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Reforma del sector salud en el Perú: Derecho, gobernanza, cobertura universal y respuesta contra riesgos sanitariosVelásquez, Aníbal, Suarez, Dalia, Nepo-Linares, Edgardo 09 1900 (has links)
In 2013, Peru initiated a reform process under the premise of recognizing the nature of health as a right that must be protected by the state. This reform aimed to improve health conditions through the elimination or reduction of restrictions preventing the full exercise of this right, and the consequent approach aimed to protect both individual and public health and rights within a framework characterized by strengthened stewardship and governance, which would allow system conduction and effective responses to risks and emergencies. The reform led to an increase in population health insurance coverage from 64% to 73%, with universalization occurring through the SIS affiliation of every newborn with no other protection mechanism. Health financing increased by 75% from 2011, and the SIS budget tripled from 570 to 1,700 million soles. From 2012 to May 2016, 168 health facilities have become operational, 51 establishments are nearing completion, and 265 new projects are currently under technical file and work continuity with an implemented investment of more than 7 billion soles. Additionally, this reform led to the approval of the Ministry of Health intervention for health emergencies and strengthened the health authority of the ministry to implement responses in case of risks or service discontinuity resulting from a lack of regional or local government compliance with public health functions. / In 2013, Peru initiated a reform process under the premise of recognizing the nature of health as a right that must be protected by the state. This reform aimed to improve health conditions through the elimination or reduction of restrictions preventing the full exercise of this right, and the consequent approach aimed to protect both individual and public health and rights within a framework characterized by strengthened stewardship and governance, which would allow system conduction and effective responses to risks and emergencies. The reform led to an increase in population health insurance coverage from 64% to 73%, with universalization occurring through the SIS affiliation of every newborn with no other protection mechanism. Health financing increased by 75% from 2011, and the SIS budget tripled from 570 to 1,700 million soles. From 2012 to May 2016, 168 health facilities have become operational, 51 establishments are nearing completion, and 265 new projects are currently under technical file and work continuity with an implemented investment of more than 7 billion soles. Additionally, this reform led to the approval of the Ministry of Health intervention for health emergencies and strengthened the health authority of the ministry to implement responses in case of risks or service discontinuity resulting from a lack of regional or local government compliance with public health functions.
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Assessing the readiness to implement national health insurance at a clinic in Soweto / Phethogo MadishaMadisha, Phethogo January 2015 (has links)
The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system.
The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas.
The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI.
Recommendations from the study:
- Managers must drive the quality improvement agenda for their facilities.
- Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts.
- Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients.
Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015
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Assessing the readiness to implement national health insurance at a clinic in Soweto / Phethogo MadishaMadisha, Phethogo January 2015 (has links)
The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system.
The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas.
The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI.
Recommendations from the study:
- Managers must drive the quality improvement agenda for their facilities.
- Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts.
- Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients.
Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015
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Toward Universal Health Coverage : Assessing Health Financing Reforms in Low and Middle Income Countries.Barroy, Hélène 15 December 2014 (has links)
