Universal health coverage (UHC)—ensuring that everyone has access to quality, affordable health services when needed—can be a vehicle for improved equity, health, financial well-being, and economic development. In its 2013 report, Global Health 2035: A World Converging within a Generation, the Commission on Investing in Health made the case that pro-poor pathways towards UHC, which target the poor from the outset, are the most efficient way to achieve both improved health outcomes and increased financial protection (FP). Countries worldwide are now embarking on health system changes to move closer to achieving UHC, often with a clear pro-poor intent.
Much has been written about what steps countries have taken and are currently taking to: (1) set and expand guaranteed services, (2) develop health financing systems to fund guaranteed services and ensure FP, (3) ensure high-quality service availability and delivery, (4) improve governance and management of the health sector, and (5) strengthen other aspects of health systems to move closer to UHC. As background for a meeting on UHC implementation, held at the Rockefeller Foundation’s Bellagio Center, Italy, from 7–9 July 2015, we reviewed this body of literature, and conducted interviews with global UHC implementers and researchers. In this short policy brief, we synthesize the key messages from the literature and interviews.
Implementing Pro-Poor Universal Health CoverageHFG Project
From The Lancet Global Health: Countries worldwide are embarking on health system reforms that move them closer to UHC, in many cases with a clear pro-poor focus. Along the way, there is a wealth of guidance on the technical aspects of UHC, such as designing health service packages and developing health financing systems. However, there is very little practical guidance on how to implement these policies.
Motivated by a shared interest in helping to close this information gap, a diverse international group of 21 practitioners and academics, including ministry of health officials and representatives of global health agencies and foundations, convened at The Rockefeller Foundation’s Bellagio Center for a three-day workshop from July 7–9, 2015.
The participants shared their experiences of implementing UHC and discussed the limited evidence on how to implement UHC, focusing on a set of seven key “how” questions from across five domains of UHC.
Researching Purchasing to achieve the promise of Universal Health Coverageresyst
This presentation was given by Professor Kara Hanson at the BMC Health Services Research Conference, in July 2014.
The presentation illustrates the important role that strategic purchasing can play in achieving effective health coverage, and how the topic is being studied by researchers. It highlights RESYST's multi-country study of purchasing arrangements that is currently taking place in Nigeria, Kenya, Tanzania, South Africa, India, Thailand and Vietnam.
Health Financing for UHC – two sides of the coinHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
The purpose of this presentation is to equip audiences with the ability to:
Define universal health coverage (UHC) and understand the basic tenets of UHC
Identify how UHC fits in USAID’s health and poverty reduction strategies
Effectively communicate to country stakeholders how USAID can support a country’s progress towards UHC
Identify relevant UHC resources within the Office of Health Systems and USAID
The presentation is part of the “UHC Toolkit” and accompanies Universal Health Coverage: An Annotated Bibliography, and Universal Health Coverage: Frequently Asked Questions.
Universal Health Coverage: Frequently Asked QuestionsHFG Project
This brief answers several “frequently asked questions” (FAQ) on universal health coverage (UHC):
What is Universal Health Coverage (UHC)?
How does UHC align with USAID’s priorities?
How does UHC relate to broader goals for development, including the Sustainable Development Goals?
How is UHC measured?
What progress has been made towards UHC?
How does USAID support countries’ UHC efforts?
The FAQ accompanies Universal Health Coverage: An Annotated Bibliography, which presents resources that provide an overview of UHC and also delve into specific topics within UHC, such as measurement, health financing, and benefit plans. The bibliography also includes links to relevant websites that can provide additional resources.
Each year, the OHE sponsors a lecture that explores a timely issue in medicine or health economics. At the 22nd Annual Lecture, the issues and challenges of universal health care coverage in low- and middle-income countries were presented by Professor Anne Mills of the London School of Hygiene and Tropical Medicine.
The audio of this lecture now is available at http://news.ohe.org/2014/08/19/annual-lecture-2014-universal-health-coverage/
Monitoring progress towards universal health coverage at country and global l...The Rockefeller Foundation
A movement towards universal health coverage (UHC) – ensuring that everyone who needs health services is able to get them, without undue financial hardship – has been growing across the globe (1). This has led to a sharp increase in the demand for expertise, evidence and measures of progress and a push to make UHC one of the goals of the post-2015 development agenda (2). This paper proposes a framework for tracking country and global progress towards UHC; its aim is to inform and guide these discussions and assessment of both aggregate and equitable coverage of essential health services as well as financial protection. Monitoring progress towards these two components of UHC will be complementary and critical to achieving desirable health outcome goals, such as ending preventable deaths and promoting healthy life expectancy and also reducing poverty and protecting household incomes.
This paper was written jointly by the World Health Organization (WHO) and The World Bank Group on the basis of consultations and discussions with country representatives, technical experts and global health and development partners (3). A draft of this paper was posted online and circulated widely for consultation between December 2013 and February 2014. Nearly 70 submissions were received from countries, development partners, civil society, academics and other interested stakeholders. The feedback was synthesized and reviewed at a meeting of country and global experts in Bellagio, Italy, in March 2014 (4). The paper was modified to reflect the views emerging from these consultations.
Implementing Pro-Poor Universal Health CoverageHFG Project
From The Lancet Global Health: Countries worldwide are embarking on health system reforms that move them closer to UHC, in many cases with a clear pro-poor focus. Along the way, there is a wealth of guidance on the technical aspects of UHC, such as designing health service packages and developing health financing systems. However, there is very little practical guidance on how to implement these policies.
Motivated by a shared interest in helping to close this information gap, a diverse international group of 21 practitioners and academics, including ministry of health officials and representatives of global health agencies and foundations, convened at The Rockefeller Foundation’s Bellagio Center for a three-day workshop from July 7–9, 2015.
