Universal health coverage-Exploring the what, how, and why using realist review

Area of Science:

• Health Systems Research
• Public Health Policy
• Global Health Security

Background:

• Universal health coverage (UHC) is a key global health strategy for achieving "good health and wellbeing."
• Varied interpretations and implementation of UHC necessitate a clearer understanding of its scope and strategies.
• Existing literature shows interchangeable use of terms like "universal coverage" and "universal healthcare" with UHC.

Purpose of the Study:

• To synthesize evidence on the meaning, components, significance, and strategies of UHC.
• To address the knowledge gap regarding the diverse understandings and practical applications of UHC.
• To provide a comprehensive overview of UHC for improved health system strategies.

Main Methods:

• Realist review methodology employed to synthesize evidence.
• Systematic search of major databases (PubMed, EMBASE, Scopus, Web of Science) and grey literature.
• Data extraction and synthesis following a defined scope and initial program theory.

Main Results:

• UHC is understood as a legal, human rights-based concept promoting fair and comprehensive healthcare.
• Key rationales for UHC include disease prevention, promoting equity, and enhancing global health security.
• Implementation mechanisms encompass health insurance, social protection, digital financing, public-private partnerships, and primary healthcare.

Conclusions:

• UHC is a multifaceted political and ethical imperative essential for health equity and human dignity.
• Despite its importance, UHC is not universally applied, with service inclusion and scope varying significantly by country.
• Realizing UHC necessitates sustained advocacy, strategic research, and strong political commitment.