Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 1 | 12 ORIGINAL RESEARCH Contribution of Information-Education-Communication in the adoption of Universal Health Coverage by the populations in the Economic and Monetary Community of Central Africa in 2020. Nathalie Ambounda Ledaga 1, Robertine Mamche 1, Sylvain Honore Woromogo 1, Jesse Saint Saba Antaon 1, Fatou Sow Saar 2 1InterState Centre for Higher Public Health Education in Central Africa (CIESPAC), Brazzaville, Congo. 2 Director of the Gender and Family Institute Dakar, Senegal. Corresponding author: Nathalie Ambounda Ledaga; Address: InterState Centre for Higher Public Health Education in Central Africa (CIESPAC), Brazzaville, Congo; E-mail: ledagan@yahoo.com mailto:ledagan@yahoo.com Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 2 | 12 Abstract Aims: This study aims to assess the knowledge of people from Central Africa about Universal Health Coverage and show the contribution of Information-Education-Communication for its adoption. Methods: a cross-sectional analytical study across 4 of 6 Central African Countries was con- ducted. Independent variables are sociodemographic characteristics. Dependent variables are knowledge about Information-Education-Communication and Universal Health Coverage. The questionnaire was disseminated by WhatsApp images or word file or copy/paste of the text and send to the contacted and trained focal points. From the Smartphone, the filmed or transferred data were entered into a CSpro 5.0 input form. Mean score calculations and Odd Ratio with 95 % Confidence Interval for p < 0.005 were used to make associations. Results: the Universal Health Coverage had never been heard of by 56.3% of the participants. The Universal Health Coverage was defined as health insurance by (43.9%), free care (30.3%). Respondents with secondary and higher education are more likely to have heard of the UHC than respondents with no education or those with elementary education [OR = 2.95 (1.01-8.64), p = 0.021] and [OR = 4.27 (1.50 – 12.16), p = 0.002] respectively. Conclusion: 9.3% of the Economic and Monetary Community of Central Africa (CEMAC) po- pulation is aware of the Universal Health Coverage; 89.4% of these accept universal health cove- rage in their country, and 87.4% of them think that the Information Education Communication could enable better adherence to the Universal Health Communication. Implemention of Univer- sal Health Coverage for the general population and adoption of Information-Education-Commu- nication to promote Universal Health Coverage and pool efforts and affiliation procedures in the CEMAC zone is very important. Keywords : Universal Health, Coverage, Central Africa Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 3 | 12 Introduction According to WHO's definition, Universal Health Coverage (UHC) is achieved when ‘all people and communities can use the pro- motive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship’ (1, 2). Universal Health Coverage « is driving the global health agenda; it is embedded in the Sustainable Development Goals (SDGs) and is now designated by an official United Nations UHC day on December 12. ‘Al- though many sub-Saharan African countries have made efforts to provide universal health coverage for their citizens, several of these initiatives have achieved little success’ (3,4). Local health authorities need guidance on how they can set fair and sustainable priori- ties (5,6). ‘Progressive realisation is invoked as the guiding principle for countries on their own path to UHC and achievement of the SDG health targets. It refers to the govern- mental obligations to immediately and pro- gressively move towards the full realisation of UHC, recognising the constraints imposed by limited available resources’ (7). Information-Education-Communication (IEC) is a process for individuals, communi- ties and societies to develop communication strategies to promote health-promoting beha- viour (8). Africa's population is young and the burden of non-communicable and com- municable diseases is a double burden, the lack of health knowledge could become a triple burden if nothing is done for IEC to move towards disease-related communica- tion for