The participants shared their experiences of implementing UHC and discussed the limited evidence on how to implement UHC, focusing on a set of seven key “how” questions from across five domains of UHC.
Researching Purchasing to achieve the promise of Universal Health Coverageresyst
This presentation was given by Professor Kara Hanson at the BMC Health Services Research Conference, in July 2014.
The presentation illustrates the important role that strategic purchasing can play in achieving effective health coverage, and how the topic is being studied by researchers. It highlights RESYST's multi-country study of purchasing arrangements that is currently taking place in Nigeria, Kenya, Tanzania, South Africa, India, Thailand and Vietnam.
Health Financing for UHC – two sides of the coinHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
The purpose of this presentation is to equip audiences with the ability to:
Define universal health coverage (UHC) and understand the basic tenets of UHC
Identify how UHC fits in USAID’s health and poverty reduction strategies
Effectively communicate to country stakeholders how USAID can support a country’s progress towards UHC
Identify relevant UHC resources within the Office of Health Systems and USAID
The presentation is part of the “UHC Toolkit” and accompanies Universal Health Coverage: An Annotated Bibliography, and Universal Health Coverage: Frequently Asked Questions.
Universal Health Coverage: Frequently Asked QuestionsHFG Project
This brief answers several “frequently asked questions” (FAQ) on universal health coverage (UHC):
What is Universal Health Coverage (UHC)?
How does UHC align with USAID’s priorities?
How does UHC relate to broader goals for development, including the Sustainable Development Goals?
How is UHC measured?
What progress has been made towards UHC?
How does USAID support countries’ UHC efforts?
The FAQ accompanies Universal Health Coverage: An Annotated Bibliography, which presents resources that provide an overview of UHC and also delve into specific topics within UHC, such as measurement, health financing, and benefit plans. The bibliography also includes links to relevant websites that can provide additional resources.
Each year, the OHE sponsors a lecture that explores a timely issue in medicine or health economics. At the 22nd Annual Lecture, the issues and challenges of universal health care coverage in low- and middle-income countries were presented by Professor Anne Mills of the London School of Hygiene and Tropical Medicine.
The audio of this lecture now is available at http://news.ohe.org/2014/08/19/annual-lecture-2014-universal-health-coverage/
Monitoring progress towards universal health coverage at country and global l...The Rockefeller Foundation
A movement towards universal health coverage (UHC) – ensuring that everyone who needs health services is able to get them, without undue financial hardship – has been growing across the globe (1). This has led to a sharp increase in the demand for expertise, evidence and measures of progress and a push to make UHC one of the goals of the post-2015 development agenda (2). This paper proposes a framework for tracking country and global progress towards UHC; its aim is to inform and guide these discussions and assessment of both aggregate and equitable coverage of essential health services as well as financial protection. Monitoring progress towards these two components of UHC will be complementary and critical to achieving desirable health outcome goals, such as ending preventable deaths and promoting healthy life expectancy and also reducing poverty and protecting household incomes.
This paper was written jointly by the World Health Organization (WHO) and The World Bank Group on the basis of consultations and discussions with country representatives, technical experts and global health and development partners (3). A draft of this paper was posted online and circulated widely for consultation between December 2013 and February 2014. Nearly 70 submissions were received from countries, development partners, civil society, academics and other interested stakeholders. The feedback was synthesized and reviewed at a meeting of country and global experts in Bellagio, Italy, in March 2014 (4). The paper was modified to reflect the views emerging from these consultations.
Options for Developing a Collective Payment System and Co-payment Mechanism f...HFG Project
What follows is a draft proposal submitted by Health Finance & Governance (HFG) to local partners to present policy options for centralized reimbursement and co-payment. In this way, HFG provides much needed technical support to the Ministry of Health and other government agencies in Vietnam. Furthermore, this proposal illustrates the means by which HFG, through the Sustainable Finance Initiative (SFI), is facilitating domestic revenue generation and strengthening public financial management in support of HIV/AIDS treatment and care.
This presentation discusses IHME's research in public financing of health in developing countries, including study design, findings, study limitations, and recommendations for governments and future research.
For more information please visit www.healthmetricsandevaluation.org
Understanding the concept of Universal Health CoverageHFG Project
Presented during Day One of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Elaine Baruwa. More: https://www.hfgproject.org/hcf-training-nigeria
Universal Health Coverage (UHC) Day 12.12.14, NepalDeepak Karki
This presentation is made on the first ever Universal Health Coverage (UHC) Day 12.12.14 celebration in Nepal by Nepal Health Economics Association (NHEA).
Decentralizing Health Insurance in Nigeria: Legal Framework for State Health ...HFG Project
Presented during Day Three of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Jonathan Eke. More: https://www.hfgproject.org/hcf-training-nigeria
Overview of Ghana’s National Health Insurance SchemeHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Universal health coverage was established in the WHO constitution of 1948 declaring health a fundamental human right.The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.
Japan has made numerous achievements in health most notably the world’s highest life-expectancy in the past two decades, since its founding Universal Health Insurance System in 1961. However, ageing population with low-fertility rates, stagnating economy, increasing burden of NCDs and growing use of expensive technologies pose the critical challenges in service delivery and financial stability in health. Japan HiT reports current health system reforms undertaken and also recent discussion on paradigm shift to the new system as proposed in Japan Vision: Health Care 2035.
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
As the burden of NCDs increases, various countries have introduced new and innovative modes of managing them in primary healthcare setting. APO, in conjunction with Duke Kunshan University, China, conducted a 4-country study (Bangladesh, China, Nepal and Viet Nam) to understand the different approaches used in involving CHWs in preventing and managing NCDs. Access full publication here http://bit.ly/2XnWwcd
Universal health coverage (UHC)—ensuring that everyone has access to quality, affordable health services when needed—can be a vehicle for improved equity, health, financial well-being, and economic development. In its 2013 report, Global Health 2035, the Commission on Investing in Health (CIH) made the case that progressive (“pro-poor”) pathways towards UHC, which target the poor from the outset, are the most efficient way to achieve both improved health outcomes and increased financial protection (FP). Countries worldwide are now embarking on health system changes to move closer to achieving UHC, often with a clear pro-poor intent. While they can draw on guidance related to the technical aspects of UHC (the “what” of UHC), such as on service package design, there is less information on the “how” of UHC—that is, on how to maximize the chances of successful implementation.
