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9.
Global Health ; 15(Suppl 1): 0, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31775785

RESUMO

In many African countries, hundreds of health-related NGOs are fed by a chaotic tangle of donor funding streams. The case of Mozambique illustrates how this NGO model impedes Universal Health Coverage. In the 1990s, NGOs multiplied across post-war Mozambique: the country's structural adjustment program constrained public and foreign aid expenditures on the public health system, while donors favored private contractors and NGOs. In the 2000s, funding for HIV/AIDS and other vertical aid from many donors increased dramatically. In 2004, the United States introduced PEPFAR in Mozambique at nearly 500 million USD per year, roughly equivalent to the entire budget of the Ministry of Health. To be sure, PEPFAR funding has helped thousands access antiretroviral treatment, but over 90% of resources flow "off-budget" to NGO "implementing partners," with little left for the public health system. After a decade of this major donor funding to NGOs, public sector health system coverage had barely changed. In 2014, the workforce/ population ratio was still among the five worst in the world at 71/10000; the health facility/per capita ratio worsened since 2009 to only 1 per 16,795. Achieving UHC will require rejection of austerity constraints on public sector health systems, and rechanneling of aid to public systems building rather than to NGOs.


Assuntos
Cooperação Internacional , Organizações/economia , Cobertura Universal do Seguro de Saúde/organização & administração , Infecções por HIV/tratamento farmacológico , Infecções por HIV/economia , Humanos , Moçambique , Setor Público/organização & administração , Estados Unidos
10.
Global Health ; 15(Suppl 1): 72, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31775796

RESUMO

The triple goals of Universal Health Coverage (UHC) are to cover the whole population, to reduce patients' costs, and to expand coverage to all effective services, equitably available to all. This paper analyses the experience of Japan in achieving these goals, focusing on the central role played by the payment system. The payment system, or fee schedule, sets the price of services and pharmaceuticals, as well as the conditions that providers must comply with in order to receive payment. The fee schedule was first introduced following the enactment of social health insurance (SHI) in 1922. Initially, the SHI program covered only manual workers, who comprised a mere 3% of the population. However, the fee schedule of the largest SHI plan was subsequently adopted by all other SHI plans. From 1958, there has been only one fee schedule. Population coverage was achieved in 1961 by mandating all residing in Japan to enroll in SHI, thereby making everyone entitled to all the services and pharmaceuticals listed in the fee schedule. Next, co-insurance was capped to an affordable level by the introduction of catastrophic coverage in 1973. Lastly, extra billing and balance billing were explicitly restricted in 1984. The key to achieving and sustaining UHC goals in Japan lies in being able to contain costs and reallocate resources by revising the fee schedule.


Assuntos
Gastos em Saúde/legislação & jurisprudência , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/organização & administração , Metas , Humanos , Japão
11.
Global Health ; 15(Suppl 1): 75, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31775851

RESUMO

Sri Lanka reports impressive health indicators compared to its peers in the South Asian region. Maternal and infant mortality are relatively low, and several intractable communicable diseases have been eliminated. The publicly financed and delivered "free" healthcare system has been critical to these health achievements. Placing the country's healthcare system in historical context, this commentary analyses the contradictions and political tensions surrounding Sri Lanka's 2018 Universal Health Coverage (UHC) policy, with attention to the Ministry of Health's plans for public-private partnerships (PPP). As economic exigencies and private interests increasingly erode the 1951 "Free Health" policy, this commentary calls for a re-envisioning of UHC that can meet people's aspirations for health and social justice.


Assuntos
Política de Saúde , Parcerias Público-Privadas , Cobertura Universal do Seguro de Saúde/organização & administração , Assistência à Saúde/economia , Previsões , Humanos , Sri Lanka
12.
Global Health ; 15(Suppl 1): 0, 2019 11 28.
Artigo em Inglês | MEDLINE | ID: mdl-31775869

RESUMO

The presumed global consensus on achieving Universal Health Coverage (UHC) masks crucial issues regarding the principles and politics of what constitutes "universality" and what matters, past and present, in the struggle for health (care) justice. This article focuses on three dimensions of the problematic: 1) we unpack the rhetoric of UHC in terms of each of its three components: universal, health, and coverage; 2) paying special attention to Latin America, we revisit the neoliberal coup d'état against past and contemporary struggles for health justice, and we consider how the current neoliberal phase of capitalism has sought to arrest these struggles, co-opt their language, and narrow their vision; and 3) we re-imagine the contemporary challenges/dilemmas concerning health justice, transcending the false technocratic consensus around UHC and re-infusing the profoundly political nature of this struggle. In sum, as with the universe writ large, a range of matters matter: socio-political contexts at national and international levels, agenda-setting power, the battle over language, real policy effects, conceptual narratives, and people's struggles for justice.


