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Country Summary

Kenya

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Analytical summary

Organizational framework of universal coverage

Health mapping and geographical coverage

Health financing strategy towards universal coverage

Other initiatives towards universal coverage

Barriers on access to health services

Endnotes: sources, methods, abbreviations, etc.

Central_African_Republic

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Résumé analytique

Cadre organisationnel de la couverture universelle

Cartographie de la santé et couverture géographique

Stratégie de financement des soins de santé en vue de la couverture universelle

Autres initiatives en vue de la couverture universelle

Obstacles à l'accès aux services de santé

Notes de fin: sources, méthodes, abréviations, etc.

Cameroon

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

Burkina_Faso

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.


Résumé analytique

The English content will be available soon.

La couverture sanitaire universelle n’est pas effective au Burkina Faso.

Cape_Verde

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Resumo analítico - Cobertura universal

The English content will be available soon.

Durante a última década, Cabo Verde tem tido um crescimento constante, impulsionado pelo turismo, remessas da diáspora, o investimento directo estrangeiro e ajuda ao desenvolvimento, enquanto o déficit orçamentário e da dívida pública permaneceram limitados. A maioria dos indicadores de desenvolvimento humano apontam para melhorias consideráveis e estão entre os mais altos na África subsaariana.

Meninos Tartaruguinhas.jpg

A expectativa de vida ao nascer é de 72 anos, a taxa de mortalidade infantil caiu pela metade nos últimos 20 anos, a taxa de alfabetização é de 80% e a taxa de matrícula no ensino primário recentemente chegou a 100%. A taxa de pobreza diminuiu de 36,7% em 2001 para 26,6% em 2007. Cabo Verde é um dos poucos países na África que prevê atingir todas as metas dos Objectivos de Desenvolvimento do Milénio.

Burundi

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Résumé analytique

The English content will be available soon.

S’accordant à la loi fondamentale, le Gouvernement du Burundi s’est engagé à assumer toutes ses responsabilités pour offrir à tout citoyen burundais des services de santé de base de qualité tel que repris dans l’axe N° 3 du Cadre Stratégique de Lutte contre la Pauvreté de première génération CSLPI (2006- 2010).

L’accessibilité géographique est satisfaisante puisque la population en général (80%) [1] peut accéder à un centre de santé à moins de 5 km de distance, quoiqu’il existe des disparités géographiques surtout en faveur des centres urbains. La cartographie sanitaire la plus récente est de 2009 et le pays compte l’actualiser en 2012. La plupart des formations sanitaires (plus de 90%) sont accessibles par une route même si elles sont parfois défectueuses. Cette voie de communication joue un rôle important dans le système de référence et contre référence.


Cadre organisationnel de la couverture universelle

Cartographie de la santé et couverture géographique

Stratégie de financement des soins de santé en vue de la couverture universelle

Autres initiatives en vue de la couverture universelle

Obstacles à l'accès aux services de santé

Notes de fin: sources, méthodes, abréviations, etc.

Référence

  1. Enquête PETS (Public Expenditure Track Survey), 2008

Botswana

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Analytical summary

For ease of management and coordination, Botswana's public health sector is organized into 29 health districts through district health management teams. Each district is responsible for taking stock of its population to ensure accessibility of health services to all. The National Health Policy incorporates socioeconomic determinants of health such as poverty and lifestyle such that the economically disadvantaged populations have access to quality health care.

The involvement of local structures such as village development committees ensures identification of populations that need special attention, such as the poor, orphans and vulnerable populations, young people, older people and people with disability. The organization of the health care delivery system by facility level and the referral system provides some degree of standardization of service packages at different levels of facilities.


Organizational framework of universal coverage

Health mapping and geographical coverage

Health financing strategy towards universal coverage

Other initiatives towards universal coverage

Barriers on access to health services

Endnotes: sources, methods, abbreviations, etc.

Benin

The English content will be available soon.

