SSM - Health Systems最新文献

{"title":"Rethinking cross-border health systems for contexts of mobility and forced displacement","authors":"Fouad Fouad ,&nbsp;Kyu Kyu Than ,&nbsp;Maria Paola Bertone ,&nbsp;Sophie Witter ,&nbsp;Nyi Nyi Kyaw ,&nbsp;Ibrahim R. Bou-Orm","doi":"10.1016/j.ssmhs.2026.100172","DOIUrl":"10.1016/j.ssmhs.2026.100172","url":null,"abstract":"<div><div>Health systems today are deeply affected by conflicts, forced displacement, and other stressors such as climate change. Traditional health system frameworks, while influential, often assume stable, territorially bounded national systems and do not fully capture the realities of mobility, contested authority, and health care seeking and delivery across borders. This paper explores how health systems operate in contexts where both internationally recognized borders and internal power lines shape the dynamics of health provision for displaced and mobile populations. Drawing on illustrative cases from Northwest Syria and Myanmar, we examine how health systems adapt across and beyond borders in the absence of formal national response. In Syria, humanitarian cross-border mechanisms, local governance bodies, and mobile referral networks have sustained care despite fragmented authority. In Myanmar, ethnic health organizations, diaspora networks, and transnational supply chains have long supported communities in border areas, with populations frequently moving across borders into Thailand, China, and Bangladesh to access essential care. We propose a new approach to cross-border health systems that includes recognizing the roles of non-state and humanitarian actors, enabling flexible financing and workforce recognition across jurisdictions, and developing interoperable data systems sensitive to mobility. By incorporating these dimensions, health systems can be better understood and supported in ways that reflect the realities of forced displacement and mobility in complex conflict-affected settings.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating family planning into Nigeria’s public health insurance: Challenges, opportunities, and feasibility for enhanced primary health care","authors":"Emmanuel Nwala ,&nbsp;Ayan Jha ,&nbsp;Sa’id Gaya ,&nbsp;Jay Gribble ,&nbsp;Frances Ilika","doi":"10.1016/j.ssmhs.2026.100169","DOIUrl":"10.1016/j.ssmhs.2026.100169","url":null,"abstract":"<div><div>In Nigeria, integrating family planning (FP) into the essential benefits package under public health insurance is pivotal to improving reproductive health and combating poverty. The government’s commitment to achieve 90 % health insurance coverage by 2030 presents a timely opportunity to expand FP access and affordability. Through policy analysis, stakeholder interviews across 11 states, and a multi-stakeholder roundtable, we identified key barriers including inadequate and inefficient public financing, donor over-reliance, weak procurement, and workforce shortages. While some states have integrated FP, coverage remains fragmented with variations in services offerings. Key stakeholders advocated for comprehensive integration of FP services into primary healthcare and public health insurance, ensuring access to education, counseling, and a full range of contraceptives. Services were proposed to be tiered as primary (for all facilities) and secondary (for advanced facilities). Sustainable integration shall require a phased approach with necessary insurance premium adjustments. A blended payment model combining capitation and fee-for-service was recommended for provider compensation. Addressing the shortage of skilled FP providers, particularly for long-acting reversible contraceptives, requires training programs like the Community-Based Health Research Innovative Training and Services Program to equip frontline health workers. These actions can support integration, ensure equitable contraceptive access, and advance Nigeria’s health sector reforms.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From crisis to resilience: Catalysing epidemic and pandemic preparedness through National Public Health Institutes","authors":"Thanitsara Rittiphairoj ,&nbsp;Catherine Smallwood ,&nbsp;Moa Herrgard ,&nbsp;Wasiq Khan","doi":"10.1016/j.ssmhs.2025.100165","DOIUrl":"10.1016/j.ssmhs.2025.100165","url":null,"abstract":"<div><div>The COVID-19 pandemic highlighted the critical role of National Public Health Institutes (NPHIs) in responding to global health emergencies. This commentary examined the contributions and challenges of NPHIs in four countries of the Eastern Mediterranean Region (EMR), including Somalia, Morocco, Pakistan, and Jordan, during the pandemic response. Drawing on country case studies, we highlighted shared achievements, unique contributions, and operational challenges. Key successes included strengthening public health surveillance systems, expanding laboratory testing capacities, establishing emergency operations centers, and advancing pandemic-related research. However, several systemic challenges impeded effective response, including insufficient funding, workforce shortages, weak health information systems, unclear leadership roles, lack of standardized operating procedures, and limited evidence use in policymaking. Based on these experiences, we proposed key strategies to strengthen NPHIs and improve pandemic preparedness. These included securing sustainable financing (e.g., contingency funds), coordinating donor support, investing in workforce training and simulations, improving peripheral laboratory infrastructure and data integration, developing standardized, multisectoral protocols led by NPHIs, strengthening international partnerships for surveillance and resource mobilization, and enhancing risk communication and community engagement. The paper emphasized the importance of sustained political commitment and long-term investment in NPHIs to build resilient health systems capable of effectively responding to future health threats.