Asbu Eyob Zere, Masri Maysoun Dimachkie, Kaissi Amer
Health System Financing Division, Health Authority Abu Dhabi, Abu Dhabi, United Arab Emirates.
Department of Healthcare Administration, Trinity University, San Antonio, TX USA.
Glob Health Res Policy. 2017 Sep 4;2:25. doi: 10.1186/s41256-017-0044-9. eCollection 2017.
Since the declaration of the Millennium Development Goals (MDGs) in 1990, many countries of the Middle East and North Africa (MENA) region made some improvements in maternal and child health and in tackling communicable diseases. The transition to the global agenda of Sustainable Development Goals brings new opportunities for countries to move forward toward achieving progress for better health, well-being, and universal health coverage. This study provides a profile of health status and health financing approaches in the MENA region and their implications on universal health coverage.
Time-series data on socioeconomics, health expenditures, and health outcomes were extracted from databases and reports of the World Health Organization, the World Bank and the United Nations Development Program and analyzed using Stata 12 statistical software. Countries were grouped according to the World Bank income categories. Descriptive statistics, tables and charts were used to analyze temporal changes and compare the key variables with global averages.
Non-communicable diseases (NCDs) and injuries account for more than three quarters of the disability-adjusted life years in all but two lower middle-income countries (Sudan and Yemen). Prevalence of risk factors (raised blood glucose, raised blood pressure, obesity and smoking) is higher than global averages and counterparts by income group. Total health expenditure (THE) per capita in most of the countries falls short of global averages for countries under similar income category. Furthermore, growth rate of THE per capita has not kept pace with the growth rate of GDP per capita. Out-of-pocket spending (OOPS) in all but the high-income countries in the group exceeds the threshold for catastrophic spending implying that there is a high risk of households getting poorer as a result of paying for health care.
The alarmingly high prevalence of NCDs and injuries and associated risk factors, health spending falling short of the GDP and GDP growth rate, and high OOPS pose serious challenges for universal health coverage. Using multi-sector interventions, countries should develop and implement evidence-informed health system financing roadmaps to address these obstacles and move forward toward universal health coverage.
自1990年宣布千年发展目标（MDGs）以来，中东和北非（MENA）地区的许多国家在孕产妇和儿童健康以及应对传染病方面取得了一些进展。向可持续发展目标全球议程的过渡为各国朝着实现更好的健康、福祉和全民健康覆盖取得进展带来了新机遇。本研究介绍了中东和北非地区的健康状况和卫生筹资方法及其对全民健康覆盖的影响。
从世界卫生组织、世界银行和联合国开发计划署的数据库和报告中提取关于社会经济、卫生支出和健康结果的时间序列数据，并使用Stata 12统计软件进行分析。国家根据世界银行的收入类别进行分组。描述性统计、表格和图表用于分析时间变化，并将关键变量与全球平均水平进行比较。
除两个低收入中等收入国家（苏丹和也门）外，非传染性疾病（NCDs）和伤害在所有国家的伤残调整生命年中占比超过四分之三。危险因素（血糖升高、血压升高、肥胖和吸烟）的患病率高于全球平均水平以及按收入组划分的对应水平。大多数国家的人均卫生总支出（THE）低于类似收入类别国家的全球平均水平。此外，人均THE的增长率未能跟上人均GDP的增长率。除该组中的高收入国家外，所有国家的自付费用（OOPS）均超过灾难性支出阈值，这意味着家庭因支付医疗费用而陷入贫困的风险很高。
非传染性疾病和伤害及其相关危险因素的惊人高患病率、卫生支出低于GDP和GDP增长率以及高自付费用对全民健康覆盖构成了严峻挑战。各国应通过多部门干预措施，制定和实施基于证据的卫生系统筹资路线图，以应对这些障碍并朝着全民健康覆盖迈进。
