Health policy and planning最新文献

Mobile health (mHealth) technologies are increasingly being used in innovative ways to overcome traditional barriers to the provision of, and access to, sexual and reproductive health (SRH) services among young people in rural low-and-middle income countries (LMICs). In rural Ghana, mHealth platforms are now being implemented by health care providers (HCPs) to improve access to SRH information for young people. However, the actual use of these platforms from the perspective of HCPs has not yet been explored. This study investigated HCPs' perspectives on the availability of mHealth platforms in rural Ghana and the perceived benefits of using such platforms to provide SRH information and services to rural dwelling young people. A qualitative exploratory study using semi-structured interviews was conducted with a convenience sample of 20 HCPs across three rural regions of Ghana. Participants were recruited using the snowballing method between May and August 2021. Interviews were audio recorded via Zoom with participants' consent. The data were transcribed verbatim and thematically analysed. All participants had experience providing mHealth-based SRH information and services to young people in rural Ghana. The mobile platforms used included phone calls, text messages, voice messages, Facebook, WhatsApp, and Twitter. These platforms facilitated SRH education on contraception,Human immunodeficiency Virus (HIV), sexually transmissible infections, hygiene, and menstruation. HCPs reported several benefits of using mHealth, including ease and convenience, low cost, anonymity, privacy and confidentiality (especially in light of socio-cultural norms and religious beliefs), reduced healthcare delivery workload, and reduced pressure on limited health infrastructure. The findings suggest that innovative mHealth platforms have the potential to improve young people's access to conventional SRH information and services in rural Ghana. Furthermore, the findings demonstrate the preferred and acceptable use of these platforms among users. The results highlight the acceptability and utility of mHealth, as well as the need for its wider adoption and integration. While the provision of SRH information and services through mHealth is promising, further research is needed to understand the barriers that affect access and delivery for young people in rural communities.

India has made good progress in the use of modern contraceptives in recent decades, however identifying women who are left behind is important to policy makers for further improving availability, accessibility, and coverage of family planning services to the marginalized population and hence achieving the international and national development agenda. Using five rounds of the National Family Health Survey data conducted between 1992-93 to 2019-21, this study examined the trends and patterns in inequality-by household wealth quintile and women's education-in modern contraceptive prevalence rates (mCPR) and demand for family planning satisfied with modern methods in urban and rural areas. The findings showed a secular trend of increasing rates in the use of modern contraceptives across socioeconomic sub-groups within urban (mCPR among the poorest quintile increased from 32% to 49%, and among the richest quintile from 51% to 60% in 1992-93 to 2019-21, respectively) and rural (mCPR among the poorest quintile increased from 27% to 49%, and among the richest quintile from 49% to 59% in 1992-93 to 2019-21, respectively) areas. Similarly, the inequality over time-measured by the concentration index-in mCPR has declined from 0.311 to 0.158 in urban areas and from 0.247 to 0.143 in rural areas between 1992-93 to 2019-21. Despite the overall decline in inequality, the pro-rich situation persists in contraceptive use in the country, and the extent of the inequality was high for modern reversible methods, both in urban and rural areas. Our findings underscore the increasing availability and accessibility of modern reversible methods, particularly among marginalized populations, along with improved information provided on the range of choices. This will help in achieving the global commitment of universal access to reproductive health, including family planning, and balance the method-mix in a country that is currently dominated by female sterilization.