development and universal health co- verage to prevent, detect and treat diseases early and cheaply (9, 10). Within the Econo- mic and Monetary Community of Central Africa (CEMAC) countries, university health coverage seems to be unknown to the popu- lation despite the commitments made by the states to move towards it (11-14). The objec- tive of this work was to study the contribution of IEC in the adoption of universal health co- verage by the populations in the CEMAC zone in 2020. Methods Study design: This was a cross-sectional, analytical, interventional study conducted from July 15 to July 30 2020 in the major ci- ties of the CEMAC countries as Cameroon, Central African Republic (CAR), Congo, Ga- bon, Equatorial Guinea (EG) and Chad. Study population: Residents of the CEMAC countries, whose general population is esti- mated at 55 781 513, constituted the target population studied (15). Residents under 15 years of age and those who refused to answer the questionnaire were not included. Sampling: Probabilistic and exhaustive type of sampling was chosen. The sample size, to ensure representativeness, was calculated using Daniel SCHWARTZ's formula (16): N= p(1-p)(z(α/2) ) 2/ i², where N is the mini- mum sample size, p is the prevalence of UHC in Africa (50%), Z(α/2) = is the confidence le- vel of the study at risk α = 95%, i.e. 1.96, i is the accepted printing error on either side of the result, i.e. 5%. We obtained N = 403. Sample size by country : the general popula- tion by country was 23 779 022 (Cameroon), 5 745 135 (CAR), 5 279 517 (Congo), 2 074 656 (Gabon), 2 015 334 (EG) and 15 162 044 (Chad). To obtain the sample per country, we used the following formula n = (country population x 403) / general popula- tion for the 6 countries. Thus, we obtained 182 for Cameroon, 42 for CAR, 40 for Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 4 | 12 Congo, 16 for Gabon, 15 for EG and 110 for Chad. Data collection tool and collection procedure: We used a questionnaire with two sections, a definition and concepts. The questionnaire was disseminated by WhatsApp images or word file or copy/paste of the text and send to the contacted and trai- ned focal points. Through relationships with NGOs Adolescence et Santé, Exit Gate from Gabon, Whatapps contacts were made in the capitals of the countries; volunteer intervie- wers were trained and deployed in the city respecting the barrier gestures also those who could fill in numerically did so. In the end, there was one principal interviewer in each country except Cameroon where there were two. The questionnaires were filled in and collected in the community face to face in fo- cus groups of less than 5 people and through the WhatsApp network on the questionnaire sent online. For the digital responses, ques- tionnaires were sent by WhatsApp to the country correspondents who collected the responses via whatsapp before transmitting them via the same channel or internet. Variables Independent variables : sociode- mographic characteristics (Age, Gender, Le- vel of education, Marital status, Occupation. Dependent variables : Knowledge of IEC and UHC, Attitudes towards IEC and UHC, Adoption of IEC and UHC. Data entry and analysis: from the Smarthphone, the filmed or transferred data were entered into a CSpro 5.0 input form, im- ported and analysed using SPSS. Mean score calculations and OR with 95 % CI for p < 0.05 were used to make associations. Ethical considerations: Requests for autho- risation were sent to the Ministries of Health of the 6 countries with acknowledgement of receipt. Informed consent file submitted to participants who read and agreed before par- ticipating in the interview. Results A total of 403 questionnaires, of which 100 were on hard paper and 303 on digital, were submitted and transferred to the population. Only 302 responded, i.e. a participation rate of 74.94% (302/403). Out of 6 countries, 4 returned the questionnaires. Cameroonian participation represented 37.7%, Congolese 34.2%, Gabonese 18.5% and Central African 9.6% (Table 1). Sociodemographic characteristics : The mean age was 31.29 ± 10.74 years. The 25- 34 age group accounted for 39.1%; the 15-24 and 35-44 age groups for 29.1 and 18.9% res- pectively. The female and male sex repre- sented 46% and 54% respectively, sex ratio: 1.17 (163/139). Higher education was found in 52% of the participants. The marital status revealed 65.9% of single people. Unemployed participants represented 47.7% (Table 1). Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 5 | 12 Table 1. Sociodemographic characteristics of participants Variables Number Percentage (%) Country participation rates Cameroon 114 37.7 Central African Republic (RCA) 56 18.5 Congo 103 34.2 Gabon 29 9.6 Age (years) : Mean/SD 31.29 (10.74); Min/Max 15/74 15-24 88 29.1 25-34 175 58.0 45-54 39 12.9 Sex Sex ratio : 1.17 Female 139 46.0 Male 163 54.0 Education No education 22 7.3 Primary 21 7.0 Secondary 101 33.4 University 158 52.3 Marital status Single 199 65.9 Married 86 28.5 Divorced 14 4.6 Widowed 3 1.0 Sector of activities Public 51 16.9 Private 64 21.1 Liberal 38 12.6 Without 149 49.4 Knowledge of UHC and IEC: the UHC had never been heard of by 56.3% of the partici- pants. The information sources mentioned by the participants were television (25.8%) and social networks (28%). The UHC was defi- ned as health insurance by (43.9%), free care (30.3%) participants. The concept of IEC was not known by 63.6% of participants. Social networks, health structures and television re- presented 24.1%, 24.1% and 15.7% respecti- vely. The participants who acknowledged not having received IEC on UHC represented 59.3% (Table 2). Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 6 | 12 Table 2. Knowledge of participants about UHC and IEC Knowledge Number Percentage N = 302 % Have you heard about UHC ? Yes 132 43.7 No 170 56.3 What is the UHC ? Health insurance 58 43.9 Mutual insurance 4 3.0 Free care 40 30.3 Dont’t know 24 18.2 Other 3 2.3 Not specified 3 2.3 You heard through which channel? TV 34 25.8 Radio 18 13.6 Social networks 37 28.0 Health structure 20 15.2 Other 18 13.6 Not specified 5 3.8 Have you heard about IEC ? Yes 108 35.7 No 192 63.6 Not specified 2 0.7 You heard through which channel? TV 17 15.7 Radio 16 14.8 Social networks 26 24.1 Health structure 26 24.1 Other 22 20.4 Not specified 1 0.9 Was there an IEC on UHC? Yes 39 36.1 No 64 59.3 Not specified 5 4.6 Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 7 | 12 Attitudes towards the IEC and UHC: the UHC was accepted in their country by 89.4% of participants; 81.8% were willing to enrol and 88.4% accepted the IEC on UHC. Participants without UHC represented 89.4%; of the 9.3% with insurance 42.9% had full coverage (Table 3). The origin of the UHC fund was not known for 28.8%. 80.5% of the participants were willing to practice IEC. IEC on UHC does not exist in their country according to 55.6% of the partici- pants. 87.4% of the participants felt that UHC is necessary for the population; 74.8% had not been trained on IEC and 87.4% thought that IEC can improve adherence to UHC. Table 3. Attitudes of participants towards UHC and IEC Attitudes Number Percentage N =302 % Do you agree with the UHC in your country ? Yes 270 89.4 No 30 9.9 Not specified 2 0.7 Are you ready to subscribe to the UHC ? Yes 247 81.8 No 55 18.2 Would you accept the IEC on UHC ? Yes 267 88.4 No 29 9.6 Not specified 6 2.0 Have you subscribed to an UHC ? Yes 28 9.3 No 270 89.4 Not specified 4 1.3 If yes Total or Partial ? Total 2 7.1 Partial 12 42.9 Not specified 14 50.0 Are you willing to practice IEC ? Yes 243 80.5 No 56 18.5 Not specified 3 1.0 In your country has there been IEC on UHC ? Yes 30 9.9 Enough 23 7.6 Not enough 78 25.8 No 168 55.6 Not specified 3 1.1 Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 8 | 12 Have you ever been trained on IEC ? Yes 75 24.8 No 226 74.8 Not specified 1 0.4 Does IEC lead to better adherence to UHC ? Yes 264 87.4 No 36 11.9 Not specified 2 0.7 Influences of socio-demographic factors on the level of knowledge: respondents with secondary and higher education are more li- kely to have heard of the UHC than respon- dents with no education or those with ele- mentary education [OR = 2.95 (1.01-8.64), p = 0.021] and [OR = 4.27 (1.50 – 12.16), p = 0.002] respectively. Public, private and liberal sector workers are more likely to have heard of the UHC than non-employees [OR = 8.67 (4.26-17.66), p < 0.001], [OR = 2.39 (1.29 – 4.44), p = 0.00] and [OR = 2.34 (1.11 - 4.91), p = 0.013] res- pectively. Workers are more likely to have heard of the IEC than non-workers (Table 4). Table 4. Influences of sociodemographic factors on the level of knowledge Sociodemographic factors Yes No OR (95% CI) p Knowledge: Heard about UHC Education Without education 05 17 - Primary 9 12 2.55 (0.68 – 9.54) 0.090 Secondary 47 54 2.95 (1.01 – 8.64) 0.021 University 88 70 4.27 (1.50 - 12.16) 0.002 Sector of activities Public 42 14 8.67 (4.26 – 17.66) < 0.001 Private 29 35 2.39 (1.29 – 4.44) 0.003 Liberal 17 21 2.34 (1.11 – 4.91) 0.013 Without 37 107 144 (100) - Knowledge: Heard about IEC Sector of activities Public 30 26 2.89 (1.53 – 5.48) < 0.001 Private 28 36 1.95 (1.06 – 3.60) 0.017 Liberal 21 17 3.10 (1.49 – 6.47) 0.001 Without 41 103 143 (100) - Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 9 | 12 Discussion The most represented age group was 25-34. The young African population may explain the predominant age ranges. More than half of our respondents were men and university education was more represented as well as the private sector of activity. The period of containment may explain the higher partici- pation rate of men as they are more out of the home and also as workers in the private sec- tors have many more work constraints than those in the public sector. Knowledge: we assessed participants' knowledge of universal health coverage and IEC and the ways in which they acquired this knowledge. More than half of the partici- pants had never heard of universal health co- verage and the concept of IEC, although we found that more than half of the respondents were employees or had attended university. Our findings clearly show the low level of knowledge and perception of universal health coverage among the urban population of the CEMAC zone countries. Taking into account the expectations of the populations of the dis- tricts of certain countries, which notably show that ‘respondents seek improvements in the quality of care, community engagement activities, expansion of the range of services to include emergency referral services, and enhancement of clinical health insurance co- verage to include preventive health services’ (17), it is important for the countries of the CEMAC zone to initiate perspectives aimed at strengthening the implementation of the UHC by taking into account the actions re- commended by the WHO and certain studies (7,18). The case of Nepal and Ghana which illustrates the role and contribution of Com- munity health worker counseling family is prominent (8, 19, 20, 21). Almost half of the respondents defined the UHC as health insu- rance. One of the paths for strengthening the practice of UHC is therefore health insu- rance. In the CEMAC zone, only Gabon has adopted this policy; countries are encouraged to have their population subscribe to health insurance, considering that the role of insu- rance in the achievement of universal cove- rage within a developing country context has been demonstrated (22) as well as that of the IEC (18, 23). Health services are expected to play an important role in the implementation of the UHC as more than half of the respon- dents mentioned these health services. Fi- nally, we noted that knowledge of the UHC and IEC is related to the respondents' level of education as well as their business sector. CEMAC member states are encouraged to use different methods to sensitise the popula- tion on the UHC as we have noted that cor- respondents have mentioned social networks and television as the main sources of infor- mation on the UHC. It can be seen today that there is an increase in the number of people using social networks and television as sources of information. Attitudes : the UHC was accepted in their country by 89.4% of participants; 81.8% were willing to enrol and 88.4% accepted the IEC on UHC. We noticed that people are wil- ling to embrace the UHC and the concept of IEC, which many have found to be innova- tive. Governments can build on this to boost the UHC. But before that it would be useful to go through a situational analysis at diffe- rent levels of the community and business sector as proposed by some studies (7,18). Study limitations : for this study, Covid-19 imposed digital communication and this Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 10 | 12 seemed to be little used by the populations for the surveys; the high penetration rates and costs of the internet seemed to reduce the en- thusiasm of the investigators and the sur- veyed population. The Spanish language in Malabo obstructed the data collection pro- cess. In Ndjamena, the investigator did not adopt the digital tool. The rainy season in Bangui and the expensive and poorly pene- trating internet were reported by the investi- gator to explain the low participation rate. Conclusions Less than 10%of the CEMAC population is aware of the UHC; 89.4% of them accept uni- versal health coverage in their country and 87.4% of them think that the IEC could enable better adherence to the UHC. Only 30% have an UHC. In view of these results, the following suggestions are proposed to the CEMAC states: Implemention of UHC for the general population, adoption of IEC as a means of promoting UHC and to pool efforts and affiliation procedures in the CEMAC zone is very important. References 1. Verrecchia R, Thompson R, Yates R. Universal Health Coverage and pu- blic health : a truly sustainable ap- proach. Lancet 2019 ; 4(1) : e10-e11 2. WHO. What is health financing for universal health coverage ? Geneva : World Health Organization. http://www.who.int/health_finan- cial/universal_coverage_definition (accessed April 04 2021) 3. Mclntyre D, Garshong B, Mtei G, Meheus F, Thiede M, Akazili J, Ally M, Aikins M, Mulligan JA, Goudge J. Beyong fragmentation and towards universal coverage : insights from Ghana, South Africa and the United Republic of Tanzania. Bull World Health Organ 2008 ; 86(11) :871-6 4. Chukwuemeka AU. Challenges to- ward achieving universal health co- verage in Ghana, Kenya, Nigeria, and Tanzania. Int J Health Plann Ma- nage 2018 ; 33(4) : 794-805 5. Jansen MPM, Bijlmakers L, Baltus- sen R, Rouwette EA, Broekhuizen H. A sustainable apporach to universal health coverage. Lancet Glob Health 2019 ; 7(8) : e1013 6. Sakolsatayadorn P, Chan M. Breaking down the barriers to uni- versal health coverage. Bull World Health Organ 2017 ; 95(2) :86 7. WHO Consultative Group on Equity and Universal Health Coverage. Ma- king fair choices on the path to UHC. Geneva 2016 8. Schwarz R, Thapa A, Sharma S, Ka- launee SP. At a crossroads : How can Nepal enhance its community health care system to achieve Sustainable Development Goal 3 and universal health coverage ? J Glob Health 2020 ; 10(1) :010309 9. Sanofi [Internet]. The Rise and Rise of Chronic Diseases in Africa. [Cited July 12 2020]. Available on: https://www.sanofi.com/your- health/the-rise-and-rise-of-chronic- diseases-in-africa http://www.who.int/health_financial/universal_coverage_definition http://www.who.int/health_financial/universal_coverage_definition https://www.sanofi.com/your-health/the-rise-and-rise-of-chronic-diseases-in-africa https://www.sanofi.com/your-health/the-rise-and-rise-of-chronic-diseases-in-africa https://www.sanofi.com/your-health/the-rise-and-rise-of-chronic-diseases-in-africa Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 11 | 12 10. United Nations [Internet]. High-level meeting on non-communicable di- seases: Assembly adopts Political Declaration committing Member States to align with WHO guidelines. [Cited July 12 2020]. Available on : https://www.un.org/press/fr/2011/A G11138.doc.htm 11. United Nations [Internet]. Non-com- municable diseases: States adopt an "ambitious and balanced" Political Declaration on these ailments res- ponsible for 71% of deaths worldwide. [Cited July 12 2020]. Available on : https://www.un.org/press/fr/2018/ag 12069.doc.htm 12. World Health Assembly: Congo re- ports progress towards universal health coverage | adiac-congo.com : all the news from the Congo Basin [Internet]. [Cited July 12 2020]. Available on : https://www.adiac- congo.com/content/assemblee-mon- diale-de-la-sante-le-congo-fait-part- de-ses-avancees-vers-la-couverture 13. Shareweb health. Achieving univer- sal health coverage in Chad [Inter- net]. [Cited April 04 2021]. Avai- lable on: https://www.share- web.ch/site/Health/abou- tus/Pages/Contributions-Summer- 