Universal health coverage and COVID-19: recent developments and implications

UHC in Morocco: a bottom-up estimation of public hospitals' financing size based on a costing database

BACKGROUND

Morocco is engaged in a health system reform aimed at generalizing health insurance across the whole population by 2025. This study aims to build a national database of costs at all levels of public hospitals in Morocco and craft this database as a resource for further use in a strategic purchasing system. It also aims at estimating the funding gap and the budget that should be secured for public hospitals in Morocco to fully play their roles in the current ambitious reform.

METHOD

A costing study was implemented in 39 hospitals in 12 regions of Morocco (10 provincial hospitals, 11 regional hospitals, and 18 teaching hospitals). Using the hospital costing approach, we adapted and validated nationally our methodology to generate a database of unit costs based on data from 2019. All perspectives on cost were considered. Data collection was performed by cadres from MoH and facilitated by the WHO country office in Morocco. The production of the cost database allowed the development of a bottom-up estimation of the financing size for public health hospitals.

RESULTS

The study showed the feasibility of large-scale costing in the context of Morocco. The ownership of MoH and adherence to the process ensured the high quality of the collected data. There are many differences in unit costs for the same services moving from one hospital to another, which indicates existing inefficiencies. The database will contribute to shaping the strategic purchasing mechanism within the generalized health insurance schemes. The studied hospitals could be used as references to systematically update the billing system for health insurance.

Mitigating the impacts of the COVID-19 pandemic on vulnerable populations: Lessons for improving health and social equity

The COVID-19 pandemic had an inequitable and disproportionate impact on vulnerable populations, reversing decades of progress toward healthy populations and poverty alleviation. This study examines various programmatic tools and policy measures used by governments to support vulnerable populations during the pandemic. A comparative case study of 15 countries representing all World Health Organization's regions offers a comprehensive picture of countries with varying income statuses, health system arrangements and COVID-19 public health measures. Through a systematic desk review and key informant interviews, we report a spectrum of mitigation strategies deployed in these countries to address five major types of vulnerabilities (health, economic, social, institutional and communicative). We found a multitude of strategies that supported vulnerable populations such as migrant workers, sex workers, prisoners, older persons and school-going children. Prioritising vulnerable populations during the early phase of COVID-19 vaccination campaigns, direct financial subsidies and food assistance programmes were the most common measures reported. Additionally, framing public health information and implementing culturally sensitive health promotion interventions helped bridge the communication barriers in certain instances. However, these measures remain insufficient to protect vulnerable populations comprehensively. Our findings point to the need to expand fiscal space for health, enlarge healthcare coverage, incorporate equity principles in all policies, leverage technology, multi-stakeholder co-production of policies and tailored community engagement mechanisms.

Determinants of COVID-19 cases and deaths in OECD countries

Aim

This research aims to examine the effects of variables that can affect COVID-19 deaths and cases in Organisation for Economic Co-operation and Development (OECD) countries during the years 2020 (first wave), 2021 (vaccine available), and 2022 (vaccine available and Omicron variant appeared).

Material and method

The factors that are thought to affect the case and death rates in 37 OECD countries were examined by multiple linear regression analysis using SPSS 22. The dependent variables were the COVID-19 deaths and cases per 10,000 (in 2020, 2021, and 2022); the independent variables were universal health coverage, physicians, nurses, intensive care beds, hospital beds, non-communicable diseases mortality per 100,000 people, population over 65 years of age, out-of-pocket expenditure, private expenditure, and health expenditure per capita and percent of % GDP.

Results

It was determined that the non-communicable diseases mortality is the relatively important variable COVID-19 cases and deaths in 2020 and 2021. After controlling for the scores of other variables, according to the ß coefficients, a one-unit increase in the number of physicians variable increases COVID-19 cases by 1.14 units in 2022; a one-unit increase in the universal coverage variable decreases COVID-19 deaths by 0.33 units in 2022.

