Factors associated with health outcomes among the uninsured population

The United States health care system lacks uniform and universal health coverage, causing approximately 10% of the population to be without health insurance, a critical determinant of health care access. Safety net organizations, including free clinics, provide free and/or reduced health care services to sociodemographic disadvantaged individuals. Despite concerns about the uninsured population, free clinic patients have not been sufficiently studied. This dissertation was designed to address this gap by adding to the literature and was designed around three empirical chapters utilizing mixed methodology.The first study used cross-sectional primary data to examine the differences between perceived and physiological stress levels and the effect of a social support network among uninsured free clinic patients. Findings suggest that higher levels of perceived stress are not significantly more prevalent than higher levels of salivary cortisol among these populations. Higher levels of social networking are significantly associated with lower perceived stress levels;having more friends than family members is slightly more associated with lower levels of perceived. However, social support and networking was not significantly associated with patients' salivary morning cortisol levels.The second study utilized a qualitative approach regarding COVID-19 vaccine perception and hesitancy among uninsured free clinic patients. Social networks are found to be important factors in reducing vaccine hesitancy. Hesitant patients had concerns related to vaccines' safety, effectiveness, and side effects. Lack of valid and reliable COVID-19 vaccination information was a challenge among this study's participants.The third study also utilized cross-sectional primary data to examine whether certain factors, including the component of patient-centeredness, are associated with patient autonomy among these populations. Findings conclude that Spanish speaking patients at the free clinic have a stronger belief in a paternalist model of the provider-patient relationship. Better communication between patients and providers results in higher levels of autonomy. Higher levels of educational attainment and better communication partnership were associated with higher levels of a free clinic patient's understanding of treatment risks.In conclusion, this dissertation's focus was to understand characteristics of an uninsured population to help develop strategies and intervention on changing behaviors, providing information that leads to their better health outcome. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The impact of universal health coverage and COVID-19 pandemic on out-of-pocket expenses in Thailand: an analysis of household survey from 1994 to 2021.

OBJECTIVES: After Thailand achieved Universal Health Coverage (UHC) in 2002, the extent of financial risk protection has not been assessed in the long term, especially after the COVID-19 pandemic. Therefore, this study aims to revisit the impact of UHC on out-of-pocket expenses (OOPE) for health and to descriptively explore the impact of COVID-19 on OOPE. METHODS: This study was a secondary data analysis and used data from the Socio-Economic Survey from 1994 to 2021 in Thailand. The effect of UHC on the percentage of OOPE in total health expenditures (THE) from 1994 to 2019 was investigated with an interrupted time-series analysis. Descriptive analyses of OOPE in absolute value during the COVID-19 were conducted. RESULTS: The percentage of OOPE in THE significantly decreased both before (ß -2.02%; 95% CI: -2.70% to - 1.33%) and during (ß 1.41%; 95% CI: 0.70% to 2.11%) the UHC period. During the pandemic, total household OOPE for medical equipment was found to have rapidly increased from 643 million THB in 2019 to 9.4 billion THB in 2020. CONCLUSIONS: The trend of providing financial risk protection (measured by OOPE/THE) in Thailand continues until 2019. Providing medical equipment in sufficient and equally accessible manners should be prioritized during the future pandemic.

