Health Policy And Planning[JOURNAL]
Sun
200 papers
Understanding the formulation of non-communicable disease policies in Nepal: a qualitative study.
Vaidya A, Simkhada P, van Teijlingen E … +1 more , Lee ACK
Health Policy Plan · 2026 Jun · PMID 41964417 · Full text
Few policies have focused specifically on the growing burden of non-communicable diseases (NCDs) in low- and middle-income countries. Health policy formulation plays a vital role in the allocation of resources to impleme...
Few policies have focused specifically on the growing burden of non-communicable diseases (NCDs) in low- and middle-income countries. Health policy formulation plays a vital role in the allocation of resources to implement effective interventions and reforms; hence, a nuanced understanding of the health policy formulation process is essential. However, there is limited evidence about the process through which NCD policies were formulated in Nepal. This study used Kingdon's multiple streams framework to explore how NCDs were recognized and prioritized, how policy alternatives were decided, how policy windows were opened, and which contextual factors influenced the policy formulation process. A qualitative case study approach was applied to gain a comprehensive understanding of the formulation of major NCD-related policies in Nepal. Semi-structured interviews were conducted with 12 key stakeholders and policy documents were analyzed using framework analysis. The NCDs were gradually recognized and prioritized through the convergence of global and local evidence, sustained advocacy, and international commitments. Policymakers encountered several challenges, such as competing health priorities, the chronic nature of NCDs, donor preferences for communicable diseases, financial constraints, and multisectoral complexities of NCDs. The Package of Essential Non-communicable diseases interventions were adopted as a policy alternative, informed by global evidence, World Health Organization recommendations, and lessons from other countries. While coordinated efforts by stakeholders brought the problem, policy, and politics streams together, the role of policy entrepreneurs was found to be less relevant in Nepal's context. The findings highlight the need to consider external influences while conducting similar studies in low- and middle-income countries. Further research is needed on strategies to address persistent structural and financial challenges in NCD policy formulation.
The pervasiveness of racism in healthcare facilities in Latin America: a scoping review.
Castro A, Silva M, Silvestre E
Health Policy Plan · 2026 Jun · PMID 41955572 · Full text
Racism in healthcare facilities across Latin America systematically affects Indigenous, Afrodescendant, and migrant populations. Yet, no comprehensive synthesis has mapped its scope across different populations, healthca...
Racism in healthcare facilities across Latin America systematically affects Indigenous, Afrodescendant, and migrant populations. Yet, no comprehensive synthesis has mapped its scope across different populations, healthcare settings, and countries in the region. This scoping review followed PRISMA guidelines and searched PubMed, EBSCOhost, and EMBASE for peer-reviewed studies published between January 2015 and June 2025. We included studies addressing racism in healthcare facilities where clinical encounters between populations and healthcare workers occur. Data were charted using AI-assisted tools and analyzed thematically. We retained 70 studies from 15 countries, predominantly Brazil (n = 30) and Mexico (n = 14). Racism manifested through three interconnected forms: institutional racism (policies restricting access, absence of data reflecting ethnic identification and racialization processes, resource inequities), personally mediated racism (verbal abuse, physical mistreatment, denial of culturally appropriate care), and internalized racism (self-devaluation, acceptance of mistreatment). These forms of discrimination pervade multiple medical fields, including maternal and reproductive health, mental health services, dental care, chronic disease management, infectious disease treatment, and emergency care. Racialized populations experience delayed diagnoses, inadequate treatment protocols, and systematic exclusion from preventive care. Language barriers, cultural dismissal, and discriminatory triage decisions compound these inequities. Intersectional marginalization based on gender, class, migration status, and sexuality amplifies these effects, producing multiplicative rather than additive health impacts. Achieving health equity requires dismantling institutional racism through meaningful community participation in healthcare governance, mandatory collection of ethno-local data-population descriptors reflecting local ethnic identification and racialization processes-integration of anti-racist and decolonial frameworks in medical education, legal accountability mechanisms, and recognition of racism as a fundamental determinant of health. Interventions targeting only individual bias will fail without addressing structural transformation.
Primary health care-oriented reforms: the political economy dynamics underlying health-system shifts across nine countries.