Conclusion

The results of this research provide evidence that the effects of the COVID-19 outbreak have changed between 2020, the first wave of the epidemic, 2021, when the vaccine is available, and 2022, when both the vaccine is available and the Omicron variant is seen. With the increase in vaccination in 2022, the impact of non-communicable diseases mortality on the number of COVID-19 cases has decreased.

Impact of good governance, economic growth and universal health coverage on COVID-19 infection and case fatality rates in Africa

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has disrupted lives across all countries and communities. It significantly reduced the global economic output and dealt health systems across the world a serious blow. There is growing evidence showing the progression of the COVID-19 pandemic and the impact it has on health systems, which should help to draw lessons for further consolidating and realizing universal health coverage (UHC) in all countries, complemented by more substantial government commitment and good governance, and continued full implementation of crucial policies and plans to avert COVID-19 and similar pandemic threats in the future. Therefore, the objective of the study was to assess the impact of good governance, economic growth and UHC on the COVID-19 infection rate and case fatality rate (CFR) among African countries.

METHODS

We employed an analytical ecological study design to assess the association between COVID-19 CFR and infection rate as dependent variables, and governance, economic development and UHC as independent variables. We extracted data from publicly available databases (i.e., Worldometer, Worldwide Governance Indicators, Our World in Data and WHO Global Health Observatory Repository). We employed a multivariable linear regression model to examine the association between the dependent variables and the set of explanatory variables. STATA version 14 software was used for data analysis.

RESULTS

All 54 African countries were covered by this study. The median observed COVID-19 CFR and infection rate were 1.65% and 233.46%, respectively. Results of multiple regression analysis for predicting COVID-19 infection rate indicated that COVID-19 government response stringency index (β = 0.038; 95% CI 0.001, 0.076; P = 0.046), per capita gross domestic product (GDP) (β = 0.514; 95% CI 0.158, 0.87; P = 0.006) and infectious disease components of UHC (β = 0.025; 95% CI 0.005, 0.045; P = 0.016) were associated with COVID-19 infection rates, while noncommunicable disease components of UHC (β = -0.064; 95% CI -0.114; -0.015; P = 0.012), prevalence of obesity among adults (β = 0.112; 95% CI 0.044; 0.18; P = 0.002) and per capita GDP (β = -0.918; 95% CI -1.583; -0.254; P = 0.008) were associated with COVID-19 CFR.

CONCLUSIONS

The findings indicate that good governance practices, favourable economic indicators and UHC have a bearing on COVID-19 infection rate and CFR. Effective health system response through a primary healthcare approach and progressively taking measures to grow their economy and increase funding to the health sector to mitigate the risk of similar future pandemics would require African countries to move towards UHC, improve governance practices and ensure economic growth in order to reduce the impact of pandemics on populations.

How Universal Health Coverage can curb the escalating antimicrobial resistance in Pakistan: a call to action for the country's healthcare system

Antimicrobial resistance (AMR) has emerged as a major threat to the global healthcare economy during Coronavirus disease 2019 (COVID-19), especially in developing countries like Pakistan where the healthcare facilities are already substandard. To combat AMR, the World Health Organization (WHO) has taken several initiatives including the establishment of a sustainable Universal Health Coverage (UHC) system. The implementation of UHC could eliminate various factors that contribute to a high AMR rate including self-medication. Our commentary explores in depth the current UHC system in Pakistan and how UHC could be the answer to Pakistan’s AMR crisis.

