Health policy and planning最新文献

There is a growing need for healthcare professionals to ensure that their practices are inclusive and that they are considerate of the needs of marginalized communities. Inclusion health (IH) seeks to correct the imbalances that result in health inequities and requires health practitioners to have an adequate understanding and knowledge of the needs of marginalized and vulnerable population groups. The aim of this systematic review was to synthesize and critically appraise evidence from studies that explored healthcare professionals' knowledge and/or awareness of IH. Academic Search Complete, CINAHL Plus with Full Text, MEDLINE, APA PsycArticles, APA PsycInfo, and SocINDEX were systematically searched without any year or language limits. The last search was conducted on 16 December 2024. A total of 4870 studies were identified, of which 37 were included (21 qualitative studies, 7 quantitative studies, 6 mixed-methods studies, 2 cross-sectional studies, and 1 quasi-experimental study). The methodological quality of the studies was appraised. Most studies were from the USA and Australia and focused on IH knowledge regarding members of the lesbian, gay, bisexual, trans, and queer community, people with disabilities, and culturally diverse populations. Studies examining healthcare professionals' knowledge and awareness were not homogenous in nature resulting in a wide variety of studies and types of data. Different minority groups require varied levels of insight and understanding from their healthcare professionals. There is therefore no one-size-fits-all solution. We recommend targeted interventions throughout the training and education of healthcare professionals, informed and designed by the participation of members of those marginalized communities.

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.

The shortage and uneven distribution of primary healthcare workers in rural China have long persisted, with many studies focusing predominantly on salary and working conditions improvement. A discrete choice experiment involving 183 rural primary healthcare workers in Sichuan Province revealed the critical role of Bianzhi (a state-controlled employment system) in workforce retention. Findings demonstrated that Bianzhi dominated job preferences (β=0.964), with practitioners willing to sacrifice 18.2% of their monthly income to exchange for it. Beyond Bianzhi, near location, housing allowances, opportunities for continuing education, and children's education support significantly influenced job choices. Female workers exhibited 1.189 times greater sensitivity to workplace proximity than males (P < 0.001), while those with school-age children required 12.64% additional compensation for remote postings. Policy simulations indicated that combining Bianzhi with children's education support outperformed salary incentives alone. The study advocates optimizing rural healthcare workforce strategies by narrowing the gap between Bianzhi and non-Bianzhi positions, complemented by gender-sensitive and family-friendly measures. For other LMICs, it highlights the importance of understanding the true needs of health workers with different employment statuses.

Recent evidence indicates that budget space for health can be improved through increasing government revenues, expanding the budget's health share, and improving expenditure efficiency through enhancing public financial management (PFM), with government revenue mobilization being the most substantial. Government revenue mobilization can be achieved by broadening the tax base, a key component of which is the rationalization of tax expenditures. Tax expenditures are preferential tax treatments, relative to a baseline tax regime, intended to achieve specific objectives by providing financial support to specific beneficiaries. They may, however, result in huge revenue losses, which could be otherwise invested in priority sectors, including health. In addition, tax expenditures ultimately exacerbate inequality, while also creating complexities that foster tax avoidance and evasion, all of which contribute to deteriorating health outcomes. In the context of scarce public finances in low- and middle-income countries, rationalizing tax expenditures can create the necessary fiscal space for development. This paper provides a first comprehensive analysis of the 'health costs' of tax expenditures by analysing the relationship between tax expenditures and health outcomes, with a focus on under-five and maternal mortality. Using data from 55 developing countries from 2000 to 2022, we find that an increase in tax expenditures leads to higher under-five and maternal mortality, especially in low-income countries. The results are robust to several instrumental variable strategies, alternative measures of tax expenditures, and alternative methods. We also find that PFM, through the quality of public administration, transparency in the public sector, and the efficiency of revenue mobilization, mitigates the corrosive effects of tax expenditures. A key implication of our findings is that understanding the 'health costs' of tax expenditures is a necessary precursor to eliminating wasteful tax expenditures, the benefits of which can contribute to expanding the budget space for health and improving health outcomes.

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.

Distributed leadership has been proposed to offer value for health systems-by enabling people to work towards collective goals within settings such as hospitals. Yet, there is still limited empirical exploration of its dynamics in practice, especially in low- and middle-income contexts. To address this knowledge gap, this case study draws on conceptual work in empirically examining leadership in one district hospital in the Western Cape province, South Africa, seeking to identify evidence of distributed leadership and the factors influencing its emergence. Data were extracted from 28 academic theses, policies and strategic documents relating to health leadership, management and governance in the provincial health system (Phase 1) and 12 semi-structured, in-person interviews were conducted with hospital personnel (Phase 2). Phase 1 data provided the context of the case and guided the collection of data in Phase 2. All data were thematically analysed. The analysis reveals that there were pockets of distributed leadership within the hospital, as characterized by chains of multiple leaders working together to co-create shared meaning, take collective decisions and achieve common goals, enabled by relational leadership practices. These pockets supported both routine service delivery and bottom-up service improvement action. However, the unequal distribution of decision-making power, in the context of bureaucratic and professional hierarchies, limited the widespread emergence of distributed leadership. The case study suggests that distributed leadership can emerge in district hospitals with positive consequences for health service delivery, but that efforts to nurture its emergence should both bolster the leadership capabilities of individual leaders and address the bureaucratic and professional hierarchies that characterize the context within which hospital leadership unfolds. To aid the future practice of, and research about, distributed leadership the paper proposes a comprehensive definition of the concept, derived from the combination of wider literature and this study's empirical findings.

