SSM - Health Systems最新文献

{"title":"De facto health governance policies and practices in a decentralized setting of Ghana: Implication for policy making and implementation","authors":"Samuel Amon ,&nbsp;Jana Gerold ,&nbsp;Patricia Akweongo ,&nbsp;Susan E. Bulthuis ,&nbsp;Samuel Agyei Agyemang ,&nbsp;Moses Aikins","doi":"10.1016/j.ssmhs.2024.100017","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100017","url":null,"abstract":"<div><h3>Background</h3><p>Current Universal Health Coverage (UHC) considerations confirm the need for strong governance in improving health sector performance. However, empirical evidence on the effects of decentralized health system governance remains limited in Low-and-middle-income countries (LMICs). This paper assesses the <em>de facto</em> health governance policies and practices of the decentralized health system of Ghana and its implications, for better policy formulation and implementation.</p></div><div><h3>Material and methods</h3><p>The study employed a cross-sectional design, comprising of systematic literature review (SLR) and in-depth interviews on health governance components. The literature review (n=103) was performed to document the factors that affect health governance management and policy uptake. A total of 32 purposively sampled key health system actors were individually interviewed face-to-face between January and February, 2018. Thematic content analyses of literature and interviews were done.</p></div><div><h3>Results</h3><p>Tension regarding power relationships exists between the policies governing the health sector of Ghana, which has rendered the decentralization reform effort in health governance policies and practices uncoordinated, incoherent and sometimes contradictory. Implication of the <em>de facto</em> decentralized health governance policies and practice include: limited involvement of sub-national level in policy development; weak interaction between policy formulators and implementers; and political interference in policy implementations compromising evidence-based policy formulation.</p></div><div><h3>Originality/value</h3><p>Drawing on diverse literatures and opinions of key health actors, this paper contributes to knowledge on health governance practices in a decentralized and resource constrained health system, and offers practical accounts of the implications of the <em>de facto</em> health governance system of Ghana for health policy formulation and implementation.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100017"},"PeriodicalIF":0.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000102/pdfft?md5=37b2fa217785259b23fb0e9d3ce0a6ae&pid=1-s2.0-S2949856224000102-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to the utilization of facility births during a national health system strengthening initiative: A mixed-methods assessment from rural Guinea-Bissau","authors":"Sabine Margarete Damerow ,&nbsp;Helquizine da Goia Mendes Lopes ,&nbsp;Giuliano Russo ,&nbsp;Morten Skovdal ,&nbsp;Jane Brandt Sørensen ,&nbsp;Ane Bærent Fisker","doi":"10.1016/j.ssmhs.2024.100015","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100015","url":null,"abstract":"<div><h3>Background</h3><p>There is growing focus on improving maternal-perinatal survival through health system strengthening (HSS). Despite such efforts, facility birth coverage often remains low in low-income settings. We explored factors influencing facility birth utilization during a national HSS initiative in rural Guinea-Bissau.</p></div><div><h3>Methods</h3><p>Using an explanatory sequential mixed-methods approach nested in the Bandim Health Project’s rural Health and Demographic Surveillance System (HDSS), we conducted 258 structured and 12 in-depth interviews with women who had recently given birth. Data were analysed using descriptive statistics and thematic network analysis guided by theories of social practice.</p></div><div><h3>Findings</h3><p>In the structured interviews, most women reported that they had planned a facility birth (171/258, 66 %), and 28 % reported access barriers (73/258). However, only half of the interviewed women actually gave birth at a health facility (128/258, 50 %), suggesting that facility births frequently remained unattainable. In the in-depth interviews, women described multiple “prerequisites” that needed to be met to access facility births such as financial means for out-of-pocket payments (OOPs). Despite official user fee waivers, OOPs were reported by 71 % of the structured-interview participants with facility births (91/128) but only three of these women referred to OOPs as barriers.</p></div><div><h3>Conclusions</h3><p>Our findings suggest that the women do not feel entitled to free-of-charge facility births, which may explain underreporting of financial barriers. Ubiquitous OOPs are further suggestive of ‘commodification’ of facility births, such that individual ability to pay remains key to utilization. Our findings raise equity concerns and call for closer monitoring of the implementation of HSS initiatives.