Universal Health Coverage in Francophone Sub-Saharan Africa: Assessment of Global Health Experts' Confidence in Policy Options

Elisabeth Paul; Fabienne Fecher; Remo Meloni; Wim van Lerberghe

doi:10.9745/GHSP-D-18-00001

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TABLE 1.

Common UHC Policy Options Selected for the Delphi Survey

UHC Dimension	Policy Options
Diminish financial barriers to access	B1 Fee exemptions for children and pregnant women B2 Fee exemptions for the poorest B3 Fee exemptions for priority services (e.g., cesarean deliveries, malaria, HIV) B4 Mandatory health insurance with subsidization of the poor B5 Voluntary community-based health insurance B6 Vouchers for the poor

Improve health care funding	F1 Ring-fenced domestic health budgets F2 Innovative financing for health (e.g., sin tax, bonds) F3 Pooling and defragmentation of existing financing mechanisms F4 Reducing inefficiencies and wastage F5 Performance-based aid funding F6 Creation of a global UHC fund

Improve the supply and management of services	S1 Start with a package of essential services for the whole population and progressively expand the package (“universalist” approach) S2 Start with a full package of services for some categories of population or geographic areas, and progressively extend UHC coverage to other types of populations or areas (“sequenced” approach) S3 Strengthen the supply of quality primary health care services S4 Develop public-private partnerships S5 Results- or performance-based payment of providers S6 Separate provider and purchaser functions through creation of autonomous health services or agencies

Abbreviations: B, barriers; F, funding; S, supply; UHC, universal health coverage.

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TABLE 2.

Characteristics of the Delphi Study Panel of Experts

Expert No.	Country of Origin	Experience in:
Expert No.	Country of Origin	LMIC MOH Staff or Technical Assistant	Multilateral Organization	Bilateral Agency	Consultancy Firm or Freelance	Academia and/or Civil Society
1	Belgium	X	X		X	X
2	Belgium	X		X		X
3	Belgium				X	X
4	France				X
5	Germany	X		X	X
6	Germany	X		X
7	Germany	X	X	X	X
8	Italy		X		X	X
9	Netherlands	X	X		X
10	Burundi	X			X
11	Democratic Rep. of the Congo	X	X	X	X
12	Guinea	X	X	X	X	X
13	Côte d'Ivoire	X			X	X
14	Mali	X	X
15	Morocco	X	X
16	Senegal	X			X	X
17	Tunisia	X	X

Abbreviations: LMICs, low- and middle-income countries; MOH, Ministry of Health.

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TABLE 3.

Average Scores of Delphi Study Participants for Confidence in and Degree of Consensus^a on Effectiveness and Feasibility of Common UHC Policy Options, Classified by Increasing Confidence in Effectiveness

UHC Dimension Code	Policy Option	Effectiveness		Feasibility
UHC Dimension Code	Policy Option	Confidence	Consensus	Confidence	Consensus
B5	Community-based health insurance	40	75	49	60
F5	Performance-based aid funding	43	72	48	72.5
S5	Performance-based payment of providers	48	67.5	49	80
F1	Ring-fenced budgets	48	80	56	73.75
S2	Expansion of population covered	49	80	54	70
F2	Innovative financing	51	80	59	65
S4	Public-private partnerships	54	80	58	72.5
B2	Fee exemption for poorest	55	80	66	85
B6	Vouchers	56	80	63	75
F4	Reduction of inefficiencies	59	75	60	75
B1	Fee exemption for children and pregnant women	60	80	64	77.5
F3	Pooling of schemes	60	75	57	65
S6	Purchaser-provider split	60	75	60	68.75
B3	Fee exemption for specific services	61	75	65	77.5
F6	Global fund for UHC	64	75	67	67.5
S1	Expansion of package of services	64	76.25	68	75
B4	Mandatory health insurance	67	75	68	70
S3	Strengthen supply of quality primary health care	79	90	78	73.75

Abbreviations: B, barriers; F, funding; S, supply; UHC, universal health coverage.
↵a Degree of consensus measured through 100 (total consensus) minus the interquartile range of individual scores.