Health Policy And Planning[JOURNAL]
Sun
200 papers
Does health insurance increase health care utilization? evidence of ex-post moral hazard from the Social Security Scheme in Thailand.
Sirisankanan A, Kananurak P, Yoongthong T
Health Policy Plan · 2026 May · PMID 42175745 · Publisher ↗
Expanding health insurance improves access to care, but it may also increase healthcare utilization and fiscal pressure on public systems. Using multiple waves of the Thailand Socio-Economic Survey, this study applies a...
Expanding health insurance improves access to care, but it may also increase healthcare utilization and fiscal pressure on public systems. Using multiple waves of the Thailand Socio-Economic Survey, this study applies a difference-in-differences (DD) approach combined with propensity score matching to estimate the causal effect of Social Security Scheme (SSS) coverage. The results show that insurance coverage increases healthcare utilization, consistent with behavioral responses associated with ex-post moral hazard, although part of this increase reflects improved access to necessary care. The magnitude of the effects varies across types of medical expenditures, estimation methods, and study periods. These findings highlight the importance of balancing expanded healthcare access with the financial sustainability of the SSS. Policymakers may consider targeted cost-management measures, efficiency improvements, and strengthened preventive health policies while maintaining equitable access to healthcare services.
Aid, Debt, IMF Conditionalities and Domestic Health Financing in Low- and Middle-Income Countries.
Federspiel F, Borghi J
Health Policy Plan · 2026 May · PMID 42166722 · Publisher ↗
Across Low- and Middle-Income Countries (LMICs), public external debt burdens as well as the number of International Monetary Fund (IMF) loan conditionalities have grown over time. These externally derived macro-fiscal f...
Across Low- and Middle-Income Countries (LMICs), public external debt burdens as well as the number of International Monetary Fund (IMF) loan conditionalities have grown over time. These externally derived macro-fiscal factors, along with Official Development Assistance (ODA), may influence the fiscal space for health and policy decisions that co-determine to what extent countries finance their health systems with domestic government funds (GHE-S), and to what extent they rely on household Out-Of-Pocket Payments (OOP). The levels and balance of these sources have great implications for health service access and health outcomes, particularly among poorer population groups. However, we did not identify studies that have jointly examined how these key external factors are associated with GHE-S and OOP, nor compared their correlation sizes. This is key for understanding which might be the most effective policy levers for pursuing Universal Health Coverage (UHC). We performed a panel data study of 105 LMICs from 2005-2019, investigating associations between GHE-S and OOP, and a set of ODA-, public external debt- and IMF programme and conditionality variables. We used the Generalised Method of Moments estimator and performed a range of robustness checks. Increases in ODA via the recipient country public sector were associated with modest reductions in both OOP and GHE-S, measured per GDP. Increases in public external debt servicing per GDP were associated with slight relative increases in OOP and slight relative decreases in GHE-S per CHE. We found no relationship between IMF programme participation or conditionalities and GHE-S or OOP. Our findings support less donor concern of aid fungibility in the health sector, while adding that both on- and off-budget ODA for health also appear to modestly subsidise OOP. Our findings for debt indicated a small shift in the burden of payment from government onto the user from increasing public external debt servicing. This provides some added support to calls for debt resolution among more heavily indebted LMICs to avoid the negative health service access implications from OOP.
COVID-19 kit distribution in six Latin American countries: bureaucratic autonomy, populism, and evidence-based policymaking.
Requejo Domínguez JA, Croke K, Wirtz VJ
Health Policy Plan · 2026 May · PMID 42161894 · Publisher ↗
During the COVID-19 pandemic, governments varied widely in the extent to which policy decisions aligned with scientific evidence. We examine decision-making regarding the public distribution of COVID-19 kits containing i...