Multisectoral action towards sustainable development goal 3.d and building health systems resilience during and beyond COVID-19: Findings from an INTOSAI development initiative and World Health Organization collaboration.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. As the world faces global health crises such as pandemics, epidemics, climate change and evolving disease burdens and population demographics, building strong and resilient public health systems is of critical importance. The need for an integrated approach to building health system resilience; the widening of inequalities; and fears of vulnerable populations being left behind are critical issues that require Supreme Audit Institutions (SAIs) enquiry as independent public oversight bodies. Each country has a Supreme Audit Institution with a remit to audit public funds as an effective, accountable, and inclusive institution. Government audits are key components of effective public financial management and Good Governance. SAIs contribute to the quality of government engagement and better state-society relations through their work. As SAIs provide independent external oversight and contribute to follow up and review of national targets linked to the Sustainable Development Goals (SDGs) in their respective countries, they can play an important role in national recovery efforts. WHO and INTOSAI Development Initiative (IDI) have been collaborating in facilitating SAIs' audits of strong and resilient national public health systems linked to the national target of SDG 3.d in 40 countries across Africa, Americas, Asia and Oceania between 2021 and 2022. This paper aims to convey key lessons learned from the joint multisectoral collaboration for facilitating the 3.d audits that can contribute to building health systems resilience in ongoing recovery efforts. The collaboration included facilitation of the audits through professional education and audit support using a health systems resilience framework. The 3.d audits are performance audits and follow IDI's SDG Audit Model (ISAM). Following the ISAM implies that the SAI should focus on a whole-of-government approach, policy coherence and integration, and assess both government efforts at 'leaving no one behind' and multi-stakeholder engagement in implementing the chosen national SDG target linked to 3.d. WHO's Health Systems Resilience team has supported IDI and SAIs by delivering training sessions and reviewing working papers and draft reports of the SAIs from a health systems resilience perspective. IDI has provided the technical expertise on performance audits through its technical team and through in-kind contributions from mentors from many SAIs in the regions participating in the audit. In the 3.d audit, SAIs can ask how governments are acting to enhance capacity in some or all of the following, depending on their own national context and risk: forecasting, preventing and preparing for public health emergencies (PHEs) and threatsadapting, absorbing and responding to PHEs and threatsmaintaining essential health services in all contexts (including during emergencies/crises). The audits are expected to highlight current capacities of health systems resilience; the extent to which a whole-of-government approach and policy coherence have been utilised; and government efforts related to multistakeholder engagement and leaving no one behind in building health systems resilience related to progressing towards achieving the national target linked to 3.d by 2030. An overall positive achievement noted was that undertaking a complex health audit in the middle of a pandemic is possible and can contribute to building health systems resilience and recovery efforts. In their review of audit plans, draft summaries, and other work by the SAIs, both WHO and IDI have observed that SAIs have used the training and supplementary materials and applied various parts of it in their audits. This collaboration also demonstrates key considerations needed for successful partnership across multisectoral partners at global, regional and national levels. Such considerations can be applied in different contexts, including socioeconomic and health system recovery, to ensure whole-of-society and whole-of-government action in building health systems resilience and monitoring and evaluation to maintain and accelerate progress towards the national target linked to SDG3.d, health security and universal health coverage (UHC), as well as broader socioeconomic development.

Area-specific covid-19 effects on health services utilization in the Democratic Republic of the Congo using routine health information system data.

BACKGROUND: Since March 2020, the COVID-19 pandemic has shocked health systems worldwide. This analysis investigated the effects of the pandemic on basic health services utilization in the Democratic Republic of the Congo (DRC) and examined the variability of COVID effects in the capital city Kinshasa, in other urban areas, and in rural areas. METHODS: We estimated time trends models using national health information system data to replicate pre-COVID-19 (i.e., January 2017-February 2020) trajectories of health service utilization, and then used those models to estimate what the levels would have been in the absence of COVID-19 during the pandemic period, starting in March 2020 through March 2021. We classified the difference between the observed and predicted levels as the effect of COVID-19 on health services. We estimated 95% confidence intervals and p-values to examine if the effect of the pandemic, nationally and within specific geographies, was statistically significant. RESULTS: Our results indicate that COVID-19 negatively impacted health services and subsequent recovery varied by service type and by geographical area. COVID-19 had a lasting impact on overall service utilization as well as on malaria and pneumonia-related visits among young children in the DRC. We also found that the effects of COVID-19 were even more immediate and stronger in the capital city of Kinshasa compared with the national effect. Both nationally and in Kinshasa, most affected services had slow and incomplete recovery to expected levels. Therefore, our analysis indicates that COVID-19 continued to affect health services in the DRC throughout the first year of the pandemic. CONCLUSIONS: The methodology used in this article allows for examining the variability in magnitude, timing, and duration of the COVID effects within geographical areas of the DRC and nationally. This analytical procedure based on national health information system data could be applied to surveil health service disruptions and better inform rapid responses from health service managers and policymakers.

Strengthening Health Systems Using Innovative Digital Health Technologies in Africa.

While effective health systems are needed to advance Universal Health Coverage and actualize the health Sustainable Development Goals, information system verticalization remains a challenge among African health systems. Most investments are vertical, partner-driven and program-specific with limited system-wide impacts. Poor linkages exist amongst different solutions as they are not designed to capture robust data across multiple programmatic areas. To address these challenges, the World Health Organization Africa Regional Office has proposed the adoption of a Digital Health Platform (DHP) to streamline different solutions to a cohesive whole. The DHP presents a pragmatic approach of bringing multiple platforms together using recognized standards to create a national infostructure, which bridges information solutions toward healthy and sustainable outcomes. It has capacities to curate accurate, high fidelity and timely data feedback loops needed to strengthen and continuously improve program delivery, monitoring, management, and informed decision-making at every level of the health system regardless of location. This paper contributes to the ongoing regional conversations on the need to harness innovative digital solutions to improve healthcare delivery in Africa.

