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Resilient and high-performing health systems that can respond to the global polycrisis hinge upon the effectiveness of their primary healthcare (PHC) system. This requires adequate and sustainable financing for PHC, which should be predominantly government financed. The recent Ayushman Bharat health reforms in India aim to ensure comprehensive PHC services and enhance financial risk protection through increased government financing. The government has augmented investments to fortify the PHC system by establishing Health and Wellness Centers (HWCs), equipped with an expanded benefit package for PHC services & human resource capacity. Aligned with the National Health Mission's targeted and flexible financial mechanisms, this offers States the opportunity to contextualize solutions and offer incentives to healthcare workers. However, aligning public financing arrangements to service delivery complexities and health outcomes pose intricate challenges in shaping the required reforms. The economic growth and room for increased taxation on health products provide an avenue for increased funding. Smart and efficient payment mechanism with improved accountability should complement increased investment.

Background: Digital Health technologies (DHT) have potential to deliver intensive, novel and engaging rehabilitation for people with neurological conditions, yet health services lack a strong track record in embedding DHT into practice. The aim of this review was to synthesise factors that have been shown to influence implementation of DHT into neurological rehabilitation.

Method: An integrative review was undertaken. An extensive search of MEDLINE, CINAHL, AMED, EMBASE was undertaken. The title and abstract of all retrieved sources were screened against pre-defined criteria. Retained sources underwent full text review. The quality of all included sources was assessed. A meta-ethnographic synthesis explored commonalities and contradictions of the included studies.

Results: Fourteen studies (1 quantitative, 8 qualitative and 5 mixed methods) were included. Eleven implementation theories/models/frameworks were used across the 14 studies. Five themes were identified: (i) individual factors; (ii) user experience of the technology; (iii) the content of the intervention; (iv) access to the technology and (v) supporting use.

Conclusions: Key factors which appear to influence the implementation of DHT into clinical settings are highlighted. Implementation theories, models and frameworks are under-utilised in DHT rehabilitation research. This needs to be addressed if DHT are to realise their potential in neurological rehabilitation.

Registration: The protocol was registered and is available from PROSPERO (CRD42021268984).

The eating habits of adolescents are often inadequate, with high consumption of unhealthy foods and low consumption of healthy foods. It is necessary to design and implement effective interventions to improve eating habits at this age and evaluate their feasibility, acceptability, and effectiveness. The use of theories for behavior change in health interventions favors the adoption of healthy behaviors. Due to this, the objective was set to determine the feasibility, acceptability, and effect on food consumption of a new educational nutritional intervention program for adolescents based on the Social Cognitive Theory (SCT) and supported by the Trans-theoretical Model (TTM) and identify areas of improvement in study design and intervention for future larger-scale studies. A pilot study of a cluster randomized controlled trial was conducted in adolescents of both sexes, 12 to 15 years of age, students from a public secondary school in Tonala, Jalisco, Mexico. The results show that a nutritional education intervention for adolescents, based on SCT and supported by the TTM, is feasible, acceptable, and with positive results in the modification of the consumption of ultra-processed foods, vegetables/fruits, and water. This pilot study identified some aspects that could be improved to enhance the effectiveness of the interventions in future studies.

Nowadays, the global medical tourism market size has grown quite rapidly, with a projected increase of 21.1% between 2021 and 2028. This study aimed to explore barriers and potential strategies for the development of medical tourism in Indonesia. A qualitative case study design was employed, where 8 respondents were selected using an expert sampling method from various groups according to the helix framework, including academics, government, professional organizations, the private sector, and the media. Data was collected through document analysis and in-depth interviews, and was analyzed manually using an inductive thematic content analysis approach. Limitations to the development of Indonesian medical tourism are related to regulations concerning medical tourism, the number of health services, distribution, supporting resources, public trust, and competition. At the institutional level, the challenges comprise services and products, hospital facilities, supporting facilities, and marketing processes. Furthermore, at the micro level, the low competency of both health and non-health workers persist as an obstacle. The potential strategy at the macro level include the development of robust marketing and branding strategies, health infrastructure, and resources. At the institutional level, it was necessary to develop related products and services provided, improve quality, and focus on branding and marketing strategies. Additionally, improving human resource skills was needed at the micro level.

Background: Early identification of people living with hepatitis B virus infection is required to initiate treatment and care, prevent community transmission, and expand vaccination. However, only an estimated 10% of people living with chronic hepatitis B infection are diagnosed, and only 2% are on treatment globally. This study aimed to assess the prevalence of hepatitis B virus infection and its associated factors among high school students in Shinshicho Town, southern Ethiopia.

Methods: An institutional-based cross-sectional study was conducted among 380 high school students in Shinshicho Town, southern Ethiopia, from September to October 2022. A laboratory investigation of hepatitis B surface antigen was done to determine infection status. An odds ratio with a 95% confidence interval was used to declare statistical significance.

Results: The prevalence of hepatitis B virus infection among high school students in Shinshicho town was observed to be 7.6% (95% CI: 5.5, 10.5%). Age 20 to 24 years [AOR: 2.7; 95% CI: (1.0-7.0)], rural residence [AOR: 3.4; 95% CI: (1.3-8.9)], and history of unprotected drug injection [AOR: 11.3; 95% CI: (3.7-34.8)] were independently associated with hepatitis B virus infection.

