Health policy and planning最新文献

Informal healthcare providers (IHPs) play a crucial role in healthcare delivery in urban slums, but the lack of linkages between IHPs and the formal healthcare system results in fragmented, low-quality care. Integrating IHPs into the formal healthcare system poses challenges that are common across such settings. This study explores the perceptions of healthcare providers and consumers in Nigerian urban slums regarding linking IHPs to the formal healthcare system, while also aiming to identify stakeholder perceptions on how the linkage might best work. Using cross-sectional consumer and provider surveys, we collected data via questionnaires from 1024 households and 255 providers, purposively selected from eight urban slums in Anambra and Enugu states, southeast Nigeria. We estimated overall and subgroup-specific percentages, percentage-point differences, and associated 95% confidence intervals for question responses using logistic regression models and marginal effects methods. Most consumers were female (96%), with a median age of 31 years, reflecting the sampling design and focus on females in households with women of childbearing age and/or young children, and 63% were employed in the informal sector, reflecting the setting. Most providers were IHPs (93%) and private (94%), with the most common job title being patent medicine vendors (54%). We found that 92% (95% CI: 84%, 96%; n/N = 943/1025) of consumers and 87% (95% CI: 60%, 97%; n/N = 221/255) of providers supported linking IHPs to the formal health system. Both groups of respondents primarily favoured (i) training, supervision, and referral as the main strategies and aspects of services to be linked, (ii) having the Ministry of Health lead the linkage, and (iii) managing the linkage through government legislation. There was little evidence for any large differences in consumer or provider views across subgroups based on key sociodemographic characteristics or provider attributes. The study findings offer guidance for future policymaking.

Hospitals, as an important component of the health system, consume a substantial amount of health resources and are instrumental in improving population health. While many health financing interventions have been implemented at hospitals, evidence exploring common factors facilitating their implementation in low and lower-middle income countries (LLMICs) remains limited. We conducted a scoping review of existing hospital financing interventions in LLMICs. A combination of search strategies and key informant consultations were used to search for relevant literature. A total of 35 articles spanning six categories of hospital financing interventions were included in the review. The review centered on design and implementation factors associated with hospital financing interventions. Factors affecting a hospital financing intervention's results were numerous and context specific. From the design and implementation perspective, five interconnected factors-governance and accountability, participatory process, proper intervention design, adequate resources and capacity, and monitoring and evaluation-underline the most influential factors across the six categories of hospital financing interventions. Understanding the connections among these factors and making efforts to align them with the country's context make for a more promising intervention. The evidence on specifics across different types of hospital financing implementations remains limited, requiring more implementation studies guided by comprehensive theoretical frameworks to generate more concrete evidence.

Adolescent mental health remains a critical yet under-prioritized issue in low- and middle-income countries (LMICs) like Kenya, where resource limitations, stigma, and systemic barriers hinder access to care. While policies and strategies such as Kenya's Mental Health Action Plan (2021-2025) exist on paper, their implementation is constrained by limited resources and a weak mental health service delivery infrastructure. This qualitative descriptive study examines the perspectives of mental health actors and youth advocates on the development and implementation of adolescent mental health policy in Kenya. Using a political economy analysis, we conducted 15 key informant interviews (KIIs) and analyzed observational field notes from a Google Jam board exercise to explore factors that enable or impede the prioritization of adolescent mental health policy and care. Thematic analysis was guided by Shiffman and Smith's policy framework, focusing on four domains: actor power, ideas, political context, and issue characteristics. Findings reveal significant barriers, including the exclusion of adolescents from decision-making, limited family involvement, weak policy formulation, and the destabilizing effects of government transitions. Stigma, poverty, and chronic underfunding further hinder progress, despite ongoing strategic efforts. Comparisons with other LMICs indicate that these challenges are widespread, underscoring the need for localized, inclusive, and well-coordinated approaches. Addressing these issues will require strong political commitment, increased youth-led advocacy, and sustained investment in mental health services. By prioritizing adolescent mental health, Kenya can move toward a more equitable and effective mental health system that supports the wellbeing of its youth.

