Universal health coverage: the roof has been leaking for far too long

Ridde, Valéry; Hane, Fatoumata

doi:10.1136/bmjgh-2021-008152

Cited by 6 publications

(5 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Despite the fact that quality of care is vital to the success of UHC initiatives, governments have paid little attention to it, which Ridde and Hane (2021) described it as a “known but often ignored challenge” [ 60 ]. Quality of care will continue to be a major bottleneck to the scheme’s sustainability unless the government devotes significant resources to health system strengthening, particularly human resource development and pharmaceutical supply, in order to meet the rising health care demand.…”

Section: Discussionmentioning

confidence: 99%

A mixed methods study of community-based health insurance enrollment trends and underlying challenges in two districts of northeast Ethiopia: A proxy for its sustainability

2022

View full text Add to dashboard Cite

Background The term "community-based health insurance" refers to a broad range of nonprofit, prepaid health financing models designed to meet the health financing needs of disadvantaged populations, particularly those in the rural and informal sectors. Due to their voluntary nature, such initiatives suffer from persistently low coverage in low- and middle-income countries. In Ethiopia, the schemes’ membership growth has not been well investigated so far. This study sought to examine the scheme’s enrollment trend over a five-year period, and to explore the various challenges that underpin membership growth from the perspectives of various key stakeholders. Methods The study employed a mixed methods case study in two purposively selected districts of northeast Ethiopia: Tehulederie and Kallu. By reviewing the databases of health insurance schemes, quantitative data were collected retrospectively from 2017 to 2021 to examine enrollment trends. Trends for each performance indicator were analyzed descriptively for the period under study. Face-to-face interviews were conducted with nine community members and 19 key informants. Study participants were purposely selected using the maximum variation technique. Interviews were audio recorded, transcribed verbatim, and translated into English. Thematic analysis was employed with both deductive and inductive coding approaches. Results Over the course of the study period, enrollment in the scheme at both districts exhibited non-linear trends with both positive and negative growth rates being identified. Overall, the scheme in Tehulederie has a relatively higher population coverage and better membership retention, which could be due to the strong foundation laid by a rigorous public awareness campaign and technical support during the pilot phase. The challenges contributing to the observed level of performance have been summarized under four main themes that include quality of health care, claims reimbursement for insurance holders, governance practices, and community awareness and acceptability. Conclusions The scheme experienced negative growth ratios in both districts, indicating that it is not functionally viable. It will fail to meet its mission unless relevant stakeholders at all levels of government demonstrate political will and commitment to its implementation, as well as advocate for the community. Interventions should target on the highlighted challenges in order to boost membership growth and ensure the scheme’s viability.

show abstract

Section: Discussionmentioning

confidence: 99%

A mixed methods study of community-based health insurance enrollment trends and underlying challenges in two districts of northeast Ethiopia: A proxy for its sustainability

2022

View full text Add to dashboard Cite

show abstract

“…In India, insured households claimed that hospitals turned them down for unknown reasons when they sought medical treatment (53). Despite the fact that quality of care is vital to the success of UHC initiatives, governments have paid little attention to it, which Ridde and Hane described as a "known but often ignored challenge" (54). Quality of care will continue to be a major bottleneck to the scheme's sustainability unless the government devotes significant resources to health system strengthening, particularly human resource development and pharmaceutical supply, in order to meet the rising health care demand.…”

Section: Discussionmentioning

confidence: 99%

A mixed methods study of community-based health insurance enrollment trends and underlying challenges in two districts of northeast Ethiopia: a proxy for its sustainability