A five-year (2017-2021) time series evaluation of patient-reported informal healthcare payments in Romania.

Low wages of health professionals are widely recognized as one of the drivers of informal payments in Romania's healthcare system. In January 2018, the government increased wages by an average of 70% to 172% in the public healthcare sector. This study examined the trends in patient-reported informal healthcare payments, discussing the effect of a one-time wage increase in 2018 and the impact of the COVID-19 pandemic in 2020 and 2021. It draws on monthly survey data of patient-reported informal payments collected between January 2017 and December 2021. We analyzed three periods: before the wage rise ("low pay"), between the wage rise and the COVID-19 pandemic ("high pay"), and during the COVID-19 pandemic. We found that patient-reported informal payments decreased between the "low pay" and "high pay" period but with a sharper decline during the COVID-19 pandemic. The share of respondents willing to report informal payments increased during the "high pay" period, indicating a stronger willingness to voice dissatisfaction with health services and informal payments, but slowed down during the first lockdown in 2020. Informal payments were more frequently reported in larger hospitals and the poorest geographical areas. While the 2018 wage increase may have contributed to less prevalent informal payments, survey coverage and design must be improved to draw robust, system-level conclusions to inform tailored policy actions.

Catastrophic "costs": A hindrance to eliminate tuberculosis.

Globally, one quarter of the population is infected with TB; and only a small proportion of those infected will become sick. Tuberculosis along with poverty disproportionately affects the households causing a financial burden and catastrophic costs (if the total costs incurred by a household's exceeds 20% of its annual income), which could be direct or indirect and procuring detrimental effects on the effective strategic plans. Out of all diseases, India accounts for 18% of the catastrophic health expenditure including tuberculosis. Therefore, an utmost need for a national cost survey either separately or combined with other health surveys should be held for the comprehension of the baseline burden of Tuberculosis in the affected households, to identify the predictors of catastrophic costs, and simultaneously, intensive research and appropriate innovations are needed to assess the effectiveness of the measures undertaken for the reduction of the proportionate patients who overlook catastrophic costs.

COVID-19 Aftermath: Direction Towards Universal Health Coverage in Low-Income Countries Comment on "Health Coverage and Financial Protection in Uganda: A Political Economy Perspective".

Progressive realization of universal health coverage (UHC) requires health systems capacity to provide quality service and financial risk protection which supports access to services without financial hardship. Government health spending in low-income countries (LICs) has been low and heavily relied on external donor resources and out-of-pocket payment. This has resulted in high prevalence of catastrophic health spending or foregone care by those who cannot afford. Under fiscal constraints posed by pandemic, reforms in LICs should focus on efficiency through health resource waste reduction. Targeting the poor even with low level of health spending can make a significant health gain. Investment in primary healthcare and health workforce is the foundation for realizing UHC which cannot be postponed. Innovative tax on health hazardous products, conditional debt relief can increase fiscal space for health; while international collaboration to accelerate coronavirus disease 2019 (COVID-19) vaccine coverage can bring LICs out of acute phase of pandemic.

Universal health coverage mitigated COVID-19 health-related consequences in Asia Oceania.

The COVID-19 pandemic has been a continual challenge since 2020, and it continues to impact people and industries as a disaster caused by a biological hazard. This study examined universal health coverage (UHC) scores in relation to the performance in combating COVID-19 in the Southeast Asian region (SEAR) and the Western Pacific region (WPR), along with the State Party Self-Assessment Annual Reporting (SPAR) index under the international health regulations (IHC). The numbers of infections and deaths per million population from December 2019 to June 2022 were used as primary outcomes to measure countries' performance. Countries with UHC scores of 63 or higher had a significantly lower number of infected patients and deaths. In addition, several inter-capacity correlations within the SPAR capacities, including with C8 (the National Health Emergency Framework), as well as a very strong correlation to C4 (Food Safety), C5 (Laboratory), and C7 (Human Resources). Furthermore, C9 (Health Service Provisions) has a very strong correlation to C1 (Legislation and Financing), C2 (International Health Regulation Coordination and a National IHR Focal Point function), and C4 (Food Safety), suggesting that the capability to manage an emerging infectious disease form blocks of capacities. In conclusion, UHC clearly mitigated the health-related consequences of COVID-19 in South-East Asia Region (SEAR) and Western Pacific Region (WPR). Investigating the correlation between the SPAR capacities and UHC is a promising approach for future research, including the importance of the provision of health services, points of entry, and, most importantly, risk communications as critical factors for managing pandemic. This study constitutes a good opportunity to apply the SPAR index to define which capacities correlate with the outcome of the pandemic in terms of infections and deaths.