During the COVID-19 pandemic, governments varied widely in the extent to which policy decisions aligned with scientific evidence. We examine decision-making regarding the public distribution of COVID-19 kits containing ivermectin in six Latin American countries in 2020 and 2021, despite international scientific authorities advising against using these medicines outside of clinical trials. We focus on institutions, ideology, and interests. Theories emphasising the centrality of institutions predict that autonomous scientific institutions are more likely to resist political pressure to adopt ineffective interventions. Theories focused on ideology suggest that populist leaders may favour highly visible policy responses, including ineffective treatments, even when these diverge from expert advice. A third approach emphasises the relative power of groups favouring or opposing kit distribution. Using the comparative case study method, we analyse policy processes across Guatemala, Peru, Mexico, Costa Rica, Colombia, and Argentina. We find that neither bureaucratic autonomy, populism, nor interests alone explains policy variation. Instead, the findings are consistent with a conditional relationship in which populist leaders are more likely to favour kit distribution, but autonomous National Medicines Regulatory Agencies (NMRAs) appear to moderate the influence of populist political pressures. Countries with non-populist leaders but low institutional autonomy were also likely to distribute kits if powerful political actors favoured such policies. These findings suggest that institutional design and political context jointly shape the capacity for evidence-informed decision-making during public health emergencies. Strengthening the autonomy of regulatory agencies may help support evidence-based evaluation of emerging health technologies during future crises.
The Health Systems Research section: scope and future.
Spicer N, Marchal B, Srinivas P … +2 more , Khan M, Sheikh K
Health Policy Plan · 2026 May · PMID 42159022 · Full text
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"This is not our mandate": A qualitative case study on the resilience of a humanitarian health programme in Lebanon.
Truppa C, Valente M, Celentano G … +3 more , Savoy C, Ragazzoni L, Saulnier D
Health Policy Plan · 2026 May · PMID 42145030 · Publisher ↗
Decision-making in humanitarian crises is rarely based on evidence and often constrained by uncertainty. Humanitarian health organisations such as the International Committee of the Red Cross (ICRC) operate in conflict s...
Decision-making in humanitarian crises is rarely based on evidence and often constrained by uncertainty. Humanitarian health organisations such as the International Committee of the Red Cross (ICRC) operate in conflict settings, characterised by multi-layered, complex crises. Understanding how their decision-making processes influence the continuity of humanitarian health operations can provide insight to inform the development of resilience-oriented interventions in these contexts. We conducted a qualitative case study on the ICRC health operations in Lebanon, with the objective of exploring the elements shaping decision-making, and understanding how different organisational factors influenced absorptive, adaptive, and transformative capacities in response to disruptive events in a hospital programme. Twenty semi-structured interviews were conducted with ICRC decision-makers. Data were analysed through qualitative content analysis. Three themes emerged, describing how decisions were shaped by people and the trust they were able to develop in internal and external relationships; political considerations often overriding public health priorities; and unresolved tensions around the institutional identity and mandate. Resilience capacities were sustained by different factors. Absorptive capacities were primarily sustained by the availability of material resources, as well as operational contingency plans allowing for flexibility in their allocation. Adaptive capacities were strengthened by cohesive social networks among committed team members. Transformative capacities were limited, promoted by the ability to innovate while at the same time constrained by a rigid organisational culture. Our findings suggest that health governance and local leadership need to be strengthened to enable transformative capacities within humanitarian organisations. Through this, accountability and legitimacy can be enhanced, especially amid growing critiques and dramatically contracting funding.
Participation of Civil Society Organisations and Academia in COVID-19 Governance: Insights from a Six Country Study.
Asthana S, Lin R, Mukherjee S … +13 more , Phelan AL, Gobir IB, Woo JJ, Wenham C, Husain MM, Shirin T, Govender N, Al Nsour M, Ukponu W, Ihueze AC, Asthana S, Mutare RV, Standley CJ
Health Policy Plan · 2026 May · PMID 42141905 · Publisher ↗
This paper focuses on the engagement of persons and groups with diverse interests in the governance of the COVID-19 pandemic. During emergencies, involving diverse perspectives in governance mechanisms can contribute to...
This paper focuses on the engagement of persons and groups with diverse interests in the governance of the COVID-19 pandemic. During emergencies, involving diverse perspectives in governance mechanisms can contribute to more equitable and evidence-based policies that address societal needs. Previous literature shows that, even with the intent to include diverse perspectives , there can be gaps in engaging non-governmental entities in epidemic governance. This study sought to analyze participation of two important interest groups: academia and civil society organisations (CSOs) during the COVID-19 response, to identify best practices and strategies for enhancing their roles in future health crisis governance. We adopted a comparative case study design to collect data from six countries: Nigeria, Singapore, South Africa, Bangladesh, Jordan, and the United Kingdom, representing varied political and economic contexts, geographic locations, and response strategies during the pandemic. Data sources included key informant interviews and focus group discussions with a total of 64 stakeholders, including government officials, academic experts, and personnel from CSOs. During the COVID-19 pandemic, CSOs actively participated in response efforts, but in the six countries we analyzed, they largely did so independently of the government, particularly during the initial response phase. In some countries, governments involved CSOs only after reports of clusters of new transmission, primarily for risk communication and service delivery like vaccine distribution, without involving them in governance mechanisms like making pandemic preparedness and response policies. Other governments worked with public universities to gather evidence for decision-making and policy formulation starting from the pre-pandemic phase to the initial phase of the pandemic. Across disciplines, experts in epidemiology, mathematical modelling and infectious diseases were more likely to be consulted, whereas economists, sociologists, ethicists and anthropologists were less involved.