Motivated by a shared interest in helping to close this information gap, a diverse international group of 21 practitioners and academics, including ministry of health officials and representatives of global health agencies and foundations, convened at The Rockefeller Foundation’s Bellagio Center for a three-day workshop from July 7–9, 2015. The participants shared their experiences of implementing UHC and discussed the limited evidence on how to implement UHC, focusing on a set of seven key “how” questions from across five domains of UHC.
Options for Developing a Collective Payment System and Co-payment Mechanism f...HFG Project
What follows is a draft proposal submitted by Health Finance & Governance (HFG) to local partners to present policy options for centralized reimbursement and co-payment. In this way, HFG provides much needed technical support to the Ministry of Health and other government agencies in Vietnam. Furthermore, this proposal illustrates the means by which HFG, through the Sustainable Finance Initiative (SFI), is facilitating domestic revenue generation and strengthening public financial management in support of HIV/AIDS treatment and care.
This presentation discusses IHME's research in public financing of health in developing countries, including study design, findings, study limitations, and recommendations for governments and future research.
For more information please visit www.healthmetricsandevaluation.org
Understanding the concept of Universal Health CoverageHFG Project
Presented during Day One of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Elaine Baruwa. More: https://www.hfgproject.org/hcf-training-nigeria
Universal Health Coverage (UHC) Day 12.12.14, NepalDeepak Karki
This presentation is made on the first ever Universal Health Coverage (UHC) Day 12.12.14 celebration in Nepal by Nepal Health Economics Association (NHEA).
Decentralizing Health Insurance in Nigeria: Legal Framework for State Health ...HFG Project
Presented during Day Three of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Jonathan Eke. More: https://www.hfgproject.org/hcf-training-nigeria
Overview of Ghana’s National Health Insurance SchemeHFG Project
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Universal health coverage was established in the WHO constitution of 1948 declaring health a fundamental human right.The goal of universal health coverage is to ensure that all people obtain the health services they need without suffering financial hardship when paying for them.
Japan has made numerous achievements in health most notably the world’s highest life-expectancy in the past two decades, since its founding Universal Health Insurance System in 1961. However, ageing population with low-fertility rates, stagnating economy, increasing burden of NCDs and growing use of expensive technologies pose the critical challenges in service delivery and financial stability in health. Japan HiT reports current health system reforms undertaken and also recent discussion on paradigm shift to the new system as proposed in Japan Vision: Health Care 2035.
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
As the burden of NCDs increases, various countries have introduced new and innovative modes of managing them in primary healthcare setting. APO, in conjunction with Duke Kunshan University, China, conducted a 4-country study (Bangladesh, China, Nepal and Viet Nam) to understand the different approaches used in involving CHWs in preventing and managing NCDs. Access full publication here http://bit.ly/2XnWwcd
Universal health coverage (UHC)—ensuring that everyone has access to quality, affordable health services when needed—can be a vehicle for improved equity, health, financial well-being, and economic development. In its 2013 report, Global Health 2035, the Commission on Investing in Health (CIH) made the case that progressive (“pro-poor”) pathways towards UHC, which target the poor from the outset, are the most efficient way to achieve both improved health outcomes and increased financial protection (FP). Countries worldwide are now embarking on health system changes to move closer to achieving UHC, often with a clear pro-poor intent. While they can draw on guidance related to the technical aspects of UHC (the “what” of UHC), such as on service package design, there is less information on the “how” of UHC—that is, on how to maximize the chances of successful implementation.
Motivated by a shared interest in helping to close this information gap, a diverse international group of 21 practitioners and academics, including ministry of health officials and representatives of global health agencies and foundations, convened at The Rockefeller Foundation’s Bellagio Center for a three-day workshop from July 7–9, 2015. The participants shared their experiences of implementing UHC and discussed the limited evidence on how to implement UHC, focusing on a set of seven key “how” questions from across five domains of UHC.
Community Based Health Insurance as a Pathway to Universal Health Coverage: L...HFG Project
Presentation by Hailu Zelelew, Abt Associates, at Haiti's International Conference on Access to Health Care for All in Haiti: Challenges and Perspectives for Funding, April 28-29, 2015, Haïti
Strengthening the Health Workforce to Improve Quality and Achieve Universal H...HFG Project
Universal health coverage (UHC) means anyone can access necessary, good quality health care without suffering financial hardship. A strong health workforce is crucial to achieving UHC, but poor quality pre-service training and governance often weaken the health workforce. In many countries, governments and families alike spend their limited funds on pre-service training institutions that graduate health workers with inadequate skills, which can result in poor patient care and poor health outcomes. Further, some governments do not provide strong stewardship of the health workforce, and miss critical opportunities to improve morale, retention, and skills.
This presentation focuses on three countries that are taking a systems approach to solving these two problems, with help from HFG: Haiti, Côte d’Ivoire, and Swaziland.
In Haiti, HFG is working with the Ministry of Health to bolster its process for accrediting nursing education institutions, known as reconnaissance. More than 40 schools have already received the new accreditation. The government of Côte D’Ivoire identified task-sharing between nurses/midwives and doctors for HIV care as a key strategy to improve HIV outcomes. HFG is supporting the Ministry of Health in developing policies and training programs on task-sharing to integrate into health worker training curricula. In Swaziland, HFG is working with the government to establish standardized hiring and compensation policies for health workers, and to strengthen human resource information systems. HFG also worked with the Swaziland Nursing Council to strengthen their capacity to regulate the nursing profession and expand nursing competencies to incorporate international best practices.
