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Universal Health Coverage (UHC) as a health policy goal is gaining added currency in the policy agendas of many Low and Middle‐Income Countries (LMIC) following the onslaught of the coronavirus (COVID‐19) pandemic. The goal of UHC is to ensure that every citizen has access to quality healthcare services that they need without suffering financial hardship. Whereas most industrialised countries have achieved UHC through the implementation of various traditional health financing mechanisms, most LMIC have not made significant progress in providing financial protection against the costs of illness for majority of the population due to limited fiscal space and or lack of political commitment to raise government revenues and increase fiscal space for health. While the onslaught of COVID‐19 refreshes the call for reform of countries' health financing policies to reflect the healthcare needs of the population, the debate about the type or combination of health financing models to employ in LMIC has yet to reach a consensus. This review critically analyses five health financing models to ascertain their appropriateness in providing financial risk protection against the cost of illness, especially in this era of COVID‐19. Given the limited fiscal space for health in LMICs, we argue that one viable pathway towards achieving UHC is the adoption of an adaptive mix of diverse pooling mechanisms. Moreover, because the creation of fiscal space is context‐specific, and UHC is a political issue rather than technical, securing strong political support is necessary for improving the governance and institutional frameworks for health and ensuring sustained economic growth to respond to the fiscal demands of health systems.

Aim: Following growing concern about healthcare quality in many developing countries, this article analyses the relationship between facilitative supervision (FS) and the quality of primary healthcare (PHC) services in north-western Ghana. Background: While adherence to the tenets of FS aims to trigger improvement in the quality of PHC services, research has seldom explored this relationship to facilitate effective planning and implementation of PHC services, particularly in deprived areas. Methodology: Based on the implementation of FS in primary health facilities in a district and a municipality in north-western Ghana, a multi-case study approach was employed to collect and analyse the data. Specifically, 52 semi-structured interviews were conducted in the two study settings and the data were analysed using a thematic framework. Observation and secondary analysis were also employed to generate data to triangulate and supplement the interview data. Findings: The results reveal that health facilities in the Wa West district are relatively under-resourced, and this impedes the regularity of supervisory visits compared to the Wa Municipality. This notwithstanding, adherence to the prescriptions of FS is rated by the study participants as moderately satisfactory in both districts, culminating in improvement in the quality of PHC. This finding has implications for innovation in the mobilisation of health resources to increase the regularity of facilitation supervision in deprived settings. We advocate further research to establish whether the marginal improvement in the quality of PHC achieved in the two districts has resulted in an increase in uptake of PHC services to improve the health of the population or not.

Aim: This article draws on the poverty and access to health care framework to explore the barriers to access and utilization of primary health care among aged indigents under the Livelihood Empowerment Against Poverty Programme (LEAP) in Ghana. Background: Although many developing countries have made progress in extending primary health care to their populations following the Alma-Ata Declaration of 1978, the establishment of the Millennium Development Goals, and the Sustainable Development Goals (SDGs), barriers remain pervasive, particularly among vulnerable population groups. Previous studies have hardly paid in-depth attention to this important indicator for measuring progress toward achieving SDG 3. Methodology: To this end, we conducted a case study of access to health care services and utilization among aged indigents enrolled on the LEAP programme in the Daffiama Bussie Issa District of the Upper West. We collected and analyzed qualitative data from indigents aged 65 years and above, health care providers, and staff of the LEAP and the National Health Insurance Scheme (NHIS). Findings: Our analysis found geographic inaccessibility of health care, high costs of drugs and related services, exclusion of essential services from NHIS benefits package, and irregular transfer of cash to negatively influence access and utilization of health care among aged LEAP beneficiaries in the district. In addition to the need to strengthen the economy, provide health infrastructure and human resources for health in rural areas, the government needs to review the beneficiaries’ bimonthly stipends to reflect the daily minimum wage, eliminate the delay in payments, and review the benefits package of the NHIS to include essential services and medical devices commonly used by aged people. Yet implementing these recommendations has affordability implications that require innovation to mobilize additional resources and create the desired fiscal space and institutions that can sustainably implement universal coverage programmes such as the LEAP.

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