Atlas des statistiques sanitaires africaines 2022: analyse de la situation sanitaire de la Région africaine ­ rapport de synthèse

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Reforms for financial protection schemes towards universal health coverage, Senegal

Advancing the public health insurance system is one of the key strategies of the Senegalese government for achieving universal health coverage. In 2013, the government launched a universal health financial protection programme, la Couverture Maladie Universelle. One of the programme's aims was to establish a community-based health insurance scheme for the people in the informal sector, who were largely uninsured before 2013. The scheme provides coverage through non-profit community-based organizations and by the end of 2016, 676 organizations had been established across the country. However, the organizations are facing challenges, such as low enrolment rates and low portability of the benefit package. To address the challenges and to improve the governance and operations of the community-based health insurance scheme, the government has since 2018 planned and partly implemented two major reforms. The first reform involves a series of institutional reorganizations to raise the risk pool. These reorganizations consist of transferring the risk pooling and part of the insurance management from the individual organizations to the departmental unions, and transferring the operation and financial responsibility of the free health-care initiatives for vulnerable population to the community-based scheme. The second reform is the introduction of an integrated management information system for efficient and effective data management and operations of the scheme. Here we discuss the current progress and plans for future development of the community-based health insurance scheme, as well as discussing the challenges the government should address in striving towards universal health coverage in the country

Purchasing reforms and tracking health resources, Kenya

As low- and middle-income countries undertake health financing reforms to achieve universal health coverage, there is renewed interest in making allocation of pooled funds to health-care providers more strategic. To make purchasing more strategic, countries are testing different provider payment methods. They therefore need comprehensive data on funding flows to health-care providers from different purchasers to inform decision on payment methods. Tracking funding flow is the focus of several health resource tracking tools including the System of Health Accounts and public expenditure tracking surveys. This study explores whether these health resource tracking tools generate the type of information needed to inform strategic purchasing reforms, using Kenya as an example. Our qualitative assessment of three counties in Kenya shows that different public purchasers, that is, county health departments and the national health insurance agency, pay public facilities through a variety of payment methods. Some of these flows are in-kind while others are financial transfers. The nature of flows and financial autonomy of facilities to retain and spend funds varies considerably across counties and levels of care. The government routinely undertakes different health resource tracking activities to inform health policy and planning. However, a good source for comprehensive data on the flow of funds to public facilities is still lacking, because these activities were not originally designed to offer such insights. We therefore argue that the methods could be enhanced to track such information and hence improve strategic purchasing. We also offer suggestions how this enhancement can be achieved

Changes in surgical practice in 85 South African hospitals during COVID-19 hard lockdown

Background. In preparation for the COVID-19 pandemic, South Africa (SA) began a national lockdown on 27 March 2020, and many hospitals implemented measures to prepare for a potential COVID-19 surge.Objectives. To report changes in SA hospital surgical practices in response to COVID-19 preparedness.Methods. In this cross-sectional study, surgeons working in SA hospitals were recruited through surgical professional associations via an online survey. The main outcome measures were changes in hospital practice around surgical decision-making, operating theatres, surgical services and surgical trainees, and the potential long-term effect of these changes.Results. A total of 133 surgeons from 85 hospitals representing public and private hospitals nationwide responded. In 59 hospitals (69.4%), surgeons were involved in the decision to de-escalate surgical care. Access was cancelled or reduced for non-cancer elective (n=84; 99.0%), cancer (n=24; 28.1%) and emergency operations (n=46; 54.1%), and 26 hospitals (30.6%) repurposed at least one operating room as a ventilated critical care bed. Routine postoperative visits were cancelled in 33 hospitals (36.5%) and conducted by telephone or video in 15 (16.6%), 74 hospitals (87.1%) cancelled or reduced new outpatient visits, 64 (75.3%) reallocated some surgical inpatient beds to COVID-19 cases, and 29 (34.1%) deployed some surgical staff (including trainees) to other hospital services such as COVID-19 testing, medical/COVID-19 wards, the emergency department and the intensive care unit.Conclusions. Hospital surgical de-escalation in response to COVID-19 has greatly reduced access to surgical care in SA, which could result in a backlog of surgical needs and an excess of morbidity and mortality

Trends and correlates of patient satisfaction with services under the National Health Insurance Scheme of Nigeria: A review

