Bou-Karroum Lama, Iaia Domenico G, El-Jardali Fadi, Abou Samra Clara, Salameh Sabine, Sleem Zeina, Masri Reem, Harb Aya, Hemadi Nour, Hilal Nadeen, Hneiny Layal, Nassour Sahar, Shah Mehr Gul, Langlois Etienne V
Faculty of Health Sciences, Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon.
Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon.
PLOS Glob Public Health. 2024 Sep 12;4(9):e0003573. doi: 10.1371/journal.pgph.0003573. eCollection 2024.
Over the past few decades, the world has witnessed considerable progress in women's, children's and adolescents' health (WCAH) and the Sustainable Development Goals (SDGs). Yet deep inequities remain between and within countries. This scoping review aims to map financing interventions and measures to improve equity in WCAH in low- and middle-income countries (LMICs). This scoping review was conducted following Joanna Briggs Institute (JBI) guidance for conducting such reviews as well as the PRISMA Extension for Scoping Reviews (PRISMA-ScR) for reporting scoping reviews. We searched Medline, PubMed, EMBASE and the World Health Organization's (WHO) Global Index Medicus, and relevant websites. The selection process was conducted in duplicate and independently. Out of 26 355 citations identified from electronic databases, relevant website searches and stakeholders' consultations, 413 studies were included in the final review. Conditional cash transfers (CCTs) (22.3%), health insurance (21.4%), user fee exemptions (18.1%) and vouchers (16.9%) were the most reported financial interventions and measures. The majority were targeted at women (57%) and children (21%) with others targeting adolescents (2.7%) and newborns (0.7%). The findings highlighted that CCTs, voucher programs and various insurance schemes can improve the utilization of maternal and child health services for the poor and the disadvantaged, and improve mortality and morbidity rates. However, multiple implementation challenges impact the effectiveness of these programmes. Some studies suggested that financial interventions alone would not be sufficient to achieve equity in health coverage among those of a lower income and those residing in remote regions. This review provides evidence on financing interventions to address the health needs of the most vulnerable communities. It can be used to inform the design of equitable health financing policies and health system reform efforts that are essential to moving towards universal health coverage (UHC). By also unveiling the knowledge gaps, it can be used to inform future research on financing interventions and measures to improve equity when addressing WCAH in LMICs.
在过去几十年里，世界见证了妇女、儿童和青少年健康（WCAH）及可持续发展目标（SDGs）方面取得的显著进展。然而，国家之间和国家内部仍存在严重的不平等现象。本范围综述旨在梳理改善低收入和中等收入国家（LMICs）妇女、儿童和青少年健康公平性的筹资干预措施。本范围综述是按照乔安娜·布里格斯研究所（JBI）开展此类综述的指南以及用于报告范围综述的PRISMA扩展版（PRISMA-ScR）进行的。我们检索了Medline、PubMed、EMBASE和世界卫生组织（WHO）的全球医学索引以及相关网站。筛选过程由两人独立重复进行。在从电子数据库、相关网站搜索及利益相关者咨询中识别出的26355条文献中，最终纳入综述的有413项研究。有条件现金转移支付（CCTs）（22.3%）、医疗保险（21.4%）、免除用户费用（18.1%）和代金券（16.9%）是报告最多的筹资干预措施。大多数措施针对的是妇女（57%）和儿童（21%），其他针对青少年（2.7%）和新生儿（0.7%）。研究结果强调，有条件现金转移支付、代金券计划和各种保险计划可以提高贫困和弱势群体对母婴健康服务的利用率，并降低死亡率和发病率。然而，多种实施挑战影响了这些项目的有效性。一些研究表明，仅靠筹资干预措施不足以实现低收入人群和偏远地区居民在医疗覆盖方面的公平性。本综述提供了有关筹资干预措施的证据，以满足最脆弱社区的健康需求。它可用于为公平的卫生筹资政策设计和卫生系统改革工作提供信息，这些对于实现全民健康覆盖（UHC）至关重要。通过揭示知识差距，它还可用于为未来关于改善低收入和中等收入国家妇女、儿童和青少年健康公平性的筹资干预措施的研究提供信息。
