Road to Universal Health Coverage 2030: Health Financing for Maternal and Child Health among East African Community Countries, what they do and what they achieved. A scoping Review.
Creators: name: Simon James Korsuk, Doki
Publisher: name: figshare
Year: 2023
Subjects: Public health not elsewhere classified
Health systems

description: <br> <strong>Road to Universal Health Coverage 2030: Health Financing for Maternal and Child Health in East African Community Member Countries, what they do and what they achieved. A Scoping Review.</strong> <strong>1.The Study Aim;</strong> The aim of this study is to explore health financing strategies used by each EAC country to achieve Universal health coverage for Maternal and child health. Secondly, to examine the progress made towards attaining universal health coverage for maternal and child health by 2030. <strong>2.</strong> <strong>The study Objectives.</strong> <strong>2.1 General Objective, </strong>To examine health financing strategies and their impacts on achieving Universal health coverage for maternal and child health among East African member community countries. <strong>2.2. Specific Objective.</strong> <strong>2.2.1. </strong>To explore health systems financing strategies for maternal and child health coverage among the East African Community member countries. <strong>2.2.2</strong> To compare progress in maternal and child health indicators and link them to the health financing strategies on improved access, utilization, quality of care and benefits package (Antenatal Care, Institutional Delivery, Postnatal care, vaccinations) to see whether these have contributed to reducing maternal and under 5 mortality. <strong>2.2.3</strong>. To formulate recommendations based on best performing practices of health financing strategies on maternal and child health outcomes for South Sudan. A scoping review methodology approach was used to synthesize relevant evidence of information on the study topic based on the study objectives. The Joanna and Briggs Institute (JBI) methodology approach to scoping reviews written by Peters et al.58 (2020) version was used to explore and synthesize evidence across the existing body of literature.58 The steps described in the JBI include selecting a study topic, obtaining sources of information, designing a search strategy, charting data, extracting findings and reporting the results. Accordingly, this study used the description of Participant, Concept and Context (PCC) approach to evidence synthesis. The Participant refers to the state as the health financing and governing entity in individual EAC Countries. The Concept being strategies of Health systems financing targeting MCH and the Context being the East African Community countries. The hypothesis behind the study questions is Healthcare Financing strategies aimed at improving access, utilization, quality and affordability of MCH care may translate into improved coverage and reduction in maternal and child mortality. <strong>The PCC Framework; Characteristic and Justification.</strong> <strong>Participant;</strong> The state as health actor of each country; Obligations and commitments to UHC, SDGs, and EAC ’s Common health Agenda Vision 2050. <strong>Concepts;</strong> Strategies for Health systems financing for maternal and child health; Complexities in financing approaches employed by each country for maternal and child health coverage, varying levels of Maternal and child health indicators. <strong>Context;</strong> East African Community Countries; Common vision and goals on maternal and child health agenda as a regional block. <strong>3.1 Study Questions.</strong> I formulated the research questions according to the PCC frame work and in line with the study objectives as follows; 1. What health financing strategies are used by EAC states to achieve Universal health coverage for maternal and child health? 2. What impact did these strategies have on reduction in maternal and Under 5 mortality? 3. How and why did these strategies lead to impacts in maternal and Under 5 mortality? <strong>3.2 Identification of Literature Sources. </strong> <strong>3.2.1. Literature Search Strategy.</strong> The study was based on information gathered from existing published and unpublished literature sources including policy documents from respective EAC states. I made searches on three sets of databases; PubMed, Global Health database, Web of Science and Google search to obtain relevant literature to the study questions. Google search was used to obtain online unpublished literature including policy documents from EAC state government websites and international organizations like WHO, WB, UNICEF, UN websites of respective EAC countries <strong>3.2.2 Inclusion Criteria.</strong> The selection process began with screening the titles and abstracts of the articles from the databases. The study papers considered in the search included both primary and secondary articles. The study included qualitative, quantitative and review articles with varying study designs. Searches were made for articles published in English for the EAC Countries and were limited to 10 years duration from 1st January 2013 to the final search date on 6th April 2023. <strong> Inclusion Criteria summary</strong> -Paper type; Primary, secondary, peer review papers. -Type of literature; Published and grey literature, policy documents, thesis, books, reports, webpages. -Period of Publication-from January 01, 2013 to April 06,2023. -Language- Articles published in English. -Health systems and policy documents with focus on maternal and child health. <strong>3.2.3 Exclusion Criteria</strong> Excluded were those articles that didn’t mention health financing strategies or Universal health coverage specific for Maternal and child health. Articles that involved health care financing for specified disease conditions other than in pregnancy or Maternal and child health care were excluded. Also, articles published in languages other than English were not included. This was due to the challenge of word translations and the interpretations that came with other languages. Articles published before January 2013 were also excluded (Box 2). <strong>Exclusion Criteria summary</strong> - Papers not meeting the PCC attribute. - Articles published in languages other than English. - Articles published before January 01, 2013. - Health systems financing strategies for conditions outside maternal and child health care. <strong>3.4. Data Charting</strong> <strong>3.4.1 Data Charting Process.</strong> Data were extracted from the selected papers for the review, first by characterizing them and then charting on Microsoft Excel tables developed by the author. The characteristics were based on the PCC, study methodology and key study findings. A summary of elements included in the data charting are described in Box 3. <strong>Box 3. Elements included in the data Charting.</strong> - Author(s), Year of Publication, Paper source, paper type, Country, area of focus. - Physical access to MCH care. - Financial access to MCH care. - Quality improvement of MCH care - Analytical Framework <strong>3.4.2. Data Syntheses.</strong> Analytical Frame work; The framework classified findings based on access categories to care across the EAC countries. I classified them into physical access, financial access and access to quality MCH care. However, sometimes one literature source may describe two access categories and in that case the decision on classifying is guided by the main study objective and its findings. 1. Physical access to MCH care; this category refers to free services access using the primary health care (PHC) approach to MCH as a way of protection from OPP. The focus here is usually to make public health facilities as easily accessible as possible through minimizing travel distance to seek care. Transport vouchers, conditional Cash transfers (CCTs) and referral packages are classified here. 2. Financial access to MCH care; This is for category of all financial strategies aimed at increasing uptake of the already existing MCH services. This is aimed at removing or minimizing financial access barriers and may include insurance, reimbursements, or co-payments. These includes risk protection mechanisms such as CBHI, social or private health insurance and prepayment schemes. 3. Quality of MCH care; as quality services is part of UHC, this strategy is aimed at improving the performance of health facilities and the health workers to improve quality of services received by mothers. This is normally done through bonus incentives to workers and facilities while ensuring services are provided in a patient cantered approach to enhance efficiency and effectiveness. <br>