh; Assefa, Yibeltal | Multisectoral actions in primary health care: A realist synthesis of scoping review | PLoS ONE | 10.1371/journal.pone.0289816 | Background Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems. Methods We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley’s realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level). Results A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals’ social determinants of health. Conclusion Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
34 | Journal Article | 2012 | Kaur, Manmeet; Prinja, Shankar; Singh, PravinK; Kumar, Rajesh | Decentralization of health services in India: barriers and facilitating factors | WHO South-East Asia Journal of Public Health | 10.4103/2224-3151.206920 | Background: In India, the process of decentralization of health services started taking shape in the mid-1990s. Systemic reforms envisaged delegation of administrative and financial responsibilities at district level for management of health-care institutions in 23 states of India in 1999. Subsequently, some of these reforms became part of the National Rural Health Mission (NRHM) launched in 2005. This study aims to document the process of decentralization in health services with special reference to the barriers and facilitating factors encountered during formulation and implementation of reform policies. Methods: Secondary data were reviewed, health facilities were observed, and semi-structured interviews of the key actors involved in decentralization were carried out in Haryana (India). Results: Political and bureaucratic commitment to reforms was found to be the most important facilitating factor. Orientation training on decentralized administrative structures and performance- based resource distribution were the other important facilitators. Structural changes in administrative procedures led to improvement in the financial management system. Significant improvement in the public health infrastructure was observed. From 2004 to 2008, the state government increased the budget of health sector by nearly 60%. Frequent changes in the top administration at the state level hampered the decentralization process. Districts having a dynamic administrative leadership implemented decentralization more effectively than the rest. Conclusions: Decentralization of financial resources has improved the functioning of health services to some extent. Major policy decisions on decentralization of human resource management, increase in financial allocation, and greater involvement of community in decision- making are required. Key words: Health services, policy, programme, qualitative, decentralization, management. Introduction | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
35 | Journal Article | 2023 | Joseph, Jaison; Sankar, Hari; Benny, Gloria; Nambiar, Devaki | Who are the vulnerable, and how do we reach them? Perspectives of health system actors and community leaders in Kerala, India | BMC Public Health | 10.1186/s12889-023-15632-9 | Background: Among the core principles of the 2030 agenda of Sustainable Development Goals (SDGs) is the call to Leave no One behind (LNOB), a principle that gained resonance as the world contended with the COVID-19 pandemic. The south Indian state of Kerala received acclaim globally for its efforts in managing COVID-19 pandemic. Less attention has been paid, however, to how inclusive this management was, as well as if and how those “left behind” in testing, care, treatment, and vaccination efforts were identified and catered to. Filling this gap was the aim of our study. Methods: We conducted In-depth interviews with 80 participants from four districts of Kerala from July to October 2021. Participants included elected local self-government members, medical and public health staff, as well as community leaders. Following written informed consent procedures, each interviewee was asked questions about whom they considered the most “vulnerable” in their areas. They were also asked if there were any special programmes/schemes to support the access of “vulnerable” groups to general and COVID related health services, as well as other needs. Recordings were transliterated into English and analysed thematically by a team of researchers using ATLAS.ti 9.1 software. Results: The age range of participants was between 35 and 60 years. Vulnerability was described differentially by geography and economic context; for e.g., fisherfolk were identified in coastal areas while migrant labourers were considered as vulnerable in semi-urban areas. In the context of COVID-19, some participants reflected that everyone was vulnerable. In most cases, vulnerable groups were already beneficiaries of various government schemes within and beyond the health sector. During COVID, the government prioritized access to COVID-19 testing and vaccination among marginalized population groups like palliative care patients, the elderly, migrant labourers, as well as Scheduled Caste and Scheduled Tribes communities. Livelihood support like food kits, community kitchen, and patient transportation were provided by the LSGs to support these groups. This involved coordination between health and other departments, which may be formalised, streamlined and optimised in the future. Conclusion: Health system actors and local self-government members were aware of vulnerable populations prioritized under various schemes but did not describe vulnerable groups beyond this. Emphasis was placed on the broad range of services made available to these “left behind” groups through interdepartmental and multi-stakeholder collaboration. Further study (currently underway) may offer insights into how these communities – identified as vulnerable – perceive themselves, and whether/how they receive, and experience schemes designed for them. At the program level, inclusive and innovative identification and recruitment mechanisms need to be devised to identify populations who are currently left behind but may still be invisible to system actors and leaders. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
