Who Needs Big Health Sector Reforms Anyway? Seychelles’ Road to UHC Provides Lessons for Sub-Saharan Africa and Island Nations

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

“…They also point to important areas for future focus. For example, The overall literature is highly skewed towards better funded areas, with more external support and interest, which means that local level innovations and smaller projects are neglected. We also highlight the tendency to evaluate what are seen as “new” initiatives, while many important areas of potential reform are overlooked if seen as “more of the same,” such as strengthening public health functions or directing more resources to primary care It also appears that more operational topics such as supply chain management and health information systems do not receive the same research and evaluative attention. More complex packages of measures, even if potentially more powerful, are harder to evaluate and also to publish on, leading to a bias towards studies of discrete investments. Much of what is identified in the review is project based.…”

“…• We also highlight the tendency to evaluate what are seen as "new" initiatives, while many important areas of potential reform are overlooked if seen as "more of the same," such as strengthening public health functions or directing more resources to primary care. 49 • It also appears that more operational topics such as supply chain management and health information systems do not receive the same research and evaluative attention.…”

Strengthening the Health System as a Strategy to Achieving a Universal Health Coverage in Underprivileged Communities in Africa: A Scoping Review

“…Policy makers involved stakeholders from the health and financial sectors [ 17 ]; providers of services under the formal sector social health insurance [ 18 ]; district councils across the country [ 19 ]; governments, implementers, drone providers, and funders of healthcare [ 41 ]; politicians and donor officials [ 21 ]; enrollees’ medical care utilization [ 47 ]; actors and policy processes [ 22 ]; health system governance and community health worker programs [ 42 ]; national UHC legislation that promote universal access to medicines [ 26 ]; decision makers, academic researchers, civil society organizations, community-based organizations, development partners, health professional organizations [ 29 ]; private health systems; Ministry of Finance [ 30 ]; and a range of political contexts [ 32 ].…”

“…This scoping review reports the different strategies (derived from the included studies) to strengthen the health system for attaining UHC in Africa. These strategies include those that fall under capacity building in health facilities, as well as developing and improving health infrastructure (e.g., training, supervising, and retaining healthcare workers, developing healthcare facilities) [ 19 , 24 , 27 , 30 , 35 , 42 , 49 ]; health information systems (health technology assessment) [ 29 , 41 ]; access to essential medicines (access to medicines and introducing African traditional medicine and traditional health practitioners into health systems) [ 23 , 26 ]; and health financing [ 17 , 18 , 20 , 21 , 22 , 25 , 28 , 31 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 43 , 44 , 45 , 46 , 47 , 48 , 50 ].…”

“…It was reported that UHC can be attained by developing and improving the health infrastructure in Ethiopia, Senegal, Seychelles, South Africa, Tanzania, and Zambia [ 19 , 24 , 27 , 30 , 35 , 42 , 49 ]. These strategies include increasing leadership capacity and management skills of facility managers, increasing healthcare worker force, and upgrading primary healthcare facilities.…”