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Universal coverage

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People expect their health systems to be equitable. The roots of health inequities lie in social conditions outside the health system’s direct control. These root causes have to be tackled through intersectoral and cross-government action. At the same time, the health sector can take significant action to advance health equity internally. The basis for this is the set of reforms that aims at moving towards universal coverage, i.e. towards universal access to health services with social health protection. Health inequities also find their roots in the way health systems exclude people, such as inequities in availability, access, quality and burden of payment, and even in the way clinical practice is conducted.

Three ways of moving towards universal coverage

The fundamental step a country can take to promote health equity is to move towards universal coverage: universal access to the full range of personal and non-personal health services required, with social health protection. The technical challenge of moving towards universal coverage is to expand coverage in three ways (see figure).:

  • The breadth of coverage – the proportion of the population that enjoys social health protection – must expand progressively to encompass the uninsured, i.e. the population groups that lack access to services and/or social protection against the financial consequences of taking up health care.
  • The depth of coverage must also grow, expanding the range of essential services that is necessary to address people’s health needs effectively, taking into account demand and expectations, and the resources society is willing and able to allocate to health. The determination of the corresponding “essential package” of benefits can play a key role here, provided the process is conducted appropriately.
  • The height of coverage, i.e. the portion of health care costs covered through pooling and prepayment mechanisms, must also rise, diminishing reliance on out-of-pocket copayment at the point of service delivery. Prepayment and pooling institutionalizes solidarity between the rich and the less well-off, and between the healthy and the sick. It lifts barriers to the uptake of services and reduces the risk that people will incur catastrophic expenses when they are sick. Finally, it provides the means to reinvest in the availability, range and quality of services.

This section of the health system profile is structured as follows:

Contents

Résumé analytique

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Descriptive summary

The use of health services is average. This situation is strongly influenced by socioeconomic status of households and image of health facilities as perceived by households. The low purchasing power explains the use of self-medication as first-line (46%) of household heads, the health facility involved in second-line (26.7%). In CSI, the average utilization rate of curative consultation is 0.3 new cases per inhabitant per year in urban areas and 0.18 new cases in rural areas; utilization of prenatal care, is is around 54.3%, the coverage rate of consultation with children under 5 years is equal to 52.5% in rural areas and 35% in urban areas, the coverage rates achieved for antigens of reference are respectively 65.4% for DTC3P3, and 66.5% for TT2 in 2005. Overall, the use of CSI remains low because of frequent stock outs of essential drugs generic information of the sub-communities on health initiatives and weaknesses in the supervision and monitoring activities.

Forces
  • Free management of malaria in pregnant women and children from 0 to 15 years


Weaknesses
  • Health coverage is still low in CSI streamlined resulting in the slow implementation of the NHDP.


Recommendations
  • Increased health coverage CSI national public and private hospitals and reference respectively streamlined offering of LDCs and ACP including comprehensive health services of the FAC;
  • reducing exclusions and inequalities in access to care and quality services in relation to gender, poverty and other factors;

Cadre organisationnel de la couverture universelle

Aperçu des principaux acteurs et des principales dispositions en relation avec la couverture universelle

Cf : descriptions détaillée des dispositions relatives à l’accès universel aux soins et services ci-après :

  • Accès universel à la thérapie antirétrovirale ;
  • Accès universel au traitement de la tuberculose (DOTS) ;
  • Accès universel à la prise en charge du paludisme, y compris la gratuité du traitement du paludisme ;
  • Gratuite de la césarienne et autres interventions chirurgicales liées à la grossesse et à l’accouchement.

Cadre réglementaire spécifique

Le pays n’a pas mis en place une structure spécifique de régulation de l’accès universel. Toutefois le Comité de Pilotage du PNDS ainsi que les autres organes de suivi de la mise en œuvre et de coordination des programmes et projets spécifiques devraient pouvoir accomplir cette fonction de régulation.

Cartographie de la santé et couverture géographique

Exception faite des taux de couverture vaccinale, qui sont rendus par district sanitaire, le pays ne dispose pas d’une cartographie des structures sanitaires et des taux de couverture des interventions offertes.

Stratégie de financement des soins de santé en vue de la couverture universelle

Des dispositions ont été prises par les pouvoirs publics pour : (i) financer l’acquisition et la distribution des médicaments essentiels génériques dans les Circonscriptions socio sanitaires, par le biais de la COMEG et (ii) assurer la gratuité des traitements antirétroviraux, de la prise en charge du paludisme et de la césarienne. Toutes ces dispositions attendent d’être inscrites dans une stratégie globale de financement de l’accès universel des populations aux soins et services de santé.

Portée - étendre la population cible

Les populations cibles visées par les dispositions relatives aux interventions ci-dessus décrites concernent principalement la mère et l’enfant ainsi que les personnes vivant avec le VIH.

Profondeur - élargir la gamme de services

En 2007, le Ministère de la santé a défini les paquets de services essentiels du district sanitaire et élaboré un manuel d’instructions et directives techniques pour leur mise en œuvre . Ces paquets définis par niveaux (communauté, centre de santé et hôpital de district) intègrent à la fois des interventions ayant des impacts prouvés sur la mortalité maternelle et infantile ainsi que celles relatives à la surveillance épidémiologique, à la promotion de la santé et à l’environnement. A titre indicatif, les paquets de services essentiels focalisés sur la réduction de la mortalité maternelle et infantile concernent notamment : (i) les consultations curatives de base : mise en œuvre de la prise en charge intégrée des maladies de l’enfant ; (ii) les consultations prénatales ; (iii) l’assistance aux accouchements ; (iv) les consultations des enfants de moins de 5 ans ; (v) les vaccinations et (vi) la surveillance nutritionnelle.

Other initiatives towards universal coverage

Barriers on access to health services

Endnotes: sources, methods, abbreviations, etc.