Hospital Twinning Partnership for Health System Strengthening in Rural China: A Mixed-Methods Implementation Study Using WHO Building Blocks and CFIR Framework.
Tao W, Shen W, Guo H … +6 more , Yu X, Tian M, Di X, Li J, Guo J, Wen J
Health Policy Plan · 2026 May · PMID 42133836 · Publisher ↗
Hospital twinning partnerships have emerged as a strategy for health system strengthening, yet evidence on their implementation in domestic settings within low- and middle-income countries remains limited. This study exa...
Hospital twinning partnerships have emerged as a strategy for health system strengthening, yet evidence on their implementation in domestic settings within low- and middle-income countries remains limited. This study examined a hospital twinning partnership between West China Hospital and Dafang County People's Hospital in western China to identify partnership components and implementation determinants, complemented by assessment of implementation outcomes. A mixed-methods implementation study was conducted using the World Health Organization health system building blocks and the Consolidated Framework for Implementation Research (CFIR). Data were collected through semi-structured interviews (n = 10), structured surveys (n = 63), and administrative records. Partnership elements were mapped to the building blocks, while CFIR constructs were rated to identify facilitators and barriers. Qualitative and quantitative findings were integrated to provide a comprehensive understanding of implementation determinants. Partnership elements spanned all six building blocks, with particular emphasis on leadership and governance, service delivery, and health workforce development. Key facilitators included source credibility and reputation of the supporting hospital, government support, and a two-way partnership philosophy. Barriers included IT infrastructure limitations, inadequate external funding, intervention complexity, sustainability pressure, and cultural inertia toward change. Implementation outcomes showed improvements in service capacity, workforce development, and organizational culture, with observable changes extending to township health centers within the County Medical Consortium. The findings from this study suggest that structured domestic hospital twinning partnerships may serve as a promising approach to rural health systems. The comprehensive approach addressing multiple health system building blocks, combined with mechanisms for extending support to primary care facilities, offers a replicable model for health system strengthening in resource-limited settings.
Climate-related health threats in Tanzania: a multi-level analysis of key policies, strategies and community response.
Urassa AP, Finda MF, Okumu FO … +1 more , Kreppel K
Health Policy Plan · 2026 May · PMID 42133821 · Publisher ↗
Tanzania faces increasing climate-sensitive health threats, including vector-borne diseases, water-borne infections, and malnutrition. Effective preparedness at both national and community levels is critical for health s...
Tanzania faces increasing climate-sensitive health threats, including vector-borne diseases, water-borne infections, and malnutrition. Effective preparedness at both national and community levels is critical for health system resilience and livelihood security. This study applied a multilevel mixed-methods approach to assess Tanzania's policy structures and community-level experiences related to climate-health preparedness. Between January 2024 and May 2025, we conducted a concurrent mixed-methods study. At national level, we reviewed climate-health policy documents, mapped 30 key stakeholders, and conducted 15 semi-structured interviews with representatives from government ministries, research institutes, development partners and non-government organizations. At community level, we surveyed 388 adults and conducted eight focus group discussions in four councils in southern Tanzania. Data were analyzed and triangulated across all sources. Tanzania has developed several climate-health policies and community initiatives. However, gaps remain in cross-sectoral coordination, financing, and policy implementation. National stakeholders cited challenges in translating strategies into community-level action. Among community respondents, 77% acknowledged climate change and 97% reported exposure to hazards such as floods, drought, or extreme heat. Health impacts included malaria surges, diarrhoeal disease, and food scarcity. While 73.7% had received some government assistance, access to reliable health and climate information was limited. Households relied mainly on personal observations and informal networks. Communities and institutions jointly emphasized four priorities: strengthened risk communication, climate-smart agriculture, resilient health facilities, and inclusive early-warning systems. Strengthening multilevel governance, financing mechanisms, and community-driven adaptation planning is essential to improve Tanzania's preparedness for climate-related health threats.
