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Karamagi HC, Njuguna D, Kidane SN, Djossou H, Kipruto HK, Seydi ABW, Nabyonga-Orem J, Muhongerwa DK, Frimpong KA, Nganda BM. Financing health system elements in Africa: A scoping review. PLoS One 2023; 18:e0291371. [PMID: 37703243 PMCID: PMC10499258 DOI: 10.1371/journal.pone.0291371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 08/26/2023] [Indexed: 09/15/2023] Open
Abstract
Countries that are reforming their health systems to progress towards Universal Health Coverage (UHC) need to consider total resource requirements over the long term to plan for the implementation and sustainable financing of UHC. However, there is a lack of detailed conceptualization as to how the current health financing mechanisms interplay across health system elements. Thus, we aimed to generate evidence on how to utilize resources from different sources of funds in Africa. We conducted a scoping review of empirical research following the six-stage methodological framework for Scoping Review by Arksey & O'Malley and Levac, Colquhoun & O'Brien. We searched for published and grey literature in Medline, Cochrane Library, PubMed, WHO database, World bank and Google Scholar search engines databases and summarized data using a narrative approach, involving thematic syntheses and descriptive statistics. We included 156 studies out of 1,168 studies among which 13% were conceptual studies while 87% were empirical studies. These selected studies focused on the financing of the 13 health system elements. About 45% focused on service delivery, 13% on human resources, 5% on medical products, and 3% on infrastructure and governance. Studies reporting multiple health system elements were 8%, while health financing assessment frameworks was 23%. The publication years ranged from 1975 to 2021. While public sources were the most dominant form of financing, global documentation of health expenditure does not track funding on all the health system dimensions that informed the conceptual framework of this scoping review. There is a need to advocate for expenditure tracking for health systems, including intangibles. Further analysis would inform the development of a framework for assessing financing sources for health system elements based on efficiency, feasibility, sustainability, equity, and displacement.
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Affiliation(s)
- Humphrey Cyprian Karamagi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - David Njuguna
- Health Economist, Ministry of Health, Nairobi, Kenya
| | - Solyana Ngusbrhan Kidane
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Herve Djossou
- Economic Planning Manager, Ministry of Health, Benin
| | - Hillary Kipchumba Kipruto
- Universal Health Coverage–Life Course, WHO Regional Office for Africa, Brazzaville, Republic of the Congo
| | - Aminata Binetou-Wahebine Seydi
- Data Analytics and Knowledge Management, World Health Organization (WHO) Regional Office for Africa, Brazzaville, Republic of Congo
| | - Juliet Nabyonga-Orem
- Health Financing, Universal Health Coverage Life Course Cluster, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Diane Karenzi Muhongerwa
- Health Financing, Universal Health Coverage Life Course Cluster, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Kingsley Addai Frimpong
- Health Financing, Universal Health Coverage Life Course Cluster, World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Benjamin Musembi Nganda
- Health Financing, Universal Health Coverage Life Course Cluster, World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Kitole FA, Lihawa RM, Mkuna E. Equity in the public social healthcare protection in Tanzania: does it matter on household healthcare financing? Int J Equity Health 2023; 22:50. [PMID: 36941603 PMCID: PMC10026448 DOI: 10.1186/s12939-023-01855-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023] Open
Abstract
Efforts to promote equity in healthcare involve implementing policies and programs that address the root causes of healthcare disparities and promote equal access to care. One such program is the public social healthcare protection schemes. However, like many other developing countries, Tanzania has low health insurance coverage, hindering its efforts to achieve universal health coverage. This study examines the role of equity in public social healthcare protection and its effects on household healthcare financing in Tanzania. The study used secondary data collected from the National Bureau of Statistics' National Panel Survey 2020/21 and stratified households based on their place of residence (rural vs. urban). Moreover, the logit regression model, ordered logit, and the endogenous switching regression model were used to provide counterfactual estimates without selection bias and endogeneity problems. The results showed greater variations in social health protection across rural and urban households, increasing disparities in health outcomes between these areas. Rural residents are the most vulnerable groups. Furthermore, education, income, and direct healthcare costs significantly influence equity in healthcare financing and the ability of households to benefit from public social healthcare protection schemes. To achieve equity in healthcare in rural and urban areas, developing countries need to increase investment in health sector by reducing the cost of healthcare, which will significantly reduce household healthcare financing. Furthermore, the study recommends that social health protection is an essential strategy for improving fair access to quality healthcare by removing differences across households and promoting equality in utilizing healthcare services.
