Evidence-based policy: nursing now and the importance of research synthesis.

Impact of COVID-19 pandemic on the attainment of universal health coverage and sustainable development goals

BackgroundInadequate access to quality health care services due to weak health systems and recurrent public health emergencies are impediments to the attainment of Universal Health Coverage and health security in Africa. To discuss these challenges and deliberate on plausible solutions, the World Health Organization Regional Office for Africa, in collaboration with the Government of Cabo Verde, convened the second Africa Health Forum in Praia, Cabo Verde on 26–28 March 2019, under the theme Achieving Universal Health Coverage and Health Security: The Africa We Want to See.MethodsThe Forum was conducted through technical sessions consisting of high-level, moderated panel discussions on specific themes, some of them preceded by keynote addresses. There were booth exhibitions by Member States, World Health Organization and other organizations to facilitate information exchanges. A Communiqué highlighting the recommendations of the Forum was issued during the closing ceremony. More than 750 participants attended. Relevant information from the report of the Forum and notes by the authors were extracted and synthesized into these proceedings.ConclusionsThe Forum participants agreed that the role of community engagement and participation in the attainment of Universal Health Coverage, health security and ultimately the Sustainable Development Goals cannot be overemphasized. The public sector of Africa alone cannot achieve these three interrelated goals; other partners, such as the private sector, must be engaged. Technological innovations will be a key driver of the attainment of these goals; hence, there is need to harness the comparative advantages that they offer. Attainment of the three goals is also intertwined – achieving one paves the way for achieving the others. Thus, there is need for integrated public health approaches in the planning and implementation of interventions aimed at achieving them.RecommendationsTo ensure that the recommendations of this Forum are translated into concrete actions in a sustainable manner, we call on African Ministers of Health to ensure their integration into national health sector policies and strategic documents and to provide the necessary leadership required for their implementation. We also call on partners to mainstream these recommendations into their ongoing support to World Health Organization African Member States.

Immunization coverage remains a challenge in many developing countries Tanzania being no exception. The current increase in technology adoption in the immunisation supply chain promises the attainment of universal health coverage and Sustainable Development Goals (SDGs) on immunisation. This study evaluates the effectiveness of technology integration in Vaccine and Immunization Health Supply Chain Management (VIHSCM) in Tanzania. This study adopted an exploratory descriptive cross-sectional design. The study collected data using structured questionnaires from health facilities that adopted VIHSCM technologies in Arusha, Mwanza, Morogoro and Mbeya regions, Tanzania. Data were analysed using descriptive statistics and cross-tabulations with the aid of the Statistical Package of Social Sciences 23rd Edition (SPSS). The study included 37 health facilities in Tanzania, mainly district hospitals (59.5%). Respondents were mostly female (70.3%), averaging 45 years old, with 1–5 years of immunization experience. While all facilities had refrigerators, digital reporting tool usage was low, with many relying on paper forms. District hospitals and health centres had higher digital tool adoption rates compared to dispensaries. Despite the underutilization of systems like ILS, TImR, and GoTHOMIS, digital tools were deemed crucial for vaccine supply management. While District Hospitals report high relevance of digital tools, Health Centres and Dispensaries show moderate relevance. Challenges include incomplete technology adoption, inadequate infrastructure, and variable perceptions of technology effectiveness. Digital technologies significantly improve vaccine and immunization supply chain management, particularly in larger facilities. Technologies like the Tanzania Immunization Registry (TImR) and Integrated Logistics Systems (ILS) enhance data accuracy and efficiency. Addressing facility-specific challenges and increasing investment in digital tools are crucial for optimizing vaccine supply chains and achieving immunization targets in Tanzania. Future research should involve larger samples to generalize findings and further explore technology impacts on VIHSCM.

