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universal health coverage in Somalia: Charting the Path to Equitable healthcare Financing and Governance

health 2023年第11期15卷 1298-1317页

作者： Abdirazak Yusuf Ahmed Fawziya Abikar Nor Mustafa Yusuf Ahmed Marian Muse Osman Dmertini Public health Health System Adviser at Ministry of Mogadishu Somalia Mogadishu Somalia The Federal Ministry of health Mogadishu Somalia Dean Faculty of Medicine and health Science at Darulhikmah University Mogadishu Somalia Research Department National Institute of Health Mogadishu Somalia

Somalia is a country facing numerous challenges in achieving universal health coverage (UHC) and ensuring adequate healthcare financing, This article explores the complexities and obstacles that Somalia must overcome in its pursuit of UHC, the paper begins by providing an overview of the current healthcare landscape in Somalia, highlighting the lack of infrastructure, political instability, and limited financial resources that hinder the establishment of a comprehensive and equitable healthcare system. It then examines the role of international aid and non-governmental organizations (NGOs) in filling the healthcare gap, while emphasizing the need for a more sustainable, domestically financed solution. Drawing on a range of data sources and case studies, the article proposes a multi-faceted approach to strengthen healthcare governance, improve resource allocation, and foster local capacity building, the study delves into the unique obstacles that Somalia faces, including a lack of infrastructure, political instability, and limited financial resources, which hinder the establishment of a comprehensive and equitable healthcare system. The paper also examines the role of international aid and non-governmental organizations (NGOs) in filling the healthcare gap, while highlighting the need for a more sustainable, domestically financed solution. The findings underscore the importance of political commitment, international cooperation, and innovative financing mechanisms in advancing towards UHC in Somalia, providing valuable insights for other low resource, conflict affected settings.

关键词： universal health coverage health Governance health Finance Equitable health Access

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

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Global health Research and Policy 2021年第1期6卷 429-437页

作者： Susan C.Ifeagwu Justin C.Yang Rosalind Parkes-Ratanshi Carol Brayne Department of Public health and Primary Care Cambridge Public HealthUniversity of CambridgeCambridgeUK Department of Epidemiology and Applied Clinical Research Division of PsychiatryFaculty of Brain SciencesUniversity College LondonLondonUK Infectious Diseases Institute Makerere University College of Health SciencesKampalaUganda

Background:universal health coverage(UHC)embedded within the United Nations Sustainable Development Goals,is defined by the World health Organization as all individuals having access to required health services,of sufficient quality,without suffering financial *** strategies for financing healthcare are critical in achieving this goal yet remain a challenge in Sub-Saharan Africa(SSA).This systematic review aims to determine reported health financing mechanisms in SSA within the published literature and summarize potential ***:A systematic review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)reporting *** 19 to 30 July 2019,MEDLINE,EMBASE,Web of Science,Global health Database,the Cochrane Library,Scopus and JSTOR were searched for literature published from *** describing health financing approaches for UHC in SSA were *** was synthesised in form of a table and thematic ***:Of all records,39 papers were selected for *** the included studies,most studies were conducted in Kenya(n=7),followed by SSA as a whole(n=6)and Nigeria(n=5).More than two thirds of the selected studies reported the importance of equitable national health insurance schemes for *** results indicate that a majority of health care revenue in SSA is from direct out-of-pocket *** common financing mechanism was donor funding,which was reported by most of the *** average quality score of all studies was 81.6%,indicating a high appraisal *** interrater reliability Cohen’s kappa score,κ=0.43(p=0.002),which showed a moderate level of ***:Appropriate health financing strategies that safeguard financial risk protection underpin sustainable health services and the attainment of *** is evident from the review that innovative health financing strategies in SSA are *** limitations of this review include potentia

关键词： universal health coverage health financing Sub-Saharan Africa Systematic review

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Building quality primary health care development in the new era towards universal health coverage:a Beijing initiative

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Global health Research and Policy 2023年第1期8卷 2-7页

