Time to get our act together on UHC and health emergencies

UHC2030 will launch a discussion paper to consolidate our vision for resilient health systems, and priority actions for both emergency preparedness and UHC goals. With this, we aim to bring partners together around common messages on public health actions as ‘step zero’ of UHC, so health systems better support health security and UHC. This builds on the recent statement from UHC2030 co-chairs which called on world leaders to remember their UHC commitments as they respond to COVID-19.

Ilona Kickbusch, Chair of the International Advisory Board of the Global Health Centre, will moderate a panel discussion with senior leaders from WHO, World Bank, OECD and respondents from academia and civil society. This event proposes to stimulate discussion with stakeholders from across the UHC movement and beyond, immediately after the World Health Assembly, in order to leverage the momentum around the discussions among ministers of health.

The event is jointly organised by ...

Covid-19 and the Need for Health Care Reform

The Covid-19 pandemic has brought into sharp focus the need for health care reforms that promote universal access to affordable care. lthough all aspects of U.S. health care will face incredible challenges in the coming months, the patchwork way we govern and pay for health care is unraveling in this time of crisis, leaving millions of people vulnerable and requiring swift, coordinated political action to ensure access to affordable care.Our policies on health and health care, both during this pandemic and in the future, should reflect this reality, and we should not let the lessons of this crisis pass us by.

Celebrating the 4th anniversary of the approval of the WHO Framework on integrated and people-centred health services: progress and opportunities ahead

This month marks the fourth anniversary of the approval of the Framework on integrated people-centred health services (IPCHS) and its accompanying resolution WHA69.24 (2016) on “Strengthening integrated people-centred health services” by the World Health Assembly. In May 2016, Member States showed exceptional support to these global commitments and requested WHO to help them implement, adapt, and operationalize this Framework. However, this was not the first time WHO recognized the relevance of health services being managed and delivered so that people, who are active participants of health systems, receive a continuum of care according to their needs throughout the life course. Other previous WHO global and regional commitments, including “People-centred health care: a policy framework” produced by the Western Pacific Region in 2007, the “World health report 2008 on primary health care: now more than ever”, and resolution WHA62.12 (2009) on Primary health care, including health system strengthening, had ...

WHO Guideline: recommendations on digital interventions for health system strengthening

The key aim of this guideline is to present recommendations based on a critical evaluation of the evidence on emerging digital health interventions that are contributing to health system improvements, based on an assessment of the benefits, harms, acceptability, feasibility, resource use and equity considerations. For the purposes of this version of the guideline, the recommendations examine the extent to which digital health interventions, primarily available via mobile devices, are able to address health system challenges along the pathway to UHC. By reviewing the evidence of different digital interventions against comparative options, as well as assessing the risks, this guideline aims to equip health policy-makers and other stakeholders with recommendations and implementation considerations for making informed investments into digital health interventions.

Community perceptions of universal health coverage in eight districts of the Northern and Volta regions of Ghana

Ever since Ghana embraced the 1978 Alma-Ata Declaration, it has consigned priority to achieving ‘Health for All.’ The Community-based Health Planning and Services (CHPS) Initiative was established to close gaps in geographic access to services and health equity. CHPS is Ghana’s flagship Universal Health Coverage (UHC) Initiative and will soon completely cover the country with community-located services.

This paper aims to identify community perceptions of gaps in CHPS maternal and child health services that detract from its UHC goals and to elicit advice on how the contribution of CHPS to UHC can be improved.

Primary Health Care That Works: The Costa Rican Experience

Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica’s innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica’s experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented.

Building a Thriving Primary Health Care System: The story of Costa Rica

Situated in Central America, Costa Rica’s 4.9 million citizens have access to one of the most effective primary health care systems in the world. The country’s unique, team-based model of primary care service delivery successfully combines preventive and curative care to provide comprehensive primary health care to nearly all Costa Rican citizens. This case study examines the process by which Costa Rica developed its laudable primary health care system, fully describes the functioning of the system through both clinical and patient perspectives, and elucidates key lessons about primary health care delivery that can be learned from the Costa Rican experience.

High Quality Primary Health Care in Action: The Story of Costa Rica

Costa Rica’s primary health care system is supported by robust integrated care teams that provide comprehensive, coordinated, continuous, and person-centered care to empaneled populations. As a result, health outcomes in Costa Rica are consistently strong and improving.

