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The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9

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Start date: 2020Subject: search.filters.subject.Health Financing

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Now showing 1 - 3 of 3
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    Integrating healthcare financing for refugees into national health systems: findings from a rapid review of the literature
    (Elsevier, 2025-10-16) Bertone, Maria Paola; Palmer, Natasha; Witter, Sophie
    As the number of refugees increases and displacement becomes protracted, providing equitable healthcare in sustainable ways is increasingly challenging. The Global Compact for Refugees calls for greater inclusion of refugees in national health systems. However, evidence is limited on the most suitable approaches to achieve integration, including from a health financing perspective. This study reviewed normative and empirical literatures on health financing for refugees, reflecting on existing arrangements, and their level of integration with national health systems. A total of 52 documents were reviewed following a purposeful search of grey and published literature. Data were analysed according to core health financing sub-functions as defined by the WHO, specifically reflecting on pathways and approaches to integration for each. The analysis found that challenges remains in relation to funding for refugee healthcare, and areas of focus concern fair burden-sharing and engagement of development funders. Fund pooling proves to be a potential entry point for integration to reduce fragmentation in health financing through use of existing mechanisms (budgets or social health insurance schemes), despite challenges highlighted in the empirical literature. Fewer documents look at purchasing and benefit packages, and they highlight the importance of tailoring those to the specific needs of refugees. In relation to equity and efficiency, integration is often assumed to lead to improvements, but evidence is limited and issues related to the underlying weaknesses of the national health system might hamper the benefits of integration. Overall, the review findings support the development of hypotheses as to how best support health financing integration processes, and highlight areas for further research.
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    Political economy analysis of Universal health coverage and health financing reforms in low- and middle-income countries: The role of stakeholder engagement in the research process
    (BMC, 2021-12-11) Loffreda, Giulia; Bello, Kéfilath; Kiendrébéogo, Joël Arthur; Selenou, Isidore; Ag Ahmed, Mohamed Ali; Dossou, Jean Paul; Witter, Sophie; Bertone, Maria Paola
    Background: Progress towards Universal Health Coverage (UHC) is an inherently political process. Political economy analysis (PEA) is gaining momentum as a tool to better understand the role of the political and economic dimensions in shaping and achieving UHC in different contexts. Despite the acknowledged importance of actors and stakeholders in political economy considerations, their role in the PEA research process beyond ‘study subjects’ as potential co-creators of knowledge and knowledge users has been overlooked so far. We therefore aimed to review the approaches with reference to stakeholder engagement during the research process adopted in the current published research on the political economy of UHC and health financing reforms, and the factors favouring (or hindering) uptake and usability of PEA work. Methods: We reviewed the literature to describe if, when and how stakeholders were involved in the research process of studies looking at the political economy of UHC and health financing reforms, and to identify challenges and lessons learned on effective stakeholder engagement and research uptake. We used a standardised search strategy with key terms across several databases; we screened and included articles that focused on PEA and UHC. Additionally, we conducted a short survey of authors of the included studies to complement the information retrieved. Results: 50 articles met the inclusion criteria and were included in the analysis. We found overall little evidence of systematic engagement of stakeholders in the research process, which focused mostly on the data collection phase of the research (i.e., key informant interviews). Our study identifies some reasons for the varying stakeholder engagement. Challenges include PEA requiring specific skills, focusing on sensitive issues and the blurriness in researchers’ and stakeholders’ roles and the multiple roles of stakeholders as research participants, study subjects and research users. Among the approaches that might favour usability of PEA work, we identified early engagement, co-production of research questions, local partners and personal contact, political willingness, and trust and use of prospective analysis. Conclusions: Stakeholder engagement and research uptake are multifaceted concepts and complex processes, particularly when applied to PEA. As such, stakeholder engagement in the research process of PEA of UHC and health financing reforms is limited and underreported. Despite the challenges, however, stakeholder engagement remains key to ensure relevance, usability, and research uptake of PEA studies. More efforts are required to ensure engagement at different stages of the research process and better reporting in published articles.
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    Understanding the resilience of health systems
    (Springer, 2020-02-26) Blanchet, Karl; Diaconu, Karin; Witter, Sophie; Bozorgmehr, Kayvan; Roberts, Bayard; Razum, Oliver; Biddle, Louise
    Globally, displacement is now at the highest level ever recorded with 68.5 million people being forcibly displaced due to violence, political instability or poor economic conditions. Migration towards neighbouring countries or more distant high-income settings in Europe is creating new challenges for national health systems. This chapter explores health systems resilience, i.e. the capacity of health systems to adapt and transform themselves in response to challenges. We offer reflections and a new conceptual framework on resilience based on systems thinking and complexity theories. The chapter also offers examples of migration-related challenges and resilience responses in health systems and policies in order to illustrate the utility and relevance of the developed conceptual framework for European and neighbouring health systems faced by population flows and conflict. Finally, we make recommendations for a new research agenda.