Table 2 Description of included studies
From: Quality of care in the context of universal health coverage: a scoping review
Authors, year | Title | Study design | Geographic regions | Quality dimensions | Review objectives | Key findings |
|---|---|---|---|---|---|---|
Agarwal et al., 2019 | A conceptual framework for measuring community health workforce performance within primary health care systems | Narrative review | LMICs | Effectiveness, equity | Identify indicators to monitor community health workers’ performance in LMICs | Identified 21 subdomains to measure CHW performance including service quality and CHW absenteeism and attrition |
Alhassan et al., 2016 | A review of the National Health Insurance Scheme in Ghana: what are the sustainability threats and prospects? | Scoping review | AFR | Effectiveness, people centredness, timeliness, equity | Describe threats to, and opportunities to strengthen the sustainability of the NHIS in Ghana | Poor perceived quality of care within Ghana’s NHIS has reduced clients’ trust in the insurance scheme and decreased re-enrollment rates |
Almeida, 2017 | The role of private non-profit healthcare organizations in NHS systems: implications for the Portuguese hospital devolution programme | Narrative review | EUR | Effectiveness, people centredness, efficiency | Evaluate the effects of privatization on the efficiency, quality and responsiveness of services in publicly available universal health care systems | Results suggest that privatization, through transferring management of some hospitals from the public sector to private, non-profit organizations can improve efficiency and access within NHS systems without sacrificing quality |
Ansu-Mensah et al., 2020 | Maternal perceptions of the quality of care in the Free Maternal Care Policy in sub-Sahara Africa: a systematic scoping review | Scoping review | AFR | Integrated care, people centredness, timeliness | To summarize evidence on the perceptions of the quality of free maternal healthcare services in sub-Saharan Africa | 8 of 13 included studies reported that pregnant women and/or women in the postnatal period were generally not satisfied with the quality of free maternal healthcare services provided |
Assefa et al., 2019 | Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare services | Systematic review | AFR | Effectiveness, safety, people centredness, equity, efficiency | Assess the successes and challenges faced by the community health extension programme in Ethiopia and develop a framework to strengthen the programme and progress toward universal coverage for primary healthcare services | Community health extension programme in Ethiopia has been associated with significant improvements in maternal and child health, communicable diseases, hygiene and sanitation, and knowledge and care seeking |
Báscolo et al., 2018 | Construction of a monitoring framework for universal health | Narrative review | AMR | Effectiveness, people centredness, timeliness, equity, efficiency | Develop a framework to monitor progress toward UHC | Identified 64 indicators for monitoring framework for universal health access and UHC, grouped under the following dimensions: strategic actions, outputs, outcomes and impacts |
Bitton et al., 2019 | Primary healthcare system performance in low-income and middle-income countries: a scoping review of the evidence base from 2010 to 2017 | Scoping review | LMICs | Effectiveness, integrated care, people centredness, equity, efficiency, timeliness, safety | Assess the state of research on primary healthcare (PHC) in LMICs and identify priority areas for research | Highly researched areas included PHC policy, payment and workforce (including competence and motivation). Low research areas included population health management, facility management, effectiveness and quality of service delivery |
Blanchet et al., 2012 | How to achieve universal coverage of cataract surgical services in developing countries: lessons from systematic reviews of other services | Overview of systematic reviews | ‘Developing’ countries | Effectiveness, timeliness, equity, integrated care, efficiency | Review evidence on effective strategies to promote coverage and access to eye care and other health services in ‘developing’ countries | No reviews met the study’s inclusion criteria for cataract surgery. Literature search pertaining to other health sectors identified several factors facilitating universal coverage in ‘developing’ countries including peer education, increased staff in rural areas, task shifting and integration of services |
Boerma et al., 2014 | Monitoring progress towards universal health coverage at country and global levels | Narrative review | Global | Effectiveness, timeliness, equity | Summarize evidence on monitoring progress toward UHC | Focusing on the levels of coverage and financial protection, with a focus on equity, in monitoring UHC is both relevant and feasible. UHC monitoring can be integrated into the monitoring of overall health system performance and progress |
Bresick et al., 2019 | Primary health care performance: a scoping review of the current state of measurement in Africa | Scoping review | AFR | Effectiveness, safety, people centredness, efficiency, timeliness | Summarize current state of measurement of primary care performance in Africa | Few validated instruments have been used to measure primary care performance in Africa. Further performance-based research is required to ensure access to high-quality care in a universal health coverage system |