La République du Bénin reconnaît la protection sociale comme un droit pour tout individu et une condition du progrès économique et social, en adhérant à la plupart des conventions et accords internationaux y relatifs. Par ailleurs, la constitution du 11 décembre 1990 légitime en son article8, l’accès à un niveau adéquat de protection sociale pour tous comme un droit fondamental et fait obligation à l’Etat d’assurer à ses citoyens un accès égal à la santé, à l’éduction, à l’information, à la formation professionnelle et à l’emploi. Aussi, la nécessité d’améliorer l’accessibilité et la qualité des services de santé et de nutrition est reconnue dans l’axe 3 des orientations stratégiques 2006-2011 de développement du Bénin [1], comme étant l’un des domaines prioritaire du développement du capital humain. De plus, les états généraux de la santé [2] tenus à Cotonou en 2007 ont recommandé l’institution au Bénin d’un régime d’assurance maladie universelle.

Angola

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Analytical summary

Organizational framework of universal coverage

Health mapping and geographical coverage

Health financing strategy towards universal coverage

Other initiatives towards universal coverage

Barriers on access to health services

Endnotes: sources, methods, abbreviations, etc.

Algeria

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

Zimbabwe

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.


This section on Universal coverage is structured as follows:

Analytical summary

Zimbabwe has a wealth of resources with a potential for health financing, a highly literate population and rich natural, mineral and agricultural resources. However, the country has faced economic and social challenges in the past decade that threaten provision of health.

The level of debt makes debt relief important to ensure that debt servicing does not withdraw resources from investing in this social recovery[3].


Organizational framework of universal coverage

Health mapping and geographical coverage

Health financing strategy towards universal coverage

Other initiatives towards universal coverage

Barriers on access to health services

Endnotes: References, sources, methods, abbreviations, etc.

  1. OSD 2006-2011. 8,49Mo
  2. Etats généraux. 202Ko
  3. MoHCW, TARSC EQUINET (2012) Stakeholders meeting on the Zimbabwe Equity Watch Harare, Zimbabwe February 23 2012, EQUINET, Harare

Chad

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Résumé analytique

Cadre organisationnel de la couverture universelle

Cartographie de la santé et couverture géographique

Stratégie de financement des soins de santé en vue de la couverture universelle

Autres initiatives en vue de la couverture universelle

Obstacles à l'accès aux services de santé

Notes de fin: sources, méthodes, abréviations, etc.

Comoros

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Résumé analytique

Cadre organisationnel de la couverture universelle

Cartographie de la santé et couverture géographique

Stratégie de financement des soins de santé en vue de la couverture universelle

Autres initiatives en vue de la couverture universelle

Obstacles à l'accès aux services de santé

Notes de fin: sources, méthodes, abréviations, etc.

Guinea

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Résumé analytique

Cadre organisationnel de la couverture universelle

Cartographie de la santé et couverture géographique

Stratégie de financement des soins de santé en vue de la couverture universelle

Autres initiatives en vue de la couverture universelle

Obstacles à l'accès aux services de santé

Notes de fin: sources, méthodes, abréviations, etc.

Ghana

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health systems profile is structured as follows:

Analytical summary

Organizational framework of universal coverage

Health mapping and geographical coverage

Health financing strategy towards universal coverage

Other initiatives towards universal coverage

Barriers on access to health services

Endnotes: sources, methods, abbreviations, etc.

Guinea-Bissau

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Resumo analítico - Cobertura universal

Quadro organizativo da cobertura universal

Mapeamento da saúde e cobertura universal

Estratégia de financiamento da saúde no sentido da cobertura universal

Outras iniciativas no sentido da cobertura universal

Barreiras no acesso aos serviços de saúde

Notas finais: fontes, métodos, abreviaturas, etc.

Gabon

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Résumé analytique

The English content will be available soon.

La couverture universelle en soins de santé est globalement satisfaisante au Gabon. Les efforts du gouvernement se poursuivent pour parachever le programme d’équipement du pays en structures sanitaires, de manière à ce que tout habitant soit à moins de dix minutes d’une formation sanitaire pour le niveau primaire, moins de trente minute pour le niveau secondaire et moins d’un heure pour le niveau tertiaire.