Tuberculosis amidst COVID-19 in Pakistan: a massive threat of overlapping crises for the fragile healthcare systems

Mycobacterium tuberculosis is the cause of tuberculosis (TB), a granulomatous illness that mostly affects the lungs. Pakistan is one of the eight nations that accounts for two-thirds of all new cases of developing TB. TB has long been an endemic disease in Pakistan. According to the World Health Organization (WHO) estimates, the nation has over 500 000 incident TB infections per year, with a rising number of drug-resistant cases. Recently, the coexistence of COVID-19 and TB in Pakistan has provided doctors with a problem. Fever or chills, cough, shortness of breath or difficulty breathing are all signs of COVID-19. After SARS-CoV-2 infection, cough might persist for weeks or months and it is frequently accompanied by persistent tiredness, cognitive impairment, dyspnoea or pain – a group of long-term consequences known as post-COVID syndrome or protracted COVID. Coughing with mucus or blood, and coughing that continues over 2 months are indications of TB. The same clinical presentation features make it difficult for healthcare personnel to effectively evaluate the illness and prevent the spread of these fatal diseases. Pakistan lacks the necessary healthcare resources to tackle two contagious diseases at the same time. To counteract the sudden increase in TB cases, appropriate management and effective policies must be implemented. Thus, in order to prevent the spread of these infectious diseases, it is critical to recognise and address the problems that the healthcare sector faces, as well as to create an atmosphere in which the healthcare sector can function at its full potential.

A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys

Background: The core Universal Health Coverage (UHC) objectives are to ensure universal access to healthcare services by reducing all forms of inequalities. However, financial constraints are major barriers to accessing healthcare, especially in countries such as Nigeria and South Africa. The findings of this study may aid in informing and communicating health policy to increase financial access to healthcare and its utilization in South Africa and Nigeria. Nigeria-South Africa bilateral relations in terms of politics, economics and trade are demonstrated in the justification of the study setting selection. The objectives were to estimate the prevalence of health insurance coverage, and to explore the socio-demographic factors associated with health insurance in South Africa and Nigeria. Methods: This was a cross-sectional study using the 2018 Nigeria Demographic Health Survey and the 2016 South Africa Demographic Health Survey. The 2018 Nigeria Demographic Health Survey data on 55,132 individuals and the 2016 South Africa Demographic Health Survey on 12,142 individuals were used to investigate the prevalence of health insurance associated with socio-demographic factors. Percentages, frequencies, Chi-square and multivariate logistic regression were e mployed, with a significance level of p < 0.05. Results: About 2.8% of the Nigerian population and 13.3% of the South African population were insured (Nigeria: males-3.4%, females-2.7% vs. South Africa: males-13.9%, females-12.8%). The multivariate logistic regression analyses showed that higher education was significantly more likely to be associated with health insurance, independent of other socio-demographic factors in Nigeria (Model I: OR: 1.43; 95% CI: 0.34-1.54, p < 0.05; Model II: OR: 1.34; 95% CI: 0.28-1.42, p < 0.05) and in South Africa (Model I: OR: 1.33; 95% CI: 0.16-1.66, p < 0.05; Model II: OR: 1.76; 95% CI: 0.34-1.82, p < 0.05). Respondents with a higher wealth index and who were employed were independently associated with health insurance uptake in Nigeria and South Africa (p < 0.001). Females were more likely to be insured (p < 0.001) than males in both countries, and education had a significant impact on the likelihood of health insurance uptake in high wealth index households among both male and females in Nigeria and South Africa. Conclusion: Health insurance coverage was low in both countries and independently associated with socio-demographic factors such as education, wealth and employment. There is a need for continuous sensitization, educational health interventions and employment opportunities for citizens of both countries to participate in the uptake of wide health insurance coverage.

COVID-19 pandemic: The fears and hopes for SDG 3, with focus on prevention and control of noncommunicable diseases (SDG 3.4) and universal health coverage (SDG 3.8)

The 17 Sustainable Development Goals (SDGs) were adopted by the United Nations (UN) General Assembly in 2015 to set the world on the path to peace, prosperity, and sustainable development. As a result of the global focus on SDGs, in particular SDG 3—ensuring a healthy life and promoting well-being for all—and its 13 targets, significant progress has been made in global health. The Global Action Plan for the Prevention and Control of Noncommunicable Diseases (NCDs) was officially placed on the World Health Organization (WHO) agenda in 2013. Subsequently, the UNs’ SDGs incorporated SDG 3.4, based on which many countries have been developing national strategies to reduce burden of NCDs. Besides, building upon WHO’s efforts to promote universal health coverage (UHC) since 2010, SDG 3.8 with a focus on UHC was adopted, following which 75% of national health policies were developed with the aim of moving toward UHC.