Universal health coverage as a concept was born in 1883 when Germany introduced health coverage for achieving health status of its young population.India, is still attempting to find a way for providing appropriate, affordable and accessible health care to its population.
Linkages Between the Essential Health Services Package and Government-Sponsor...HFG Project
Priority setting is a key function of health systems that seek to achieve universal health coverage. The Essential Health Services Package (EHSP) explicitly prioritizes certain services; government-sponsored health benefit plans implicitly prioritize others. To gain insights into the purpose, policy objectives, and governance of the EPHS and dominant health benefit plans in Ethiopia, we conducted a case study in 2016. Methods included a desk review of relevant documents and qualitative analysis of 15 key informant interviews of leading health finance experts in Addis Ababa. All data were coded and analyzed using a thematic inductive framework.
This is a presentation , which broadly explains the different strategies of Health Financing, as described and developed by World Health Organisation. Apart from the different strategies, this ppt also includes the report of the National Health Accounts (NHA), GOI, which helps in getting a better understanding of the current scenario, when we may compare what we have to reach upto, as per the new National Health Policy 2017 !!!
Improving Efficiency to Achieve Health System Goals in Botswana: Background P...HFG Project
Health outcomes have improved in Botswana over the last few decades. These successes have come at the same time as overall macroeconomic growth, with annual Gross Domestic Product (GDP) growth averaging around 6 percent between 2010 and 2015 (IMF 2015), and Human Development Index ranking above the regional average. These improvements originate in a strong health service delivery system. In 2008, Botswana’s public health system included 338 health posts and 277 health clinics, sufficient to ensure that at least 80 percent of the population has coverage of essential, high-impact services. Management of these services was initially done by the Ministry of Local Government but has been transferred to district health teams under the Ministry of Health (MOH). As of 2008, Botswana’s public health system also had 17 primary hospitals, 14 district hospitals, two referral hospitals, and one mental health hospital; these hospitals are managed by the central government.
Community Health Financing as a Pathway to Universal Health Coverage: Synthes...HFG Project
Community-based health insurance (CBHI) emerged in West Africa the 1990s as a grassroots response among rural and poor communities to fees charged by private and public clinics and hospitals. Three countries – Ghana, Senegal, and Ethiopia – have leveraged CBHI in different ways to expand publicly funded coverage to the informal sector in rural and urban settings. This paper synthesizes the experiences from these three countries to illustrate the role that CBHI can play in UHC.
Understanding Health Accounts: A Primer for PolicymakersHFG Project
An update of the 2003 brief, this new primer provides an introduction to Health Accounts, the framework (System of Health Accounts 2011 or SHA 2011), and key steps involved in conducting Health Accounts exercises using SHA 2011 with particular emphasis on how policymakers can get involved to facilitate the process. The primer also includes country experiences illustrating show how Health Accounts data can be used for policy purposes, with specific attention to the importance of institutionalizing Health Accounts so that it may serve as an ongoing resource to policymakers.
The health of a people to a very large extent determines their productivity and wealth. The 2010
Population and Housing Census indicates that a significant proportion of the Bunkpurugu-Yunyoo District in
Ghana (over 75%) are living below the poverty line of GH¢228.00 per annum (approximately US $120 per
annum). It then implies that approximately the same proportion or even a little above that might not be able to
access health care under the ‘cash and carry’ system. Inability to access health care will lead to poor health
status of the residents and thus lower their productivity.
hapter 5What Are the Governmental AlternativesThe United StatJeanmarieColbert3
hapter 5
What Are the Governmental Alternatives?
The United States has tried an alphabet soup of health policy options: HSAs, HMOs, IPAs, PPOs, POS plans, ACOs, and so on. Health care analysts often must look beyond specific organizational and financial alternatives and address issues at a higher level and deal with the threads of economic and political thought behind different proposals while considering the overall criteria of access, cost, and quality of care.
Politicians and businesspeople from outside the health care sector advocate many alternatives. To offset their tendency to ignore professional issues, in this chapter we discuss alternatives affecting professional status and roles and institutional responses to them. Table 5-1 presents an array of federal alternatives organized by their primary criteria—access, quality, or cost—and then by the economic philosophies behind them. The items in this array are not intended to be either mutually exclusive or collectively exhaustive; rather, the table provides a framework for looking at both the broad policy picture and specific health care actions taken at various times and places. Later in the chapter, another table (Table 5-3) summarizes policy alternatives added by state and local governments. Many of these alternatives were included as provisions of the Affordable Care Act (ACA). They are still included here, partly because they may be subject to reconsideration in the future.
Table 5-1 Illustrative Federal Government Health Policy Options
Access to Care
• Administered systems
• Universal coverage
• Expand or reduce eligibility or benefits
• Mandate coverage and services
• Captive providers
• Control insurance industry practices
• Mandate employer-based insurance coverage
• Consumer-driven competition
• Implement insurance exchanges
• Encourage basic plans with very low premiums for low-income workers and “young invincibles”
• Mandate individual coverage
• Allow states flexibility to reallocate federal funds for vouchers
• Oligopolistic competition
• Expand or contract coverages in entitlement and categorical programs
• Allow states to reallocate federal uncompensated care funds
• Eliminate ERISA constraints on the states
• Expand the capacity of the system
Quality of Care
• Administered system
• Mandate participation in quality improvement efforts in federal plans and programs
• Add more pay-for-performance incentives
• Select providers and programs on the basis of quality excellence
• Consumer-driven competition
• Encourage or mandate transparency of quality reporting in federal plans and programs
• Oversee licensure and credentialing of foreign-trained providers
• Oligopolistic competition
• Work reporting of quality care and adverse events into purchasing specifications for federal programs and disseminate to the public
• Encourage wider use of health information technology
Cost of Care
• Administered system
• Use full bargaining power in negotiation of ...
