Challenges and Opportunities for Universal Health Coverage in South Asia: A Scoping Review

Area of Science:

• Public Health
• Health Systems Research
• Health Policy

Background:

• South Asia faces significant deficits in healthcare access and financial protection, impeding progress toward universal health coverage (UHC).
• Existing health systems grapple with numerous challenges that hinder equitable and comprehensive healthcare delivery.

Purpose of the Study:

• To conduct a scoping review examining the multifaceted challenges and opportunities for achieving universal health coverage (UHC) within the South Asian region.
• To synthesize current literature on UHC progress, identifying persistent barriers and potential pathways forward.

Main Methods:

• Employed the six-stage Arksey and O'Malley methodological framework for scoping reviews.
• Utilized the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR) checklist for structured reporting.
• Conducted a systematic search across three databases and 13 gray literature sources, reviewing 27 selected records.

Main Results:

• Key challenges identified include chronic underfunding of health systems, underdeveloped social protection or insurance mechanisms, and significant health system fragmentation.
• Inability to effectively regulate the private healthcare sector, inadequate preparedness for non-communicable diseases, and concerns regarding healthcare quality and equitable access were frequently reported.
• While country-specific contexts drive diverse challenges, consistent themes emerged across the region.

Conclusions:

• Progress toward UHC in South Asia is significantly hampered by a complex interplay of systemic, financial, and regulatory challenges.
• Further research is recommended to longitudinally track the evolution of these challenges and associated priorities to inform effective UHC strategies.