Towards universal health coverage in the WHO African Region: assessing health system functionality, incorporating lessons from COVID-19.
health systems
health systems evaluation
Journal
BMJ global health
ISSN: 2059-7908
Titre abrégé: BMJ Glob Health
Pays: England
ID NLM: 101685275
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
03
12
2020
revised:
24
02
2021
accepted:
10
03
2021
entrez:
1
4
2021
pubmed:
2
4
2021
medline:
13
4
2021
Statut:
ppublish
Résumé
The move towards universal health coverage is premised on having well-functioning health systems, which can assure provision of the essential health and related services people need. Efforts to define ways to assess functionality of health systems have however varied, with many not translating into concrete policy action and influence on system development. We present an approach to provide countries with information on the functionality of their systems in a manner that will facilitate movement towards universal health coverage. We conceptualise functionality of a health system as being a construct of four capacities: access to, quality of, demand for essential services and its resilience to external shocks. We test and confirm the validity of these capacities as appropriate measures of system functionality. We thus provide results for functionality of the 47 countries of the WHO African Region based on this. The functionality of health systems ranges from 34.4 to 75.8 on a 0-100 scale. Access to essential services represents the lowest capacity in most countries of the region, specifically due to poor physical access to services. Funding levels from public and out-of-pocket sources represent the strongest predictors of system functionality, compared with other sources. By focusing on the assessment on the capacities that define system functionality, each country has concrete information on where it needs to focus, in order to improve the functionality of its health system to enable it respond to current needs including achieving universal health coverage, while responding to shocks from challenges such as the 2019 coronavirus disease. This systematic and replicable approach for assessing health system functionality can provide the guidance needed for investing in country health systems to attain universal health coverage goals.
Identifiants
pubmed: 33789869
pii: bmjgh-2020-004618
doi: 10.1136/bmjgh-2020-004618
pmc: PMC8015798
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : World Health Organization
ID : 001
Pays : International
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
J Public Health Res. 2018 Jan 02;6(3):917
pubmed: 29441330
Health Serv Res. 2007 Oct;42(5):1797-801
pubmed: 17850520
Health Syst Reform. 2020 Dec 1;6(1):e1744988
pubmed: 33416439
Soc Sci Med. 1986;23(6):559-66
pubmed: 3764507
Epidemiol Infect. 2019 Nov 11;147:e299
pubmed: 31709961
Int J Equity Health. 2018 May 31;17(1):69
pubmed: 29855334
Int J Health Policy Manag. 2018 Feb 06;7(6):491-503
pubmed: 29935126
PLoS Med. 2011 Jul;8(7):e1001066
pubmed: 21814499
BMJ Glob Health. 2020 May;5(5):
pubmed: 32451366
PLoS Med. 2014 Sep 22;11(9):e1001701
pubmed: 25244520
BMJ. 2005 Jun 18;330(7505):1426-31
pubmed: 15961815
BMJ Glob Health. 2020 Oct;5(10):
pubmed: 33115858
BMJ Glob Health. 2019 Oct 5;4(Suppl 9):e002006
pubmed: 31673440
Global Health. 2014 Feb 13;10:5
pubmed: 24524554
BMC Proc. 2020 Dec 3;14(Suppl 19):16
pubmed: 33292240
Int J Health Serv. 2015;45(4):743-61
pubmed: 25995306
Health Res Policy Syst. 2014 Aug 26;12:51
pubmed: 25160707
Lancet Glob Health. 2018 Feb;6(2):e152-e168
pubmed: 29248365
Lancet. 2015 May 9;385(9980):1910-2
pubmed: 25987159
BMJ Glob Health. 2019 Nov 12;4(6):e001871
pubmed: 31799000
BMJ Glob Health. 2019 Jan 29;4(1):e001157
pubmed: 30775006
Health Aff (Millwood). 2006 Nov-Dec;25(6):w457-75
pubmed: 16987933
Front Public Health. 2020 Aug 07;8:372
pubmed: 32850595
Glob Health Res Policy. 2020 Mar 9;5:10
pubmed: 32166129
PLoS Med. 2011 Aug;8(8):e1001073
pubmed: 21857809
Health Aff (Millwood). 2004 May-Jun;23(3):167-76
pubmed: 15160814