Universal health coverage (UHC) means that all people receive the quality, essential health services they need, without being exposed to financial hardship.
A significant number of countries, at all levels of development, are embracing the goal of UHC as the right thing to do for their citizens. It is a powerful social equalizer and contributes to social cohesion and stability. Every country has the potential to improve the performance of its health system in the main dimensions of UHC: coverage of quality services and financial protection for all. Priorities, strategies and implementation plans for UHC will differ from one country to another.
Moving towards UHC is a dynamic, continuous process that requires changes in response to shifting demographic, epidemiological and technological trends, as well as people’s expectations. But in all cases, countries need to integrate regular monitoring of progress towards targets into their plans.
In May 2014, the World Health Organization and the World Bank jointly launched a monitoring framework for UHC, based on broad consultation of experts from around the world. The framework focuses on indicators and targets for service coverage – including promotion, prevention, treatment, rehabilitation and palliation – and financial protection for all. This report provides the first global assessment of the current situation and aims to show how progress towards UHC can be measured.
A majority of countries are already generating credible, comparable data on both health service and financial protection coverage. Nevertheless, there are data blind spots on key public health concerns such as the effective treatment of noncommunicable diseases, the quality of health services and coverage among the most disadvantaged populations within countries.
UHC is a critical component of the new Sustainable Development Goals (SDGs) which include a specific health goal: “Ensure healthy lives and promote wellbeing for all at all ages”. Within this health goal, a specific target for UHC has been proposed: “Achieve UHC, including financial risk protection, access to quality essential health care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. In this context, the opportunity exists to unite global health and the fight against poverty through action that is focussed on clear goals. Supporting the right to health and ending extreme poverty can both be pursued through universal health coverage.
Capital Investment in Health Systems: What is the latest thinking?HFG Project
Capital investment in health typically refers to large expenditures in construction of hospitals and other facilities, investment in diagnostic and treatment technologies, and information technology platforms. These investments are characterized by their longevity and they are critical to efforts to improve healthcare quality and efficiency. Contrary to developed countries where there is well documented experience on capital investment in the health sector, including use of public private partnerships for the investment; there is little evidence on capital investment in health from low and middle income countries.
This work was undertaken to add to the HFG’s knowledge and learning strategy by clarifying what good practice guidance exists in capital benchmark in LMICs health sectors, as well as the HFG project’s experience in the area. This brief will be of value to all those interested in the planning and financing the capital investment in the health sector. This includes politicians, planners, managers, health professionals, architects, designers, and researchers in both the public and private sectors.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Policy Brief: What Steps Are Countries Taking To Implement Pro-Poor Universal Health Coverage?
1. The June 6–10, 2015 workshop at the Rockefeller Foundation Bellagio Center in Italy on implementing pro-poor universal
health coverage was supported by The Rockefeller Foundation and the United States Agency for International Development.
What Steps Are Countries
Taking To Implement
Pro-Poor Universal Health
Coverage?
Key messages from the literature
and expert interviews
POLICY
BRIEF
2. Prolicy Brief: What Steps Are Countries Taking To Implement Pro-Poor Universal Health Coverage? | 1
Background
Universal health coverage (UHC)—ensuring that everyone
has access to quality, affordable health services when
needed—can be a vehicle for improved equity, health,
financial well-being, and economic development. In its
2013 report, Global Health 2035: A World Converging within
a Generation, the Commission on Investing in Health made
the case that pro-poor pathways towards UHC, which
target the poor from the outset, are the most efficient way
to achieve both improved health outcomes and increased
financial protection (FP).i
Countries worldwide are now
embarking on health system changes to move closer to
achieving UHC, often with a clear pro-poor intent.
Much has been written about what steps countries have
taken and are currently taking to: (1) set and expand
guaranteed services, (2) develop health financing systems
to fund guaranteed services and ensure FP, (3) ensure
high-quality service availability and delivery, (4) improve
governance and management of the health sector, and (5)
strengthen other aspects of health systems to move closer
to UHC.ii
As background for a meeting on UHC implemen-
tation, held at the Rockefeller Foundation’s Bellagio Center,
Italy, from 7–9 July 2015, we reviewed this body of literature,
and conducted interviews with global UHC implementers
and researchers.iii
In this short policy brief,iv
we synthesize
the key messages from the literature and interviews.
1. What countries are doing to set and expand
guaranteed services
As countries move towards UHC, they are taking a number
of different approaches to setting and expanding popula-
tion coverage and service packages. In setting pathways to
expand coverage, countries should consider the ability of
i See globalhealth2035.org
ii These five buckets categorizing the steps that countries are taking in
the path towards UHC closely align with WHO’s health system build-
ing blocks, namely: delivery of high quality, effective health services; a
solid health financing system; strong leadership and governance; and
a well-functioning and well-performing health system (where inputs
such as human resources and medical products, vaccines, and tech-
nologies are available and of high quality and where a strong health
information system is available and used).
iii In contrast to the large amount of literature on what steps countries
are taking to implement UHC, there is less information published or
otherwise easily accessible about the “how” of UHC—how to max-
imize the chances of successful implementation. “How” questions
were the focus of the Bellagio meeting: participants shared their ex-
periences in, and discussed the limited amount of empirical evidence
on, tackling a set of key “how” questions. The Bellagio meeting report,
and a short practice brief summarizing the main discussion points,
are available at globalhealth2035.org.
iv The full background report, which expands on the topics in this brief,
is available at http://globalhealth2035.org/sites/default/files/bellagio/
background-paper-pro-poor-uhc-evidence.pdf.
selected strategies to meet the health needs of the
population, to meet the equity and FP goals of UHC, and to
ensure value for money.