作者： Minghui Ren Tuohong Zhang Jin Xu Jie Qiao Jianrong Qiao Siyan Zhan Jiangmei Qin Daping Song Yanru Fang Yifang Lin Xiaopeng Jiang Yan Guo Qingyue Meng Xu Qian Yunguo Liu Sophia Siu Chee Chan Feng Zhao Winnie Yip Hong Wang Minmin Wang Hui Yin Zuokun Liu Na Li Xinyi Song Fangfang Liu Yinzi Jin Fangjing Liu Yangmu Huang Department of Global health School of Public HealthPeking UniversityBeijingChina Institute for Global health Peking UniversityBeijingChina China Centre for health Development Studies Peking UniversityBeijingChina Center for Reproductive Medicine Department of Obstetrics and GynecologyPeking University Third HospitalBeijingChina World health Organization Representative Office in China BeijingChina Department of Epidemiology and Biostatistics School of Public HealthPeking University Health Science CenterBeijingChina China National health Development Research Center BeijingChina College of Agronomy and Biotechnology China Agricultural UniversityBeijingChina Department of Rehabilitation Medicine Huashan HospitalFudan UniversityShanghaiChina School of Public health Fudan UniversityShanghaiChina Global health Research Center Duke Kunshan UniversityKunshanJiangsuChina School of Nursing LKS Faculty of MedicineThe University of Hong KongPok Fu LamHong Kong SARChina health Nutrition and Population South Asia RegionWorld BankBangkokThailand Department of Global health and Population Harvard T H Chan School of Public HealthBostonMAUSA Bill&Melinda Gates Foundation BeijingChina

Primary health care(PHC)is the most effective way to improve people’s health and well-being,and primary care services should act as the cornerstone of a resilient health system and the foundation of universal health *** promote high quality development of PHC,an International Symposium on Quality Primary health Care Development was held on December 4-5,2023 in Beijing,China,and the participants have proposed and advocated the Beijing Initiative on Quality Primary health Care *** Beijing Initiative calls on all countries to carry out and strengthen 11 actions:fulfill political commitment and accountability;achieve“health in all policies”through multisectoral coordination;establish sustainable financing;empower communities and individuals;provide community-based integrated care;promote the connection and integration of health services and social services through good governance;enhance training,allocation and motivation of health workforce,and medical education;expand application of traditional and alternative medicine for disease prevention and illness healing;empower PHC with digital technology;ensure access to medicinal products and appropriate technologies;and last,strengthen global partnership and international health *** Initiative will enrich the content of quality development of PHC,build consensus,and put forward policies for quality development of PHC in China in the new era,which are expected to make contributions in accelerating global actions.

关键词： Primary health care universal health coverage Sustainable development agenda

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Challenges faced by community health nurses to achieve universal health coverage in Myanmar:A mixed methods study

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International Journal of Nursing Sciences 2021年第3期8卷 271-278,I0002,I0003页

作者： Sein Yaw May Naw Clara Ohn Khin Khin Win Win Mar Aye Nandar Han Su Su Maw Community health Nursing Department University of Nursing-YangonMyanmar

Objective:This study aimed to identify the challenges of community health nurses(CHNs)in delivering effective community health care to achieve universal health coverage(UHC)in ***:A total of 30 CHNs from township health centers in the northeastern,southern,and western parts of Myanmar were purposefully recruited for quantitative and qualitative *** data were processed using Microsoft Excel software,and qualitative data were analyzed using thematic *** study is registered with ***:Around the country,30 CHNs uncovered their hardships in implementing primary health care to achieve *** 90%of the participants agreed to the problem of inadequate health infrastructure,while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career *** problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health *** are incapable of evaluating health services for policy-making and the inability to conduct health research to develop evidencebased *** work and living conditions,unsupportive community relationships,and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to *** only the health system itself but also the population and other geographical factors have contributed to many challenges to ***:Myanmar’s CHNs face many challenges in achieving *** challenges are not confined to the health *** situations,such as geographical barriers and transportation problems,remain persistent challenges for healthcare *** study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infras

关键词： Community health nurses Community health services health personnel Myanmar Primary health care Professional practice Social conditions universal health coverage

