Abstract:Managers and administrators in charge of social protection and health financing, service purchasing and provision play a crucial role in harnessing the potential advantage of prudent organization, management and purchasing of health services, thereby supporting the attainment of Universal Health Coverage. However, very little is known about the needed quantity and quality of such staff, in particular when it comes to those institutions managing mandatory health insurance schemes and purchasing services. As man… Show more
“…[11] A holistic approach to improving the health workforce also demands greater attention to enhanced training and adequate mentoring; use of evidence to inform interprofessional education; a shift from predominantly hospital-based care to care in the community; and increased attention to the importance of robust management capacity, especially in low and middle income countries. [12] In addition to highlighting HRH issues as a key element to ensuring UHC, our analysis also offers insights into the broader set of service priorities which countries should address so as to achieve universal access. Recognizing that any investment in health programs is essentially a political rather than a technical choice, [13] we assert that this dominance analysis can help inform the political economy around where and how resources are invested in the health system.…”
Background Despite increasing political will to achieve Universal Health Coverage (UHC), there is a paucity of empiric data describing what health system indicators are useful surrogates of country-level progress towards UHC. We sought to determine what public health interventions were useful tracers of country-level UHC progress. Methods Across 183 countries we evaluated the extent to which 16 service delivery indicators explained variability in the UHC Service Coverage Index, (UHC SCI) a WHO-validated indicator of country-level health coverage. Dominance analyses, stratifying countries by World Bank income criteria, were used to determine which indicators were most important in in predicting UHC SCI scores. Findings Health workforce density ranked first overall, provision of basic sanitation and access to clean water ranked second, and provision of basic antenatal services ranked third. In analysis stratified by World Bank income criteria, health workforce density ranked first in Lower Middle Income-Countries (LMICs) (n = 45) and third in Upper Middle Income-Countries (UMICs) (n = 51). Conclusions While each country will have a different approach to achieving UHC, strengthening the health workforce will need to be a key priority if they are to be successful in achieving UHC.
“…[11] A holistic approach to improving the health workforce also demands greater attention to enhanced training and adequate mentoring; use of evidence to inform interprofessional education; a shift from predominantly hospital-based care to care in the community; and increased attention to the importance of robust management capacity, especially in low and middle income countries. [12] In addition to highlighting HRH issues as a key element to ensuring UHC, our analysis also offers insights into the broader set of service priorities which countries should address so as to achieve universal access. Recognizing that any investment in health programs is essentially a political rather than a technical choice, [13] we assert that this dominance analysis can help inform the political economy around where and how resources are invested in the health system.…”
Background Despite increasing political will to achieve Universal Health Coverage (UHC), there is a paucity of empiric data describing what health system indicators are useful surrogates of country-level progress towards UHC. We sought to determine what public health interventions were useful tracers of country-level UHC progress. Methods Across 183 countries we evaluated the extent to which 16 service delivery indicators explained variability in the UHC Service Coverage Index, (UHC SCI) a WHO-validated indicator of country-level health coverage. Dominance analyses, stratifying countries by World Bank income criteria, were used to determine which indicators were most important in in predicting UHC SCI scores. Findings Health workforce density ranked first overall, provision of basic sanitation and access to clean water ranked second, and provision of basic antenatal services ranked third. In analysis stratified by World Bank income criteria, health workforce density ranked first in Lower Middle Income-Countries (LMICs) (n = 45) and third in Upper Middle Income-Countries (UMICs) (n = 51). Conclusions While each country will have a different approach to achieving UHC, strengthening the health workforce will need to be a key priority if they are to be successful in achieving UHC.
“…O resultado são produtos de serviços de qualidade e, para tanto, é preciso adequação do planejamento, dos processos e da avaliação institucional. O gerenciamento da qualidade busca modificar as relações institucionais, transformar estruturas organizacionais, criar parcerias e incentivar funcionários a atingir as metas da organização (Obermann et al, 2018).…”
Este estudo objetivou analisar as investigações empíricas sobre o modelo de excelência em gestão e sua relevância para avaliar a qualidade da gestão em saúde. Trata-se de uma revisão narrativa da literatura realizada nas bases de dados MEDLINE via PubMed®, Web of ScienceTM, Scopus (Elsevier), índice bibliográfico LILACS, biblioteca eletrônica SciELO e Google Scholar. Foram selecionadas 16 publicações e identificados a localização, o modelo de gestão estudado, o tipo de instituição, procedimentos metodológicos e os desfechos dos estudos. A produção aborda os aspectos teóricos que embasam os modelos de gestão, sua aplicação em diversos tipos de instituição e a contribuição do modelo adotado na melhoria gerencial e dos resultados. Concluiu-se que a busca da qualidade nas instituições de saúde promove eficiência, eficácia e efetividade. Os estudos apontam os benefícios da adoção do modelo de gestão, como melhorias em processos e produtos, redução de custos, ampliação do grau de maturidade da gestão, aumento da produtividade e melhores condições de atingir e manter o desempenho desejado.
“…These dimensions provide an assessment framework for UHC-targeted initiatives, reflecting how many (or what proportion of) people received various needed health services of sufficient quality, while being protected from undue financial risks [ 44 ]. Although the framework does not take into account specific contextual factors, it has been widely used globally for conceptualising UHC across diverse health systems and contexts [ 45 – 47 ]. Fig.…”
Background
Implementation research has emerged as part of evidence-based decision-making efforts to plug current gaps in the translation of research evidence into health policy and practice. While there has been a growing number of initiatives promoting the uptake of implementation research in Africa, its role and effectiveness remain unclear, particularly in the context of universal health coverage (UHC). Hence, this scoping review aimed to identify and characterise the use of implementation research initiatives for assessing UHC-related interventions or programmes in Africa.
Methods
The review protocol was developed based on the methodological framework proposed by Arksey and O’Malley, as enhanced by the Joanna Briggs Institute. The review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). MEDLINE, Scopus and the Cochrane Library were searched. The search also included a hand search of relevant grey literature and reference lists. Literature sources involving the application of implementation research in the context of UHC in Africa were eligible for inclusion.
Results
The database search yielded 2153 records. We identified 12 additional records from hand search of reference lists. After the removal of duplicates, we had 2051 unique records, of which 26 studies were included in the review. Implementation research was used within ten distinct UHC-related contexts, including HIV; maternal and child health; voluntary male medical circumcision; healthcare financing; immunisation; healthcare data quality; malaria diagnosis; primary healthcare quality improvement; surgery and typhoid fever control. The consolidated framework for implementation research (CFIR) was the most frequently used framework. Qualitative and mixed-methods study designs were the commonest methods used. Implementation research was mostly used to guide post-implementation evaluation of health programmes and the contextualisation of findings to improve future implementation outcomes. The most commonly reported contextual facilitators were political support, funding, sustained collaboration and effective programme leadership. Reported barriers included inadequate human and other resources; lack of incentives; perception of implementation as additional work burden; and socio-cultural barriers.
Conclusions
This review demonstrates that implementation research can be used to achieve UHC-related outcomes in Africa. It has identified important facilitators and barriers to the use of implementation research for promoting UHC in the region.
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