• Determining which populations to cover. Many countries
have begun their path to UHC by offering targeted
coverage to a subset of the population. Common
strategies used to determine coverage include targeting
by employment status (e.g. social health insurance for
formal sector employees), and targeting specific popu-
lation groups, such as by geographic location (Lagarde
et al, 2012) or health priority (e.g. pregnant women and/
or children under 5 years of age) (Yates 2010). These
approaches vary in their ability to provide coverage to
poor populations at the outset, and in response, some
countries have chosen to gradually expand coverage to
poorer populations as more resources become available.
A major challenge that several countries face is that of a
“coverage wall:” for example, coverage rates stubbornly
remain at 60–70% in Indonesia, the Philippines, and
Vietnam, and are considerably lower in Ghana (35%)
and Nigeria (5%), despite efforts to expand towards
universality (Nicholson et al, 2015).
There are a number of challenges associated with
targeted approaches, including concerns about quality
of care, fragmentation, and lack of coverage for the
informal sector and middle-income populations. To
address these, Nicholson and colleagues (2015) suggest
that achieving full population coverage from the outset,
with a smaller package of services, is preferable
to “covering selected population groups with more
generous packages of services and leaving some
people relatively uncovered.”
• Defining which services to guarantee. The World
Health Organization (2014) outlines three elements to
consider when deciding which services to cover: cost-
effectiveness, priority for the worst-off, and FP. Nicholson
and colleagues (2015) also highlight the importance of
reducing inequality when determining service packages,
while the World Bank (2014) includes a strong emphasis
on public health program investment and primary
health care principles. The Global Health 2035 report
made the case that infectious disease control,
maternal and child health services, and “best buys” for
non-communicable diseases should be prioritized first
in pro-poor pathways to UHC because the poor are
disproportionately affected by these conditions. There
is a growing emphasis on the need for research
evidence and country-specific contexts to be taken into
consideration in determining service packages,
something that many countries are starting to do
(Nakhimovsky et al, 2015).
3. Prolicy Brief: What Steps Are Countries Taking To Implement Pro-Poor Universal Health Coverage? | 2
Such fragmented systems may be more costly, and can
be inequitable. Nonetheless, providing the poor with
coverage through at least one mechanism is a move
towards improving equity, enabling them to access
essential services with out-of-pocket payments (OOPs)
even if they do not have access to as extensive a service
package as wealthier populations.
Some countries have a longer-term vision to reduce
or eliminate fragmentation, and with it, inequality.
Thailand, for example, has a goal of merging its three
existing health insurance schemes—the social securi-
ty scheme, the civil servants’ medical benefit scheme,
and the universal coverage scheme (Evans et al, 2012).
However, to date this has been politically challenging. It
is also possible for governments to play a risk-equaliza-
tion role between the different schemes, effectively
ensuring greater government subsidies go to the
scheme covering the poor.
2. What countries are doing to develop health
financing systems
To achieve UHC, countries must develop health financing
strategies and systems that (i) provide adequate resources
to guarantee and expand coverage over time and (ii) in-
centivize the efficient use of resources, provision of high
quality care, and equitable distribution of health coverage
across populations.
• Raising funds: Countries have many options for raising
additional domestic funds for health (see Box 1). In se-
lecting among these options, it is important to evaluate
the ability of these fund sources to provide sustainable
finance, and to ensure the FP of poor populations.
There is broad agreement that the poor should have free
or very low cost payments for services. In most low-
income countries (LICs) and middle-income countries
(MICs), where a priority is to increase FP, OOPs should
not be used as the main mechanism for revenue
generation as they are regressive and inequitable, they
deter use of health services, and they are a common
cause of impoverishment. Decreasing the reliance on
forms of direct payments, including OOPs, requires
increasing the amount of revenue from forms of pre-
payment, such as through insurance premiums. Cur-
rently, no national health insurance system relies solely
on wage-related deductions or contributions; even in
high-income countries, general government revenue is
required to supplement the cost of assuring coverage.
• Ensuring value for money using cost-effectiveness
analysis (CEA) and extended CEA. As countries expand
coverage, it is increasingly important to ensure the im-
pact and cost-effectiveness of UHC programs. There is
general consensus that good value for money can
be achieved by emphasizing primary care and
community-based services, as well as some district
hospital services (Jamison et al, 2013; Nicholson et
al, 2015). Examples of the former include Ethiopia’s
community-health worker scheme (Crowe, 2013), and
China’s barefoot doctors (Weiyuan, 2008), both of which
contributed to impressive population health gains at
relatively low cost.
Cost-effectiveness analysis—which compares the costs
and outcomes of alternative interventions—is one
important tool for improving the efficiency of health
service delivery, although it should not be used in isola-
tion from considerations about priority for the poor and
equity. However CEA does not assess an intervention’s
impact on FP. A newer tool, extended cost-effectiveness
analysis (ECEA), measures both the health and FP ben-
efits of alternative interventions (Jamison et al, 2013)
and can help decision-makers by showing the financial
versus mortality trade-offs between investing in differ-
ent interventions. While many countries are beginning
to use CEA and ECEA in determining service packages
(Nakhimovsky et al, 2015), this information is not always
incorporated into decision-making where there is politi-
cal pressure to the contrary (Giedion et al, 2014; Kapiriri,
2012). In addition to focusing on specific interventions,
new information on the cost-effectiveness of different
types of delivery platforms, such as clinic-, hospital-,
community- or outreach-based strategies, will be need-
ed to help countries determine which service delivery
strategies are likely to have the greatest reach and
impact at the lowest cost.
• Differing populations may be guaranteed different
services. We use the term “universalism” somewhat
loosely to mean “everyone covered.” This does not
necessarily mean that all people are in the same pool,
paying the same premiums and co-payments, and ac-
cessing the same services. Instead, the reality in several
countries that have made great progress towards UHC,
including Mexico and Thailand, is “fragmentation.” For
historical reasons, different populations are covered by
different schemes, contribute different amounts
(nothing for the poor except through general taxation),
and are guaranteed a different set of health services.
