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June 20, 2026Frontiers in Health ServicesOpen Access

Strengthening health systems in low and middle-income countries: performance determinants and pathways to universal health coverage

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Authors

MSMayadhar SethySMSandhya R. MahapatroGMGrace Bahalen Mundu

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Overview

Longitudinal analysis identifies key determinants and resource allocation strategies for health systems in LMICs, indicating potential improvements.

Key Points

  • This study aims to identify determinants influencing health system performance and propose effective resource allocation strategies to achieve universal health coverage in low and middle-income countries.
  • Constructed a longitudinal dataset for 135 LMICs (2000–2023) using data from WHO, World Bank, IHME, DHS/MICS, and ITU.
  • Employed fixed effects, system GMM, and structural equation modeling for performance analysis.
  • Developed mathematical optimization models for efficient resource allocation under budget constraints.
  • A 10% increase in government health expenditure per capita is linked to a 3.2% reduction in out-of-pocket spending (p < 0.01) and a 0.8-year increase in life expectancy.
  • Health workforce density (β = 0.24, p < 0.05) and digital health adoption (β = 0.18, p < 0.05) positively affect UHC service coverage.
  • Reallocating 15% of health budgets toward primary care and digital infrastructure could avert approximately 1.2 million annual deaths (0.9–1.6 million) and reduce catastrophic health expenditures by 18% (14%–23%).

Cite This Study

Sethy et al. (2026) studied this question.

synapsesocial.com/papers/6a362d32db0793dc1a535a5ahttps://doi.org/10.3389/frhs.2026.1808077
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