Health policy and planning最新文献

Literature suggests that individuals may trade off health for income in face of an economic shock. Being in a close contact profession, the livelihoods of sex workers were severely affected by the COVID-19 pandemic. Few studies exist on whether prevalence of better-renumerated condomless sex increased among this population in low and middle-income countries and discuss its implications on HIV/STI transmission, specifically during pandemic situations. We reported cross-sectional condom use prevalence estimates of 600 female sex workers in Dakar, Senegal from data collected before (2015, 2017) and during the pandemic (June-July 2020). Condom use prevalence was elicited via list experiments for more truthful estimates. Double list experiment estimates of mean condom use prevalence declined from 78.2% (95% CI: 70.9-85.5%) in 2017 to 65.1% (95% CI: 57.6-72.7%) in 2020. This statistically significant decrease of 13.1 percentage points (P = .014) represents a 16.8% fall in condom use and a 60.2% increase in condomless sex prevalence. The fall in condom use prevalence was largely concentrated amongst the asset-poor, providing some suggestive evidence that economic reasons drove the fall in condom use, reinforcing findings in existing literature regarding the positive relationship between economic shocks and risky sexual behaviours. At the point of the survey, the observed decline in client numbers exceeded the reduction in condom use prevalence, suggesting potential mitigation of HIV/STI transmission risks during the COVID-19 pandemic; nevertheless, the lack of direct comparability between these two metrics warrants cautious interpretation. However, more accurate epidemiological modelling considering the non-sex worker population and longer-term studies on whether condom use prevalence returned to pre-COVID levels after client numbers recovered are required for a comprehensive assessment of the pandemic's short-term and longer-term impact on HIV/STI transmission.

Households with ill members often face financial hardship when seeking healthcare. Households mobilize their resources from various sources to pay for treatment costs. Financially, some households resort to borrowing money and selling their assets. This type of financial coping strategy is called distress financing (DF). This study aims to estimate the prevalence and determinants of DF among households with hospitalized members at University Malaya Medical Centre, Malaysia. It further explores the dynamics of DF and its impact on households' welfare by employing a convergent mixed-method approach. Quantitative data were collected using a structured interview. Households having reported to either borrow money, sell their assets, and/or withdraw from an employee provident fund were categorized as those suffering DF. To explore how households coped with high medical expenses and the consequences of DF, seven households adopting more than one DF strategy were purposively selected for in-depth interview. Of 199 households, 22 (11.1%) reported undergoing DF. Psychological distress, medical indebtedness, and poverty were typical consequences of DF. During hardship, the social network played a principal role in alleviating the financial burden, further emphasizing the importance of kinship. Households undergoing catastrophic health expenditure, headed by Chinese ethnicity, living in states other than Selangor, and living in a rental house were 8.2, 4.6, 4.4, and 3.5 times more likely to undergo DF, respectively. Targeted assistance in removing financial barriers would assure the continuum of care among households possibly suffering DF, thereby improving their health outcomes.

While health is a fundamental right, health inequities between urban and rural residents remain significant in China. Medical consortia aim to bridge this gap by providing equitable and affordable healthcare. However, their effectiveness in enhancing health equity remains underexplored. This study aims to explore whether medical consortia have mitigated health inequity between urban and rural residents. We employed propensity score matching to mitigate selection bias among 9918 electronic medical records. We focused on two key areas: the effectiveness of medical consortia in reducing healthcare burdens and their influence on health equity, as indicated by the disparities in medical expenses between urban and rural residents. To obtain more detailed insights, we segmented medical expenses into low, medium, and high categories for both urban and rural residents and examined how medical consortia differentially affect health equity across these segments. Moreover, we evaluated whether the differences in referral effects on medical expenses between urban and rural residents can be explained by their varying disease structures and age distributions. We found that medical consortia can significantly reduce the medical burden on populations, but have limitations in improving health equity. The findings highlight a substantial reduction in medical expenses for urban populations. However, no significant reduction was observed in rural populations, with the low-medical-expense group experiencing an increased healthcare burden following the implementation of medical consortia. These findings are robust across various matching methods. Despite reducing healthcare burdens, medical consortia have not equalized health outcomes between urban and rural residents. Significant differences in the disease and age structures exist between urban and rural residents, which may account for the differing causal effects observed between them. Policymakers must prioritize health equity in healthcare reform and consider targeted interventions to address the distinct healthcare challenges of different socioeconomic groups.

