Beyond UHC: Monitoring Health and Social Protection Coverage in the Context of Tuberculosis Care and Prevention
Beyond UHC: Monitoring Health and Social Protection Coverage in the Context of Tuberculosis Care and Prevention
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DOI：
10.1371/journal.pmed.1001693
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发表时间：
2014-09-01
期刊：
影响因子：
15.8
通讯作者：
Raviglione, Mario
中科院分区：
文献类型：
--
作者：
Loennroth, Knut;Glaziou, Philippe;Raviglione, Mario
结核病（TB）仍然是一个主要的全球公共卫生问题。在所有社会中，这种疾病对最贫穷的人的影响最严重。世卫组织制定了一项新的2015年后全球结核病战略，其中明确强调了全民健康覆盖和社会保障的关键作用。其中一个拟议的目标是，无结核病影响的家庭因结核病而承受灾难性的代价。高昂的直接和间接护理费用阻碍了获得治疗，增加了结核病治疗效果不佳的风险，加剧了贫困，并助长了结核病的持续传播。UHC通常被定义为获得卫生保健，而不会因自付卫生保健支出而面临经济困难的风险，它对于有效和公平的结核病护理和预防至关重要，但还不够。社会保障干预措施也很重要，可以预防或减轻与结核病相关的其他财务风险，包括收入损失和非医疗支出，如交通和食品支出。我们提出了一个监测卫生和社会保障覆盖率及其对结核病流行病学影响的框架。我们描述了关键指标，并审查方法上的考虑。我们表明，虽然监测一般卫生保健的可及性对于跟踪结核病服务提供的卫生系统环境很重要，但结核病可及性、质量和财务风险保护的具体指标也可以作为公平敏感的跟踪指标，用于跟踪总体可及性和社会保障的进展和实现。
Tuberculosis (TB) remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC) and social protection. One of the proposed targets is that No TB affected families experience catastrophic costs due to TB. High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection.