Health policy and planning最新文献

Primary healthcare provider networks (PHCPNs) are increasingly recognized as promising strategies to effectively strengthen health systems in low- and middle-income countries (LMICs). However, there is limited information on the influence PHCPNs may have on the process and clinical outcomes of health services. This study sought to answer the questions: what is the extent, range and nature of research on PHCPNs in LMICs, what are the types of PHCPNs described, and what are the processes e.g. access to care, coverage of health services, quality of care and services, safety of care and the clinical care outcomes of PHCPNs reported in the published literature? We report on a systematic mixed-methods review on PHCPNs as a strategy to strengthen health systems in LMICs following the PRISMA guidelines. The quality of the included studies was assessed using the ROBINS-I and Mixed Methods Appraisal tools, while a narrative synthesis was employed to describe the results. Fifteen primary studies were found eligible for the review. From the included papers, eight types of PHCPNs were identified across various contexts and countries. We found that the PHCPNs primarily focus on maternal, newborn, and child health outcomes. The study reveals that: (1) PHCPNs contribute to improvements in the process outcomes of health services by enhancing access to care, coverage of health services, quality of care and services, and safety of care, and (2) they support improvements in clinical outcomes by helping to reduce maternal, neonatal, and perinatal mortalities and stillbirths. This body of literature we reviewed suggests that PHCPNs make a difference in the process and clinical outcomes of health services in LMICs. This review serves as both a mapping and clarification exercise to promote the adoption of PHCPNs and as a foundation for further research, especially in areas of health services beyond maternal, newborn, and child health.

India's second wave of the COVID-19 pandemic in April-June 2021 involved an explosion of case numbers, with devastating consequences for the country's already strained health systems. This case study examines the private health market response to the pandemic in Uttar Pradesh, India's most populous state. We analyzed 203 news articles to understand both the experiences of private providers and patients in response to government policies being implemented in the state. This analysis informed our interviews with 20 state-level officials, district-level key informants, and formal and informal private-for-profit providers across 3 districts. We found that private sector hospitals were rapidly engaged to manage a surge in new infections and severe cases, but private bed capacity quickly filled, causing patients to be turned away. Informal private providers played a vital role in rural areas, serving as round-the-clock care sources. However, the news media reported inadequate medical care from such providers leading to COVID-19-related deaths. Access to reliable information on COVID-19 was challenging and social media became a platform for citizens and providers to share information about available resources, treatment, and COVID-19 management. However, misinformation also spread. While the government attempted to counter misinformation and regulate private hospitals, challenges persisted in providing and accessing accurate information. Oxygen and drug supply challenges also emerged, with private hospitals requiring patients to arrange oxygen due to scarcity. To address this and rising costs of care, the government issued price caps, monitored overcharging, and regulated drug and oxygen distribution. Government schemes also attempted to provide insurance for both public and private health workers, however, awareness and implementation of such schemes were inadequate. Policymakers should develop mechanisms to engage, or where relevant, integrate all private-for profit providers onto a common platform, strengthen referral linkages amongst them, and support communities of practice to increase awareness of government health policies and improve the implementation of government schemes. All together, these measures would help facilitate equitable access to care and help manage current health needs and future health emergencies.

Community pharmacies are increasingly recognised as access points for public health interventions (PHIs) such as vaccination, family planning services and disease screening. In Kenya, evidence suggests feasibility of pharmacy delivered PHIs, however, the uptake remains inconsistent. This is partly attributed to poor program design without taking pharmacy providers preferences into consideration. We employed a discrete choice experiment (DCE) to investigate community pharmacists preferences for attributes of PHIs delivered in community pharmacies in Kenya. We constructed a Bayesian efficient design and conducted a DCE survey among 663 community pharmacy providers in Makueni, Nairobi and Kisumu counties in Kenya from January 2025 to March 2025. Panel multinomial mixed logit, generalised multinomial logit and latent class models were used in the analysis. We also estimated willingness to pay (WTP) and willingness to accept (WTA) estimates using cost and profit margins as the monetary estimates respectively. We found that community pharmacists were willing to offer PHIs with a low preference for opting out (β=-3.5723, P<0.01). Preferences for PHIs significantly increased with higher profit margins (β=0.028, P<0.01) and decreased with higher cost of equipment (β= -0.00023, P<0.01). There were higher preferences for PHIs that require moderate training (β=0.266, P<0.01) and extensive training (β=0.141, P<0.05) compared to no additional training; and lower preferences for PHIs with complex interventions compared to simple interventions (β=-0.323, P<0.01). The WTP estimates showed that providers were willing to pay Khs. 11,738 (USD 90) for moderate training and Kshs. 7,327 (USD 56) for extensive training. Moreover, the WTA estimates showed that providers were willing to accept a 10.9% increase in profit margin in order to deliver complex interventions. In addition to this, a three-class latent class model revealed preference heterogeneity among the respondents. These findings can be used to inform the design of PHIs to enhance uptake and acceptability among providers.