China has long struggled with high medical costs and irrational drug pricing but has recently made significant progress by implementing drug negotiation strategies to effectively reduce the prices of targeted drugs. To accurately depict drug prices on a global scale, a cross-sectional time-series analysis was conducted in China using Multinational Integrated Data Analysis System data from the first quarter of 2017 to the fourth quarter of 2022. This analysis compared the prices of 140 price-negotiated innovative drugs across 15 countries using five distinct price indices-Average Price Index, Laspeyres, Paasche, Fisher, and Chained Laspeyres-aiming to address gaps in understanding China's negotiated drug prices globally. The five drug price index (DPI) showed general consistency and revealed significant variations in drug prices across countries. China's drug pricing reforms have successfully reduced drug costs and alleviated the financial burden on patients, offering insights for other developing countries. Drug price indices serve as valuable tools for monitoring prices and promoting transparency, while using PPPs may better reflect actual affordability and provide a more reasonable assessment.

Alcohol consumption poses significant public health challenges globally, with low- and middle-income countries (LMICs) experiencing a substantial burden from alcohol-related harm. However, the effectiveness of interventions to control alcohol consumption in LMICs remains understudied. This paper aims to investigate the effectiveness of alcohol regulatory interventions adopted in LMICs. A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science was conducted on 10 August 2024. The search strategy included terms related to regulatory interventions and their impact on alcohol consumption, health, and other related outcomes. Risk of bias was assessed using the National Institutes of Health, Cochrane Effective Practice and Organization of Care checklist, ISPOR-SDMD checklist, and CASP quality assessment tools, and a narrative synthesis was performed to summarize the review findings. Of the 169 full texts screened, 62 studies were included in this review. Most of the studies were conducted in upper-middle-income countries (n = 48, 77%), seven were from lower-middle-income countries, one from a low-income country, and others were combinations of the above. Sixty per cent of the included studies were of good quality. In terms of World Health Organization alcohol policy domains, 18 studies focused on restriction of physical availability, 11 on pricing, 1 on marketing, 21 on drink driving, and 11 on a combination of all policy domains. Alcohol consumption-related outcomes were reported in 26 studies, while health and other outcomes were reported in 25 and 14 studies, respectively. Restrictions on physical availability of alcohol were largely effective across all outcomes, while the pricing policy domain consistently demonstrated effectiveness in reducing alcohol consumption. The scarce evidence on marketing policy interventions was inconclusive; interventions targeting drink driving showed beneficial effects. The available evidence suggests that alcohol control policies are largely effective in LMICs. Further regular and statutory enforcement of these interventions is likely to improve their effectiveness.

The presence, absence, or effectiveness of policy entrepreneurs is often invoked as an explanation for the state of health policy making, especially in the global South. However, much remains under-analyzed about their structure and function. This qualitative study aims to understand how policy entrepreneurs influence policy change in the global South. We complemented a review of the literature (26 papers) with key informant interviews of seven policy entrepreneurs from Zimbabwe. We used an adapted framework with four elements of policy entrepreneurship to frame the analysis: displaying social acuity, defining problems, building teams, and leading by example. Our analysis showed that policy entrepreneurship exists amongst high-level elites and low-level actors. Local policy entrepreneurs tend to exhibit high levels of social acuity to define context-relevant problems and devise holistic solutions. They define situations as problems through comparison with desirable states of affairs, emphasizing the failure of current policies and interpreting data as crises. They achieve team building by constantly re-framing problems to expand policy portrayals and increase the number of people mobilized around the problem. Displaying social acuity stands out as highly consequential for policy entrepreneurship, as it helps in defining problems in a way that resonates with other actors and in mobilizing teams to take collective action. Local policy entrepreneurs lead by example as they implement and demonstrate the workability of their solutions, ultimately proving to be key actors in tackling pervasive and oft-marginalized health problems. That underscores the need to value local ideas as opposed to preference for those that are influenced by global movements. Systematic programmes-such as establishing policy institutes in the global South-should be set up to drive such processes and to, more broadly, support local policy entrepreneurship, including through the formal training of actors in policy sciences.

