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Beau Wright
Beau Wright

Towards Universal Health Care In Emerging Economies: Opportunities And Challenges (Social Policy In [2021]

As a foundation for and way to move towards UHC, WHO recommends reorienting health systems to primary health care (PHC). PHC enables universal, integrated access in everyday environments to the full range of quality services and products people need for health and well-being, thereby improving coverage and financial protection. Most (90%) essential UHC interventions can be delivered through PHC and there are significant cost efficiencies in using an integrative PHC approach. Some 75% of the projected health gains from the SDGs could be achieved through PHC, including saving over 60 million lives and increasing average global life expectancy by 3.7 years by 2030.

Towards Universal Health Care in Emerging Economies: Opportunities and Challenges (Social Policy in


As a foundation for UHC, WHO recommends reorienting health systems towards primary health care (PHC). In countries with fragile health systems, WHO focuses on technical assistance to build national institutions and service delivery to fill critical gaps in emergencies. In more robust health system settings, WHO drives public health impact towards health coverage for all through policy dialogue for the systems of the future and strategic support to improve performance.

In addition to the growing movement to incorporate health impact/outcome considerations into non-health policy areas, there are also emerging efforts to address non-medical, social determinants of health within the context of the health care delivery system. These include multi-payer federal and state initiatives, Medicaid initiatives led by states or by health plans, as well as provider-level activities focused on identifying and addressing the non-medical, social needs of their patients.

a. They will be voluntary and country-led, will take into account different national realities, capacities and levels of development and will respect policy space and priorities. As national ownership is key to achieving sustainable development, the outcome from national level processes will be the foundation for reviews at regional and global levels, given that the global review will be primarily based on national official data sources.b. They will track progress in implementing the universal Goals and targets, including the means of implementation, in all countries in a manner which respects their universal, integrated and interrelated nature and the three dimensions of sustainable development.c. They will maintain a longer-term orientation, identify achievements, challenges, gaps and critical success factors and support countries in making informed policy choices. They will help mobilize the necessary means of implementation and partnerships, support the identification of solutions and best practices and promote coordination and effectiveness of the international development system.d. They will be open, inclusive, participatory and transparent for all people and will support the reporting by all relevant stakeholders.e. They will be people-centred, gender-sensitive, respect human rights and have a particular focus on the poorest, most vulnerable and those furthest behind.f. They will build on existing platforms and processes, where these exist, avoid duplication and respond to national circumstances, capacities, needs and priorities. They will evolve over time, taking into account emerging issues and the development of new methodologies, and will minimize the reporting burden on national administrations.g. They will be rigorous and based on evidence, informed by country-led evaluations and data which is high-quality, accessible, timely, reliable and disaggregated by income, sex, age, race, ethnicity, migration status, disability and geographic location and other characteristics relevant in national contexts.h. They will require enhanced capacity-building support for developing countries, including the strengthening of national data systems and evaluation programs, particularly in African countries, LDCs, SIDS and LLDCs and middle-income countries.i. They will benefit from the active support of the UN system and other multilateral institutions.

The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and deliver culturally competent services. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.(1) A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities. Examples of strategies to move the health care system towards these goals include providing relevant training on cultural competence and cross-cultural issues to health professionals and creating policies that reduce administrative and linguistic barriers to patient care.

The concept of social welfare refers broadly to the resources and opportunities people need to lead satisfying and productive lives (Midgley & Livermore, 2009). Virtually everything the government does affects social welfare, from tax and national defense to education and healthcare policy, but so does government inaction; that is, the failure to respond to human need (DiNitto & Johnson, 2016). More narrowly, definitions of social welfare policy focus on policies and programs that provide income assistance and social services to those in need.

We found 14 studies that were related to legal assurance, risk pulling and financing of health service, 11 studies associated to UHC service coverage status and, 7 articles linked to government stewardship, health system and governance on health care. Constitutional provision, global support, progress on the health insurance act, decentralization of health service to the grass root level, positive trends of increasing service coverage are seen as opportunities. However, existing volunteer types of health insurance, misleading role of trade unions and high proportion of population outside the country are main challenges. The political commitment under the changing political context, a sense of national priority and international support were identified as the facilitating factors towards UHC.

Legal guarantee is the first step to move forward universal health coverage. Legal protection is possible after political commitment, policy endorsement and conceptualization of specific program. Constitutional guarantee of health service to all citizens, amendment of health insurance act, discourse on health financing policy, extension of social health insurance are the major breakthrough and possibilities but poor and volunteer type of health insurance and inadequate awareness level on risk pooling approach during illness are major challenges (Table 1).

In this study, the opportunities and factors hindering achievement of UHC in Nepal were explored. Those challenges are multidimensional. Nepal started an insurance scheme recently after a serious lobby of visionary health care professionals, international organizations and interest groups. However, small community based health insurance (CBHI) have been on the scene since 1990s providing small subsidy to people. The coverage of health insurance was small, new enrollment was limited; renewal of health insurance membership dwindled rapidly after some years of implementation. The service coverage of health care was not satisfactory. The quality of health service and financial protection were inadequate. Grass root level health workers were confused about the changing policy of government like user fee, community drug program, free health service, special health care services to minority groups, etc. and none of them ensures comprehensive package of health service with universal access.

This is a crucial time to take action for UHC in Nepal because the political system has shifted and the UN SDG is highly focused on UHC in health related goals. Of course, there are some challenges to achieving UHC but those challenges can be addressed with high level political commitment and a businesslike accountable workforce. Population coverage for quality care and financial protection would be major breakthroughs to achieve UHC. Government stewardship, support of stakeholders, policy contribution of experts can only speed up the path towards UHC in Nepal.

Social policies are more impactful on health and health outcomes than genetic endowment, individual behaviors, or access to healthcare services. There is a growing and robust body of evidence that links policy actions in four key social domains with improvements in well-being and reductions in health inequities. These domains are child and youth education and development; fair employment and decent work; social protection; and the living environment. Social policies are more impactful on health and health outcomes than genetic endowment, individual behaviors, or access to healthcare services (Carey & Crammond, 2015; Webb, 2012). Social policies that have the greatest impact on health include early childhood care and youth development; child poverty; inclusive economic investment strategies; and programs to enhance job readiness and promote fair, equitable, and safe work opportunities and conditions. See Table 1 for a select list of SDOH, potentially impactful policies, and opportunities for nurses to advocate on behalf of poor, disadvantaged, and vulnerable populations within these four policy-sensitive areas.


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