Methodological issues on ‘challenges and opportunities towards the road of universal health coverage (UHC) in Nepal: a systematic review’

Ranabhat, Chhabi Lal; Acharya, Devaraj

doi:10.1186/s13690-020-00418-x

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…is finding was also revealed by other studies [22,[36][37][38]. is might be due to the accessibility of public health centers in rural areas and the good quality of services at private health facilities.…”

Section: Discussionsupporting

confidence: 72%

Community-Based Health Insurance Utilization and Its Associated Factors among Rural Households in Akaki District, Oromia, Ethiopia, 2021

Geferso

Sharo

2022

Advances in Public Health

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Background. Community-based health insurance is widely recognized as the most effective way to achieve universal health coverage (UHC) with adequate financial protection against healthcare costs, to promote equal access to high-quality healthcare, increase financial security, and enhance social cohesion and solidarity. Objective. The objective of this study was to determine community-based health insurance utilization and its associated factors among rural households in Akaki District, Oromia special zone surrounding Finfinnee, Oromia, Ethiopia, in May 2021. Methods and Materials. A community based cross-sectional study was conducted on 600 households in May 2021. A multistage sampling technique was used to select households. Data were collected using pretested and standardized questionnaires entered into Epi Info version 7.2.4 and analyzed using SPSS version 26. Bivariate and multivariate logistic regressions were computed to identify the factors associated with community-based health insurance utilization. A P value <0.05 with 95% CI was used as a cut-off point to declare the level of statistical significance. Results. The magnitude of community-based health insurance (CBHI) utilization was 398 (66.3%) (95% CI: 0.63, 0.70). In the multivariate logistic regression analysis, the odds of CBHI utilization for males were 2 times higher (AOR = 1.629; 95% CI: 1.063, 2.497) compared to female-headed households; household family size <5 was 3 times higher (AOR = 2.99; 95% CI: 1.987, 4.139) compared to household family size >5; farmer was 4 times higher (AOR = 3.763; 95% CI: 1.371, 10.327) compared to other occupational status; household income <30,000 ETB was 2 times higher (AOR = 2.474; 95% CI: 1.514, 4.043) compared to the household income of 30000 ETB, and all these were factors significantly associated with CBHI utilization. Conclusion. The magnitude of CBHI utilization was low (66.3%) compared to the HSTP II target (80%) and other studies. The results of the study showed that age, sex, household family size, household income, and trustworthiness were among the factors significantly associated with community-based health insurance utilization.

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Section: Discussionsupporting

confidence: 72%

Community-Based Health Insurance Utilization and Its Associated Factors among Rural Households in Akaki District, Oromia, Ethiopia, 2021

Geferso

Sharo

2022

Advances in Public Health

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“…Nonetheless, these studies have not explored the factors that might contribute to enrollment from purchaser side. Usually, these studies are lacking a balance in both demand and supply, poor in policy and program review [36] and have drawn one sided conclusion. None of the studies clearly investigated the characteristics of dropout, multiple factors associated with enrollment and drop-out in wide array and how the program would be successful.…”

Section: Theoretical Groundingsmentioning

confidence: 99%

Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study

Ranabhat

Subedi²,

Karn³

2020

Cost Eff Resour Alloc

Self Cite

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Background Compared to other countries in the South Asia Nepal has seen a slow progress in the coverage of health insurance. Despite of a long history of the introduction of health insurance (HI) and a high priority of the government of Nepal it has not been able to push rapidly its social health insurance to its majority of the population. There are many challenges while to achieve universal health insurance in Nepal ranging from existing policy paralysis to program operation. This study aims to identify the enrollment and dropout rates of health insurance and its determinants in selected districts of Nepal. Methods The study was conducted while using a mixed method including both quantitative and qualitative approaches. Numerical data related to enrollment and dropout rates were taken from Health Insurance Board (HIB) of Nepal. For the qualitative data, three districts, Bardiya, Chitwan, and Gorkha of Nepal were selected purposively. Enrollment assistants (EA) of social health insurance program were taken as the participants of study. Focus group discussions (FGD) were arranged with the selected EAs using specific guidelines along with unstructured questions. The results from numerical data and focus group discussions are synthesized and presented accordingly. Results The findings of the study suggested variation in enrollment and dropout of health insurance in the districts. Enrollment coverage was 13,545 (1%), 249,104 (5%), 1,159,477 (9%) and 1,676,505 (11%) from 2016 to 2019 among total population and dropout rates were 9121(67%), 110,885 (44%) and 444,967 (38%) among total enrollment from 2016 to 2018 respectively. Of total coverage, more than one-third proportion was subsidy enrollment—free enrollment for vulnerable groups. The population characteristics of unwilling and dropout in social health insurance came from relatively well-off families, government employees, businessman, migrants’ people, some local political leaders as well as the poor class families. The major determinants of poor enrollment and dropout were mainly due to unavailability of enough drugs, unfriendly behavior of health workers, and indifferent behavior of the care personnel to the insured patients in health care facilities and prefer to take health service in private clinic for their own benefits. The long maturation time to activate health service, limited health package and lack of copayment in different types of health care were the factors related to inefficient program and policy implementation. Conclusion There is a high proportion of dropout and subsidy enrollment, the key challenge for sustainability of health insurance program in Nepal. Revisiting of existing HI policy on health care packages, more choices on copayment, capacity building of enrollment assistants and better coordination between health insurance board and health care facilities can increase the enrollment and minimize the dropout.

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“…Previous reviews were conducted in Africa [ 37 ] and low- and middle-income countries (LMICs) outside Africa around UHC [ 2 , 52 , 53 ]. These previously conducted investigations focused on health financing and suggested that financial constraints are a significant limitation to accessing quality healthcare services in LMICs.…”

Section: Discussionmentioning

confidence: 99%

Strengthening the Health System as a Strategy to Achieving a Universal Health Coverage in Underprivileged Communities in Africa: A Scoping Review

Jaca

Malinga

Iwu

et al. 2022

IJERPH

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Universal health coverage (UHC) is defined as people having access to quality healthcare services (e.g., treatment, rehabilitation, and palliative care) they need, irrespective of their financial status. Access to quality healthcare services continues to be a challenge for many people in low- and middle-income countries (LMICs). The aim of this study was to conduct a scoping review to map out the health system strengthening strategies that can be used to attain universal health coverage in Africa. We conducted a scoping review and qualitatively synthesized existing evidence from studies carried out in Africa. We included studies that reported interventions to strengthen the health system, e.g., financial support, increasing work force, improving leadership capacity in health facilities, and developing and upgrading infrastructure of primary healthcare facilities. Outcome measures included health facility infrastructures, access to medicines, and sources of financial support. A total of 34 studies conducted met our inclusion criteria. Health financing and developing health infrastructure were the most reported interventions toward achieving UHC. Our results suggest that strengthening the health system, namely, through health financing, developing, and improving the health infrastructure, can play an important role in reaching UHC in the African context.

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Methodological issues on ‘challenges and opportunities towards the road of universal health coverage (UHC) in Nepal: a systematic review’

Cited by 5 publications

References 19 publications

Community-Based Health Insurance Utilization and Its Associated Factors among Rural Households in Akaki District, Oromia, Ethiopia, 2021

Community-Based Health Insurance Utilization and Its Associated Factors among Rural Households in Akaki District, Oromia, Ethiopia, 2021

Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study

Strengthening the Health System as a Strategy to Achieving a Universal Health Coverage in Underprivileged Communities in Africa: A Scoping Review

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