It is the obligation of the state to provide free and universal access to quality health-care services to its citizens. India continues to be among the countries of the world that have a high burden of diseases. The various health program and policies in the past have not been able to achieve the desired goals and objectives. 65th World Health Assembly in Geneva identified universal health coverage (UHC) as the key imperative for all countries to consolidate the public health advances. Accordingly, Planning Commission of India constituted a high level expert group (HLEG) on UHC in October 2010. HLEG submitted its report in Nov 2011 to Planning Commission on UHC for India by 2022. The recommendations for the provision of UHC pertain to the critical areas such as health financing, health infrastructure, health services norms, skilled human resources, access to medicines and vaccines, management and institutional reforms, and community participation. India faces enormous challenges to achieve UHC by 2022 such as high disease prevalence, issues of gender equality, unregulated and fragmented health-care delivery system, non-availability of adequate skilled human resource, vast social determinants of health, inadequate finances, lack of inter-sectoral co-ordination and various political pull and push of different forces, and interests. These challenges can be met by a paradigm shift in health policies and programs in favor of vulnerable population groups, restructuring of public health cadres, reorientation of undergraduate medical education, more emphasis on public health research, and extensive education campaigns. There are still areas of concern in fulfilling the objectives of achieving UHC by 2022 regarding financing model for health-care delivery, entitlement package, cost of health-care interventions and declining state budgets. However, the Government's commitment to provide adequate finances, recent bold social policy initiatives and enactments such as food security bill, enhanced participation by civil society in all health matters, major initiative by some states such as Tamil Nadu to improve health, water, and sanitation services are good enough reasons for hope that UHC can be achieved by 2022. However, in the absence of sustained financial support, strong political will and leadership, dedicated involvement of all stakeholders and community participation, attainment of UHC by 2022 will remain a Utopia.

The attainment of universal health coverage (UHC) is incomplete without achieving respectful maternity care (RMC). While planning for UHC, the need and importance of RMC should be considered. In India, the government has started a health scheme on UHC, namely the Ayushman Bharat Scheme. RMC being an important component of UHC, if not achieved, will result in failure to achieve UHC in the true sense.

Primary Health Care Matters.

Human security and universal health coverage: Japan's vision for the G7 Hiroshima Summit

Attainment of universal health coverage in the occupied Palestinian territory assessed by a general equilibrium approach: is informality an irreversible hurdle for universality?

ObjectivesIndonesia aims to achieve universal health coverage (UHC) and Sustainable Development Goals (SDGs), including SDG 3 target 4, which focuses on cancer control, by 2030. This study aimed to forecast...

Amidst the myriad of challenges that constrain good quality health care services delivery in the World’s youngest nation, South Sudan, there is a beacon of hope. The country’s revitalized peace agreement offers a new impetus for rebuilding the country, including its health system. Key achievements in the health care sector of the country such as development and implementation of a health sector strategic and health sector stabilization and recovery plans and implementation of a Boma Health Initiative programme which aims to scale up health services delivery at the community level provide a foundation on which acceleration of universal health coverage could rest. Other key achievements include polio-free certification of the country, significant reductions in the prevalence of Guinea Worm and other neglected tropical diseases and timely detection and response to the ongoing COVID-19 outbreak. Moving forward, attainment of universal health coverage in the country requires a strong and people-centred primary healthcare approach which will ensure that services reach the last mile. Bridging the humanitarian-development nexus is required to ensure accelerated recovery of the country’s health system. Furthermore, scaling up of community-based health initiatives such as the Boma Health Initiative as platforms for taking good quality health services to the hard-to-reach areas is imperative. This Journal Supplement highlights the key achievements and challenges on the road to universal health coverage in South Sudan and provides evidence-based information for rapidly scaling up health services provision.

BackgroundKenya has prioritized the attainment of universal health coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fund (NHIF). In 2015, the NHIF introduced reforms in premium contribution rates, benefit packages, and provider payment methods. We examined the influence of these reforms on NHIF’s purchasing practices and their implications for strategic purchasing and health system goals of equity, efficiency and quality.MethodsWe conducted an embedded case study with the NHIF as the case and the reforms as embedded units of analysis. We collected data at the national level and in two purposively selected counties through 41 in-depth interviews with health financing stakeholders, facility managers and frontline providers; 4 focus group discussions with 51 NHIF members; and, document reviews. We analysed the data using a Framework approach.ResultsThe new NHIF reforms were characterized by weak purchasing actions. Firstly, the new premium contribution rates were inadequately communicated and unaffordable for certain citizen groups. Secondly, while the new benefit packages were reported to be based on service needs, preferences and values of the population, they were inadequately communicated and unequally distributed across different citizen groups. In addition, the presence of service delivery infrastructure gaps in public healthcare facilities and the pro-urban and pro-private distribution of contracted health facilities compromised delivery of, and access to, these new services. Lastly, the new provider payment methods and rates were considered inadequate, with delayed payments and weak links to financial accountability mechanisms which compromised their ability to incentivize equity, efficiency and quality of healthcare delivery.ConclusionWhile NHIF sought to expand population and service coverage and reduce out-of-pocket payments with the new reforms, weaknesses in the reforms’ design and implementation limited NHIF’s purchasing actions with negative implications for the health system goals of equity, efficiency and quality. For the reforms to accelerate the country’s progress towards UHC, policy makers at the NHIF and, national and county government should make deliberate efforts to align the design and implementation of such reforms with strategic purchasing actions that are aimed at improving health system goals.