Comprehensive Primary Health Care Reform in Costa Rica

In the past, Costa Rica was characterized by a duplicative and fragmented public primary healthcare system. In 1994, the country initiated a sweeping reform of the health system, including primary health care. Bureaucratic reorganization of the Ministry of Health (MOH) and the Social Security Agency (CCSS) led to the integration of all healthcare delivery under the CCSS, from public health activities to tertiary care. Comprehensive multidisciplinary primary healthcare teams (EBAIS)—comprised of a doctor, nurse assistant, community health worker, and data specialist—were created to care for approximately 5,000 patients each. A system of geographic empanelment was implemented to assign every Costa Rican to one of the newly-formed EBAIS teams. Finally, quality assurance mechanisms were initiated and promoted data collection and feedback central as a central function of the EBAIS teams. The first EBAIS team was established in 1995 and by 2002, there were 818 active teams throughout the ...

Consultation on the Handbook on Social Participation for UHC for civil society

UHC2030, WHO and the UHC Partnership have launched a consultation for civil society to provide substantial feedback on the contents of the Handbook on Social Participation for UHC. The ‘Handbook on Social Participation for UHC’ will provide specific best practice guidance to policymakers on how to effectively and meaningfully engage with populations, civil society and communities for policy- and decision-making.

The Handbook is in an advanced stage of development and your views would be useful to shape the final document. Currently, you can comment on the overview of five of the chapters through a survey until February 2020.

See more information about the handbook and an overview presentation.

Political struggles for a universal health system in Brazil: successes and limits in the reduction of inequalities

Brazil is a populous high/middle-income country, characterized by deep economic and social inequalities. Like most other Latin American nations, Brazil constructed a health system that included, on the one hand, public health programs and, on the other, social insurance healthcare for those working in the formal sector. This study analyzes the political struggles surrounding the implementation of a universal health system from the mid-1980s to the present, and their effects on selected health indicators, focusing on the relevant international and national contexts, political agendas, government orientations and actors.

Primary Health Care: The Engine to Universal Health Coverage

The Global Conference on Primary Health Care hosted in Astana, Kazakhstan, in October 2018, renewed the core principles included in Alma Ata Declaration in 1978, emphasizing the essential role of primary health care (PHC) around the world. The Declaration of Astana focused on primary health care to ensure that everyone everywhere is able to achieve a good standard of health.

On 23 September 2019, the United Nations General Assembly held a high-level meeting on universal health coverage.  This meeting, held under the theme “Universal Health Coverage: Moving Together to Build a Healthier World,” identifies primary health care as the route to universal health coverage (UHC).

UHC shouldn´t be a luxury that only high-income countries can afford. However, it needs some levers that must be strengthened everywhere. One of the most important ways to achieve UHC is to prioritize PHC as a crucial strategy in health systems. PHC is the ...

A qualitative appraisal of stakeholders’ perspectives of a community-based primary health care program in rural Ghana

The Ghana Community-based Health Planning and Services (CHPS) initiative is a national strategy for improving access to primary health care services for underserved communities. Following a successful trial in the North Eastern part of the country, CHPS was adopted as Ghana’s flagship programme for achieving the Universal Health Coverage. Recent empirical evidence suggests, however, that scale-up of CHPS has not necessarily replicated the successes of the pilot study. This study examines the community’s perspective of the performance of CHPS and how the scale up could potentially align with the original experimental study.

Integrated care for older people (ICOPE) implementation framework: guidance for systems and services

Alongside supporting community-level services, the Integrated Care for Older People (ICOPE) approach helps broader health and social care systems effectively respond to the diverse and complex needs of older people. The ICOPE Implementation Framework provides guidance for policy makers and programme managers to concretely assess and measure the capacity of services and systems to deliver integrated care at the community level.

The ICOPE Implementation Framework provides a score card to help assess the overall capacity of health and social care services and systems to deliver integrated care in community settings and support the development of ICOPE implementation action plans. There are 19 actions needed to implement ICOPE on the services level (meso) and systems level (macro). The scoring process provides an evidence-based means of highlighting areas for improvement as well as establishing concrete measures of future improvements.