Background: In spite of over a decade of operations, the National Health Insurance Scheme (NHIS) of Nigeria has continuously been criticized for its quality of services. Healthcare consumer satisfaction surveys (an important measure of service quality worldwide) in this domain have presented differing accounts of satisfaction with the services of the NHIS from their vantage perspectives. This narrative review aimed at studying the preliminary trends in the utilization of and patient satisfaction with the NHIS services. The correlates of patient satisfaction were also studied. Materials and Methods: We searched local literature whose full texts were accessible using predominantly Google Scholar. Results: We found progressive improvement in scheme enrolment, service utilization, and above-average overall satisfaction scores (i.e., >50% of respondents were satisfied) from most studies. Overall satisfaction scores/ratings were associated patients' level of education, knowledge of the scheme, years of enrolment, facility cleanliness, consultation time, pharmaceutical services, ease in accessing medical records and laboratory results, health worker availability, health worker friendliness, and responsiveness to patients' requests. Conclusion: The observed trajectory in service utilization, satisfaction scores, and their correlates may be useful for strategic planning to improve NHIS services in the country toward universal health coverage

Preferred approach to performance improvement among stakeholders in the health insurance industry in Southwest Region of Nigeria: Implications for Universal Health Coverage

Background: Population coverage of the National Health Insurance Scheme (NHIS) of Nigeria is low. This study aimed to assess the capacity gaps of personnel in the health insurance industry in southwest Nigeria as well determined the approach to improvement. Methods: This was a cross-sectional survey conducted in the health insurance industry in southwest Nigeria. Survey tool adapted was the World Health Organization adopted Hennessy-Hicks Training Needs Analysis Questionnaire with a set of 30 tasks which are important to the job performance of personnel in the health insurance industry. From the register made available by stakeholders, there were a total of 275 personnel in the industry in the zone. A total population of all available personnel in all the organizations were recruited into the study. Data analysis was done using the guideline provided in the Hennessy-Hicks Training Needs Analysis Questionnaire. Results: Only 32 (13.7%) reported having a training background in health-related degrees, 119 (50.9%) had work-related (actuarial science) training while 148 (63.3%) has had a form of on-the-job actuarial science and related training. The training course approach was generally preferred to organisational change in all items. Conclusion: This study showed that there were gaps in the capacity of personnel in the health insurance industry. Training course was the preferred approach to addressing these. While not neglecting organizational change, stakeholders in Nigeria and in similar settings are advised to pay more attention to personnel training to improve performance

Uptake of health insurance among Muslims in Nairobi county, Kenya

Introduction: in Kenya and the world across, health insurance has been reckoned as an important health policy that serves to protect households from the direct financial consequences of health care and meet the Sustainable Development Goal of Universal Health Coverage and Poverty Eradication. However, health insurance uptake has remained to be a major challenge for universal health care coverage especially among Kenyan Muslims who have conflicting religious faith towards conventional health insurance. This study had two main objectives: (1) to determine level of uptake of health insurance among Muslims and (2) to examine the role of religion in health insurance uptake among Muslims.Methods: the study adopted a cross-sectional study design. Post-stratified sampling was used to select 389 respondents who participated in the survey questionnaires. Descriptive statistics, cross-tabulation and Test of independence (Chi-square) were used to analyze quantitative data using SPSS Version 20.Results: findings revealed that only 86(22%) of Muslims were enrolled in a health insurance scheme. Among the 86 Muslims who had an insurance cover, Majority were enrolled in National Health Insurance Fund (65,70.6%) while 21(29.4%) were enrolled in private health insurance schemes. Among the 303 Muslims who had no insurance cover, 285 (94.1%)preferred being enrolled in Takaful Health insurance which is Shariah Compliant. Religion played a significant role on choice and enrollment of Muslims to health insurance schemes. Religious beliefs and Shariah teachings had a statistically significant relationship with uptake of health insurance (p < 0.05).Conclusion: uptake of health insurance among Muslims is low despite the growing population of Muslims in Kenya partly due to Muslims strong religious belief and Shariah laws, which prohibits them from enrolling into conventional insurance hence limiting freedom of individual decisions on the insurance schemes to enroll in. Despite high demand for health insurance products among Muslims, there lacks health insurances products aligned to the religious beliefs and needs of Muslim hence exposing them to hefty medical bills which deepens poverty and inaccessibility to basic health care