La Couverture Santé Universelle (CSU) vise permettre à chaque individu d’utiliser les services de santé dont il a besoin sans risque de ruine financière ou d’appauvrissement. Bien que le concept de CSU offre un cadre directeur important pour une nation, tous les pays, quel que soit leur niveau de revenu, sont aux prises avec la réalisation ou le maintien de la couverture universelle. Dans ce contexte, générer des preuves sur les expériences des pays et partager les leçons sur les principales contraintes et les choix stratégiques utilisés pour surmonter les barrières techniques serait susceptible de permettre aux pays à revenus faibles ou intermédiaires d’aller de l'avant et de progresser plus rapidement vers la CSU. La thèse propose une analyse comparative de plusieurs instruments politiques, utilisés par cinq cas pays (Niger, Vietnam, Bangladesh, Gabon, France), pour étendre la couverture sanitaire et la protection financière. L’analyse montre que les interventions simples, comme la suppression des frais des utilisateurs (Niger) ou de l'assurance santé à base communautaire (Bangladesh), peuvent accroître l'utilisation des services pour les groupes les plus défavorisés, mais font face à de fortes limitations dans l’atteinte de plus grandes ambitions. Des réformes plus articulées ont démontré des gains importants dans le développement de la couverture santé, mais font également face à des défis pour trouver l'espace budgétaire suffisant (Gabon) et améliorer l’efficience et l'équité du système (Vietnam). Enfin, la thèse analyse les effets de différentes réformes utilisées pour maintenir les gains de la CSU dans des systèmes de santé mûrs, tel que la France. Dans l'ensemble, la thèse a démontré que le menu des réformes vers la couverture universelle est vaste, complexe et perpétuel mais que certains chemins peuvent conduire au succès. / Universal Health Coverage (UHC) is to ensure that everyone can use the health services they need without risk of financial ruin or impoverishment. While the UHC concept offers a powerful framework for a nation, all countries, irrespective of their income level, are struggling with achieving or sustaining universal coverage. In this context, generating evidence about countries’ experiences and sharing lessons on key constraints and strategic choices used to overcome technical barriers would likely enable low-and-middle countries to move forward and make faster progress toward UHC. The thesis provides a comparative analysis of policy instruments used by five selected country cases (Niger, Vietnam,Bangladesh, Gabon and France), to expand health coverage and financial coverage. Analysis shows that single interventions, like user fee removal (Niger) or community-based insurance (Bangladesh), can increase service utilization for the most disadvantaged groups but face strong limitations toward greater ambitions. More articulated reforms have demonstrated significant gains in expanding health coverage but also face challenges in finding the adequate fiscal space (Gabon) and in strengthening system’s efficiency and equity (Vietnam). Finally, the thesis analyzed the effects of different reforms used to sustain gains of UHC in mature health systems, like France. Overall, the thesis demonstrated that the reform agenda for universal coverage is large, complex and perpetual but that certain pathways can ensure success.
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[pt] OS IMPACTOS DA QUARTA REVOLUÇÃO INDUSTRIAL NA GOVERNANÇA DA SAÚDE GLOBAL: UHC2030 / [en] THE FOURTH INDUSTRIAL REVOLUTION AND ITS IMPACTS ON GLOBAL HEALTH GOVERNANCE: UHC2030ENIO RAMOS CARDOSO 13 February 2020 (has links)
[pt] A quarta revolução industrial já está bem próxima do seu ponto de inflexão. As novas tecnologias que, em breve, farão parte das nossas vidas irão impactar a forma como os indivíduos e sociedades se relacionam. A Governança da Saúde Global também precisará se adaptar para absorver essas inovações e o poder que elas terão sobre a agenda de saúde. Avaliar os possíveis impactos sobre os atuais desafios, aumenta a capacidade de se antecipar e incorporar as mudanças. Isso será fundamental para acelerar os processos de fortalecimento e convergência, necessários, em direção à Cobertura Universal da Saúde, até 2030. / [en] The fourth industrial revolution is already very close to its inflection point. The new technologies that will be soon part of our lives, will impact how individuals and societies relate. The Global Health Governance also need to adapt and absorb these innovations and the power it will have on health s agenda. Assess potential impacts on current challenges, increases the ability to anticipate and incorporate these changes. This will be valuable to accelerate processes of strengthening and convergence necessary towards Universal Health Coverage by 2030.