Approval of political resolution on Universal Health Coverage in UN High-Level meeting

World leaders came together for the United Nations High Level Meeting (HLM) on Universal Health Coverage (UHC): Moving Together to Build a Healthier World, held at the UN General Assembly in New York, on Monday, 23 September 2019. This was the first time the UN had called for a HLM devoted to UHC and the encounter provided an unprecedented opportunity to mobilize the global community and secure political commitment from Heads of State and Government to accelerate progress toward achieving UHC by 2030. As a result UN Member States have adopted the most comprehensive set of health commitments ever adopted at this level, the political declaration on UHC. Among other key attributes, the declaration recognizes the need for health systems to be integrated and people-centred, with primary health care being the cornerstone of a sustainable health system for UHC and health-related SDGs.

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Access the political declaration here.

UN High-Level Meeting on universal health coverage

On 23 September 2019, the United Nations General Assembly will hold a high-level meeting on universal health coverage (UHC). This meeting, held under the theme Universal Health Coverage: Moving Together to Build a Healthier World, aims to accelerate progress towards UHC, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

The meeting will result in a political declaration on universal health coverage endorsed by Heads of State. Among other key attributes, the declaration recognizes the need for health systems to be integrated and people-centred, with primary health care being the cornerstone of a sustainable health system for UHC and health-related SDGs.

Strengthening national health research systems in the WHO African Region – progress towards universal health coverage

Health challenges and health systems set-ups differ, warranting contextualised healthcare interventions to move towards universal health coverage. As such, there is emphasis on generation of contextualized evidence to solve local challenges. However, weak research capacity and inadequate resources remain an impendiment to quality research in the African region. WHO African Region (WHO AFRO) facilitated the adoption of a regional strategy for strengthening national health research systems (NHRS) in 2015. This article assessed the progress in strengthening NHRS among the 47 member states of the WHO AFRO.

Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare services

The Alma-Ata Declaration of 1978 identified primary health care (PHC) as the key approach to the attainment of the goal of “Health for All”. The PHC approach tackles the main health problems in the community through the provision of essential health services. The implementation of the PHC approach relies on health workers, including community health workers (CHWs) Ethiopia has been implementing a community health extension program (HEP) since 2003. The aim of this studya was to assess the successes and challenges of the HEP over time, and develop a framework that may assist the implementation of the program toward universal primary healthcare services

Does rural health system reform aimed at improving access to primary health care affect hospitalization rates? An interrupted time series analysis of national policy reforms in Iran

Primary health care reforms are often proposed for their efficiency outcomes (i.e. reduction in costs and use of hospitals) as well as their impact on improving health outcomes. The aim of this study was to evaluate the effects of rural health insurance and family physician reforms on hospitalization rates in Iran and it demonstrated that in populations with unmet needs, such reforms are likely to substantially increase hospitalization rates. This is an important consideration for successful design and implementation of interventions aimed at achieving universal health coverage in low- and middle-income countries.

Future of Digital Health Systems in the European Region

The WHO Symposium on the Future of Digital Health Systems in the European Region will bring together evidence and experience to show how governments and organizations can adopt digital health to reduce inequalities and improve the health and well-being of populations.

The Symposium will help policy-makers prepare for the digitalization of health systems by sharing country experiences of:

• - How digital health and emerging innovations are being used to strengthen national health systems
• - Digital health activities currently underway
• - How digital technologies can empower individuals and health-care workers.

Towards universal health coverage and sustainable financing in Afghanistan: progress and challenges

Afghanistan has made impressive progress in introducing primary health care across the country over the last fifteen years. In the face of the diverse challenges ranging from persistent insecurity, conservative social norms, weak public financing, and reducing donor aid, Afghanistan is arguably among one of the most challenging contexts to achieve universal health coverage (UHC). Therefore, it is important to consider additional avenues towards UHC while building on the progress in coverage and financing of primary health care to date.
The right to health is considered a fundamental human right and UHC has gained prominence globally as a goal for countries in the Sustainable Development Goals (SDGs). UHC is defined by the World Health Organization (WHO) as: “access to key promotive, preventive, curative and rehabilitative health
interventions for all at an affordable cost, thereby achieving equity in access.