Universal Healthcare : Through the Eyes of a Medical Student

Regardless of which Bioethical Theory one consults - be it; for example; Utilitarianism; which states that one must do the most good for the greatest number of people 'An action is morally right if the consequences of that action are on balance more positive than negative for the greatest number' [1]; or perhaps Deontology; which is Duty Theory 'there are certain actions which we have a duty to perform or to refrain from performing' [1] - one will likely come to the conclusion that Universal Healthcare is an ideal which; if at all possible; should be achieved by mankind. It is a question of human rights; and respect for ones' fellow man; or perhaps; more fundamentally treating those around us with the care we would expect for ourselves; or family members.In this paper; I shall attempt to unravel Universal Healthcare as an ideal. To bring it down to fundamentals and perhaps make suggestions towards how such an ideal may be realised. I will look at relevant Healthcare systems which have been implemented overseas; and compare them to what government hopes to implement in South Africa - a National Health Insurance. Most importantly; I will analyse Universal Healthcare in the context of South Africa; and establish whether this ideal is attainable. Universal healthcare is the gem of healthcare in the 21st century. It is what all health care professionals would love to achieve within their life-times; but to achieve a goal as immense as this; one needs to build from the foundations upwards. As such; I shall discuss and suggest ways in which healthcare students can contribute to this ultimate ideal

Operationalizing Universal Health Coverage in Nigeria through Social Health Insurance

Nigeria faces challenges that delay progress toward the attainment of the national government's declared goal of universal health coverage (UHC). One such challenge is system-wide inequities resulting from lack of financial protection for the health care needs of the vast majority of Nigerians. Only a small proportion of Nigerians have prepaid health care. In this paper; we draw on existing evidence to suggest steps toward reforming health care financing in Nigeria to achieve UHC through social health insurance. This article sets out to demonstrate that a viable path to UHC through expanding social health insurance exists in Nigeria. We argue that encouraging the states which are semi-autonomous federating units to setup and manage their own insurance schemes presents a unique opportunity for rapidly scaling up prepaid coverage for Nigerians. We show that Nigeria's federal structure which prescribes a sharing of responsibilities for health care among the three tiers of government presents serious challenges for significantly extending social insurance to uncovered groups. We recommend that rather than allowing this governance structure to impair progress toward UHC; it should be leveraged to accelerate the process by supporting the states to establish and manage their own insurance funds while encouraging integration with the National Health Insurance Scheme

Estimation of Maternal and Child Mortality One Year after User-Fee Elimination: an Impact Evaluation and Modelling Study in Burkina Faso

Objective To estimate the impact on maternal and child mortality after eliminating user fees for pregnant women and for children less than five years of age in Burkina Faso. Methods: Two health districts in the Sahel region eliminated user fees for facility deliveries and curative consultations for children in September 2008. To compare health-care coverage before and after this change; we used interrupted time series; propensity scores and three independent data sources. Coverage changes were assessed for four variables: women giving birth at a health facility; and children aged 1 to 59 months receiving oral rehydration salts for diarrhoea; antibiotics for pneumonia and artemesinin for malaria. We modelled the mortality impact of coverage changes in the Lives Saved Tool using several scenarios. Findings Coverage increased for all variables; however; the increase was not statistically significant for antibiotics for pneumonia. For estimated mortality impact; the intervention saved approximately 593 (estimate range 168-1060) children's lives in both districts during the first year. This lowered the estimated under-five mortality rate from 235 deaths per 1000 live births in 2008 to 210 (estimate range 189-228) in 2009. If a similar intervention were to be introduced nationwide; 14 000 t o 19 000 ( estimate range 4000-28 000) children's lives could be saved annually. Maternal mortality showed a modest decrease in all scenarios. Conclusion In this setting; eliminating user fees increased use of health services and may have contributed to reduced child mortality

