**3. A blueprint for health sector reforms in LMICs**

To achieve effective UHC, meaning that people receive quality prioritized healthcare services resulting in the actual translation of goals into out-come improvements on prioritized conditions, the LMIC countries will need to address and correct some of the dysfunctional gears in the health system. In approaching this health sector reform process, we have decided to focus on several key issues (see **Table 1**). After describing each strategic challenge, we provide our proposed actions for reform. This is our blueprint for health sector reforms in LMICs.

**7**

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

• Physical, social, and financial barriers to access • Focus on expanding "close to client services,"

• Poor demand for evidence-based interventions • Community mobilization by creation of

• Weak drug policies and supplies system • Introduce new supply mechanisms

for example, primary care services provided by community health volunteers (CHVs) • Improve financial protection by expanding health insurance coverage and removing financial barriers at the point of use • Improve responsiveness of the health service delivery through pay for performance approaches

support groups and welfare organizations to spread health information such as antenatal care and screening for chronic illnesses

• Implement task shifting by training CHVs to

• Increase allowance for work in remote areas

• Increase salaries sustainably and strengthen training and support supervision

• Improve public supply systems and utilize

• Allocate adequate resources for renovating, upgrading, and expanding public facilities, contract nongovernmental organizations to

• Decentralize planning and management

• Strengthen regulation through enforcement legal mechanisms, for example, licensing provisions for healthcare providers and setting

• Engagement of civic organizations in planning

• Use of output-based payments and external

• Implement reforms to aid management and delivery (e.g., sector wide approaches and International Health Partnership Plus) • Provide increased financing for systems

• Encourage improved stewardship and accountability mechanisms by encouraging growth in

• Increase number of qualified staff

treat common illness

private retail system

provide services

up health facilities

and service oversight

assistance programs

civic organizations

support

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

**Community and household level**

**Healthcare service delivery**

primary care level

and supervision

healthcare services

management systems

private health sector

support

accountability)

• Inadequate qualified health workforce especially at

• Lack of motivation of staff and low remuneration, weak technical guidance, program management,

• Inadequate medical supplies and equipment, poor health infrastructure, and limited access to

**Policy and strategy management in health sector** • Fragmented and overly centralized planning and

• Rigid regulatory frameworks and proliferation unregulated, unaccountable, and out of control

• Poor cooperative action and partnership between

• Weak incentives to use inputs efficiently and to respond to user needs and preferences

• Fragmented donor funding, which reduces flexibility and ownership; low priority given to systems

• Governance and overall policy framework (e.g., corruption, weak government, weak rule of law and enforceability of contracts, political instability and insecurity, social sectors not given priority in funding decisions, and weak structure for public

civic organizations and government

**Political and physical environment**

**Key issue Strategy**

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


*Healthcare Access - Regional Overviews*

coverage.

**2.1 Driving forces for changes**

health insurance schemes.

and the quality of healthcare services provided.

**3. A blueprint for health sector reforms in LMICs**

sector and free for the poorest members of the population. However, the challenges of having affordable premiums and maintaining voluntary enrolment have prompted the national government to propose a one-time payment rather than annual payment from those in the informal sector [13]. Given that the national healthcare system of Ghana is mainly financed by general taxation through valueadded tax therefore the proposal to introduce a one-time payment would signal a

In view of the limited resources and narrow tax base, budgetary allocations in most LMICs to the healthcare sector have fallen short of the 15% envisaged in the Abuja declaration [18]. Consequently, there has been a limited ability of many households to pay for health care, whether directly or through health insurance. While progress toward universal health coverage may inevitably be gradual, LMIC countries need to draw on a mix of healthcare financing sources. In particular, the financing options should take into account the diversities in the economic, social, and political environment and ensure that the most vulnerable segment of the population is financially protected with a reasonable depth of

Despite LIMCs spending an average of 6% of its GDP on health, there have been minimal impacts compared to high-income countries. The health care system challenges in LMICs can be observed throughout the public and private sectors. First, public health services delivery is highly fragmented, and implementation of decentralization policies has failed in most LMICs. Also, there is a lack of primary care orientation, low institutional capacity, poor health information systems, and widespread inequalities in health care utilization. Second, most LMICs have low health insurance coverage and limited financial protection of households from the impoverishing effects of catastrophic health expenditures mainly due to the high levels of unemployment and poor management of pooled resources via the national

In the private health sector, problems arise due to a rigid regulatory framework that has resulted in the proliferation of private health providers which are unregulated, unaccountable, and out of control. In most LMICs, the growth of the private health sector has been characterized by poor planning and government reluctance in monitoring licensing provisions. Most health professional councils are defunct and being misused by the dominant vested interests. Although equity in health service delivery and availability of health resources including human power have featured in policy documents of LMICs, the legal and licensing provisions for healthcare providers, setting up health facilities are not often seriously enforced. As a result, there is gross imbalance between the actual growth of the physical services

To achieve effective UHC, meaning that people receive quality prioritized healthcare services resulting in the actual translation of goals into out-come improvements on prioritized conditions, the LMIC countries will need to address and correct some of the dysfunctional gears in the health system. In approaching this health sector reform process, we have decided to focus on several key issues (see **Table 1**). After describing each strategic challenge, we provide our proposed actions for reform. This is our blueprint for health sector reforms in LMICs.

decline in the importance attached to contributory insurance [13].

**6**


**Table 1.**

*Key issues faced by healthcare systems in LMICs and proposed action for reform.*