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100165"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146037904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From legacy systems to real-time response: VPD-SMART implementation and its impact on public health surveillance in Paraguay and the Americas","authors":"Claudia Ortiz ,&nbsp;Felipe A. Millacura ,&nbsp;Christian Atavillos ,&nbsp;Pamela Bravo-Alcántara ,&nbsp;Juan Espinoza ,&nbsp;Victor Osorio ,&nbsp;Carolina Baeza ,&nbsp;Paola Ojeda ,&nbsp;Fernando Revilla ,&nbsp;Carmelita Pacis ,&nbsp;Susana Bobadilla ,&nbsp;Faviola Araceli ,&nbsp;Pablo Del Medico ,&nbsp;Carlos Tejo ,&nbsp;Enzo Rossi ,&nbsp;Fabian Ordoñez ,&nbsp;Silvana Zapata-Bedoya ,&nbsp;Emilia Cain ,&nbsp;Pilar Tavera ,&nbsp;Mirta Magarinos ,&nbsp;Martha Velandia-Gonzalez","doi":"10.1016/j.ssmhs.2025.100166","DOIUrl":"10.1016/j.ssmhs.2025.100166","url":null,"abstract":"<div><div>In the Americas, traditional public health surveillance systems often face a significant data-use gap, hindering a timely response to vaccine-preventable diseases (VPDs). This manuscript details the implementation of VPD-SMART, a novel DHIS2-based system, as a digital transformation initiative to enhance VPD surveillance and bridge this gap. We analyze Paraguay's transition from the legacy Integrated Surveillance Information System (ISIS) to VPD-SMART, focusing on how its functionalities, including real-time decentralized data collection and enhanced analysis, improve the performance of health information systems. We find that the transition to VPD-SMART significantly improved data quality, consistency, and timeliness. A quantitative analysis showed a notable increase in data completeness and a rise in consistency for key variables from 54 % to 97 %. The average time for data entry also decreased, shifting from a weekly to a daily basis. Qualitative findings confirm that the system empowers health authorities with real-time, data-driven insights. By examining these challenges and opportunities, we provide empirical evidence on how leveraging DHIS2 can enhance public health surveillance and inform similar digital transformation efforts in other low- and middle-income countries.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and opportunities for policy development on digital health equity in four Canadian jurisdictions","authors":"James Shaw ,&nbsp;Caroline Tait ,&nbsp;Ubaka Ogbogu ,&nbsp;Lorian Hardcastle ,&nbsp;Ewan Affleck ,&nbsp;Ivar Mendez ,&nbsp;Ambreen Sayani ,&nbsp;Sheryl Spithoff ,&nbsp;Simone Shahid ,&nbsp;Sumaya Mehelay ,&nbsp;Heather Ross ,&nbsp;Janine Badr ,&nbsp;Amy Ma ,&nbsp;Jean-Louis Denis","doi":"10.1016/j.ssmhs.2025.100164","DOIUrl":"10.1016/j.ssmhs.2025.100164","url":null,"abstract":"<div><div>Digital health equity is an increasingly important topic, understood here as an aspirational state where everyone has access to the health-related digital technologies that support them in meeting their health-related needs. Despite strong emerging evidence regarding policy options to promote digital health equity, little policy action has been taken internationally to implement these options. The purpose of this paper is to report on a qualitative research project that explores the challenges and opportunities for policy development and implementation on digital health equity in four Canadian jurisdictions: Alberta, Saskatchewan, Ontario, and Quebec. We completed an Intersectionality-Based Policy Analysis, involving in-depth qualitative interviews with 23 participants, including both policy actors (i.e., those in positions to develop and/or implement digital health equity policy) and community leaders (i.e., those in positions advocating for the needs of structurally marginalized communities). Our findings illustrate a set of foundational policy options and more tailored policy programs for digital health equity, including the development of equity-focused accountability processes in new funding for digital health innovation. We also found challenges related to the political structure of Canada as a federation, and novel challenges related to the development of policy for digital health equity specifically. In our discussion, we explore three policy development challenges in detail: conflicting views on the priority status of health equity, challenges in building long-term partnerships with community for policy development, and conflicting views on the role of technology vendors in public policy for health care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of healthcare services by informal workers: Evidence from Assam","authors":"Kanchan Devi ,&nbsp;Vandana Upadhyay","doi":"10.1016/j.ssmhs.2025.100163","DOIUrl":"10.1016/j.ssmhs.2025.100163","url":null,"abstract":"<div><div>The informal sector is a crucial part of the economy, yet its workers face significant healthcare access barriers, including financial constraints, long working hours, and limited social security. While research on healthcare utilization in India exists, studies focusing on informal workers, especially at the state level, remain limited. Assam, with its high dependence on the informal economy, presents unique healthcare challenges