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 and significant cuts to global health assistance. 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 actor: multilateral and global health organizations, country governments, donors and international finance institutions, and civil society organizations. It reveals important insights into 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 to be well underway. It further contends that strengthening coherence between GHS and UHC not only depends on, but also enhances, three key imperatives: (i) overcoming geopolitical power asymmetries, (ii) leveraging strategic collaboration across actor types, and (iii) pursuing integrative health diplomacy amid overlapping crises. While this study centres 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.

Addressing men's own specific health concerns in the context of sexual and reproductive health (SRH) remains a largely neglected topic, despite growing levels of unmet SRH needs among men and the broader benefits of engaging men in the SRH of women and others. A comprehensive policy analysis explored how men are currently addressed and characterized within 37 key global and regional SRH-focused policies. Men's own SRH was found to be a significantly neglected policy issue. Less than half (43%) of the policies provided reference to men's SRH, and only 16% purposefully outlined steps to address men's own SRH needs. This contrasted with 78% of policies addressing women's SRH. Policies rarely provided sex disaggregated data nor targets on men's SRH outcomes. The inclusion of men was typically for solely instrumental reasons-in order to improve women's SRH. Men's SRH was best addressed within language on HIV and sexuality transmitted infections (STIs), particularly for men who have sex with men. Policy coverage was poor on men's SRH needs and roles in relation to contraception, fertility, sexual dysfunction, reproductive cancers, sexual pleasure, healthy relationships. and SRH-related discrimination. Only a quarter (24%) of the policies included a focus on one or more vulnerable male sub-group, with inadequate policy attention to the specific SRH needs of older men, disabled men, men living with serious health conditions, transgender people, and heterosexual men. An absence of focus on men's distinct SRH needs, alongside that of women, limits global understanding and visibility of SRH challenges particular to men, impeding the formulation of policies, programs, and funding priorities that sufficiently address men's needs. It also reinforces SRH as a women's sole burden and entrenches gender inequalities. Health policies should prioritize men's increased access to SRH information and care and better frame SRH as a critical part of men's lives.

The global health landscape is undergoing a significant transformation as traditional frameworks of cooperation face fragmentation amid geopolitical tensions. Declining support from Western nations, exemplified by US withdrawal from the World Health Organization and cuts to programs like the President's Emergency Plan for AIDS Relief, has exposed the profound instability of an aid architecture built on colonial dependencies. The COVID-19 pandemic, marked by vaccine nationalism, was a stark litmus test of this systemic failure for low- and middle-income countries (LMICs). This commentary argues that the current geopolitical fragmentation, while a crisis, also presents a critical opportunity to dismantle colonial legacies and reimagine global health equity not as a donor-driven ideal, but as a practice of shared power and sovereignty. We first document the rise of alternative pathways, critically examining China's health diplomacy and India's pharmaceutical disruption, while highlighting robust, LMIC-led initiatives like the African Medicines Agency and local mRNA vaccine production in Rwanda and Thailand. In response to the fractured status quo, we then propose a new global health compact built on four interdependent pillars: (i) Epistemic Justice, valuing local knowledge systems; (ii) Structural Audacity in Financing, such as taxing multinational corporations for reparative funding; (iii) Governance for Agency, ceding decisive power to LMICs; and (iv) Open Knowledge and Innovation, by dismantling restrictive intellectual property regimes. Achieving this decolonized future requires concrete action from all stakeholders. We conclude with a blueprint urging high-income countries to cede power, LMICs to invest in local capacity, funders to provide untied financing, and researchers to practise equitable collaboration. This actionable agenda is the foundation for a truly equitable global health system capable of achieving Universal Health Coverage.

Intervention evaluation is critical for determining the value of health interventions; however, real-world implementation frequently falls short of achieving anticipated large-scale impacts. This evidence-to-practice gap often arises from challenges in capturing the complexity inherent in intervention implementation. This complexity may stem from the intervention itself, the dynamic and interrelated processes of dissemination, implementation, and sustainment, or the constraints of real-world settings characterized by interconnected systems. Integrating implementation science, which employs theories, models, and frameworks to understand the adoption and integration of evidence-based interventions, with systems science, which provides tools to model and analyze complex systems, offers a promising pathway for addressing these challenges. However, practical guidance on combining these approaches to evaluate dynamic interactions between interventions and implementation contexts, while simultaneously capturing system-level learnings, remains limited. In this methodological musing, we reflect on our experience integrating systems and implementation science to develop a conceptual and quantitative model for scenario evaluation of a maternal health service delivery redesign initiative in Kakamega, Kenya. We use four research objectives as a touchstone for organizing our reflections, explicated by three steps of an evaluation process: (i) developing a qualitative systems model using implementation frameworks and causal loop diagrams; (ii) constructing and parameterizing a quantitative computational model; and (iii) conducting scenario analyses to explore "what-if" strategies and inform adaptive planning. These reflections highlight the potential strengths of an integrated approach and offer practical considerations for researchers and practitioners evaluating complex health interventions through quantitative modeling and scenario development.