Barriers and facilitators to implementation of essential health benefits package within primary health care settings in low‐income and middle‐income countries: A systematic review

El‐Jardali, Fadi; Fadlallah, Racha; Daouk, Aref; Rizk, Rana; Hemadi, Nour; Kebbi, Ola El; Farha, Aida; Akl, Elie A.

doi:10.1002/hpm.2625

Cited by 14 publications

(15 citation statements)

References 34 publications

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“…The literature on the benefits package definition shows the importance of involving stakeholders through debate and dialogue to set national priorities in terms of designing its content and the process to perform further adaptation [40]. Although the benefits package was a political and sensitive issue, participants did not shy away from discussing it and suggested that its current definition can no longer survive.…”

Section: Discussionmentioning

confidence: 99%

Policy dialogue and participation: a new way of crafting a national health financing strategy in Morocco

Akhnif

Hachri

Belmadani³

et al. 2020

Health Res Policy Sys

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Background Policy dialogue for health policies has started to gain importance in recent years, especially for complex issues such as health financing. Moroccan health financing has faced several challenges during the last years. This study aims to document the Moroccan experience in developing a consolidated health financing strategy according to the policy dialogue approach. It especially considers the importance of conceptualising this process in the Moroccan context. Method We documented the process of developing a health financing strategy in Morocco. It concerned four steps, as follows: (1) summarising health financing evidence in preparation of the policy dialogue; (2) organising the health policy dialogue process with 250 participants (government, private sector, NGOs, civil society, parliamentarians, technical and financial partners); (3) a technical workshop to formulate the strategy actions; and (4) an ultimate workshop for validation with decision-makers. The process lasted 1 year from March 2019 to February 2020. We have reviewed all documents related to the four steps of the process through our active participation in the policy debate and the documentation of two technical workshops to produce the strategy document. Results The policy dialogue approach showed its usefulness in creating convergence among all health actors to define a national shared vision on health financing in Morocco. There was a high political commitment in the process and all actors officially adopted recommendations on health financing actions. A strategy document produced within a collaborative approach was the final output. This experience also marked a shift from previous top-down approaches in designing health policies for more participation and inclusion. The evidence synthesis played a crucial role in facilitating the debate. The collaborative approach seems to work in favouring national consensus on practical health financing actions. Conclusion The policy dialogue process adopted for health financing in Morocco helped to create collective ownership of health financing actions. Despite the positive results in terms of national mobilisation around the health financing vision in Morocco, there is a need to institutionalise the policy dialogue with a more decentralised approach to consider subnational specificities.

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Section: Discussionmentioning

confidence: 99%

Policy dialogue and participation: a new way of crafting a national health financing strategy in Morocco

Akhnif

Hachri

Belmadani³

et al. 2020

Health Res Policy Sys

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“…The ECSP is defined as a collection of health and social services necessary to care for PLWD in the care settings of home, community and institution, which including the type of service and hours of care needed for each type. The guiding principle for the development of the ECSP is to take person-centered care service need as the orientation, universal care coverage on safeguarding vulnerable populations as the focus, to balance the basic services needs for PLWD with affordability, equity, feasibility and sustainability in implementation by national and local governments [10,26,27]. There were three major steps involved in the development process: 1) estimation of perceived needs based on the service use data obtained from the survey; 2) estimation of time needed to provide each type of service; and 3) comparison between perceived needs and actual utilization data to determine which services should be included in the ECSP.…”

Section: Essential Care Service Package (Ecsp)mentioning

confidence: 99%

“…Informed by the Australian model of care and the ESP development for medical care, 80% of the health service needs were selected as the threshold for inclusion of the General Care Service of ECSP [26]. Thus, any service perceived by 80% or more of PLWD as being needed was included in the ECSP, so was any service with actual utilization rate of 60% or more were also included, that is, the basic care services for PLWD with low-level (mild cognitive impairment).…”

Section: Essential Care Service Package (Ecsp)mentioning

confidence: 99%

Development of a Needs-Based Essential Care Service Package for Institutional Dementia Care in China