Hussien

Azage

Bayou

2022

Preprint

View full text Add to dashboard Cite

Background Community-based health insurance initiatives in low- and middle-income countries are plagued by persistently low coverage due to their voluntary orientation. In Ethiopia, the schemes’ membership growth has not been well investigated so far. This study sought to examine the scheme's enrollment trend over a five-year period, and to explore the various challenges that underpin membership growth from the perspectives of various key stakeholders. Methods The study employed a mixed methods case study in two districts of northeast Ethiopia: Tehulederie and Kallu. Quantitative data was collected by reviewing the databases of schemes. Key informant interviews and in-depth interviews were conducted face-to-face with 19 key stakeholders and nine community members, respectively. Study participants were purposely selected using the maximum variation technique. Interviews were audio recorded, transcribed verbatim, and translated into English. Thematic analysis was employed with both deductive and inductive coding approaches. Results Enrollment in the two districts has shown an inconsistent trend over the study period (2017 to 2021). The scheme in Tehulederie has a relatively better enrollment trend, particularly in terms of membership retention, which could be due to the strong foundation laid by a rigorous public awareness campaign and technical support during the pilot phase. The challenges contributing to the observed level of performance have been summarized under four main themes that include quality of health care, claims reimbursement for insurance holders, governance practices, and community awareness and acceptability. Conclusions The scheme experienced negative growth ratios in both districts with inconsistent trends, showing that the scheme is not functionally viable. It will regress unless relevant stakeholders at all levels of government demonstrate political will and commitment to its implementation, as well as advocate for the community. Interventions should target on the highlighted challenges in order to boost membership growth and ensure the viability of the community-based health insurance.

show abstract

“…It is the combination of climate-induced changes with non-climate-induced changes that impact livelihoods, and we might even say it imprints, directly and indirectly, the lives, flesh, and souls of people through livelihoods, health and well-being on many generations to come through societal and political choices. Political and societal choices are specifically in question because there is no climate justice without social justice, and inequities need to be addressed to leave nobody behind [4,12,60,78].…”

Section: Plos Climatementioning

confidence: 99%

Local social-ecological context explains seasonal rural-rural migration of the poorest in south-west Bangladesh

Clech,

Sierra,

Mannan

et al. 2024

PLOS Clim

View full text Add to dashboard Cite

Bangladesh is one of the countries most affected by climate change. Internal migration is often presented as a response to environmental degradation. Here, using a people-centred perspective, we explore the complexity of the links between climate-induced change, environmental degradation caused by waterlogging and seasonal rural migration. We used an inductive qualitative approach in social sciences, conducting fourteen semi-directed interviews and six focus group discussions in March-April 2022. We related those results to a rainfall analysis on CHIRPS data for 1981-2021and we represented interactions and feedback between changes and livelihoods in a model. A complex picture of the situation is emerging, showing the interweaving effects of non-climatic and climatic changes, their interplay at different scales, their cumulative effects, the interactions between livelihood types and feedback between social and natural systems. Most of the climate-induced changes gradually become noticeable over the past 25 years. Climate data confirm these changes in recent decades, with July being wetter and January being dryer. Villagers reported waterlogging as the most significant change in their community, pointing to its multiple causes, originating in non-local and local, non-climatic anthropic changes, exacerbated by shrimp farm enclosures and worsened by climate-induced changes such as heavier rains, wetter monsoons and cyclones. Tiger prawn farms, reported as a lucrative and local adaptation to waterlogging and salinisation for the ones who can afford it, worsen the situation for the less wealthy, causing waterlogging and salinisation of the adjacent agricultural lands and buildings, the disappearance of traditional fishing and a reduction of the local job market. In addition, erratic rain patterns, droughts and cyclones affect local production and labour markets. COVID-19 lockdowns, by impacting markets and mobilities, further aggravated the situation. Inequality has increased as the range of adaptations of the less wealthy appears limited in this context of multiple crises.

show abstract

Universal health coverage: the roof has been leaking for far too long

Cited by 6 publications

References 20 publications

A mixed methods study of community-based health insurance enrollment trends and underlying challenges in two districts of northeast Ethiopia: A proxy for its sustainability

A mixed methods study of community-based health insurance enrollment trends and underlying challenges in two districts of northeast Ethiopia: A proxy for its sustainability

A mixed methods study of community-based health insurance enrollment trends and underlying challenges in two districts of northeast Ethiopia: a proxy for its sustainability

Local social-ecological context explains seasonal rural-rural migration of the poorest in south-west Bangladesh

Contact Info

Product

Resources

About