Cross-posted from the UHC Forward blog.

UHC Forward website (UHCForward.org)

UHC Forward website (UHCForward.org)

To support the efforts of countries that have committed to making substantive universal health coverage reforms, experts in many areas of financial protection must continually share in dialogue and debate.

To this end, the Results for Development Institute, in partnership with the Rockefeller Foundation, is pleased to announce the launch of UHC Forward, a new website that tracks and consolidates key health coverage information from hundreds of sources into a one-stop portal with feature news, events, and publications related to the growing global universal health coverage (UHC) movement.

The launch of UHC Forward responds to the growing global interest in the expansion of health coverage through more equitable and sustainable domestic health financing reforms. Recent examples include: the 2010 World Health Report, Health Systems Financing: The Path to Universal Coverage and the related 2011 World Health Assembly Resolution on Sustainable Health Financing Structures and Universal Health Coverage (PDF); and the recent 2010 and planned 2012 Global Symposiums on Health Systems Research, each focusing on universal coverage.

Universal Health Coverage – also referred to as Universal Coverage or Social Health Protection – is a fairer, more efficient financing mechanism that pools risk and shares health care costs more equitably across a population to improve access to services and reduce out-of-pocket costs and poverty caused by catastrophic health care expenditures.

Despite progress in some countries, close to half the world’s population must pay a hefty fee at the door before they receive health care. Many are forced to choose between paying catastrophic portions of their available income and going without needed services, perpetuating a vicious cycle of sickness and poverty.

According to the World Health Organization (WHO), each year these costs push approximately 100 million people  worldwide below the poverty line. Statistics such as this have spurred countries as varied as South Africa, India, Indonesia, and Nigeria to begin aggressively navigating complex legal, financial, and political frameworks to determine the best path towards universal health coverage reform.

While universal health coverage is not a new concept, over the past decade we have seen a growing movement within low- and middle income countries towards UHC reforms.

Over the past year alone, South Africa released a National Health Insurance (NHI) Green Paper outlining its plans to offer all South Africans access to a defined package of comprehensive health services, India’s central government announced its own plans to begin making moves towards universal coverage by the end of the current decade, and Mexico is expected to announce that it has achieved universal health coverage through Seguro Popular – its innovative health insurance program.

The process of achieving universal health coverage is iterative, and it requires political will to make significant strides. There is much healthy debate about how countries should approach coverage reforms and the specific policies they should adopt to achieve their goals and avoid unintended consequences. However, there is growing evidence that movement toward universal health coverage is possible. While reforms in many countries are imperfect and require continuous improvements, their efforts show promise for increasing access to health services and reducing out-of-pocket payments by poor and vulnerable populations.

We hope that this website will bring together the health financing community, allow visitors to stay informed of health coverage efforts in countries around the world, explore key issues and policy debates related to universal health coverage, and exchange ideas with others by submitting blogs.

By encouraging our colleagues to engage in debate, we hope that this site will support the global movement toward universal health coverage implementation and financial protection for the poor.

David de Ferranti is the President (and founder) of Results for Development.

Comment on this post at UHC Forward.

{ Comments on this entry are closed }

Norah Nakato receiving care from Fausta Nalukwago, midwife at Mpigi Health Center IV in Uganda.

Norah Nakato (right) receiving care from Fausta Nalukwago, midwife at Mpigi Health Center IV in Uganda. (Photo: MSH)

Norah, a 21-year-old teacher at a private school in Nansana, Uganda, did not know she was pregnant. Pain in her lower abdomen prompted her to go for a consultation at a private clinic in Nansana, where a urine test revealed the pregnancy. “I was shocked because I had last had my period on the 15th of that month,” Norah said.

At the clinic, Norah was given an antibiotic and a pain killer to relieve abdominal pain. Norah left the clinic excited about her pregnancy. But, two weeks later, the pain persisted and Norah began bleeding. Her mother advised her to go to Mpigi Health Center IV for an ultrasound.

At the health center, Norah saw a problem on the ultrasound screen. “The doctor showed me what was in my uterus and there was no baby,” Norah said. “It was swollen with liquid and unclear substances. He said the substance had to be removed. I was very scared.”

After counseling from the doctor, Norah was admitted and given medication to induce labor. When the contractions began, she was taken into surgery.

The doctor advised her to wait at least one and a half years before conceiving another child to allow time for her uterus to heal and the abnormal hormone levels to normalize.

USAID-funded STRIDES for Family Health, led by MSH, awarded a performance-based contract to Ernest Cook Ultrasound Research and Education Institute (ECUREI). Through this funding, seven health centers in Mpigi district received a solar-powered, portable ultrasound machine.

The machines can be taken into the community where these services can be life saving — and where a great need for these services exists. Every pregnant woman attending antenatal care at any of the seven health centers will be entitled to two free scans, and women with suspected complications will be referred to the hospital.

Norah said she is feeling better — and that the ultrasound scan saved her life.