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100015"},"PeriodicalIF":0.0,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000084/pdfft?md5=cd14bb65b92e4a8c2d3897a87864d446&pid=1-s2.0-S2949856224000084-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141542349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The process of developing and piloting a tool in the Maldives and Zimbabwe for assessing disability inclusion in health systems performance","authors":"Hannah Kuper ,&nbsp;Phyllis Heydt ,&nbsp;Shaffa Hameed ,&nbsp;Tracey Smythe ,&nbsp;Tapiwanashe Kujinga","doi":"10.1016/j.ssmhs.2024.100014","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100014","url":null,"abstract":"<div><p>There are 1.3 billion people with disabilities globally. On average, they experience greater healthcare needs and more barriers accessing healthcare. Yet, health systems have failed to adequately include people with disabilities. The purpose of this study was to develop and pilot-test a tool for assessing disability inclusion in health system performance. We presented the “Missing Billion” disability-inclusive health system framework, which includes 4 system-level components and 5 service delivery components, and outputs and outcomes. We developed a tool, consisting of 48 indicators related to the framework components. We consulted international experts, who considered the framework and indicator set to be logical and comprehensive. The tool was pilot-tested in the Maldives (2020) and Zimbabwe (2021), working with local researchers to collect relevant data through document review and key informant interviews. The pilot data demonstrated that collecting data on the indicators was feasible. The tool highlighted areas where the health systems were performing well in terms of disability inclusion (e.g. governance) and other areas where there were large gaps (e.g. leadership) or lack of data (e.g. accessibility, outputs and outcomes). The indicators were updated and refined. We established a process for undertaking the assessment, highlighting the importance of leadership and ownership by the Ministry of Health, to facilitate data collection and implementation of recommendations. In conclusion, this new tool for assessing disability inclusion in health systems performance can help to identify key issues and guide and monitor action.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100014"},"PeriodicalIF":0.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000072/pdfft?md5=1f1a30c36cb46067adc58920c31ade04&pid=1-s2.0-S2949856224000072-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refugee women in the informal health sector in Lebanon: Gendered experiences of close to community healthcare providers during the COVID-19 response","authors":"Rouham Yamout ,&nbsp;Wesam Mansour ,&nbsp;Maya About Saad ,&nbsp;Joanna Khalil ,&nbsp;Fouad M. Fouad ,&nbsp;Joanna Raven","doi":"10.1016/j.ssmhs.2024.100013","DOIUrl":"10.1016/j.ssmhs.2024.100013","url":null,"abstract":"<div><h3>Introduction</h3><p>During the COVID-19 pandemic, Close-to-Community (CTC) healthcare providers emerged to compensate for the lack of healthcare workers in areas with high concentrations of Syrian refugees. Gender norms and power relations shaped the experiences of those CTC providers.</p></div><div><h3>Methodology</h3><p>A qualitative study explored the lived experiences of men and women CTC providers in Beqaa - Lebanon. It examined their gendered experiences during the COVID-19 response using in-depth interviews with informal CTC providers who are members of the Syrian refugee community themselves, and key informant interviews with their managers. Thematic data analysis and synthesis were guided by gender analysis frameworks and supported by NVivo 12.</p></div><div><h3>Results</h3><p>CTC providers faced many challenges in their work including illegal work, absence of benefits, high workload, insufficient income, transportation challenges, disturbances in family life, and social isolation. Working illegally as refugees led to underpayment and absence of benefits. Gender norms and power dynamics significantly influenced the experiences of these CTC providers. Women CTC providers faced increased workload, lower payment, limited opportunities for extra hours, the pressure of juggling work and family life, transport challenges, psychological distress and lack of support from their organizations.</p></div><div><h3>Conclusion</h3><p>The COVID-19 pandemic has shed light on how gender shapes vulnerabilities within the healthcare response. Women and men informal CTC providers experienced different challenges providing healthcare services for their communities during the COVID-19 response. There is a need to address the vulnerabilities for women CTC providers and develop and implement practical interventions to address them.