4. Prolicy Brief: What Steps Are Countries Taking To Implement Pro-Poor Universal Health Coverage? | 3
of inefficiency (WHO, 2010). Countries seeking to reduce
this inefficiency use two primary strategies: (i) conduct-
ing active or “strategic” purchasing, and (ii) introducing
forms of results- or outputs-based payments. Strategic
purchasing requires that countries explicitly consider:
the costs and benefits of alternative packages of health
services; where services should be made available; who
delivers them; and the costs and incentives for effi-
ciency and quality that exist in the alternative payment
mechanisms potentially available. Changing payment
from historical line item budgets that do nothing to en-
courage efficiency to forms of paying for results or out-
puts can be difficult and requires good administrative
capacities, but is a strategy that is increasingly being
pursued in several countries around the world.
• Considering equity in health finance arrangements:
Countries must explicitly consider the equity impli-
cations of decisions about all three health financing
functions—raising funds, pooling them, and using them
to provide or purchase services. Decisions about raising
funds impact who pays and how much they pay. With
pooling, critical questions such as who is eligible to
receive benefits emerge. For example, should it only
be individuals (i.e. the policyholder)? Or should it be
individuals and their families (and what is the limit on
the number of family members who can be covered)? In
terms of purchasing, equity considerations are related to
the question of what services are purchased or provided,
and if these services meet the health needs of poor and
vulnerable populations.
3. What countries are doing to ensure
high-quality service availability and delivery
• Ensuring service availability and use. There are many
steps that countries can take to improve service avail-
ability and use, such as (i) seeking to involve all of the
“vertical” health programs in development, review, and
modification of national health plans and policies, and
(ii) using planning tools, such as the OneHealth Cost
and Impact Tool, which estimates costs and impacts of
scaling up disease-specific programs and health
systems. It is important that countries engage a variety
of actors in these discussions, from external partners to
civil society. Countries should also ensure that plans to
improve FP go hand-in-hand with plans to improve the
availability and quality of needed health services.
• Ensuring continuity of care. Countries are developing
strategies to provide and link services across the con-
tinuum of health needs, from promotion and prevention,
to treatment, rehabilitation and palliation; throughout
the life course; and across the various levels of care (e.g.
Box 1. Sources of domestic funds for health
Out-of-pocket payments
Payment for service delivery by individuals at the
point of care
Health insurance premiums
Paid by individuals directly or through wage
deductions, by companies through employer
contributions, or by governments
Taxes and charges
Options include income and company taxes, indirect
taxes such as value added tax (VAT), and taxes on
specific items such as alcohol, tobacco, imports,
and exports.
Contributions from charitable organizations and
external development partners
There are many options for raising additional govern-
ment revenues, including various tax strategies, at
least some of which can be used for health. However,
ensuring the earmarking or allocation of these revenue
sources towards health, and UHC specifically, remains a
challenge in many countries. Many counties could also
increase the share of government funding currently
allocated to health. While there is no clear evidence on
exactly what proportion of government spending should
be directed to health, in 2001 the heads of state of the
African Union in the Abuja Declaration determined
that 15% was an appropriate level. However, in most
LICs and lower MICs, government allocations to health
remain well below this target.
• Pooling to spread risk: Pooling mechanisms enable
costs to be subsidized across populations, while also
minimizing the financial risk of the insurers. Contribu-
tions from a larger population (either by households
directly or through third-party government or employer
contributions) effectively enable the healthy to subsi-
dize the costs for the sick. Most pooling schemes also
develop progressive contribution systems such that the
rich subsidize the poor. Government revenues, some of
which are used to provide or fund health services, and
health insurance funds serve the same purpose as
prepayment and pooling.
• Using funds more efficiently: The 2010 World Health
Report estimated that between 20% and 40% of health
resources were typically wasted through various forms
5. Prolicy Brief: What Steps Are Countries Taking To Implement Pro-Poor Universal Health Coverage? | 4
Common governance challenges that governments face in
moving towards UHC include: (1) identifying an appropriate
role for the private sector and regulating this sector ac-
cordingly; (2) establishing adequate leadership and techni-
cal capacity within the health system; (3) instituting mech-
anisms for accountability and transparency in financing
and delivery decisions; (4) ensuring participation in these
decisions; (5) controlling corruption; and (6) maintaining
regulatory strength and enforcement capacity for financers
and providers of health services.
• Strengthening governance: Strategies used to improve
the governance function of health systems include
methods of control (e.g. laws and contracts), coordi-
nation (e.g. joint strategic planning, cost-sharing or
resource pooling), collaboration (e.g. partnerships with
civil society, inter-ministerial committees), and commu-
nication (e.g. satisfaction surveys, and publicly available
budgetary information) (Barbazza and Tello, 2014). In
some cases, strong leadership has translated into pub-
licly-announced commitments to moving towards UHC.
Tools that support the development and maintenance
of strategic direction in policy development (such as
creation of a national health plan), and implementation
(such as operational guidelines and protocols) can be
very helpful in improving transparency. Tools can also
support knowledge generation (such as periodic audits
or public expenditure performance reviews), improved
accountability (such as performance-based payment,
licensing, and accreditation) and monitoring and con-
trolling corruption (such as through routine auditing).
Finally, a handful of tools—such as open meetings, pub-
lic workshops and national fora—can increase public
engagement and collaboration across stakeholders.
• Measuring governance: Governments and health
system leaders require information about governance
in order to improve governance systems and ensure
the desired outcomes of quality, equity, and efficiency.
