Asaria M, Ali S, Doran T, Ferguson B, Fleetcroft R, Goddard M, et al. Policymakers and managers can use this framework as a useful and practical tool in achieving UHC, depending on the goals of their countrys health system [24]. It helps you get to where you want/need to go. The political commitment during political turmoil, excessive attention to the treatment, referral system, paying out of pocket(OOP) and protection against high costs, economic growth, sanctions, conflict of interests, weakness of the information system, prioritization of services, health system fragmented, lack of managerial support and lack of standard benefits packages were identified as the leading factors on the way to UHC. Evans DB, Saksena P, Elovainio R, Boerma T. Measuring progress towards universal coverage. Naghdi S, Moradi T, Tavangar F, Bahrami G, Shahboulaghi M, Ghiasvand H. The barriers to achieve financial protection in Iranian health system: a qualitative study in a developing country. Article But WHO is not alone: WHO works with many different partners in different situations and for different purposes to advance UHC around the world. Atun R, De Andrade LOM, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, et al. Bull World Health Organ. PubMedGoogle Scholar. JMAJ. "Exploring Pathways to Affordable, Universal Health Coverage Care" . The participants statements were recorded by using a digital audio recorder and the research also used note-taking during the interviews. Health Policy. It managed to do so by passing policies that direct the use of tax revenue and foreign aid to cover health care costs and asking its citizens to pay voluntary premiums scaled by income, the New York Times reported. 2020;12:45972. Chu A, Kwon S, Cowley P. Health financing reforms for moving towards universal health coverage in the western pacific region. All data generated or analyzed during this study are included in this published article in Additionalfiles1 and 2. SDG Target 3.8 | Achieve universal health coverage, including financial PDF Universal Health Coverage and Health Outcomes - Oecd https://doi.org/10.1186/s12913-021-06673-0, DOI: https://doi.org/10.1186/s12913-021-06673-0. Achieving Universal Health Coverage (UHC): Dominance analysis across 2013;21(42):5060. Obare V, Brolan CE, Hill PS. PLoS One. 2015;351. 2019;1:1. Human resources for health and universal health coverage: fostering equity and effective coverage. Independent Assess First. 2019;14(5):e0216112. 2019;19(1):670. Int J Health Plann Manag. Bull World Health Organ. Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. Second, the health system. Tobe M, Stickley A, del Rosario Jr RB, Shibuya K. Out-of-pocket medical expenses for inpatient care among beneficiaries of the National Health Insurance Program in the Philippines. Despite having fewer factors categorized within this dimension, the payment system plays a distinct role regarding UHC. Lancet. 2016;18(4):32935. This was contained in a statement issued by the US State Department, copied to the Ghana News Agency (GNA), Accra. Economic consequences of outsourcing in public hospitals in Iran: a systematic review. Med J Islam Repub Iran. The health care company has worked to provide education and training accessible to health professionals, including programs that target young health workers. Garrett L, Chowdhury AMR, Pablos-Mndez A. You can check out our Privacy Policy to see how we safeguard and use the information you provide us with. Whenever it was not possible, a third author (SA-A) helped with reaching the consensus. Items such as poverty, review of other countries experiences, unemployment rate, active delivery of primary health care, the status of the countrys health indicators, demographic and epidemiological transition, knowledge transfer, community-based service delivery, health system service preferences (prevention-oriented or treatment-oriented), diseases pattern and communicable and non-communicable disease prevention programs, were categorized in this column. Having the capabilities and potential to do so, Iran can take benefit of the experiences of LMICs such as Turkey [28] and Thailand [29] that have achieved UHC previously. In the systematic review stage, 160 factors and in the qualitative stage 64 factors were identified. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation and palliative care. 2012;1(3):193206. Governments, global health donors, non-profit organizations, and development banks struggle with finding a way to ensure countries really achieve universal health coverage by 2030. The partnership will build on Ghanas primary health care system the Community-Based Health Planning and Services and health centres to strengthen the quality of health services, it explained. Universal Health Coverage for Inclusive and Sustainable Development Koohpayehzadeh J, Kassaeian SS. In 2022, 84% of countries still reported disruptions. Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success. Arani AA, Atashbar T, Antoun J, Bossert T. Irans health reform plan: measuring changes in equity indices. Hosp Top. Arch Iran Med. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course. The study indicated that the most number of identified factors were within the Regulation and Supervision control knob (33 factors). Your email address will not be published. While governments can, and should, play a leading role in the global UHC movement, to make the dream of UHC for all a reality, governments, nonprofits, and businesses must work together to create and invest in robust health systems. Another critical point is the great dependence of this knob on the context of the health system which contains the political and administrative structure of the country, too. Garchitorena A, Miller AC, Cordier LF, Ramananjato R, Rabeza VR, Murray M, et al. Mehrolhassani M, Najafi B, Yazdi Feyzabadi V, Abolhallaje M, Ramezanian M, Dehnavieh R, et al. 2016;5(7):417. Appendix 6- Quality assessment of the study. 4710 Olley Lane Anything goes on the path to universal health coverage? Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Mental disorders are the leading contributor to the global burden of years lived with disability. An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS). The industrys low wages and long hours may deter others from entering the field or motivate them to move to areas with potential for higher pay and away from the frontlines, causing a shortage of health care workers who serve a critical function on the ground. Keeping universal coverage basic will keep the cost to the taxpayer down as well. Although all countries pursue the same goal, the method and timings are different based on the structure and available resources of the countries as well as the unique factors affecting countries [9]. 2012;4(6):105062. All UN Member States have agreed to try to achieve universal health coverage (UHC) by 2030, as part of the Sustainable Development Goals. Int J Collab Res Intern Med Public Health. Pakistan must address the burden of infectious disease and curb rising rates of non-communicable diseases. Cite this article. Ibrahimipour H, Maleki MR, Brown R, Gohari M, Karimi I, Dehnavieh R. A qualitative study of the difficulties in reaching sustainable universal health insurance coverage in Iran. Indicators for universal health coverage: can Kenya comply with the proposed post-2015 monitoring recommendations? Appendix 4- Identification affecting factors to achieving UHC trough FGD and semi-structured interviews in Iran. The vision outlines health system performance dimensions and policy entry and included as part of universal health coverage. Hakim Res J. The percentage of influential factors for achieving universal health coverage in Iran based on health system control knob framework. J Educ Health Promot. A study conducted in 11 different countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam) with different UHC status showed that countries must have both of the necessary technical and political knowledge to move towards UHC [125]. Policy analysis of the Iranian health transformation plan in primary healthcare. At the United Nations General Assembly High Level Meeting on UHC in 2019, countries reaffirmed that health is a precondition for and an outcome and indicator of the social, economic and environmental dimensions of sustainable development. Tang S, Tao J, Bekedam H. Controlling cost escalation of healthcare: making universal health coverage sustainable in China. The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: a population-based study. Ehsani-Chimeh E, Sajadi HS, Majdzadeh R. Iran towards universal health coverage: the role of human resources for health. S.A-A & N. D contributed in designing, analyzing and drafting the paper. Family physician model in the health system of selected countries: a comparative study summary. Towards universal health coverage: achievements and challenges of 10 2000;320(7227):1146. Therefore, it is vital to set up the influential factors within a framework/model, to ensure the applicability of the policy at different levels of the health system. 2019;77(1):5. A lack of vaccines and medication means that even when they are willing and able to seek care, treatment may not be available or affordable, or there may not be skilled workers to provide care. In another study in China, factors such as social security system, population, economic development, and education have been introduced as contextual factors for achieving UHC [131]. BMC Public Health. 2010;4(2):97100. Bahadori M, Ravangard R, Alimohammadzadeh K, Hosseini SM. 2023 BioMed Central Ltd unless otherwise stated. He urged the brand-new Congress to create what became a compulsory, tax-financed, health insurance program for commercial . 