Evaline Chepchirchir Langat, Paul Ward, Hailay Gesesew, Lillian Mwanri
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引用次数: 0

摘要

背景:全民医保(UHC)是全球优先事项,其目标是确保每个人都能获得高质量的医疗保健服务,而不会遭受经济困难。过去二十年来,非洲大多数国家的政府都将全民医保作为优先事项。尽管如此,非洲向全民医保的过渡仍然缓慢,某些国家面临惰性。本研究旨在考察非洲以全民医保为重点的医疗改革实施进展情况,调查所采用的方法、面临的挑战以及潜在的解决方案:方法:我们采用《系统综述和元分析的首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews)指南,对文献进行了范围界定,以找出有关非洲国家采用、推广、实施全民医保的证据、挑战和机遇。2023 年,我们对 Cochrane 系统综述数据库、PUBMED、EBSCO、Eldis、SCOPUS、CINHAL、TRIP 和 Google Scholar 进行了文献检索。利用预先确定的纳入标准,我们重点关注了非洲国家全民健康保险的采用、推广、实施以及挑战和机遇。我们纳入了主要的定性、定量和混合方法证据,以及对二手数据的原始分析。我们采用主题分析法对证据进行了综合:我们找到了 2005 年 5 月至 2023 年 12 月间发表的 9633 篇文献,其中 167 篇被纳入分析。在非洲实施的全民健康计划中,有很大一部分侧重于建立社会健康保护计划,另一些则侧重于加强初级医疗保健系统,还有一些则采取了综合方法。虽然在某些领域取得了进展,但仍然存在相当大的障碍。资金限制和供应方面的挑战,如医护人员短缺、基础设施有限、医疗用品不足等,仍然是整个非洲实施全民医保的重大障碍。一些可行的解决方案包括增加医疗保健系统的公共资金、加强公共卫生系统、确保医疗保健服务的公平性和包容性,以及加强治理和社区参与机制:在非洲成功实施全民医保需要采取多方面的方法。这包括在医疗保险计划之外加强公共卫生系统,并探索创新的融资机制。此外,应对非正规部门的挑战、医疗保健服务的不公平、确保政治承诺和社区参与,对于实现所有非洲公民可持续的全面医疗保健覆盖至关重要。
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Challenges and Opportunities of Universal Health Coverage in Africa: A Scoping Review.

Background: Universal health coverage (UHC) is a global priority, with the goal of ensuring that everyone has access to high-quality healthcare without suffering financial hardship. In Africa, most governments have prioritized UHC over the last two decades. Despite this, the transition to UHC in Africa is seen to be sluggish, with certain countries facing inertia. This study sought to examine the progress of UHC-focused health reform implementation in Africa, investigating the approaches utilized, the challenges faced, and potential solutions.

Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, we scoped the literature to map out the evidence on UHC adoption, roll out, implementation, challenges, and opportunities in the African countries. Literature searches of the Cochrane database of systematic reviews, PUBMED, EBSCO, Eldis, SCOPUS, CINHAL, TRIP, and Google Scholar were conducted in 2023. Using predefined inclusion criteria, we focused on UHC adoption, rollout, implementation, and challenges and opportunities in African countries. Primary qualitative, quantitative, and mixed-methods evidence was included, as well as original analyses of secondary data. We employed thematic analysis to synthesize the evidence.

Results: We found 9633 documents published between May 2005 and December 2023, of which 167 papers were included for analysis. A significant portion of UHC implementation in Africa has focused on establishing social health protection schemes, while others have focused on strengthening primary healthcare systems, and a few have taken integrated approaches. While progress has been made in some areas, considerable obstacles still exist. Financial constraints and supply-side challenges, such as a shortage of healthcare workers, limited infrastructure, and insufficient medical supplies, remain significant barriers to UHC implementation throughout Africa. Some of the promising solutions include boosting public funding for healthcare systems, strengthening public health systems, ensuring equity and inclusion in access to healthcare services, and strengthening governance and community engagement mechanisms.

Conclusion: Successful UHC implementation in Africa will require a multifaceted approach. This includes strengthening public health systems in addition to the health insurance schemes and exploring innovative financing mechanisms. Additionally, addressing the challenges of the informal sector, inequity in healthcare access, and ensuring political commitment and community engagement will be crucial in achieving sustainable and comprehensive healthcare coverage for all African citizens.

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期刊介绍: International Journal of Environmental Research and Public Health (IJERPH) (ISSN 1660-4601) is a peer-reviewed scientific journal that publishes original articles, critical reviews, research notes, and short communications in the interdisciplinary area of environmental health sciences and public health. It links several scientific disciplines including biology, biochemistry, biotechnology, cellular and molecular biology, chemistry, computer science, ecology, engineering, epidemiology, genetics, immunology, microbiology, oncology, pathology, pharmacology, and toxicology, in an integrated fashion, to address critical issues related to environmental quality and public health. Therefore, IJERPH focuses on the publication of scientific and technical information on the impacts of natural phenomena and anthropogenic factors on the quality of our environment, the interrelationships between environmental health and the quality of life, as well as the socio-cultural, political, economic, and legal considerations related to environmental stewardship and public health. The 2018 IJERPH Outstanding Reviewer Award has been launched! This award acknowledge those who have generously dedicated their time to review manuscripts submitted to IJERPH. See full details at http://www.mdpi.com/journal/ijerph/awards.
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