Le problème principal est celui des gaps quantitatifs et qualitatifs en ressources humaines dans les établissements de soins, et celui du renouvellement des plateaux techniques dans les formations sanitaires du premier niveau. L’accès financier aux soins a été considérablement amélioré grâce à la CNAMGS, qui est à ce jour l’outil majeur d’achèvement du programme d’accès aux soins de qualité pour tous.

Cadre organisationnel de la couverture universelle

Cartographie de la santé et couverture géographique

Stratégie de financement des soins de santé en vue de la couverture universelle

Autres initiatives en vue de la couverture universelle

Obstacles à l'accès aux services de santé

Notes de fin: sources, méthodes, abréviations, etc.

Gambia

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Analytical summary

In the Gambia, the mission of the health sector as stated in the National Health Policy 2012–2020 is to "promote and protect the health of the population through the equitable provision of quality health care". The private sector, nongovernment organizations and faith-based organizations also play a vital role in the delivery of health services with a view to complementing the Government of the Gambia's effort in this direction. These joint efforts result in increased access to health services in nearly every community in the country.

The health and health-related laws and acts are designed to regulate or influence outcomes in service delivery. Enforcement of these regulations often poses a challenge due to lack of delineation of functions between the Ministry of Health and Social Welfare and the various professional councils.


Organizational framework of universal coverage

Health mapping and geographical coverage

Health financing strategy towards universal coverage

Other initiatives towards universal coverage

Barriers on access to health services

Endnotes: sources, methods, abbreviations, etc.

Democratic_Republic_of_the_Congo

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Résumé analytique

Cadre organisationnel de la couverture universelle

Cartographie de la santé et couverture géographique

Stratégie de financement des soins de santé en vue de la couverture universelle

Autres initiatives en vue de la couverture universelle

Obstacles à l'accès aux services de santé

Notes de fin: sources, méthodes, abréviations, etc.

Ethiopia

The Alma-Ata Declaration signatories noted that health for all would contribute to a better quality of life and also to global peace and security. Although circumstances both within and outside the health sector contribute to the health status of the population, timely access to health services is considered key in promoting and sustaining society’s health.

Thus, in 2005 with the goal of universal coverage WHO Member States committed to developing health financing systems so that all people have access to service without out-of-pocket financial burden.[1]

Eritrea

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Analytical summary

Organizational framework of universal coverage

Health mapping and geographical coverage

Health financing strategy towards universal coverage

Other initiatives towards universal coverage

Barriers on access to health services

Endnotes: sources, methods, abbreviations, etc.

Equatorial_Guinea

The English content will be available soon.

Le financement par le système d'assurance

L’Institut National de Sécurité Sociale (INSESO) c’est le seul gérant et administrateur de la sécurité sociale en Guinée Equatoriale. Comme l'un des avantages du Système de Sécurité Sociale (RSS) pour cela, la Loi sur la sécurité sociale fournit des services de soins de santé en fournissant des soins médicaux et pharmaceutiques, d'hospitalisation et de réadaptation, et de la gestion et la sécurisation de ces prestations aux assurés, il est le INSESO, à cet effet, ont assez d'hôpitaux avec des équipements appropriés et le personnel médical approprié.

Il a été signé un accord avec le MINISABS. l INSESO couvrent le Les soins de santé des travailleurs dans les secteurs public et privées, membres de la famille reconnue par l’INSESO, les retraités et leurs familles. Les services sont offerts par la maladie commune ou professionnelle, de maternité, accident de en générale. Les soins médicaux dispensés le même paquet de service standard pour tous les assurés, ce qui assure l'équité dans l'utilisation des services. actuellement L'INSESO couvre 3,7% de la population en général.

