Global Health, Center for Global Development, London, UK.
Decision Sciences, Bill & Melinda Gates Foundation, Seattle, Washington, USA.
BMJ Glob Health. 2021 Aug;6(8). doi: 10.1136/bmjgh-2021-005842.
Countries are recommended to progressively work towards universal health coverage (UHC), and to make explicit choices regarding the expansion of priority services. However, there is little guidance on how to manage the inclusion of vertical programmes, funded by external partners, in health benefits packages (HBP) in low and middle-income countries (LMICs).
We conducted a scoping review to map the inclusion of six vertical programmes (HIV, tuberculosis, malaria, maternal and child health, contraceptives, immunisation) in 26 LMICs.
We identified 26 LMICs with an HBP that was not aspirational (eg, with evidence of implementation or funding). For each HBP, we collected information on the corresponding UHC scheme, health financing at the time of establishment, revisions since inception and entitlements. For each vertical programme, we developed a list of tracer interventions based on the Disease Control Priorities 3 and the 100 Core Health Indicators List. We then used this list of tracer interventions to map the coverage of the six vertical programmes.
The review shows that there is no common starting point for countries embarking into UHC. Some HBPs were almost three decades old. Whole package revisions are rare. The inclusion of vertical programme does not follow a given pattern based on health financing indicators or country's income group. Maternal child health services are the most often included and family planning the least. Six countries in our sample covered all vertical programmes, while one covered only one of six.
This review has shown that there has been a long history of countries facing this question and we have provided the first mapping of inclusion of vertical programmes in UHC. The results of the mapping can inform decisions in countries embarking in UHC.
各国被建议逐步实现全民健康覆盖，并明确扩大优先服务的选择。然而，对于如何管理将外部合作伙伴资助的垂直规划纳入中低收入国家的卫生福利套餐，几乎没有指导。
我们进行了范围界定审查，以绘制在 26 个中低收入国家中纳入六种垂直规划（艾滋病毒、结核病、疟疾、母婴健康、避孕药具、免疫接种）的情况。
我们确定了 26 个拥有非理想卫生福利套餐（例如，有实施或供资证据）的中低收入国家。对于每个卫生福利套餐，我们收集了相应的全民健康覆盖计划、建立时的卫生筹资、自成立以来的修订情况和应享权利方面的信息。对于每个垂直规划，我们根据疾病控制优先事项 3 和 100 项核心卫生指标清单制定了一个追踪干预措施列表。然后，我们使用该追踪干预措施列表来绘制六种垂直规划的覆盖情况。
审查结果表明，各国在迈向全民健康覆盖方面没有共同的起点。一些卫生福利套餐已有近三十年的历史。整个套餐的修订很少。纳入垂直规划并非基于卫生筹资指标或国家收入组而遵循特定模式。母婴健康服务是最常纳入的，计划生育则是最不常纳入的。我们样本中的六个国家涵盖了所有六种垂直规划，而一个国家仅涵盖了六种中的一种。
这项审查表明，各国已经在这个问题上有了很长的历史，我们已经首次绘制了全民健康覆盖中纳入垂直规划的情况。该映射的结果可以为开始全民健康覆盖的国家提供决策参考。
