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  • br Although safe effective evidence based interventions that

    2019-04-19


    Although safe, effective, evidence-based interventions that LDN193189 Hydrochloride cost are simple enough to be provided at primary-care level exist, provision of safe abortion remains restricted to physicians and often only to gynaecologists in many parts of the world. WHO\'s new guideline highlights that moving beyond specialists and enabling a wide range of health workers in safe abortion care promotes a rational use of the available health workforce and facilitates equitable and timely access to care. This is essential in settings where shortages of skilled workers are the most acute, but is also relevant in high-income countries to address subnational imbalances and to promote care that might better meet women\'s needs. The guideline was developed from a systematic search, synthesis, and assessment of the evidence. The search identified 36 studies on safety and effectiveness and 204 qualitative studies that looked at acceptability and feasibility. Data came from both high-resource and low-resource settings and included a case study synthesis of five country contexts where abortion-related task shifting has occurred to various degrees (Bangladesh, Ethiopia, Nepal, South Africa, and Uruguay). In keeping with WHO\'s broad and inclusive definition of health workers, a wide range of health worker types were considered.
    Nigeria has shown commitment to achieving universal health coverage (UHC), but progress has been slow. The 2014 Presidential Summit Declaration affirms that UHC is key to ensuring equitable access to high-quality, affordable health care LDN193189 Hydrochloride cost for all Nigerians. Although the summit was built on a highly participatory stakeholder engagement process, its concomitant momentum has waned. The new government led by President Muhammadu Buhari can re-energise the drive towards achieving UHC in Nigeria. A recent review of health-system financing for UHC in Nigeria shows high out-of-pocket expenses for health care, a very low budget for health at all levels of government, and poor health insurance penetration. According to WHO, general government expenditure on health as a percentage of total government expenditure was very low at 3·3% in 2002, increasing consistently per year to 9·4% in 2007, and dropped to 6·7% in 2012. Private expenditure on health as a percentage of total health expenditure remains high, dropping slightly from 74·4% in 2002 to 68·9% in 2012. Out-of-pocket expenditure as a percentage of private expenditure on health has consistently remained higher than 90% since 2002, and was 95·7% in 2012. Less than 5% of Nigerians have health insurance coverage; most enrolees are in the formal sector with very poor coverage in the informal sector. Two states (Bauchi and Cross River) attempted enrolling their employees, but nine states (Abia, Enugu, Gombe, Imo, Jigawa, Kaduna, Lagos, Ondo, and Oyo) have indicated interest. Other states including Lagos, Kwara, Ogun, and Akwa Ibom are implementing state-led community-based health insurance programmes to reach the informal sector with varying levels of coverage and inherent sustainability challenges. The recently signed National Health Act is a viable framework, the implementation of which can fast-track progress towards UHC. This act sets the background to earmark adequate public resources to health towards strengthening primary health care through the Basic Healthcare Provision Fund. 50% of the fund will be managed by the National Health Insurance Scheme to ensure access to a minimum package of health services for all Nigerians and 45% by the National Primary Healthcare Development Agency for primary health-care facility upgrade and maintenance, provision of essential drugs, and deployment of human resources to primary health-care facilities. The Federal Ministry of Health will manage the remaining 5% for national health emergency and response to epidemics. Counterpart funding from state and local governments is at the core of the National Health Act implementation. Resource mobilisation and accountability are key factors for successful implementation of the National Health Act. Although there is substantial evidence palynology public financing is key to the achievement of UHC, government expenditure on health has been very low in Nigeria and domestic resource mobilisation is weak. The new government should creatively and aggressively explore innovative domestic financing despite attendant fiscal constraints. Tax avoidance and inefficient tax collection are major roadblocks that the new government should tackle to improve domestic revenue generation. Lagos successfully increased its monthly internally generated revenue from N600 million to N20 billion between 2000 and 2010. Lagos\'s example should be adapted at the national and subnational levels in Nigeria to expand fiscal space and prioritise health investments.