Background: Equity seems inherent to the pursuance of universal health coverage (UHC), but it is not a natural consequence of it. We explore how the multidimensional concept of equity has been approached in key global UHC policy documents, as well as in country-level UHC policies. Methods: We analysed a purposeful sample of UHC reports and policy documents both at global level and in two Western African countries (Benin and Senegal). We manually searched each document for its use and discussion of equity and related terms. The content was summarised and thematically analysed, in order to comprehend how these concepts were understood in the documents. We distinguished between the level at which inequity takes place and the origin or types of inequities. Results: Most of the documents analysed do not define equity in the first place, and speak about "health inequities" in the broad sense, without mentioning the dimension or type of inequity considered. Some dimensions of equity are ambiguousespecially coverage and financing. Many documents assimilate equity to an overall objective or guiding principle closely associated to UHC. The concept of equity is also often linked to other concepts and values (social justice, inclusion, solidarity, human rightsbut also to efficiency and sustainability). Regarding the levels of equity most often considered, access (availability, coverage, provision) is the most often quoted dimension, followed by financial protection. Regarding the types of equity considered, those most referred to are socioeconomic , geographic, and gender-based disparities. In Benin and Senegal, geographic inequities are mostly pinpointed by UHC policy documents, but concrete interventions mostly target the poor. Overall, the UHC policy of both countries are quite similar in terms of their approach to equity. Conclusions: While equity is widely referred to in global and country-specific UHC policy documents, its multiple dimensions results in a rather rhetorical utilisation of the concept. Whereas equity covers various levels and types, many global UHC documents fail to define it properly and to comprehend the breadth of the concept. Consequently, perhaps, country-specific policy documents also use equity as a rhetoric principle, without sufficient consideration for concrete ways for implementation.
BackgroundRegardless of national contexts, the institutions responsible for research ethics, founded on international regulations, are all expected to be structured and to operate in a common way. Our experience with several countries on different continents, however, has raised questions in this regard. This article examines the differences and structural weaknesses of ethics committees in four countries (Burkina Faso, Palestine, Peru, and the Democratic Republic of the Congo) where we have conducted the same socio-anthropological study in the field of reproductive health.MethodsIn addition to recording our observations during field surveys for this study, we performed a documentary review and interviewed expert members of ethics committees, research participants, and researchers who had experience with requesting ethics approvals for research protocols in the field of social sciences and health.ResultsThe results of this study showed that, despite having the same mandate, the committees functioned differently, while they all exhibited the same weaknesses. Thus, the universalization and standardization of institutional conditions for applying ethical standards in research still present problems that are, at the very least, relevant.ConclusionThis study on ethics committees in four countries demonstrated the profound influence of context on the ways in which different institutions function and enforce regulations. In effect, in all social fields, every innovation is infused by its context.
Le financement basé sur la performance (FBP) s’est rapidement répandu dans les pays à faible et à moyen revenu (PFMR), malgré le manque de données probantes sur les processus de mise en œuvre et son efficacité. L’objectif de cette analyse est de comprendre le rôle des acteurs de la santé mondiale dans l’expansion du FBP dans les PFMR. Nous abordons, entre autres, deux cas concrets au Burkina Faso et au Bénin afin d’illustrer l’importance des acteurs de la santé mondiale dans la conception, la promotion, la modélisation et l’évaluation du FBP.
Background: In its pursuance of universal health coverage (UHC), the government of Benin is piloting a project of mandatory social insurance for health entitled "ARCH". Methods: We analysed budget data and ARCH documents, and conducted four observation missions in Benin between March 2018 and January 2020. Results are presented in terms of the three classical objectives of public expenditure management. Results: The government of Benin faces important budgeting challenges when it comes to implementing the ARCH social insurance project: (i) the fiscal space is quite limited, there is a limited potential for new taxes and these may not benefit the ARCH funding, hence the need to prioritise fiscal resources without jeopardising other areas; (ii) the purchasing of health services should be more strategic so as to increase allocative efficiency and equity; (iii) the efficiency of the expenditure process needs to be improved, and more autonomy needs to be devoted to the operational level, so as to ensure that health facilities are reimbursed in a timely fashion in order to meet insured people's health costs, in such a way as to avoid jeopardizing the financial equilibrium of these facilities. Conclusion: The important budgeting challenges faced by Benin when it comes to implementing its UHC policy are also faced by many other African countries. It is important to avoid a situation in which the resources dedicated by the government to the social health insurance system are at the expense of a reduction in the financing of preventive and promotional primary healthcare services.
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