Tadeo Atuhura is Communications Specialist for STRIDES for Family Health (STRIDES) in Uganda. Edith Nantongo and Diana Nanono – STRIDES staff from Communication Development Foundation Uganda (CDFU) — collaborated on this post.

{ 0 comments }

Mildred Akinyi waits outside a family planning unit in Masufu, Uganda.

Mildred Akinyi sitting by a family planning unit in Masafu sub-county, Uganda. Photo: MSH.

Mildred Akinyi is 33 years old and living with HIV. Married to Patrick Wabwire and mother to 5 children, Akinyi hails from Buhatuba Parish, Masafu sub-county, Busia district, Uganda.

The USAID-funded Strengthening TB and AIDS Response – Eastern Region (STAR-E) project, led by Management Sciences for Health (MSH), first came into direct contact with Akinyi in Masafu hospital during a reproductive health workshop organized for HIV-positive couples in July 2011. Like many women, Akinyi did not know she had developed cervical cancer until she was diagnosed with the condition during the screening exercise organized by STAR-E for women living with HIV/AIDS.

Asked how she felt before the screening, Akinyi said:

“I always felt pain in my abdomen, and would take a lot of panadols to ease the pain. I did not know what was wrong with me. When I heard from the case manager at Masafu hospital that STAR-E had organized for women living with HIV and their partners to be screened for cervical cancer and Sexually Transmitted Infections (STIs), I could not wait to use that chance to get checked. I came to Masafu very early that day. When the Nurse checked me, she said I had cancer. I feared I would die soon, because I had been told cancer is dangerous especially if one is HIV positive, but nurse told me it could still be treated. I was assigned to a case manager for follow up.”

On July 30, Akinyi underwent her first cryotherapy at Mbale regional referral hospital. She narrated her experience:

“The case manager Immaculate Ajambo escorted me to Mbale hospital to start treatment. When musawo Hellen put the machine in me, I was scared because she said she was going to ‘burn’ my cervix. There was cold pain, but I was determined to go through it.”

On September 5, Akinyi , accompanied by the same case manager, completed her cryotherapy. She was declared out of danger — and possible death — from cervical cancer. Akinyi said:

“STAR-E has really touched my life. Imagine I was dying silently from a disease I did not know I had. I knew I had HIV, but not cancer, until you people of STAR-E came to sensitize and test us for cancer. Now I am happy, and I don’t feel any pain, and I can do a lot of work which I was not able to do before because of the pain I used to feel. At least now I can look after my family knowing that I only have HIV, not cancer!”

Jennifer Francesca Acio is the gender & people living with HIV advisor for STAR-E.

{ 7 comments }

Blog post updated Dec. 28, 2011.

Aynalem with community outreach worker, Woineshet, in Ethiopia. (Photo credit: MSH)

Aynalem with community outreach worker, Woineshet, in Ethiopia. (MSH)

Twenty six year-old Aynalem Bekele has spent her entire life struggling to survive. Left in poverty after her father’s death, Aynalem and her mother baked injera (bread) and washed clothes to afford the rent on their small, dilapidated house in Hawassa, Ethiopia.

In late 2008, Aynalem’s health began to deteriorate leaving her bedridden, unable to work or care for her elderly mother, and struggling to survive yet again.

Into this dire situation walked Woineshet and Wolela, two community outreach workers from USAID’s HIV/AIDS Care and Support Program, who first encountered Aynalem during a routine community assessment visit to neighboring homes. Recognizing the seriousness of her condition, Woineshet and Wolela counseled Aynalem and eventually convinced her to visit the local health center where she discovered she was HIV-positive. Supported by Woineshet and Wolela and the health center staff, Aynalem received counseling and learned she could live a healthy and productive life with HIV.

Community mobilization is vital to the success of USAID’s HIV/AIDS Care and Support Program, implemented by Management Sciences for Health (MSH). Community outreach workers, often HIV-positive themselves, conduct home visits during which they provide health education and sensitization counseling, identify families in need, and connect these families to services available at the health center.

These outreach workers serve as a direct link between the community and the health center.

Thanks to the support of her local community outreach workers, Aynalem is now on antiretroviral therapy, and her health has improved dramatically. Woineshet and Wolela have even helped her get a job as a cleaner at the University of Hawassa.

“These days I am in very good health. I am strong and energetic. I have regular income and job security. It happened because of these two ladies,” said Aynalem, referring to the two outreach workers. “For me, Woineshet and Wolela are not simple community volunteers. Rather, they are precious gifts from God. They are angels sent from God to save and shape my life.”

Dr. Fentahun Tadesse Akale is the technical director of the Ethiopia Network for HIV/AIDS Treatment, Care and Support (ENHAT) project’s Tigray regional office.

{ 3 comments }

Yvonise is a good-natured 40-year-old woman with an easy smile. She is mother to four children: two boys and two girls. Her youngest, a little girl, is six years old.