36 | Journal Article | 2014 | Joarder, Taufique; Sarker, Malabika | Achieving universal health coverage through community empowerment: A proposition for Bangladesh | Indian Journal of Community Medicine | 10.4103/0970-0218.137143 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
37 | Journal Article | 2018 | Hone, Thomas; Macinko, James; Millett, Christopher | Revisiting Alma-Ata: what is the role of primary health care in achieving the Sustainable Development Goals? | The Lancet | 10.1016/S0140-6736(18)31829-4 | The Sustainable Development Goals (SDGs) are now steering the global health and development agendas. Notably, the SDGs contain no mention of primary health care, reflecting the disappointing implementation of the Alma-Ata declaration of 1978 over the past four decades. The draft Astana declaration (Alma-Ata 2·0), released in June, 2018, restates the key principles of primary health care and renews these as driving forces for achieving the SDGs, emphasising universal health coverage. We use accumulating evidence to show that countries that reoriente their health systems towards primary care are better placed to achieve the SDGs than those with hospital-focused systems or low investment in health. We then argue that an even bolder approach, which fully embraces the Alma-Ata vision of primary health care, could deliver substantially greater SDG progress, by addressing the wider determinants of health, promoting equity and social justice throughout society, empowering communities, and being a catalyst for advancing and amplifying universal health coverage and synergies among SDGs. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
38 | Journal Article | 2013 | Evans, David B.; Hsu, Justine; Boerma, Ties | Universal health coverage and universal access | Bulletin of the World Health Organization | 10.2471/BLT.13.125450 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
39 | Journal Article | 2022 | Gulati, Kamal; Singh, Angel Rajan; Gupta, Shakti Kumar; Sarkar, Chitra | Strengthening leadership capacity: an unaddressed issue in Indian healthcare system | Leadership in Health Services | 10.1108/LHS-11-2021-0094 | Purpose: Leadership skills are vital for efficient delivery of health reforms. India, a low- and middle-income country, is transforming its public health care significantly. The health workforce, particularly doctors, however lacks leadership skills. This study aims to highlight the leadership skills gap and raise concerns about how India might achieve its ambitious health reforms in the lack of formal, prospective leadership training for its workforce. Design/methodology/approach: This study conducted nine management development programmes between 2012 and 2020 and collected data from 416 (N = 444, 94% response rate) health-care professionals using a questionnaire. Participants were asked to inform leadership challenges that they perceived critical. A total of 47 unique challenges were identified, which were distributed across five domains of American College of Healthcare Executives Competency Assessment Tool (2020). Relevant information was also obtained from review of secondary sources including journal articles from scientific and grey literature and government websites. Findings: Majority of participants (85.36%) had never attended any management training and were from public sector (56.1%). Mean total experience was 18 years. Top 5 challenges were lack of motivation (54.26%), communication (52.38%), contracts management (48.31%), leadership skills (47.26%) and retention of workforce (45.56%). Maximum challenges (29) were in domain of business skills and knowledge, followed by knowledge of health-care environment (9), leadership, professionalism, and communication and relationship management (3 each). Originality/value: In absence of the leadership training, senior health professionals particularly doctors in India, suffer leadership challenges. Efforts should be made to strengthen leadership capacity in Indian health-care system to advance the country’s ongoing national health reforms. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
