**4. Measuring and monitoring implementation**

The essential components of the health sector reforms proposed in **Table 1** are only the gears to drive health sector reforms in LMICs to improve health outcomes. The realized gains from these reforms should be equitable distributed between and with LMICs. Monitoring progress of health sector reforms requires a robust health management information system embedded in a national interoperability plan. The measurable standards at the national at global level can be obtained level can be obtained from this plan to ensure that information generated can be harmonized and used for surveillance, monitoring, and evaluation of interventions and policies and clinical decision making at the point of care.

Enhancing prevention, promotion, treatment, rehabilitation, and palliative care to people in need without financial hardship as envisaged in the UHC requires major focus on the three interrelated components of UHC: first, ensuring a full spectrum of quality health services according to the needs; second, improving financial protection from direct payment for health services when consumed; and, lastly, expanding coverage for the entire population. In this regard, we propose a system of UHC monitoring in LMICs that will ensure that progress toward UHC reflects the unique epidemiological and demographic profiles of LMICs as well as the population demands and levels of economic development. The monitoring and evaluation plan for UHC in LMIC should include two guiding principles: financial protection and coverage of healthcare services. The primary outcomes include effectiveness, equity, and quality of healthcare at all levels of the health system for the full population across the life cycle, including all ages and genders.

### **5. Conclusions**

Health sector reforms in LMIC not only require a central focus on the health systems components but also a supportive environment for innovation and change. Health sector reform is a gradual process with complex systems hence the need for a vision and long-term strategies to realize the desired goals. Although most LMICs have prioritized UHC in their national policy agenda, there are still needs to work on achieving effective UHC, especially with regard to quality and equity. Therefore, the LMIC should focus on achieving actual and not aspirational UHC by strengthening health systems by improving health insurance coverage and financial protection, improving access to healthcare, reducing disparities in healthcare coverage especially on prioritized health problems, and enhancing a primary care-oriented healthcare system.

**9**

**Author details**

Peter O. Otieno\* and Gershim Asiki

provided the original work is properly cited.

African Population and Health Research Center, Nairobi, Kenya

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

\*Address all correspondence to: pootienoh@gmail.com

*Making Universal Health Coverage Effective in Low- and Middle-Income Countries…*

*DOI: http://dx.doi.org/10.5772/intechopen.91414*

The authors declare no conflict of interest.

**Conflict of interest**

*Making Universal Health Coverage Effective in Low- and Middle-Income Countries… DOI: http://dx.doi.org/10.5772/intechopen.91414*