Universal health coverage necessitates a system approach: an analysis of Community-based Health Planning and Services (CHPS) initiative in Ghana

The 9th Global conference on health promotion (Shanghai 2016) reaffirmed the role of primary health care (PHC) in achieving the 2030 Sustainable Development Agenda. Gaining much international recognition, the community-based health planning and services (CHPS) initiative is considered one of the pragmatic strategy in delivering on the promise of universal health coverage (UHC) through the PHC strategy, in Ghana. Yet, certain key factors threaten its successes – renewing the relevance of this study to present the barriers to and facilitators of the initiative. According to their findings, CHPS contribution particularly in bridging geographical access to health cannot be demeaned. Nevertheless, the full functioning of the initiative is limited by factors centered on the following themes: health governance and leadership, provision of services of quality, financial risk protection strategies targeting public health, information and care continuity, and the right mix of trained health professionals of even distribution across communities. Addressing the challenges ...

Community health workers and accountability: reflections from an international “think-in”

Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a ‘think in’, held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger “accountability ecosystem.” While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs’ social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, this study put forward several propositions for further conceptual development ...

Equity in access to care in the era of health system reforms in Turkey

The aim of this study was to evaluate access to healthcare from an equity perspective on the way toward Universal Health Coverage in Turkey. In order to  The country representative data from 2006 to 2013 Turkey Income and Living Conditions Surveys were analyzed. Private household residents aged fifteen and older were asked for self-reported unmet need for medical care in the past twelve months. 

Health system innovations: adapting to rapid change

A fundamental challenge for health systems is the need to adapt to changes in the patterns of health service need, scientific and technological developments, and the economic and institutional contexts within which providers of health services are embedded. This is especially true of many low and middle-income countries, where the pace of multiple and interconnected changes is breath-taking. 

A Critical Analysis of Purchasing Arrangements in Kenya: The Case of the National Hospital Insurance Fund

Purchasing refers to the process by which pooled funds are paid to providers in order to deliver a set of health care interventions. Very little is known about purchasing arrangements in low-and middle- income countries, and certainly not in Kenya. This study aimed to critically analyse purchasing arrangements in Kenya, using the National Hospitals Insurance Fund as a case study. 

Challenges and achievements in integrated care: different health and social care providers working together. Successful projects that show that this is the way

The Catalan health system is a public healthcare system, funded by taxes, with universal coverage and public healthcare services portfolio. There´s a mixed healthcare providers network. Delivery of integrated health and social care witha a shift to a patient-centered model is one of the main challenges of our public system. this artcile share three experiences of different models developed to improve integration of social and healthcare services, to guarantee the continuum of care and to achieve quality health and social care outcomes. 

Lessons from Brazil: on the difficulties of building a universal health care system

A number of developing countries that are often referred to as emerging economies have turned their attention to addressing their public health issues in more comprehensive and systematic ways. While the trajectory of this particular initiative and similar ones elsewhere is yet to be determined, the aim of this piece is to draw some lessons from an emerging economy that, for contingent historical and political reasons, started building a universal public health care system earlier: Brazil. The key argument offered from the Brazilian experience is that building a robust public health care system based on the principles of universality and equity is a challenge of a political economy nature and one that ought to be met at multiple levels simultaneously. 

A systematic review of strategies to increase access to health services among children in low and middle income countries

Universal Health Coverage is widely endorsed as the pivotal goal in global health, however substantial barriers to accessing health services for children in low and middle-income countries exist. Failure to access healthcare is an important contributor to child mortality in these settings. Demand side interventions included: educational programmes, text messages, and financial or other incentives. Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes.

There are some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home.

Strengthening universal health coverage through role delineation in the Solomon Islands

To achieve effective coverage of services, Role Delineation Policy (RDP) was developed following extensive consultation. The RDP defines service delivery packages for six levels of health facilities: rural health centres, area and urban health centres, general hospitals and the national referral hospital; successful advocacy led to inclusion of Universal Health Coverage in the National Development Plan, and to Role Delineation being the central unifying feature of the National Health Strategic Plan, 2016-2020, based on initial implementation experiences, the RDP was revised and will be sequentially will be implemented in rural provinces commencing in 2017.

Defining and standardizing primary care in Georgia

Government reforms aiming to establish universal health care, increase state involvement in the health system and strengthen regulation have been introduced; articulating a clear government vision ensured a strong foundation on which to build reforms; learning from previous experiences and seeking expertise from international partners helped the initiative avoid potential difficulties; inclusion of stakeholders in the design process helped build local consensus for change; following the strategy development process, detailed plans were drawn up to guide proposed reforms.

No universal health coverage without primary health care

Correspondance

Universal health coverage is currently the aspiration of many countries worldwide. We commend Michael Reich and colleagues for analysing lessons learned from different country experiences, but we believe there is a crucial element neglected within the ongoing universal health coverage debate.