Promoting occupational health is pivotal for achieving the UN's Sustainable Development Goals (SDGs) and shaping an eco-friendly economy. Acknowledging the connections among poverty reduction, health, decent work, universal health coverage, and workforce health for sustainability highlights the importance of nurturing a resilient workforce for a greener future. In the context of transitioning to a green economy, workers' well-being is paramount. Establishing safe workplaces, reducing hazards, and providing healthcare not only protect workers but also foster a workforce capable of contributing to sustainable and productive progress. Effective labour inspection and occupational health regulations also play a critical role in ensuring adherence to these principles and in turn contribute to attaining the SDGs. Moreover, from a poverty eradication standpoint, a green economy can uplift underserved communities by creating green jobs that offer fair wages, safety, and dignity. These opportunities not only reduce poverty but also enhance overall well-being including worker well-being. Universal health coverage remains crucial in this context. A healthy workforce can effectively drive the shift toward greener industries. By prioritizing employees' well-being, we enhance their ability to innovate and contribute to environmentally conscious sectors. The intertwining occupational health, green economy principles, and labour inspection to the SDGs aligns poverty alleviation, safe and secure employment, universal health coverage, and ecological sustainability. This approach recognizes that a flourishing future of work relies on the interconnectedness of individual health, economic prosperity, effective regulation, and planet wellbeing.

Burns in India: a call for health policy action

The road to universal health coverage depends on resources committed to the health sector. In many cases, the political structure and strength of advocacy play an important role in setting budgets for health. However, this has, until recently, not been of interest to health system researchers and policymakers. In this study, we document the political path to the establishment of the Ghana National Health Insurance Scheme (NHIS) as well as continuous political interest in the scheme. To achieve our objectives, we used qualitative data from interviews with key stakeholders. These include stakeholders instrumental in the design and establishment of the NHIS. We also reviewed party manifestoes from the two main political parties in the country. Promises relating to the NHIS were extracted from the various manifestos and analysed. Other documents that account for the design and implementation of the scheme were reviewed. We found that the establishment of the NHIS was down to political commitment and effective engagement with relevant stakeholders. It was considered a solution to the political promise to remove user fees and make healthcare accessible to all. A review of the manifestos shows that in almost every election year after the NHIS was established, there has been some promise related to improving the scheme. There were several policy propositions repeated in different election years. The findings imply that advocacy to get health financing on the political agenda is crucial. This should start from the development of party manifestos. It is important to also ensure that proposed party policies are consistent with national priorities in the medium to long term.

Background: Access to health services is limited in many parts of the world, particularly in low- and middle-income countries (LMICs), where the health system is weak and often excludes many people living in hard-to-reach areas. Medical outreach (MO) is a means of extending essential health services to such underserved populations. It is one of the tools used in the pursuit of universal health coverage (UHC), which envisions a world where all citizens have access to quality health services whenever they need them, regardless of where they live or their socioeconomic circumstances, without experiencing financial hardship in the process Objective: This narrative review describes informal medical outreach (IMO), a type of MO, explains the nexus between IMO and the six building blocks of the World Health Organization’s health systems framework, and highlights how its optimal use can expedite the achievement of UHC and strengthen the weak health systems of LMICs. Findings: IMO has been used for several years to provide essential health services to excluded populations. It is conducted by various organisations for different reasons. Despite its contribution to closing the healthcare coverage gap, its non-integration with the local or national health system has undermined its impact. Conclusion: Informal medical outreach remains a useful strategy for delivering essential care to underserved populations. By addressing potential obstacles, its integration with the existing health system using a systems thinking approach can optimise its contribution to the achievement of UHC and a strengthened health system in many LMICs.