Côte_d'Ivoire

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Résumé analytique

Cadre organisationnel de la couverture universelle

Cartographie de la santé et couverture géographique

Stratégie de financement des soins de santé en vue de la couverture universelle

Autres initiatives en vue de la couverture universelle

Obstacles à l'accès aux services de santé

Notes de fin: sources, méthodes, abréviations, etc.

Uganda

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.


This section on Universal coverage is structured as follows:

Analytical summary

Queen Elizabeth Park

Uganda has a strategy of free health care in publicly owned health units. However, these units experience shortages of supplies and staff, resulting in many seeking care in private units with user fees. The net effect is lack of protection and catastrophic health expenses.

The proposed national health insurance scheme is one of the financing mechanisms to increase universal coverage.

The high geographical coverage of health units is one of the country's strategies to achieve universal coverage.


Organizational framework of universal coverage

Health mapping and geographical coverage

Health financing strategy towards universal coverage

Other initiatives towards universal coverage

Barriers on access to health services

Endnotes: sources, methods, abbreviations, etc.

Togo

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Tanzania

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Mauritania

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Mali

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Malawi

One of the core objectives of the health sector in Malawi is to ensure that all Malawians have access to basic health services, especially in the rural areas. The Ministry of Health has made a policy commitment to institute service-level agreements with other service providers such as the Christian Health Association of Malawi and Banja la Mtsogolo, a nongovernmental organization, as one of the strategies to improve access to health services, especially by the rural poor.

Specific regulator frameworks have been put in place to ensure that all Malawians have access to basic health services, especially in rural areas. A Memorandum of Understanding has been signed between the Government of Malawi, represented by the Ministry of Health, and the Christian Health Association of Malawi secretariat while a service-level agreement has been signed between district health officers and proprietors of health facilities.

Mozambique

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Madagascar

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Lesotho

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Liberia

Physical access to primary health care has improved dramatically across Liberia, from one health facility serving an average of 8000 population in 2006 to one health facility per 5500 population in 2009. In several counties, namely Bomi, Grand Cape Mount, Grand Kru, River Cess and Sinoe, this ratio is below one per 4000 population. The national average ratio of facilities to served population is already lower than the norm established by the Basic Package of Health Services.

In light of the registered expansion of physical access to health care facilities (see figure), the inadequate coverage of immunization services is a matter of concern. It improved from 39% of fully immunized children in 2007 to 52% in 2010, but remains low. Most south-eastern counties present a lower than average coverage.

Congo

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Descriptive summary

The use of health services is average. This situation is strongly influenced by socioeconomic status of households and image of health facilities as perceived by households. The low purchasing power explains the use of self-medication as first-line (46%) of household heads, the health facility involved in second-line (26.7%). In CSI, the average utilization rate of curative consultation is 0.3 new cases per inhabitant per year in urban areas and 0.18 new cases in rural areas; utilization of prenatal care, is is around 54.3%, the coverage rate of consultation with children under 5 years is equal to 52.5% in rural areas and 35% in urban areas, the coverage rates achieved for antigens of reference are respectively 65.4% for DTC3P3, and 66.5% for TT2 in 2005. Overall, the use of CSI remains low because of frequent stock outs of essential drugs generic information of the sub-communities on health initiatives and weaknesses in the supervision and monitoring activities.

AFRO

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services


Click here to access the statistical fact sheets on health systems.

Mauritius

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Niger

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Swaziland

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.


This section on Universal coverage is structured as follows:

Analytical summary

Health care service delivery is set out to be in an integrated manner in all health facilities, ranging from treatment of common ailments to disease control, antenatal care, care of the sick child to immunization and other preventive care. It was meant to ensure that there would be no missed opportunities.

This has presented special challenges in terms of the need for health workers with generalist skills, especially at health centre and regional levels. The eight kilometre radius set out to promote universal access to health care has been achieved in the country but the accepted WHO standard of five kilometres has not been reached.


Organizational framework of universal coverage

Health mapping and geographical coverage

Health financing strategy towards universal coverage

Other initiatives towards universal coverage

Barriers on access to health services

Endnotes: sources, methods, abbreviations, etc.

