Background
Methods
Results
Equity in key global UHC reports and policy documents
Document No. | Source | Title | # pages | # occurrences “equit*” | # occurrences “equal*” | # occurrences “disparit*” | Levels of equity considered | Types of inequity considered (stratifiers) | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Broadly speaking/ undefined | Social determinants and/or health behaviours and/or risk factors | Health outcomes | Health systems and/or policies and/or distribution of resources/funds/expenditure | Access to (quality) healthcare/services and/or coverage and/or use of services | Funding/ financing (contribution) | Financial protection (access) and/or benefit entitlement and/or risk equalisation | Across countries | Income/ wealth/ poverty | Education | Undefined / other socio-economic aspects (e.g. occupation, financial protection schemes) | Geographic: regions and/or urban/rural | Gender | Age | Culture/ ethnicity/ religion/ migrants | |||||||
G1 | WHO 2008 | World Health Report 2008: Primary health care: Now more than ever [2] | 148 | 168 | 82 | 5 | x | x | x | x | x | x | x | x | x | x | x | x | x | x | |
G2 | WHO 2010 | World Health Report 2010: Health Systems Financing: The path to universal coverage [30] | 128 | 41 | 32 | 1 | x | x | x | x | x | x | x | x | x | x | x | ||||
G3 | WHO 2013 | World Health Report 2013: Research for Universal Health Coverage [31] | 168 | 27 | 1 | 0 | x | x | x | x | x | ||||||||||
G4 | WHO 2013 | Arguing for Universal Health Coverage [32] | 40 | 23 | 2 | 0 | x | x | x | x | x | x | x | x | |||||||
G5 | WHO 2013 | Universal Health Coverage: Supporting Country Needs [33] | 12 | 9 | 7 | 0 | x | x | x | x | x | x | x | x | x | x | |||||
G6 | WHO & WB 2013 | Background document Towards UHC: concepts, lessons and public policy challenges [34] | 4 | 2 | 3 | 0 | x | x | x | x | |||||||||||
G7 | WB 2013 | The Impact of Universal Coverage Schemes in the Developing World [35] | 151 | 21 | 9 | 0 | x | x | x | x | |||||||||||
G8 | Rockefeller Foundation, Save the Children, UNICEF and WHO 2013 | Universal Health Coverage: A Commitment to Close the Gap [36] | 84 | 373 | 26 | 4 | x | x | x | x | x | x | x | x | x | x | x | x | x | x | x |
G9 | WHO & WB 2014 | Monitoring progress towards universal health coverage at country and global levels – Framework, measures and targets [25] | 14 | 20 | 0 | 0 | x | x | x | x | x | ||||||||||
G10 | ILO 2014 | Universal Health Protection: Progress to date and the way forward [29] | 130 | 52 | 20 | 0 | x | x | x | x | x | x | x | x | x | x | x | ||||
G11 | WB 2013 | Going Universal – How 24 Developing Countries Are Implementing Universal Health Coverage Reforms from the Bottom Up [37] | 289 | 51 | 27 | 0 | x | x | x | x | x | x | x | x | x | ||||||
G12 | WHO/ regional office for Africa 2015 | The African Health Monitor Special issue: Universal Health Coverage [38] | 76 | 51 | 6 | 5 | x | x | x | x | x | x | |||||||||
G13 | WHO & WB 2015 | Tracking universal health coverage: first global monitoring report [1] | 98 | 35 | 22 | 11 | x | x | x | x | x | x | x | x | x | x | x | x | |||
G14 | WHO 2016 | Health financing country diagnostic: a foundation for national strategy development [39] | 58 | 62 | 22 | 0 | x | x | x | x | x | x | x | ||||||||
G15 | WHO 2016 | Public Financing for Health in Africa: from Abuja to the SDGs [40] | 92 | 12 | 1 | 0 | x | x | x | x | |||||||||||
G16 | WHO 2017 | Global Report: New Perspectives on Global Health Spending for Universal Health Coverage [41] | 40 | 4 | 2 | 0 | x | x | x | x | |||||||||||
G17 | WHO 2017 | Together on the road to universal health coverage – a call to action [42] | 38 | 9 | 10 | 0 | x | x | x | x | x | x | x | ||||||||
G18 | WHO 2017 | Developing a national health financing strategy: a reference guide [43] | 44 | 20 | 2 | 0 | x [UHC intermediate obj.] | x [final coverage goal] | x | x [final coverage goal] | x | x | |||||||||
G19 | WHO & WB 2017 | Tracking universal health coverage: 2017 global monitoring report [43] | 88 | 12 | 43 | 0 | x | x | x | x | x | x | x | x | x | ||||||
G20 | WHO/Regional Office for Africa 2017 | The state of health in the WHO African Region: an analysis of the status of health, health services and health systems in the context of the SDGs [44] | 184 | 38 | (8)* | 2 | x | x | x | x | x | x | x | x | |||||||
Total (out of 20 documents): | 12 | 7 | 7 | 13 | 18 | 12 | 14 | 7 | 15 | 5 | 12 | 13 | 10 | 4 | 6 |
Document no. | Source | Title | Explicit definition of equity? | How equity is approached in the document |
---|---|---|---|---|
