Health policy and planning最新文献

This study develops an inverse rank-weighted index (IRWI) to adjust catastrophic thresholds for out-of-pocket expenditure (OOPE) components. The proposed method eliminates the arbitrariness of the existing proportionate approach by ensuring fairness in determining component-specific catastrophic thresholds. It measures the effective expenditure share of each OOPE component while considering the concentration of component-specific spending across household income levels. Using nationally representative household survey data on healthcare consumption from 2017-18, the study estimates catastrophic health expenditure (CHE) at both aggregate and component levels in India under uniform, proportionate, and IRWI thresholds. The findings reveal that the uniform threshold significantly underestimates CHE incidence, whereas component-specific thresholds identify twice as many households that experience CHE. Shifting from the proportionate method thresholds to IRWI thresholds significantly alters CHE estimates. The IRWI approach offers a more reliable framework for integrating component-specific and aggregate CHE assessments. It underscores the need for income-sensitive, component-specific thresholds to accurately quantify financial hardship and prevent underestimating healthcare-related economic burden.

Recent reductions in U.S. global health funding have disrupted essential programs in sub-Saharan Africa (SSA), highlighting the region's vulnerability to external financing shocks. The suspension of USAID initiatives has affected disease control, maternal care, and health system operations across 47 countries, raising urgent questions about how to sustain progress without reliable donor support. This commentary examines the potential of Public-Private Partnerships (PPPs)-structured collaborations in which governments and private actors share financing, risk, and managerial responsibility-to strengthen domestic capacity. Drawing on examples from Senegal, Nigeria, and Kenya, we explore how service, concession, financing, and technology-focused PPPs can mobilize additional resources, expand access, and improve service delivery. We also address key challenges, including governance risks, fiscal constraints, and shifting global power dynamics. While not a substitute for aid, well-designed PPPs aligned with national priorities can support more resilient, equitable, and self-reliant health systems in SSA.

There has been increasing interest in co-designing interventions with end users to prevent violence against women (VAW). Co-design is theorised as an ethical approach to research able to engage some of the most marginalised groups in VAW prevention. However, there is little evidence of whether co-designing interventions can reduce violence against women, or theoretical consideration of how it might do so. This paper contributes to current discussions about co-design by examining the results of the E le Saua le Alofa ("Love Shouldn't Hurt")-a pilot intervention that engaged Samoan communities in co-designing violence prevention activities. A mixed methods evaluation of the pilot has shown promising results, and in this paper we consider how the co-design process may have contributed to these results. The evaluation of the co-design process assessed four theorised mechanisms: (1) increased ownership of the problem of violence; (2) improved health behaviours and social norms; (3) relevance of actions taken to address VAW; (4) addressing power structures arising from coloniality. Our results show that change in violence outcomes occurred through the pilot's ability to revisit previous conversations about violence in Samoa, prompting new activities by local leaders, and tightening village rules on violence. Yet, the activities implemented by local leaders were largely unpredictability and sometimes conflicted with global evidence. We argue that such actions should not be construed by policymakers as the 'unpredictable outcomes' of an intervention, but rather understood within a broader framework of diversified knowledge systems. The need for balance in co-designing VAW interventions with communities affected by violence highlights a key challenge of decolonising VAW practice within a co-production framework.

Corruption in health systems has serious implications for health outcomes and equitable care. Although various methods exist to measure it, their application, purpose, effectiveness, and context have not yet been systematically consolidated to enable learning. We conducted a scoping review to identify empirical approaches used to measure health-sector corruption globally, with a focus on low- and middle-income countries. We examined the opportunities and challenges of these methods and developed a typology to guide future research. We searched Econlit, Embase, Global Health, Medline, Social Policy and Practice, Web of Science, and websites of international organisations focused on corruption research. Reference lists of included studies were also hand-searched. Two rounds of searches were conducted: first for studies published between 2000 and 2022, then for earlier publications dating back to 1993. Thirty-seven studies were narratively synthesised. Common methods included surveys, interviews, focus groups, and audits. Surveys were more common before 2000. Ethnography, investigative journalism, co-production, and crowdsourcing-though previously recommended-were rarely used or reported in the literature. Often, measuring corruption was not the primary aim, and methods were poorly described. Many lacked a clear definition of corruption or a theoretical grounding. Our review and typology highlight trade-offs between rigour, feasibility, and utility. As demand for evidence in this field grows, consensus on corruption definitions and sub-types is needed to guide study design and improve comparability across contexts. Promising directions include theory-informed mixed methods, context-sensitive designs, qualitative pilots, and interdisciplinary approaches.

Public health asset mapping involves working in a community partnership to form a systematic inventory of a local community's health-promoting features. Assets include physical amenities such as parks or fitness centers, community clinics, welfare agencies, health-promoting non-governmental organizations (NGOs), and businesses. A curated list of these resources constitutes an asset map that can be shared to promote better health and better health policies that build on local strengths rather than deficits to address upstream social determinants of health. Procedures for asset mapping must be adapted for local contexts because the identity and focus of assets differ significantly between countries. Asset mapping emerged as an element of an overall approach to Asset-Based Community Development (ABCD). However, an expository gap persists between a rich ABCD literature and practice-oriented guidance on how to operationalize these processes through coherent asset map design, data collection, analysis, and integration of qualitative insights, especially for the metropolitan context in the public health field. In response, we developed a systematic and replicable five-step guide to systematically map public health assets. Our approach integrates desk research with qualitative insights and produces a structured, evidence-based process for identifying and classifying super-connectors, thereby providing a robust foundation for subsequent knowledge exchange and implementation. Public health practitioners, researchers, and community leaders can use this guide to identify and mobilize community assets towards co-creating better health policy and better policy implementation.

