International Journal of Health Planning and Management最新文献

The COVID-19 pandemic exposed critical weaknesses in global health governance, prompting the development of the WHO Pandemic Agreement, formally adopted by the World Health Assembly in May 2025. This landmark Agreement seeks to address the shortcomings of the 2005 International Health Regulations by establishing legally binding commitments to enhance pandemic preparedness, equity, and international solidarity. However, the negotiation process revealed deep geopolitical divisions, raising concerns about the Agreement's legitimacy and enforceability. Key provisions include improved surveillance, data sharing, protection for healthcare workers, and equitable access to medical countermeasures. Nevertheless, its effectiveness may be compromised by vague language, unresolved issues, and the absence or abstention of influential states. Implementation is further challenged by political fragmentation, sovereignty concerns, and disparities in national capacities. The Agreement's success will depend on sustained political will, robust accountability mechanisms, and meaningful national adoption. Ongoing debates over the definition of ‘pandemic’ and the WHO's limited enforcement powers underscore the tension between multilateral cooperation and national sovereignty. While the Agreement represents a significant step forward, it is not a panacea. Its promise lies in its potential to catalyse coordinated global action, but only if supported by genuine commitment and adaptive governance. As the world faces future health threats, the Pandemic Agreement must evolve into a practical tool for resilience, equity, and collective security.

During the COVID-19 pandemic, policymakers focused on improving health outcomes and safeguarding healthcare availability, which have led to negative consequences for other societal systems that persist today. The impact of these policies on health and non-healthcare systems depends on the resilience of these systems, that is, the capability of a system to maintain functioning during crises by using its adaptive capacity and transformative response. Policymaking during the COVID-19 pandemic might have benefitted from considering the resilience of non-healthcare societal systems and the impact of policy choices on these systems. However, so far, the development of resilience indicators for complex systems and their application in a pandemic context remains undervalued. Therefore, in this paper, we developed performance measures for the resilience of healthcare and education as showcases for pandemic policymaking. We applied a disaster management model (COPEWELL) to both the healthcare and educational system in the Netherlands. An initial list of performance measures for each system was established based on their national quality registries. To safeguard face and content validity actors ranked these measures for each system, resulting in five performance measures for each. The healthcare resilience measures cover healthcare performance both inside and outside hospitals, and the education resilience measures apply to primary, secondary schools, and higher education. Assessing the added value of multisystem policymaking using such resilience measures is a next step to be taken.

Achieving horizontal equity in the access and use of public health resources is one of the main goals of the 17 Spanish regions. We analyse geographical inequities in the allocation of human and material resources for specialised care in Spanish hospitals, paying attention to the public-private partnership. We measure inequity using Gini, Concentration and Dissimilarity indices, and Lorenz and Concentration curves, and find that regions having fewer resources in the public sector and less public health spending tend to have higher levels of resources in the private sector, which could contribute to achieve horizontal equity in the public health system.

Formalised public-private-partnerships (PPPs) for primary care have proliferated in the mixed health systems of India, Pakistan and Bangladesh, managed and funded by the state. This perspective provides a process-based understanding of pathways adopted by home-grown PPPs and underlying drivers to identify lessons for advancement under Universal Health Coverage (UHC). PPPs have been deployed to respond to local primary care needs ranging from diagnostic screening, maternity services, management of government health centres, mobile clinics to urban primary care systems. Partnerships have evolved to include a diverse range of private partners and more purposeful arrangements, with increase in service volumes, innovations albeit less standardised quality of care. The pathway of PPP instigation, rollout and sustaining in South Asia is based on local starting points by sub-national governments, diffusion of practice across states, common interests and shared bureaucratic coalitions. Success drivers include administrative support beyond the health sector, simplified contractual and payment systems providing operational ease and decision space, and the use of relational management and digital monitoring for resolving issues. However, PPPs are constrained by either too little accountability or excessive accountability in contract design, trust deficits between private and government, and fire-walled PPP implementation creates disconnects from national primary care planning and regulation. Donor supported projectized PPP funding and accompanying rules of business makes PPPs implementation more cumbersome. We conclude that future attention must centrally focus on pathways and drivers to impactfully introduce, scale-up and sustain PPPs in South Asia. Emphasis must be on pathways that build on local simplified ideation, progressive adaptation and allowing contextual diversity under a larger UHC planning architecture, as opposed to centralised one-fit and heavily technocratic initiatives. Success drivers must feature in design of PPP initiatives. Furthermore, we contend that international donor assistance should shift from projectized support for PPPs to building public sector competencies for stewardship, private sector engagement skills as well as the more traditional performance management capacity.