Achieving universal health coverage for people with stroke in South Africa: protocol for a scoping review

Niekerk, S.M. Van; Inglis-Jassiem, Gakeemah; Kamalakannan, Sureshkumar; Fernandes, Silke; Webster, Jayne; English, René; Smythe, Tracey; Louw, Quinette

doi:10.1136/bmjopen-2020-041221

Cited by 5 publications

(3 citation statements)

References 38 publications

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“…While recent figures indicate that only 32% of the Tanzanian population have health insurance coverage, 9 our data illustrate the urgent need for advocating access to universal health insurance coverage which will facilitate provision of essential services to all stroke patients that will ultimately reduce morbidity and mortality. 29 Similarly, based on these findings, we are developing systems for documentation of all key elements of the World Stroke Organization Roadmap to serve as a foundation for quality improvement.…”

Section: Discussionmentioning

confidence: 99%

Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry

Matuja,

Ngimbwa,

Andrew

et al. 2023

International Journal of Stroke

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Background: Stroke is a second leading cause of death globally, with an estimated one in four adults suffering a stroke in their lifetime. We aimed to describe the clinical characteristics, quality of care, and outcomes in adults with stroke in urban Northwestern Tanzania. Methods: We analyzed de-identified data from a prospective stroke registry from Bugando Medical Centre in Mwanza, the second largest city in Tanzania, between March 2020 and October 2022. This registry included all adults ⩾18 years admitted to our hospital who met the World Health Organization clinical definition of stroke. Information collected included demographics, risk factors, stroke severity using the National Institutes of Health Stroke Scale, brain imaging, indicators for quality of care, discharge modified Rankin Scale, and in-hospital mortality. We examined independent factors associated with mortality using logistic regression. Results: The cohort included 566 adults, of which 52% (294) were female with a mean age of 65 ± 15 years. The majority had a first-ever stroke 88% (498). Premorbid hypertension was present in 86% (488) but only 41% (200) were taking antihypertensive medications before hospital admission; 6% (32) had HIV infection. Ischemic strokes accounted for 66% (371) but only 6% (22) arriving within 4.5 h of symptom onset. In-hospital mortality was 29% (127). Independent factors associated with mortality were severe stroke (adjusted odds ratio (aOR) = 1.81, 95% confidence interval (CI) = 1.47–2.24, p < 0.001), moderate to severe stroke (aOR = 1.49, 95% CI = 1.22–1.84, p < 0.001), moderate stroke (aOR = 1.80, 95% CI = 1.52–2.14, p < 0.001), leukocytosis (aOR = 1.19, 95% CI = 1.03–1.38, p = 0.022), lack of health insurance coverage (aOR = 1.15, 95% CI = 1.02–1.29, p = 0.025), and not receiving any form of venous thromboembolism prophylaxis (aOR = 1.18, 95% CI = 1.02–1.37, p = 0.027). Conclusion: We report a stroke cohort with poor in-hospital outcomes in urban Northwestern Tanzania. Early diagnosis and treatment of hypertension could prevent stroke in this region. More work is needed to raise awareness about stroke symptoms and to ensure that people with stroke receive guidelines-directed therapy.

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Section: Discussionmentioning

confidence: 99%

Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry

Matuja,

Ngimbwa,

Andrew

et al. 2023

International Journal of Stroke

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“…Achieving universal health coverage (UHC) is a priority global goal in almost every country worldwide, as it provides expanded access to quality health services for the general population through primary health care (Kapologwe et al, 2020;Van Niekerk et al, 2020). The provision of quality health services in all programs requires the existence of efficient health care supply chains to ensure the sustainable availability of essential health commodities at all points of care in each country (Clauson et al, 2018;Dubois et al, 2017).…”

Section: Eissn: 2707-0425mentioning

confidence: 99%

effect of IMPACT team approach implementation processes on health supply chain management data use in Singida region: A quantitative study

