Towards universal health coverage: an example of malaria intervention in Nepal

ABSTRACT

A comprehensive and integrated assessment of health-system functioningrequires measurement of universal health coverage (UHC) for disease-specificinterventions. This paper aims to contribute to measurement of UHC by utilizinglocally available data related to malaria in Nepal. This paper utilizes the elementsof UHC as outlined by the World Health Organization (WHO). The concept ofUHC represents both improvements in health outcomes and protection of peoplefrom poverty induced by health-care costs. Measuring UHC focusing on a tropicaldisease highlights the progress made towards elimination of the disease andexhibits health-system bottlenecks in achieving elimination of the disease. Severalbottlenecks are found in the Nepalese health system that strongly suggest the needto focus on health-system strengthening to shift the health production function ofmalaria intervention. The disaggregated data clearly show the inequality of servicecoverage among subgroups of the population. Analysis of effective coverage ofmalaria interventions indicates the insufficient quality of current interventions. Noneof households faced catastrophic impact due to payment for malaria care in Nepal.However, the costs of hospital-based care of malaria were not captured in thisanalysis. The paper provides the current status of UHC for malaria interventionsand reveals system bottlenecks on which policy-makers and stakeholders shouldfocus to improve Nepal’s malaria control strategy. It concludes that financialcoverage of the malaria intervention is at an acceptable level; however, servicecoverage needs to be improved