Psychological distress and risk of burnout among community health workers (CHWs) in low- and middle-income countries represent a serious global public health concern and threat to efficient health system functioning and resilience. This mixed methods study aimed to test the acceptability, feasibility and preliminary effectiveness of a digital adaptation of the WHO's evidence-based Self-Help Plus (SH+) psychological intervention among CHWs, called Accredited Social Health Activists (ASHAs), in rural India. A total of 40 ASHAs, all women, were recruited from Sehore district, Madhya Pradesh, from October 2022 to March 2023. The intervention, a culturally adapted, digitized version of the WHO's evidence-based SH+ intervention, called SAMBHAV, was delivered via smartphone app. Psychological distress was measured using the Kessler-10 at baseline, 6- and 12-week follow up. The System Usability Scale and Client Satisfaction Questionnaire-8 were used to assess usability and satisfaction with the digital intervention, respectively. Focus group discussions were used to assess acceptability. From baseline to 12-week follow-up, psychological distress levels significantly reduced (mean decrease of 2.5 points, P = .043), indicating improved psychological health and psychological distress management capacity. The intervention demonstrated favorable acceptability (mean = 20.45) and usability (mean = 69.31), though challenges related to user interface and app navigation were identified. Qualitative feedback supported these findings, with ASHAs describing the intervention as practical, easy to learn, and effective in reducing their psychological distress while empowering them to assist others in managing tension. These findings highlight that the WHO's SH+ intervention can be adapted for different low resource contexts and tailored to meet the needs of specific target groups, specifically for alleviating psychological distress among frontline CHWs. Future research is needed to determine the benefits of scalable brief digital self-help interventions in promoting the well-being of frontline health workers and its resulting impacts on service delivery and health system functioning.

Universal health coverage (UHC) provides a platform for attaining 'Health for All'. Attaining UHC requires substantial investment and resources in the health sector. This can be challenging for many sub-Saharan African (SSA) countries. Public-private partnerships (PPPs) could be a potential solution. The implementation of healthcare PPPs for developing health system capacities for UHC presents both significant opportunities and notable challenges. This scoping review, part of a broader review on PPPs, examines the facilitators and barriers of healthcare PPPs and their impact on UHC. The review was guided by Arksey and O'Malley's guidelines for conducting a scoping review. PubMed, Medline (Ovid), Global Health (Ovid), Web of Science, Scopus, and EconLit were searched for peer-reviewed English language publications from January 2013 to December 2023. Nineteen studies were eligible for the final analysis following screening of 944 studies. Identified key facilitators of PPPs for UHC included well-established institutional structures, robust accreditation systems, accountability mechanisms, and political will and support. These factors contributed to improving primary healthcare delivery, which is a critical dimension for UHC. Key barriers identified were limited capacity of implementing partners, regulatory inadequacies, and insufficient funds. These barriers negatively affected the performance of healthcare PPPs, which translates into systemic inequities in access to essential health services, impeding progress towards achieving UHC. Considering contract management capacity of implementers, sources and flow of funds, and regulatory frameworks are highly recommended for UHC to be realized using PPPs.

The accessibility to the prevention and management of perinatal depression can be improved by using community health workers. This review was aimed at determining the effectiveness of interventions led by community health workers (CHWs) in reducing depressive symptoms and the prevalence of depression during the perinatal period. We conducted a search in PubMed, CINAHL, SCOPUS, and ProQuest Databases of Dissertation and Thesis (PQDT) to locate studies conducted in sub-Saharan Africa. We appraised the quality of eligible studies using standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). We extracted data from the included studies using an a priori prepared data extraction tool. We pooled the findings of the studies using meta-analysis. The initial search yielded 199 studies, out of which we included 16 articles in this review. During the first 3 months after birth, CHW-led preventive psycho-social interventions reduced the risk of depressed mood by 35% [RR = 0.65(0.46,092)] [low-quality evidence]. The interventions reduced the risk of depressed mood by 32% 6-months post-birth [RR = 0.68(0.52, 0.87)] [very low-quality evidence]. The effect of the interventions is sustained through 9-12 months after birth resulting in a reduction in the risk of depressed mood by 38% [RR = 0.72(0.54,0.96)] [low-quality evidence]. Among women with moderate depressive symptoms, compared to usual care, CHW-led therapeutic psycho-social interventions reduced the symptoms by an average of 0.71 [SMD = -0.71 (-0.84, -0.59) units during the first 3 months after birth. The effect lasts 9-12 months after birth [SMD = -0.28 (-0.41, -0.15)] [Moderate-quality evidence]. In conclusion, the work of CHWs may be integrated into the prevention and management of perinatal depression after careful analysis of the feasibility, applicability and meaningfulness of the interventions to local context. High-quality randomized trials may help to inform further optimization of the role of CHWs in reducing the risk of depressed mood and depressive symptoms during perinatal period.