Does dosage matter? Effects of results-based financing layered on top of less comprehensive direct facility financing in Tanzania.
Loha E, Somville V, Borghi J … +2 more , Binyaruka P, Mæstad O
Health Policy Plan · 2026 Jun · PMID 42128523 · Full text
Performance-based financing at health facility level has improved service delivery in many low- and middle-income countries. However, the high costs of implementing such schemes have prompted interest in less complex for...
Performance-based financing at health facility level has improved service delivery in many low- and middle-income countries. However, the high costs of implementing such schemes have prompted interest in less complex forms of direct health facility financing. This paper measures the effects of layering a full-blown performance-based financing scheme (results-based financing, RBF) on top of a less comprehensive direct financing scheme in Tanzania. This enables us to assess whether implementing a less comprehensive scheme exhausted the potential for financing reforms to improve service delivery, or whether there are significant gains from adding more resources and incentives to the scheme. We estimated the effects of RBF using a difference-in-differences approach. Over 4 years, we tracked 150 health facilities and more than 3000 households, equally divided between eight districts that implemented both schemes and six districts that implemented only the less comprehensive scheme. Strong positive trends were observed for most outcomes in both groups of districts. At the same time, RBF had positive and statistically significant effects on 14 of 24 directly incentivized outcomes and on 22 of 47 other outcomes, including on service coverage (e.g. prenatal and vaccination services), service quality (e.g. content of care for antenatal and delivery services, drug availability, communication, and responsiveness), and patient satisfaction. A negative effect was estimated for one outcome only (use of family planning method). Statistically significant effects of RBF ranged from -4.3 to 16.2 percentage points (average: 8.7 pp). Analysis of intermediary outcomes revealed that RBF had a positive effect on health worker job satisfaction. We conclude that dosage matters: comprehensive direct financing schemes-with more resources and incentives-can significantly improve service delivery beyond what is achieved by less comprehensive ones.
Assessing intervention effects on healthcare-related financial protection in low and middle-income countries: a rapid evidence review.
Kruja K, Brikci N, Bertone MP … +1 more , Witter S
Health Policy Plan · 2026 May · PMID 42124364 · Publisher ↗
Financial protection is a key goal for universal health coverage, but globally this indicator has been lagging, especially for low-income households. Understanding how to improve it is urgent. This rapid evidence review...
Financial protection is a key goal for universal health coverage, but globally this indicator has been lagging, especially for low-income households. Understanding how to improve it is urgent. This rapid evidence review examined the effectiveness of interventions which affected financial protection in health across low- and middle-income countries (LMICs). A systematic search of published literature identified empirical studies reporting on outcomes such as out-of-pocket expenditure (OOPE), catastrophic spending, impoverishment, and care foregone for financial reasons, with data extracted and categorized using structured tools. A narrative synthesis was used to interpret the evidence. The review included 214 studies published between 1999 and 2024, covering interventions in 39 countries. About one-quarter of studies assessed equity, often revealing mixed or regressive effects. Financial protection is affected through multiple channels but evaluations still largely focus on health-sector specific interventions, failing to examine potentially impactful wider policies. Insurance schemes were the most studied intervention type, with mixed results. Demand-side financing, such as vouchers or cash transfers, and user fee reforms often struggled to benefit the poorest due to structural barriers and indirect costs. Provider payment reforms were more likely than other categories to show adverse effects, including unintended supplier behaviour changes that drove up OOPE and costs to the system. Less frequently evaluated interventions, such as social protection and behaviour change programs, showed some positive effects. Whilst no single intervention consistently ensured financial protection, the evidence points to the value of interventions that act across multiple sectors and health areas. Designing reforms with an explicit objective of improving financial protection, with local context, system capacity, and equity in mind and adjusting based on continuous monitoring, can support achievement of improved and equitable financial protection.
Correction to: Assessing the costs of antenatal care in Eastern Ethiopia: implications for improving the free maternity services policy.
Health Policy Plan · 2026 Jun · PMID 42118814 · Full text
Abstract loading — click title to view on PubMed.
