Jesper Sundewall

When it comes to mental health, all countries are developing countries. – Shekhar SaxenaMental health is a fundamental aspect of human well-being and good mental health in the population is both an...

Self-care interventions for sexual and reproductive health (SRH), including HIV self-testing, self-injected contraception and self-managed abortion, offer promising pathways to advance universal health coverage, particularly in low- and middle-income countries. While often framed as cost-saving measures, this paper argues that self-care should be understood as a strategic investment in health system performance. Drawing on costing and financing analyses and previous literature, we explore how self-care interventions can enhance efficiency, resilience and equity of health systems. We propose a costing framework that outlines cost components across development, implementation and scale-up, emphasising both system and individual-level considerations. We argue that sustainable scale-up of self-care requires diversified financing models, including tax-based funding, insurance mechanisms and reduced out-of-pocket costs for users. Successful integration also demands governance structures that prioritise quality, equity and continuity of care. By reframing self-care as a health system investment rather than a cost-containment tool, policymakers can better harness its potential to improve access, reduce burden on facilities and empower individuals in managing their health. Self-care interventions for SRH, when embedded within broader health system strengthening efforts, have the potential to be transformative for SRH outcomes and for progressing towards universal health coverage.

Background: Countries around the world have committed to universal health coverage (UHC), a global vision that affirms the right for all people to access essential healthcare, when and where they need it and regardless of their ability to pay. UHC, as a political commitment, developed as part of the Sustainable Development Agenda in 2015 and, more recently, at the United Nations High-Level meeting on UHC in 2019. A policy commitment to UHC means translating the broad vision of UHC into nationally appropriate, locally relevant health policies. The aim of this work is to develop an analytical framework for describing the key features of UHC to assess how UHC is conceptualised and translated at the national health policy level. Methods: We analysed purposively collected documents on UHC and conducted case studies of relevant health policies in three countries: South Africa, Botswana, and Kenya. Results: We propose a framework that includes five components we consider central to a UHC approach, namely: population coverage, healthcare service provision, health financing, health equity, and leadership and governance. The framework was applied to health policies in three countries in Africa (Botswana, Kenya, and South Africa) to test its relevance and applicability. Conclusions: Analysing policy commitments for UHC is central to understanding how countries are translating the broad aspiration into action. Our framework provides a useful tool by breaking down UHC into five core components and proposes questions to guide how policy commitments can be identified.

Background: The response to the COVID-19 pandemic involved various lockdown measures, including school closures, which significantly impacted young populations, particularly in low-and middle-income countries (LMICs). Given the well-known protective effect of regular school attendance on sexual and reproductive health and rights (SRHR), reports of disrupted education, compromised SRHR, and an increase in unintended pregnancies among adolescent girls and young women (AGYW 10–24 years) have caused major concerns. We conducted a scoping review to compile the available evidence of the impact of COVID-19 lockdown measures on unintended pregnancies among AGYW aged 10–24 in LMICs. Methods: The scoping review followed the five-stage framework by Arksey and O´Malley. A systematic search on two comprehensive databases, using search terms related to COVID-19 and unintended pregnancies, was conducted along with grey literature searches of articles in English language published between 2019 and 2024. The systematic review software Covidence was used for publication screening, selection and data extraction. Results: After deduplication, 241 publications were screened, and 72 full-text publications were assessed for eligibility. 13 publications from the database searches, citation searching and grey literature, were included. The scoping review included seven studies that applied quantitative methods, four that used qualitative approaches and the remaining two mixed methods. Five out of 13 publications were set in Uganda, two in Kenya and two in Nigeria, while six other countries were represented once. All included studies reported increases in pregnancies among AGYW during the COVID-19 period. School dropout among girls following a pregnancy was reported to have increased. Factors associated with unintended pregnancy were school closures, limited access to SRHR services including contraceptives, and increasing sexual encounters. Conclusion: School closures and other lockdown measures during the COVID-19 pandemic led to an increase in unintended pregnancies among AGYW in LMICs. The long-term consequences for these young individuals, their communities and to the broader society are still to be measured and available evidence is limited, few studies have applied robust study designs, and several relied on small sample sizes. Further research is needed to build a stronger evidence base for health and socio-economic impacts of school closures and lockdowns among young people.