Christmals et al., 2020 | Implementation of the National Health Insurance Scheme (NHIS) in Ghana:  lessons for South Africa and low- and middle-income countries | Scoping review | AFR | Equity, people centredness, efficiency, | Synthesize evidence on the implementation of the NHIS in Ghana | Though NHIS has helped increase access to healthcare for the poor and most vulnerable, there are a number of challenges facing the NHIS, including poor perceived quality of care and ineffective governance |
Fallah et al., 2021 | Participation of delivering private hospital services in universal health coverage: a systematic scoping review of the developing countries’ evidence | Scoping review | 'Developing' countries | Equity, efficiency, | Summarize evidence on the participation of private hospital services in advancing UHC in ‘developing’ countries | The role and contribution of private hospitals in efforts toward UHC differs depending on the country context |
Farzaneh et al., 2020 | The ethical framework for policy-making of universal health coverage: a systematic review | Systematic review | Global | Effectiveness, people centredness, equity, efficiency | Examine ethical frameworks used in the context of policy-making for UHC | Ethical frameworks used in UHC policy-making consist of ethical principles and criteria, including fairness, justice, sustainability, solidarity, good governance and efficiency |
Gupta et al., 2018 | Measuring progress toward universal health coverage: does the monitoring framework of Bangladesh need further improvement? | Systematic review | SEAR | Effectiveness, safety, equity | Compare Bangladesh’s monitoring framework for UHC to global-level recommendations proposed by WB/WHO and identify existing gaps in Bangladesh’s framework | Bangladesh’s UHC monitoring framework incorporates all of the global recommendations regarding financial risk protection and equity. However, there are significant gaps in indicators regarding service coverage in the areas of mental illness, cataract and neglected tropical diseases, despite a high disease burden attributable to these health conditions in Bangladesh |
Hayati et al., 2018 | Scoping literature review on the basic health benefit package and its determinant criteria | Scoping review | Global | Effectiveness, equity, safety, efficiency | Identify criteria used by countries globally to develop basic health benefit packages | The most widely applied criteria for basic health benefit packages globally are cost-effectiveness , effectiveness, budget impact , equity and burden of disease |
Kamei et al., 2017 | Toward advanced nursing practice along with people-centered care partnership model for sustainable universal health coverage and universal access to health | Narrative review | Global, WPR | People centredness, equity | Develop a people-centred care partnership model, to sustain UHC focused on ageing populations | Presented a people-centred care partnership model to address the health needs of an ageing society that centres the role of advanced practice nurses in sustaining UHC |
Kiil, 2012 | What characterises the privately insured in universal health care systems? A review of the empirical evidence | Systematic review | ‘Developed’ countries | Equity, timeliness | Characterize patients who have voluntary private health insurance in UHC systems | Patients with voluntary private insurance in UHC systems have higher income and socioeconomic status. With a few exceptions, the privately insured are in equal or better health in comparison to the remaining population |
Kim et al., 2020 | Utilization of traditional medicine in primary health care in low-and middle-income countries: a systematic review | Systematic review | LMICs | People centredness, integrated care, timeliness, equity, effectiveness, safety | Examine the use and describe the strengths and limitations of traditional medicine in primary healthcare in LMICs | Traditional medicine is widely used in LMICs and helps increase access to healthcare, especially in low resource settings. However, some evidence demonstrates an association between traditional medicine and adverse health outcomes, including higher mortality. Further training of traditional medicine practitioners, and integrating their services within national health systems could help improve the quality of care provided |
Lê et al., 2016 | Can service integration work for universal health coverage? Evidence from around the globe | Systematic review | Global | People centredness, effectiveness, equity, efficiency, integrated care, timeliness | Assess the impacts of different types of service integration on service delivery, equity and health outcomes | Service integration can deliver incremental improved outcomes for both patients and healthcare providers without additional financial costs, with high levels of user satisfaction |
Li et al., 2017 | The development and impact of primary health care in China from 1949 to 2015: a focused review | Systematic review | WPR | Equity, effectiveness, safety, efficiency | Summarize the evidence on the development and impacts of PHC reforms in China and ongoing challenges | The Chinese government has focused on strengthening PHC, particularly after the SARS outbreak. Positive health outcomes have included reductions in child mortality and decreased maternal mortality rates. However, challenges remain including resource and workforce shortages, rural–urban disparities in health and inadequate utilization of PHC institutions, threatening the realization of ‘health for all’. Further investments and policy actions are required to improve China’s PHC system |