Health-care system development requires more than financing and human resource considerations. Although essential, these components must be integrated into an overall framework for organising and delivering care that best meets population needs. Primary health care provides such a framework, builds the backbone of an effective health-care system, and can improve health, reduce growth in costs, and lower inequality^. Strong orientation towards primary health care and its core principles (often outlined as first contact, continuous, comprehensive, and coordinated care) is shown to be stable over time and was often incorporated in the early days of many health-care systems that have a strong primary health-care orientation today. This observed stability ...

Director-General’s Opening address to the 69th World Health Assembly

Dr. Margaret Chan’s opening address for the 69th World Health Assembly holding from the 23rd to the 28th of May 2016, in Geneva, called for celebration of the stunning health achievements to date, but warned that health challenges have grown far more numerous and complex.

The speech spanned across the various areas of focus of the WHO. As such, the global strategy on people-centred and integrated health services also featured:

“[…] Innovations help, but ambitious goals are feasible and affordable only if we cut out waste and inefficiency.

We do so through integrated, people-centred care that spans the life course, from pre-conception through ageing, and brings prevention to the fore. The target for universal health coverage moves us in that direction.

UHC is the target that underpins all others. It is the ultimate expression of fairness that leaves no one behind. It also has the best chance of meetings people ...

State humanitarian verticalism versus universal health coverage: a century of French international health assistance revisited

The French contribution to global public health over the past two centuries has been marked by a fundamental tension between two approaches: State-provided universal free health care and what we propose to call State humanitarian verticalism. Both approaches have historical roots in French colonialism and have led to successes and failures that continue until the present day. In this paper, the second in The Lancet's Series on France, we look at how this tension has evolved. During the French colonial period (1890s to 1950s), the Indigenous Medical Assistance structure was supposed to bring metropolitan France's model of universal and free public health care to the colonies, and French State imperial humanitarianism crystallised in vertical programmes inspired by Louis Pasteur, while vying with early private humanitarian activism in health represented by Albert Schweitzer. From decolonisation to the end of the Cold War (1960-99), French assistance to newly independent states ...

Multi-country purchasing study

The international research consortium RESYST (Resilient & responsive Health Systems) has examined healthcare purchasing functions in some low and middle-income countries to identify factors that influence the ability of healthcare purchasers and other key actors to take strategic actions. The countries included in the study are: Kenya, India, Nigeria, South Africa, Tanzania, Thailand and Vietnam.

From a universal health coverage perspective, this research project focus on purchasing of services from healthcare providers. This core function of healthcare financing must be designed and undertaken strategically to promote quality, efficiency, equity and responsiveness in health service provision and, in doing so, purchasing facilitate progress towards universal health coverage.

The research examined the relationships between purchasers and other groups of actors involved in purchasing mechanisms, including the government, healthcare providers and citizens, so as to understand the various components of strategic purchasing and the organizational environment within which it operates.

The study makes some ...

Can service integration work for universal health coverage? Evidence from around the globe

Universal health coverage (UHC) is at the heart of the new 2030 Agenda for SustainableDevelopment. Health service integration is seen by World Health Organization as an essen-tial requirement to achieve UHC. However, to date the debate on service integration hasfocused on perceived benefits rather than empirical impact. We conducted a global reviewin a systematic manner searching for empirical outcomes of service integration experimentsin UHC countries and those on the path to UHC. Sixty-seven articles and reports were found.We grouped results into a unique integration typology with six categories – medical stafffrom different disciplines; patients and medical staff; care package for one medical condi-tion; care package for two or more medical conditions; specialist stand-alone services withGP services; community locations. We showed that it is possible to integrate services indifferent human development contexts delivering positive outcomes for patients and clin-icians without incurring additional costs. However, the improved outcomes shown wereincremental rather than ...

Global Learning Laboratory for Quality Universal Health Coverage

Welcome to the Community of Practice for the WHO Global Learning Laboratory (GLL) for Quality Universal Health Coverage (UHC). The GLL is deeply rooted in the five interwoven strategies of the Integrated People Centred Health Services Framework—engaging and empowering people and communities; strengthening governance and accountability; reorienting health services; strengthening coordination of care and creating an enabling environment. The GLL recognizes the key role of people-centred health services in order to achieve the Sustainable Development Goals (SDGs) and UHC.