The Indian Medical Association's Role in Federal and State Policy Processes in India: A Scoping Review.
Montecalvo A, Sriram V, Khumbhar K … +1 more , Keshri V
Health Policy Plan · 2026 May · PMID 42104676 · Publisher ↗
Physician associations play a significant role in shaping health policy at national and sub-national levels. However, the influence of such associations in low- and middle-income countries has not been synthesized or ass...
Physician associations play a significant role in shaping health policy at national and sub-national levels. However, the influence of such associations in low- and middle-income countries has not been synthesized or assessed. The Indian Medical Association (IMA), one of the largest physician associations in the world, has a long history of policy engagement at national and state levels across multiple issues. This review aims to assess - for the first time - the empirical literature available on the IMA as a political actor. Adopting a scoping review methodology, the paper sought to identify the policy stances, strategies and influence of the IMA over India's health policy. Nine health, social science, and policy research databases were searched for English-language studies published between 1974 and 2024. Reviewing 37 papers, it finds that the IMA has been active in seven main policy domains: violence against doctors; regulation of the private healthcare sector; restriction of traditional medicine; professional authority or autonomy for physicians; publicly funded health insurance; medical ethics; and partnership in public health programs. It has been reactive against new legislation, reform or regulation in all domains except for violence against doctors. Through interrelated interior and exterior strategies, the organization has been successful in influencing, stalling or limiting legislation. While the IMA holds influence through the size of its membership and its embeddedness in health administration and corporate interests, the tactics of the organization often lack coherence and consistency. Situating these findings in the broader landscape of health governance, our review contributes further evidence for the need to develop more inclusive and transparent pathways for participation in decision-making.
Tailoring Implementation Strategies for the Acute Coronary Syndrome Quality Improvement Programme at Primary Care Level in East, West and Central China.
Liu C, Wu Y, Wang Z … +3 more , Xie S, Zheng ZJ, Zhou S
Health Policy Plan · 2026 May · PMID 42102268 · Publisher ↗
Acute coronary syndrome (ACS) remains a leading contributor to cardiovascular disease burden in China, and ST-segment elevation myocardial infarction (STEMI) is the most severe ACS. To improve early identification and ti...
Acute coronary syndrome (ACS) remains a leading contributor to cardiovascular disease burden in China, and ST-segment elevation myocardial infarction (STEMI) is the most severe ACS. To improve early identification and timely treatment of STEMI patients, the Chest Pain Unit (CPU) program was established to strengthen referral pathways to qualified facilities. This study explores key barriers and facilitators to the CPU implementation and proposes context-specific strategies to optimize its delivery and scale-up. We conducted a qualitative study using semi-structured interviews in three purposively selected, representative counties across eastern, central, and western China. A total of 61 key informants from 36 township hospitals, participated in the study. All interviews were audio-recorded, transcribed verbatim, and thematically coded guided by the Consolidated Framework for Implementation Research (CFIR) 2.0 using Atlas.ti 9. Implementation strategies were mapped and refined using Expert Recommendations for Implementing Change. We identified 46 barriers and 50 facilitators, spanning all 5 domains of CFIR. Technical deficiencies, residents' lack of health-seeking awareness, financial difficulties, inefficient awareness campaign, and limited professional knowledge are respectively the most significant barriers for five domains. We developed a three-pronged strategy framework including innovation optimization, external empowerment and internal improvement to inform future practice. Accordingly, the most urgent strategies encompass enhancing technical capacity, expanding financing mechanisms, empowering communities, implementing mass media campaigns, strengthening patient adherence through structured follow-up, and providing continuous practical training. We recommend the proposed strategies should be taken into full consideration to facilitate timely detection and intervention of ACS in primary healthcare context.
Understanding informal payments in the health sector in Malawi: results of a multi-district household survey.
Umar E, Chilumpha M, Chatha G … +4 more , McKee M, Angell B, Sabin L, Balabanova D
Health Policy Plan · 2026 May · PMID 42099282 · Publisher ↗
In Malawi, health services are officially free at the point of use, but patients often make informal payments to access services or obtain medicines. These payments undermine equity and trust in the health system. This s...
