Mchenga Martina, Manthalu Gerald, Chingwanda Atamandike, Chirwa Emily
Ministry of Health, Lilongwe, Malawi.
Front Health Serv. 2022 Feb 10;1:786186. doi: 10.3389/frhs.2021.786186. eCollection 2021.
The inclusion of Universal Health Coverage (UHC) in the Sustainable Development Goals (target 3.8) cemented its position as a key global health priority and highlighted the need to measure it, and to track progress over time. In this study, we aimed to develop a summary measure of UHC for Malawi which will act as a baseline for tracking UHC index between 2020 and 2030. We developed a summary index for UHC by computing the geometric mean of indicators for the two dimensions of UHC; service coverage (SC) and financial risk protection (FRP). The indicators included for both the SC and FRP were based on the Government of Malawi's essential health package (EHP) and data availability. The SC indicator was computed as the geometric mean of preventive and treatment indicators, whereas the FRP indicator was computed as a geometric mean of the incidence of catastrophic healthcare expenditure, and the impoverishing effect of healthcare payments indicators. Data were obtained from various sources including the 2015/2016 Malawi Demographic and Health Survey (MDHS); the 2016/2017 fourth integrated household survey (IHS4); 2018/2019 Malawi Harmonized Health Facility Assessment (HHFA); the MoH HIV and TB data, and the WHO. We also conducted various combinations of input indicators and weights as part of sensitivity analysis to validate the results. The overall summary measure of UHC index was 69.68% after adjusting for inequality and unadjusted measure was 75.03%. As regards the two UHC components, the inequality adjusted summary indicator for SC was estimated to be 51.59% and unadjusted measure was 57.77%, whereas the inequality adjusted summary indicator for FRP was 94.10% and unweighted 97.45%. Overall, with the UHC index of 69.68%, Malawi is doing relatively well in comparison to other low income countries, however, significant gaps and inequalities still exist in Malawi's quest to achieve UHC especially in the SC indicators. It is imperative that targeted health financing and other health sector reforms are made to achieve this goal. Such reforms should be focused on both SC and FRP rather than on only either, of the dimensions of UHC.
将全民健康覆盖（UHC）纳入可持续发展目标（目标3.8）巩固了其作为全球关键卫生优先事项的地位，并突出了衡量它以及跟踪随时间推移取得的进展的必要性。在本研究中，我们旨在为马拉维制定一项全民健康覆盖的综合衡量指标，该指标将作为2020年至2030年跟踪全民健康覆盖指数的基线。我们通过计算全民健康覆盖两个维度（服务覆盖（SC）和财务风险保护（FRP））指标的几何平均值，制定了全民健康覆盖的综合指数。纳入服务覆盖和财务风险保护的指标均基于马拉维政府的基本卫生包（EHP）以及数据可得性。服务覆盖指标计算为预防和治疗指标的几何平均值，而财务风险保护指标计算为灾难性医疗支出发生率以及医疗支付贫困影响指标的几何平均值。数据来自多个来源，包括2015/2016年马拉维人口与健康调查（MDHS）、2016/2017年第四次综合住户调查（IHS4）、2018/2019年马拉维统一卫生设施评估（HHFA）、卫生部的艾滋病毒和结核病数据以及世界卫生组织。作为敏感性分析的一部分，我们还对输入指标和权重进行了各种组合，以验证结果。调整不平等因素后，全民健康覆盖指数的总体综合衡量指标为69.68%，未调整的指标为75.03%。关于全民健康覆盖的两个组成部分，服务覆盖的不平等调整后综合指标估计为51.59%，未调整指标为57.77%，而财务风险保护的不平等调整后综合指标为94.10%，未加权指标为97.45%。总体而言，马拉维的全民健康覆盖指数为69.68%，与其他低收入国家相比表现相对较好，然而，在马拉维实现全民健康覆盖的进程中，尤其是在服务覆盖指标方面，仍存在显著差距和不平等。必须进行有针对性的卫生筹资和其他卫生部门改革以实现这一目标。此类改革应同时关注服务覆盖和财务风险保护，而不是仅侧重于全民健康覆盖的其中一个维度。
