Progress Toward Universal Health Coverage

Rahman, Mizanur; Karan, Anup; Rahman, Shafiur; Parsons, Alexander; Abe, Sarah Krull; Bilano, Ver; Awan, Rabia; Gilmour, Stuart; Shibuya, Kenji

doi:10.1001/jamainternmed.2017.3133

Cited by 47 publications

(30 citation statements)

References 30 publications

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“…While each country must decide its own path towards UHC based on the individual country contexts, all should draw on existing evidence and shared experience. Currently available evidences from Bangladesh on UHC mostly include quantitative household surveys on out of pocket expenditure [14,15], financial risk protection [6,[15][16][17], and equity analysis [6,[16][17][18]. The policy environment around UHC issues has been analyzed by very few studies, which includes an assessment of a set of proposed indicators related to UHC [19,20], and generic policy papers without description of methodology [21,22].…”

Section: Introductionmentioning

confidence: 99%

Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

Joarder¹,

Chaudhury

Mannan

2019

Advances in Public Health

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Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage (UHC) and the challenges faced in these endeavors. This qualitative study involved document reviews (n=22) and key informant interviews (KII, n=15). Thematic analysis of texts (themes: activities around UHC, implementation barriers, suggestions) was done using the manual coding technique. We found that Bangladesh has a comprehensive set of policies for UHC, e.g., a health-financing strategy and staged recommendations for pooling of funds to create a national health insurance scheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three subdistricts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector’s implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.

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Section: Introductionmentioning

confidence: 99%

Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

Joarder¹,

Chaudhury

Mannan

2019

Advances in Public Health

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“…Not only financing and institutionalization are critical for achieving UHC, but also measuring progress towards UHC is equally important. The three core dimensions of UHC proposed by the WHO 8 are “the proportion of a population covered by existing healthcare systems, the range of healthcare services available to a population, and the extent of financial risk protection available to local populations” 9 . An analysis of South Asian countries reported that access to basic care varied substantially within and across each country.…”

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confidence: 99%

“…An analysis of South Asian countries reported that access to basic care varied substantially within and across each country. In India, financial risk protection was only 17.9 per cent and prevention and treatment coverage for selected heath conditions was 83.5 per cent 9 . The study also raised equity concerns, highlighting that access to care for maternal and child health services was higher among rich as compared to poor mothers.…”

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confidence: 99%

“…Rashtriya Swasthya Bima Yojana (RSBY) was another innovative initiative launched by the Ministry of Labour and Employment (now with MoHFW), which provided financial risk protection to poor families through government-funded health insurance. However, in spite of all the efforts, the total health expenditures (THEs) in India remained at 4.7 per cent of gross domestic product (GDP) in 2014 9 . The contribution of public health expenditure also remained stagnant at 30 per cent, which is one of the lowest among LMICs 9 .…”

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Universal health coverage in India: Progress achieved & the way forward

Zodpey

Farooqui

2018

Indian J Med Res

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“…With these new challenges, we see inequalities forming along the same old social fault lines and the same axes of deprivation and discrimination. In high-income countries, new risk factors such as obesity and food insecurity cluster in the poorest communities [3,4], while on a global level, we see the greatest burden of new diseases such as HIV falling on the poorest countries [5], and continuing challenges of health access and financing for the poorest people [6]. Much of this inequality arises from simple economic inequality and the consequences of colonialism, but much also results from the marginalization of certain individuals and groups at community, national and global levels.…”

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Progress towards Health for All: Time to End Discrimination and Marginalization

Gilmour

Nguyen

et al. 2020

IJERPH

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Although it has been more than 40 years since "health for all" was presented as a focus in the Alma Ata declaration [1], the world is still far from achieving this goal. Although great progress has been made since then in many areas of health, much of that progress has been confined to rich countries, and even within the richest of countries, health inequality persists. New health problems and threats have arisen in the generations since that hopeful statement, with the scourge of HIV and the challenge of non-communicable diseases (NCDs) facing high and low-income countries alike [2]. With these new challenges, we see inequalities forming along the same old social fault lines and the same axes of deprivation and discrimination. In high-income countries, new risk factors such as obesity and food insecurity cluster in the poorest communities [3,4], while on a global level, we see the greatest burden of new diseases such as HIV falling on the poorest countries [5], and continuing challenges of health access and financing for the poorest people [6]. Much of this inequality arises from simple economic inequality and the consequences of colonialism, but much also results from the marginalization of certain individuals and groups at community, national and global levels. Sexual minorities, people with mental illness, migrants, refugees, the homeless, transient populations, transgender people, sex workers and many other groups who do not conform to existing social norms, or who have historically been marginalized and excluded, experience many often completely preventable illnesses. Discrimination against some members of the community, their exclusion from economic, cultural and social processes, and the selective provision of basic services to these communities put them at increased risk of poor health and expose them to preventable risk factors. Because the marginalization of these people is socially and historically determined, the health consequences for these people continue to be severe and pernicious, despite being preventable.In this Special Issue on the health of marginalized people, we have gathered 15 papers from many countries, describing a wide range of physical and mental health issues, using a variety of advanced research methods to understand the health challenges faced by a diverse array of marginalized populations globally, and recommending interventions to improve the health of marginalized populations. First, we summarize the research articles presented in this Special Issue and then issue a call for renewed action to end discrimination and marginalization in our societies, and to strengthen wider efforts to support the health of the most marginalized people.Mental health and suicide are significant issues among marginalized populations which do not receive sufficient attention. In this issue, Gilmour et al. [7] describe the suicide mortality rates of foreigners living in Japan compared with those in their country of origin and in Japanese nationals. They showed that, distinct from other nationalities...

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Progress Toward Universal Health Coverage

Cited by 47 publications

References 30 publications

Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

Universal health coverage in India: Progress achieved & the way forward

Progress towards Health for All: Time to End Discrimination and Marginalization

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