Silabi¹,

Sukums

Paulo

2023

EAJSTI

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The Government of Tanzania (GoT), in collaboration with development partners, has made significant improvements in the health supply chain since 2013 through developing of an electronic Logistics Management Information System (e-LMIS) and strengthening of the Logistics Management Services (LMS) component. Nevertheless, the use of reported data in the e-LMIS remained very low. In efforts to respond to low data use at all supply chain levels, the GoT introduced the Information Mobilized for Performance Analysis and Continuous Transformation (IMPACT) approach to reinforce data use culture for decision-making to improve the supply chain. Therefore, this study aimed to determine the effect of IMPACT team approach implementation processes on health supply chain data use in Singida region. This was a pre- and post-cross-section study whereby the quantitative data were obtained from e-LMIS stock imbalance reports. This data was processed using Microsoft Excel power query and analysed using Microsoft Excel 2019 pivot tables to get indicator results on availability, not-in-demand and overstocked health commodities. The overall pre (2018) and post (2020) intervention results for both Iramba district council (DC) and Singida municipal council (MC) were 66% and 81% for the availability of essential health commodities, 17.2% and 21% for not-in-demand health commodities and 17% and 20.7% for overstocked health commodities respectively. Iramba DC demonstrated a significant statistical increase in both indicators compared to Singida MC, as the P-value was less than 0.05 at a 95% confidence level (df=35). Conclusively, the IMPACT team approach positively influenced data use and availability of health commodities. However, it was not the case for overstocked and not-in-demand indicator results. Apart from the possible low quality of logistics data, further studies should explore other contributing factors behind the increasing trends of overstocks and not-in-demand health commodities in the region.

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“…To address this gap, there has been an increasing number of research publications. These include exploration of mapping the available literature on UHC (12), identification of best practices towards realizing UHC (19), measurement and attainment of UHC for older people (20) and people with stroke (21), and analysis of UHC’s influence on health policy (4). This raises variations in its understanding and implementation.…”

Section: Introductionmentioning

confidence: 99%

Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

Endalamaw,

Mengistu,

Khatri

et al. 2024

Preprint

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Background: Universal health coverage (UHC) is a critical target in many health system strategies to achieve the ‘good health and wellbeing’. Evidence on the meaning and scope of UHC and the strategies required to achieve it are needed, as variations in its understanding and implementation have risen. We synthesised evidence on the meaning, components, significance, and strategies of UHC. Methods: A review of evidence was conducted based on realist synthesis. We searched PubMed, EMBASE, Scopus, and Web of Science for published materials and websites for grey literature. We have followed some steps: define the scope of the review and develop initial programme theory, search for evidence, data extraction, and synthesis of evidence. Results: Universal coverage, universal health, universal healthcare, universal access, and insurance coverage are used interchangeably with UHC. It is a legal notion that embodies a human rights-based and collaborative approach to ensure fair and comprehensive health care services. Universal health coverage is relevant for three macro reasons: first, it prevents and reduces the impact of diseases; second, it addresses inequality and promotes equity; and third, it is key for global health security. Various mechanisms involved to implement UHC, such as health insurance, social health protection, digital financing systems, value-based care, private sectors, civil societies, partnership, primary health care, and reciprocal health care systems. Conclusions: Universal health coverage is a multifaceted concept that can be expressed by various terms in different contexts. Universal health coverage is a political and ethical imperative that aims to promote health equity and protect human dignity across different levels of society. It is essential in preventing diseases and serving a crucial role in global health security. Practically, UHC is not truly universal, as it does not include all services under its scheme and varies across countries. This requires consistent advocacy, strategic and operational research as well as political will to ensure UHC.

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Achieving universal health coverage for people with stroke in South Africa: protocol for a scoping review

Cited by 5 publications

References 38 publications

Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry

Stroke characteristics and outcomes in urban Tanzania: Data from the Prospective Lake Zone Stroke Registry

effect of IMPACT team approach implementation processes on health supply chain management data use in Singida region: A quantitative study

Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

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