Table 3 Successes and challenges of HSG towards UHC and health security, 2021
Framework dimension | UHC | Health security | Strategies to realize UHC and/or health security | ||
|---|---|---|---|---|---|
Successes | Challenges | Successes | Challenges | ||
Policy formulation and strategic plans | Single-payer scheme in Indonesia improved health equity and access after the novel UHC initiative [25] Prepaid health spending and financial risk pooling is a crucial sign of progress towards UHC [24] Public financing improves health system functioning [23] Expansion of pro-poor healthcare services resulted in good progress towards UHC in Sri Lanka [26] Decentralization of healthcare services enhances healthcare access and equity [27] Village health volunteers in Thailand, the lady health workers in Pakistan and health extension workers (HEWs) in Ethiopia are all successful community-based models which have contributed immensely towards health programmes [28] Refresher or other types of training, supervision, clear policies on reward systems and good management support helped community health workers to give good quality of care in Botswana [33] | Shortages in human resources and medical supplies; and poor physical healthcare services access [30], Poor physical access to essential health services reported in most countries in Africa [31], Disparity of health service utilization in Nigeria varies across educational level, residence, gender and socioeconomic status of the service users [29] Socially excluded population groups received health services from a dysfunctional publicly provided health system marked by gaps and often invisible barriers, which undermines the progress towards UHC[32] | Integration of human resource planning with health emergency planning assisted in controlling the cholera epidemic [34] | A centralized one-size-fits-all approach did not address the complexity and diversity in Indonesia [25] Absence of clear judicial, executive and legislative authority and clarity of structures in conflict settings, like Syria [35] Unclear administrative roles and command structures during health emergencies [16] | Resilient health workforces at country levels were critical to ensuring health security and support planning and prioritization of health issues [36] Moving away from a one-size-fits-all approach in guiding pandemic response [37] Political commitment, fair contribution and distribution of resources speed up the path of UHC [38] An economic architecture allows reducing poverty, unemployment and inequities [39] Rebuilding HSG had progressive changes on service delivery in conflict settings, like Syria [35] Conceptualization of health workforce governance enables the operationalization of governance policies to achieve UHC and global health security (GHS) [40] Effective strategic planning, regulation and management of the health workforce to combat health shocks [30] Well-designed and community-driven initiatives are a means to achieve UHC and GHS [41] |
Intelligence | High-quality health information systems (HIS) enable effective monitoring of global and national health inequality [43] Community health household registers improve health system outcomes [44] Innovative data management in a unified process, assists in providing a timely response for patient care outcomes in Ethiopia [46] Mobile phones and internet are creating opportunities to improve access to appropriate knowledge and advice to realize UHC [45] Australia was the first to establish a formal national health technology assessment programme in the Asian Pacific region [42] | Neglect of effective people-centred healthcare information affected access to essential health services [47] | An independent, objective and transparent assessment of health system gaps needed to ensure early detection, prevention and response to biological threats [48] A timely response needed to meet the national and global health goals [16] Surveillance capacity and strong investments to improve the strength of the health system during crisis [16] | Late responses due to poor surveillance and lack of combining routine data weakened the functionality of plans [49] | Using indicators in the private sector and subnational levels helps ensure data quality and response to public health threats [52] Strengthening local-level managers' ability is substantial leverage in supporting informed local decision-making [51] Strategic direction to sustain the achievements of digital data culture and an automated single reporting system for multiple stakeholders to make the system user-friendly [50] |
Regulation | Established national and subnational regulatory agencies are crucial to monitor and enforce laws and regulations to access emergency care [53] Centralized public regulatory authority of the redistributive funding model in the French healthcare system reduced financial barriers to access for the poor population [54] Mentorship and enhanced supervision of health staff improve quality care at health facilities [44] Regulators are encouraged to invest in gauging their performance and information sharing [60] Regulating the cost of private healthcare improves the move towards UHC [55] Close monitoring at all levels on the trends of key indicators and early corrective measures brought good health outcomes in Rwanda [56] | Political interference and unclear roles and responsibilities of different governmental regulatory bodies contributed to failures in service delivery [55] The regulatory architecture for healthcare in Mongolia resulted in poor affordability and quality of private care [55] Inadequacies of the human resource capacities of the regulatory organizations [57] Lack of enforcement for free health services to the poor in government-subsidized private hospitals in Delhi [57] | Adequate training and supportive supervision to community health workers (CHWs) are helpful to save the life of patients at the time of emergencies [58] | Inadequacies of the human resource capacities of the regulatory organizations [57] | International treaties, constitutional and statutory law, regulations, guidelines, protocols and informal practice patterns are instrumental in governing the health system and improving service delivery [59] Adopting strategic purchasing and ensuring an independent accreditation system/organization accelerates progress on healthcare quality [27] Regulation shall be exercised in medical and pharmaceutical practices in the healthcare system to improve supply chain management [60] |
Collaboration and coalition | Strong partnership with national and global actors is required to avoid late responsiveness of the health system [61] Coordination with nongovernmental organizations (NGOs) and local councils in conflict settings help to address health system fragmentation [35] Coordination between public, private for-profit and not-for-profit sectors were needed to optimize the health service delivery [19] Holistic and integrated health service delivery helps to avoid resource fragmentation and improve efficiency in healthcare delivery [62] Participatory governance in health systems platforms, such as the national health assembly in Thailand, is a key pillar for achieving UHC [63] | Poor leadership practices at the subnational and national levels were the main challenges, which lead to poor coordination and absence of a prompt response to specific health shocks [64] | Multisectoral, collaborative working within and across sectors improves international health regulation (2005) [65] High-level negotiations and health diplomacy efforts in the Caribbean region resulted in the “Port of Spain Declaration” to prevent noncommunicable diseases (NCDs) [66] The Global Health Security Agenda (GHSA) speeds up the progress towards a safe and secure world from infectious disease threats [67] Collective action by all to mitigate, prevent and fight against health security threats [68] | Poor leadership practices were the main challenge for the poor prompt response of the health shocks [64] | Strong leadership, tight bonds and sense of kinship at the community level and trusted communication channels to address health shocks [70] Promoting and strengthening the political momentum towards UHC facilitates its realization [41] Health sector governance will require new partnerships and opportunities for dialogue [69] The global health governance of the COVID-19 response strengthens to combat the conditions of the pandemic [37] |
Accountability | Effective stewardship role of the government to ensure the progress towards UHC [71] Ensuring accountability, managing health resources, and decision-making were the factors for HSG to achieve an effective and equitable health system [72] | Corruption, fear of reprisal and limited funding [73] Policy-distorting corruption can potentially prevent society from achieving health development goals [74] | Effective governance processes build strong partnerships for health and create accountability to respond to health emergencies [16] | Rule of law, engaging partners in public policy and transparency to ensure accountability [76] Integration of anti-corruption, transparency and accountability measures into health systems helps to achieve SDGs [77] Strong and transparent monitoring systems at different levels of the healthcare system can ensure accountability [78] Low socioeconomic status was the challenge to receiving healthcare services in Chile. Copayment levels fixed by law and maintaining free care for indigent and low-income families after the Universal Access with Explicit Guarantees (AUGE) programme in Chile were helpful to receive equitable and responsive health services utilization and to ensure accountability [75] | |