Implementing evidence-based alcohol policies can reduce the negative impact of alcohol consumption on public health. However, Brazil has permissive alcohol policies and weakly adheres to World Health Organization's recommendations as the 'best buys'. To explore stakeholders' perceptions of alcohol policy needs and barriers in Brazil, we conducted semi-structured interviews with 31 stakeholders, including 15 from civil society and 16 policymakers. Civil society participants included non-governmental organization leaders addressing alcohol-related issues, while policymakers comprised civil servants and politicians experienced in alcohol-related harms. Interviews were transcribed verbatim and thematically analyzed using a deductive approach guided by research questions and an inductive approach to identify emergent themes. Most participants supported World Health Organization-recommended 'best buy' policies regulating alcohol's marketing. However, agreement on price and availability control was not unanimous. All participants acknowledged significant political barriers to adopting these policies, including intentional delays in parliamentary voting, industry lobbying, and arguments about infringing on rights such as freedom. Facing obstacles to advancing population-level policies, stakeholders often shifted their focus to individual-level interventions, such as education and treatment. While these were recognized as less effective, educational efforts were highlighted for raising public awareness of alcohol's harms and changing normative beliefs. Participants noted the lack of a formal coalition to reduce alcohol-related harm, despite its perceived necessity. Overall, stakeholders supported population-level alcohol policies but were pessimistic about their implementation due to political barriers. Many, particularly from civil society, emphasized small-scale, targeted interventions as a more feasible alternative to address alcohol-related harm in Brazil.

The Maternal and Newborn Health (MNH) Service Delivery Redesign (SDR) in Kakamega County, Kenya, represents the country's first system-level reorganization of MNH services. The reform aimed to improve care quality and reduce mortality by centralizing delivery care at designated hubs. Using a political economy lens, we examined how ideology, political dynamics, and institutional structures shaped the agenda-setting, adoption, implementation, and sustainability of SDR. We drew on data from document reviews, stakeholder analysis, semi-structured interviews, and non-participant observation to assess the structural, contextual, and institutional factors influencing the reform. Ambiguity around SDR's purpose contributed to the community's uncertain engagement characterized by neither full endorsement nor resistance, highlighting the need for clearer communication and participation to build ownership. The interaction between formal institutions (county health governance and partnership frameworks) and informal norms (trust, shared interpretation, and relational coordination) created early momentum for implementation, particularly among health system actors. However, limited financial capacity and unclear alignment with national policy priorities undermined progress and long-term viability. Kakamega's experience demonstrates how political incentives, devolved autonomy, and local institutional context jointly shape reform outcomes. Achieving successful implementation of system level reforms requires integrating local political leadership, strengthening community engagement, aligning with evolving national policies, and securing predictable financing. This study provides practical lessons for future MNH and system-level reforms in Kenya and similar decentralized, resource-constrained settings. Lessons include the importance of balancing formal and informal institutions to ensure both political feasibility and enduring impact.

Gender-based violence (GBV) is a major public health issue, further intensified in humanitarian crises. In Ethiopia's northern conflict (2021-ongoing), the scale of GBV underscores the urgent need for context-sensitive policy and service delivery. We conducted a policy analysis of national GBV-related policies within the context of the Northern Ethiopia conflict. This was complemented by nine focus group discussions with relevant stakeholders; community representatives and ten key informant interviews with key policy makers at sub-national and national levels. Data were analyzed thematically using the Health Policy Triangle framework. No reviewed policies were contextualized for humanitarian emergencies or inclusive of all GBV forms. Most focused exclusively on sexual violence against women, overlooking other GBV types and male survivors. Policy development was largely top-down, involving government bodies and international actors, with minimal input from frontline providers or affected communities. There was also a lack of consensus on which policies are being implemented, driven by poor dissemination, resource constraints, limited prevalence data, and weak coordination. Ethiopia lacks a government-led, humanitarian-specific GBV policy. This hinders a coordinated health response. Strengthening community participation in policy formulation, ensuring inclusive and context-relevant policy content, improving coordination among all governmental and non governmental GBV actors, and addressing funding gaps are critical for effective GBV response in humanitarian settings.

In recent years, low- and middle-income countries (LMICs) have received substantial amounts of Official Development Assistance for Health (DAH) to address domestic health funding gaps and improve access to universal healthcare. However, the effectiveness of DAH in improving health outcomes remains contested, with varying findings across studies due to differences in methodologies, data sources, and target populations. This systematic review synthesises the existing evidence on the impact of DAH on health outcomes in LMICs, highlighting both the positive and negative effects, and identifying key mechanisms through which aid influences health. A total of 61 studies were included in the review, with a primary focus on maternal and child health outcomes. Despite methodological differences, the weight of evidence indicates a generally positive impact of DAH, particularly in countries with higher governance standards and better economic conditions. Our findings underscore the importance of contextual factors, such as governance and proximity to aid-funded projects, in shaping the effectiveness of health aid. To maximise the impact of DAH, policymakers need to strengthen donor coordination, align aid with national health priorities, and reinforce domestic health systems. Future research should focus on refining causal inference methods and exploring innovative aid-delivery mechanisms to sustain long-term health improvements.

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.