South_Sudan

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Sierra_Leone

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.


This section on Universal coverage is structured as follows:

Analytical summary

Universal coverage aims to achieve population coverage through universal pooled funding. This is an important objective of most health systems and requires provision of comprehensive preventive and curative care, free at point of delivery to the entire population. This definition implies two dimensions of coverage: breadth and depth.

Breadth refers to the proportion of the population receiving access to the package. Depth refers to the extent of the services that are covered. In almost all societies, even those that are considered wealthy, there is some trade-off between breadth and depth.

At this stage of development, universal coverage for a comprehensive package of services for the majority of the population of Sierra Leone is not achievable. However, other initiatives exist towards universal coverage.


Organizational framework of universal coverage

Health mapping and geographical coverage

Health financing strategy towards universal coverage

Other initiatives towards universal coverage

Barriers on access to health services

Endnotes: References, sources, methods, abbreviations, etc.

  1. Health systems financing. The path to universal coverage (pdf 2.82Mb) Geneva, World Health Organization, 2010

South_Africa

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Senegal

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Seychelles

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Sao_Tome_and_Principe

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Nigeria

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Rwanda

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

3.11.1 Analytical summary
3.11.2 Organizational framework of universal coverage
3.11.2.1 Overview of main actors and arrangements related to universal coverage
3.11.2.2 Specific regulatory framework
3.11.3 Health mapping and geographical coverage
3.11.4 Health financing strategy towards universal coverage
3.11.4.1 Breadth – extending the target population
3.11.4.2 Depth – expanding the package of services
3.11.4.3 Height – reinforcing protection against financial risk
3.11.4.4 Transversal challenges of universal health financing
3.11.5 Other initiatives towards universal coverage
3.11.6 Barriers on access to health services

Namibia

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.


This section on Universal coverage is structured as follows:

Analytical summary

The public and private not‐for‐profit health‐care system serves 85% of the Namibian population and is accessed by the lower income population. The private for‐profit health‐care system serves the remaining 15% of the population, consisting of the middle and high income groups.

Organizational framework of universal coverage

Overview of main actors and arrangements related to universal coverage

The 2008 HSSR recommended a feasibility study for universal coverage (free health services through universal insurance scheme), which is one of the principles of the government’s Primary Health Care approach to public health.

Zambia

People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.


This section on Universal coverage is structured as follows:

Analytical summary

Access by the population to quality social and health services has been an area of concern for successful Zambian Governance since ninepence in 1964. Public health infrastructures have been progressively brought closer to the population, while decentralization policies were aimed at giving them ownership on their health services. Different health financing systems have been tested, resulting today in an increasing tendency towards the provision of free or highly subsidized health services.


Organizational framework of universal coverage

Overview of main actors and arrangements related to universal coverage

Coverage of the health and other social needs of the population has been a driving force in successive Zambian political orientations since the independence.

As from 1964, Zambia set out on a mission to expand access to health care services, education and other social services and reduce social inequities. The main focus at that time was to promote employment and to facilitate the expansion of health services, education and other social services on a free of charge basis. This Socialist-oriented held the power power from 1964 to 1991. Major successes were achieved, particularly in infrastructure development at all the levels, including primary level, health, educational and transport and communication infrastructure, thanks to maintained political will and a strong economy boasted by high international copper prices

However, the situation deteriorated during the 1970s and 1980s, mainly due to major economic crisis precipitated by the drop in copper prices, the mainstay of the economy. This led to reduced investments at all levels of health services, especially primary level, and deteriorations in standards of living of the general population.

In 1991, multi-party politics were reintroduced and the economy turned towards a free market system. Since then, Zambia has been implementing major socio-economic reforms. By that time, significant deterioration in health services had been observed, with resource allocation to the health sector dropping from US$26 per capita in the 1970s to US$6 in the 1990s. The main focus of the health sector has been on equity of access to health care services, as close to the family as possible.