40 | Journal Article | 2023 | Dubey, Sweta; Deshpande, Swasti; Krishna, Lokesh; Zadey, Siddhesh | Evolution of Government-funded health insurance for universal health coverage in India | The Lancet Regional Health - Southeast Asia | 10.1016/j.lansea.2023.100180 | India has run multiple Government-Funded Health Insurance schemes (GFHIS) over the past decades to ensure affordable healthcare. We assessed GFHIS evolution with a special focus on two national schemes - Rashtriya Swasthya Bima Yojana (RSBY) and Pradhan Mantri Jan Arogya Yojana (PMJAY). RSBY suffered from a static financial coverage cap, low enrollment, inequitable service supply, utilization, etc. PMJAY expanded coverage and mitigated some of RSBY's drawbacks. Investigating equity in PMJAY's supply and utilization across geography, sex, age, social groups, and healthcare sectors depicts several systemic skews. Kerala and Himachal Pradesh with low poverty and disease burden use more services. Males are more likely to seek care under PMJAY than females. Mid-age population (19–50 years) is a common group availing services. Scheduled Caste and Scheduled Tribe people have low service utilization. Most hospitals providing services are private. Such inequities can lead the most vulnerable populations further into deprivation due to healthcare inaccessibility. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
41 | Journal Article | 2004 | Cueto, Marcos | The origins of primary health care and selective primary health care | American Journal of Public Health | 10.2105/AJPH.94.11.1864 | I present a historical study of the role played by the World Health Organization and UICEF in tlie emergence and diffusion of the concept of primary health care during the late 1970s and early 1980s. I have analyzed these organizations' political context, their leaders, the methodologies and technologies associated with the primary health care perspective, and the debates on the meaning of primary health care. These debates led to the development of an alternative, more restricted approach, known as selective primary health care. My study examined library and archival sources; I cite examples from Latin America. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
42 | Journal Article | 2014 | Boerma, Ties; Eozenou, Patrick; Evans, David; Evans, Tim; Kieny, Marie Paule; Wagstaff, Adam | Monitoring Progress towards Universal Health Coverage at Country and Global Levels | PLoS Medicine | 10.1371/journal.pmed.1001731 | Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population. This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC. The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
43 | Journal Article | 2017 | Bitton, Asaf; Ratcliffe, Hannah L.; Veillard, Jeremy H.; Kress, Daniel H.; Barkley, Shannon; Kimball, Meredith; Secci, Federica; Wong, Ethan; Basu, Lopa; Taylor, Chelsea; Bayona, Jaime; Wang, Hong; Lagomarsino, Gina; Hirschhorn, Lisa R. | Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries | Journal of General Internal Medicine | 10.1007/s11606-016-3898-5 | Primary health care (PHC) has been recognized as a core component of effective health systems since the early part of the twentieth century. However, despite notable progress, there remains a large gap between what individuals and communities need, and the quality and effectiveness of care delivered. The Primary Health Care Performance Initiative (PHCPI) was established by an international consortium to catalyze improvements in PHC delivery and outcomes in low- and middle-income countries through better measurement and sharing of effective models and practices. PHCPI has developed a framework to illustrate the relationship between key financing, workforce, and supply inputs, and core primary health care functions of first-contact accessibility, comprehensiveness, coordination, continuity, and person-centeredness. The framework provides guidance for more effective assessment of current strengths and gaps in PHC delivery through a core set of 25 key indicators (“Vital Signs”). Emerging best practices that foster high-performing PHC system development are being codified and shared around low- and high-income countries. These measurement and improvement approaches provide countries and implementers with tools to assess the current state of their PHC delivery system and to identify where cross-country learning can accelerate improvements in PHC quality and effectiveness. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
44 | Journal Article | 2021 | Bhatia, M.; Dwivedi, L. K.; Banerjee, K.; Bansal, A.; Ranjan, M.; Dixit, P. | Pro-poor policies and improvements in maternal health outcomes in India | BMC Pregnancy and Childbirth | 10.1186/s12884-021-03839-w | Background: Since 2005, India has experienced an impressive 77% reduction in maternal mortality compared to the global average of 43%. What explains this impressive performance in terms of reduction in maternal mortality and improvement in maternal health outcomes? This paper evaluates the effect of household wealth status on maternal mortality in India, and also separates out the performance of the Empowered Action Group (EAG) states and the Southern states of India. The results are discussed in the light of various pro-poor programmes and policies designed to reduce maternal mortality and the existing supply side gaps in the healthcare system of India. Using multiple sources of data, this study aims to understand the trends in maternal mortality (1997–2017) between EAG and non EAG states in India and explore various household, economic and policy factors that may explain reduction in maternal mortality and improvement in maternal health outcomes in India. Methods: This study triangulates data from different rounds of Sample Registration Systems to assess the trend in maternal mortality in India. It further analysed the National Family Health Surveys (NFHS). NFHS-4, 2015–16 has gathered information on maternal mortality and pregnancy-related deaths from 601,509 households. Using logistic regression, we estimate the association of various