2020;8(6):e82939. Public Health. As a foundation for and way to move towards UHC, WHO recommends reorienting health systems using a primary health care (PHC) approach. One of these models presented by the WHO in 2017 was the framework of strengthening health systems to achieve UHC. Watkins DA, Qi J, Kawakatsu Y, Pickersgill SJ, Horton SE, Jamison DT. Doshmangir L, Yousefi M, Hasanpoor E, Eshtiagh B, Haghparast-Bidgoli H. Determinants of catastrophic health expenditures in Iran: a systematic review and meta-analysis. This not only means individuals may be discouraged from getting preventative treatment like vaccines, but also means they will wait until their lives hang in the balance to seek medical attention. To this, assuring health equity can also help a lot . Savedoff WD, de Ferranti D, Smith AL, Fan V. Political and economic aspects of the transition to universal health coverage. New report calls for greater attention to childrens vital first years, Independent Oversight and Advisory Committee, WHO Global Health Observatory Data Repository for UHC, Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP), Alliance for Health Policy and Systems Research, Primary health care measurement framework and indicators: monitoring health systems through a primary health care lens, Sexual and Reproductive Health and Universal health Coverage Learning by Sharing Portal (SRH-UHC LSP), Global spending on health: rising to the pandemic's challenges, UHC Service Package Delivery & Implementation (SPDI) Tool. However, focusing on increasing economic growth [86, 87] and GDP, while allocating a proportional percentage of this GDP to the health sector are other leading elements in this case [83, 88]. Achieving UHC is one of the targets the nations of the world set when they adopted the 2030 Sustainable Development Goals (SDGs) in 2015. Data Extraction in this study was done in several steps. How to Achieve Universal Health Coverage volume21, Articlenumber:724 (2021) 2 A key strategy to tackling this burden is universal coverage of cost effective interventions for mental disorders, 3 . Lancet. Universal health coverage is within our reach 2013;16(1):S348. Health Res Policy Syst 2013, 11(1):19. Also, it is essential to identify these factors according to the countrys unique circumstances. COVID-19 showed us the power of strategic partnership with our allies to build a healthier, more equitable, and more prosperous world. Provided by the Springer Nature SharedIt content-sharing initiative. It covers all essential, quality health services - from health promotion to prevention, treatment, rehabilitation, and palliative care - across the life course. Alinia C, Lahijan JD. For instance, countries such as Germany and Japan had achieved UHC in 127 and 36years according to their specific structure and challenges [32]. 2 In September 2019, all United Nations Member States have committed strongly to achieve UHC by . PLoS Med. BMC Health Serv Res. Q&A: How to achieve universal health coverage in Africa In order to achieve UHC by 2030, a holistic approach involving multiple stakeholders is needed. After removing duplicate studies, titles of all articles were reviewed and articles that were incompatible with the aims of the study were excluded. Bastani P, Hakimzadeh SM, Teymourzadeh E, Nouhi M. Universal health coverage under the joint comprehensive plan of Actions sanctions: strategic purchasing approach in the Iranian health system. Despite recent coverage gains, approximately 9% of the U.S. population remains uninsured. It empowers the NHIA to be a more effective regulator and integrator. Glob Health Action. Health-system reform and universal health coverage in Latin America. In the present study, some factors that could not be classified in the control knobs were categorized in a separate column and were discussed between experts. The maximum score of articles was 24 and the minimum score was 8. 2019;33:106. PLoS Med. Asadi-Lari M, Sayyari A, Akbari M, Gray D. Public health improvement in Iranlessons from the last 20 years. SDG Target 3.8 | Achieve universal health coverage, 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 framework was designed and recommended in 2004 to improve the performance of countries health systems. Yasar GY, Ugurluoglu E. Can Turkey's general health insurance system achieve universal coverage? 2014;11(9):e1001676. Wouldnt it be nice to have this facility everywhere for everyone to get quality healthcare when they need it? Universal Health Coverage (UHC) has been introduced as a viable solution to promote, restore, and/or maintain the health of the population in countries [1, 2]. In more robust health system settings, WHO drives public health impact towards health coverage for all through policy dialogue for the systems of the future and strategic support to improve performance. Koohpayehzadeh J, Azami-Aghdash S, Derakhshani N, Rezapour A, Kalajahi RA, Khasraghi JS, et al. Int J Equity Health. It is expected that the three countries shared commitment will enhance primary health care and strengthen health security defences, particularly against current and future pandemic threats. Health Res Policy Syst. Health Policy Plan. 2014;13(1):123. 