Financial protection is a core pillar of universal health coverage (UHC), yet current monitoring approaches in low- and middle-income countries (LMICs) largely focus on direct medical costs, neglecting direct transport costs and indirect time costs lost when seeking care. This commentary highlights the importance of fully accounting for these often-excluded costs, which disproportionately affect poorer and rural populations and can significantly hinder access to essential health services and lead to foregone care. We outline five priority areas for action, including improved measurement of transport and time costs through household surveys, methodological advancements in valuing time, increased investment in primary health care to reduce physical access barriers, adaptation of financing schemes and social protection programs to cover non-medical costs, and a multisectoral approach to address structural determinants. Fully integrating these dimensions into financial protection metrics and policies is critical for ensuring more equitable progress toward UHC in LMICs.

Most sub-Saharan Africa (SSA) countries are implementing free maternity services starting from the first antenatal care (ANC) visit to postnatal care. However, out of pocket (OOP) health expenditures significantly affect the utilization of maternal services in SSA. Limited evidence exists on the costs incurred for ANC health service utilization in this region. This study aimed to assess the costs of ANC service utilization among adolescent and adult women in Eastern Ethiopia. Data were collected from pregnant women participating in the Kersa Health and Demographic Surveillance Site (KHDSS). The study prospectively followed 394 pregnant women across two rounds, collecting both direct medical and indirect costs of ANC service utilization. Direct medical and non-medical costs were summed up to give OOP health expenditures. Catastrophic health expenditure (CHE) and intensity were assessed using the budget share approach at different thresholds. All costs were converted to 2023/2024 USD and compared between adolescent and adult women. A total of 390 women were included in the final analysis. The total amount of OOP payment due to ANC service utilization was 35.7 USD among adolescents compared to 28.5 USD in adults. Adolescents spent 32.6 USD on direct medical costs compared to 24.9 USD for adult women, and 19.3 USD on direct non-medical costs compared to 19.8 USD in adult women. There was a significant difference in the proportion of women who incurred OOP payments, 85.7% of adolescents versus 66.7% of adults (P-value < .001). CHE incidence among adolescents was 46.8% and 15.6% compared to 28.7% and 9.3% among adult women at 5% and 15% threshold, respectively. Overall, adolescent women faced higher financial hardship than adult women. This highlights the need to expand financial protection beyond direct medical costs and to develop targeted financial protection mechanisms specifically for adolescents in resource-limited settings. Furthermore, strengthening the implementation and ensuring the sustainability of the Free Maternal Services policy could help reduce disparities in service utilization between adolescent and adult women.

In the absence of documented health workforce deployment policies and limited access to key job history data, existing health systems research methods are inadequate for examining policy implementation. The analysis of self-reported job histories offers a valuable research method for overcoming these limitations; however, its application and usefulness remain largely unexamined in health system and policy research, particularly in the context of health workforce and policy implementation. In this paper, we reflect on our experiences of using self-reported job histories to investigate the experiences of public sector doctors with deployment systems related to recruitment, initial posting, and transfers. We interviewed 33 public sector doctors from two Indian states to gain insight into their experiences with policies and systems related to deployment. The initial interview process revealed a pattern in which the doctors developed a work-life chronology to organize their responses. This was formalized in subsequent interviews, creating structured chronological job histories. Job histories serve as a useful and flexible research method for understanding the complexities of how health workforce deployment systems operate and are experienced by health workers. Commentary by doctors regarding these job histories revealed negative perceptions of transfer practice, disruptions in their career trajectories, and gaps in policy implementation. The recollection process of forming job histories is organic and fluid, rich in qualitative data, and its construction involves making sense of diverse work-related stories of health workers. Job histories offer flexibility for collecting data in a more structured manner through a simple set of quantitative questions. Despite their usefulness, constraints such as the inability to triangulate and recall bias exist. Beyond research, job history analysis has practical implications; it is useful for policy implementers and researchers through a more nuanced analysis of challenges related to effective workforce management systems, thereby improving workforce planning, policies, and systems.