Mate et al., 2013 | Improving health system quality in low- and middle-income countries that are expanding health coverage: a framework for insurance | Narrative review | LMICs | Effectiveness, people centredness | Develop a framework to present insurance-driven strategies to improve quality of care within the context of UHC | A conceptual framework was created to present strategies available to public insurers responsible for expanding access to care, to influence healthcare quality. Framework further identified four mechanisms through which insurers can influence quality: investment in systems, patients and providers; selective contracting; provider payment; and benefit package design |
McMichael et al., 2017 | Health equity and migrants in the Greater Mekong Subregion | Scoping review | WPR, SEAR | Equity, people centredness | Examine the health needs of cross-border migrants in the Greater Mekong Subregion and their access barriers to healthcare and identify policy responses to improve their access to care | Despite increasing attention to migrant health globally, migrants continue to experience poor access to good quality care in the Greater Mekong Subregion due to legal, language and cultural barriers, as well as discrimination from healthcare providers. Further research is required to address the health needs of migrants in UHC efforts and advance health equity |
Morgan et al., 2016 | Performance of private sector health care: implications for universal health coverage | Narrative review | LMICs | Equity, effectiveness, efficiency, timeliness | Develop a conceptual framework that theorizes the linkages between private sector performance and wider health systems, and its implications for universal health coverage | The role of the private sector in supporting progress towards UHC in LMICs varies, and its performance is largely influenced by the characteristics of patients and providers, as well as the regulatory structures governing both the public and private sector. Influencing the performance of the private sector to benefit population health will require large-scale shifts that focus on the health system, as opposed to individual providers alone |
Mumghamba et al., 2015 | Capacity building and financing oral health in the African and Middle East region | Narrative review | AFR, EMR | Equity, efficiency | Summarize existing knowledge and identify gaps related to capacity building and financing of oral health in the African and Middle East region and identify priorities for future research | There is a lack of evidence on the impacts of oral health financing on the equity, efficiency and utilization of dental services in the African and Middle East region. Existing evidence suggests there are significant gaps between oral health needs and existing financial and human resource capacity. Further efforts are required to move toward universal coverage in oral health through innovative health insurance schemes and financing mechanisms |
Naher et al., 2020 | The influence of corruption and governance in the delivery of frontline health care services in the public sector: a scoping review of current and future prospects in low and middle-income countries of South and South-East Asia | Scoping review | SEAR, WPR | Equity, timeliness, efficiency, people centredness | Examine practices of corruption within PHC in the LMICs of the South and South-East Asia region and explore strategies to address these irregular and informal practices | Practices of corruption within health systems in the LMICs in the South and South-East Asia region are largely driven by poor governance and financial causes such as poor salary benefits and lack of adequate incentives. These practices increase out of pocket payments, reduce patient confidence in the health system and decrease utilization |
Nandi et al., 2020 | Using an equity-based framework for evaluating publicly funded health insurance programmes as an instrument of UHC in Chhattisgarh State, India | Narrative review | SEAR | Equity, effectiveness | Analyze the equity impacts of publicly funded health insurance (PFHI) schemes in Chhattisgarh State in India and identify evidence gaps | Evidence of high and equitable enrollment from household surveys may mask inequities within households among the most vulnerable. Equitable enrollment does not necessarily lead to financial protection or equity of utilization. Deepening inequities have been observed in utilization patterns as funds have been funnelled to better off areas and the private sector. The development of PFHI schemes, in the context of neoliberal policies that promote private sector provision of care, has significant consequences for health equity |
O’Connell et al., 2015 | Synthesizing qualitative and quantitative evidence on non-financial access barriers: implications for assessment at the district level | Systematic review | AFR, SEAR, WPR | Equity, people centredness | Examine non-financial barriers to access and utilization of maternal, newborn and child health services in Ghana, Bangladesh, Vietnam and Rwanda | Common non-financial barriers to access and utilization of maternal, newborn and child health services in Ghana, Bangladesh, Vietnam and Rwanda relate to ethnicity; religion; physical accessibility; decision-making, gender and autonomy; and knowledge, information and education |