Globally, an estimated 22.7 million children are unimmunized or "zero-dose" (ZD), with 3.1 million in Nigeria. The political and economic environment plays a critical role in influencing the number of ZD and under-immunized (UI) children. We explored stakeholder perceptions of the political and economic context of vaccination services in Kano and Lagos States, two Nigerian states with a high number of ZD children. We conducted stakeholder mapping, followed by key informant interviews with 84 state, local, and community informants responsible for or influential in immunization. Transcripts were analyzed using a reflective thematic framework approach. We describe the multi-level network of domestic and international actors characterizing Nigeria's immunization policymaking and implementation landscape. Respondents perceived a strong and mutual political commitment by all actors involved in routine immunization. The pivotal role of local influencers further reinforced this commitment, from traditional to religious leaders, in improving uptake in challenging settings. Knowledge of national policies, and thus, perception of their adequacy in addressing under-immunization, was weakest among participants working at the local and community levels. Other reported barriers to policy implementation included bureaucratic delays in fund disbursement, outdated policies, slow dissemination of policies to local levels, and inadequate policy provisions for funding and staffing at the local level. To enhance equitable immunization coverage in Kano and Lagos, our findings suggest a need for meaningful engagement of community actors in policy development, timely policy revisions, and the establishment of mechanisms for expedited fund disbursements and addressing funding shortfalls at the local levels.

Unmet healthcare needs are a significant concern in China, possibly due to the underutilization of primary healthcare services. Patients disproportionately seek tertiary hospital services, reflecting the historical underinvestment in community healthcare and a weak referral system. This misallocation of medical resources burdens the capacity of tertiary hospitals and limits access to necessary healthcare. To address this, the Family Doctor Contracting System (FDCS) was introduced to enhance community health services and reduce unmet healthcare needs. This study empirically analyzes the impact of the FDCS on unmet healthcare needs using data from the 2018 National Health Service Survey in Shandong Province, which included 27 447 individuals aged ≥18 years. An entropy balancing method was employed to address self-selection bias. Logistic regression results show that individuals contracted with family doctors (FDs) are associated with a 1.6% lower probability of experiencing unmet outpatient healthcare needs compared to those who did not participate, although the FDCS had no significant impact on unmet inpatient needs. A potential mechanism is that the FDCS has improved the accessibility of outpatient services. We found that signing up with FDs reduced the likelihood of citing inaccessibility as the main reason for unmet outpatient care needs by 43.7 percentage points, while the impact on unacceptability and unavailability was relatively more minor at 0.5 percentage points. The findings highlight the effectiveness of the FDCS in enhancing the role of primary care and improving access to healthcare. Future policy initiatives should focus on promoting the benefits of the FDCS and encouraging utilization of the FD service while strengthening community-based primary care by providing adequate infrastructure, resources, and training.

Limited research has been conducted on strategies to improve the efficiency of HIV services for key populations (KPs). This study investigates ways to enhance healthcare delivery efficiency, focusing on HIV services for KPs. We explore two strategies: expanding service volume and offering multiple HIV services within a single health facility. Using data from the Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) program in Kenya and Malawi, we exploit the variation in services provided to assess correlations between different service delivery configurations and their costs. We apply log-log fixed-effects regression models to analyze relationships between the total costs of four HIV services and the volume and range of services delivered. We find that service volume increases correlate with higher total costs, albeit less than proportionally, consistent with possible economies of scale. Negative correlations between service integration and total costs suggest that integrating HIV services for KPs could lead to reduced total costs for some service combinations. These results indicate potential strategies to increase the efficiency of HIV services for KPs, which can inform strategic planning and program execution in Kenya, Malawi, and similar countries.

A harmonious relationship between the medical profession and the society it serves is essential for any country's health system to fulfill its mandate. Society offers trust, respect, authority, and professional autonomy to doctors, and in return, expects doctors to provide good care and prioritize people's welfare. However, in many parts of the world, we observe growing dissatisfaction, increasingly expressed violently, with the medical profession. Understanding what explains this growing dissatisfaction is necessary to initiate measures to maintain and improve this important social relationship and social contract. Using India as a case, and drawing on insights from qualitative, in-depth interviews with purposively selected doctors, journalists, legal experts, police, patients and patients' rights activists, and social commentators, we demonstrate how a range of mismatched expectations-regarding the organization of the medical profession, the structure of healthcare provision, the status and identity of doctors in society, and fair compensation for care provides-are contributing to the disruption of this critical social relationship. We argue that these dynamics can be meaningfully examined through the lens of the 'social contract' between the medical profession and the society it serves. Our analysis also shows how these mismatched expectations are highly contentious and how they are rooted in the increasingly market-logic-based organization of healthcare. For researchers across the world, our study offers a novel approach to researching the relationship between the medical profession and society, and, for policy makers and health system leaders in India, our findings offer practical entry points to develop policy interventions to help restore, recalibrate, and secure this important social contract.