for this workforce. This study examines inpatient and outpatient healthcare utilization among informal workers in Assam, analysing barriers and sources of care. Using both primary, a cross-sectional household survey was conducted across three districts, Dhubri, Sonitpur, and Dhemaji. Healthcare utilization patterns were analysed using probit and logistic regression models, with model selection based on comparative pseudo values. Key socioeconomic, demographic, and health-related factors were examined to assess their influence on healthcare utilization. The findings reveal significant district-wise disparities, with outpatient care rates higher than inpatient care. Urban residents, insured individuals, and non-migrants utilized both services more frequently. Gender disparities persist, with males accessing more inpatient care except in Dhemaji. SC/ST groups and lower-income populations faced greater barriers, while non-communicable diseases primarily drove inpatient care demand. Key barriers included poor service quality and long distances to healthcare facilities. To improve healthcare utilization among informal workers, policies should focus on strengthening public healthcare infrastructure, expanding financial assistance programs, and improving service quality. Awareness campaigns, socioeconomic equity measures, and effective implementation of universal health coverage initiatives are essential for ensuring equitable healthcare access in Assam.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Readiness of health facilities to provide HIV testing and counseling and TB services in Nepal: Findings from a 2021 Nepal Health Facility Survey","authors":"Kiran Acharya ,&nbsp;Ali Mirzazadeh ,&nbsp;Keshab Deuba","doi":"10.1016/j.ssmhs.2025.100160","DOIUrl":"10.1016/j.ssmhs.2025.100160","url":null,"abstract":"<div><h3>Introduction</h3><div>HIV and Tuberculosis (TB) are major public health challenges in Nepal, requiring well-prepared health systems to provide effective care. We assessed the readiness of Nepal’s health facilities to provide HIV testing and counseling (HTC) and TB services.</div></div><div><h3>Methods</h3><div>We conducted a secondary analysis of 359 health facilities providing HTC and TB services using data from the 2021 Nepal Health Facility Survey. We used WHO Service Availability and Readiness Assessment manual, focusing on key domains such as trained staff, guidelines, equipment, diagnostics, and medicines/commodities to calculate readiness scores. We reported the readiness scores for HTC and TB services across different types of facilities. Further, the multivariable linear regression analyses were conducted to assess the relationship between exposures and the HTC and TB service readiness.</div></div><div><h3>Results</h3><div>The overall readiness score for both HTC and TB services was 51 %. Stand-alone HTC centres demonstrated the highest readiness (80 %–100 %), and public hospitals also showed strong readiness for both HTC (69 %) and TB (63 %) services, particularly when equipped with quality assurance systems, routine management meetings, and external supervision. In contrast, basic health care centers and private hospitals demonstrated substantially lower readiness for HTC (47 %–48 %) and TB services (48 %–55 %). Urban facilities had higher readiness than rural facilities (53 % vs. 47 %), and readiness varied across provinces, with Sudurpashchim showing relatively higher scores. Multivariable analysis indicated that private facilities, primary health care centers, and basic health care centers had significantly lower readiness compared to public hospitals. Health facilities in rural locations and those in Karnali Province were associated with lower HTC readiness, whereas Sudurpashchim Province had higher TB readiness. Facilities performing quality assurance had higher readiness for both services, and for HTC services, those receiving external supervision in the past four months also demonstrated significantly improved readiness.</div></div><div><h3>Conclusions</h3><div>This study highlights critical gaps and subnational variations in HTC and TB service readiness across health facilities in Nepal. Strengthening quality assurance systems, routine supervision, and management practices is essential to improve readiness, particularly in rural areas, basic health care centers, and private hospitals. Investments in infrastructure and targeted interventions are recommended to enhance equitable access to HTC and TB services in Nepal.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145841085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community health workers’ perspectives on challenges faced by diverse, low-income suburban residents in Long Island, New York, United States","authors":"Tatiana Ramirez,&nbsp;Meshack Achore,&nbsp;Martine Hackett","doi":"10.1016/j.ssmhs.2025.100162","DOIUrl":"10.1016/j.ssmhs.2025.100162","url":null,"abstract":"<div><h3>Background</h3><div>Serving as a bridge between community members and the healthcare system, community health workers (CHWs) play a vital role in addressing health inequities within their communities. Research on CHWs, particularly in suburban contexts, remains limited. This study aims to identify the challenges faced by diverse, low-income suburban residents in Long Island, New York, United States, through the perspectives of the CHWs who serve these communities.</div></div><div><h3>Methods</h3><div>Data were collected through demographic surveys and semi-structured interviews with 10 CHWs working in Long Island, New York, from April 2024 to September 2024. Interview transcripts were coded and analyzed for themes and sub-themes using Atlas.ti software.