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Affiliation(s)
| | | | - Eliaza Mkuna
- Department of Economics, Mzumbe University, P.O Box 5, Mzumbe, Tanzania
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Kitole FA, Lihawa RM, Mkuna E. Analysis on the equity differential on household healthcare financing in developing countries: empirical evidence from Tanzania, East Africa. HEALTH ECONOMICS REVIEW 2022; 12:55. [PMID: 36342557 PMCID: PMC9639327 DOI: 10.1186/s13561-022-00404-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/25/2022] [Indexed: 05/23/2023]
Abstract
BACKGROUND Achieving equity in healthcare services has been a global priority. According to the literature, a slew of initiatives aimed at increasing household equity in healthcare financing have exacerbated the problem, making it hard for most developing countries to understand the real cause of the problem. METHOD The non-experimental research design has been used to explore the Tanzania Panel Survey (NPS) data 2019/2020, to investigate equity differential in household healthcare financing in Tanzania by the use of conventional instrumental variable methods of Two-stage and Three-stage least square methods RESULTS: Despite the global agenda of universal health coverage, this paper reveals that 86 percent of Tanzania lacks health insurance with a high degree of inequitable distribution of health facilities as 71.54 percent of the population is in rural areas, yet these areas have poor health systems compared to urban ones. These disparities increase pressure on household healthcare financing and widen the inequity and equality gaps simultaneously. Additionally, a household's income, education, health care waivers, out-of-pocket expenditure, and user fees have been found to have a significant impact on household equity in healthcare financing. CONCLUSION To reverse the situation and increase equity in household healthcare financing in most developing countries, this paper suggests that an adequate pooling system should be used to allow more people to be covered by medical prepayment programs, and the donor-funded programs in developing countries should focus on health sector infrastructure development and not the capacity building.
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Affiliation(s)
| | | | - Eliaza Mkuna
- Department of Economics, Mzumbe University, P.O Box 5, Mzumbe, Tanzania
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Family Physician Perceptions of Climate Change, Migration, Health, and Healthcare in Sub-Saharan Africa: An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126323. [PMID: 34207979 PMCID: PMC8296126 DOI: 10.3390/ijerph18126323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
Although family physicians (FPs) are community-oriented primary care generalists and should be the entry point for the population’s interaction with the health system, they are underrepresented in research on the climate change, migration, and health(care) nexus (hereafter referred to as the nexus). Similarly, FPs can provide valuable insights into building capacity through integrating health-determining sectors for climate-resilient and migration-inclusive health systems, especially in Sub-Saharan Africa (SSA). Here, we explore FPs’ perceptions on the nexus in SSA and on intersectoral capacity building. Three focus groups conducted during the 2019 WONCA-Africa conference in Uganda were transcribed verbatim and analyzed using an inductive thematic approach. Participants’ perceived interactions related to (1) migration and climate change, (2) migration for better health and healthcare, (3) health impacts of climate change and the role of healthcare, and (4) health impacts of migration and the role of healthcare were studied. We coined these complex and reinforcing interactions as continuous feedback loops intertwined with socio-economic, institutional, and demographic context. Participants identified five intersectoral capacity-building opportunities on micro, meso, macro, and supra (international) levels: multi-dimensional and multi-layered governance structures; improving FP training and primary healthcare working conditions; health advocacy in primary healthcare; collaboration between the health sector and civil society; and more responsibilities for high-income countries. This exploratory study presents a unique and novel perspective on the nexus in SSA which contributes to interdisciplinary research agendas and FP policy responses on national, regional, and global levels.
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