Abstract
Background: Achieving Universal Health Coverage (UHC) in low- and middle-income countries (LMICs) requires a robust digital infrastructure capable of monitoring healthcare services and associated costs. A major barrier is the absence of a standardized and comprehensive nomenclature for billable healthcare services. Assessment across five hospitals in Burundi confirmed this problem by showing significant inconsistencies in service naming and coding. This study presents the development of a Universal Nomenclature of Health Services (UNHS) for Burundi, a meta-classification for billable health services, designed to align international classification systems with local operational needs.
Methods: The methodology comprised a need assessment, literature review, the selection of relevant international standards, national adaptation, integration of operational sub-codes, and validation through stakeholder engagement.
Results: The developed meta-classification based on six international standards (ICD-10-PCS, CPT, HCPCS, LOINC, RxNorm, and UB04) produces 82,433 codes covering 97.7% of health services relevant to UHC tracking.
Conclusions: This paper details the methodology, structure, coverage, and implementation of the UNHS, offering a scalable model for improving health information system interoperability and UHC monitoring in LMICs.
Plain language summary
Universal Health Coverage (UHC) is intended to ensure that all individuals have access to quality healthcare services without encountering financial barriers. In pursuit of this objective, numerous low- and middle-income countries (LMICs) have undertaken the digitization of their healthcare systems to enhance and monitor the delivery of healthcare services. Nevertheless, the effective monitoring of service delivery in LMICs remains a complex undertaking. This complexity stems from healthcare software’s inefficient data collection, often made worse by the use of incompatible, non-standard coding systems. The present study seeks to address these challenges by developing a comprehensive nomenclature for billable healthcare services. It provides a detailed account of the creation of a meta-classification, which is based on six widely recognized international classification systems. It also describes the implementation of the resulting nomenclature within the context of Burundi, where it has been validated and endorsed by the Ministry of Health. The adoption of the nomenclature is anticipated to enhance billing processes within healthcare facilities, promote interoperability among disparate systems, and facilitate effective monitoring of UHC initiatives.
© 2026. The Author(s).