Health Sector Reform in the Middle East and North Africa: Prospects and Experiences

Yazbeck, Abdo S.; Rabie, Tamer Samah; Pande, Aakanksha

doi:10.1080/23288604.2016.1272984

Cited by 19 publications

(42 citation statements)

References 4 publications

(2 reference statements)

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“…Globally, the UHC discussion must contend with the need for displaced persons to be covered under national insurance schemes. This discourse must also address the low levels of health spending and the resource limitations that exist in countries hosting the largest numbers of refugees [44]. One study among countries in the Association of Southeast Asian Nations (ASEAN) identified varying levels of government commitment to extending UHC to migrants, with Thailand exhibiting the most progressive policies – making coverage available for citizens, as well as regular and irregular migrants [45].…”

Section: Discussionmentioning

confidence: 99%

“What’s happening in Syria even affects the rocks”: a qualitative study of the Syrian refugee experience accessing noncommunicable disease services in Jordan

McNatt

Freels²,

Chandler

et al. 2019

Confl Health

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Background Humanitarian actors and host-countries in the Middle East and North Africa region are challenged with meeting the health needs of Syrian refugees and adjusting the response to contemporary humanitarian conditions – urban-based refugees, stressed host-country health systems and high NCD prevalence. Although several studies have explored NCD prevalence, utilization of services and barriers to access, these analyses took place prior to dramatic shifts in Jordanian health policy and did not account for nuances in health seeking and utilization behaviors or operational barriers. Accordingly, we aimed to understand the depth and nuances of Syrian refugees’ experiences accessing NCD services in urban and semi-urban settings in Jordan. Methods A qualitative study was conducted to explore the healthcare experiences of Syrian refugees in Jordan. The study team conducted 68 in-depth interviews with Syrian refugees in urban and semi-urban locations in central and northern Jordan. Results The findings indicated four themes key to understanding the healthcare experience: (1) emotional distress is a central concern and is frequently highlighted as the trigger for a non-communicable disease or its exacerbation; (2) service provision across all sectors – government, NGO, private – is complex, inadequate, expensive and fragmented, making engagement with the health sector physically and financially burdensome; (3) given financial constraints, participants make harmful decisions that further damage their health in order to reduce financial burdens, and (4) host-community members actively exhibit solidarity with their refugee neighbors and specifically do so during emergency health episodes. The findings from this study can be used to inform program design for forcibly displaced persons with NCDs and identify points of entry for effective interventions. Conclusions Opportunities exist for humanitarian and host-country actors to provide more comprehensive NCD services and to improve the relevance and the quality of care provided to Syrian refugees in Jordan. Global and national funding will need to align with front-line realities and foster better coordination of services between host-country health systems, private actors and non-governmental organizations.

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Section: Discussionmentioning

confidence: 99%

“What’s happening in Syria even affects the rocks”: a qualitative study of the Syrian refugee experience accessing noncommunicable disease services in Jordan

McNatt

Freels²,

Chandler

et al. 2019

Confl Health

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“…Similarly, the Affordable Care Act in the US has resulted in an impressive decrease in the percentage of uninsured adults [ 58 ].. Specifically to the Middle East and North Africa region, researchers have commented on the increased focus on building or reforming health insurance systems as a popular method of reform [ 59 ].…”

Section: Discussionmentioning

confidence: 99%

Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review

Koornneef

Robben

Blair

2017

BMC Health Serv Res

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BackgroundThe United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent and success of these reforms has not recently been comprehensively reviewed. In this paper we review the progress and outcomes of health systems reform in the UAE.MethodsWe searched relevant databases and other sources to identify published and unpublished studies and other data available between 01 January 2002 and 31 March 2016. Eligible studies were appraised and data were descriptively and narratively synthesized.ResultsSeventeen studies were included covering the following themes: the UAE health system, population health, the burden of disease, healthcare financing, healthcare workforce and the impact of reforms. Few, if any, studies prospectively set out to define and measure outcomes. A central part of the reforms has been the introduction of mandatory private health insurance, the development of the private sector and the separation of planning and regulatory responsibilities from provider functions. The review confirmed the commitment of the UAE to build a world class health system but amongst researchers and commentators opinion is divided on whether the reforms have been successful although patient satisfaction with services appears high and there are some positive indications including increasing coverage of hospital accreditation. The UAE has a rapidly growing population with a unique age and sex distribution, there have been notable successes in improving child and maternal mortality and extending life expectancy but there are high levels of chronic diseases. The relevance of the reforms for public health and their impact on the determinants of chronic diseases have been questioned.ConclusionsFrom the existing research literature it is not possible to conclude whether UAE health system reforms are working. We recommend that research should continue in this area but that research questions should be more clearly defined, focusing whenever possible on outcomes rather than processes.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2597-1) contains supplementary material, which is available to authorized users.

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“…As a second step, all Health System Reviews of high-and high-middle-income Arab countries were also reviewed, as there was a particular interest in learning about the Eastern Mediterranean region. This is a region with especially scarce compiled information, and it was a priority to compile all relevant information to aid policy-makers in HRH planning, which is picking up with the transformations occurring within the region [11]. From the Health System Reviews and HiT Reports, cited relevant reports were scanned to extract additional relevant information.…”

Section: Search Process and Selectionmentioning

confidence: 99%

Human resources for health interventions in high- and middle-income countries: findings of an evidence review

et al. 2020

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Many high-and middle-income countries face challenges in developing and maintaining a health workforce which can address changing population health needs. They have experimented with interventions which overlap with but have differences to those documented in low-and middle-income countries, where many of the recent literature reviews were undertaken. The aim of this paper is to fill that gap. It examines published and grey evidence on interventions to train, recruit, retain, distribute, and manage an effective health workforce, focusing on physicians, nurses, and allied health professionals in high-and middle-income countries. A search of databases, websites, and relevant references was carried out in March 2019. One hundred thirty-one reports or papers were selected for extraction, using a template which followed a health labor market structure. Many studies were cross-cutting; however, the largest number of country studies was focused on Canada, Australia, and the United States of America. The studies were relatively balanced across occupational groups. The largest number focused on availability, followed by performance and then distribution. Study numbers peaked in 2013-2016. A range of study types was included, with a high number of descriptive studies. Some topics were more deeply documented than others-there is, for example, a large number of studies on human resources for health (HRH) planning, educational interventions, and policies to reduce in-migration, but much less on topics such as HRH financing and task shifting. It is also evident that some policy actions may address more than one area of challenge, but equally that some policy actions may have conflicting results for different challenges. Although some of the interventions have been more used and documented in relation to specific cadres, many of the lessons appear to apply across them, with tailoring required to reflect individuals' characteristics, such as age, location, and preferences. Useful lessons can be learned from these higher-income settings for low-and middle-income settings. Much of the literature is descriptive, rather than evaluative, reflecting the organic way in which many HRH reforms are introduced. A more rigorous approach to testing HRH interventions is recommended to improve the evidence in this area of health systems strengthening.

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Health Sector Reform in the Middle East and North Africa: Prospects and Experiences

Cited by 19 publications

References 4 publications

“What’s happening in Syria even affects the rocks”: a qualitative study of the Syrian refugee experience accessing noncommunicable disease services in Jordan

“What’s happening in Syria even affects the rocks”: a qualitative study of the Syrian refugee experience accessing noncommunicable disease services in Jordan

Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review

Human resources for health interventions in high- and middle-income countries: findings of an evidence review

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