Challenges and Opportunities for Universal Health Coverage in South Asia: A Scoping Review.

Abstract

With a significant proportion of the population facing considerable deficits in access to health care and financial protection, progress toward universal health coverage (UHC) continues to be a challenge in South Asia. The objective of this scoping review is to examine the challenges and opportunities for UHC in South Asia. We used the six-stage Arksey and O'Malley methodological framework for investigation and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist to structure and report the review. A systematic search retrieved 2776 records from three databases and 13 gray literature sources, of which 27 records were reviewed. Frequently emerging challenges include underfunding of the health system, the nascent stage or inadequate coverage of the social protection or insurance system, fragmentation in the health system, the inability to effectively regulate the private sector, a health system that is unprepared to effectively address non-communicable diseases, and concerns about the quality of and equality of access to health care. While a diversity of challenges, mostly driven by the country-specific context, continue to falter progress toward UHC in the South Asia region, several consistent themes emerge. Considering this as an initial attempt to map the existing literature, we recommend future research to examine how the challenges and priorities evolve over time.