Frontiers in health services最新文献

Singapore's ageing population and exposure to climate-related and pandemic risks demand a health system that is not only efficient but also inherently resilient to shocks and equitable in health service delivery. Policies need to address the current supply chain evaluations in public health to focus on cost and speed of healthcare delivery to close critical gaps in preparedness during times of sudden disruptions. Embedding a humanitarian perspective in public healthcare systems provides frameworks for resilience, equity, and sustainability. Yet these principles remain siloed from routine health governance. This policy brief argues for embedding humanitarian supply evaluation into Singapore's health and community care systems through a "Response-to-Routine" paradigm. We propose an implementable four-dimensional framework: Resilience & Equity, Climate & Sustainability, Governance & Collaboration, and Innovation & Learning, supported by scenario-based stress testing and community-level integration. This approach designed for policy level decision making ensures continuity of care for vulnerable populations, particularly older adults, while aligning with climate and health equity goals. Importantly, policymakers should institutionalise resilience audits and pilot integrated evaluation models in the existing healthcare landscape through a logistics and health systems lens.

Introduction: The safe management of medical and pharmaceutical waste (MPW) is a major challenge for preventing environmental and health risks in hospitals. In Morocco, several studies still highlight shortcomings in knowledge, practices, and risk management related to MPW. To assess the knowledge, attitudes, and practices (KAP) of healthcare staff regarding MPW management at El Idrissi Hospital in Kenitra, as well as their perception of the associated risks.

Methods: A descriptive cross-sectional study was conducted among healthcare staff using an anonymous questionnaire with four sections: sociodemographic characteristics, knowledge of MPW management procedures, management attitudes, and risk perception. A total of 136 participants were included after excluding four invalid questionnaires. The data were analyzed descriptively.

Results and discussion: The majority of participants were women (67.6%). Nearly half of the staff (41.2%) were under 35 years old, with a mean age of 38 years (SD = 10.4). The mean administrative seniority was 13 years (SD = 9.2), and 47.1% had less than 10 years of experience. Staff came from various services and departments. A minority (18.8%) of them benefited from a day of awareness training on the management of medical waste (χ² = 8.64, p = 0.003). Meanwhile, 25% of them attended a meeting on this topic (χ² = 7.30, p = 0.007). Conversely, we found no significant associations (p > 0.05) with the media as a means of raising awareness, suggesting the need for enhanced training and improved organizational conditions.

Conclusion: This study highlights persistent gaps in medical waste management at El Idrissi Hospital. Strengthening staff skills, improving internal organization, and regularly updating protocols are essential to ensure the safe management of hospital waste and reduce risks to healthcare workers, patients, and the environment.

Healthcare systems are witnessing the rapid emergence of new professional roles, including physician assistants, nurse practitioners, technical physicians, and healthcare data scientists. These occupational groups develop in contexts marked by role ambiguity, contested expertise claims, and fragmented organizational structures, making professional identity work-the processes through which individuals and groups construct, negotiate, and revise understandings of who they are as professionals-a central challenge shaping their development. This targeted conceptual review synthesizes current debates and identifies four strategic dilemmas that arise when emerging healthcare professions attempt to construct collective identity. These dilemmas concern whether to maintain flexible, generative identities or establish standardized, fixative definitions; whether collective professional identity emerges organically from practice or requires deliberate engineering in emerging professions where weak infrastructures leave unclear who has the authority to coordinate identity work; whether to position through differentiation claiming unique expertise or complementarity as essential partners; and whether to pursue jurisdictional control or relational accountability within interprofessional networks. Each dilemma is shaped by internal stratification along career paths, positional power, disciplinary traditions, and geographic locations, while professions simultaneously manage relationships with diverse external stakeholders including other professions, patients, policymakers, and the public. The review identifies critical research gaps concerning the recursive relationship between identity and practice, identity work proceeding without established occupational communities, the neglect of failed professionalization projects, and the underexplored material basis of professional expertise. Professional identity construction is fundamentally political. Understanding these dynamics is essential for workforce policy and professional development models that support person-centered care.

The COVID-19 vaccine has been classified as an 'essential medicine', yet shortages and unequal distribution during the pandemic have reignited concerns about vaccine self-sufficiency in Africa. This study examined the mechanisms for acquiring, distributing, and administering existing COVID-19 vaccines in the Democratic Republic of Congo (DRC). A qualitative case study was conducted using semi-structured interviews with 23 key informants selected using reasoned choice, based on their professional roles in vaccine policy, logistics, and implementation. Participants were recruited from public institutions, with most being medical doctors and having experience in vaccination. Data were transcribed and analyzed were transcribed and analysis thematically using Atlas-ti 7.0. The study found that vaccine acquisition in the DRC relied heavily on international donations and multilateral initiatives, with limited national financial contribution. Distribution followed a five-tier supply chain managed by the Expanded Program on Immunization, moving vaccines from Kinshasa to provincial and field offices, then to selected health facilities. The Cold chain limitations, transport issues, and inconsistent vaccine availability challenged the administration. To improve vaccine access and coverage, stakeholders emphasized the need to strengthen logistical infrastructure and promote regional vaccine production. Honoring government commitments to co-finance procurement was also identified as a critical step toward sustainable vaccine supply.