Today, Yvonise sits patiently at the pharmacy of Hôpital Immaculée Conception de Port-de-Paix (HIC Port-de-Paix) in Haiti, waiting for Miss Sevrine, her caregiver, to provide her with a month’s supply of life-saving medicine.

Yvonise is one of 2,200 patients enrolled in the HIV/AIDS program at HIC Port-de-Paix. She was infected years ago with the AIDS virus, but her family does not know. Keeping her secret is a constant burden.

“I tell my kids that I have an infection for which I am being treated,” she said. This is how she justifies her monthly trips to the hospital.

Yvonise knows first hand how important it is for her to keep her appointments. “Since I’ve been coming to the clinic and taking my medication, I’ve been feeling more energetic,” she said, grinning from ear to ear.

Having energy is important to Yvonise; she wants to keep up the façade of good health and counsels her children about the dangers of unprotected sex. Yvonise’s estranged husband recently returned home after a four year absence. She is worried about infecting him, but so far has been careful to avoid intimacy. “He asked me why I was going to the hospital today, but I didn’t tell him the truth. He only knows that I am going for ‘treatment.’”

Hôpital Immaculée Conception de Port-de-Paix, where Yvonise is a patient, is one of the approximately 160 PEPFAR sites that Supply Chain Management System (SCMS), a project managed in Haiti by Management Sciences for Health (MSH), delivers life-saving medicines to.

In addition to antiretroviral medicines and drugs to treat opportunistic infections such as Tuberculosis, SCMS provides rapid test kits for AIDS screening to the hospital, where over one thousand tests are performed on a monthly basis.

SCMS also offers technical assistance in stock management to HIC staff and has trained 90 percent of the hospital employees, including pharmacists, dispensers and lab technicians. The HIC staff have learned how to write accurate and reliable consumption and stock reports and how to arrange drugs by order of expiry to limit medication expiring.

As a result of this technical assistance, there has been no stock-outs at the hospital since SCMS started working with them, explained Célima Isor, Head of Laboratory at HIC Port-de-Paix.  To Madame Isor, “no stock-outs means that patients who often travel long distances to come to the lab always get tested and are never sent away.”

Like hundreds of patients who still fear the stigma associated with AIDS, Yvonise travels three hours to Port-de-Paix from her hometown of St. Louis du Nord to keep her community from knowing she has the virus. She finds comfort at the hospital, surrounded by caregivers like Miss Sevrine and Miss Anna-Lange, who are concerned about her well-being. She is grateful for the monthly supply of Cotrimaxazole, multivitamins and iron supplement that she receives at the hospital’s pharmacy, at no cost to her, thanks to SCMS and US government funds.

“I’ve never had an unsuccessful visit to the clinic; there is always medicine waiting for me,” smiles Yvonise.

Holding on to her precious cargo, she is confident that she will stay healthy enough to raise all of her children.

Marie-Nadine Gaston is client relations & activity coordinator for Supply Chain Management System (SCMS).

{ 0 comments }

Dr. Iwamura: Inspiration for a Generation

by Jonathan D. Quick, MD, MPH 12.22.2011

MSH’s 40th anniversary year has been a catalyst to revisit our origins, recommit to our mission and renew our values. As we approach the holidays and look toward 2012, I’d like to share reflections on one of the most poignant events of the year for me: my recent visit with Mrs. Fumiko Iwamura in Japan. [...]

Read More »

Mapping Civil Society’s Response to HIV/AIDS in Namibia

by Elizabeth Walsh 12.20.2011

Namibia, with just 2.2 million people, has one of the highest AIDS prevalence rates in the world, at roughly 13.1 percent. The country’s small population is spread over a large geographic area, making the delivery of AIDS services a challenge especially in remote villages. Civil society organizations (CSOs) play a large role in the AIDS [...]

Read More »

Creative Solutions Address Skilled Births: Rethinking Skilled Delivery Approaches

by Erin Polich 12.19.2011

All project health indicators for the second phase of the USAID-funded Sudan Health Transformation Project (SHTP II), led by Management Sciences for Health (MSH) in partnership with the International Rescue Committee, have shown improved performance over the past two years. On the ground, this means that more people are being immunized against diseases, communities are receiving education on HIV, [...]

Read More »

Stemming the Tide of African Health Worker Migration

by Mary O'Neil 12.14.2011

Cross-posted from the Global Health Magazine blog. How did Malawi control its brain drain? The British Medical Journal issued a report last month estimating that nine African countries have lost $2 billion worth of investment in training and educating doctors who have subsequently migrated abroad. It needn’t be this way. Doctors, nurses and other health [...]

Read More »

World Premiere of ‘Inside Story: The Science of HIV/AIDS’

by Naume Kupe 12.13.2011

Inside Story: The Science of HIV/AIDS, a new feature-length docudrama in which USAID plays a supporting role, premiered to a packed theater in Johannesburg, South Africa, on World AIDS Day, December 1, 2011. Inside Story is a unique mixture of science and fiction and includes cast members and characters from Nigeria, Kenya and South Africa. Kalu, a rising [...]

Read More »