C1 | WHO 2008 | World Health Report 2008: Primary health care: Now more than ever [2] | No | - Chapter 1 “The challenges of a changing world” devotes a section to the “Changing values and rising expectations” which comprises a subsection on “Health equity” - Equity is a central concern of Chapter 2 “Advancing and sustaining universal coverage”, especially in the following sections: “The central place of health equity in primary health care (PHC)” and “Mobilizing for health equity” - Among the four reforms advocated for in the report, universal coverage reforms are viewed as those that “ensure that health systems contribute to health equity, social justice and the end of exclusion, primarily by moving towards universal access and social health protection” (page ix, message of the Director General -- bold ours) - The report points to the multiple dimensions of health inequality - Associations of equity with UHC and other concepts: o The report explains the links between UHC and equity – mostly through social health protection, increasing financial access to healthcare (by contrast, out-of-pocket payments (OOPs) are denounced as inequitable) o Equity is viewed as a value driving the primary healthcare movement, together with solidarity and social justice |
C2 | WHO 2010 | World Health Report 2010: Health Systems Financing: The path to universal coverage [30] | No | - The report argues in chapter 3 that compulsory prepaid funds, if possible pooled into a single pool, enables to achieve equity goals – sometimes called equity funds - It makes the case for decisions that contribute to equity in contributions, in pooling, and in use of resources - Associations of equity with UHC and other concepts: o Equity is associated repeatedly with efficiency o It is mentioned once with fairness and basic decency |
C3 | WHO 2013 | World Health Report 2013: Research for Universal Health Coverage [31] | No | - The report has a section dedicated to “Equity and universal health coverage” - It points to the “inequitable access to the products of research” (p. 45) - Associations of equity with UHC and other concepts: o Equity is associated with cultural values, right to health and social justice as well as with discrimination o It is also associated with quantity and quality of services, and with efficiency |
C4 | WHO 2013 | Arguing for Universal Health Coverage [32] | Yes: “Equitable: does the mechanism raise funds according to people’s ability to pay and are the benefits distributed according to people’s health needs?” (p. 25) | - The document focuses on the equity of the health financing system, and provides the case for “health funding policies that promote equity, efficiency and effectiveness, and ensure that the rights of the most vulnerable are not forgotten” - It singles out out-of-pocket financing as failing badly in terms of equity and financial risk protection - Associations of equity with UHC and other concepts: o Equity is associated with efficiency and effectiveness, and (human) rights (to health) o The document considers that equity is part of UHC: “equity and financial risk protection, which are integral to achieving progress towards UHC “(p. 25); “the equity criterion fundamental to attaining UHC” (p. 27); “the equity principles that should be the foundation of any UHC strategy” (p. 32) |
C5 | WHO 2013 | Universal Health Coverage: Supporting Country Needs [33] | Yes: “Equity: If all people obtain the health services they need without suffering financial hardship, equity in access has been achieved” (p. 9) | - Associations of equity with UHC and other concepts: The document considers equity is part of UHC: “This vision of UHC embodies principles of equity in access to and use of services, quality of the services people obtain, and financial protection for people needing health services” (p. 5); UHC is not only about health but also “moving closer to UHC is also about equity, development priorities, social inclusion and cohesion” (p. 10); UHC “is a concept that is fundamentally about equity” (p. 12) |
C6 | WHO & WB 2013 | Background document Towards UHC: concepts, lessons and public policy challenges [34] | No | - The document makes the case for health financing reforms: “the objectives of universal financial protection and equity in the use of needed services are best served when health systems rely predominantly on compulsory prepaid funds” - It also makes the case for strengthening the primary level of care |
C7 | WB 2013 | The Impact of Universal Coverage Schemes in the Developing World [35] | No | - Associations of equity with UHC and other concepts: o UHC viewed as a means to increase equity o Equity associated with efficiency (and quality) |
