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- Kazibwe, Joseph, et al.
(författare)
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The impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries : a systematic review of the evidence
- 2024
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Ingår i: BMC Health Services Research. - 1472-6963. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Low- and middle-income countries have committed to achieving universal health coverage (UHC) as a means to enhance access to services and improve financial protection. One of the key health financing reforms to achieve UHC is the introduction or expansion of health insurance to enhance access to basic health services, including maternal and reproductive health care. However, there is a paucity of evidence of the extent to which these reforms have had impact on the main policy objectives of enhancing service utilization and financial protection. The aim of this systematic review is to assess the existing evidence on the causal impact of health insurance on maternal and reproductive health service utilization and financial protection in low- and lower middle-income countries. Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search included six databases: Medline, Embase, Web of Science, Cochrane, CINAHL, and Scopus as of 23rd May 2023. The keywords included health insurance, impact, utilisation, financial protection, and maternal and reproductive health. The search was followed by independent title and abstract screening and full text review by two reviewers using the Covidence software. Studies published in English since 2010, which reported on the impact of health insurance on maternal and reproductive health utilisation and or financial protection were included in the review. The ROBINS-I tool was used to assess the quality of the included studies. Results: A total of 17 studies fulfilled the inclusion criteria. The majority of the studies (82.4%, n = 14) were nationally representative. Most studies found that health insurance had a significant positive impact on having at least four antenatal care (ANC) visits, delivery at a health facility and having a delivery assisted by a skilled attendant with average treatment effects ranging from 0.02 to 0.11, 0.03 to 0.34 and 0.03 to 0.23 respectively. There was no evidence that health insurance had increased postnatal care, access to contraception and financial protection for maternal and reproductive health services. Various maternal and reproductive health indicators were reported in studies. ANC had the greatest number of reported indicators (n = 10), followed by financial protection (n = 6), postnatal care (n = 5), and delivery care (n = 4). The overall quality of the evidence was moderate based on the risk of bias assessment. Conclusion: The introduction or expansion of various types of health insurance can be a useful intervention to improve ANC (receiving at least four ANC visits) and delivery care (delivery at health facility and delivery assisted by skilled birth attendant) service utilization in low- and lower-middle-income countries. Implementation of health insurance could enable countries’ progress towards UHC and reduce maternal mortality. However, more research using rigorous impact evaluation methods is needed to investigate the causal impact of health insurance coverage on postnatal care utilization, contraceptive use and financial protection both in the general population and by socioeconomic status. Trial registration: This study was registered with Prospero (CRD42021285776).
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| 2. |
- Saulnier, Dell, et al.
(författare)
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Truth, humane treatment, and identity: perspectives on the legitimacy of the public and private health sectors during Covid in Zambia
- 2024
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Ingår i: Humanities & Social Sciences Communications. - 2662-9992. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Legitimacy is necessary for resilience and trust helps to legitimize health systems. Providing services during Covid has relied on both the private and public sectors but there is little information on differences in trust between these sectors during shocks like Covid and how it may impact the health system’s legitimacy. The purpose of this study was to explore community trust in the public and private sectors of the Zambian health system during Covid, to generate understanding on how trust in the different sectors may influence the system’s legitimacy. Twelve focus groups discussions and 22 key informant interviews were conducted in 2022 with community members who used public, private, and faith-based services during Covid and service providers, and thematic analysis identified perceptions of trust between the different sectors. The themes ‘Humane, patient-centred treatment’ and ‘Communicating the truth’ describe the desire for humane interactions and truthfulness during Covid, compromised by fear, uncertainty, and suspicions of the motives of the sectors, and alleviated by support, security, and shared identity. The legitimacy of the public sector was influenced by shared spaces, values, and identities with communities. The private sector maintained its legitimacy through service quality and its identity as a non-governmental business. Interpersonal trust was important, but identity played a larger role than high-quality interactions for legitimacy in Zambia during the pandemic. To enhance legitimacy and resilience during shocks, potential strategies include strengthening the quality of public sector interactions to meet private sector standards, emphasizing the public sector as a public good, and clarifying the public sector’s role vis-à-vis the government during crises.
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