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Towards universal health coverage in Tunisia : theoretical analysis and empirical tests / Vers une couverture santé universelle en Tunisie : analyse théorique et tests empiriquesMakhloufi, Khaled 23 January 2018 (has links)
La présente thèse explore, à travers quatre papiers, la possibilité d’étendre le régime d’assurance maladie sociale (SHI) vers la couverture santé universelle (CSU) et ce en présence d’obstacles structurels économiques.Les effets moyens de deux traitements, les deux assurances MHI et MAS, sur l’utilisation des soins de santé (consultations externes et hospitalisations) sont estimés. L’actuel régime d’assurance sociale en Tunisie (SHI), malgré l’amélioration de l’utilisation des soins de santé procurée aux groupes couverts, reste incapable d’atteindre une couverture effective de tous les membres de la population vis-à-vis des services de soins dont ils ont besoin. L’atteinte de cet objectif requière une stratégie qui cible les ‘‘arbres’’ et non la ‘‘forêt’’.Le chapitre deux contourne les principaux obstacles à l’extension de la couverture par l’assurance maladie et propose une approche originale permettant de cibler les travailleurs informels et les individus en chômage. Une étude transversale d’évaluation contingente (CV) a été menée en Tunisie se proposant d’estimer les volontés d’adhésion et les consentements à payer (WTP) pour deux régimes obligatoires présentés hypothétiquement à l’adhésion. Les résultats confirment l’hypothèse selon laquelle la proposition d’une affiliation volontaire à un régime d’assurance obligatoire serait acceptée par la majorité des non couverts et que les WTP révélés pour cette affiliation seraient substantiels. Enfin, dans le chapitre trois, on insiste sur l'’importance de prendre en compte les attitudes protestataires en évaluant la progression vers la CSU. / This thesis explores, in a four paper format, the possibility of extending social health insurance (SHI) schemes towards Universal Health Coverage (UHC) in presence of structural economic obstacles.The average treatment effects of two insurance schemes, MHI and MAS, on the utilization of outpatient and inpatient healthcare are estimated. The current Tunisian SHI schemes, despite improving utilization of healthcare services, are nevertheless incapable of achieving effective coverage of the whole population for needed services. Attaining the latter goal requires a strategy that targets the “trees” not the “forest”.Chapter two gets around major challenges to extending health insurance coverage and proposes an original approach by targeting informal workers and unemployed. A cross-sectional Contingent valuation (CV) study was carried out in Tunisia dealing with willingness-to-join and pay for two mandatory health and pension insurance schemes.Results support the hypotheses that the proposition of a voluntary affiliation to mandatory insurance schemes can be accepted by the majority of non-covered and that the WTP stated are substantial.Finally in chapter three we focus on methodological aspects that influence the value of the WTP. Our empirical results show that the voluntary affiliation to the formal health insurance scheme could be a step towards achieving UHC in Tunisia. Overall, we highlight the importance of taking into account protest positions for the evaluation of progress towards UHC.
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Equitable access to life-saving child health care: an equity lens for EthiopiaKassa Mohammed Abbe 06 1900 (has links)
Ethiopia has two stories to tell: a fast progress and unfair distribution of the gains in child health care. Despite Ethiopia’s achievement in meeting MDG4, wealth-related mortality inequality increased by 1.5 for every 1,000 live births between 2000 and 2011. Two major dividing lines contribute to child health inequality in Ethiopia: place of residence and wealth status. Lack of proper studies on health inequality policy making is affecting the comprehensiveness and quality of inequality reduction in Ethiopia.
This study wished to assess child health inequality and policy factors that affect progress in inequality reduction. Accordingly, the study explored policy-makers’ attitude and interest; policy contents, and institutions to make recommendations that promote child health equity in Ethiopia.
The research is mainly a qualitative policy research. Conducted between 2013 and 2017, it was design based on health policy researching and health inequality theories. The researcher conducted semi-structured interviews among health policy makers; policy analysis; and a review of the literature. Twenty policy-makers, 15 policy documents, over 350 literatures were selected through purposing and theoretical open sampling methods. Data was synthesised and analysed with ATLAS.ti 7.1.4 through applying the tools of critical interpretive synthesis and ground theory.
The study found that Ethiopia is in an early state of recognizing and intervening against health inequalities. The quality and level of knowledge is mixed and gets reduced as one goes far from the centre. Consensus is still growing on the major underlying causes of child health inequalities in Ethiopia. Most of the policy makers focus on down-stream factors than broader determinants of health. Wealth inequality is less discussed and intervened than geographical inequalities.
The production of a new Plan of Action can helped to resolve the challenges of lack of detailed approaches that can help reduce the gap in Ethiopia. However, the content of the health policy documents is not comprehensive and based on global lessons. Policy makers from the central government in Ethiopia tend to reject the use of redistribute justice intervention as policy options. There were multiple reasons including: fear of sustainability, ethics and effectiveness were used to reject these interventions. However, leaders from DRS and DPs broadly support the proper adaption of these interventions.