The major policy reforms passed since 1991 in relation to the concept of universal health coverage in Zambia include:

  • 1995 – National Health Services Act passed. Willingness to raise the voice of the population in the management of health services through the decentralization of health services;
  • 1995 - User fees introduced in the health sector following Alma Ata and Bamako declarations. Also introduced in other social sectors, such as education. Exemption of some categories of the population from paying for health services, including children, the aged and military personnel;
  • 2005 – Second phase of major restructuring of health sector. Reduction in the decentralisation of powers, through the dissolution of health management boards;
  • 200X - Basic education services are decreed free, before health services. Extended in 2009;
  • 2006 - Removal of user fees for health centres and district hospitals in rural areas, extended to peri-urban areas in 2007;
  • 2008-2009 - Draft Health care Financing Policy and Social Health Insurance (SHI) scheme developed. Finalisation planned for late 2009 or early 2010;

Nowadays, universal coverage issues are discussed (together with other health system issues) in the existing coordination forums at national and decentralized level. The long-lasting coordination with partners and SWAp arrangements has certainly contributed to set the issues of universal coverage and equity high on the Zambian agenda. Progresses in the field of equity are also being made within these institutions to allow the voice of a diversity of actors in the governance on health issues. For example, SWAp bodies are progressively getting extended to include previously excluded players, such as the NGOs and grassroot organization.

There are also a number of other mechanisms to make the demands of the population heard regarding inequities and coverage failures: (1) the planning cycle developed through the reforms provides a decent opportunity to decentralized level, including the population, to raise their voice in the national policy debate; (2) traditional leaders are becoming more and more active in claiming the rights to social services for their populations, due partly to the decisive influence they may have on local votes in national elections; (3) churches also play an important role in passing on the communities’ complaints to the related authorities (the Catholic Commission for Justice and Peace is one such important church institutions in advocating and promoting peace and social justice); (4) finally, a number of Non-Governmental Organisations (NGOs) and Community Based Organisations (CBOs) are also specialized in advocacy for health-related and other social problems and are having increasing influence in the course of liberalization of Zambia.

Zambia benefits from a significant set of information sources to measure inequities and coverage failures. As discussed in the chapter on Health Information System, recent reforms in the HMIS allow for detailed socio-economic analyses by age, gender, socio-economic status, etc. In addition, a number of reports and surveys (DHS, ZSBS, MIS, LCMS) provide additional information. Institutional arrangements within the MOH and with partners at central level allow for optimal use of this information in decision-making and policy formulation processes, including universal coverage issues.


Health mapping and geographical coverage

The total population of Zambia is estimated at approximately 12 million people, comprising of 40% urban and 60% rural populations. According to the xxxxx survey, approximately xxx% of the total population have access to decent health care, representing xxx% of the urban and xxx% of the rural populations. As a result of this failure in achieving the desirable levels in universal coverage, some people resort to seeking health services from sub-standard unauthorised providers, which endangers their lives.

The country face a number of issues regarding geographical coverage. The overall problem relies in an uneven repartition of health infrastructures, personnel and other inputs between urban and rural areas, and between provinces (Lusaka and Copperbelt being significantly advantaged).

More particularly, the poor state of transport and communication infrastructure, especially for rural areas, presents a major challenge. Even though the government has already mapped and defined the types and numbers of health facilities needed for each district, the available facilities are inadequate. Further, some facilities are considered as inappropriate by the patients (e.g. mothers delivering at home due to the absence of mothers’ waiting shelters that meet their standards). The country has also continued to face a critical shortage of qualified health workers, with only about 52% of the total number of health workers needed. The rural areas are worst affected, due to inequitable distribution of the available health workers. Though the Joint Annual Review 2008 observed that there were significant improvements in the availability and distribution of essential drugs and other pharmaceuticals, it also pointed out that there were still shortages being experienced in some parts. This again, is more prevalent in rural areas.