Achieving Universal Health Coverage in Low- and Middle-Income Countries: Challenges for Policy Post-Pandemic and Beyond.

Background: Achieving universal health coverage (UHC) is critical for ensuring equity, improving health, and protecting households from financial catastrophe. The COVID-19 pandemic derailed the progress made across primary health targets. This article aims to review the policy challenges to achieve UHC in a post-pandemic world. Methods: A narrative review of 118 peer reviewed and grey literature was conducted. A total of 77 published articles were identified using an electronic search in PubMed and Scopus and a bibliographic search of relevant literature. Another 41 Reports, websites, blogs, news articles, and data were manually sourced from international agencies (WHO, World Bank, IMF, FAO, etc.), government agencies, and non-government organizations. Findings: The challenges were identified and discussed under five broad findings: i) weak public health care systems ii) challenges to building resilient health systems, iii) health care financing and financial risk protection, iv) epidemiological and demographic challenges, and v) governance and leadership. Conclusion: LMICs in Africa and South Asia face significant challenges to achieving UHC by 2030. As countries recover from the pandemic's aftermath, significant investments and innovations are needed to ensure progress toward UHC. Efficient resource mobilization through internal accruals, international cooperation, and resource sharing is needed.

Who are the vulnerable, and how do we reach them? Perspectives of health system actors and community leaders in Kerala, India.

BACKGROUND: Among the core principles of the 2030 agenda of Sustainable Development Goals (SDGs) is the call to Leave no One behind (LNOB), a principle that gained resonance as the world contended with the COVID-19 pandemic. The south Indian state of Kerala received acclaim globally for its efforts in managing COVID-19 pandemic. Less attention has been paid, however, to how inclusive this management was, as well as if and how those "left behind" in testing, care, treatment, and vaccination efforts were identified and catered to. Filling this gap was the aim of our study. METHODS: We conducted In-depth interviews with 80 participants from four districts of Kerala from July to October 2021. Participants included elected local self-government members, medical and public health staff, as well as community leaders. Following written informed consent procedures, each interviewee was asked questions about whom they considered the most "vulnerable" in their areas. They were also asked if there were any special programmes/schemes to support the access of "vulnerable" groups to general and COVID related health services, as well as other needs. Recordings were transliterated into English and analysed thematically by a team of researchers using ATLAS.ti 9.1 software. RESULTS: The age range of participants was between 35 and 60 years. Vulnerability was described differentially by geography and economic context; for e.g., fisherfolk were identified in coastal areas while migrant labourers were considered as vulnerable in semi-urban areas. In the context of COVID-19, some participants reflected that everyone was vulnerable. In most cases, vulnerable groups were already beneficiaries of various government schemes within and beyond the health sector. During COVID, the government prioritized access to COVID-19 testing and vaccination among marginalized population groups like palliative care patients, the elderly, migrant labourers, as well as Scheduled Caste and Scheduled Tribes communities. Livelihood support like food kits, community kitchen, and patient transportation were provided by the LSGs to support these groups. This involved coordination between health and other departments, which may be formalised, streamlined and optimised in the future. CONCLUSION: Health system actors and local self-government members were aware of vulnerable populations prioritized under various schemes but did not describe vulnerable groups beyond this. Emphasis was placed on the broad range of services made available to these "left behind" groups through interdepartmental and multi-stakeholder collaboration. Further study (currently underway) may offer insights into how these communities - identified as vulnerable - perceive themselves, and whether/how they receive, and experience schemes designed for them. At the program level, inclusive and innovative identification and recruitment mechanisms need to be devised to identify populations who are currently left behind but may still be invisible to system actors and leaders.

Developing technical support and strategic dialogue at the country level to achieve Primary Health Care-based health systems beyond the COVID-19 era.