Kalita A, Croke K, Barbazza E … +14 more , Sparkes S, Cosmas L, Hassany M, Jurgutis A, Matheson D, Wa Mukalay AM, Partapsingh VA, Sabri B, Schenck M, Syed S, Tangcharoensathien V, Yelgezekova Z, Dalil S, Khalid F
Health Policy Plan · 2026 May · PMID 41955203 · Full text
Using evidence from nine countries (Democratic Republic of Congo, Dominica, Egypt, Kazakhstan, Kenya, New Zealand, Thailand, Tunisia, and Uruguay), we analyze the political economy dynamics that emerged during implementa...
Using evidence from nine countries (Democratic Republic of Congo, Dominica, Egypt, Kazakhstan, Kenya, New Zealand, Thailand, Tunisia, and Uruguay), we analyze the political economy dynamics that emerged during implementation of primary health care (PHC)-oriented reforms. Across these cases, we identify 10 recurring health-system "shifts" toward stronger PHC orientation, which serve as a descriptive framework for examining the political economy challenges reformers faced and the strategies they used to navigate them. Primary data were collected from 356 participants through key informant interviews, focus groups, and expert consultations and were triangulated with document review. Using deductive mapping and inductive thematic analysis, we identify 10 PHC-focused health-system shifts present in some or all of the cases. These entailed shifts from: (i) short-term initiatives with limited scope to long-term, system-wide transformations; (ii) centralized control to devolved multilevel governance; (iii) hospital-centric resource allocation to strategic reallocations favoring primary care; (iv) physician-dominated care to multidisciplinary teams including non-physician providers; (v) siloed disease-focused services to integrated models of comprehensive care; (vi) peripheral, minimally regulated private sectors to their integration and actively state-stewarded participation; (vii) passive input-based budget allocations and provider payments to strategic purchasing; (viii) perceiving citizens as passive recipients of care to building active community engagement; (ix) ad hoc data collection to embedded learning and accountability; and (x) externally driven changes to local ownership for reforms. Reforms routinely triggered political economy dynamics-opposition from physicians, hospitals, specialists, and central bureaucracies; citizen skepticism; and capacity and patronage challenges under devolution. Strategies to address these included: high-level endorsement and passage of legislation; use of political and economic windows of opportunity; local capacity-building; decentralized autonomy; formal engagement with physician associations; regulated private sector participation; strategic purchasing to incentivize a PHC approach; strong data systems and assessments; community engagement; and locally grounded design with domestic capacity and financing. The paper underscores the value of anticipating political economy dynamics for designing and implementing PHC-oriented reforms.
Tailored video-based lifestyle intervention for overweight or obese adults in Phnom Penh, Cambodia: a pilot cluster randomized controlled trial.
Yang Y, Yuth S, Hwang O … +1 more , Koy V
Health Policy Plan · 2026 Jun · PMID 41954907 · Full text
Physical activity plays a crucial role in preventing and managing obesity and its related comorbidities, with minimal side effects. Similarly, consuming a balanced diet is essential for maintaining good health and adequa...
Physical activity plays a crucial role in preventing and managing obesity and its related comorbidities, with minimal side effects. Similarly, consuming a balanced diet is essential for maintaining good health and adequate nutrition. However, most adults fail to meet population-based dietary and physical activity guidelines. In this pilot cluster-randomized controlled trial, we aimed to evaluate the effectiveness of a video-based physical activity and dietary intervention among adults aged 30-59 years in Phnom Penh, Cambodia. A total of 63 adults participated in the 12-week program, with 31 assigned to the intervention group and 32 to the control group. The intervention group received a video-based program delivered via Telegram and YouTube, complemented by a 2-h in-person session focusing on technical orientation and safety training. Standard care was provided to both the intervention and control groups and consisted of a single 60-min in-person lifestyle education session and a printed booklet commonly used in Cambodian health center settings. The intervention group demonstrated greater improvements in physical activity adherence, healthy eating adherence, exercise self-efficacy, healthy eating self-efficacy, systolic blood pressure, body weight, body mass index, waist circumference, fasting blood glucose, and high-density lipoprotein cholesterol levels compared with the control group (P < .05). Given its high accessibility and ease of implementation, video-based content appears to be an effective approach and policy for improving health behaviors, even in resource-limited settings. These findings support the use of video and digital platforms as potential strategies and evidence-based policy for preventing and managing non-communicable diseases in low-resource settings. Trial registration ISRCTN11839050 (retrospectively registered).