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100013"},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000060/pdfft?md5=b5aac88cc50eb1bb08c0a361fc9db9d2&pid=1-s2.0-S2949856224000060-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141050973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of perennial malaria chemoprevention in infants at district-level in Togo: mixed methods assessment of health system readiness","authors":"Natacha Revollon ,&nbsp;Koku Delanyo Dzoka ,&nbsp;Diane Fifonsi Gbeasor-Komlanvi ,&nbsp;Arnold Sadio ,&nbsp;Shino Arikawa ,&nbsp;Abraham Atekpe ,&nbsp;Rodion Konu ,&nbsp;Bandana Bhatta ,&nbsp;Martin Tchankoni ,&nbsp;Cristina Enguita-Fernàndez ,&nbsp;Francisco Saute ,&nbsp;Mohamed Samai ,&nbsp;Bernard Tossou Atchrimi ,&nbsp;Valérie Briand ,&nbsp;Clara Menendez ,&nbsp;Didier Koumavi Ekouevi ,&nbsp;Joanna Orne-Gliemann ,&nbsp;for the MULTIPLY project consortium","doi":"10.1016/j.ssmhs.2024.100012","DOIUrl":"10.1016/j.ssmhs.2024.100012","url":null,"abstract":"<div><h3>Introduction</h3><p>In June 2022, WHO recommended the administration of Perennial Malaria Chemoprevention (PMC) alongside Expanded Immunization Programmes for children under two years. We investigated the health systems readiness for PMC implementation in Togo.</p></div><div><h3>Method</h3><p>As part of the multi-country MULTIPLY project, we conducted a mixed methods implementation research study in the 27 health facilities of Haho district in Togo. All district health care providers (n=188) and a sample of community health workers (n=43) were invited to respond to a self-administered Knowledge-Attitudes-Practices questionnaire. Structured observations in 4 health facilities and 19 semi-structured interviews were conducted. Descriptive analysis was conducted on quantitative data. Qualitative data was analysed thematically, using an inductive approach. We report here on the implementation context for PMC, its infrastructural feasibility and its acceptability among health care workers (HCWs).</p></div><div><h3>Results</h3><p>Overall, respondents perceived PMC as relevant in the context of high malaria burden and had a good knowledge about malaria and its prevention. HCWs foresaw good community acceptability of PMC. Although some HCWs did not understand the rationale of PMC if children are not sick, they also believed PMC would be effective, in line with their perceptions of preventive malaria treatment during pregnancy. Several challenges were foreseen such as distance barriers for accessing health facilities, difficulties in accessing drinking water, supplies for PMC administration, or lack of dedicated health workforce and area for PMC administration.</p></div><div><h3>Conclusion</h3><p>At district-level in Togo, overall pre-intervention acceptability of PMC was encouraging. Structural and operational challenges were identified as possible barriers to implementation feasibility.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100012"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000059/pdfft?md5=3d606829699d8e8faf769b134447d984&pid=1-s2.0-S2949856224000059-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141040249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a multidimensional measure of health care access among LGBTQ midlife and older adults in the United States","authors":"Meghan Romanelli,&nbsp;Karen Fredriksen-Goldsen,&nbsp;Hyun-Jun Kim","doi":"10.1016/j.ssmhs.2024.100011","DOIUrl":"10.1016/j.ssmhs.2024.100011","url":null,"abstract":"<div><h3>Purpose</h3><p>Lesbian, gay, bisexual, transgender, and queer (LGBTQ) midlife and older adults are a health disparity population whose health and health care needs are distinguished by the intersection of gender, sexuality, and age. Research and measurement considering multidimensional factors influencing health care access among this population, however, remain limited. Theoretically cohesive indicators of health care access were combined to develop a comprehensive and reliable, yet parsimonious scale that assesses the unique health care access needs and experiences of LGBTQ midlife and older adults.</p></div><div><h3>Methods</h3><p>Data from the U.S.-based Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) were used, including 2322 LGBTQ participants from the 2015 wave of data collection. Twenty-four items were initially included in an assessment of scale reliability. The underlying factor structure of health care access was tested. Differences in mean health care access scores were examined across sexual identity, current gender, gender identity, and age cohort.</p></div><div><h3>Results</h3><p>Nineteen items remained in the final scale (α=0.90). Data supported health care access as multidimensional among NHAS participants. Heterogeneity in health care access scores was identified across participants. Bisexual, straight, and sexually diverse participants, women and gender diverse participants, and transgender participants faced more difficulties accessing care. Participants aged 66–80 and 81+ reported significantly higher health care access scores.</p></div><div><h3>Conclusion</h3><p>Final indicators represented the complex health care experiences of LGBTQ midlife and older adults<em>.