Monitoring Progress towards Universal Health Coverage at Country and Global Levels

Universal health coverage (UHC) has been defined as the desired outcome of health system performance whereby all people who need health services (promotion, prevention, treatment, rehabilitation, and palliation) receive them, without undue financial hardship. UHC has two interrelated components: the full spectrum of good-quality, essential health services according to need, and protection from financial hardship, including possible impoverishment, due to out-of-pocket payments for health services. Both components should benefit the entire population.This paper summarizes the findings from 13 country case studies and five technical reviews, which were conducted as part of the development of a global framework for monitoring progress towards UHC.The case studies show the relevance and feasibility of focusing UHC monitoring on two discrete components of health system performance: levels of coverage with health services and financial protection, with a focus on equity. These components link directly to the definition of UHC and measure the direct results of strategies and policies for UHC. The studies also show how UHC monitoring can be fully embedded in often existing, regular overall monitoring of health sector progress and performance. Several methodological and practical issues related to the monitoring of coverage of essential health services, financial protection, and equity, are highlighted. Addressing the gaps in the availability and quality of data required for monitoring progress towards UHC is critical in most countries.

Summary Points

• The overall goal of universal health coverage (UHC) is that all people obtain the good-quality essential health services, including promotion, prevention, treatment, rehabilitation, and palliation, that they need without enduring financial hardship.
• A global UHC monitoring framework, developed by WHO and the World Bank Group in interaction with the process that led to this PLOS Collection, was used in 13 country case studies, underpinned by five technical reviews.
• The UHC monitoring framework focuses on the simultaneous monitoring of coverage of the population with essential health services and with financial protection against catastrophic out-of-pocket health payments, stratified by wealth quintile, place of residence, and sex.
• Most countries focus on regular monitoring of a set of tracer indicators for priority health services, as well as the occurrence of financial hardship and impoverishment due to out-of-pocket health expenses. The indicators generally follow international standards of measurement and can be used for global comparisons.
• Most countries do not have an explicit framework for UHC monitoring. The monitoring of UHC is, however, partially embedded in regular overall health sector progress and performance reviews which include health system inputs, service delivery, and health status indicators.
• There are major gaps in the availability and quality of data required for monitoring progress towards UHC. Countries mostly rely on international survey programs or national surveys to obtain disaggregated data on coverage and financial protection indicators, complemented by health facility data, but often the frequency and contents of these surveys are not sufficient to meet the country''s information needs.
• Monitoring progress towards the two components of UHC will be complementary and critical to achieving desirable health outcome goals, such as ending preventable deaths and promoting healthy life expectancy, and also reducing poverty and protecting household incomes.

     

Pathological Changes in Pulmonary Circulation in Carbon Tetrachloride (ccl4)-Induced Cirrhotic Mice

Rationale

Lack of an experimental model of portopulmonary hypertension (POPH) has been a major obstacle in understanding of pathophysiological mechanisms underlying the disease.

Objective

We investigated the effects of CCl₄-mediated cirrhosis on the pulmonary vasculature, as an initial step towards an improved understanding of POPH.

Methods And Results

Male C57BL/6 mice received intraperitoneal injection of either sterile olive oil or CCl₄ 3 times/week for 12 weeks. Cirrhosis and portal hypertension were confirmed by evidence of bridging fibrosis and nodule formation in CCl₄-treated liver determined by trichrome/picrosirius red staining and an increase in spleen weight/body weight ratio, respectively. Staining for the oxidative stress marker, 4-hydroxynonenal (4-HNE), was strong in the liver but was absent in the lung, suggesting that CCl₄ did not directly induce oxidative injury in the lung. Pulmonary acceleration time (PAT) and the ratio of PAT/pulmonary ejection time (PET) measured by echocardiography were significantly decreased in cirrhotic mice. Increase in right ventricle (RV) weight/body weight as well as in the weight ratio of RV/(left ventricle + septum) further demonstrated the presence of pathological changes in the pulmonary circulation in these mice. Histological examination revealed that lungs of cirrhotic mice have excessive accumulation of perivascular collagen and thickening of the media of the pulmonary artery.

Conclusion

Collectively, our data demonstrate that chronic CCl₄ treatment induces pathological changes in pulmonary circulation in cirrhotic mice. We propose that this murine cirrhotic model provides an exceptional tool for future studies of the molecular mechanisms mediating pulmonary vascular diseases associated with cirrhosis and for evaluation of novel therapeutic interventions.     

