Health policy and planning最新文献

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.

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.

This innovation and practice report examines the achievements and challenges of the development and implementation of two policies guiding climate adaptation and mitigation action in Thailand's healthcare system, namely (i) The GREEN and CLEAN hospitals policy and (ii) The Health National Adaptation Plan. Based on key informant interviews and focus groups it was found that at the government level adaptation and mitigation planning was well developed. However, adaptation planning could be strengthened at the organizational level. Social values such as strong leadership and a sense of shared ownership significantly influenced initiative outcomes. Sub-district public health officials also served as crucial intermediaries between the government and local communities however, strengthening the coupling of environmental monitoring data with health impact analysis could further policy progression in the adaptation space. Participants also highlighted the need for increased funding, improved training, and greater knowledge sharing. Other healthcare systems could learn much from Thailand's approach to tackling climate change and health, particularly in the benefits of a detailed health-focused national mitigation and adaptation policy; establishment of local public health units; encouraging a sense of shared ownership; and, conceptualizing environmental sustainability as core to healthcare.

Many low- and middle-income countries are affected by catastrophic health expenditures due to overstretched public health financing, indicating need for complementary inclusive health insurance solutions. Promoting these solutions requires understanding drivers, including psychological determinants, of health insurance purchase. Yet, relevant evidence is lacking. We employed hybrid choice models to analyze discrete choice experiment data and examine preferences for Huimin Insurance, a widely diffused complementary inclusive health insurance in China. We relied on KuRunData to collect our discrete choice experiment data. We found that people who regarded themselves to be at greater health risk preferred more generous benefits, while they did not value strong government involvement in product operation, design, and publicity. Higher scheme awareness was associated with a greater propensity to purchase coverage, to be willing to pay higher premium, and to accept lower reimbursement rates. High awareness coupled with a low perception of the scheme value resulted in a preference for an expanded package covering prevention and screening services. Stronger value was attributed to the Huimin Insurance among population groups that lack access to other insurance products, such as women and rural residents. By integrating psychological constructs in the decision-making analysis, we provide new evidence to guide design and promotion of appropriate health insurance schemes, especially catastrophic diseases.

International research partnerships are crucial to strengthening research capacity (RCS) efforts. However, little is known about how such partnerships work to enhance the capacity of postgraduate trainees. We applied an Indigenous realist evaluation (RE) approach to examine how the 'African Research Initiative for Scientific Excellence' (ARISE) programme works to strengthen the capacity for trainees. The Indigenous RE integrates critical and scientific realism paradigms with the Postcolonial Indigenous paradigm, focusing strongly on power, relationality, and decolonization. We used a multi-case study design to investigate two cases of innovation- and laboratory-based research projects led by African principal investigators (PIs). We conducted realist-informed interviews and observations with PIs, interviews with collaborators and partners, and storytelling with students. Realist thematic analysis helped to identify context, intervention, mechanism, and outcomes (CIMO). Deductive, inductive, abductive, and retroductive reasoning were applied to generate programme theories through an iterative and rigorous theory-building process. Findings show that trainees who are committed and self-driven, based in a research-intensive university that provides complementary opportunities and where there is demand for multidisciplinary research, will improve their skills, secure additional funding, and transition from master's to PhD programmes. This is because the RCS resources would inspire, challenge, empower, activate a sense of agency, and provide the trainees with eye-opening experiences. However, trainees would secure jobs outside Africa (brain drain) if career opportunities in specialized fields are limited locally. If trainees are junior faculty staff and fully funded, and their university provides protected time, RCS resources would inspire, motivate, and empower them, resulting in increased research outputs and career growth. RCS efforts targeting (post)graduate trainees need to consider 'inter alia' the university contexts (e.g. availability of complementary resources and protected time), the individual traits and readiness for postgraduate training, and the broader ecosystem, which determines if the trainees' skills benefit Africa's research and development.