C8 | Rockefeller Foundation, Save the Children, UNICEF and WHO 2013 | Universal Health Coverage: A Commitment to Close the Gap [36] | Yes: “inequity – unfair and avoidable inequalities” (p. 4 and later) | - Equity is a central concern of this report: “This report focuses on how and why inequity – unfair and avoidable inequalities – should be prioritised as countries progress on the path towards UHC” (p. 4): o The report refers to all types and levels of equity identified in Table 1 o Section 2 explains why equity is important for UHC o Section 3 provides a conceptual framework for assessing equity in pathways to UHC, and then lessons for equitable pathways towards UHC o Section 4 makes the economic case for equitable pathways towards UHC - The report specifies that “Within health systems, equity applies to the goals of improved health outcomes, equity in finance, financial risk protection and responsiveness, as well as the objectives of good quality and utilisation based on need” (p. 15) - Associations of equity with UHC and other concepts: o UHC viewed as a means to achieve greater equity, or “the response to” inequities (p. 6); and as necessitating consideration for equity throughout reform processes o Equity related to fairness; calls to “a moral and ethical perspective” (p. 4) |
C9 | WHO & WB 2014 | Monitoring progress towards universal health coverage at country and global levels – Framework, measures and targets [25] | No, but definition of equity indicators of coverage and financial protection | - The framework for monitoring progress towards UHC monitoring of UHC puts a focus on equity regarding the two discrete components of health system performance (coverage of health services and financial protection), and recommends that “Measures should be disaggregated by socioeconomic and demographic strata” (p. 5) - The global framework proposes three primary elements for disaggregation that can be measured comparably in all settings: household income, expenditure or wealth (coverage of the poorest segment of the population as compared with richer segments); place of residence (rural or urban); and gender (p. 6) - Each country is expected to add further measures of service coverage and further equity stratifiers in order to tailor UHC monitoring to its context (p. 10) - Recommended indicators comprise an aggregate and an equity measures - Associations of equity with UHC and other concepts: o Reckons that “At the heart of UHC is a commitment to equity” (p. 6) |
C10 | ILO 2014 | Universal Health Protection: Progress to date and the way forward [29] | No | - Mentions that OOPs are the most inequitable source of health financing (p. 2); their removal can help progress in terms of “effective and equitable access to health care, affordability and financial protection in addition to availability of quality services” (p. 6) - Refers to “inequities in legal health coverage due to political, legislative and administrative failures” (p. 2) - Has a section on “Moving towards Equity: National Social Protection Floors as a key strategy for achieving universal coverage in health” - Associations of equity with UHC and other concepts: o UHC and equity viewed as two distinct aims (p. iii) o Equity associated with human rights to social security and health and the rights-based approaches underpinning the need for equity and poverty alleviation (p. iii); with social change, poverty alleviation the elimination of deprivation (pp. 4, 47); with social justice (pp. 9, 77); with vulnerability and social exclusion (p. 37); with universality (p. 39); with solidarity (p. 66); with social fairness (p. 72); with inclusion (p. 111) o Mentions the trade-off between equity and quality of essential health services (p. 45) |
C11 | WB 2015 | Going Universal – How 24 Developing Countries Are Implementing Universal Health Coverage Reforms from the Bottom Up [37] | No | - Points repeatedly to the trade-off between equity in the benefit package and (fiscal) sustainability - Associations of equity with UHC and other concepts: o Equity repeatedly associated with “better results for the money spent” (p. xiv) / with efficiency and effectiveness o Also associated with sustainability, accessibility, quality, integration; implementability |