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Assessment of health Purchasing Functions for universal health coverage in Nigeria: Evidence from Grey Literature and Key Informant Interviews

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health 2022年第3期14卷 330-341页

作者： Eric Obikeze Daniel Onyeje Jennifer Anyanti Omokhudu Idogho Uchenna Ezenwaka Nkoli Uguru Department of health Administration and Management College of Medicine University of Nigeria Enugu Campus Enugu Nigeria health Policy Research Group College of Medicine University of Nigeria Enugu Campus Enugu Nigeria Society of Family health Abuja Nigeria Department of Preventive Dentistry College of Medicine University of Nigeria Enugu Campus Enugu Nigeria

Objective: Out of pocket expenditure is the primary means of financing healthcare in middle and low-income countries. The 2021 government health expenditure in Nigeria at 4.52% falls short of the 15% recommendation of the 2001 Abuja Declaration. This paper examines healthcare purchasing in Nigeria, in order to explore how resources were allocated and create better insight into healthcare purchasing for universal health coverage. Data Source/Study Setting: The study was conducted in the Federal Capital Territory and three states—Lagos, Enugu and Sokoto. Study Design: A cross sectional method was used to examine health purchasing functions in Nigeria. Key informant interviews and review of grey and published literature on health financing in the selected study areas. Data Collection Methods: Primary data were collected from relevant stakeholders across the selected study areas, using a structured interview guide. A search of grey and published literature gave a total of 57 references. Principal Findings: The NHIS has a clearly articulated benefit package, for its formal sector and pro-poor BHCPF program. NHIS covers only about 5% of the Nigerian population. BHCPF (SOML) program targets the bottom 40% of Nigerians on paper, but there is no specific design for reaching them. The NHIS uses both public and private sector providers. It is not clear which providers are used for the BHCPF (SOML) program. The NHIS uses actuarially calculated capitations for primary care services and market-based fee-for-service rates for reimbursing secondary and tertiary care. BHCPF (SOML) uses a macroscale pay-for-performance mechanism to reward states achieving specific health outcomes. Conclusion: health purchasing functions have serious implication for UHC. However, health care provision in Nigeria is not pro-poor and government efforts do not promote efficiency. Available option is prioritization of health initiatives that ensure value for money through performance-based financing and p

关键词： universal health coverage Nigeria healthcare Purchasing Insurance healthcare Funding

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Understanding surgical care delivery in Sub-Saharan Africa:a cross-sectional analysis of surgical volume,operations,and financing at a tertiary referral hospital in rural Tanzania

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Global health Research and Policy 2019年第1期4卷 78-86页

作者： Praveen Paul Rajaguru Mubashir Alavi Jusabani Honest Massawe Rogers Temu Neil Perry Sheth Center for Public health Initiatives University of PennsylvaniaPhiladelphiaPAUSA Department of Orthopaedic Surgery Kilimanjaro Christian Medical CenterMoshiTanzania Department of Orthopaedic Surgery University of PennsylvaniaPhiladelphiaPAUSA

Background:Access to surgical care in Low-and Middle-Income Countries(LMICs)such as Tanzania is extremely *** Tanzania is served by a single tertiary referral hospital,Kilimanjaro Christian Medical Centre(KCMC).The surgical volumes,workflow,and payment mechanisms in this region have not been *** these factors is critical in expanding access to *** authors sought to evaluate the operations and financing of the main operating theaters at KCMC in Sub-Saharan ***:The 2018 case volume and specialty distribution(general,orthopaedic,and gynecology)in the main operating theaters at KCMC was retrieved through retrospective review of operating report *** workflow(*** and cancelled cases,lengths of procedures,lengths of operating days)and financing data(patient payment methods)from the five KCMC operating theater logs were retrospectively reviewed for the available fivemonth period of March 2018 to July *** statistics and statistical analysis were ***:In 2018,the main operating theaters at KCMC performed 3817 total procedures,with elective procedures(2385)outnumbering emergency procedures(1432).General surgery(1927)was the most operated specialty,followed by orthopaedics(1371)and gynecology(519).In the five-month subset analysis period,just 54.6%of planned operating days were fully *** were 238 cancellations(20.8%of planned operations).Time constraints(31.1%,74 cases)was the largest reason;lack of patient payment accounted for as many cancellations as unavailable equipment(6.3%,15 cases each).Financing for elective theater cases included insurance 45.5%(418 patients),and cash 48.4%(445 patients).Conclusion:While surgical volume is high,there are non-physical inefficiencies in the system that can be addressed to reduce cancellations and improve *** physical resources is not enough to improve access to care in this region,and likely in many LMIC set