Governance evaluation tools and indicators are
commonly divided into four areas:v
(i) governance inputs
or determinants (existence of policies and institutions
that make up and influence the health system), (ii) gover-
nance processes and performance (implementation of the
policies and systems in place to understand the gaps
between expected and actual practice), (iii) governance
outcomes (determining how well health system policies
result in the desired health system goals), and (iv) con-
textual factors (external factors that impact the type of
governance structures that need to be in place and
their enforcement).
v See Baez-Camargo and Jacobs, 2011 and Savedoff, 2011.
primary care to tertiary hospitals, and between public
and private providers). Organized provider networks
with clear and appropriate referral systems are
important, as are decisions about integration across
delivery platforms.
• Overcoming barriers to service access. It can be very
helpful for countries to conduct reviews to determine
population service access barriers. Financial barriers
are common, including those linked to OOPs, transport,
accommodation, food, and lost work time. Barriers can
also be linked to gender, ethnicity, and social or edu-
cational status. Countries should develop appropriate
responses based on the best available international
experiences, adapted to the local setting. If health ser-
vices are already known to be of such poor quality that
people avoid them except when absolutely necessary,
improving quality is an important first step.
• Balancing the role and integration of non-governmen-
tal sector service provision. Countries must balance
the appropriate role for the public sector and non-gov-
ernmental sectors (NGOs, faith-based organizations,
private non-profits, and private for-profits) in service
delivery, including in health promotion and non-per-
sonal services such as laboratories, medical products,
and cleaning and catering services. Quality in the
non-government sector ranges widely, from state of the
art facilities to unlicensed medicine vendors. In many
settings government regulatory capacity is weak. Many
governments must expand their capacity to legislate,
regulate, and set and enforce quality standards with-
in the non-government sector, which has commonly
expanded more rapidly than government’s capacity to
oversee and monitor. Countries that have moved most
successfully towards UHC have taken a pragmatic
approach to expanding service availability by assessing
what mix of government and non-government services
makes most sense in their settings, and ensuring
government has the capacity to set, incentivize, and
enforce quality standards everywhere.
4. How countries are improving health sector
governance and management
Governance includes the process and rules through which
health systems are administered and managed, including
policy formulation and implementation, how responsibility
and accountability are assigned to actors, and the incentive
structures that shape the relationships between these
actors (Brinkerhoff and Bossert, 2008; Kaufmann and
Kraay, 2008; Savedoff, 2011; Barbazza and Tello, 2014).
6. Prolicy Brief: What Steps Are Countries Taking To Implement Pro-Poor Universal Health Coverage? | 5
• Seek quality improvement. Health service quality is a
key objective of a health system and is often considered
a third goal of UHC (alongside improved health outcomes
and increased FP) (Kruk, 2013). Nonetheless, the
quality of care in many LICs and MICs remains very low
(Berendes et al, 2011). It is critical that services are safe
and of good quality—and perceived by the population
to be so. Strategies that countries are using to improve
quality of care include: (i) approaches at the policy and/
or regulatory level (e.g. setting licensing and accredi-
tation standards or implementing performance-based
financial incentives); (ii) facility and/or provider level
strategies to motivate better practices (e.g. educational
inputs, or audit and feedback); and (iii) demand-side
strategies that seek to change social norms and
care-seeking behavior (e.g. vouchers and other
demand-side performance-based financial incentives)
(Mate et al, 2013).
6. Moving forward
As countries continue forward on the path towards UHC,
it is critical to continue to capture and document their
different experiences—both positive and those that are
less positive. The expanding evidence base on what works
best with regards to service definition, financing, and
delivery, and on ensuring effective health sector
governance and strengthened health systems, is a rich
resource for country leaders, researchers, and donors
alike. These stakeholders can learn from this resource,
and take it into consideration when considering possible
next steps forward.
This Practice Brief was written by Alix Beith, Independent
Global Health Consultant, Naomi Beyeler, Policy Program
Manager, Global Health Group, UCSF, and David Evans,
Scientific Project Leader, Swiss Tropical and Public Health
Institute, Switzerland (and Chair of the Bellagio workshop).
The authors declare that there are no competing interests.
5. Other health system strengthening steps that
countries are taking to move closer to UHC
• Strengthening human resources. The primary strategy
countries are using to strengthen human resources is
health workforce training. Pre-service training essen-
tially increases the numbers (and quality) of providers
while in-service training either increases provider skills
or prevents these from deteriorating over time. Training
efforts can target expansion into (i) particular service
areas (such as building a primary care workforce
through the use of community health worker programs
to expand access in rural and underserved areas), or (ii)
geographic areas (such as expanding the rural health
workforce by increasing the recruitment of rural popula-
tions into the health professions). Other strategies being
used are (i) development and review of comprehensive
national health plans and strategies to strengthen
in-service training, and (ii) task sharing that enables
existing cadres of health workers to take on new ser-
vice areas or creates new cadres of health workers that
require less training, which can expand the accessibility
of high need services in underserved areas.
Countries are also implementing recruitment and
retention policies—including the use of financial and
educational incentives and regulatory policies—that
seek to improve the motivation, skills mix, and
geographic distribution of the health workforce. At
the global level, the international community is working
to support health worker retention through policies to
discourage health worker migration from countries
with health workforce shortages.
• Ensure essential infrastructure, medicines, and health
technologies. In addition to human resources, health
systems require additional inputs—such as high-quality
diagnostics, medicines, health technologies, and health
delivery infrastructure—to ensure effective and efficient
health care delivery. Countries worldwide are imple-
menting strategies to improve the selection, procure-
ment, distribution, and use of medicines, to ensure that
populations access and appropriately use high-quality
appropriate low-price quality medicines and technolo-
gies (such as diagnostics).
7. Prolicy Brief: What Steps Are Countries Taking To Implement Pro-Poor Universal Health Coverage? | 6
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8. The Bellagio workshop was funded by The Rockefeller
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