Sun¹,

Meng²,

Zhu³

et al. 2021

Preprint

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Alzheimer’s disease and related dementias (ADRD) remain a public health challenge in developing counties. We developed a needs-based essential care service package (ECSP) for care planning of persons living with dementia (PLWD) using a cross-sectional survey among PLWD in institutions in six cities in China (n= 1,299). Face-to-face interviews were conducted with caregivers of PLWD by trained staff between 2018 and 2019. Care service needs and utilization by the level of cognitive impairment were summarized. The average age of PLWD was 80.7 years. 76% of participants had severe cognitive impairment. The needs-based ECSP with 30 service items would be sufficient in supporting care services of PLWD in China, of which seven items are core care. The selection plan for ECSP at different levels is designed as “General Care Services + Selective Care Services”, in which service items for low-, mid-and high-level care for PLWD are 7+3, 7+6, and 7+10, respectively. The findings provide the first large-scale data on service needs and utilization of PLWD in mainland China. The ECSP for PLWD advanced in the paper was a practicable and effective quantitative management means. It is deserved to application in a large scale.

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“…The newly codified concept of "Networks of Care" (NOC) offers a promising option for implementation of UHC. 12 The NOC approach, a style of integrated health delivery, is described in a multi-method scoping study and case studies from six diverse implementation settings. [1][2][3][4][5][6] The articles provide a set of practicable, measurable means to bridge Networks of Care and Universal Health Coverage.…”

mentioning

confidence: 99%

“…A country may define a costeffective health benefits package through a rigorous, evidence-based priority setting exercise at national level, only to find that there are limited levers to identify and reach those most in need, and to deliver this package in practice. 12 Assessments of the implementation of health benefits packages have noted several key barriers, including lack of communication between policymakers and implementers, lack of coordination with community networks, and ineffective primary health-care service delivery arrangements. 13 The NOC administrative and clinical management model could be applied at subnational level to contribute to all four UHC implementation steps, and is particularly relevant to the fourth step to set up structures to actualize service delivery.…”

mentioning

confidence: 99%

Harnessing the Power of Networks of Care for Universal Health Coverage

Brady¹,

Carmone²,

Das

et al. 2020

Health Systems & Reform

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On the global health agenda, Universal Health Coverage has been displaced by the COVID-19 pandemic while disparities in COVID-19 outcomes have exposed stark gaps in quality, access, equity, and financial risk protection. These disparities highlight the importance of the core goals of Universal Health Coverage and the need for innovative approaches to working toward them. The newly codified concept of "Networks of Care" offers a promising option for implementation. The articles in this special issue present the Networks of Care lexicon and framework and demonstrate the development of leadership, responsibility, intra-and inter-facility cooperation, and dynamic cycles of quality improvement. These elements are associated with better access to services and better health outcomes, the ultimate goals of Universal Health Coverage. Increases in poverty, food insecurity, and deleterious impact on the status of women secondary to the COVID-19 pandemic add urgency to Universal Health Coverage, while the economic impact of pandemic mitigation may reduce availability of resources for years to come. The need for Universal Health Coverage and efficiency and flexibility in health spending, including the ability to contract directly, has become even more important. Countries where Universal Health Coverage efforts have yet to carry through to provision of good quality, accessible and equitable service delivery could potentially benefit from concurrent Networks of Care implementation. Documentation of Networks of Care in the context of Universal Health Coverage should be prioritized to understand how Networks of Care can be used to help realize the goals of Universal Health Coverage around the world.

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Barriers and facilitators to implementation of essential health benefits package within primary health care settings in low‐income and middle‐income countries: A systematic review

Abstract: We identified a set of barriers and facilitators that need to be addressed to ensure proper implementation of EHPs within primary health care settings.

Cited by 14 publications

References 34 publications

Policy dialogue and participation: a new way of crafting a national health financing strategy in Morocco

Policy dialogue and participation: a new way of crafting a national health financing strategy in Morocco

Development of a Needs-Based Essential Care Service Package for Institutional Dementia Care in China

Harnessing the Power of Networks of Care for Universal Health Coverage

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