2016;4(5):e3056. On May 19, 2022, the National Health Insurance Authority Bill was signed into law: it makes health insurance mandatory for all citizens and legal residents. PubMed Pope C, Ziebland S, Mays N. Qualitative research in health care. World Hepatitis Day: Accelerate hepatitis testing and treatment 2019;33:65. 2018;47(7):10612. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Google Scholar. Sajadi HS, Ehsani-Chimeh E, Majdzadeh R. Response to: letter to the editor universal health coverage in Iran: where we stand and how we can move forward. In my experience, most countries do not know what the structure of their health system is or how it works. 2017;46(9):115666. 2014;11(9):e1001701. On the way to UHC, LMICs Governments require adequate and sustainable funding [91, 95, 96]. 2013;91(11):85363. Create a free account and access your personalized content collection with our latest publications and analyses. Also, it can affect justice in access to health services and make the path clear or uneven to UHC for every country [98,99,100]. An emerging consensus among global health leaders is that efforts to achieve universal health coverage will require harnessing multidisciplinary teams in community-based care delivery settings. CAS Control knobs are used to determine the results and outputs of health systems to which it concentrates on five dimensions including, financing, payment system, organization, regulation & supervision, and behavior [44]. .chakra .wef-facbof{display:inline;}@media screen and (min-width:56.5rem){.chakra .wef-facbof{display:block;}}You can unsubscribe at any time using the link in our emails. In the SDGs, progress on UHC is tracked using two indicators: Detailed data is provided in the WHO Global Health Observatory Data Repository for UHC. This study was part of a Ph.D. Thesis supported by Iran University of Medical Sciences (Thesis NO: 19114). The COVID-19 pandemic further disrupted essential services in 92% of countries at the height of the pandemic in 2021. Int J Health Plann Manag. The importance of this dimension best highlights when we consider its direct impact on three goals of UHC including, financial protection, population coverage, and service coverage. Therefore, it necessitates paying a sufficient amount for inter-sectoral partnerships and government commitment in this dimension. Elhadi YAM, Adebisi YA, Abel UV, Daniel EM, Zaghloul A, III DEL-P: National health systems strengthening as the primary strategy to achieve Universal Health Coverage in African countries. Piroozi B, Moradi G, Nouri B, Bolbanabad AM, Safari H. Catastrophic health expenditure after the implementation of health sector evolution plan: a case study in the west of Iran. The key search terms selection was done by experts and using the mesh, which included universal health coverage, universal coverage, universal healthcare coverage, universal health care coverage, UHC and Iran combined with OR Boolean in the title or abstract (Additionalfile1). The agreement comes at a pivotal time when public health experts are focusing on building capacity for the next epidemic or pandemic, yet health indicators including global life expectancy and childhood vaccinations are slipping. Furthermore, UHC is a way of promoting the populations quality of life while ensuring financial risk protection, equity, and access to essential and quality health services [6,7,8,9,10,11]. After refining them by the experts panel, 105 factors were categorized within the control knob framework (financing 19, payment system7, Organization 23, regulation and supervision 33, Behavior 11, and Others 12). KOICA will also invest approximately $23 million, and JICA will invest its technical and financial resources as approvals are obtained. In LMICs, this dimension takes a double-folded value, where, the countries face severe shortages in health resources [58, 112,113,114,115,116]. This type of analysis is used when the theories on the subject are limited [42, 43]. Reich MR, Harris J, Ikegami N, Maeda A, Cashin C, Araujo EC, et al. Experts who did not have the eligibility criteria were excluded. The health status of Iranian has been improved during the last decades thanks to the health networks where primary healthcare was provided for both rural and urban populations; however, many weaknesses and challenges are threatening the health system, such as high degrees of OOP payments [21], limited financial resources, increase in unofficial payments to the