C12 | WHO/ regional office for Africa 2015 | The African Health Monitor Special issue: Universal Health Coverage [38] | Not in general, but vertical equity is defined as “cross-subsidization from wealthy to poor” (p. 24) | - Several chapters are focused on the equity aspects of community-based health insurance - A case study in Senegal focuses on vertical equity – and mentions that it “is likely to overlap with the “health risk” dimension of solidarity” (p. 24) - Another case study in Senegal reckons that the equity paradigm has been developed at the international level, as a consequence of financial barriers that have reduced utilisation of healthcare by the poorest (p. 63) - Associations of equity with UHC and other concepts: o Equity repeatedly associated with efficiency o Also associates equity with adequacy (of coverage) and sustainability (p. 51); with universality and solidarity (p. 59–60) o The Regional Director mentioned the “shared values of equity, dignity, transparency, integrity, professionalism and openness”; inequities also compared to injustices (p. 67) |
C13 | WHO & WB 2015 | Tracking universal health coverage: first global monitoring report [1] | No | - The first global monitoring report of UHC regret that “Because of the lack of data, it is not yet possible to compare the UHC service coverage index across key dimensions of inequality” (p. viii) - A key challenge is to monitor equity in access to quality health services (p. 4) - Associations of equity with UHC and other concepts: o The report states that “Equity is key to the SDGs in general and to UHC specifically” (p. xii) – and recalls SDG 3: Equitable health outcomes and well-being; global public health security and resilient societies (p. xiii) |
C14 | WHO 2016 | Health financing country diagnostic: a foundation for national strategy development [39] | Yes, partly: makes the distinction between different utilisations of the concept of equity (see next column) | - Specifies that “equity in the use of services refers to reducing the gap that exists between the need for a health service and the actual use of that service” (p. 3) - Defines equity in finance, which “is strongly related to the goal of financial protection, but is conceptually distinct. Equity in finance refers to the distribution of the burden of financing the health system across different socio-economic groups. To be considered equitable, the burden of health financing should be distributed according to individuals’ ability-to-pay” (p. 3) - It is distinct from equity in financing which “has to do with how revenues are raised, not with how the money is spent” (p. 23) - The report has a subsection on “Financial protection and equity in finance” (pp. 21–25) and another one on “Equity in service use and in the distribution of resources” (pp. 26–27) - It makes a distinction between equity in health finance and equity in financing: “Equity in financing has to do with how revenues are raised, not with how the money is spent . This latter issue – also highly relevant to the performance of health financing arrangements – is addressed below in the section on equity in health service use and the distribution of system resources.” - Box B2 shows a summary of key findings from previous studies on equity in financing (pp. 44–45) - Associations of equity with UHC and other concepts: o Equity is approached through the links between health financing, UHC goals and intermediate objectives – indeed, equity in service use is a UHC goal, and the distribution of resources is a UHC intermediate objective o Thus association of equity with other UHC objectives/goals: efficiency, transparency and accountability, quality, financial protection |
C15 | WHO 2016 | Public Financing for Health in Africa: from Abuja to the SDGs [40] | No | - Associations of equity with UHC and other concepts: o Equity is associated with sustainability (pp. 8, 33), quality (p. 22), efficiency (pp. 30, 33) |
C16 | WHO 2017 | Global Report: New Perspectives on Global Health Spending for Universal Health Coverage [41] | No | - Associations of equity with UHC and other concepts: o Equity is associated with social cohesion (p. 4), sustainability (p. 8) o Intends to promote “equitable progress towards UHC” (p. 29), thus differentiating the two concepts |
C17 | WHO 2017 | Together on the road to universal health coverage – a call to action [42] | No | - Associations of equity with UHC and other concepts: o Equity is associated with efficiency (p. 14), human rights (pp. 18, 20), gender equality (p. 20) |
C18 | WHO 2017 | Developing a national health financing strategy: a reference guide [43] | No | - Associations of equity with UHC and other concepts: o Considers equity in utilisation or service use relative to need as part of a normative set of goals embedded in the concept of UHC, together with financial protection and quality; equity in the distribution of health system resources as part of a set of intermediate objectives, together with efficiency, transparency and accountability (p. 1) o Equity also associated with effectiveness and the management of expenditure growth (p. 12) |