In Malawi, health services are officially free at the point of use, but patients often make informal payments to access services or obtain medicines. These payments undermine equity and trust in the health system. This study examined for the first time the prevalence, types, and determinants of informal payments among Malawians who had recently used health services. We conducted a multi-district cross-sectional household survey in four districts chosen to reflect urban and rural Malawi. Households containing someone who had been hospitalised in the previous six months were interviewed using a structured questionnaire. Descriptive analyses identified the types and prevalence of informal payment, while multivariable logistic regressions identified factors associated with informal payments. Overall, 17% of respondents reported paying for services that are officially free. Informal payments are most often for medicines (52%), consumables (24%) and consultations (24%). Female respondents and those living in urban areas were significantly more likely to report giving informal payments, while those with higher levels of education were less likely. Participants with a good or very good financial situation were more likely to make such payments. Significant geographical variations were observed, with higher probabilities in Mchinji and Mzimba than in the Blantyre district. Nearly one in five Malawians reported making informal payments to access health services, questioning the formal policy that these are free. These findings highlight the need for governance reforms, greater accountability and community awareness to reduce informal payments and promote equitable access to care.
Financial Protection in Flux: Longitudinal Evidence on Out-of-Pocket Spending Among Middle-Aged and Older Mexicans During the Seguro Popular-INSABI Transition.
Cabrero-Castro JE, Gonzalez M, Aguila E … +4 more , Arreola-Ornelas H, Touchton M, Knaul FM, Rojas-Alvarez A
Health Policy Plan · 2026 May · PMID 42098933 · Publisher ↗
Mexico is aging rapidly, placing growing strain on health financing and long-term care systems. Older adults face a double burden: higher healthcare needs due to chronic conditions and multimorbidity, and limited or info...
Mexico is aging rapidly, placing growing strain on health financing and long-term care systems. Older adults face a double burden: higher healthcare needs due to chronic conditions and multimorbidity, and limited or informal income in later life, leaving them highly exposed to out-of-pocket (OOP) spending. In 2020, the government replaced Seguro Popular (SP) with the Instituto de Salud para el Bienestar (INSABI) to strengthen financial protection, but its implications on older adults remain unclear. We analyzed OOP among 13 616 individuals aged ≥50 years in the Mexican Health and Aging Study, interviewed in 2018 and 2021. Expenditures for hospitalizations, outpatient procedures, medical visits and medications in the previous 12 months were indexed to inflation and converted to 2021 US dollars. Tobit models estimated total and component OOP, including an interaction between insurance category (Uninsured; Social Security - IMSS/ISSSTE/PEMEX/Defense; SP 2018/INSABI 2021; Other) and survey year, adjusting for sociodemographic and health covariates. Between 2018 and 2021 the proportion of older adults reporting no health insurance tripled from 9.5% to 27.2%, while SP affiliation fell from 30.1% to 10.9%. Social Security beneficiaries spent substantially less than the uninsured on total OOP (about US$1 033 less in 2018 and US$539 less in 2021). SP in 2018 and INSABI in 2021 were also associated with lower OOP (-US$291 and -US$298 versus the uninsured, respectively). Only Social Security was associated with a statistically significant reduction in medication-related OOP. Overall, the transition from SP to INSABI coincided with a marked rise in reported uninsurance and persistently high OOP, particularly for medicines, the principal driver of financial burden among older adults. These findings highlight the fragility of recent health financing reforms and the need to ensure sustained, employment-independent financial protection for Mexico's aging population.
Survive and Thrive in Brazil: Estimating the Impact of the Boa Vista Early Childhood Program.
Brentani A, Loss G, Bessa L … +6 more , Chang-Lopez S, Walker S, Ferrer AP, Grisi S, Lopez Boo F, Fink G
Health Policy Plan · 2026 Apr · PMID 42045812 · Publisher ↗
This study aimed to evaluate the impact of the Survive and Thrive program on neonatal mortality and child development in Boa Vista, Brazil. Between November 2017 and May 2021, the program to support pregnant women as wel...