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Pursuing the objectives of the Declaration of Alma-Ata for Primary Health Care (PHC), the World Health Organization (WHO) and global health partners are supporting national authorities to improve governance to build resilient and integrated health systems, including recovery from public health stressors, through the long-term deployment of WHO country senior health policy advisers under the Universal Health Coverage Partnership (UHC Partnership). For over a decade, the UHC Partnership has progressively reinforced, via a flexible and bottom-up approach, the WHO's strategic and technical leadership on Universal Health Coverage, with more than 130 health policy advisers deployed in WHO Country and Regional Offices. This workforce has been described as a crucial asset by WHO Regional and Country Offices in the integration of health systems to enhance their resilience, enabling the WHO offices to strengthen their support of PHC and Universal Health Coverage to Ministries of Health and other national authorities as well as global health partners. Health policy advisers aim to build the technical capacities of national authorities, in order to lead health policy cycles and generate political commitment, evidence, and dialogue for policy-making processes, while creating synergies and harmonization between stakeholders. The policy dialogue at the country level has been instrumental in ensuring a whole-of-society and whole-of-government approach, beyond the health sector, through community engagement and multisectoral actions. Relying on the lessons learned during the 2014-2016 Ebola outbreak in West Africa and in fragile, conflict-affected, and vulnerable settings, health policy advisers played a key role during the COVID-19 pandemic to support countries in health systems response and early recovery. They brought together technical resources to contribute to the COVID-19 response and to ensure the continuity of essential health services, through a PHC approach in health emergencies. This policy and practice review, including from the following country experiences: Colombia, Islamic Republic of Iran, Lao PDR, South Sudan, Timor-Leste, and Ukraine, provides operational and inner perspectives on strategic and technical leadership provided by WHO to assist Member States in strengthening PHC and essential public health functions for resilient health systems. It aims to demonstrate and advise lessons and good practices for other countries in strengthening their health systems.

[The lomé platform: a plea carried by the mutualist movement]. / La plateforme de lomé : un plaidoyer porté par le mouvement mutualiste.

The adoption of the Abidjan Platform in 1999 accompanied the development of mutual health insurance on the African continent. Twenty years after the adoption of the Abidjan Platform, mutual health insurance companies have indeed experienced development, structuring and professionalization. In January 2019, the international mutualist movement adopted the "Lomé Platform" during the Lomé conference, a document presenting a new consensus for the development of mutuality, taking into account the impact of national, regional and international decision-making levels on the environment influencing the development of mutual health insurance. Two years after the adoption of the document, its recommendations remain relevant and the COVID-19 crisis reveals the importance of seizing all resources to develop health systems on the African continent.

Towards applying the essential public health functions for building health systems resilience: A renewed list and key enablers for operationalization.

The COVID-19 pandemic, climate change-related events, protracted conflicts, economic stressors and other health challenges, call for strong public health orientation and leadership in health system strengthening and policies. Applying the essential public health functions (EPHFs) represents a holistic operational approach to public health, which is considered to be an integrated, sustainable, and cost-effective means for supporting universal health coverage, health security and improved population health and wellbeing. As a core component of the Primary Health Care (PHC) Operational Framework, EPHFs also support the continuum of health services from health promotion and protection, disease prevention to treatment, rehabilitation, and palliative services. Comprehensive delivery of EPHFs through PHC-oriented health systems with multisectoral participation is therefore vital to meet population health needs, tackle public health threats and build resilience. In this perspective, we present a renewed EPHF list consisting of twelve functions as a reference to foster country-level operationalisation, based on available authoritative lists and global practices. EPHFs are presented as a conceptual bridge between prevailing siloed efforts in health systems and allied sectors. We also highlight key enablers to support effective implementation of EPHFs, including high-level political commitment, clear national structures for institutional stewardship on EPHFs, multisectoral accountability and systematic assessment. As countries seek to transform health systems in the context of recovery from COVID-19 and other public health emergencies, the renewed EPHF list and enablers can inform public health reform, PHC strengthening, and more integrated recovery efforts to build resilient health systems capable of managing complex health challenges for all people.

Health financing and public financial management during the Covid-19 pandemic: Evidence from Pakistan as low-income country.