socio-economic variables on maternal deaths in the various states of India. Results: On an average, wealth status of the households did not have a statistically significant association with maternal mortality in India. However, our disaggregate analysis reveals, the gains in terms of maternal mortality have been unevenly distributed. Although the rich-poor gap in maternal mortality has reduced in EAG states such as Bihar, Odisha, Assam, Rajasthan, the maternal mortality has remained above the national average for many of these states. The EAG states also experience supply side shortfalls in terms of availability of PHC and PHC doctors; and availability of specialist doctors. Conclusions: The novel contribution of the present paper is that the association of household wealth status and place of residence with maternal mortality is statistically not significant implying financial barriers to access maternal health services have been minimised. This result, and India’s impressive performance with respect to maternal health outcomes, can be attributed to the various pro-poor policies and cash incentive schemes successfully launched in recent years. Community-level involvement with pivotal role played by community health workers has been one of the major reasons for the success of many ongoing policies. Policy makers need to prioritise the underperforming states and socio-economic groups within the states by addressing both demand-side and supply-side measures simultaneously mediated by contextual factors. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
45 | Journal Article | 2012 | Baru, Rama V. | A limiting perspective on universal coverage | Economic and Political Weekly | The report of the High Level Expert Group on Universal Health Coverage for India reaffirms the principles of universality and equity in access to healthcare and the central role public services have to play in bringing this about. However, the HLEG pays inadequate attention to regulating the deeply entrenched private health sector, which is not only embedded within an intricate and interdependent web of power relations, but also has a marked influence on policy. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
46 | Journal Article | 2021 | Asgari-Jirhandeh, Nima; Zapata, Tomas; Jhalani, Manoj | Strengthening Primary Health Care as a Means to Achieve Universal Health Coverage: Experience from India | Journal of Health Management | 10.1177/0972063421995004 | Compared to its peers, India has always spent far less on health. This is slowly changing as are the drivers that are forcing some of these changes. Demographical and epidemiological changes have moved the disease burden away from communicable and maternal and childhood diseases to non-communicable diseases. More people are city dwellers and achieving UHC is one of Sustainable Development Goals. To tackle these commitments and shifting demands, in 2017, there was a committed move towards improving primary health care by introducing comprehensive PHC through health and wellness centres. These centres are close to the community and by improving the quality of care given and increasing the range of services that they provide, there should be an increase in access to health. However, much needs to be done to ensure that these centres will provide high quality care to the local populations. Training the healthcare workers needed to staff these HWCs will take time. Keeping the required funding to expand the programme will be challenging in the current fiscal space. There is a need to integrate care and flow of funds between primary and secondary care and empowering local populations to engage in governance of the HWCs will take time. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
47 | Journal Article | 2020 | Assefa, Yibeltal; Hill, Peter S.; Gilks, Charles F.; Admassu, Mengesha; Tesfaye, Dessalegn; Van Damme, Wim | Primary health care contributions to universal health coverage, Ethiopia | Bulletin of the World Health Organization | 10.2471/BLT.19.248328 | Many global health institutions, including the World Health Organization, consider primary health care as the path towards achieving universal health coverage (UHC). However, there remain concerns about the feasibility and effectiveness of this approach in low-resource countries. Ethiopia has been implementing the primary health-care approach since the mid-1970s, with primary health care at the core of the health system since 1993. Nevertheless, comprehensive and systemic evidence on the practice and role of primary health care towards UHC is lacking in Ethiopia. We made a document review of publicly available qualitative and quantitative data. Using the framework of the Primary Health Care Performance Initiative we describe and analyse the practice of primary health care and identify successes and challenges. Implementation of the primary health-care approach in Ethiopia has been possible through policies, strategies and programmes that are aligned with country priorities. There has been a diagonal approach to disease control programmes along with health-systems strengthening, community empowerment and multisectoral action. These strategies have enabled the country to increase health services coverage and improve the population’s health status. However, key challenges remain to be addressed, including inadequate coverage of services, inequity of access, slow health-systems transition to provide services for noncommunicable diseases, inadequate quality of care, and high out-of-pocket expenditure. To resolve gaps in the health system and beyond, the country needs to improve its domestic financing for health and target disadvantaged locations and populations through a precision public health approach. These challenges need to be addressed through the whole sustainable development agenda. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
