Measuring progress towards Sustainable Development Goal 3.8 on universal health coverage in Kenya
Measuring progress towards Sustainable Development Goal 3.8 on universal health coverage in Kenya
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DOI：
10.1136/bmjgh-2018-000904
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发表时间：
2018-05-01
影响因子：
8.1
通讯作者：
McIntyre, Di
中科院分区：
文献类型：
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作者：
Barasa, Edwine;Nguhiu, Peter;McIntyre, Di
将全民健康覆盖作为一项与卫生相关的可持续发展目标，巩固了其作为全球卫生重点的地位。我们的目标是为肯尼亚制定全民健康覆盖的综合衡量标准，并跟踪该国2003年至2013年的进展情况。方法通过计算全民健康覆盖（SC）和财务风险保护（FRP）两个维度指标的几何平均值，构建全民健康覆盖综合指数。SC指标被计算为预防和治疗指标的几何平均值，而财务保护指标被计算为灾难性医疗保健支出发生率和医疗保健支付的贫困化效应指标的几何平均值。我们分析了两次全国代表性家庭调查的三波数据。结果SC的加权汇总指标从2003年的27.65%（27.13% ~ 28.14%）上升到2013年的41.73% (41.34% ~ 42.12%)，FRP的加权汇总指标从2003年的69.82%（69.11% ~ 70.51%）下降到2013年的63.78%（63.55% ~ 63.82%）。在这两个指标中都观察到不公平现象。全民健康覆盖的加权汇总指标从2003年的43.94% （95% CI 43.48%至44.38%）增加到2013年的51.55% （95% CI 51.29%至51.82%）。肯尼亚在实现全民健康覆盖方面存在重大差距。为实现这一目标，必须进行有针对性的卫生筹资和其他卫生部门改革。这些改革应同时关注全民健康覆盖的两个方面，而不是只关注其中一个方面。
Background The inclusion of universal health coverage (UHC) as a health-related Sustainable Development Goal has cemented its position as a key global health priority. We aimed to develop a summary measure of UHC for Kenya and track the country's progress between 2003 and 2013.Methods We developed a summary index for UHC by computing the geometrical mean of indicators for the two dimensions of UHC, service coverage (SC) and financial risk protection (FRP). The SC indicator was computed as the geometrical mean of preventive and treatment indicators, while the financial protection indicator was computed as a geometrical mean of an indicator for the incidence of catastrophic healthcare expenditure, and the impoverishing effect of healthcare payments. We analysed data from three waves of two nationally representative household surveys.Findings The weighted summary indicator for SC increased from 27.65% (27.13%-28.14%) in 2003 to 41.73% (41.34%-42.12%) in 2013, while the summary indicator for FRP reduced from 69.82% (69.11%-70.51%) in 2003 to 63.78% (63.55%-63.82%) in 2013. Inequities were observed in both these indicators. The weighted summary measure of UHC increased from 43.94% (95% CI 43.48% to 44.38%) in 2003 to 51.55% (95% CI 51.29% to 51.82%) in 2013.Conclusion Significant gaps exist in Kenya's quest to achieve UHC. It is imperative that targeted health financing and other health sector reforms are made to achieve this goal. Such reforms should be focused on both, rather than on only either, of the dimensions of UHC.