C19 | WHO & WB 2017 | Tracking universal health coverage: 2017 global monitoring report [43] | No | - Has a lot in common with the first global monitoring report on UHC as for its approach of equity (lack of data preventing comparing the UHC service coverage index across key dimensions of inequality, link with SDGs and UHC, etc.) - Associations of equity with UHC and other concepts: o The report reckons that “Unless health interventions are designed to promote equity, efforts to attain UHC may lead to improvements in the national average of service coverage while inequalities worsen at the same time” (p. viii) – therefore making a clear distinction between UHC and equity |
C20 | WHO/Regional Office for Africa 2017 | The state of health in the WHO African Region: an analysis of the status of health, health services and health systems in the context of the SDGs [44] | No | - The report highlights the inequities between the countries of the WHO African region, and also within countries - It originally mentions the inequities in the countries health security status (p. 33) - It notices the interconnection between the different levels of inequity: “These inequities in health are a result of inequities in investments in and outcomes from these investment” (p. 83) - Associations of equity with UHC and other concepts: o Equity is associated repeatedly with sustainability, efficiency and effectiveness; and once with resource adequacy (p. 71) and human rights (p. 84) o The report notices that the 2030 Agenda for Sustainable Development has “a strong focus on equity” (p. 1) o It also states that “progress towards UHC and the SDGs, particularly from the equity perspective” (p. 83), suggesting that equity is a dimension of UHC & SDGs |
Implications on country UHC policies
Document no. | Source | Title | # pages | # occurrences “equit*” | # occurrences “equal*” | # occurrences “disparit*” | Levels of equity considered | Types of inequity considered (stratifiers) | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Broadly speaking/ undefined | Social determinants and/or health behaviours and/or risk factors | Health outcomes | Health systems and/or policies and/or distribution of resources/funds/expenditure | Access to (quality) healthcare/services and/or coverage and/or use of services | Funding/financing (contribution) | Financial protection (access) and/or benefit entitlement and/or risk equalisation | Income/ wealth/ poverty | Education | Undefined / other socio-economic aspects (formal/informal, financial protection schemes) | Geographic: regions and/or urban/rural | Gender | Age | Culture/ ethnicity/ religion/ migrants | |||||||
C1 | Senegal/MoH 2009 | PNDS (NHSP) 2009–2018 [46] | 86 | 13 | 5 | 5 | x | x | x | x | x | |||||||||
C2 | Senegal/MoH 2013 | Strategic plan for the development of universal health insurance in Senegal 2013–2017 [47] | 127 | 13 | 2 | 0 | x | x | x | |||||||||||
C3 | Senegal/MoH 2017 | Sector Investment Plan 2017–2021 [48] | 25 | 2 | 4 | 0 | x | x | x | x | ||||||||||
C4 | Senegal/MoH | Strategic development plan of the Agency for universal health insurance [49] | 66 | 5 | 21 | 6 | x | x | x | x | ||||||||||
C5 | Senegal/MoH 2017 | National health financing strategy (NHFS) [50] | 33 | 16 | 7 | 6 | x | x | x | x | x | x | x | |||||||
C6 | Benin/MoH 2010 | PNDS (NHSP) 2009–2018 [51] | 96 | 6 | 5 | 7 | x | x | x | x | x | x | x | x | ||||||
C7 | Benin/MoH 2015 | National health financing strategy (NHFS) 2016–2020 [52] | 43 | 21 | 1 | 1 | x | x | x | x | x | x | x | |||||||
C8 | Benin / Government 2019 | Project document: Insurance for the strengthening of human capital (ARCH) [53] | 45 | 9 | 4 | 2 | x | x | x | x | x | |||||||||
Total (out of 8 documents): | 1 | 2 | 2 | 5 | 8 | 5 | 4 | 3 | 0 | 6 | 5 | 2 | 0 | 0 |
Document no. | Source | Title | Definition of equity? | Way equity is approached in the document |
---|---|---|---|---|
C1 | Senegal/MoH 2009 | PNDS (NHSP) 2009–2018 [46] | No | - The Plan states that more than before, equity in health service distribution and financial access (financing the demand-side) were prioritised - Strategies announced to improve equity in health service distribution: o Making a minimum healthcare supply capacity available in the regions (including creating district hospitals) o Revising the health map (norms in terms of infrastructure, equipment and personnel per level of care) to make it more ambitious in terms of supply capacities of services / ensuring a better distribution of health facilities throughout the country o Improving the resource allocation system (not further explained) - A number of measures are announced to reinforce the regulatory function of the State, including regarding issues of equity, gender, discrimination, and social protection - Associations of equity with UHC and other concepts: o Equity is viewed as a principle guiding the implementation of the NHSP, together with participation, multisectoriality, transparency, solidarity, and gender o Inequities are also associated with exclusion |