PURPOSE: This article aims to explore the areas of misalignment between the public financial management (PFM) and health financing during the COVID-19 pandemic in Pakistan. ORIGINALITY/VALUE: To the best of our knowledge, it is the first study on South Asian countries to adopt a framework and bring forward the dominant themes that cause the misalignment between PFM and health financing. The timing of the research was excellent as the world was facing the biggest health challenge in the form of COVID-19 which has put pressure on the PFM and has seriously hampered health service delivery. Therefore, the findings of the study are helpful for the ministry of health to draft policies to improve health allocations and move towards Universal Health Coverage. DESIGN/METHODOLOGY/APPROACH: In-depth semi-structured interviews of 15 participants were used to explore the areas of misalignment between PFM and health financing. Based on qualitative data, thematic content analysis has been carried out. FINDINGS: The findings of the study can be divided into five clusters and their explanations. First overall budget allocation has an impact on the health sector budget. For example, the budget for priority health interventions is not reflected in the budget allocation process. Further, the budget is classified by inputs rather than disease and finally, the budget is not released by the health priorities. The second cluster was the devolution of health to provinces which is unfinished agenda. Under this cluster fiscal decentralisation has been found to cause problems for the provinces as they have not provided fiscal autonomy to spend the money and there is a lack of coordination between the federal and provincial authorities. The third cluster was donor funding, and it was observed that it is not aligned with the government policies and priorities. Forth cluster was procurement and it was discovered that it is a lengthy process and caused delays in procuring the essential health equipment. The fifth cluster was an organisational culture that is not conducive to the health sector. Under this cluster, the attitude, knowledge, and practices of departments responsible for the health sector require complete revamping.

Of primary health care reforms and pandemic responses: understanding perspectives of health system actors in Kerala before and during COVID-19.

BACKGROUND: In 2016, the Government of the southern Indian state of Kerala launched the Aardram mission, a set of reforms in the state's health sector with the support of Local Self Governments (LSG). Primary Health Centres (PHCs) were slated for transformation into Family Health Centres (FHCs), with extended hours of operation as well as improved quality and range of services. With the COVID-19 pandemic emerging soon after their introduction, we studied the outcomes of the transformation from PHC to FHC and how they related to primary healthcare service delivery during COVID-19. METHODS: A qualitative study was conducted using In-depth interviews with 80 health system actors (male n = 32, female n = 48) aged between 30-63 years in eight primary care facilities of four districts in Kerala from July to October 2021. Participants included LSG members, medical and public health staff, as well as community leaders. Questions about the need for primary healthcare reforms, their implementation, challenges, achievements, and the impact of COVID-19 on service delivery were asked. Written informed consent was obtained and interview transcripts - transliterated into English-were thematically analysed by a team of four researchers using ATLAS.ti 9 software. RESULTS: LSG members and health staff felt that the PHC was an institution that guarantees preventive, promotive, and curative care to the poorest section of society and can help in reducing the high cost of care. Post-transformation to FHCs, improved timings, additional human resources, new services, fully functioning laboratories, and well stocked pharmacies were observed and linked to improved service utilization and reduced cost of care. Challenges of geographical access remained, along with concerns about the lack of attention to public health functions, and sustainability in low-revenue LSGs. COVID-19 pandemic restrictions disrupted promotive services, awareness sessions and outreach activities; newly introduced services were stopped, and outpatient numbers were reduced drastically. Essential health delivery and COVID-19 management increased the workload of health workers and LSG members, as the emphasis was placed on managing the COVID-19 pandemic and delivering essential health services. CONCLUSION: Most of the health system actors expressed their belief in and commitment to primary health care reforms and noted positive impacts on the clinical side with remaining challenges of access, outreach, and sustainability. COVID-19 reduced service coverage and utilisation, but motivated greater efforts on the part of both health workers and community representatives. Primary health care is a shared priority now, with a need for greater focus on systems strengthening, collaboration, and primary prevention.

A discourse and content analysis of representation in the mainstream media of the South African National Health Insurance policy from 2011 to 2019.

BACKGROUND: Media is a crucial factor in shaping public opinion and setting policy agendas. There is limited research on the role of media in health policy processes in low- and middle-income countries. This study profiles South Africa as a case example, currently in the process of implementing a major health policy reform, National Health Insurance (NHI). METHODS: A descriptive, mixed methods study was conducted in five sequential phases. Evidence was gathered through a scoping review of secondary literature; discourse analysis of global policy documents on universal health coverage and South African NHI policy documents; and a content and discourse analysis of South African print and online media texts focused on NHI. Representations within media were analysed and dominant discourses that might influence the policy process were identified. RESULTS: Discourses of 'health as a global public good' and 'neoliberalism' were identified in global and national policy documents. Similar neoliberal discourse was identified within SA media. Unique discourses were identified within SA media relating to biopolitics and corruption. Media representations revealed political and ideological contestation which was not as present in the global and national policy documents. Media representations did not mirror the lived reality of most of the South African population. The discourses identified influence the policy process and hinder public participation in these processes. They reinforce social hierarchy and power structures in South Africa, and might reinforce current inequalities in the health system, with negative repercussions for access to health care. CONCLUSIONS: There is a need to understand mainstream media as part of a people-centred health system, particularly in the context of universal health coverage reforms such as NHI. Harmful media representations should be counter-acted. This requires the formation of collaborative and sustainable networks of policy actors to develop strategies on how to leverage media within health policy to support policy processes, build public trust and social cohesion, and ultimately decrease inequalities and increase access to health care. Research should be undertaken to explore media in other diverse formats and languages, and in other contexts, particularly low- and middle-income countries, to further understand media's role in health policy processes.

Disparities in access to cancer diagnostics in ASEAN member countries.

Diagnostics, including laboratory tests, medical and nuclear imaging, and molecular testing, are essential in the diagnosis and management of cancer to optimize clinical outcomes. With the continuous rise in cancer mortality and morbidity in the Association of Southeast Asian Nations (ASEAN), there exists a critical need to evaluate the accessibility of cancer diagnostics in the region so as to direct multifaceted interventions that will address regional inequities and inadequacies in cancer care. This paper identifies existing gaps in service delivery, health workforce, health information systems, leadership and governance, and financing and how these contribute to disparities in access to cancer diagnostics in ASEAN member countries. Intersectoral health policies that will strengthen coordinated laboratory services, upscale infrastructure development, encourage health workforce production, and enable proper appropriation of funding are necessary to effectively reduce the regional cancer burden.

Rethinking the donor's role in strengthening health systems through sexual and reproductive health and rights partnerships: A qualitative analysis of Ugandan case studies

International donors continue to prefer vertical programming over systems strengthening despite the universal health agenda. This study explored Dutch policy and practice towards health systems within sexual and reproductive health and rights-focused partnerships between the Netherlands Ministry of Foreign Affairs and civil society, through a document analysis, 13 in-depth interviews and a stakeholder workshop. The findings revealed that partnerships supported the Ugandan health system in unstructured ways and had difficulties finding synergies. To ensure sustained outcomes and respond to the renewed urgency of strong health systems in the face of crises, donors should incorporate systems strengthening as an explicit goal.

Building back better children's surgical services toward universal health coverage: Perspectives from Bangladesh and Zimbabwe.

Introduction: This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Children's surgical services are crucial, yet underappreciated, for children's health and must be sufficiently addressed to make and sustain progress toward universal health coverage (UHC). Despite their considerable burden and socioeconomic cost, surgical diseases have been relatively neglected in favor of communicable diseases living up to their inauspicious moniker: 'the neglected stepchild of global health'. This article aims to raise awareness around children's surgical diseases and offers perspectives from two prototypical LMICs on strengthening surgical services in the context of health systems recovery following the COVID-19 experience to make and sustain progress toward UHC. Approach: We used a focused literature review supplemented by the perspectives of local experts and the 6-components framework for surgical systems planning to present two case studies of Bangladesh and Zimbabwe. The lived experiences of the authors are used to describe the impact of COVID-19 on respective surgical systems and offer perspectives on building back the health system and recovering essential health services for sustainability and resilience. Findings: We found that limited high-level policy and planning instruments, an overburdened and under-resourced health and allied workforce, underdeveloped surgical infrastructure (from key utilities to essential medical products), lack of locally generated research, and the specter of prohibitively high out-of-pocket costs for children's surgery are common challenges in both countries that have been exacerbated by the COVID-19 pandemic. Discussion: Continued chronic underinvestment and inattention to children's surgical diseases coupled with the devastating effect of the COVID-19 pandemic threaten progress toward key global health objectives. Urgent attention and investment in the context of health systems recovery is needed from policy to practice levels to improve infrastructure; attract, retain and train the surgical and allied health workforce; and improve service delivery access with equity considerations to meet the 2030 Lancet Commission goals, and make and sustain progress toward UHC and the SDGs.