Gaps in universal health coverage in Malawi: a qualitative study in rural communities.
Gaps in universal health coverage in Malawi: a qualitative study in rural communities.
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DOI：
10.1186/1472-6963-14-234
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发表时间：
2014-05-22
影响因子：
2.8
通讯作者：
De Allegri M
中科院分区：
文献类型：
--
作者：
Abiiro GA;Mbera GB;De Allegri M
在撒哈拉以南非洲，全民医保改革往往采取技术官僚自上而下的办法，很少关注农村社区在确定具体背景差距以指导改革设计方面的观点。这种做法可能会影响那些不能充分满足当地需求的改革。我们的研究探讨了农村社区如何体验和定义马拉维全民健康覆盖的差距，马拉维是一个支持免费获得基本健康包（EHP）作为实现全民健康覆盖的手段的国家。我们在马拉维的六个农村社区进行了定性的横断面研究。收集的数据来自12个焦点小组讨论与社区居民和三角形与8个关键的知情人访谈与卫生保健提供者。所有受访者都是通过分层目的抽样选出的。这些材料是由三名独立的研究人员录音，完全转录和编码的。结果表明，全民健康计划创造了一种普遍的意识，即在使用时应享有免费保健。然而，答复者报告说，卫生设施分布不均，公私服务水平协议执行不力，导致人口覆盖和财政保护方面的地域不平等。大多数答复者报告说，私人设施的医疗费用和交通费用的可负担性是普遍财政保护的主要障碍。从农村马拉维人的角度来看，财政保护方面的差距主要是由公共卫生部门与供应方准入有关的障碍引起的，例如：药品、紧急服务短缺，卫生人员和设施短缺，卫生工作者态度差，距离和交通困难，以及认为卫生服务质量差。因此，在马拉维实现全民健康覆盖意味着采取适当的干预措施，以填补私营部门在财政保护方面的差距和公共部门在获得服务方面的差距，和/或建立有效的公私伙伴关系，将这两个部门完全结合起来。目前的全民医保改革需要解决具体情况下的差距，并精心设计，以避免产生一种原则上的普遍应享权利的感觉，由于背景和业务瓶颈，受益人可能无法有效地获得这种权利。
In sub-Saharan Africa, universal health coverage (UHC) reforms have often adopted a technocratic top-down approach, with little attention being paid to the rural communities’ perspective in identifying context specific gaps to inform the design of such reforms. This approach might shape reforms that are not sufficiently responsive to local needs. Our study explored how rural communities experience and define gaps in universal health coverage in Malawi, a country which endorses free access to an Essential Health Package (EHP) as a means towards universal health coverage. We conducted a qualitative cross-sectional study in six rural communities in Malawi. Data was collected from 12 Focus Group Discussions with community residents and triangulated with 8 key informant interviews with health care providers. All respondents were selected through stratified purposive sampling. The material was tape-recorded, fully transcribed, and coded by three independent researchers. The results showed that the EHP has created a universal sense of entitlements to free health care at the point of use. However, respondents reported uneven distribution of health facilities and poor implementation of public-private service level agreements, which have led to geographical inequities in population coverage and financial protection. Most respondents reported affordability of medical costs at private facilities and transport costs as the main barriers to universal financial protection. From the perspective of rural Malawians, gaps in financial protection are mainly triggered by supply-side access-related barriers in the public health sector such as: shortages of medicines, emergency services, shortage of health personnel and facilities, poor health workers’ attitudes, distance and transportation difficulties, and perceived poor quality of health services. Moving towards UHC in Malawi, therefore, implies the introduction of appropriate interventions to fill the financial protection gaps in the private sector and the access-related gaps in the public sector and/or an effective public-private partnership that completely integrates both sectors. Current universal health coverage reforms need to address context specific gaps and be carefully crafted to avoid creating a sense of universal entitlements in principle, which may not be effectively received by beneficiaries due to contextual and operational bottlenecks.
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影响因子：
3.3
作者：
Agyepong, Irene Akua;Nagai, Richard A.
通讯作者：
Nagai, Richard A.
DOI：
10.2471/blt.06.033167
发表时间：
2007-08-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Kemp, Julia R;Mann, Gillian;Squire, Stephen Bertel
通讯作者：
Squire, Stephen Bertel
影响因子：
3.2
作者：
Baltussen, RMPM;Yé, Y;Sauerborn, RS
通讯作者：
Sauerborn, RS
影响因子：
3.2
作者：
Borghi, Josephine;Mtei, Gemini;Ally, Mariam
通讯作者：
Ally, Mariam
影响因子：
3.2
作者：
Jacobs, Bart;Ir, Por;Van Damme, Wim
通讯作者：
Van Damme, Wim