This study evaluated the scale-up of an innovative approach to increasing modern contraceptive use in the Democratic Republic of the Congo (DRC) on multiple outcomes: fidelity to design, acceptability, sustainability, satisfaction, adoption by other organizations, and penetration. The intervention consisted of incorporating a family planning (FP) module into the training of third-year nursing students, who then counseled and delivered services during community outreach events as their practicum several times annually in selected provinces. In late 2023, eight different stakeholder groups were interviewed (national-level health authorities, provincial-level health authorities, program managers replicating the model, chief district medical officers, nursing school focal points, nursing students, FP clients, and a parent association), for a total of 1238 persons. It consisted of telephone interviews (for three stakeholder groups), in-depth interviews (for three other groups), in-person interviews (one group), and focus group (one group). Data were triangulated across stakeholder groups for each outcome. The scale-up of the nursing school model achieved many of its desired outcomes regarding fidelity to design, acceptability, satisfaction, penetration, and adoption. Unresolved issues included pervasive contraceptive stockouts, difficulties in accurately capturing data on contraceptive distribution in the national health information system, and sustainability. The DRC model originated from a scarcity of government or donor resources to pay community health workers but has proven to be a promising means of increasing access to contraception. The results of this research will inform the further expansion of the model within the DRC and possibly to other countries facing similar challenges.

Zoonotic influenzas are major, ongoing public health policy challenge, not the least because of the importance of functional multisector partnerships (MSPs) for their prevention and control. However, despite years of investment in developing them, many countries have found multisectoral approaches, such as One Health, difficult to operationalize at national and subnational levels. One explanation for the lack of uptake is the limited nature of guidance on the design and adaptation of MSPs that consider local institutional dynamics. In this paper, we describe the process of developing a practical framework for assessment and characterization of MSPs. We use findings from an earlier review of academic and programmatic literature to develop a Theory of Action for multisector One Health partnerships that can nest into the short-term outcomes identified in the Theory of Change for One Health developed by the One Health Quadripartite. This comprises five elements: Characteristics; Starting conditions; Collaborative process; Outputs; and Responsiveness. We develop additional attributes to undertake a detailed characterization of different 'levels' of One Health partnerships. In addition, this Theory of Action allows for multiple outcomes of interest to be recognized and addressed. We then use the Theory of Action to develop a reflection tool to help country programme managers identify the specific characteristics of their respective One Health partnerships; recognize the differences in capacities and expectations of different partners; and use these insights to identify specific ways to strengthen the collaborative process. To our knowledge, this is the first time a detailed characterization of MSPs based upon programmatic attributes has been developed. Such a conceptualization of MSPs can facilitate the design, implementation, and evaluation of One Health and other multisector programmes and increase their relevance to the needs of the local context within which these are based.

The COVID-19 pandemic had significant widespread financial impacts, resulting in decreased household income, increased unemployment, and disrupted health services. Despite the higher prevalence of infections of tuberculosis (TB) and human immunodeficiency virus (HIV) in poorer populations, research on the financial challenges faced by these populations during the pandemic is still limited. Indonesia recorded the highest COVID-19 cases in Southeast Asia (6 815 156) while contending with the dual burden of HIV and TB. This study investigates the factors influencing out-of-pocket (OOP) payments and catastrophic health spending during the pandemic, alongside patients' challenges and coping mechanisms in Bandung and Yogyakarta, Indonesia. We employed a parallel convergent mixed-methods approach, combining quantitative analysis of OOP costs with qualitative interviews. The determinants of OOP payments were analysed using a two-part cluster-robust regression model. Catastrophic health spending was defined as OOP payments exceeding 10% of a household's annual income. Data on OOP spending were recorded via diaries, while qualitative data were gathered from in-depth interviews with TB and HIV patients and healthcare workers from January to October 2022. The findings indicated that 5.13% [95% confidence interval (CI): 2.99-7.28] of households incurred catastrophically. The median household spent USD 8.48 OOP, with nonmedical expenses comprising the largest share (median USD 5.93). Key predictors of higher costs included facility location in Yogyakarta (OOP costs difference USD 23.84, 95% CI: 9.90-37.77, P < .001), seeking care from public hospitals (USD 17.37, 95% CI: 8.83-25.90, P < .001), and the absence of health insurance (USD 10.49, 95% CI: 2.40-18.58, P = .011). Patients reported that job losses during lockdowns exacerbated financial strain, while coping strategies documented included borrowing, family contributions, and selling assets. This is the first study to focus on OOP spending and the financial hardships experienced by TB and HIV patients in Indonesia during the pandemic, providing insights for targeted policy and preparedness efforts to alleviate the financial burden during large-scale public health crises.

