Health policy and planning最新文献

Two billion people globally lack access to a basic toilet, and sanitation is a critical determinant of health and well-being. Evaluations of sanitation programmes typically measure disease or behaviour, and visual analogue scales (VASs) have not been used to measure users' feelings about their level of sanitation. In this study, we assess the validity of a horizontal sanitation VAS numbered 0-10, with end anchors 'best imaginable' and 'worst imaginable' sanitation. In Kumasi, Ghana, we surveyed 291 participants before and after uptake of a container-based sanitation service. In Maputo, Mozambique, we surveyed 424 participants from treatment groups of a prior trial. We assessed construct validity by testing hypothesized associations between VAS scores and toilet characteristics and by respondents valuing three hypothetical sanitation states. We assessed responsiveness by comparing VAS with/without sanitation interventions. There was evidence (P < 0.05) for 60% of hypothesized associations in Ghana and 100% in Mozambique. For responsiveness, there was a 3.4-point increase (2.1 SD) in VAS 10 weeks post-intervention in Ghana and a 2.9 point difference (1.3 SD) in Mozambique. In valuation exercises, the mean was higher (P < 0.001) for the objectively better sanitation state. The sanitation VAS could be useful in economic evaluation to identify which improvements achieve quality-of-life gains most efficiently. For future studies, we recommend a vertical sanitation VAS numbered 0-100 with emojis at end anchors but retaining a 0-10 option for those who struggle with numeracy.

Farm workers are vulnerable working populations who face significant inequalities in accessing health services, including those for human immunodeficiency virus (HIV) prevention, treatment and care. This descriptive phenomenological study aimed to explore farm workers' experiences when accessing HIV services and was conducted in Limpopo province, South Africa. Eighteen in-depth interviews were conducted in four health facilities from two districts, and two focus group discussions were conducted in one of the farms within the province. Purposive sampling and systematic random sampling were used to select study participants. A deductive thematic approach was used to analyse data, informed by the social-ecological model of health. The results reveal that farm workers perceive multiple interdependent factors that inhibit or enable their access to HIV healthcare services. Key barriers to HIV healthcare were transport affordability, health worker attitudes, stigma and discrimination, models of HIV healthcare delivery, geographic location of health facilities and difficult working conditions. Key facilitators to HIV healthcare included the availability of mobile health services, the presence of community health workers and a supportive work environment. The findings suggest disparities in farm workers' access to HIV services, with work being the main determinant of access. We, therefore, recommend a review of HIV policies and programmes for the agricultural sector and models of HIV healthcare delivery that address the unique needs of farm workers.

A realist review is a theory-driven approach to synthesizing evidence based on the realist philosophy of science. Realist reviews are conducted to provide the policy and practice community with a rich, detailed and practical understanding of complex social interventions that will likely be of much more use to them when planning and implementing programmes. Robust realist reviews must balance philosophical engagement, methodological rigour and relevance to practice. Nevertheless, they have been criticized for being more philosophically inclined and less methodologically robust, with findings that have little implication for practice. Using the philosophy/epistemology➔ methodology➔ theory➔ practice concept flow, we report how we balanced philosophical principles and practical insights in a recently conducted realist review on participatory practices that impact the benefits of non-communicable disease research and interventions in low- and middle-income countries. If realist reviews are not comprehensible enough for these practitioners, their utility and relevance may suffer from being limited to a specialist cohort of academics. We propose that realist review findings and outputs must be framed and communicated to meaningfully engage practitioners without undertaking translational efforts.

New vaccine policy adoption is a complex process, especially in low-and-middle-income countries, requiring country policymakers to navigate challenges such as competing priorities, human and financial resource constraints, and limited logistical capacity. Since the beginning of the Expanded Programme on Immunization, most new vaccine introductions under this structure have not been aimed at adult populations. The majority of adult vaccines offered under the Expanded Programme on Immunization are not typically tested among and tailored for pregnant persons, except those that are specifically recommended for pregnancy. Given that new maternal vaccines, including respiratory syncytial virus and group B streptococcus vaccines, are on the horizon, it is important to understand what barriers may arise during the policy development and vaccine introduction process. In this study, we sought to understand information needs among maternal immunization policymakers and decision-makers in Kenya for new vaccine maternal policy adoption through in-depth interviews with 20 participants in Nakuru and Mombasa, counties in Kenya. Results were mapped to an adapted version of an established framework focused on new vaccine introduction in low-and-middle-income countries. Participants reported that the policy process for new maternal vaccine introduction requires substantial evidence as well as coordination among diverse stakeholders. Importantly, our findings suggest that the process for new maternal vaccines does not end with the adoption of a new policy, as intended recipients and various actors can determine the success of a vaccine programme. Previous shortcomings, in Kenya, and globally during human papillomavirus vaccine introduction, show the need to allocate adequate resources in education of communities given the sensitive target group. With maternal vaccines targeting a sensitive group-pregnant persons-in the pipeline, it is an opportune time to understand how to ensure successful vaccine introduction with optimal acceptance and uptake, while also addressing vaccine hesitancy to increase population benefit.