Conclusion: A high prevalence of hepatitis B virus infection was observed among high school students in this study. Therefore, strengthening the school-based screen-and-treat program, especially targeting students from rural areas and young adults, and conducting awareness campaigns about the importance of practicing safe behaviors, such as avoiding unprotected drug injections, could contribute to the prevention and control of hepatitis B virus infection among high school students.

Background: Unsafe abortion is a serious reproductive health problem in developing countries including Ethiopia. The attitude of healthcare providers toward abortion is one of contributing factors to unsafe abortion. This study aimed to determine the pooled effect of healthcare workers' attitudes toward safe abortion care and its determinants factors in Ethiopia.

Methods: Search engines such as Scopus, CINAHL, EMBASE, PubMed, Web of Science, and CAB Abstracts were used to find published studies where as Google and Google Scholar were used to find unpublished research. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. The analysis was performed using STATA 14 and the random-effects model was used to calculate the odds ratios of medical professionals' attitudes regarding safe abortion services. Study heterogeneity was assessed by using I² and P-values. To evaluate the stability of pooled values to outliers and publication bias, respectively, sensitivity analysis and funnel plot were also performed.

Results: A total of 15 published and unpublished articles with a sample size of 4060 were incorporated in this Review. The overall pooled prevalence of this study was 56% (95% CI: 45-67). Sex of participants (AOR: 2.37; 95% CI: 1.57, 3.58), having training (AOR: 2.86; 95% CI: 1.58, 5.17), Professional type (AOR: 1.55; 95% CI: 1.04, 4.46), and knowledge of abortion law (AOR:2.26; 95% CI: 1.14, 4.46) were the determinants factors that significantly associated with health care workers' attitude toward safe abortion care. Sensitivity analysis shows that the pooled odds ratios were consistently stable throughout all meta-analyses, and the funnel plot shows no evidence of publication bias.

Conclusion: Half of health care providers sampled among the pooled studies have favorable attitudes toward abortion services in Ethiopia; which could hamper women's access to safe abortion care. Sex, training, type of profession, and knowing abortion law were determinants of health care workers' attitudes toward safe abortion services. Stakeholders should emphasize improving the attitude of healthcare workers toward safe abortion care which has a vital role in reducing maternal mortality. Moreover, working on modifiable factors like training, assigning personnel whose professions align with the service, and updating care providers about abortion law is also the essential key point to improve their intentions to deliver the services.

Introduction: Over the last decade, hypertension (HPT) is among the leading causes of death and morbidity in Ghana. In recent past, most health policy research in Ghana and Africa focussed on communicable diseases. In recent times, Ghana and other developing nations have shifted their attention to non-communicable diseases because most of these countries are going through an epidemiologic transition where there is a surge in the prevalence of HPT. This paper was therefore set out to estimate the cost of treating HPT in Ghana from the patients' and health system's perspectives.

Method: We used a cost of illness framework to simulate the cost of HPT management in Ghana taking into account 4 of the common target organ complications with the most mortality implication. A decision analytic model (DAM) was developed in Microsoft^® Excel to simulate the progression of HPT patients and the Markov model was employed in simulating the lifetime cost of illness.

Results: The results show that by 10 years from diagnosis, the probability of death from any of the 4 complications (ie, stroke, myocardial infarction, heart failure, and chronic kidney disease) is roughly 41.03%. By 20 years (or 243 months) from diagnosis, the probability of death is estimated to be 69.61%. However, by the 30th anniversary, the probability of death among the cohort is 82.3%. Also, the lifetime discounted cost of treating HPT is about GHS 869 106 which could range between GHS 570 239 and GHS 1.202 million if wide uncertainty is taken into account. This is equivalent to USD 119 056 (range: USD 78 115-164 723).

Conclusion: By highlighting the lifetime cost of treating HPT in Ghana, policies can be formulated regarding the cost of treating HPT by the non-communicable disease unit and National Health Insurance Authority (NHIA) of the Ministry of Health.

Children and adolescents with complex musculoskeletal conditions may receive health care that requires at least 1 transfer between 4 specialized pediatric establishments in the Montreal region (Québec, Canada). This may result in challenges in navigating the system. A collaborative approach, aiming to make the inter-establishment care pathways seamless and to improve the integration of musculoskeletal health services, brought together key stakeholders including a research team. The aim of this paper is to describe the timeline of the collaborative approach's key milestones and activities and, more specifically, to describe the context, process, and outputs of the involvement of researchers in support of a continuous quality improvement project based on an integrated approach. The descriptive timeline was constructed from a qualitative document analysis of the project-related gray literature (n = 80 documents) and was validated and interpreted with key stakeholders. The results showed how the collaborative project was set up and operated, as well as what solutions were developed and implemented. The strategies on how the research team was involved in the integrated approach in addition to its research activities were also described. Conclusions suggest practice recommendations for creating change processes by integrating research, service evaluation and clinical audit into quality improvement projects.