关键词： Global health systems Global surgery delivery Capacity building universal health coverage Access to healthcare Low-and middle-income countries Financing healthcare Systems and operations

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Primary health care in China:A decade of development after the 2009 health care reform

Health Care Science

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health Care Science 2022年第3期1卷 146-159页

作者： You Wu Zeyu Zhang Ning Zhao Yue Yan Lina Zhao Qi Song Rong Ma Changfeng Li Jinyi Li Suibin Liu Xinran Bi Zongjiu Zhang School of Medicine Tsinghua UniversityBeijingChina Institute for Hospital Management Tsinghua UniversityBeijingChina

Over 40 years ago,primary health care(PHC)was defined in the Alma-Ata Declaration as a critical component of the health care system to address the basic health demand of the *** China,the Government attaches great importance to health care at the primary *** the launch of the historical Reform of the Medical and health Care System in 2009,the PHC system in China has witnessed major progress and breakthroughs,especially in its steadily increased capacity,continuously improved accessibility,and betterment in *** this review,we summarized published literatures and official policies,synthesized data from the electronic registration information system of the National health Commission,national statistical reports,and yearbooks in health *** review is intended to describe the systematic development of PHC in China in the last *** main results include:the solid national policy foundation,increasing number of PHC institutions and workforce,better training of PHC professionals,major achievements in primary health indicators,government financial support to PHC institutions,improved PHC budgeting and insurance coverage,and the advancement of supporting *** and prospects are also discussed.

关键词： policy primary health care public health service universal health coverage

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Non-inclusion of certified herbal medicines in the National health Insurance Scheme affects patient utilization of the integrated herbal medicine services in Ghana

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Traditional Medicine Research 2022年第4期7卷 75-80页

作者： Anthony Nketia Emmanuel Nakua Andrews William Tetteh Kwesi P.Thomford Kwame O.Boadu Ama K.Thomford Department of health Promotion Education and Disability StudiesSchool of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana Department of Epidemiology and Biostatistics School of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana Department of Pharmacognosy and Herbal Medicine University of Cape CoastKumasiGhana Department of Maternal and Child health Kumasi South HospitalKumasiGhana Department of Biomedical Sciences University of Cape CoastKumasiGhana

Background:In 2011,Ghana piloted the integration of herbal medicine services into mainstream health care delivery in selected government hospitals across the *** date,however,no single certified herbal drug is generally covered by the national health insurance *** study evaluated the implications of out-of-pocket payment for prescriptions on the patronage of herbal medicine units in 3 selected government hospitals within Kumasi ***:A cross-sectional study on 413 participants was performed using a semi-structured ***:The majority of study respondents were female(54%),and the median age was 35 *** participants(83.1%)were aware that herbal medicine was integrated in the mainstream health care system of the *** the costs of certified herbal drugs,51.5%of respondents considered them very expensive;72.1%of the respondents believed that the costs of certified herbal drugs adversely affected the utilization of herbal units at government hospitals,which produced a positive correlation(r=0.5498).A total of 99.5%of the respondents recommended the inclusion of certified herbal drugs on the national health insurance drug ***:This study revealed that the costs of certified herbal medicines negatively affect utilization of herbal units at government *** improve the utilization of herbal units,certified herbal drugs dispensed at these units must thus be included in the national health insurance drug list.