Effective leadership and management has been identified as critical in enabling health systems to respond adequately to their population needs. The changing nature of low- and middle-income countries' health systems, given resource scarcity, a high disease burden and other contextual challenges, has also led to learning-including workplace-based learning (WPBL)-being recognized as a key process supporting health system reform and transformation. This review used a framework synthesis approach in addressing the question: 'What forms of WPBL, support leadership and management development; and how does such learning impact district health leadership and management strengthening?'. A search for English language empirical qualitative, mixed-methods and quantitative studies and grey literature published from January 1990 to May 2024 was conducted using four electronic databases (PubMed, EBSCOhost, Scopus and Web of Science). Twenty-five articles were included in the synthesis. The findings reveal that over the last decade, WPBL has received consideration as an approach for leadership and management development. While WPBL interventions differed in type and nature, as well as length of delivery, there was no conclusive evidence about which approach had a greater influence than others on strengthening district health leadership and management. However, the synthesis demonstrates the need for a focus on the sustainability and institutionalization of interventions, including the need to integrate WPBL interventions in health systems. To support sustainability and institutionalization, there should be flexibility in the design and delivery of such interventions and they are best supported through national or regional institutions.

Health system resilience refers to the capacity of a health system to effectively anticipate, assimilate, adjust to and recuperate from unforeseen disruptions and pressures. Evidence indicates that low- and middle-income countries (LMICs) have a double burden of dealing with the existing shortage of health resources in managing both non-emergency care and emergency care during epidemics. Intersectoral collaboration plays a pivotal role in managing crises such as pandemics. The World Health Organization has emphasized that effective intersectoral collaboration is vital for uninterrupted essential services during a pandemic. The study aimed to look at the collaborations entered into at various levels for managing the COVID-19 pandemic, taking as an example the municipal corporation in Ahmedabad, India. We undertook a qualitative study that involved conducting 52 in-depth interviews with officials from the health department, and other departments at the Ahmedabad Municipal Corporation (AMC), including firefighting, estate, engineering and education, as well as private stakeholders. Many diverse observations were documented in this study as collaboration varied across the sectors. A lack of hospital beds and shortage of essential drugs and oxygen posed challenges for healthcare providers and provided an opportunity to collaborate with private stakeholders. Mandatory COVID testing and mobile units such as the Sanjivani van and Vadil ghar seva were examples of some of the initiatives taken by the AMC to manage the pandemic that were instigated and implemented with support from various departments such as education, engineering, tax, estate, animal husbandry and firefighting. Proper communication between public and private entities will result in unfragmented efforts to combat emergencies. Thus, a resilient health system is necessary as well as systematic intersectoral collaboration to ensure the uninterrupted delivery of essential health services during health emergencies.

India's healthcare landscape is characterized by a multitude of public and private healthcare providers, yet its health systems remain weak in many areas. Informal healthcare providers (IHPs) bridge this gap, particularly in rural India, and are deeply embedded within local communities. While their importance is widely recognized, there is a knowledge gap regarding the specifics of their social networks with actors in health systems. The aim of this study was to map the social networks of IHPs to elucidate the type and nature of their relationships, in order to explore opportunities for intersectoral collaboration to achieve universal health coverage (UHC). We have adopted the social network analysis (SNA) approach using qualitative ego-network methodology to evaluate the types and strengths of ties in the Indian Sundarbans. A total of 34 IHPs participated in the study. Qualitative data were analysed using NVivo10 and Kumu.io was used to visualize the social networks. Results show that the 34 IHPs had a total of 1362 ties with diverse actors, spanning the government, private sector and community. The majority of the ties were strong, with various motivating factors underpinning the relationships. Most of these ties were active and have continued for over a decade. The robust presence of IHPs in the Indian Sundarbans is attributable to the numerous, strong and often mutually beneficial ties. The findings suggest a need to reconsider the engagement of IHPs within formal health systems. Rather than isolation, a nuanced approach is required based on intersectoral collaboration capitalizing on these social ties with other actors to achieve UHC in impoverished and underserved regions globally.

Policy engagement is an essential component of implementation research for scaling up interventions targeting non-communicable diseases (NCDs). It refers to the many ways that research team members, implementers and policymakers, who represent government decision-making, connect and interact to explore common interests. Well-conducted engagement activities foster co-production, local contextualization and assist in the successful translation of research evidence into policy and practice. We aimed to identify the challenges and facilitators to policy engagement during the early implementation phase of scale-up research studies. This qualitative study was focused on the research projects that were funded through the Global Alliance for Chronic Diseases in the 2019 round. Nineteen project teams opted to participate, with these studies implemented in 20 countries. Forty-three semi-structured stakeholder interviews, representing research, implementation and government were undertaken between August 2020 and July 2021. Transcripts were open-coded using thematic analysis to extract 63 codes which generated 15 themes reflecting both challenges and facilitators to undertaking policy engagement. Knowledge of the local government structures and trusting relationships provided the foundation for successful engagement and were strengthened by the research. Four cross-cutting concepts for engagement were identified and included: (1) the importance of understanding the policy landscape; (2) facilitating a network of suitable policy champions, (3) providing an environment for policy leaders to genuinely contribute to co-creation and (4) promoting two-way learning during researcher-policymaker engagement. We recommend undertaking formative policy analysis to gain a strategic understanding of the policy landscape and develop targeted engagement plans. Through engagement, researchers must facilitate cohesive vision and build a team of policy champions to advocate NCD research within their networks and spheres of influence. Ensuring equitable partnerships is essential for enabling local ownership and leadership. Further, engagement efforts must create a synergistic policymaker-researcher lens to promote the uptake of evidence into policy.