Health policy and planning最新文献

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.

Neonatal deaths remain a critical public health challenge in many low- and middle-income countries (LMICs), including Kenya. Affordable technologies such as Comprehensive Positive Airway Pressure (CPAP) and phototherapy machines can reduce neonatal mortality and are used in these settings. However, their introduction and implementation in resource-constrained health system contexts are poorly understood. This study investigates how communication among health professionals influences decisions to use CPAP and phototherapy devices in Kenyan newborn units. Using a focused ethnographic approach, we conducted unstructured non-participatory observations, semistructured interviews, and document reviews in two newborn units in level five Kenyan referral hospitals. The study participants were all health professionals working in the newborn units. We gathered data in two phases, 6 months apart, and analyzed the data thematically. Data collection and analysis were informed by The Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. We found four interconnected contextual factors that influenced health professionals' communication on the initiation, maintenance, discontinuation, and repair of neonatal technologies. These factors are as follows: First, physical environment, including space availability, newborn unit layout, and the arrangement of cots and incubators. Second, socio-organizational dynamics, such as the team composition, workload, management approach, and workplace culture. Third, technology-specific attributes, particularly the perceived complexity of CPAP and phototherapy's features and functions. Finally, the wider system encompasses administrative burdens from research and donor-supported programs as well as political, financial, and regulatory factors. Stakeholders, including funders, policymakers, local governments, and health professionals, must recognize that interconnected physical, organizational, technological, and wider contexts shape communication, decision-making, and use of life-saving technologies. A tailored approach that considers these complex realities, rather than a one-size-fits-all approach, should contribute to better integration and sustainability of these technologies, leading to improved outcomes in newborn care.

Since children's participation in social health insurance (SHI) in China is voluntary, fluctuations in enrollment or dropout are inevitable. Using data from the two waves of the China Family Panel Study in 2020 and 2022, this study aims to examine these participation dynamics and their impact on children's health service utilization and medical expenses. Specifically, a balanced panel of 1,958 children under the age of 15 was constructed, first-difference and difference-in-difference models were employed to assess the factors influencing children's SHI enrollment or dropout, as well as the impact of these changes on health service utilization and medical expenses. Robustness checks were conducted after excluding new enrollees and dropouts separately. Our analysis showed that between 2020 and 2022, 263 children (13.4%) were newly enrolled in SHI, while 135 (6.9%) dropped out. Maternal SHI enrollment increased the likelihood of children's enrollment and reduced the probability of dropout. Children with commercial insurance were 34% less likely to enroll and 58% more likely to dropout. Compared to children with unchanged participation status, newly enrolled children were about 8% more likely to use outpatient services and had 77% higher medical expenses in the past year, whereas no significant changes were observed among those who dropped out. These findings highlight the dynamic nature of children's SHI participation in China and suggest that passive enrollment policies and parental participation could help promote universal coverage. Improving the reimbursement system, particularly for children's outpatient care, is also recommended.

Developing pediatric intensive care units (PICU) in resource-limited regions presents several challenges, including significant resource constraints, a shortage of trained personnel, and a lack of standardized care protocols. Prioritizing skills and knowledge development for healthcare professionals, selecting effective yet affordable equipment, and strong leadership have been identified as essential for establishing sustainable pediatric critical care services in low middle-income countries (LMICs). In this article, we describe the practical, phased approach undertaken in a charitable hospital setting in northeast India to establish a pediatric intensive care unit, highlighting adaptability, institutional commitment, patient team building and systematic record-keeping in overcoming these challenges. The lessons drawn from this experience can offer valuable insights for similar healthcare settings in LMICs, demonstrating that high-quality pediatric critical care can be achieved even in resource-constrained environments.

Despite efforts to promote HPV vaccination, coverage remains suboptimal in China. Following Guangzhou's 2022 free HPV vaccination program for girls aged 9-15, a cross-sectional survey was conducted from May to August 2024 among 411 parents of eligible girls in Guangzhou. The questionnaire was developed based on the supply-demand alignment theory. Vaccine Hesitancy Scale and Family Health Scale-Short Form were administered. Generalized linear regression identified factors associated with hesitancy. Overall, 10.7% of parents exhibited high hesitancy. Key determinants included occupation [farmers: β=-3.61, 95% CI=(-6.88, -0.34)], preference for imported over domestic vaccines [β=-1.65, 95% CI= -3.10, -0.12)]. Higher family health scores [β=0.25, 95% CI=(0.16, 0.33)], moderate child health status [β=1.24, 95% CI=(0.10, 2.38)], and satisfaction with community healthcare centers (CHCs) [β=0.05, 95% CI=(0.02, 0.07)] were less hesitant. Paradoxically, longer CHC wait times (>1 hour) [β=2.29, 95% CI=(0.27, 4.31)], and difficulty accessing information [β=2.80, 95% CI=(0.33, 5.27)] correlated with lower hesitancy. The results suggest potential policy-driven tolerance. Besides, this emphasizes the critical need for enhanced service quality in CHCs, targeted health education, and confidence-building in national vaccines. These insights offer potential guidance for implementing complementary strategies to achieve equitable HPV vaccine coverage.

This article revisits the argument that in the absence of good governance, remittance inflows cause the government to renege on the provision of social services and crowd out public finance where private substitutes exist. Using a quantile approach on a sample of African countries for the period 1990-2022, and after controlling for the endogeneity of remittances, the results show a positive contribution of remittances to public health expenditure, which tis annihilated into a non-linear crowd-out of public health expenditure across quantiles in the presence of varied political regimes. This relationship does not change even in the presence of a health shock. The crowd-out of public health expenditure points to an indirect effect of remittances through household consumption, private investment and tax revenue.

