Will Universal Health Coverage (UHC) lead to the freedom to lead flourishing and healthy lives?: Comment on "Inequities in the freedom to lead a flourishing and healthy life: issues for healthy public policy"

Equity in primary health care: the legacy of Julian Tudor Hart and a personal journey he inspired

Dr Julian Tudor Hart inspired me when I worked as a locum general practitioner in the neighbouring village to Glyncorrwg, southern Wales, in 1979. Our conversations helped shape my subsequent career. But it was only years later I learned that Julian was an icon of general practice and author of the famous 'inverse care law'. Julian was both a truly compassionate dedicated general practitioner in Glyncorrwg, an impoverished Welsh working-class coal-mining village, and an epidemiologist, conducting robust research in partnership with his patients. Patients were co-producers of the research designed to improve their health outcomes. Julian led the way in advocating that first-contact, continuous, comprehensive, and coordinated care for everyone was necessary to achieve equitable health outcomes. He conducted research neither for its own sake nor for his academic advancement. His aim was always to help improve people's lives. He identified that good medical care was least likely to be available for populations most in need. More than that, he demonstrated throughout his exemplary career how it was possible to work with a socioeconomically disadvantaged community to both discover their health needs and also provide equitable personalised health care to all. His legacy lives on.

Scale-up of the DMPA-SC in Nigeria: Why policy matters

BACKGROUND

Injectable contraceptives have contributed substantially to Nigeria's rise in modern family planning methods usage. They are one of the most commonly used and preferred means of contraception among women in the country. Enabling policies are required to assure contraceptive access, security, and use. This study aimed to investigate the policy environment and how it supports or limits Nigeria's introduction and scale-up of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC).

METHODS

The design of this mixed-methods study was cross-sectional. Desk reviews of policy papers, key informant interviews, and in-depth interviews were used to obtain information from respondents about the introduction of DMPA-SC in Nigeria and how existing policies influenced its scale-up. Data on DMPA-SC and other injectables were gathered from Nigeria's national electronic logistics management information system.

RESULTS

The findings suggest that policies such as task-shifting and task-sharing, cost-free policies, reproductive health policies, and others created an enabling environment for the scale-up of DMPA-SC adoption in Nigeria. The inclusion of DMPA-SC on the essential medicines list and the approved patent medicines list facilitated the scale-up process by ensuring private sector participation, removing economic barriers to access, fostering greater collaboration among health worker cadres, improving intersectoral partnerships, and improving logistics and client access. Despite significant anomalies in some implementing policies, injectable contraceptive consumption data demonstrate a progressive increase in DMPA-SC use during the study period. The results also indicate that policy initiatives have a favorable impact on the use of DMPA-SC throughout the country.

CONCLUSION

The existence of policies, the active participation of stakeholders, and the political will of the Nigerian health system's leadership have all aided in the scaling-up of the DMPA-SC. Understanding how to build an enabling policy climate is critical for providing women with family planning options. These lessons from Nigeria emphasize the importance of these levers, which should be considered by teams intending to introduce innovative health products, particularly in developing countries.

Prevalence and intensity of catastrophic health care expenditures in Iran from 2008 to 2015: a study on Iranian household income and expenditure survey

BACKGROUND

Households exposure to catastrophic health expenditure is a valuable measure to monitor financial protection in health sector payments. The present study had two aims: first, to estimate the prevalence and intensity of catastrophic health expenditures (CHE) in Iran. Second, to investigate main factors that influence the probability of CHE.

METHODS

CHE is defined as an occasion in which a household's out-of-pocket (OOP) spending exceeds 40% of the total income that remains after subtraction of living expenses. This study used the data from eight national repeated cross-sectional surveys on households' income and expenditure. The proportion of households facing CHE, as a prevalence measure, was estimated for rural and urban areas. The intensity of CHE was also calculated using overshoot and mean positive overshoot (MPO) measures. The factors affecting the CHE were also analyzed using logistic random effects regression model. We also used ArcMap 10.1 to display visually disparities across the country.

RESULTS

An increasing number of Iranians has been subject to catastrophic health care costs over the study period in both rural and urban areas (CHE = 2.57% in 2008 and 3.25% in 2015). In the same period, the overshoot of CHE and the mean positive overshoot ranged from 0.26% to 0.65% and from 12.26% to 20.86%, respectively. The average absolute monetary value of OOP spending per month has been low in rural areas over the years, but the prevalence of CHE has been higher than urban areas. Generally put, rural settlement, higher income, receiving inpatient and outpatient services, and existence of elderly people in the household led to increase in CHE prevalence (p < 0.05). Interestingly, provinces with more limited geographical and cultural accessibility had the lowest CHE.

CONCLUSIONS

According to the findings, Iran's healthcare system has failed to realize the aim of five-year national development plan regarding CHE prevalence (1% CHE prevalence according to the plan). Therefore, revision of financial health care protection policies focusing on pre-payments seems mandatory. For instance, these policies should extend the interventions that target low-income populations particularly in rural areas, provide more coverage for catastrophic medical services in basic benefit packages, and develop supplementary health insurance.