Developing a Tool for Assessing the Achievement to Universal Health Coverage

Abstract

ABSTRACT Objective: Universal health coverage (UHC) was introduced as a global policy to improve equitable access to health services and financial risk protection. Countries with highly diverse health system that have achieved UHC have experienced different paths and strategies. Identifying key determinants in achieving UHC and developing relevant plans and polices are critical in seeking to reach UHC. This study aimed to identify determinants that affect the progress towards UHC to develop a tool for assessing the achievement of the countries to the UHC. Method and Material : To conduct the study, three steps were followed: First, a systematic review was conducted via searching international databases including PubMed, ISI Web of Science, Embase, Scopus and ProQuest, World Bank and WHO with no time limitation. The determinants (relevant factors and indicators) analyzed through inductive content analysis approach. In second step, the link between indicators and categorized themes were identified through brain storming and focus group discussion. In final step, the first draft of the tool was discussed in expert panel meetings and the tool adjusted to make the final version. Results: Out of 170 selected articles, 416 factors were extracted. Factors with conceptual proximity were combined and the total number of factors affecting UHC decreased to 118. Determinants were classified under seven categories and 20 subcategories and 88 indicators. Through content analysis, seven main categories were identified, including social infrastructure and social sustainability, financial and economic infrastructures, health status, service delivery, coverage, stewardship/governance and global movements. Conclusion: All the identified factors in UHC achievement are interrelated, with a change in one factor changing the others. The developed tool can be used- as a whole or in part- in countries. The countries can modify it according to the context and the level of their countries’ development. Periodical use of the tool can provide the trend of achievement to the UHC in the countries. Keywords: Universal Health Coverage, Health System, Tool development, Assessment tool