RESYST resources on Universal Health Coverage

December 2016

Whilst Universal Health Coverage (UHC) is high on national and international agendas, many low and middle-income countries face significant challenges in expanding access to health services and financial protection to all people. Adequately addressing these challenges requires evidence, generated through research, which considers the complexity of countries’ diverse health systems and addresses the needs of their populations.

UHC has strongly influenced the RESYST research agenda. Research on financing has investigated how low and middle-income countries can increase domestic resources to fund health services adequately, and develop the strategic purchasing capacity required to ensure equitable access to quality services. However, UHC is not only about funding; a vital element of UHC is ensuring that there are enough trained health workers to provide services to everybody, including populations in rural and remote areas. RESYST researchers have sought to address the challenge of how to attract health workers to rural areas by tracking a cohort of nursing graduates and monitoring their employment decisions over several years.  

Below is a list of RESYST resources relating to UHC, grouped according to topic.

The list includes some RESYST-related publications, authored by RESYST members but funded from other sources.

Research for Universal Health Coverage
RESYST topic overview (2014)
Area of focus: Global
Overview: This brief provides a detailed summary of RESYST research on UHC and key research findings.

How can global communities contribute to the achievement of Universal Health Coverage?
RESYST blog; Tangcharoensathien V (2016)
Area of focus: Global
Overview: This blog presents highlights from Viroj Tangcharoensathien’s keynote address at an international consultative meeting, organised by the International Health Partnership (IHP+).

Raising domestic resources for health

It is often assumed that low and middle-income countries cannot increase tax revenue due to weak administrative capacity, high levels of tax evasion and large informal sectors. However, some African countries have shown that fiscal space can be expanded by strengthening the tax administrative system. The challenge remains in ensuring this additional revenue is invested in the health sector. 

Increasing tax revenue and its impact on financing public healthcare in South Africa
RESYST working paper; Doherty J (2014)
Area of focus: South Africa
Overview: This study explains how the post-apartheid South African tax collection agency managed to increase tax revenue between 1994-2012, and assess whether the increase in general tax revenue impacted on government funding for the health sector.

Raising domestic resources for health: can tax revenue help fund Universal Health Coverage?
RESYST policy brief (2015)
Area of focus: Kenya, Nigeria, South Africa
Overview: This policy brief outlines how Kenya, South Africa and Lagos State in Nigeria, increased tax revenue, and identifies common factors across contexts. The brief concludes with recommendations for health sector officials about how to negotiate more successfully for additional resources to be spent on health. 

Can improved tax collection systems boost public funding for health?
RESYST webinar (2016)
Area of focus: Kenya, Nigeria, South Africa
Overview: In this webinar, Dr Jane Doherty presents an overview of the research that documents country experiences of improving the effectiveness of their tax collection systems. The presentation is followed by comments by researchers from Kenya and Nigeria and questions from attendees of the webinar.

Covering the informal sector
RESYST workshop report (2014)
Area of focus: Ghana, Indonesia, Rwanda, Senegal, Tanzania, Thailand
Overview: This report is from a workshop on expanding access to health services and financial protection for people outside the formal employment sector.

Strategic purchasing

Purchasing is the process by which funds are allocated to providers to obtain health services on behalf of a population. If designed and undertaken strategically, purchasing can improve health systems performance by promoting quality, efficiency, equity and responsiveness of health service provision and, in doing so, facilitate progress towards UHC.

What facilitates strategic purchasing for health system improvement?
RESYST key findings sheet (2016)
Area of focus: India, Kenya, Nigeria, South Africa, Tanzania, Thailand and Vietnam
Overview: This resource presents the key findings from the RESYST multi-country research project on strategic purchasing.

Strategic purchasing for universal health coverage: a critical assessment
Policy briefs (2016)

Area of focus: Kenya, Nigeria, South Africa, Thailand and Vietnam
Overview: A set of eight policy briefs on strategic purchasing. Each brief outlines the actions of a healthcare purchaser – ranging from government departments to private health insurance companies and community self-help groups, and compares their actual purchasing practices with strategic actions in relation to three groups: healthcare providers, the government and citizens. 

Researching purchasing to achieve the promise of universal health coverage
PowerPoint presentation; Hanson K (2014)
Area of focus: Global
Overview: Presentation at the BMC Health Services Research Conference. The presentation illustrates the important role that strategic purchasing can play in achieving effective health coverage.

Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing
Journal publication (RESYST-related); Tangcharoensathien V, Limwattananon S, et al. (2014)
Journal: Health Policy and Planning
Area of focus: Thailand
Overview: This article discusses strategic purchasing experiences in the National Health Security Office, responsible for the Universal Coverage Scheme in Thailand. 

Health equity

Equity in the allocation of public sector financial resources in low- and middle-income countries: a systematic literature review
Journal publication (RESYST related); Anselmi L, Lagarde M, Hanson K. (2014)
: Health Policy and Planning
Area of focus: Global
Overview: This review aims to identify, assess and analyse the evidence on equity in the distribution of public health sector expenditure in low and middle-income countries.

Measuring the equity of health services in Kenya: a tool for informing policy
RESYST policy brief; Molyneux S, Goodman C, Toda M, Noor A (2014)
Area of focus: Kenya
Overview: This brief introduces new way of assessing how equitable public primary health services are, by looking at the associations between health facility characteristics and the poverty level of the area in which the facility is located.

Accelerating health equity: the key role of universal health coverage in the Sustainable Development Goals
Journal publication (RESYST related); Tangcharoensathien V, Mills A,  Palu T (2015)
Journal: BMC Medicine
Area of focus: Global
Overview: This article argues that UHC requires a significant increase in government investment in strengthening primary healthcare - the close-to-client service which can result in equitable access.

Health workforce

Many countries face a severe and persistent shortage of qualified health workers, especially in rural areas. This can lead to poor service delivery and inequalities in health, and can limit progress towards Universal Health Coverage. An important first step in addressing human resource shortages in health systems is knowing what factors influence health workers’ job and location choices.

How do we train, support and retain resilient nurses in underserved areas?
RESYST key findings sheet (2016)
Area of focus: South Africa
Overview: This resource presents the key findings from the RESYST study which tracked a cohort of nursing graduates in rural and urban South Africa.

Pro-social preferences and self-selection into jobs: Evidence from South African nurses
Journal publication; Lagarde M and Blaauw D (2014)
Journal: Journal of Economic Behaviour and Organization
Area of focus: South Africa
Overview: This article analyses whether nurses’ prosocial preferences predict the uptake of rural public jobs.

Rural or urban? The role of nurses’ dedication towards patients in their choice of job
RESYST policy brief (2014)
Area of focus: South Africa
Overview: This brief highlights research findings from the cohort study showing that nurses’ decisions about job location are affected by their dedication towards patients.

Strengthening local governance to improve access and coverage

Facility and sub-district managers play a crucial role in ensuring access to essential healthcare services and, hence, in achieving UHC. Managers face a variety of everyday challenges, and they draw on different resources and capacities available to them to ensure facilities can continue to function on a day-to-day basis. Developing the leadership skills of these frontline and mid-level managers through new forms of workplace based activities is important in strengthening local governance for UHC.

Crisis and resilience at the frontline: Coping strategies of Kenyan primary health care managers in a context of devolution and uncertainty
RESYST policy brief (2016)
Area of focus: Kenya
Overview: This brief sets of findings from research that aimed to better understand the role and responsibilities of PHC managers in Kenya, and their coping strategies within the context of devolution and uncertainty.

Exploring the nature of governance at the level of implementation for health system strengthening: the DIALHS experience
Journal publication (RESYST related); Scott V, Schaay N, et al. (2014)
Journal: Health Policy and Planning
Area of focus: South Africa
Overview: This article presents a case study of an intervention to address conflict in roles and responsibilities between multiple actors supporting service delivery at the local level, and explores the broader insights this experience generates about the nature of local health system governance.

Workplace-based learning for health system leaders: practical strategies for training institutions and governments
RESYST workshop report; Doherty J and Gilson L (2015)
Area of focus
: Global
Overview: This report is from a workshop that aimed to enhance the capacity and capabilities of people and systems engaged in leadership development.

Monitoring progress towards UHC

Monitoring the implementation of Universal Health Coverage reforms in districts in Tanzania
UNITAS policy brief (RESYST related); Mtei J, Borghi J et al (2015)
Area of focus
: Tanzania
Overview: This policy brief forms part of the research undertaken for the UNITAS (Universal Coverage in Tanzania and South Africa: monitoring and evaluating progress) project. 

Measuring progress towards Universal Health Coverage: an approach in the Indian context
Journal publication (RESYST related); Vaidyanathan G, Sharma J et al (2014)
: Economic and Political Weekly
Area of focus: India
Overview: This paper proposes an approach to periodically measure the extent of progress towards universal health coverage using a set of indicators that captures the essence of the factors to be considered in moving towards universalisation.

Financing Universal Health Coverage (UHC)