Building sustainable public health data science and informatics capacity: possibilities for Eastern Europe and Central Asia.
Gotsadze G, Gelashvili M, Zhuravliova E … +4 more , Barbakadze T, Gilvydis J, Levine R, Becknell S
Health Policy Plan · 2026 May · PMID 41928449 · Full text
Prevention, detection, and response to pandemic-prone diseases involve collecting, analyzing, and applying data swiftly at scale. Achieving these goals requires adequate information technology and a skilled public health...
Prevention, detection, and response to pandemic-prone diseases involve collecting, analyzing, and applying data swiftly at scale. Achieving these goals requires adequate information technology and a skilled public health workforce capable of translating data into action. While public health informatics and data science programs are established in parts of the Western world, Eastern Europe and Central Asia (EECA) face significant gaps in educational pathways. This study mapped the educational and labor market structures in Georgia, Kazakhstan, and Moldova, identified barriers to training and retaining professionals in public health informatics and data science, and proposed sustainable models for integrating training into national systems. A mixed-methods approach included a review of 111 policy and regulatory documents, labor-market analysis, 147 semistructured interviews, seven focus groups, and two expert workshops (n = 72) that validated findings and prioritized policy options. Although all three countries demonstrate strategic commitment to digital transformation, investment in human capital remains insufficient. Educational programs are isolated, with no accredited degrees in these professions, and accreditation processes delay educational innovations. Employers lack awareness of the value of these professions, and salary gaps between the health and information technology sectors, as well as between public and private sectors, weaken workforce retention. The absence of occupational recognition in national regulations further constrains workforce development. Stakeholders endorsed modular, competency-based training-integrated into Master of Public Health programs and in-service certificates-as the most feasible way to scale capacity. Building a sustainable workforce requires short-term measures such as problem-based and continuing training, along with long-term policies that (i) prioritize human capital development in national digital health strategies, (ii) adjust educational and occupational classifications, (iii) modernize accreditation processes for modular credentialing, and (iv) align incentives to attract and retain talent. Together, these actions could enable EECA health systems to harness digital innovation for better health outcomes.
Improving medication availability through mobile wallets and pooled community funds: results from the MoPuleesa hypertension intervention in rural Uganda.
Subramonia Pillai V, Favaretti C, Basenero A … +11 more , Ntambara JB, Wesva I, Jonathan KM, Munana R, Cazier J, Bärnighausen T, Schwab J, Wachinger J, Kalyesubula R, McMahon SA, Sudharsanan N
Health Policy Plan · 2026 Jun · PMID 41926709 · Full text
In Uganda, frequent shortages of antihypertensive medications hinder continuity of care, undermining blood pressure management. Building on preliminary ethnographic research, this study evaluates a community-led, mobile-...
In Uganda, frequent shortages of antihypertensive medications hinder continuity of care, undermining blood pressure management. Building on preliminary ethnographic research, this study evaluates a community-led, mobile-wallet-based pooling intervention-MoPuleesa-designed to improve medication access at a rural clinic in Nakaseke District, Uganda. Over a 7-month period, 183 patients enrolled and were linked to a digital savings platform that required monthly contributions of 5000 UGX (∼USD 1.39) into a communal fund to bulk-purchase medications at a discounted cost. Using survey data, transaction logs, and clinic records, we assessed contribution behavior, risk of adverse selection, equity, changes in medication availability, and patient blood pressure levels. On average, 48% participants contributed each month. Contribution rates showed no significant differences across education levels or medication costs, suggesting minimal equity concerns or adverse selection. Government pharmacies fulfilled only 8% of total prescriptions; however, for contributors, MoPuleesa closed 84% of the remaining medication gap. However, despite improvements in medication supply, we did not observe statistically significant improvements in blood pressure. Our findings demonstrate the feasibility and effectiveness of mobile money pooling in addressing chronic medication shortages. MoPuleesa achieved broad participation and equitable outcomes in a resource-constrained setting and significantly improved medication availability. We conclude that mobile-based fund pooling for medication can significantly improve medication supply and, with improvements in eligibility assessments, could serve as a complementary or intermediate solution to structural barriers in under-resourced health systems.
The effect of an educational campaign on contraception seeking in Northern Nigeria: an interrupted time series analysis using routine health information system data.