Universal Health Coverage in Rwanda: Dream or Reality

Introduction: Universal Health Coverage (UHC) has been a global concern for a long time and even more nowadays. While a number of publications are almost unanimous that Rwanda is not far from UHC; very few have focused on its financial sustainability and on its extreme external financial dependency. The objectives of this study are: (i) To assess Rwanda UHC based mainly on Community-Based Health Insurance (CBHI) from 2000 to 2012; (ii) to inform policy makers about observed gaps for a better way forward. Methods: A retrospective (2000-2012) SWOT analysis was applied to six metrics as key indicators of UHC achievement related to WHO definition; i.e. (i) health insurance and access to care; (ii) equity; (iii) package of services; (iv) rights-based approach; (v) quality of health care; (vi) financial-risk protection; and (vii) CBHI self-financing capacity (SFC) was added by the authors. Results: The first metric with 96;15 of overall health insurance coverage and 1.07 visit per capita per year versus 1 visit recommended by WHO; the second with 24;8 indigent people subsidized versus 24;1 living in extreme poverty; the third; the fourth; and the fifth metrics excellently performing; the sixth with 10.80 versus ?40 as limit acceptable of catastrophic health spending level and lastly the CBHI SFC i.e. proper cost recovery estimated at 82.55 in 2011/2012; Rwanda UHC achievements are objectively convincing. Conclusion: Rwanda UHC is not a dream but a reality if we consider all convincing results issued of the seven metrics

The Critical Role of Health Financing in Progressing Universal Health Coverage

It is clear that health financing is central to providing the different components of health systems vital to making progress in the implementation of universal health coverage (UHC). However; there are several constraints on health financing systems throughout the African Region which are impeding this progress. These include: insufficient financial resources; heavy reliance on out-of-pocket health expenditure; inefficiency in management of health systems; levels of governance and accountability; harnessing stakeholder contributions in health financing; and weak research; including monitoring and evaluation. Progress is being made on the last issue with the rolling out of the revised System of Health Accounts 2011. The article concludes with a list of the Region's key requirements which would facilitate strengthening health financing and thus improve UHC

Solidarity in Community-Based Health Insurance in Senegal: Rhetoric or Reality

Continued low rates of enrolment in community-based health insurance (CBHI) suggest that in many countries strategies proposed for scaling up have not been well-designed or successfully implemented. One reason may be a lack of systematic incorporation of social and political context into CBHI policy. In this study; solidarity in CBHI is analysed from a sociological perspective in order to answer the following research questions: What are local definitions and perceptions of solidarity in CBHI? To what extent are these borne out in practice? Three case studies of Senegalese CBHI schemes using specific criteria were studied. Transcripts of interviews with 64 CBHI stakeholders were analysed using inductive coding. A conceptual framework of four dimensions of solidarity (health risk; vertical equity; scale and source) was developed to interpret the results. The results suggest that the concept of solidarity in CBHI is complex. Each dimension and source of solidarity was either not borne out in practice or highly contested; with views diverging between stakeholders and the target population. This suggests that policy-makers need to engage in a more rigorous public discussion of solidarity as regards CBHI and universal health coverage policy more widely; in order to move towards policies which both resonate with and meet the expectations of the people they aim to serve

Revenue-raising potential for universal health coverage in Benin, Mali, Mozambique and Togo

Increasing overall fiscal space is important for the health sector due to the centrality of public financing to make progress towards universal health coverage. One strategy is to mobilize additional government revenues through new taxes or increased tax rates on goods and services. We illustrate how countries can assess the feasibility and quantitative potential of different revenue-raising mechanisms. We review and synthesize the processes and results from country assessments in Benin, Mali, Mozambique and Togo. The studies analysed new taxes or increased taxes on airplane tickets, phone calls, alcoholic drinks, tourism services, financial transactions, lottery tickets, vehicles and the extractive industries. Study teams in each country assessed the feasibility of new revenue-raising mechanisms using six qualitative criteria. The quantitative potential of these mechanisms was estimated by defining different scenarios and setting assumptions. Consultations with stakeholders at the start of the process served to select the revenue-raising mechanisms to study and later to discuss findings and options. Exploring feasibility was essential, as this helped rule out options that appeared promising from the quantitative assessment. Stakeholders rated stability and sustainability positive for most mechanisms, but political feasibility was a key issue throughout. The estimated additional revenues through new revenue-raising mechanisms ranged from 0.47­1.62% as a share of general government expenditure in the four countries. Overall, the revenue raised through these mechanisms was small. Countries are advised to consider multiple strategies to expand fiscal space for health