48 | Journal Article | 2023 | Allen, Luke N.; Pettigrew, Luisa M.; Exley, Josephine; Nugent, Rachel; Balabanova, Dina; Villar-Uribe, Manuela; Baatiema, Leonard; Shubber, Zara; Mugambi, Joy; Kidd, Michael; Zewdie, Anteneh; Padula, Inez; Abimbola, Seye | The role of Primary Health Care, primary care and hospitals in advancing Universal Health Coverage | BMJ Global Health | 10.1136/bmjgh-2023-014442 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
49 | Journal Article | 2023 | Alegre, J. C.; Sharma, Suneeta; Cleghorn, Farley; Avila, Carlos | Strengthening primary health care in low- and middle-income countries: furthering structural changes in the post-pandemic era | Frontiers in Public Health | 10.3389/fpubh.2023.1270510 | Strengthening primary health care (PHC) is the most cost-effective approach in low- and middle-income countries (LMICs) to achieve sustainable universal health coverage (UHC), protect against health shocks, and promote health and wellbeing for all people. It has been 45 years since PHC was put on the global agenda followed by multiple efforts to advocate for more funding and improved performance of PHC. Yet, investment in PHC is still insufficient and overall performance of PHC systems is weak in LMICs, resulting in increased vulnerability and poor health outcomes especially among marginalized populations. As countries recover from the COVID-19 pandemic, which exposed the fragility of PHC platforms, it is imperative to go beyond advocacy for PHC investments and make systemic changes to strengthen PHC as the foundation of resilient and equitable health systems. We propose five gamechangers to facilitate structural changes for strengthening PHC through a focused health systems approach: (i) integration of client-centered health services at PHC level; (ii) digitization of PHC services; (iii) efficiency gains invested in essential health services; (iv) strengthening management practices for PHC at district and facility levels; and (v) advancing community engagement for PHC. To be successful, the implementation of the gamechangers must be contextualized and focus on achieving sustainable health outcomes, and therefore use implementation approaches that link essential health services to health outcomes. Through this way countries will maximize the possibility of achieving UHC and attaining the ambitious health targets of the Sustainable Development Goals (SDGs) by 2030. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
50 | Journal Article | 2015 | Abiiro, Gilbert Abotisem; De Allegri, Manuela | Universal health coverage from multiple perspectives: A synthesis of conceptual literature and global debates | BMC International Health and Human Rights | 10.1186/s12914-015-0056-9 | Background: There is an emerging global consensus on the importance of universal health coverage (UHC), but no unanimity on the conceptual definition and scope of UHC, whether UHC is achievable or not, how to move towards it, common indicators for measuring its progress, and its long-term sustainability. This has resulted in various interpretations of the concept, emanating from different disciplinary perspectives. This paper discusses the various dimensions of UHC emerging from these interpretations and argues for the need to pay attention to the complex interactions across the various components of a health system in the pursuit of UHC as a legal human rights issue. Discussion: The literature presents UHC as a multi-dimensional concept, operationalized in terms of universal population coverage, universal financial protection, and universal access to quality health care, anchored on the basis of health care as an international legal obligation grounded in international human rights laws. As a legal concept, UHC implies the existence of a legal framework that mandates national governments to provide health care to all residents while compelling the international community to support poor nations in implementing this right. As a humanitarian social concept, UHC aims at achieving universal population coverage by enrolling all residents into health-related social security systems and securing equitable entitlements to the benefits from the health system for all. As a health economics concept, UHC guarantees financial protection by providing a shield against the catastrophic and impoverishing consequences of out-of-pocket expenditure, through the implementation of pooled prepaid financing systems. As a public health concept, UHC has attracted several controversies regarding which services should be covered: comprehensive services vs. minimum basic package, and priority disease-specific interventions vs. primary health care. Summary: As a multi-dimensional concept, grounded in international human rights laws, the move towards UHC in LMICs requires all states to effectively recognize the right to health in their national constitutions. It also requires a human rights-focused integrated approach to health service delivery that recognizes the health system as a complex phenomenon with interlinked functional units whose effective interaction are essential to reach the equilibrium called UHC. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