Almost through one-third of SDG’s pathway, the COVID-19 pandemic has been hampering global efforts to achieve the 2030 agenda. The ongoing COVID-19 pandemic has affected all aspects of social, political, environmental, and economic life worldwide. The crisis has made SDGs almost unlikely to reach. It has unprecedentedly interrupted the provision of and access to essential healthcare services in all settings. The situation worsened particularly in low- and middle-income countries, where preexisting health inequalities and weak health systems jeopardized control and mitigation. The disruption in the provision of healthcare services may have long-term consequences for people with NCDs, especially the most vulnerable and in need of regular long-term care. Worse still, patients with NCDs have been reported to be at higher risk for serious illness or death from COVID-19. The pandemic also reinforces the importance of UHC, the need to prioritize universal health preparedness and accelerate global efforts to build back stronger and more resilient health systems to make progress toward UHC. COVID-19 has demonstrated the fact that the health systems of many countries are not fully prepared to protect the health of their populations and reaffirmed the fact that a strong and resilient health system based on primary healthcare is the basis for effective response to the crises and a reliable platform for advances in health safety and UHC. In this chapter, we will discuss the consequences of the COVID-19 pandemic on achieving SDG 3 targets—with a special focus on SDG 3.4 (NCDs) and SDG 3.8 (UHC).

Drug shops for stronger health systems: learning from initiatives in six LMICs

BACKGROUND

Private sector retail pharmacies, or drug shops, play an important role in access to essential medicines and services in low-and-middle-income countries. Recognising that they have the potential to contribute to health system strengthening efforts, many recent initiatives to engage with drug shops have been launched. These include initiatives that focus on changes in policy, regulation and training. However, the specific factors that influence their success remain poorly understood. Seven country case studies supported under the Alliance's programme of work 'Strengthening health systems: the role of drug shops' help to explore this issue.

METHODS

Country case studies from the above programme of research from Bangladesh, Indonesia, Myanmar, Nigeria, Tanzania and Zambia were used as the main sources of data for this paper. A modified version of Bigdeli et al.'s Access to Medicines framework was applied within a partially grounded approach to analyze each country case study and compare themes between countries.

RESULTS

Many factors may help initiatives targeting drug shops successfully achieve their intended outcomes. At the micro level, these include community demand for drug shops and a positive relationship between drug shops and their clients. At the meso level, facilitators of initiative success include training and positive attitudes from drug shops towards the initiative. Barriers include client pressure, procurement challenges and financial and administrative costs associated with initiatives. At the macro level, collaboration between stakeholders, high-level buy in and supervision, monitoring and regulation may influence initiative success. These factors are inter-dependent and interact with each other in a dynamic way.

CONCLUSIONS

Using a framework approach, these country case studies demonstrate common factors that influence how drug shops can strengthen health systems. These learnings can help inform the design and implementation of successful strategies to engage drug shops towards sustainable systems change.

Consumer preferences for health insurance, in the wake of covid-19: Ranked features and customer segments

The current study is conceptualized to assess the perception of the general population towards health insurance providers and the policy features, to segment them based on their attitudes. The mixed-method design is used in this study. One fifty health insurance users response were analyzed. The data analysis technique includes focus group discussion, henry garret ranking method, factor analysis and cluster analysis. This study concludes that health insurance providers needs to devise insurance policies incorporating the features of home health, telemedicine and income protection features. The existing users should be offered customization option due to covid-19 to prevent customer switch.