Towards leaving no one behind in North Macedonia : a mixed methods assessment of barriers to effective coverage with health services
© 2024. The Author(s)..
BACKGROUND: The Government of North Macedonia's Primary Health Care reform is committed to leaving no one behind on the path to Universal health Coverage (UHC). During mid-2022 to March 2023, the World Health Organization (WHO) collaborated with the Government and other national stakeholders for an assessment of barriers to effective coverage with health services experienced by adult citizens, with a specific focus on rural areas and subpopulations in situations of vulnerability.
METHODS: This study constituted the piloting of a draft forthcoming WHO handbook on assessing barriers for health services, grounded in the Tanahashi framework for effective coverage with health services. In North Macedonia, the convergent parallel mixed methods study involved four sources. These were: a nationally representative Computer Assisted Telephone Interview Survey (1,139 respondents); 24 key informant interviews with representatives from government, professional associations, non-governmental and civil society organizations, and development partners; 12 focus groups in four regions with adults from vulnerable/high risk groups in rural areas and small urban settlements and an additional focus group with persons with disabilities; and a literature review. Instrument design was underpinned by the Tanahashi framework, which also orientated data triangulation and deductive analysis. The research team synergistically incorporated emerging themes in an inductive way. A key component of the assessment was participatory design of the study protocol with inputs from national stakeholders as well as participatory deliberation of the results and the ways forward.
RESULTS: Despite considerable progress towards UHC in North Macedonia, the assessment elucidated remaining challenges. These included: insufficient numbers of health workers, in general and particularly in the more disadvantaged regions of the country; inadequate number of outpatient medicines covered by health insurance; distance and transportation obstacles, including indirect travel costs, particularly in rural areas; adverse gender norms and relations for both women and men inhibiting timely treatment seeking; perceived discrimination by providers on multiple grounds; bottlenecks including waiting times to get appointments for specialist referrals; and lack of patient adherence, due several factors including costs of medicines and health products.
CONCLUSIONS: The outputs from this study of barriers to effective coverage with health services for adult citizens of North Macedonia are feeding into the ongoing Primary Health Care reform, and provide evidence for equity-related actions in the forthcoming National Development Strategy.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:23 |
|---|---|
| Enthalten in: |
International journal for equity in health - 23(2024), 1 vom: 15. März, Seite 58 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Koller, Theadora Swift [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Barriers |
|---|
| Anmerkungen: |
Date Completed 18.03.2024 Date Revised 20.04.2024 published: Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1186/s12939-023-02082-3 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM369812220 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM369812220 | ||
| 003 | DE-627 | ||
| 005 | 20240420232341.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240317s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1186/s12939-023-02082-3 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1381.xml |
| 035 | |a (DE-627)NLM369812220 | ||
| 035 | |a (NLM)38491541 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Koller, Theadora Swift |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Towards leaving no one behind in North Macedonia |b a mixed methods assessment of barriers to effective coverage with health services |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 18.03.2024 | ||
| 500 | |a Date Revised 20.04.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2024. The Author(s). | ||
| 520 | |a BACKGROUND: The Government of North Macedonia's Primary Health Care reform is committed to leaving no one behind on the path to Universal health Coverage (UHC). During mid-2022 to March 2023, the World Health Organization (WHO) collaborated with the Government and other national stakeholders for an assessment of barriers to effective coverage with health services experienced by adult citizens, with a specific focus on rural areas and subpopulations in situations of vulnerability | ||
| 520 | |a METHODS: This study constituted the piloting of a draft forthcoming WHO handbook on assessing barriers for health services, grounded in the Tanahashi framework for effective coverage with health services. In North Macedonia, the convergent parallel mixed methods study involved four sources. These were: a nationally representative Computer Assisted Telephone Interview Survey (1,139 respondents); 24 key informant interviews with representatives from government, professional associations, non-governmental and civil society organizations, and development partners; 12 focus groups in four regions with adults from vulnerable/high risk groups in rural areas and small urban settlements and an additional focus group with persons with disabilities; and a literature review. Instrument design was underpinned by the Tanahashi framework, which also orientated data triangulation and deductive analysis. The research team synergistically incorporated emerging themes in an inductive way. A key component of the assessment was participatory design of the study protocol with inputs from national stakeholders as well as participatory deliberation of the results and the ways forward | ||
| 520 | |a RESULTS: Despite considerable progress towards UHC in North Macedonia, the assessment elucidated remaining challenges. These included: insufficient numbers of health workers, in general and particularly in the more disadvantaged regions of the country; inadequate number of outpatient medicines covered by health insurance; distance and transportation obstacles, including indirect travel costs, particularly in rural areas; adverse gender norms and relations for both women and men inhibiting timely treatment seeking; perceived discrimination by providers on multiple grounds; bottlenecks including waiting times to get appointments for specialist referrals; and lack of patient adherence, due several factors including costs of medicines and health products | ||
| 520 | |a CONCLUSIONS: The outputs from this study of barriers to effective coverage with health services for adult citizens of North Macedonia are feeding into the ongoing Primary Health Care reform, and provide evidence for equity-related actions in the forthcoming National Development Strategy | ||
| 650 | 4 | |a Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Barriers | |
| 650 | 4 | |a Gender | |
| 650 | 4 | |a Health equity | |
| 650 | 4 | |a Health financing | |
| 650 | 4 | |a Health services | |
| 650 | 4 | |a Health systems | |
| 650 | 4 | |a Health workforce | |
| 650 | 4 | |a Primary health care | |
| 650 | 4 | |a Social determinants | |
| 650 | 4 | |a Universal health coverage | |
| 700 | 1 | |a Janeva, Jelena Kjetkovikj |e verfasserin |4 aut | |
| 700 | 1 | |a Ognenovska, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Vasilevska, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Atanasova, Simona |e verfasserin |4 aut | |
| 700 | 1 | |a Brown, Chris |e verfasserin |4 aut | |
| 700 | 1 | |a Dedeu, Antoni |e verfasserin |4 aut | |
| 700 | 1 | |a Johansen, Anne |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t International journal for equity in health |d 2002 |g 23(2024), 1 vom: 15. März, Seite 58 |w (DE-627)NLM120916037 |x 1475-9276 |7 nnns |
| 773 | 1 | 8 | |g volume:23 |g year:2024 |g number:1 |g day:15 |g month:03 |g pages:58 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1186/s12939-023-02082-3 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 23 |j 2024 |e 1 |b 15 |c 03 |h 58 | ||