C2 | Senegal/MoH 2013 | Strategic plan for the development of universal health insurance in Senegal 2013–2017 [47] | No | - The strategic plan starts from the observation that the evolution of the country’s health system has not promoted equity in access to health care, household financial protection, and equity in health financing; however, free and subsidised healthcare initiatives have enabled to increase equity - The plan refers to the 2012 UNGA resolution on UHC which calls on each UN Member State to avoid out-of-pocket payments and to finance its health system through more equitable and supportive mechanisms - The plan intends to reform the health financing system by expanding health insurance to rural and informal sectors, through promotion of community-based health insurance (CBHI) and subsidisation of premiums for the poorest, and the creation of the National Health Solidarity Fund - Progressiveness in health financing is to be ensured through the development of information systems to scale contributions based on households’ ability to pay for health care (not further developed) - The logical framework of the plan has an impact indicator of equity of access, measured through health service utilisation rates - Associations of equity with UHC and other concepts: o The values and principles of the plan are: solidarity, equity and social justice, quality, efficiency, good governance, and partnership o Equity is viewed as a basic principle to ensure social inclusion, the inclusion of the poor and vulnerable groups, and equitable access to care |
C3 | Senegal/MoH 2017 | Sector Investment Plan 2017–2021 [48] | No | - In order to respond to unequal distribution of infrastructures throughout the country, the plan announces that its priorities were defined taking into account the gaps identified by the “health and social map” and equity criteria with a focus on high-impact interventions (without further detail) - It will give priority to two essential components: demand financing and construction of new infrastructure |
C4 | Senegal/MoH 2017 | Strategic development plan of the Agency for universal health insurance [49] | No | - The plan states that respect for equity is a fundamental element in improving access to care and reducing poverty; and it also refers to the 2012 UNGA Resolution on UHC - The plan recalls that the universal health insurance (“CMU”) policy is strongly affirmed as the strategy to ensure equitable access to quality health care without any form of exclusion for the entire population of Senegal, and that it is based on the development of mutual health insurance and the strengthening of free healthcare initiatives - One of the main strategies envisioned is support to the affiliation of the poorest (beneficiaries of social assistance programmes, including equal opportunity card holders) to CBHIs - Associations of equity with UHC and other concepts: o Equity is part of the Agency’s vision in order to fight exclusion, and of its values under the form of fair and equal treatment for every Senegalese |
C5 | Senegal/MoH 2017 | National health financing strategy (NHFS) [50] | No | - The strategy is based on a situation analysis that emphasises the inequitable distribution of resources, including human resources, especially between regions and living environments but also between levels of care - In particular, the identified obstacles to equitable access to health services are: remoteness, isolation, inadequate accommodation for persons with disabilities, high cost of health services, and lack of availability of health facilities - The compulsory contributory scheme to health insurance for employees in the private sector is also judged inequitable - The strategy reckons that the principle of equity will be clearly positioned in the criteria that support decisions on the allocation of resources in order to democratize access to health services - The strategy comprises four strategic orientations: o The first one intends to improve the availability of quality health services, with a focus on ensuring equitable access to quality health services – notably