Anjorin, Seun S. (2022) Progress towards universal health coverage in low- and middle-income countries : application of innovative analytic techniques to enhance policy and service delivery decision making. PhD thesis, University of Warwick.

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Abstract

Background
Despite the huge potential universal health coverage (UHC) holds for solving most public health problems, more than half of the global population yet lack access to essential health services (EHS). Low- and middle-income countries (LMICs), especially those in Africa and South Asia share the highest burden of these issues. This thesis aims to examine the determinants, impact and expected improvement in EHS in LMICs
Method
Eight analytical techniques were applied to explore the objectives of the thesis. The first three (bibliometric analysis; systematic review and ecological analysis) were applied to generate evidence on key topics on UHC research. A series of five other analytical techniques were applied to examine access to EHS in LMICs. Results were presented with tables, maps, and other figures; all the analyses were performed with STATA and R vs 4.6.
Results
The lack of financial protection in LMICs is high, with more than two-thirds (67%) exhibiting common-cause variation. The prevalence of mother-child pairs with suboptimal access to EHS varies widely in LMICs, from 5.5% in Honduras to 100% in Colombia. 54.6% of the variance in suboptimal access to EHS are attributable to neighbourhood-level factors and maternal education is the strongest determinant at individual levels. The impact of suboptimal access to EHS was strongly associated with under-five mortality across all the LMICs such that interventions aimed at shifting determinants related to sustainable development goals (SDGs) will increase access to EHS by more than 80%.
Conclusion
This thesis has added to the growing body of evidence on UHC. Findings suggest that LMICs must prioritise new approaches to ensure health insurance schemes are equitable. Policymakers and stakeholders must begin to think beyond quick but unsustainable intervention for UHC in LMICs and increase their focus on contextual issues and other socioeconomic factors that impact on EHS.

Item Type:	Thesis (PhD)
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Library of Congress Subject Headings (LCSH):	Health services accessibility -- Africa, Health services accessibility -- Asia, Primary health care -- Africa, Primary health care -- Asia, Medical policy -- Asia, Medical policy -- Africa, Medical care, Cost of -- Asia, Medical care, Cost of -- Africa, Health insurance -- Asia, Health insurance -- Africa, Health care reform -- Asia, Health care reform -- Africa
Official Date:	February 2022
Dates:	Date Event February 2022 UNSPECIFIED
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	Uthman, Olalekan A., 1977- ; Oyinlola, Oyebode ; Ayorinde, Abimlola
Sponsors:	University of Warwick. Chancellor's International Scholarship
Format of File:	pdf
Extent:	xv, 124 pages : illustrations
Language:	eng

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