Health status and health systems financing in the MENA region: roadmap to universal health coverage.
Health status and health systems financing in the MENA region: roadmap to universal health coverage.
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DOI：
10.1186/s41256-017-0044-9
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发表时间：
2017-01-01
影响因子：
8.7
通讯作者：
Kaissi, Amer
中科院分区：
文献类型：
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作者：
Asbu, Eyob Zere;Masri, Maysoun Dimachkie;Kaissi, Amer
背景：自1990年宣布千年发展目标以来，中东和北非地区的许多国家在妇幼保健和防治传染病方面取得了一些进展。向可持续发展目标全球议程的过渡为各国在改善健康、福祉和全民健康覆盖方面取得进展带来了新的机遇。本研究概述了中东和北非地区的健康状况和卫生筹资方法及其对全民健康覆盖的影响。方法：从世界卫生组织、世界银行和联合国开发计划署的数据库和报告中提取有关社会经济、卫生支出和卫生结果的时间序列数据，并使用Stata 12统计软件进行分析。各国按照世界银行的收入类别进行分组。使用描述性统计、表格和图表来分析时间变化，并将关键变量与全球平均值进行比较。结果：在除两个中低收入国家（苏丹和也门）外的所有国家，非传染性疾病（NCDs）和伤害占残疾调整生命年的四分之三以上。风险因素（血糖升高、血压升高、肥胖和吸烟）的流行率高于全球平均水平，也高于收入群体的相应水平。大多数国家的人均卫生支出总额低于类似收入类别国家的全球平均水平。此外，人均国民生产总值的增长速度没有跟上人均GDP的增长速度。除高收入国家外，该集团中所有国家的自付支出（OOPS）都超过了灾难性支出的门槛，这意味着家庭因支付医疗保健费用而变得更穷的风险很高。结论：非传染性疾病和伤害及相关风险因素的患病率高得惊人，卫生支出低于国内生产总值和国内生产总值增长率，以及高OOPS对全民健康覆盖构成严重挑战。各国应利用多部门干预措施，制定和实施循证卫生系统融资路线图，以解决这些障碍，并朝着全民健康覆盖的目标迈进。
BACKGROUND: Since the declaration of the Millennium Development Goals (MDGs) in 1990, many countries of the Middle East and North Africa (MENA) region made some improvements in maternal and child health and in tackling communicable diseases. The transition to the global agenda of Sustainable Development Goals brings new opportunities for countries to move forward toward achieving progress for better health, well-being, and universal health coverage. This study provides a profile of health status and health financing approaches in the MENA region and their implications on universal health coverage.METHODS: Time-series data on socioeconomics, health expenditures, and health outcomes were extracted from databases and reports of the World Health Organization, the World Bank and the United Nations Development Program and analyzed using Stata 12 statistical software. Countries were grouped according to the World Bank income categories. Descriptive statistics, tables and charts were used to analyze temporal changes and compare the key variables with global averages.RESULTS: Non-communicable diseases (NCDs) and injuries account for more than three quarters of the disability-adjusted life years in all but two lower middle-income countries (Sudan and Yemen). Prevalence of risk factors (raised blood glucose, raised blood pressure, obesity and smoking) is higher than global averages and counterparts by income group. Total health expenditure (THE) per capita in most of the countries falls short of global averages for countries under similar income category. Furthermore, growth rate of THE per capita has not kept pace with the growth rate of GDP per capita. Out-of-pocket spending (OOPS) in all but the high-income countries in the group exceeds the threshold for catastrophic spending implying that there is a high risk of households getting poorer as a result of paying for health care.CONCLUSION: The alarmingly high prevalence of NCDs and injuries and associated risk factors, health spending falling short of the GDP and GDP growth rate, and high OOPS pose serious challenges for universal health coverage. Using multi-sector interventions, countries should develop and implement evidence-informed health system financing roadmaps to address these obstacles and move forward toward universal health coverage.