关键词： omplementary and alternative medicines herbal medicine primary healthcare universal health coverage

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Factors determining membership in community-based health insurance in West Africa:a scoping review

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Global health Research and Policy 2022年第1期7卷 44-60页

作者： Kaba Kanko Conde Aboubacar Mariama Camara Manar Jallal Mohamed Khalis Saad Zbiri Vincent De Brouwere International School of Public health Mohammed VI University of Health SciencesBld Mohammed Taïeb NaciriCommune Hay Hassani82403 Casa-blancaMorocco Laboratory of Public health Health Economics and Health ManagementMohammed VI University of Health SciencesCasablancaMorocco Knowledge for health Policies Centre CasablancaMorocco Department of Public health Institute of Tropical MedicineAntwerpBel-gium School of Tropical Medicine and Global health University of NagasakiNagasakiJapan

Background:In many low-income countries,households bear most of the health care ***-based health insurance(CBHI)schemes have multiplied since the 1990s in West *** have significantly improved their members’access to health ***,a large proportion of users are reluctant to subscribe to a local *** the major factors affecting membership will be useful for improving CBHI *** objective of this research is to obtain a general overview of existing evidence on the determinants of CBHI membership in West ***:A review of studies reporting on the factors determining membership in CBHI schemes in West Africa was conducted using guidelines developed by the Joanna Briggs *** databases were searched(PubMed,ScienceDirect,Global health database,Embase,EconLit,***,BDPS,Cochrane database and Google Scholar)for relevant articles available by August 15,2022,with no methodological or linguistic restrictions in electronic databases and grey ***:The initial literature search resulted in 1611 studies,and 10 studies were identified by other *** eliminating duplicates,we reviewed the titles of the remaining 1275 studies and excluded 1080 irrelevant studies based on title and 124 studies based on *** the 71 full texts assessed for eligibility,32 additional papers were excluded(not relevant,outside West Africa,poorly described results)and finally 39 studies were included in the *** that negatively affect CBHI membership include advanced age,low education,low household income,poor quality of care,lack of trust in providers and remoteness,rules considered too strict or inappropriate,low trust in administrators and inadequate information ***:This study shows many lessons to be learned from a variety of countries and initiatives that could make CBHI an effective tool for increasing access to quality health care in order to achieve universal health cover

关键词： Community-based health insurance Mutual health organisations Membership universal health coverage health financing West Africa

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Impact of macro-fiscal determinants on health financing:empirical evidence from low-and middle-income countries

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Global health Research and Policy 2019年第1期4卷 167-179页

作者： Deepak Kumar Behera Umakant Dash Indian Institute of Public health Public Health Foundation of India751013 BhubaneswarIndia Department of Humanities and Social Sciences Indian Institute of Technology Madras600036 ChennaiIndia

Background:health financing is a major challenge in low-and middle-income counties(LMICs)for achieving universal health coverage(UHC).Past studies have argued that the budgetary allocation on health financing depends on macrofiscal policies of an economy such as sustained economic growth and higher revenue *** the global financial crisis of late 2008 observed a shortage of financial resources in richer countries and adversely affected the health ***,this study has examined the impact of macro-fiscal policies on health financing by adopting socioeconomic factors in 85 LMICs for the period 2000 to ***:The study has employed the panel System Generalized Method of Moment model that captures the endogeneity problem in the regression estimation by adopting appropriate instrumental ***:The elasticity of public health expenditure(PHE)with respect to macro-fiscal factors varies across *** revenue shows a positive and statistically significant relationship with PHE in full sample,pre-global financial crisis,middle-income,and coefficient value varies from 0.040 to 0.141%.Fiscal deficit and debt services payment shows a negative effect on PHE in full sample,as well as sub-samples and coefficient value,varies from 0.001 to 0.032%.Aging and per capita income show an expected positive relationship with PHE in LIMI ***:Favorable macro-fiscal policies would necessarily raise finance for the health sector development but the prioritization of health budget allocation during the crisis period depends on the nature of tax revenue mobilization and demand for health ***,the generation of health-specific revenues and effective usage of health budget would probably accelerate the progress towards the achievement of UHC.

关键词： health financing universal health coverage Macro-fiscal policies Global financial crisis Revenue mobilization Generalized method of moment

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