</em> This scale can be utilized in future health equity research. Using NHAS longitudinal data, future research could assess changes in access over the life-course and as a predictor of health outcomes.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100011"},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000047/pdfft?md5=fcd01a455993666cb551d5de2fc9a1d3&pid=1-s2.0-S2949856224000047-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141047538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actioning the Learning Health System: An applied framework for integrating research into health systems","authors":"Robert J. Reid ,&nbsp;Walter P. Wodchis ,&nbsp;Kerry Kuluski ,&nbsp;Nakia K. Lee-Foon ,&nbsp;John N. Lavis ,&nbsp;Laura C. Rosella ,&nbsp;Laura Desveaux","doi":"10.1016/j.ssmhs.2024.100010","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100010","url":null,"abstract":"<div><p>Health systems across the world experience pervasive gaps in the speed with which high quality evidence is generated, implemented and refined. A Learning Health System (LHS) approach that blends research with health care operations is to eliminate or reduce delays. This paper builds on existing LHS frameworks to deepen our practical understanding of the research-health systems operations interface and to provide actionable insights on how to realize a LHS in practice. We present a LHS action framework that describes how research and health care operations are linked and enacted in a comprehensive LHS approach to advance population health and health equity. Health systems seeking to implement a LHS approach can use this framework to identify capabilities necessary to enact the learning elements, including key questions and methods, to ensure a systematic approach to learning and achieving equity-centered quadruple aim metrics.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100010"},"PeriodicalIF":0.0,"publicationDate":"2024-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000035/pdfft?md5=b0f016d7d8e5b152c1af633b1dc5b2dc&pid=1-s2.0-S2949856224000035-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140308885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing health equity for populations with intellectual disabilities: A systematic review of facilitators and barriers to the implementation of health checks and screening","authors":"Anders Larrabee Sonderlund,&nbsp;Fereshteh Baygi,&nbsp;Jens Soendergaard,&nbsp;Trine Thilsing","doi":"10.1016/j.ssmhs.2024.100009","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100009","url":null,"abstract":"<div><p>People with intellectual disabilities (IDs) experience extensive health disparities, including premature mortality and higher incidence of chronic disease. These inequities have been linked to reduced access to preventive health care for this population. We review the evidence as it relates to barriers and facilitators of effective implementation of health checks and screenings for people with IDs. We conducted our review according to the PRISMA guidelines. We systematically searched seven academic databases for articles on barriers and facilitators of health check implementation for people with IDs. A total of 17 articles met our inclusion criteria. Four were quantitative articles and 13 were qualitative. Four of the qualitative studies focused on patient experiences of attending health checks and screenings. The remaining 13 studies reported on health professionals’ perspectives on implementation. We noted implementation barriers and facilitators at three levels: Individual, organizational, and structural. Across these levels, we identified 17 distinct implementation factors that may be avoided or harnessed to facilitate health check implementation and access for people with IDs. We discuss our results and potential solutions for better, more effective implementation of health checks and screenings for people with IDs.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100009"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000023/pdfft?md5=e677ed51e824195bb031b3cadfb98b8c&pid=1-s2.0-S2949856224000023-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139714609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the efficiency in spending for health: A systematic review of evidence","authors":"Nouria Brikci ,&nbsp;Rotimi Alao ,&nbsp;Hong Wang ,&nbsp;Darius Erlangga ,&nbsp;Kara Hanson","doi":"10.1016/j.ssmhs.2024.100008","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100008","url":null,"abstract":"<div><h3>Background</h3><p>Addressing inefficiencies in the way healthcare is financed has been identified as an important source of fiscal space for health systems. The WHO, for example, has argued that up to 40% of resources spent in health are wasted. Which reforms to focus on, their impact on fiscal space, and their feasibility have seldom been documented, however. The aim of this paper is to synthesise the evidence on these points, ascertaining the extent of fiscal space that has, to date, been created by implementing reforms aimed at addressing inefficiencies in health financing.