The government has undertaken several measures and developed strategies aimed at dealing with these challenges to geographical coverage. These include:

  • Scaling up of infrastructure development in health, transport and communication, and education;
  • Strengthening of partnership with the faith-based health sector under the Churches Health Association of Zambia (CHAZ) (now accounting for approximately 30% of total national health services and approximately 60% in rural areas);
  • Promotion of outreach operations, conducted by health facilities, the Zambia Flying Doctor Service and specific disease based programmes, as a strategy to compensate the gap of primary health care services.
  • Strengthening of the community health worker strategy for provision of basic health care services, including maternal health in communities; and
  • Continuous efforts to develop primary health care services at all level of the health system.


Health financing strategy towards universal coverage

At present time (2009), there is no formal Health Care Financing policy. A draft had been prepared in 2003, updated in 2008, but not amended yet.

In these conditions, one cannot draw with certainty the vision defended by the MOH and its partners regarding health financing options towards universal coverage, and its implication in terms of extension of the target population, package of services and social protection (see the following subheadings).

Officially, user fees are still in application in the health sector. Yet, the population benefits from so many subsidy mechanisms from the government and partners that user fees tend to narrow down to some lump sum payments in urban health facilities. There are actually a variety of exemption options:

  • Some important groups of the population (under five, elderly) benefits from free services for years;
  • The entire population gets a selection of services for free or at nominal fees under the Basic Health Care Package policy[1];
  • Health services are free in health centres and district hospital located in rural and peri-urban areas (representing about xxx% of the population), since the two successive waves of user free removal in 2006 and 2007. The early results of this strategy have been the subject of an evaluation in late 2008 utilized during the Joint Annual Review[2].
  • Some additional forms of characteristic free services come in addition (for the militaries, etc.).
  • All other services are subject to partial subsidy and only invoiced through a lump sum mechanism.


A strategy of Social Health Insurance is currently being discussed, and is supposed to be finalized by late 2009 and soon piloted (see the 2008 SHI Actuarial Report).

In line with the stated vision of the MOH to bring health services “as close to the family as possible” it is very likely that the government will adopt some form of strategy towards universal coverage at a certain stage. Yet, in the absence of health financing policy, what this strategy will be is still to be defined.

It seems, according to early works around the Health care financing policy under preparation, that insurance mechanisms would be the preferred option with extension of the forthcoming SHI for the formally-employed workers and development of community-based health insurance for the rest of the population.

As a matter of fact, in the current situation, citizens can only claim for a partial social protection for health. For instance, none of them is protected against the high out-of-pocket expenditures to be encurred at provincial or national hospital level.

In that respect, the option to progressively launch and extend insurance mechanisms, first to formal employees, and then to communities, could make sense as long as it provides a quite comprehensive protection (as Zambian citizens already enjoy some protection).

But risk pooling mechanisms are complicate process in which Zambia has virtually no experience. Beside, there might also be arguments in favour of extension of the package of already existing free services.

The subject requires further reflexion and technical guidance. In practice, the two options will imply making a choice between focusing on, strengthening and reforming two different funding sources: (1) either demand-side financing for SHI (2) or tax-based financing + donor financing for free health care services.

Breadth - extending the target population

In the absence of clear health financing policy[3], the strategy to extend the coverage of the population in Zambia is still to be defined.

See the discussion on possible options in the generic section on Health financing strategy towards universal coverage for further information.

Depth - expanding the package of services

In the absence of clear health financing policy[3], the strategy to extend the coverage of the population in Zambia is still to be defined.

See the discussion on possible options in the generic section on Health financing strategy towards universal coverage for further information.

Height - reinforcing protection against financial risk

In the absence of clear health financing policy[3], the strategy to extend the coverage of the population in Zambia is still to be defined.

See the discussion on possible options in the generic section on Health financing strategy towards universal coverage for further information.


Other initiatives towards universal coverage

Equity and universal coverage are for long high on the Zambian policy agenda, as demonstrated in the cross-sectoral National Population Policy since 1989 as discussed under specific regulatory framework, or efforts and reflexion made for more than 15 years around decentralization of decision and priority setting to the local population and health workers (see the section on decentralization of the health system)

It led to the development of actions and strategies taken in various sectors, aimed at reducing inequities and improving health and living conditions (see Social determinants for Health).