Background: The COVID-19 pandemic exposed significant infection prevention and control (IPC) gaps in Sierra Leone's primary health care system. We evaluated whether a decentralised multicomponent mentorship model could improve IPC performance across 450 government primary health facilities and support sustainable domestic financing for IPC.

Methods: We conducted a pre-post quasi-experimental evaluation without a comparison group using facility-level indicators at baseline (April 2021) and endline (January 2022). The intervention package included competency-based IPC training, twice-monthly facility mentorship using structured observation checklists, routine monitoring with feedback using national IPC assessment tools configured in District Health Information Software 2 (DHIS2), targeted support for IPC commodities and water, sanitation and hygiene (WASH)-related infrastructure, community engagement, and budget advocacy through policy briefs and stakeholder meetings. We compared paired facility indicators using McNemar's chi-square test and examined service delivery patterns using month-matched comparisons to pre-pandemic levels (April 2019-January 2020). Primary outcome domains included training coverage, IPC supplies and infrastructure availability, and observed adherence to core IPC practices.

Results: Facilities meeting ≥80% staff training coverage increased from 38% to 100% (p < 0.001). Availability of IPC SOPs/registers, triage infrastructure, and core IPC supplies improved in 20 of 22 indicators (p < 0.001). Observed adherence improved for hand hygiene (39% to 89%), appropriate mask use (50% to 98%), screening at entry (27% to 96%), waste segregation (21% to 98%), and sharps safety (89% to 100%) (all p < 0.001). Service delivery volumes were maintained or increased during the intervention period compared to pre-pandemic levels for six of eight indicators examined (p ≤ 0.007). The Ministry of Health (MoH) established the first dedicated IPC budget line, increasing domestic allocation by 25% from USD 384,000 to USD 480,000, with USD 2.3 million secured from partners.

Conclusions: A decentralized mentorship model embedded in government structures can rapidly strengthen primary care IPC capacity while catalysing the policy and financing commitments essential for sustainability. The consistency of improvements across indicators supports this approach for similar low-resource settings. Controlled designs are needed to establish attribution and assess long-term impact.

Objective: This study aims to analyze the latent profiles of job embeddedness among physical examination nurses and their influencing factors, providing a scientific basis for nursing talent management.

Methods: Using convenience sampling, 150 physical examination nurses from Shanghai Public Health Clinical Center were surveyed. Data were collected using a general information questionnaire, the Job Embeddedness Scale, the Nurse Retention Intention Scale, the Nurse Work Environment Scale, and the Psychological Capital Questionnaire (PCQ). Latent profile analysis and multivariate logistic regression analysis were employed.

Results: The average score of job embeddedness among nurses was 69.89 ± 11.67, revealing three latent profiles: low (26.7%), medium (31.4%), and high (41.9%). Multivariate analysis indicated that annual income, promotion satisfaction, retention intention, and psychological capital (PCQ) were the main influencing factors (p < 0.05).

Conclusion: Job embeddedness among physical examination nurses exhibits heterogeneity. It is recommended to enhance job embeddedness and stabilize the nursing workforce through comprehensive measures, such as establishing standardized management systems, optimizing nursing management structures, and ensuring reasonable income.

The Healthcare Career Pathways (HCCP) programme, implemented by EMMS International and Duncan Hospital in Bihar, India, addresses dual public health challenges: the shortage of long-term healthcare workforce in hard-to-staff health facilities, and the systemic exclusion of vulnerable women from higher education and professional employment. Since its expansion in 2019 to Bihar, India, HCCP has ensured targeted advocacy and selection, mentoring, financial support to pursue accredited healthcare qualifications, and guaranteed employment to economically and socially vulnerable women. This case study presents the HCCP model as implemented in Raxaul, Bihar, India, including its outcomes between 2019 and 2025, impacts, strengths and challenges. It is based on the findings of a comprehensive, independent, objective evaluation of HCCP, which was conducted using quantitative review of programme records and documents, qualitative study design comprising semi-structured interviews and focus groups, and thematic analysis of the data. By the year 2025, HCCP has supported 54 economically and socially marginalised young women in healthcare training and qualifications, with 24 of these graduates employed at The Duncan Hospital. The evaluation findings reveal substantial impacts on the young women and their families' economic independence and self-efficacy; gender norms including delayed marriage and reduction in dowry demands; and shifts in community perceptions and attitudes towards girls' marriageability, education and employment particularly in the healthcare sector as well as intergenerational educational and childbirth aspirations whereby families now welcome the birth of a girl child rather than opposing it. Key challenges include limited geographical reach, partial financial support, and narrowing of career aspirations to nursing among the young women and families. This evaluation demonstrates HCCP as an evidence-based model with potential for replicability and sustainability in lower and middle-income countries to strengthen health systems in rural and underserved regions through workforce development and guaranteed recruitment in the local geographical setting while advancing gender equity and empowerment aligned with the sustainable development goals. As of 2025, HCCP is already being replicated in Madhipura Hospital in Bihar and Jiwan Jyoti Hospital in Uttar Pradesh in India. Recommendations focus on positioning HCCP within the local socio-cultural and geographical context, diversifying career pathways, strengthening mentorship, and appropriate follow-up, monitoring and evaluation mechanisms.