Health financing for universal health coverage in Sub-Saharan Africa: a systematic review

Ifeagwu, Susan C.; Yang, Justin; Parkes-Ratanshi, Rosalind; Brayne, Carol

doi:10.1186/s41256-021-00190-7

Cited by 88 publications

(104 citation statements)

References 40 publications

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“…Thus, the risk of transmission of the virus to the elderly in these homes is magnified once a household inhabitant contracts the disease. Furthermore, lower income households are less likely to have easy access to health facilities for care in countries that rely more on out-of-pocket payment for care, such as Nigeria and Ethiopia (Ifeagwu et al, 2021 ). This can influence the decision to present in health facilities for care and the delay can further result in exposure to other members of the household and community, with eventually poor outcomes among those that might contract the disease.…”

Section: Discussionmentioning

confidence: 99%

Risk assessment for COVID-19 transmission at household level in sub-Saharan Africa: evidence from DHS

Makinde¹,

Akinyemi

Ntoimo

et al. 2021

Genus

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Household habitat conditions matter for diseases transmission and control, especially in the case of the novel coronavirus (COVID-19). These conditions include availability and adequacy of sanitation facilities, and number of persons per room. Despite this, little attention is being paid to these conditions as a pathway to understanding the transmission and prevention of COVID-19, especially in Africa, where household habitat conditions are largely suboptimal. This study assesses household sanitation and isolation capacities to understand the COVID-19 transmission risk at household level across Africa. We conducted a secondary analysis of the Demographic and Health Surveys of 16 African countries implemented between 2015 and 2018 to understand the status of households for prevention of COVID-19 transmission in home. We assessed handwashing capacity and self-isolation capacity using multiple parameters, and identified households with elderly persons, who are most at risk of the disease. We fitted two-level random intercept logit models to explore independent relationships among the three indicators, while controlling for the selected explanatory variables. Handwashing capacity was highest in Tanzania (48.2%), and lowest in Chad (4.2%), varying by household location (urban or rural), as well as household wealth. Isolation capacity was highest in South Africa (77.4%), and lowest in Ethiopia (30.9%). Senegal had the largest proportion of households with an elderly person (42.1%), while Angola (16.4%) had the lowest. There were strong, independent relationships between handwashing and isolation capacities in a majority of countries. Also, strong associations were found between isolation capacity and presence of older persons in households. Household capacity for COVID-19 prevention varied significantly across countries, with those having elderly household members not necessarily having the best handwashing or isolation capacity. In view of the age risk factors of COVID-19 transmission, and its dependence on handwashing and isolation capacities of households, each country needs to use the extant information on its risk status to shape communication and intervention strategies that will help limit the impact of the disease in its population across Africa.

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Section: Discussionmentioning

confidence: 99%

Risk assessment for COVID-19 transmission at household level in sub-Saharan Africa: evidence from DHS

Makinde¹,

Akinyemi

Ntoimo

et al. 2021

Genus

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“…The deficits in managerial awareness and capacity, coupled with their exclusion from engagement of policy formulation and rollout, is contradictory to the apparent purpose of the NHI Bill to empower the DHS to assume responsibility for the needs of predefined municipal areas. Joint learning from Asian [ 14 ], Latin American [ 12 ] and African [ 13 , 23 , 24 ] regions has shown that incomplete operationalization of the DHS hinders UHC implementation strategies [ 10 ] and leads to wasteful expenditure. Conversely, success stories from countries such as Cuba [ 12 ], Thailand and Indonesia [ 7 ] show that UHC can be successfully implemented in the face of fiscal austerity, when sustained investment in decentralised governance strategies that enabled CUPs and strategic purchasing.…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, success stories from countries such as Cuba [ 12 ], Thailand and Indonesia [ 7 ] show that UHC can be successfully implemented in the face of fiscal austerity, when sustained investment in decentralised governance strategies that enabled CUPs and strategic purchasing. Similarly, several African countries such as Uganda and Ghana have effectively used decentralised governance strategies to facilitate UHC success [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Stakeholders maintain that accountable and delegated management is the greatest predictor of successful UHC implementation [ 11 ] and both systems have reiterated the need for a ‘strategic vision’ at the level of district organizational structures [ 11 ], as well as the capacitation of local health managers (DMs) to improve their ability to enforce implementation. In the developing world, regions such as Asia, Latin America and sub-Saharan Africa have shown that inadequate decentralization of health system governance is crippling to UHC implementation strategies [ 7 , 12 , 13 ]. In contrast, UHC successes in countries such as Thailand and Indonesia, nations with low gross national income per capita, have been attributed to sustained federal investment in devolving governance to the district structures of healthcare [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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The views of public service managers on the implementation of National Health Insurance in primary care: a case of Johannesburg Health District, Gauteng Province, Republic of South Africa