Universal coverage also means favouring cross-sector interventions. For instance, in order to counter the challenges associated with long distances and communication barriers, the Government now invest on infrastructure development plan; improvement of road conditions along the ministry of works and supply policy, and communication infrastructure with the ministry of communication and the private sector. The general policy context favouring similar interventions is discussed in the section on Policies in other sectors and intersectoral policies.


Barriers on access to health services

There are no recent specific study giving an appropriate picture of the barriers faced by patients when trying to access health services. Yet the barriers issue is acknowledged and addressed in a number of recent policy decision taken by the MOH in coordination with partners (e.g. inclusion of socioeconomic indicators in the revised HMIS, development of retentions schemes and bonding systems...)

  • The distribution of health facilities is inequitable with the country. The government has classified districts in A to D zones, C & D zones being the districts suffering from the poorest level of investment. Patients in these zones are believed to face additional barriers in accessing health facilities due to poorer health mapping, allocation of health staff, equipment, maintenance level, road conditions, etc.
  • The Zambian health financing system is characterized by a combination of specific free health care policies at lower levels (see the section on health financing in this chapter). The financial barrier to access public services is then reduced, and most out-of-pocket expenditures actually relate to paying private health services[4]. Nevertheless, user fees are applied in the public secondary and tertiary level, where services are more expensive, and could lead to catastrophic health care expenditures. This is partly compensated by a general policy of subsidized lump sum payment per episode of illness. Still, in the absence of risk- and cost-pooling mechanism, the poor undoubtedly face financial barrier in accessing hospital services, and one can not talk about any form of vertical and horizontal equity[5]. Social Insurance mechanisms are envisionned as a possible option, but early pilots (in late 2009 / early 2010) will remain focused on formally employed workers, who are less confronted to financial barriers.
  • Equity in the distribution of human resources is a key concern in Zambia. Only 50% of planned posts are covered, and poorest areas (C & D) suffer the most. Yet, since 2005, the MOH and its partners have launched a comprehensive set of measures (retention schemes, incentive schemes, bonding system, invesment on training institutions) in line with the Human Resources for Health Strategic Plan 2006-2010 (see the chapter on health workforce).
  • It seems that most health facilities manage in reasonnably covering their package of activities as defined under the Basic Health Care Package. Main failures are related to investment and budgetary issues as: (1) drug stock-outs, which is a recurrent issue related among others to insufficient government grant; (2) lack for equipment or of human resources to cover specific aspects of the package (e.g. maternal care). Problems related to the "human factor" as absenteism, under-the-table payments and other shadow practices seem to be less prevalent than in numbers of low and middle income countries.

Only few information is available about the barriers on access to health services which may be related to the patient's profile. Are some sections of the population discriminated, what are the main cultural and social barriers, does the chronic patient represent a social load for his family? It remains unclear. The 2007 Demographic and Health Survey tends to show that women have a say in household expenditures decision, which is a positive sign. Also one may guess that the population from C & D zones faces additional barriers due to poorer living conditions (and then discrimination), poor education (and then a less informed decision-making process) etc. But more research is needed on this question.


Endnotes: References, sources, methods, abbreviations, etc.

  1. The elements of the Basic Health Care Package are selected on the basis of an epidemiological analysis of those diseases and conditions that cause the highest burden of disease and death.
  2. The study was conducted with the support of the London School of Hygiene and Tropical Medicine. A first draft has been delivered in mid-2009 but is not yet ready for dissemination.
  3. 3.0 3.1 3.2 The health financing policy is under discussion since the mid-2000s and should hopefully lead to an amended policy and strategy in 2010
  4. The 2008 Public Expenditure Review has shown that 71% of patients out-of-pocket expenditures were merely allocated to private health services.
  5. The rich pays the same as the poor while he could contribute more; the ill pays more than the healthy while he is not responsible for being ill.