Penetration and Post-infectional Development and Reproduction of Meloidogyne arenaria Races 1 and 2 on Susceptible and Resistant Soybean Genotypes

Penetration, post-infectional development, reproduction, and fecundity of Meloidogyne arenaria races 1 and 2 were studied on susceptible (CNS), partially resistant (Jackson), and highly resistant (PI 200538 and PI 230977) soybean genotypes in the greenhouse. The ability to locate and invade roots was similar between races, but more juveniles penetrated roots of susceptible CNS than the resistant genotypes. At 10 days after inoculation, 56% and 99% to 100% of race 1 second-stage juveniles were vermiform or sexually undifferentiated in CNS and the resistant genotypes, respectively. In contrast, only 2%, 42%, 44%, and 62% of race 2 juveniles had not initiated development in CNS, Jackson, PI 200538, and PI 230977, respectively. By 20 days after inoculation, 88% to 100% of race 2 nematodes in roots of all genotypes were females, whereas only 25% and 1% of race 1 were females in CNS and the resistant genotypes, respectively. For all four genotypes, race 1 produce 85% to 96% fewer eggs per root system 45 days after inoculation than race 2. At 45 days after inoculation race 2 produced more eggs on CNS than the other genotypes.     

QTLs associated with chlorimuron ethyl sensitivity in soybean: Effects on seed yield and related traits

 Soybean, Glycine max (L.) Merr., genotypes are known to differ in chlorimuron ethyl sensitivity (CS). Earlier we have reported two putatively independent marker loci linked to two quantitative trait loci (QTLs) controlling CS in a soybean population derived from a cross of PI97100 (sensitive to chlorimuron ethyl) and ‘Coker 237’ (tolerant to chlorimuron ethyl). The objective of the present study was to quantify the association of the two marker loci with seed yield and related traits in this soybean population following application of chlorimuron ethyl. Phenotypic data were collected for 111 F₂-derived lines of the cross grown in replicated plots at Athens, G.A., in 1994 and 1995, and at Blackville, S.C., in 1995. The two CS marker loci explained as much as 50% of the genetic variation in seed yield and seed number m^-2, but had no association with seed weight, plant height, lodging, seed protein, and seed oil. There were no epistatic interactions between the two marker loci for any of the traits. The marker locus (cr168-1 on USDA linkage group E) linked to the major CS QTL explained between 13 and 23% of the variation in seed yield. The Coker 237 allele at this locus was associated with decreased CS and increased seed yield. The marker locus (Blt015-2 on an unknown linkage group) linked to the minor CS QTL accounted for a maximum of 11% of the variation in seed yield. The Coker 237 allele at this locus was associated with an increase in CS and a decrease in seed yield. The association of the two marker loci with seed number m^-2 strongly resembled their association with seed yield. Seed yield had a strong positive correlation (r=0.74 – 0.94) with seed number m^-2, and the effect of chlorimuron ethyl on seed yield was due mainly to its effect on seed number m^-2 rather than seed weight. Received: 6 August 1996 / Accepted: 28 February 1997     

Physiological comparisons of two soybean cultivars differing in canopy photosynthesis. I. Variation in vertical 14CO2 labelling and dry weight partitioning

Differences in canopy apparent photosynthesis (CAP) among soybean [Glycine max (L.) Merr.] genotypes have been shown to be correlated to seed yields. Since the physiological basis for such differences in CAP is unknown, two cultivars known to differ in CAP, Tracy and Davis, were studied during the 1978–1980 growing seasons. The CAP and dry weights of component plant parts were determined. In 1978 and 1979, ¹⁴CO₂ uptake by vertical leaf strata was determined and specific leaf weight (SLW) and leaf area index (LAI) were determined for corresponding strata in 1979 and 1980. Measurements were taken on several dates during reproductive growth. With the exception of CAP, all measurements (¹⁴C uptake, dry weights) were made in layers within the canopy. CAP on some dates were significantly higher in Tracy than in Davis and integrated CAP values from a certain growth period, labeled as R5 to R7, averaged 16 percent higher in Tracy for the three years studied. No differences in the relative recovery of ¹⁴C from different layers of leaves in the canopy were found. This indicates that variations in canopy structure or leaf orientation did not play a major role in the CAP differences between cultivars. The differences seem related to variations in leaf dry weights. Overall, Tracy exhibited 13.5, 19.2, and 13.2 percent greater leaf dry weights than Davis during 1978, 1979, and 1980, respectively. These differences in leaf dry weight seem largely due to a differences in the SLW. Data from these experiments indicate that differences in soybean CAP values were associated with differences in SLW.Abbreviations CAP Canopy Apparent Photosynthesis - CER Carbondioxide Exchange Rates - EST Eastern Standard Time - LAI Leaf Area Index - LSD Least Significant Difference - POPOP 1,4-bis-[2(5-phenyloxazdyl)]-benzene - PPO 2,5-diphenyloxazole - SLW Specific Leaf Weight     

Mesenterical lymphangiomatosis causing volvulus and intestinal obstruction

Lymphangiomas are benign tumors consisting of lymphatic vasculature that generally occur in the skin and soft tissues. Rarely, lymphangiomas occur in the gastrointestinal tract. Here, we report a case of a 13-year-old girl presenting with an intestinal obstruction. Upon laparotomy, multiple cystic masses in the mesentery causing a volvulus were resected and histologically identified as multiple lymphangiomas, or lymphangiomatosis. Mesenteric lymphangioma is a rare entity, but should be considered as cause of bowel obstruction without other known abdominal disease. As the etiology of lymphangiomas remains elusive, further research is directed at unravelling the mechanistic and molecular factors contributing to this disease.