</p></div><div><h3>Methods</h3><p>systematic review of peer-reviewed literature in global databases (Medline, Embase, Global Health, Econlit, Africa-Wide information, Web of Science Core Collection and SciELO citation index). 20 articles were included for narrative analysis. Data extracted included: type of study; countries where the reform was implemented; the specific inefficiency discussed; the specific reform to tackle inefficiency; the efficiency indicator used; the baseline information given; the impact of the reform on health spending; and the feasibility and timing of the reform.</p></div><div><h3>Findings</h3><p>Inefficiencies in health financing exist across the world, and reforms to address these remain important. Yet the empirical evidence on savings that can be created through addressing these inefficiencies is limited, mixed, and suggests that potential savings are more modest than indicated by the WHO. The feasibility of these reforms is seldom documented. The process of implementation of these reforms is similarly poorly documented, although the available evidence suggests that it takes three to ten years for these efficiency-enhancing health financing reforms to translate into actual results.</p></div><div><h3>Interpretation</h3><p>Further research is needed to understand how to translate identified inefficiencies in the way healthcare is financed into additional fiscal space. Engaging with the political economy of designing and implementing these reforms will be key. Rooting fiscal space analysis projections in country-specific analysis of inefficiencies is also key, as the expectations of financial savings will otherwise be unrealistic.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100008"},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000011/pdfft?md5=a767f1363d3d0a9193c333c21a0ea52b&pid=1-s2.0-S2949856224000011-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139674239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The sustainability of two departmental health insurance units in Senegal: A qualitative study","authors":"Valéry Ridde ,&nbsp;Babacar Kane ,&nbsp;Ndeye Bineta Mbow ,&nbsp;Ibrahima Senghor ,&nbsp;Adama Faye","doi":"10.1016/j.ssmhs.2023.100006","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2023.100006","url":null,"abstract":"<div><p>Despite decades of implementation, community-based health insurance (CBHI) in Africa has not effectively achieved Universal Health Coverage (UHC). As a response, from 2014 to 2017, a Belgian-Senegalese project organized an alternative solution: Departmental Health Insurance Units (UDAM). Professionals managed UDAMs at a departmental level, and healthcare providers charged a flat-rate fee. While research on sustainability is scarce in Africa, this study aims to understand the factors that explain why, four years after the end of the project, UDAMs are sustained. This qualitative research used Schell et al. (2013) conceptual framework on factors influencing sustainability. The data came from 13 months of field observations, a documentation review, 120 interviews at the local level and nine at the regional and national level, and a focus group. We carried out a thematic analysis according to the conceptual framework. The results show that central political support has strengthened over time. UDAMs have managed to stabilize their funding through State subsidies and social marketing strategies to improve membership. UDAMs kept their management fees at 13%, below the 25% standard proposed by the West African Economic and Monetary Union. Multiple partnerships have been established at international, national, and local levels. Building on the professionalization of its staff, UDAMs have strengthened their organizational capacity. Internal controls and a complaints system have been organized to improve UDAMs’ accountability. Many communication activities were carried out before the end of the project to prepare the exit strategy. With their extensive coverage (penetration rate over 60%), UDAMs impact the health system (between 2014 and 2021, they paid 2.5 million EUR to healthcare providers). Innovations have been implemented, such as organizing a group contribution based on collective work in fields of culture supported by the communities and local stakeholders. As part of its UHC strategy, Senegal decided at the end of 2022 to transition its 676 communal CBHI into 46 departmental units. The sustainability of two UDAMs has demonstrated the relevance of this model. However, sustainability can only be assured if the State prioritizes the health sector and donors place greater emphasis on alignment and sustainability. We need to study how it is organized to scale up nationally.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"2 ","pages":"Article 100006"},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856223000065/pdfft?md5=7adb6eabdd7a36f6d14744fae5848446&pid=1-s2.0-S2949856223000065-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139033790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}