The recent surge of interest to address health inequalities is mainly led by small groups from the top leaders. The engagement of the middle level leaders, Developing Regional States (DRSs), civil society and development partners has been limited. The relation between different institutes is very important in the Ethiopian federal state to reduce inequality.
Without an improved level of awareness; change in attitude; broader engagement of citizens; use of independent data source and review of resource distribution Ethiopia’s progress towards Universal Health Coverage in 2030 could get delayed.
Finally, this research provided a list of recommend interventions that Ethiopia might take in its plan, to narrow down health inequalities among children by 2030. / Health Studies / D. Litt. et Phil. (Health Studies)
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Access to medicines in low- and middle-incomes countries: a health systems approach :conceptual framework and practical applications / Accès aux médicaments dans les pays à revenus faibles et moyens: une approche systémique :cadre conceptuel et applications pratiquesBigdeli, Maryam 14 July 2015 (has links)
Doctorat en Santé Publique / info:eu-repo/semantics/nonPublished
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Exploring the Role of Aid in the Malawian and Zambian Health Sectors : To what extent does development assistance contribute to aid dependency in Malawi and Zambia?Wandjowo, Rosie January 2020 (has links)
Aid is an important topic in development sector current discussions are polarised thereby creating a need for further research. This essay assesses the role that Malawi and Zambia plays in realising its development outcomes including in the area of health. There is a need to appreciate the variables that contribute to the inability of most countries in sub-Saharan Africa to finance their domestic expenditure related to healthcare. In this situation, foreign aid which has received marked interest by scholars over the past decade and is used to supplement incomes of developing countries like Malawi and Zambia. Debate on the effectiveness of aid is polarised, while highly concerned scholars see aid as ineffective and a contributor to the poor performance of economies in developing countries, others see it as essential in the achievement of development outcomes. This thesis explores the extent to which development assistance contributes to dependency in Malawi and Zambia. It further examines the link between aid and the Malawian and Zambian health sectors. The study similarly considers the role of development assistance for health in realising outcomes related to maternal health in line with SDG 3.1. By identifying two countries in sub-Saharan Africa, this essay underscores the similarities between Malawi and Zambia analysed through a historical context, health systems structures, child and maternal mortality rates and health programme models. The essay concludesthat social, political and economic barriers present challenges in financing healthcare in Malawi and Zambia. Aid contributes to dependency in the study countries.
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Between policy and reality: a study of a community based health insurance programme in Kwara State NigeriaLawal, Afeez Folorunsho 10 1900 (has links)
Bibliography: leaves 268-317 / The challenge of accessing affordable healthcare services in the developing countries prompted
the promotion of community-based health insurance (CBHI) as an effective alternative. CBHI
has been implemented in many countries of the South over the last three decades for the purpose
of improving access and attaining universal health coverage. However, the sudden stoppage of
a CBHI programme in rural Nigeria raised a lot of concerns about the suitability of the health
financing scheme. Thus, this thesis examines the stoppage of the CBHI programme in rural
Kwara, Nigeria. Premised on the health policy triangle as a conceptual framework, mixed methods approach was adopted for data collection. This involved 12 focus group discussions,
22 in-depth interviews, 32 key informant interviews and 1,583 questionaires. The study
participants were community members, community leaders, healthcare providers,
policymakers, international partner, health maintenance organisation officials and a researcher.
Findings revealed that transnational actors relied on various resources (e.g. fund and
‘expertise’) and formed alliances with local actors to drive the introduction of the programme.
As such, the design and implementation of the policy were dominated by international actors.
Despite the sustainability challenges faced by the programme, the study found that it benefitted
some of the enrolled community members. Though, even at the subsidised amount, enrolment
premium was still a challenge for many. The main reasons for the stoppage of the programme
are a paucity of fund and poor management. The stoppage of the programme, however,
signified a point of reversal in the relative achievements recorded by the CBHI scheme because
community members have deserted the healthcare facilities due to high costs of care. In view
of these, the thesis notes that short-term policies often lead to temporary outcomes and suggests
the need to repurpose the role of the state by introducing a long-term comprehensive healthcare
policy – based on the reality of the nation – to provide equitable healthcare services for the
citizenry irrespective of their capacity to pay. / Sociology / D. Phil. (Sociology)
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