Reliable governance and health financing are critical to the abilities of health systems
in different countries to sustainably meet the health needs of their peoples, including
those with kidney disease. A comprehensive understanding of existing systems and infrastructure
is therefore necessary to globally identify gaps in kidney care and prioritize areas
for improvement. This multinational, cross-sectional survey, conducted by the ISN
as part of the Global Kidney Health Atlas, examined the oversight, financing, and
perceived quality of infrastructure for kidney care across the world. Overall, 125
countries, comprising 93% of the world’s population, responded to the entire survey,
with 122 countries responding to questions pertaining to this domain. National oversight
of kidney care was most common in high-income countries while individual hospital
oversight was most common in low-income countries. Parts of Africa and the Middle
East appeared to have no organized oversight system. The proportion of countries in
which health care system coverage for people with kidney disease was publicly funded
and free varied for AKI (56%), nondialysis chronic kidney disease (40%), dialysis
(63%), and kidney transplantation (57%), but was much less common in lower income
countries, particularly Africa and Southeast Asia, which relied more heavily on private
funding with out-of-pocket expenses for patients. Early detection and management of
kidney disease were least likely to be covered by funding models. The perceived quality
of health infrastructure supporting AKI and chronic kidney disease care was rated
poor to extremely poor in none of the high-income countries but was rated poor to
extremely poor in over 40% of low-income countries, particularly Africa. This study
demonstrated significant gaps in oversight, funding, and infrastructure supporting
health services caring for patients with kidney disease, especially in low- and middle-income
countries.
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