physicians [22], lack of community participation in solving health problems [23, 24], financial constraints, lack of clarity in tariffs setting mechanisms [25], and difficulties affecting the system due to international sanctions against Iran [26, 27]. Jahangiri R, Derakhshani N, Raeissi P, Alipour S, Ghasemyani S. Evaluation of the status of organizational culture among hospital staff in Iran: a systematic review and meta-analysis. The impact of health reform in Iran on catastrophic health expenditures: equity and policy implications. Universal health coverage in Iran. During her 25 plus years in the field, she has been a physician, international health care management consultant, senior policy advisor, epidemiologist and researcher, senior project and hospital manager, and professor to graduate and undergraduate students. SciDev.Net on 7 April, the World Health Day, interviewed Matshidiso Moeti, the WHO regional director for Africa, on the continent's . To build back better, WHOs recommendation is to reorient health systems using a primary health care (PHC) approach. 2020;98(2):132. New York: Oxford University Press; 2007. Financial risk protection and universal health coverage: evidence and measurement challenges. Universal health coverage in Iran. Considering the distinctive role of the context in policymaking, the identification of the factors affecting UHC accompanying by the countries experiences about UHC, can boost our speed toward it. Universal health coverage, as a comprehensive and new policy that overwhelm all parts of the health system and even other sectors, is influenced by many factors, such as political sustainability [33, 34], economic growth [35, 36], fragmentation in the health system [37,38,39], etc. After the categorization affecting factors based on the health system control knob framework was refined through the research team, the draft version of the categorization was entered in the final phase. If yes is the answer to the first two questions, the article will continue to be evaluated. Universal health system and universal health coverage: assumptions and strategies. 2017;27(5):491500. Appendix 2- Characteristics of extracted studies with consideration to affecting factors to achieving UHC in Iran. 2020. World Health Organization (WHO) emphasized maximum population coverage, health service coverage, and financial protection, as three dimensions of UHC. Tracking universal health coverage: first global monitoring report: World Health Organization; 2015. Arch Iran Med. Giovanella L, Mendoza-Ruiz A, AdCA P, MCd R, Martins GB, Santos IS, et al. Universal health coverage (UHC) has been identified as a priority for the global health agenda. 2008;23(2):15060. Best practices in achieving universal health coverage: a scoping review; 2020. Int J Health Policy Manag. It is intended to be a key reference document for the International Health Partnership for UHC 2030 (UHC2030), as well as a broader resource for the global community to inform collaboration on the HSS and UHC agenda. UHC provides access to quality essential health services; safe, effective, and affordable essential medicines and vaccines; and protection from financial risk. Universal Health Coverage - World Health Organization (WHO) 2018;47(3):390. But for more certainty, another interview was conducted. J Health Admin. Nosratnejad S, Rashidian A, Jafari N, Ahari AM. We are proud to join Japan and the Republic of Korea in this partnership to achieve Universal Coverage in Ghana, the U.S. Achieving universal health coverage is a critical goal that most African countries are striving to achieve. The semi-structured interviews were conducted in the participants office. This feature of the study can also allow other countries to benefit from the results of the study. The Payment System is another health systems control knob. 3). 10 years of health-care reform in China: progress and gaps in universal health coverage. 2012;380(9845):92432. Some factors have played a more important role in financing the health system for achieving UHC, such as out-of-pocket payments, type of financing in the health system, high medical tariffs, sustainability of financing, international sanctions, service packages, strategic purchases, excessive inflation, and Health insurance system. Responded validity was used to ensure the rigor and accuracy of the results. Van Minh H, Pocock NS, Chaiyakunapruk N, Chhorvann C, Duc HA, Hanvoravongchai P, et al. Data collection was continued until data saturation. This study was conducted in four phases: (1) systematic review of relevant studies; (2) Qualitative Study: (Focus Group Discussion (FGD) & semi-structured interview); (3) merging factors based on Framework-Analysis; (4) refining and finalizing the factors in control knob framework through expert panels.
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