This study aimed to evaluate the impact of the Survive and Thrive program on neonatal mortality and child development in Boa Vista, Brazil. Between November 2017 and May 2021, the program to support pregnant women as well as mothers of children under age 3 were rolled out in three phases. Neighborhoods were either selected for home visits, or for group meetings held at Social Assistance Reference Centers (CRAS). To allow for an evaluation of the program, the timing of the rollout was randomized at the neighborhood level. To assess the impact of the program on neonatal mortality, we used complete vital registration data from the period 2010 to 2010, and estimated differences in child mortality before and after the program were launched. Impact on child development was assessed through a detailed assessment of 744 children born in 2019 using the CREDI and PRIDI instruments. Home visits resulted in a significant improvement in child development [d=0.28, 95% CI [-0.013, 0.57], p-value 0.06) and reduction of neonatal mortality (RR 0.58, 95% CI [0.36, 0.93], p-value 0.02). No impacts were found for the group meetings. The findings indicate that a home visiting program beginning in pregnancy can significantly reduce neonatal mortality and improve child development in poor urban neighborhoods of Brazil.
Identifying the 'real cause of death': the complexities of maternal death reviews in Tanzania.
Almdal K, Said A, Moland KM … +1 more , Melberg A
Health Policy Plan · 2026 Jun · PMID 42010338 · Full text
Identifying the causes of maternal deaths and contributing factors is essential for improving care. In 2015, Tanzania began implementing the maternal and perinatal death surveillance and response (MPDSR) system, includin...
Identifying the causes of maternal deaths and contributing factors is essential for improving care. In 2015, Tanzania began implementing the maternal and perinatal death surveillance and response (MPDSR) system, including facility-based maternal death reviews. While most MPDSR studies highlight implementation and technical barriers, less is known about how systemic and institutional dynamics influence these reviews. This study examined stakeholders' experiences and perceptions of MPDSR in Tanzania, focusing on how clinical causes of death and contributing factors were identified. The study is based on 5 months of ethnographic fieldwork conducted in a Tanzanian region in 2023-2024. It included 33 days of participatory observation of obstetric care, attending nine facility-based maternal death review meetings and conducting 20 in-depth interviews with health workers and administrative staff. Viewing MPDSR as a travelling model and drawing upon the concept of situated knowledge, we examined how institutional and professional factors influenced these reviews. Reviews were routinized and integrated into the regional health system, offering opportunities for teaching and defining standards of practice. However, participants disagreed on whether the reviews promoted quality improvement or focused on individual fault-finding, on how responsibility should be attributed, and whether reviews could accurately establish the causes of deaths. The facility-based death reviews were influenced by institutional and epistemic hierarchies, with responsibility often placed on individuals at the lowest health system level. While MPDSR aims to promote blame-free learning and quality improvement, the process narrowed attention to individual error, obscured systemic constraints, and hindered understanding of the 'real cause' of maternal deaths. To capture contextual complexity without adding reporting burden, we recommend expanding the free-text narrative fields in the official MPDSR maternal death report forms and increasing frontline representation in district- and regional reviews to strengthen links between facility and higher-level reviews.
Economic burden of depressive disorders and HIV for people living with HIV in Uganda.
Katana PV, Ross I, Kiconco BE … +8 more , Tenywa P, Neuman M, Ssembajjwe W, Sekitoleko I, Katumba KR, Kinyanda E, Laurence YV, Greco G
Health Policy Plan · 2026 Jun · PMID 41999037 · Full text
Between 8%-39% of people living with HIV (PLWH) in sub-Saharan Africa have a depressive disorder (DD). Despite considerable gains in the treatment of PLWH, DD is increasingly recognised as a threat to successful treatmen...
Between 8%-39% of people living with HIV (PLWH) in sub-Saharan Africa have a depressive disorder (DD). Despite considerable gains in the treatment of PLWH, DD is increasingly recognised as a threat to successful treatment and prevention. PLWH incur higher health-related costs than the general population due to chronic care management needs. We aimed to estimate the combined economic burden of DD and HIV amongst PLWH and explore their mechanisms of coping with high-of-pocket health expenditure. This was a cost of illness study nested in a cluster-randomized trial that assessed the effectiveness of integrating treatment of DD into routine HIV care in Uganda (HIV+D trial). The study used cross-sectional data collected from 1115 PLWH across both trial arms at baseline, using the 9-item Patient Health Questionnaire (PHQ-9) to measure DD and a structured cost questionnaire. The mean monthly economic cost of HIV and DD amongst n = 486 participants reporting at least one non-zero cost item was United States Dollars (USD) 11.72 (2022 prices), while the mean across the whole sample (including zeroes) was USD 5.05. Mean monthly out-of-pocket expenditure amongst participants reporting at least one non-zero item was USD 7.22, which is 4% of average monthly household income. It was USD 3.11 in the sample as a whole. Moderate DD symptoms (PHQ-9 between 15-19) and severe symptoms (PHQ-9 ≥ 20) were reported by 30% and 5% of respondents respectively, with the remainder experiencing mild symptoms. Social protection mechanisms combined with the integration of the management of DD into routine HIV care could help alleviate this burden.