Within the global health landscape exists a complex interplay between global health security (GHS) and universal health coverage (UHC) - two influential agendas with profound influence on health system strengthening initiatives. There is a need to understand why and how coherence between GHS and UHC is being pursued in health policy and planning, particularly in the wake of the COVID-19 pandemic, which profoundly reshaped the field of global health. This paper presents one of the first detailed analyses of contemporary efforts to conceptualize and operationalize GHS-UHC coherence - through the perspectives of key actors responsible for its implementation. The study employed thirty-one interviews with senior officials across four major types of global health actors: multilateral and global health organizations, country governments, donors and international finance institutions, and civil society organizations. It reveals important insights in the way specific actor and geopolitical groups varied in terms of shifting perceptions of GHS and UHC, as well as major factors influencing GHS-UHC coherence (e.g., strategic considerations including motivations and concerns, and structural considerations including enablers and barriers). The analysis suggests that an emerging 'hybrid norm' linking GHS and UHC appears well-underway. It further contends that strengthening coherence between GHS and UHC not only depends on, but also enhances, three key imperatives: 1) overcoming geopolitical power asymmetries, 2) leveraging strategic collaboration across actor types, and 3) pursuing integrative health diplomacy amid polycrisis. While this study centers on GHS-UHC alignment, its broader objective is to foster a more equitable and resilient global health architecture by tackling the interconnected causes of fragmentation through hybrid normative frameworks. By focusing on the politics of norms underpinning GHS and UHC integration, this work contributes to rethinking how global health institutions collaborate, ultimately helping to build more sustainable global health governance fit to withstand future political, economic, and social challenges.

Universal Health Coverage (UHC) remains a critical goal in sub-Saharan Africa, where healthcare systems face significant challenges. State-Church Partnership has emerged as an innovative strategy to address gaps in healthcare delivery, leveraging the extensive networks of Faith-Based Organizations to provide essential services, particularly in remote areas. A scoping review followed Arksey and O'Malley's framework and the PRISMA-ScR guidelines. We systematically searched peer-reviewed databases, including PubMed, Web of Science, Scopus, and CINAHL, for relevant studies published from inception until December 2024. Data were extracted and thematically analyzed using NVivo 11 to identify key themes related to state-church partnership models, their impact on UHC, implementation challenges, and emerging best practices. The review included eight studies covering various state-church partnership models in sub-Saharan Africa (SSA). Findings highlight that FBOs contribute between 30% and 70% of healthcare services in some regions, improving access, affordability, and equity. They play a critical role in maternal and child health, HIV/AIDS prevention, and health workforce training. However, challenges such as funding constraints, service quality variability, and limited policy integration hinder their effectiveness. Emerging best practices include enhanced government collaboration, community engagement, and capacity-building initiatives. In conclusion, State-Church Partnerships are vital in strengthening healthcare systems and achieving UHC in SSA. To maximize their impact, formalized policy frameworks, sustainable financing mechanisms, and quality assurance measures are essential. Strengthening state-FBO collaboration can bridge healthcare gaps and ensure equitable healthcare access.

Integrated care effectively addresses challenges like high costs and low efficiency in healthcare. This paper investigates the impact of integrated care models in urban China on inpatient costs and health services efficiency, and explores variations by age category, chronic disease status and healthcare institutions. Data is sourced from the insurance claims database in Guangzhou (2012-2015). Seven integrated care models are introduced at different times during the study period. The propensity score matching with staggered difference-in-differences approach is employed to examine the effects of integrated care models on inpatient costs (total inpatient costs and out-of-pocket (OOP) spending) and health services efficiency (length of stay (LOS)). After matching, 147 healthcare institutions are included, with 44 in the intervention group and 103 in the control group. There are 1,721 institution-month-level observations in the intervention group and 3,746 observations in the control group. Integrated care models reduce total inpatient costs (6.6%), OOP spending (17.3%), and LOS (3.3%) across all healthcare institutions. For patients aged 60 and above receiving care in primary/secondary care institutions, there are notable decreases in total inpatient costs, OOP spending, and LOS. However, for patients aged 60 and above in tertiary care institutions, integrated care models did not significantly affect these three outcomes. Additionally, patients with chronic diseases in primary/secondary care institutions also experience reductions in total inpatient costs, OOP spending, and LOS. Integrated care models in urban China contribute to lower inpatient costs and higher health services efficiency, particularly for older adults and patients with chronic diseases who are receiving care in primary/secondary care institutions. These findings have important policy implications for the implementation of integrated care models in urban China.

The global aged population is expected to reach 2.1 billion by 2050 and ∼40% of them will live in rural areas of low- and middle-income countries (LMICs). This systematic review aims to synthesize the qualitative literature on rural older adults' experiences of health-seeking in LMICs as well as explore the factors that influence their experiences during their health-seeking journeys. We searched Embase, MEDLINE, PsycINFO, and CINAHL to identify studies published from 1 January 2002 to 31 December 2024 (PROSPERO registration ID: Blinded For Review). We used a thematic synthesis approach to analyse included studies. Among the 19 studies with 28 articles and 484 participants included, 16 were rated as high quality, 9 as moderate quality, and 3 as weak quality. We identified four primary analytic domains associated with their experiences in health-seeking journeys: (i) individual-depicting the inner world of rural older adults; (ii) interpersonal-navigating the rural social network; (iii) organizational-navigating the rural health care systems, and; (iv) community and macrosystems-economy, society, and public policy in rural areas. Rural older adults in LMICs have experienced unique and multi-level challenges in seeking care. To overcome these challenges, rural older adults demonstrated resilience and creativity (e.g. utilizing informal institutions), to navigate their health-seeking journey. Future research should aim to better understand the resilience and agency in local older adults' health-seeking experiences and provide constructive solutions to overcome identified barriers to care.