Murphy

Moosa

2021

BMC Health Serv Res

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Background The South African government is implementing National Health Insurance (NHI) as a monopsony health care financing mechanism to drive the country towards Universal Health Coverage (UHC). Strategic purchasing, with separation of funder, purchaser and provider, underpins this initiative. The NHI plans Contracting Units for Primary healthcare (PHC) Services (CUPS) to function as either independent sub-district purchasers or public providers and District Health Management Offices (DHMOs) to support and monitor these CUPS. This decentralised operational unit of PHC, the heartbeat of NHI, is critical to the success of NHI. The views of district-level managers, who are responsible for these units, are fundamental to this NHI implementation. This qualitative study aimed to explore district and sub-district managerial views on NHI and their role in its implementation. Methods Purposive sampling was used to identify key respondents from a major urban district in Gauteng, South Africa, for participation in in-depth interviews. This study used framework analysis methodology within MaxQDA software. Results Three main themes were identified: managerial engagement in NHI policy development (with two sub-themes), managerial views on NHI (with three sub-themes) and perceptions of current NHI implementation (with six sub-themes). The managers viewed NHI as a social and moral imperative but lacked clarity and insight into the NHI Bill as well as the associated implementation strategies. The majority of respondents had not had the opportunity to engage in NHI policy formulation. Managers cited several pitfalls in current organisational operations. The respondents felt that national and provincial governments continue to function in a detached and rigid top-down hierarchy. Managers highlighted the need for their inclusion in NHI policy formulation and training and development for them to oversee the implementation strategies. Conclusions It appears that strategic purchasing is not being operationalised in PHC. NHI policy implementation appears to function in a rigid top-down hierarchy that excludes key stakeholders in the NHI implementation strategy. The findings of this study suggest an inadequate decentralisation of healthcare governance within the public sector necessary to attain UHC. District managers need to be engaged and capacitated to operationalise the planned decentralised purchasing-provision function of the DHS within the NHI Bill.

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“…Prior to the start of the COVID-19 pandemic, health systems in Africa have been strained from the burden of historic underinvestment (9,10). The attendant weaknesses meant that countries were not on track to achieve global human health development goals -including the health-related Sustainable Development Goals (11).…”

Section: Introductionmentioning

confidence: 99%

The direct and indirect impact of COVID-19 pandemic on maternal and child health services in Africa: a scoping review

Adu

Stallwood

Adebola

et al. 2021

Preprint

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IntroductionThe novel coronavirus disease 2019 (COVID-19) continues to disrupt the availability and utilization of routine and emergency health care services, with differing impacts in jurisdictions across the world. In this scoping review, we set out to synthesize documentation of the direct and indirect effect of the pandemic, and national responses to it, on maternal and child health (MNCH) in Africa.MethodsA scoping review was conducted to provide an overview of the most significant impacts identified up to February 2021. Our search included peer reviewed literature, working papers and news articles with the intent to capture evolving and novel updates on the topic. Narrative descriptions were written about thematic areas for which the authors extracted the most evidence.ResultsOne hundred and fifty-five articles were identified through our literature search and 17 were deemed appropriate for analysis. We identified three overarching themes: delayed care, disruption in service provision and utilization and mitigation strategies or recommendation.DiscussionAvailable literature suggests widespread service cutbacks amid a mosaic of mitigation strategies. Our results show that minor consideration was given to preserving health service access for mothers and children, especially in historically underserved areas. Lack of emergency preparedness and infrastructural constraints prevented useful approaches such as telemedicine from being meaningfully utilized.ConclusionsOur scoping review shows that limited research has been published on this topic. Reviewed literature illuminates the continuing need and prioritization for maternity services, immunization, and reproductive health services, which have not been prioritized during the pandemic, yet are necessary to shield the continent’s most vulnerable population segments from the shocks of current and future global health emergencies.

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Health financing for universal health coverage in Sub-Saharan Africa: a systematic review

Cited by 88 publications

References 40 publications

Risk assessment for COVID-19 transmission at household level in sub-Saharan Africa: evidence from DHS

Risk assessment for COVID-19 transmission at household level in sub-Saharan Africa: evidence from DHS

The views of public service managers on the implementation of National Health Insurance in primary care: a case of Johannesburg Health District, Gauteng Province, Republic of South Africa

The direct and indirect impact of COVID-19 pandemic on maternal and child health services in Africa: a scoping review

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