through the “densification and democratisation of the supply of health services” (revising the health and social map) o The second one intends to expand protection against health-related financial risk, also with a focus on equity through promotion of CBHIs to the rural and informal sectors, subsidisation of the contribution of the poorest, and unification of governance mechanisms of the various UHC schemes o The third one intends to target behavioural and environmental determinants of health o The fourth one intends to raise more resources, and improve their efficiency, notably through the application of budget allocation criteria (not further explained) - Associations of equity with UHC and other concepts: o Sustainable development necessitates the respect of the principles of equity and gender equality o The strategy is based on a vision of a Senegal where all populations have access to quality health services based on sustainable financing that respects the principles of equity and solidarity; the search for equity will be combined with the principle of solidarity to ensure the social inclusion of the poor and vulnerable groups in health risk coverage mechanisms |
C6 | Benin/MoH 2010 | PNDS (NHSP) 2009–2018 [51] | No | - The plan is based on a situation analysis that points to inequitable distribution of staff, as well as financial barriers that do not favour equitable access to healthcare - The plan intends to give priority to equitable financing and sound management of health expenditure - Associations of equity with UHC and other concepts: o The 2025 vision of the plan intends to ensure the permanent availability of quality, equitable and accessible healthcare services to populations of all categories, based on the values of solidarity and risk sharing |
C7 | Benin/MoH 2015 | National health financing strategy (NHFS) 2016–2020 [52] | No | - The situation analysis points to great geographical disparities – notably in the distribution of human resources – and to the fragmentation of financing schemes that lead to inequitable access to healthcare - The strategy is based on several principles linked to equity, including: equitable and easy access to quality health care at affordable costs according to needs, the availability of health care provision to the entire population, solidarity and risk sharing based on obligation and non-exclusion, and protection against financial risk; equitable sources of financing are looked for - The strategy comprises three strategic orientations: o Improve and streamline the utilisation of resources in the health sector o Implement the health insurance scheme and integrate other financial protection schemes o Guarantee that the health financing system is equitable, sustainable and predictable - Concretely, the proposed measures to improve equity are: o The revision of the Ministry of Health’s budget allocation procedures to ensure equity and efficiency; budget should be allocated on the basis of existing resources and performance, in line with and linked to resources from community funding o Populations’ contribution to the State-led health insurance scheme in function of their income (and exemption for the poorest) - Associations of equity with UHC and other concepts: o The strategy is based on the same vision as the NHSP 2009–2018; as well as on the following values: (i) accountability and leadership, (ii) equity, social justice, ethics and good governance, and (iii) effectiveness and efficiency o Equity repeatedly associated with sustainability and efficiency |
C8 | Benin / Government 2019 | Project document: Insurance for the strengthening of human capital (ARCH) [53] | Yes: see next column | - The overall objective of the ARCH project is to increase capacity and access to basic social services and economic opportunities in a sustainable and equitable way for Beninese people, especially the poorest - The project comprises 4 packages of social protection services (health insurance, training, credit and retirement) to improve the impact of programmes and equity in access to basic services - In the context of the implementation of the ARCH health insurance service, equity is approached in two respects: (i) equity of access, i.e. facilitating access for all Beninese citizens to the package of basic benefits, according to their individual health needs, and (ii) contributory (vertical) equity, which aims to involve each social stratum in the functioning of the ARCH system according to their ability to pay - Associations of equity with UHC and other concepts: o Equity associated with efficiency, economies of scale and sustainability |