The Challenges Of Conducting Universal Health Coverage - not
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The Essential Ingredients to Universal Health CoverageWithin the context of the Sustainable Development Goals, it is important to critically review research on healthcare financing in sub-Saharan Africa SSA Challengex the perspective of the universal health coverage UHC goals of financial protection and access to quality health services for all. Contributions to health insurance schemes, whether voluntary or mandatory, contribute a small share of current health expenditure.
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There is a growing recognition of the need to reduce out-of-pocket payments and increase domestic mandatory prepayment financing to move towards UHC. Many SSA countries have declared a preference for achieving this through contributory health insurance schemes, particularly for formal sector workers, with service entitlements tied to contributions.
UHC is defined as providing financial protection from the costs of using health services for all people of a country, as well as enabling them to obtain the health services that they need, where these services should be of sufficient quality to be effective World Health Organization, Emphasis has been placed on how to finance health Heallth to move towards UHC. Financial protection requires that health services be funded in a way that protects individuals and households from adverse effects to their economic livelihood due to paying for healthcare, which mainly arise from click OOP payments. Promoting equity in the The Challenges Of Conducting Universal Health Coverage and use of health services is a key element of moving toward UHC.
Regressive healthcare financing mechanisms, where lower socioeconomic groups contribute a greater percentage of their income to funding healthcare than higher socioeconomic Conudcting, are generally viewed as inequitable.
Equity in service use relates to reducing gaps between the need for a health service and the actual use of that service. While moving toward UHC requires interventions in all aspects of the health system, the focus of this article The Challenges Of Conducting Universal Health Coverage on healthcare financing, and more specifically, the revenue collection function of financing and to some extent the pooling function Kutzin, Due to space constraints, it is not Haelth to consider in any detail the purchasing function of healthcare financing or the range of other issues related to promoting equitable access to quality of care. In preparing this article, the authors undertook a rapid review of the research literature on healthcare financing and UHC in SSA over the past decade. The purpose of the review was to ensure that this article provides a synthesis of key Healt of relevance to this topic, and to identify the areas of emphasis and gaps in research within the SSA context.
The article begins by providing a brief overview of healthcare financing in SSA both from a historical perspective as well as the context around the time of adoption of the SDGs in This is followed by a detailed review of experience of alternative healthcare financing mechanisms in SSA, with an emphasis on the financial protection goal of UHC, and then a brief overview of SSA experience in relation to the UHC goal of access to quality health services.
The final section critically assesses existing evidence on healthcare financing that could promote progress to UHC in SSA countries and identifies priorities for additional health economics research to provide the necessary evidence base to inform policy debates on financing for UHC. While health-system development paths have varied across countries, it is possible to present some stylized facts about general historical developments in healthcare financing in SSA countries. While these services were expanded to others over time, largely to address communicable diseases, which it was feared would spread to expatriates, it was faith-based missionary facilities that played the dominant role in the provision of medical services to indigenous populations, sometimes charging nominal user fees. Upon achieving independence, many SSA governments invested in expanding health service infrastructure and funded these The Challenges Of Conducting Universal Health Coverage from tax revenue, accompanied by external funding, which gained prominence in the post-colonial era.
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Since the s, SSA health systems have generally been seen as inadequately funded and as having low staff salaries, a shortage of core supplies, and poorly maintained facilities and equipment Mills, In an effort to address the access barriers posed by user fees, small-scale Healtth health insurance schemes CBHIs were developed as a voluntary risk-pooling mechanism for rural communities and informal-sector workers in a growing number of SSA countries. Although mandatory insurance schemes exist only in a small number of countries and have low population coverage, many SSA countries are now considering this form of financing.
Before reviewing healthcare financing in SSA in the second decade of the 21st centuryit is important to consider the macroeconomic context of SSA countries. Figure 1 indicates that as ofthe composition of healthcare financing sources varies considerably across different SSA countries.
Most of this is in the form of spending by government ministries or departments and funded by tax revenue. Private health insurance or voluntary prepayment in most other SSA countries largely refers to CBHI schemes, which contribute very little funding to overall health expenditure. Figure 1. Distribution of healthcare financing across sources Note: All SSA countries for which data were available are included; countries are ordered according to the percentage share of financing in the form of mandatory prepayment, from lowest to highest.]
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