Palagyi et al., 2019 | Organisation of primary health care in the Asia–Pacific region: developing a prioritised research agenda | Systematic review | SEAR, WPR | Efficiency, effectiveness, equity, integrated care | Identify evidence gaps and priority areas for future research related to evidence-based strategies for optimizing PHC service delivery in LMICs of the Asia–Pacific region | Five priority areas for future research are related to the optimal configuration of PHC teams; PHC service delivery management; task sharing/shifting; sustainable integration of PHC services; and equity-related outcomes |
Palumbo, 2017 | Keeping candles lit: the role of concierge medicine in the future of primary care | Systematic review | Global | People centredness, equity, effectiveness | Summarize evidence on the characteristics and effects of concierge medicine on UHC and sustainability of primary care services | Concierge medicine can lead to greater satisfaction among care providers and patients, generate additional revenue and increase the sustainability of the healthcare system. However, concierge practices are also likely to increase inequities in access to care and power imbalances between patients and providers |
Petrou et al., 2018 | Single-payer or a multipayer health system: a systematic literature review | Systematic review | Global | Equity, effectiveness, efficiency, timeliness | Examine the impacts of single payer and multipayer health systems on equity, efficiency, quality of care and financial protection globally | There is some evidence that single-payer systems are more equitable to patients than multipayer systems, which tend to be costlier due to higher administrative costs. In some cases, multipayer systems may be more efficient due to a lack of incentives for improvements to efficiency in single-payer systems |
Ravaghi et al., 2018 | A holistic view on implementing hospital autonomy reforms in developing countries: a systematic review | Systematic review | ‘Developing’ countries | Equity, efficiency, effectiveness | Examine hospital autonomy reforms including their development, barriers and facilitators to implementation, their outcomes and implications for UHC in ‘developing’ countries | In general, hospital autonomy reforms in ‘developing’ countries have decreased financial protection, and increased inequities in access to quality health services, impeding progress toward UHC. Failure of these reforms can be attributed to a lack of a holistic, comprehensive view about what is required for success and poor/incomplete implementation |
Rezapour et al., 2019 | Developing Iranian primary health care quality framework: a national study | Narrative review | EMR | Equity, safety, effectiveness, people centredness, timeliness, efficiency | Create a framework to assess the quality of PHC within Iran’s health system | Literature review identified 13 Primary Health Care Quality Assessment Frameworks (PHCQAF), which evaluated the quality of PHC across 20 dimensions and 698 quality indicators. Delphi process resulted in the development of a PHCQAF for Iran, comprising 40 quality indicators across the dimensions of patient centredness; governance; access and equity; safety; efficiency and effectiveness. The largest share of indicators relates to the dimension of effectiveness (32.5%), while the lowest shares relate to dimensions of patient centredness, efficiency and governance (5% each) |
Rodney et al., 2014 | Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success | Narrative review | Global | Equity, timeliness, efficiency | Examine how equity is conceptualized and measured within the context of UHC and describe strategies to assist decision-makers in implementing equity-enhancing UHC programmes | There is growing attention on the monitoring and evaluation of equity within UHC. Literature advocates for progressive universalism, in which the most disadvantaged are targeted in the planning of UHC programmes to advance equity. In efforts to monitor equity within UHC, countries should carefully assess the proposed WHO/WB framework prior to its adoption, as it focuses on wealth quintiles, and does not include other dimensions of equity such as gender and race, which could serve to mask increasing in-country disparities |
Sanogo et al., 2019 | Universal health coverage and facilitation of equitable access to care in Africa | Systematic review | AFR | Equity | Assess the effects of UHC on equitable access to care in Africa for vulnerable and underprivileged populations | In many African countries, efforts toward achieving UHC have increased access to care, but quality of care remains an ongoing issue, which disproportionately impacts the poor. Poor-quality care can lead to a lack of confidence in the health system and decrease utilization |
Schmied et al., 2010 | The nature and impact of collaboration and integrated service delivery for pregnant women, children and families | Narrative review | WPR | Integrated care, effectiveness, equity, people centredness | Examine the nature of collaboration and integration between care providers and the impacts of various forms of integration and collaboration for pregnant women, children and families | Various forms and degrees of collaboration and integration have been adopted in the delivery of universal health services. Well-coordinated or integrated services can positively impact the wellbeing of pregnant women, children, and families. Effective collaboration and integration require agencies and professional groups to overcome tension due to professional boundaries, break down cultural barriers and build trust |