</div></div><div><h3>Results</h3><div>Three main themes emerged from the interview analysis: structural barriers and access, psychosocial and emotional well-being, and navigating systems. CHWs identified several challenges faced by diverse, low-income residents, including transportation, housing, food insecurity, emotional support, mental health resource navigation, immigration, and cultural barriers. CHWs addressed these challenges in various ways, primarily by connecting clients to resources, building relationships with them, and participating in the development of necessary programs and services.</div></div><div><h3>Conclusion</h3><div>Diverse, low-income suburban residents face numerous challenges that put them at risk for poor health outcomes and reduced quality of life. Community Health Workers (CHWs) have played a crucial role in assisting residents in navigating these challenges, although they have also faced difficulties in the process. Organizations serving these residents should develop improved CHWs resources to effectively meet community needs.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145791983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A mixed-methods study of expanding later abortion care at two U.S. facilities","authors":"Tracy A. Weitz ,&nbsp;Adrian Davis ,&nbsp;Malcolm Wilson Schwartz ,&nbsp;Julia E. Kohn","doi":"10.1016/j.ssmhs.2025.100161","DOIUrl":"10.1016/j.ssmhs.2025.100161","url":null,"abstract":"<div><div>After the U.S. Supreme Court overturned the federal right to abortion in 2022, many state laws continued to define abortion in relation to the “viability” standard established in <em>Roe v. Wade</em> (1973) and <em>Planned Parenthood v. Casey</em> (1992). Providers often operationalized this concept as an ultrasound reading of 24 weeks’ pregnancy duration, despite broad discretion to determine viability. This study examines how two Illinois facilities expanded abortion services from the commonly accepted 24-week threshold to 28 weeks. We employed a mixed-methods design including an anonymous online staff survey, qualitative interviews with a purposive sample of clinical and non-clinical staff, and analysis of administrative patient data. We aimed to identify factors that enabled or constrained service expansion and to document staff experiences. We used administrative data to assess patient characteristics. To address critiques that research on barriers and facilitators can be overly general, we triangulated findings across data sources with attention to the specific requirements of providing later abortion care. Findings highlight the importance of a supportive organizational culture—characterized by decisive leadership, tolerance for legal risk, commitment to later-care patients, and engagement with an enabling ecosystem. Equally critical was the ability to adapt service delivery, including staffing, clinical flow, pain management, and around-the-clock care. We find evidence that young people, people of color, and people from outside Illinois directly benefited from the expansion. This study contributes to understanding how health systems navigate change in contexts of high stigma, with implications for later abortion care and other contested services.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feminist political economy analysis of labor rights and protections of Nepal’s community health workers","authors":"Roosa Sofia Tikkanen ,&nbsp;Sushmita Pokhrel ,&nbsp;Usha Ghimire ,&nbsp;Biraj Neupane ,&nbsp;Svea Closser ,&nbsp;Bernadette Nirmal Kumar","doi":"10.1016/j.ssmhs.2025.100158","DOIUrl":"10.1016/j.ssmhs.2025.100158","url":null,"abstract":"<div><div>Community health workers are a feminized cadre often engaged informally with low pay and without labor law protections. Feminist political economy (FPE) argues that the undervaluation of health and care workers relates to gendered assumptions around skill and motivation. We examined the labor rights and protections of Nepal’s Female Community Health Volunteers (FCHVs) through an FPE lens to assess the valuation of their work by decision-makers and the opportunity costs of volunteering. Our case study design collected data from 165 documents, 26 semi-structured interviews and five focus groups from four districts in Bagmati province, analysed via thematic analysis using a two-pronged framework derived from the World Health Organization’s recommendations for CHW programs and health workforce labor rights: ‘remuneration fairness’ relative to cost of living, labor market and workload, and ‘social protection’ as insurance, retirement benefits and legal recognition. Remuneration was not considered ‘fair’ relative to living costs, labor market context or their workload, contributing to turnover among younger, higher-educated FCHVs. Social protection gaps persisted around health and life insurance, and retirement compensation was low relative to the longstanding experience of some FCHVs. Although informality impedes FCHVs’ labor rights, some municipalities have added incentives and expanded social protections, in part through female Deputy Mayors and FCHVs elected into local government. Gendered assumptions around time availability and skill persist among policymakers, contributing to the low valuation of FCHV labor.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"6 ","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145712514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}