Assessing the progress in implementing population-based policies to reduce the burden of noncommunicable diseases in Eastern Europe and Central Asia, 2010-2024.
Dumcheva A, Laatikainen T, Rakovac I … +2 more , Nevalainen J, Nuorti P
Health Policy Plan · 2026 Jun · PMID 41992534 · Full text
Premature mortality from noncommunicable diseases (NCDs) remains high in twelve Eastern Europe and Central Asia (EECA) countries-Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan,...
Premature mortality from noncommunicable diseases (NCDs) remains high in twelve Eastern Europe and Central Asia (EECA) countries-Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan. Although WHO-recommended 'Best Buys' offer effective strategies to reduce NCDs, their implementation in EECA remains poorly documented. We conducted a cross-country, retrospective analysis of the adoption and implementation of population-level NCD 'Best Buys' interventions targeting tobacco, alcohol, diet, and physical activity across EECA from 2010 (or earliest available year) to 2024 (or latest available year), aiming to identify progress, gaps, and priorities for action. Data were sourced from WHO NCD Country Capacity Surveys and other global databases and monitoring reports. A scoring system (0-1) captured implementation status, and spider charts and summary tables visualized trends over time. Tobacco control showed the most progress, with widespread adoption of taxation and graphic warnings. However, the implementation of smoke-free laws, cessation support, and media campaigns was inconsistent. Alcohol policies varied: most countries increased taxes and banned advertising, but gaps persisted in sales restrictions, health warnings, and treatment services. Adoption of nutrition policies remained inconsistent, with substantial gaps in food reformulation, labelling, fiscal tools, and education. Physical activity campaigns were common, but integration into healthcare systems was poorly documented. Disparities in implementation were observed across and within countries, in terms of the number and combination of 'Best Buys' strategies adopted. Despite some progress, major gaps remain in the implementation of population-level NCD 'Best Buys' across EECA. Greater prioritization of cost-effective tobacco, alcohol, nutrition, and physical activity strategies is needed. Subregional and country-level analyses of NCD 'Best Buys' implementation over time can help policymakers identify progress and gaps, guiding targeted, evidence-informed action to address shared behavioural risks and thereby prevent many NCDs and contribute to equitable and sustainable health outcomes.
Health system response and recovery in Ukraine after 3 years of war: perspectives of front-line communities and internally displaced persons.
Hellowell M, Kalendruz K, Bondar T … +2 more , Ganyukov O, Habicht J
Health Policy Plan · 2026 May · PMID 41974481 · Full text
Communities affected by war can play a vital role in sustaining and restoring health services, yet their perspectives are under-represented in the evidence base. This study examines the experiences of patients and health...
Communities affected by war can play a vital role in sustaining and restoring health services, yet their perspectives are under-represented in the evidence base. This study examines the experiences of patients and health personnel in three front-line areas of Ukraine, as well as persons internally displaced due to the full-scale invasion of February 2022. Our findings reveal community perspectives on the effects of war-related insecurity, workforce shortages, and infrastructure damage on health system functions and service availability. Respondents identified health worker shortages-driven by safety risks and resource scarcity-as among the most pressing concerns. Amid these challenges, however, recent health financing reforms, notably the Programme of Medical Guarantees and Affordable Medicines Programme, were often viewed as mitigating factors. Internally displaced persons (IDPs) generally reported positive care-seeking experiences in their host communities, though administrative and information-related barriers continue to limit access for some. Capacity constraints in areas hosting large numbers of IDPs are seen as placing further stress on service availability. Respondents valued the coordinated efforts of humanitarian actors and local authorities in restoring services, helping to maintain trust and social cohesion. Many were sceptical about the feasibility of large-scale reconstruction in the short term, prioritizing instead urgent security measures to protect facilities. However, they also acknowledged the importance of defining a long-term recovery strategy and identified workforce strengthening, integration of humanitarian services, and sustained financial protection as critical priorities.
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