The end of the COVID-19 global health emergency presents an opportunity to reflect on actions needed to enhance the effectiveness of responses to any future shocks. We highlight critical areas requiring attention from researchers and research commissioners to enhance the identification and adoption of 'good value' interventions, and we discuss the complexities of evidence-informed decision-making across multiple sectors, the evolving role of modeling, and the need for improved stakeholder engagement and institutional coordination to effectively address interconnected health and policy challenges. We conclude the commentary by making a set of related recommendations to support intervention identification and implementation. Researchers, policymakers, and other key stakeholders should: renew efforts to step out of silos and to develop methods and frameworks that link and synthesize evidence from multiple sources and perspectives, to support planetary health goals and the 'One Health' concept; support more research into understanding the constraints to adopting interventions regarded as good value for money, to enhance evaluation methods ex ante and to better inform systems and stakeholders of the implementation requirements; and maintain an ongoing commitment to equitable research partnerships to ensure that evidence use is relevant for the target settings.

Interventions are needed to reduce the impact of heat on the health and wellbeing of women and newborns in Burkina Faso where seasonal temperatures can be extremely high. In this article, we share our experience and lessons learned from co-designing an intervention to improve maternal and neonatal health, about heat in a rural and an urban district of Burkina Faso. We performed community engagement and a series of workshops with 49 community members (health workers, women group representatives, youth leaders, religious leaders, traditional leader, and mothers-in-law) and 36 implementers, stakeholders and professionals (officials from the Ministry of Health, midwives and related health workers, meteorologists, and environmental health practitioners). Following the discussions and group reflections, emerging intervention priorities were ranked based on their perceived likelihood of success, cost effectiveness, implementation feasibility, and sustainability. The co-design workshops identified behaviour change interventions encompassing raising awareness of the effects of heat through targeted messages on adaptative behaviour to adopt. The effective operationalisation of these interventions was further achieved through co-planning involving health system actors in contact with women and local stakeholders with relevant expertise. We aimed to engage health professionals and community health workers to integrate heat and dehydration messages into their routine work with pregnant and postpartum women with the aim of changing behaviour through communication: educational group talks, interpersonal exchanges in the consultation room and broadcasts of information to the public who attend the clinic (video played on a television set in the waiting room). The co-design workshops were an opportunity to build capacity among facilitators and participants as well as to prioritize and develop interventions to address the impact of heat exposure-amplified by climate change-on pregnant and postpartum women, and on newborns.

Mexico is the world's largest global migration corridor and in the last decade there has been an increase in forced migration of families, women, and unaccompanied children and adolescents. The latter population requires specific policy and implementation frameworks due to increased vulnerability related to their age, gender, and unaccompanied status, which can seriously impact their long-term health and wellbeing. However, globally and in Mexico there are reports of lack of appropriate implementation of protection measures. Thus, this article aims to explore the perspectives of frontline workers who conduct daily work with unaccompanied migrant youth. Through 29 semi-structured interviews conducted with different migration workers, mostly based in Mexico, in summer 2021, we found that possibilities for advancing child rights exist even with a scarcity of resources. In fact, although workers highlighted a context of lack of resources, partly determined by a political vision that does not recognize humanity as a priority, specific skills and knowledge were identified for fostering migrant youth resilience. Knowledge such as clear best interests of the child guidelines, and skills such as empathy, adaptation, and recognition of agency of young people enabled some workers to provide appropriate safeguarding. However, we highlight how the contextual scarcity of services overruns individual worker capacities, leading to a lack of appropriate safeguarding overall. Based on worker perspectives, we provide recommendations for appropriate policy implementation. Results are reported according to Consolidated Criteria for Reporting Qualitative Research guidelines.

Stories and storytelling stimulate inquiries in health policy, and initiate and become an integral part of policy dialogues. They can also be used as a health policy advocacy tool. Storytelling is a compelling way to engage with various actors in the health policy realm, co-creating knowledge and action in the social world of health systems. Playback Theatre (PT) is an improvisational form of theatre in which audience members share their life stories, which are then enacted on the spot by a group of citizen actors. Citizen actors are everyday people who are not necessarily professional performers but are trained in PT. PT's emphasis on emotional expression and representation allows individuals to deeply engage with the stories of others, leading to greater empathy and understanding across diverse social groups. If applied with a critical consciousness, we argue that PT methodology can illuminate health policy and systems research storytelling processes, given its ontological and epistemological alignment with social constructivism and its orientation towards values such as human dignity and social justice. In this article, we explore the possibilities and the limits of PT for storytelling in the field of Health Policy and Systems Research, as it emphasises stories as much as the storyteller.