Using data on 119 low- and lower-middle income countries from 2002 to 2020, we apply fixed-effects (FE) methods to evaluate the impacts of three different classifications of development assistance on access to three types of sexual and reproductive health (SRH) services: access to skilled birth attendance, prevalence of modern contraceptives, and coverage of antiretroviral therapies against HIV/AIDS. The results suggest that aid has had a small, but positive effect on these outcomes over this period. For example, SRH aid has increased service coverage rates by between 0.190 and 0.628 percentage points. The results also indicate that the effect of aid has improved across the period and is larger in low-income countries compared with lower-middle income countries. The findings also indicate that bilateral aid may be somewhat more effective than other types of aid. Importantly, the results suggest that development assistance is more effective if it reaches a certain share of overall health spending. The findings are robust to a series of sensitivity checks. The results of the study lend support to the continued allocation of aid to low-income countries to support the provision of sexual and reproductive health services. Both providers and recipients of SRH aid would be advised to identify ways to improve the effectiveness of development assistance in this area.

Achieving universal health coverage (UHC) is a priority of most low- and middle-income countries, reflecting governments’ commitments to improved population health. However, high levels of informal employment in many countries create challenges to progress toward UHC, with governments struggling to extend access and financial protection to informal workers. One region characterized by a high prevalence of informal employment is Southeast Asia. Focusing on this region, we systematically reviewed and synthesized published evidence of health financing schemes implemented to extend UHC to informal workers. Following PRISMA guidelines, we systematically searched for both peer-reviewed articles and reports in the grey literature. We appraised study quality using the Joanna Briggs Institute checklists for systematic reviews. We synthesized extracted data using thematic analysis based on a common conceptual framework for analyzing health financing schemes, and we categorized the effect of these schemes on progress towards UHC along the dimensions of financial protection, population coverage, and service access. Findings suggest that countries have taken a variety of approaches to extend UHC to informal workers and implemented schemes with different revenue raising, pooling, and purchasing provisions. Population coverage rates differed across health financing schemes; those with explicit political commitments toward UHC that adopted universalist approaches reached the highest coverage of informal workers. Results for financial protection indicators were mixed, though indicated overall downward trends in out-of-pocket expenditures, catastrophic health expenditure, and impoverishment. Publications generally reported increased utilization rates through the introduced health financing schemes. Overall, this review supports the existing evidence base that predominant reliance on general revenues with full subsidies for and mandatory coverage of informal workers are promising directions for reform. Importantly, the paper extends existing research by offering countries committed to progressively realizing UHC around the world a relevant updated resource, mapping evidence-informed approaches toward accelerated progress on the UHC goals.

IntroductionAddressing attitudes is central to achieving sexual and reproductive health and rights (SRHR) as per the 2030 Agenda. We aimed to develop a comprehensive index to measure individual’s support for SRHR, expanding opportunities for global trend analyses and tailored interventions. MethodsWe used nationally representative data on attitudes towards different dimensions of SRHR, collected via a new module integrated into the World Values Survey in Ethiopia, Kenya, and Zimbabwe during 2020–2021 (N=3,711). Exploratory factor analysis of 58 items was used to identify sub-scales, combined into an overall index. Adjusted regression models were used to evaluate the index according to sociodemographic characteristics, stratified by country and sex.ResultsA 23-item, five-factor solution was identified and used to construct sub-indices reflecting support for: (1) sexual and reproductive rights, (2) neighborhood sexual safety, (3) gender-equitable relationships, (4) masculinity norms, and (5) SRHR interventions. These five sub-indices performed well across countries and socioeconomic subgroups and were combined into a comprehensive “SRHR Support Index”, standardized on a 1–100 scale (mean=39.19, SD=15.27, Cronbach’s alpha=0.80) with higher values indicating more support for SRHR. Mean values were highest in Kenya (45.48, SD=16.78) followed by Ethiopia (40.2, SD=13.63) and lowest in Zimbabwe (32.65, SD=13.77), with no differences by sex. Higher education and being single were associated with more support, except in Ethiopia. Younger age and urbanicity were also associated with more support among males only.ConclusionThe SRHR Support Index has potential to broaden SRHR attitude research from a comprehensive perspective – addressing the need for a common measure to track progress over time in contexts where such data are limited, including sub-Saharan Africa.While the index performed well, further validation is needed to assess its applicability in different settings and populations.