Assuntos
Assistência à Saúde/organização & administração , Justiça Social , Cobertura Universal do Seguro de Saúde/organização & administração , Humanos , América Latina , Política
13.
Pan Afr Med J ; 34: 60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762925

RESUMO

Introduction: Approximately two-thirds of the world's population has no access to diagnostic imaging. Basic radiological services should be integral to universal health coverage. The World Health Organization postulates that one basic X-ray and ultrasound unit for every 50000 people will meet 90% of global imaging needs. However, there are limited country-level data on radiological resources, and little appreciation of how such data reflect access and equity within a healthcare system. The aim of this study was a detailed analysis of licensed Zimbabwean radiological equipment resources. Methods: The equipment database of the Radiation Protection Authority of Zimbabwe was interrogated. Resources were quantified as units/million people and compared by imaging modality, geographical region and healthcare sector. Zimbabwean resources were compared with published South African and Tanzanian data. Results: Public-sector access to X-ray units (11/106 people) is approximately half the WHO recommendation (20/106 people), and there exists a 5-fold disparity between the least- and best-resourced regions. Private-sector exceeds public-sector access by 16-fold. More than half Zimbabwe's radiology equipment (215/380 units, 57%) is in two cities, serving one-fifth of the population. Almost two-thirds of all units (243/380, 64%) are in the private sector, routinely accessible by approximately 10% of the population. Southern African country-level public-sector imaging resources broadly reflect national per capita healthcare expenditure. Conclusion: There exists an overall shortfall in basic radiological equipment resources in Zimbabwe, and inequitable distribution of existing resources. The national radiology equipment register can reflect access and equity in a healthcare system, while providing medium-term radiological planning data.


Assuntos
Equipamentos e Provisões/provisão & distribução , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Radiografia/instrumentação , Humanos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde , Zimbábue
17.
Niger J Clin Pract ; 22(11): 1516-1529, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31719273

RESUMO

Background: A Free Maternal and Child Health program (FMCHP) was implemented in 12 states in Nigeria by the National Health Insurance Scheme (NHIS), between 2009 and 2015, using funds from the debt relief gains. It was called the Millennium Development Goals (MDGs) NHIS-MDG FMCHP. The program ended with the termination of the MDG in 2015. With the creation of the Basic Health Care Provision Fund (BHCPF) in Nigeria, this study sought to examine the past implementation experiences of the NHIS-MCH project with a view to identifying the enabling and constraining factors to program implementation, and the opportunities for adaptation and program scale-up in Nigeria using the BHCPF. Methods: The study was undertaken in the Federal Capital Territory, Abuja, and involved review of relevant documents and in-depth interviews with 21 key informants. The program was assessed in themes from the conceptual framework. Interviews were transcribed and analyzed using thematic analysis. Results: The program enrolled about 1.5 million pregnant women and children during the period of implementation in the country. The respondents perceived the program as pro-poor, efficient, and effective, and led to marked improvement in the functionality of the facilities, availability of services and reduced out-of-pocket expenditure, which led to increased demand and utilization of MCH services. There was inadequate stakeholder consultation, alleged corrupt practices, challenges with registration, issues with counterpart funding and public financing management issues identified. Most respondents supported the idea of using the new fund (BHCPF) to revitalize/scale-up the Free MCH program. Conclusion: This study highlights the key lessons and implementation challenges identified by the respondents. The NHIS-MDG FMCHP had positive impact on the target population though it was not sustained following the conclusion of the MDG program. The findings will inform policy decisions about the appropriateness of sustaining the program and the feasibility of extending healthcare coverage using the proposed BHCPF. The new fund (BHCPF) can be used to reactivate and scale-up the Free MCH program, but the current level of funding will not assure universal health coverage for the target beneficiaries as realized from the costing aspect of this study.


Assuntos
Financiamento Governamental , Gastos em Saúde , Serviços de Saúde Materno-Infantil/economia , Programas Nacionais de Saúde/economia , Cobertura Universal do Seguro de Saúde/economia , Criança , Saúde da Criança , Assistência à Saúde/economia , Feminino , Promoção da Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Seguro Saúde , Serviços de Saúde Materno-Infantil/organização & administração , Nigéria , Gravidez
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