The GLL highlights the need to focus care on the needs and preferences of people. To this end, the GLL aims to create a safe space to share lessons, experiences and ideas; challenge those ideas and spark innovation on quality within the content of UHC. The GLL is organized around three areas. First, national quality policy and strategy (NQPS) in order to drive quality across all levels of the health ...

IHF 40th World Hospital Congress

The IHF 40th World Hospital Congress will be held 31 October – 3 November 2016 in Durban, South Africa with the theme: Addressing the Challenge of Patient-centered Care and Safety.

The World Hospital Congress of the International Hospital Federation (IHF) is a unique global forum that brings together key drivers of national and international policy, management, financial trends and solutions in healthcare management and service delivery. Through this forum multidisciplinary exchange of knowledge, expertise and experiences are facilitated, together with dialogue on best practices in leadership in hospital and healthcare management and delivery of services.

For further information please click here: IHF 40th World Hospital Congress

Universal Health Coverage’s evolving location in the post-2015 development agenda: Key informant perspectives within multilateral and related agencies during the first phase of post-2015 negotiations

In 2001, technocrats from four multilateral organizations selected the Millennium Development Goals mainly from the previous decade of United Nations (UN) summits and conferences. Few accounts are available of that significant yet cloistered synthesis process: none contemporaneous. In contrast, this study examines health’s evolving location in the first-phase of the next iteration of global development goal negotiation for the post-2015 era, through the synchronous perspectives of representatives of key multilateral and related organizations. As part of the Go4Health Project, in-depth interviews were conducted in mid-2013 with 57 professionals working on health and the post-2015 agenda within multilaterals and related agencies. Using discourse analysis, this article reports the results and analysis of a Universal Health Coverage (UHC) theme: contextualizing UHC’s positioning within the post-2015 agenda-setting process immediately after the Global Thematic Consultation on Health and High-Level Panel of Eminent Persons on the Post-2015 Development Agenda (High-Level Panel) released their ...

Achieving Effective Universal Health Coverage And Diagonal Approaches To Care For Chronic Illnesses

Health systems in low- and middle-income countries were designed to provide episodic care for acute conditions. However, the burden of disease has shifted to be overwhelmingly dominated by chronic conditions and illnesses that require health systems to function in an integrated manner across a spectrum of disease stages from prevention to palliation. Low- and middle-income countries are also aiming to ensure health care access for all through universal health coverage. This article proposes a framework of effective universal health coverage intended to meet the challenge of chronic illnesses. It outlines strategies to strengthen health systems through a “diagonal approach.” We argue that the core challenge to health systems is chronicity of illness that requires ongoing and long-term health care. The example of breast cancer within the broader context of health system reform in Mexico is presented to illustrate effective universal health coverage along the chronic disease continuum and across health ...

Health-system reform and universal health coverage in Latin America

Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens—with defined and enlarged benefits packages—and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and ...

Going Universal: How 24 countries are implementing universal health coverage reforms from the bottom up

This World Bank Group book is an overview of how 24 developing countries have embarked on the long journey to Universal Health Coverage (UHC). This Universal Health Coverage Study Series (UNICO) offers knowledge and operational tools to help countries tackle UHC in ways that are fiscally sustainable and that enhance equity and efficiency, by providing examples and lessons learnt from the UNICO countries (individual case studies may be accessed at http://www.worldbank.org/en/topic/health/publication/universal-health-coverage-study-series). In these countries, which together represent one third of the world’s population, efforts to achieve UHC have mainly focused on fiscal expansion, accountability, and community health workers. The study finds that most of these countries, except for success stories such as Costa Rica and Thailand, are still struggling with establishing functional integrated care networks. However, the report recommends that developing countries should continue to empower their primary sector as gatekeepers ...

World health report 2013: research for universal health coverage.

Overview Universal health coverage ensures everyone has access to the health services they need without suffering financial hardship as a result. In December 2012, a UN resolution was passed encouraging governments to move towards providing universal access to affordable and quality health care services. As countries move towards it, common challenges are emerging -- challenges to which research can help provide answers. The World health report: research for universal health coverage focuses on the importance of research in advancing progress towards universal health coverage. In addition, it identifies the benefits of increased investment in health research by low- and middle-income countries using case studies from around the world, and proposes ways to further strengthen this type of research.