Schveitzer et al., 2016 | Nursing challenges for universal health coverage: a systematic review | Systematic review | AMR | People centredness, integrated care | Summarize nursing challenges related to UHC | Nursing challenges related to UHC are due to gaps in education and training. A clearer definition of the nursing role in PHC is required |
Sehngelia et al., 2016 | Impact of healthcare reform on universal coverage in Georgia: a systematic review | Systematic review | EUR | Efficiency, equity, effectiveness | Assess the impacts of health system reforms in Georgia intended to ensure UHC on health financing sustainability, equity, efficiency, quality and cost control | Reforms implemented in Georgia to help ensure UHC have not been successful and have undermined health financing, efficiency, equity and the quality of care. Growth of privatization in the health sector without effective regulation and accreditation has hindered the quality of care |
Sprockett, 2017 | Review of quality assessment tools for family planning programmes in low- and middle-income countries | Narrative review | LMICs | Effectiveness, safety, people centredness, timeliness, equity, integrated care, efficiency | To identify quality assessment tools of relevance to clinic-based family planning programmes in LMICs | Identified 20 quality assessment tools of relevance to clinic-based family planning programmes in LMICs. A standardized quality assessment tool should be adopted to help achieve UHC, of which quality is a key component |
Teerawattananon et al., 2016 | How to meet the demand for good quality renal dialysis as part of universal health coverage in resource-limited settings? | Narrative review | EUR, WPR, SEAR | Safety, efficiency, effectiveness, people centredness, equity | Summarize the experiences of renal dialysis in seven study settings, describe how the quality of renal dialysis programs can be ensured, and discuss strategies to improve the quality of life of patients with end-stage renal disease | Five of the seven study settings have included renal dialysis as part of the UHC benefit package, with progress to do so in the remaining two settings. A holistic approach to disease prevention, identification and management, and appropriate use of financial mechanisms are required to ensure good-quality services and care for renal dialysis |
Umeh, 2018 | Challenges toward achieving universal health coverage in Ghana, Kenya, Nigeria, and Tanzania | Narrative review | AFR | Timeliness, equity, effectiveness, efficiency | Summarize the challenges to achieving UHC faced by Ghana, Kenya, Nigeria and Tanzania, and identify strategies to help ensure and strengthen UHC | Despite efforts to achieve UHC in many sub-Saharan African countries, significant challenges remain, including low informal sector enrollment and high rates of non-renewal of health insurance due to poor perceived quality of care |
van Hees et al., 2019 | Leaving no one behind? Social inclusion of health insurance in low- and middle-income countries: a systematic review | Systematic review | LMICs | Efficiency, effectiveness, equity | Assess the impacts of health insurance on vulnerable groups in LMICs | Unable to draw clear conclusions on the impacts of health insurance on financial risk protection, health outcomes and quality of care delivery for specific vulnerable groups in LMICs |
Victora et al., 2004 | Achieving universal coverage with health interventions | Narrative review | LICs | Effectiveness, equity, efficiency | Examine how known cost-effective health interventions in low-income countries can be taken to scale | Country specific strategies are required to scale up cost-effective interventions to reach the most vulnerable and reduce health inequities |
White, 2015 | Primary health care and public health: foundations of universal health systems | Narrative review | Global | Integrated care, equity, efficiency, effectiveness | Advocate for more integrated and universally accessible health services | Most health systems globally continue to focus heavily on illness. A renewed focus on public health and primary healthcare is essential to build sustainable health systems that are effective, efficient, equitable and affordable, and help realize the goals of UHC |
Wiysonge et al., 2017 | Financial arrangements for health systems in low-income countries: an overview of systematic reviews | Overview of systematic reviews | LICs | Equity, efficiency, effectiveness | Summarize evidence regarding the effects of financial arrangements for health systems in low-income countries | It is unclear whether financial incentives for health workers improve the quality of care provided by primary care physicians or outpatient referrals from primary to secondary care (very low-certainty evidence) |
Yip et al., 2019 | 10 years of health-care reform in China: progress and gaps in universal health coverage | Narrative review | WPR | Efficiency, integrated care, effectiveness, safety, equity, timeliness | Assess whether health system reform efforts in China have succeeded in providing equal access to quality healthcare and financial risk protection | Health system reform efforts in China to advance UHC have resulted in mixed effects on quality. Issues related to provider competence remain, while many patients continue to be dissatisfied with the quality of care provided. However, there is some evidence of improved hospital performance in terms of process and outcome measures for some health conditions |