How to alleviate income inequality is a significant challenge faced by all countries worldwide, and disparities in health capital are one of the fundamental causes of income gaps. A thorough exploration of the relationship between health capital disparities and income gaps holds substantial practical significance. Based on the 2012-2018 China Labor-force Dynamics Survey, we employ OLS models, quantile regression, Shapley value decomposition, and Oaxaca-Blinder decomposition to provide a detailed estimation of the impact of health capital disparities on income gaps of labour. We find that health capital is a crucial driver of income increase, with its impact most pronounced at the 20th income percentile. Additionally, through Shapley decomposition, we find that health capital contributes 12.2% to overall income inequality. Although female, middle-aged and elderly, rural, and low education-level groups exhibit larger income inequality compared to their counterparts, health capital exerts a stronger influence on within-group income inequality for these disadvantaged populations. Furthermore, using Oaxaca-Blinder decomposition, we also find that health capital disparities contribute 12.8%, 12.31%, 9.83%, and 10.66% to the income gaps across gender, age, urban-rural, and education-level groups, respectively. Health capital not only significantly affects within-group income inequality but is also a key determinant of between-group income gaps. Therefore, enhancing investment in health capital, particularly for vulnerable populations, will contribute to promoting income equality and social equity.

This study explored the knowledge and perceptions of pharmacists in Gauteng, South Africa, regarding electronic prescribing implementation. As South Africa commences digital transformation in healthcare, this study identifies factors that will facilitate implementation and barriers that will hinder e-prescribing adoption, the findings which may contribute to policy reform. A mixed-methods study using a self-administered questionnaire was used to assess pharmacists' knowledge and perception of electronic prescribing and distributed through email to pharmacists (n = 386). Knowledge and perceptions were measured using a 5-point Likert-scale, where percentage scores were categorized as per Bloom's cutoff point as follows: poor: (<60%), moderate: (60%-79%), good: (≥80%) for knowledge and negative (<60%), neutral (60%-79%), or positive (≥80%) for perceptions. A pilot study (n = 50) was conducted to assess reliability. Quantitative data were analyzed using descriptive statistics and ordinal regression, with significance set at P < 0.05. Thematic analysis was applied to qualitative responses, using an inductive and deductive approach. Integration of the quantitative and qualitative findings in the discussion ensured triangulation of the results. Pharmacists demonstrated moderate knowledge of e-prescribing (60%-79%) and positive perceptions of its usefulness (≥80%). Higher knowledge of e-prescribing was associated with positive perceptions (P < 0.001). Predictors for good knowledge include recently graduated pharmacists (P = 0.010), while pharmacists in management positions had 2.88 higher odds of perceiving e-prescribing as appropriate for the workplace (P = 0.001). Thematic analysis revealed four themes: the benefits of e-prescribing, software design recommendations, facilitators for implementation, and barriers to adoption. Key facilitators included education and training, and a standardized regulatory framework aligned with international standards. Resistance to adoption stemmed from poor knowledge, infrastructural and financial constraints. This study concludes that while pharmacists support electronic prescribing, addressing regulatory, financial, and infrastructural challenges will promote successful implementation.

One in five adolescents (aged 10-19 years) live in sub-Saharan Africa. Despite the availability of policies targeted at this age group, policy formulation, implementation, and gains in adolescent health continue to be underwhelming. Stakeholders or actors are architects of policy, bringing their ideological values, interests, power, and positions to policy formulation and implementation and thus influencing the policy process. We analysed multilevel stakeholder interests, positions, power, and their influence on adolescent mental, sexual, and reproductive health policy formulation and implementation in Ghana, West Africa, using a single-case study design with multiple embedded subunits of analysis. The case was defined as actors, their power, interests, positions, and their influence on policy formulation and implementation processes in adolescent mental, sexual, and reproductive health. A conceptual framework of conflict and synergies between stakeholder interests, power, and positions and their influence on policy formulation and implementation was used to guide the analysis. Data were obtained from key informant in-depth interviews with 19 global and national level and 16 subnational level stakeholders. Focus group discussions were also conducted with 4 district health management teams, 9 groups of frontline health workers, and 20 groups of in and out of school adolescents in four districts in the Greater Accra region of Ghana. The multiple stakeholders in adolescent health, including adolescents themselves, had sometimes synergistic and sometimes divergent and conflicting views on policy agendas, formulation, and approaches to implementation. Unresolved conflicts between powerful stakeholders in the public or bureaucratic arena stalled or hampered policy formulation and implementation, whereas consensus and adequate resourcing moved processes forward. It is important to invest effort in understanding actors, their power, positions, and interests in context to inform policy content and framing to increase the chances of consensus and effective policy formulation and implementation processes.