51 | Journal Article | 2024 | Mukherji, Arnab; Rao, Megha; Desai, Sapna; Subramanian, Sv; Kang, Gagandeep; Patel, Vikram | District-level monitoring of universal health coverage, India | Bulletin of the World Health Organization | 10.2471/BLT.23.290854 | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362688/pdf/BLT.23.290854.pdf | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
52 | Journal Article | 2017 | Leslie, Hannah H; Malata, Address; Ndiaye, Youssoupha; Kruk, Margaret E | Effective coverage of primary care services in eight high-mortality countries | BMJ Global Health | 10.1136/bmjgh-2017-000424 | https://gh.bmj.com/lookup/doi/10.1136/bmjgh-2017-000424 | Introduction Measurement of effective coverage (quality-corrected coverage) of essential health services is critical to monitoring progress towards the Sustainable Development Goal for health. We combine facility and household surveys from eight low-income and middle-income countries to examine effective coverage of maternal and child health services. Methods We developed indices of essential clinical actions for antenatal care, family planning and care for sick children from existing guidelines and used data from direct observations of clinical visits conducted in Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania and Uganda between 2007 and 2015 to measure quality of care delivered. We calculated healthcare coverage for each service from nationally representative household surveys and combined quality with utilisation estimates at the subnational level to quantify effective coverage. Results Health facility and household surveys yielded over 40 000 direct clinical observations and over 100 000 individual reports of healthcare utilisation. Coverage varied between services, with much greater use of any antenatal care than family planning or sick-child care, as well as within countries. Quality of care was poor, with few regions demonstrating more than 60% average performance of basic clinical practices in any service. Effective coverage across all eight countries averaged 28% for antenatal care, 26% for family planning and 21% for sick-child care. Coverage and quality were not strongly correlated at the subnational level; effective coverage varied by as much as 20% between regions within a country. Conclusion Effective coverage of three primary care services for women and children in eight countries was substantially lower than crude service coverage due to major deficiencies in care quality. Better performing regions can serve as examples for improvement. Systematic increases in the quality of care delivered—not just utilisation gains—will be necessary to progress towards truly beneficial universal health coverage. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
53 | Document | 2023 | Desai, Eesha; Feil, Cameron; Narkhede, Kiran Madhukar; Noonan, Caitlin Marie; Patel, Minjan Bharatbhai; Rovelo Velazquez, Natalia; Villar Uribe, Manuela | The Primary Health Care System of Gujarat - A Primary Health Care Performance Initiative Assessment | World Bank Document | http://documents.worldbank.org/curated/en/099121523193812567 | This report presents the findings of the Primary Health Care Performance Initiatives (PHCPI) assessment in Gujarat, conducted by the World Bank in consultation with the Health and Family Welfare Department and the government of Gujarat. The assessment provides an opportunity to understand the performance of Gujarat’s primary health care system, highlighting areas of strengths and opportunities to address ongoing challenges. The assessment uses the Primary Health Care Performance Initiatives framework, which organizes various domains and sub-domains of primary care, with emphasis on the processes of service delivery and performance. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
54 | Journal Article | 2010 | Evans, David B; Etienne, Carissa | Health systems financing and the path to universal coverage | Bulletin of the World Health Organization | 10.2471/BLT.10.078741 | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2878164/pdf/BLT.10.078741.pdf | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
55 | Document | 2010 | WHO | Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies | WHO Document | https://apps.who.int/iris/bitstream/handle/10665/258734/9789241564052-eng.pdf | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
56 | Document | 2016 | WHO | Framework on integrated, people-centred health services | WHO Document | http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_39-en.pdf?ua=1&ua=1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
57 | Document | 2018 | WHO | A vision for primary health care in the 21st century: Towards universal health coverage and the Sustainable Development Goals. | WHO Document | https://www.who.int/docs/default-source/primary-health/vision.pdf | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
58 | Document | 2020 | WHO | Operational framework for primary health care: transforming vision into action. | WHO Document | https://iris.who.int/bitstream/handle/10665/337641/9789240017832-eng.pdf | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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