Presentation (CTI)

OBJECTIVES: Improving patient access is a central goal of universal health coverage (UHC) reforms across the Middle East and North Africa (MENA). However, comparative evidence on how patient access is measured, alongside financial risk protection and equity, remains fragmented. This review aims to map HTA-relevant UHC indicators across MENA health system models.
METHODS: A rapid evidence review was conducted following PRISMA-ScR principles. Peer-reviewed literature (2015-2025) was identified via PubMed/MEDLINE, Embase, Scopus, and Cochrane Library, and supplemented by WHO UHC monitoring reports, health ministry reports, and World Bank datasets. Eligible sources included studies reporting at least one HTA-related indicator in MENA countries engaged in UHC reforms, including tax-funded insurance, social health insurance, and mixed financing schemes. A pre-specified HTA-oriented extraction framework was used, capturing: (1) access and service coverage indicators (e.g., service utilization rates, population coverage); (2) financial risk protection indicators (e.g., % of out-of-pocket expenditure (OOP), catastrophic health expenditure (CHE)); and (3) equity indicators (e.g., concentration indices, income quintile ratios). Indicators were stratified by country, health system model and income group.
RESULTS: Preliminary mapping suggests variation in how patient access is defined and reported across studies and data sources, with utilization and coverage measures most frequently used as proxies for access to care. Financial risk protection indicators, including OOP spending and CHE thresholds, are inconsistently reported and differ in methodological definitions. Equity-sensitive indicators, such as concentration indices and socioeconomic stratifiers, are least consistently reported and often lack standardized reporting across settings. A comparative HTA-oriented framework is being developed to enable harmonized cross-country synthesis.
CONCLUSIONS: Findings suggest substantial heterogeneity in UHC measurement across MENA countries, highlighting the need for more standardized and HTA-relevant approaches to measuring access, equity and financial protection. The final synthesis is expected to inform the development of standardized, HTA-compatible indicators to improve measurement and support cross-country comparisons in MENA.