2018/Atteindre-la-couverture-sani- taire-universelle-au-Tchad.aspx 14. Central African Republic. Universal Health Coverage [Internet]. [Cited April 04 2021]. Available on: https://www.uhcpart- nership.net/country-profile/central- african-republic/ 15. Africa. PopulationData [Internet]. [Cited 04 April 2021]. Available on: https://www.populationdata.net/con- tinents/afrique/ 16. Schwartz D. Statistical methods for Physicians and Biologists. Flamma- rion Medecins Sciences, Paris, France, 1969 17. Wright KJ, Biney AA, Kushitor MK, Awoonor-Williams JK, Bawah AA, Phillips JF. Community perceptions of universal health coverage in eight districts of the Northern and Volta regions of Ghana. Glob Health Ac- tion 2020 ; 13(1) :1705460 18. Baltussen R, Jansen MP, Bijlmakers L, Tromp N, Yamin AE, Norheim OF. Progressive realisation of uni- versal health coverage : what are the required processes and evidence ? BMJ Glob Health 2017 ; 2 :e000342 19. Assan A, Takian A, Aikins M, Akba- risari A. Challenges to achieving uni- versal health coverage through com- munity-based health planning and services delivery approach : a quali- tative study in Ghana. BMJ Open 2019 ; 9(2) :e024845 20. Assan A, Takian A, Aikins M, Akba- risari A. Universal Health coverage necessitates a system approach : an analysis of Community-based Health Planning and Services (CHPS) initia- tive in Ghana. Global Health 2018 ; 14(1) :107 21. Pandy S, Bissel P, van Teijlingen E, Simkhada P. The contribution of fe- male community health volunteers (FCHVs) to maternity care in Nepal : a qualitative sudy. BMC Health Serv Res 2017 ;17 :623 https://www.un.org/press/fr/2011/AG11138.doc.htm https://www.un.org/press/fr/2011/AG11138.doc.htm https://www.un.org/press/fr/2018/ag12069.doc.htm https://www.un.org/press/fr/2018/ag12069.doc.htm https://www.adiac-congo.com/content/assemblee-mondiale-de-la-sante-le-congo-fait-part-de-ses-avancees-vers-la-couverture https://www.adiac-congo.com/content/assemblee-mondiale-de-la-sante-le-congo-fait-part-de-ses-avancees-vers-la-couverture https://www.adiac-congo.com/content/assemblee-mondiale-de-la-sante-le-congo-fait-part-de-ses-avancees-vers-la-couverture https://www.adiac-congo.com/content/assemblee-mondiale-de-la-sante-le-congo-fait-part-de-ses-avancees-vers-la-couverture https://www.shareweb.ch/site/Health/aboutus/Pages/Contributions-Summer-2018/Atteindre-la-couverture-sanitaire-universelle-au-Tchad.aspx https://www.shareweb.ch/site/Health/aboutus/Pages/Contributions-Summer-2018/Atteindre-la-couverture-sanitaire-universelle-au-Tchad.aspx https://www.shareweb.ch/site/Health/aboutus/Pages/Contributions-Summer-2018/Atteindre-la-couverture-sanitaire-universelle-au-Tchad.aspx https://www.shareweb.ch/site/Health/aboutus/Pages/Contributions-Summer-2018/Atteindre-la-couverture-sanitaire-universelle-au-Tchad.aspx https://www.shareweb.ch/site/Health/aboutus/Pages/Contributions-Summer-2018/Atteindre-la-couverture-sanitaire-universelle-au-Tchad.aspx https://www.uhcpartnership.net/country-profile/central-african-republic/ https://www.uhcpartnership.net/country-profile/central-african-republic/ https://www.uhcpartnership.net/country-profile/central-african-republic/ https://www.populationdata.net/continents/afrique/ https://www.populationdata.net/continents/afrique/ Ledaga NA, Mamche r, Woromogo SH, Saba Antaon JS, Saar FS. Contribution of Information-Edu- cation-Communication in the adoption of Universal Health Coverage by the populations in the Eco- nomic and Monetary Community of Central Africa in 2020. (Original research). SEEJPH 2021, posted: 29 May 2021. DOI: 10.11576/seejph-4477 P a g e 12 | 12 © 2021 Ledaga et al; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 22. Van der Heever AM. The role of in- surance in the achievement of uni- versal coverage within a developing country context : South Africa as a case study. BMC Public Health 2012 ; 12(1) : S5 23. Kushitor MK, Biney AA, Wright KJ, Phillips JF, Awoonor-Williams JK, Bawah AA. A qualitative appraisal of stakeholders' perspectives of a community-based primary health care program in rural Ghana. BMC Health Serv Res 2019 ; 19(1) : 675 __________________________________________________________________________