Okpani AI, Stucchi A, Cheng L … +8 more , Hamza KL, Mooney D, Adu P, Zeitouny S, Grépin KA, Hutcheon J, Schummers L, Law MR
Health Policy Plan · 2026 May · PMID 41925037 · Full text
In Nigeria, unmet need for contraception results in 3 million unintended pregnancies annually. Despite no-cost contraception availability at health facilities, only 38% of reproductive-aged women in Nigeria used effectiv...
In Nigeria, unmet need for contraception results in 3 million unintended pregnancies annually. Despite no-cost contraception availability at health facilities, only 38% of reproductive-aged women in Nigeria used effective contraception methods in 2023. We evaluated the impact of a radio-based contraception education campaign on contraception seeking in Kano State, Nigeria. Using monthly, facility-level data from Nigeria's national health management information system, we measured contraception seeking according to the number of 'family planning clients counselled' and 'new family planning acceptors' divided by facility catchment population estimates derived from Geo-referenced Infrastructure and Demographic Data for Development (GRID3). Using controlled interrupted time series analyses, we estimated contraception seeking before (January 2019-September 2021) and after (November 2021-December 2024) the radio campaign intervention in Kano. We controlled for preintervention trends and estimated changes relative to the neighbouring control state of Jigawa. Among 376 health facilities in Kano and 241 facilities in Jigawa with sufficient data points, we observed an increasing preintervention trend in family planning clients counselled and new family planning acceptors. The radio campaign was associated with a small nonsignificant decrease in family planning clients counselled in Kano immediately postintervention compared to Jigawa. This was offset by a decrease in the trend of 0.27 fewer clients per 1000 women per month in Kano thereafter [95% confidence interval (CI): 0.10-0.44], meaning the effects were not sustained. Similarly, new family planning acceptors increased by 1.62 (95% CI: 0.12-3.12) in Kano relative to Jigawa. This effect was also offset by a relative decline in the trend of 0.29 per 1000 fewer women per month (95% CI: 0.22-0.36). The introduction of a radio-based campaign in Kano, Nigeria, had no long-term effect on contraception seeking at health facilities. Alternative strategies are needed to increase contraception service use in Nigeria and similar contexts.
Applying a gender and equity matrix for a contextualized antimicrobial stewardship intervention in Pakistan.
Khan SA, Khan MA, Lynch I … +8 more , Khan N, Khan SE, Zafar F, Ventura-Gabarró C, Westwood E, Kalbarczyk A, Morgan R, Khan MA
Health Policy Plan · 2026 May · PMID 41915706 · Full text
Antimicrobial resistance (AMR) is a growing global health threat that extends beyond biomedical dimensions, as it is profoundly shaped by social and structural determinants such as gender, socioeconomic status, and acces...
Antimicrobial resistance (AMR) is a growing global health threat that extends beyond biomedical dimensions, as it is profoundly shaped by social and structural determinants such as gender, socioeconomic status, and access to care. However, research exploring these factors remains limited. This study adapts and applies a gender and equity matrix to examine how these factors intersect to affect AMR risks in rural Pakistan. We synthesized literature on antibiotic prescription and use in Pakistan and similar sociocultural and economic context settings, focusing on upper respiratory tract and diarrhoeal infections. We then integrated these findings with insights from a structured consultation with gender and public health experts. The gender and equity matrix mapped inequities across three topic-specific domains-susceptibility/vulnerability to infection, care provision (during facility visits), and care uptake (before and after facility visits)-cross-referenced with biological and social stratifiers along with gender analysis domains. Findings were synthesized into cross-cutting themes to identify actionable drivers of AMR. The context analysis highlighted persistent gender- and equity-related barriers in access to care, including women's limited mobility, lower health literacy, and restricted decision-making autonomy. We also identified structural constraints, including limited household financial resources that result in women being deprioritized for care, alongside gender-insensitive health care service delivery. In rural low- and middle-income countries' settings, addressing these barriers requires gender-responsive health system design, equitable provider-patient communication, and interventions that reduce economic and physical barriers to care uptake. The gender and equity matrix offers a structured approach to reveal how social and structural determinants interact to drive AMR risks, providing a practical tool for systematically integrating gender and equity considerations into AMR policy and programming.
Examining supplier-induced demand under regulated fees: dynamic panel evidence from Iran.
Alinia C, Yusefzadeh H
Health Policy Plan · 2026 May · PMID 41915635 · Full text
Cataract surgery is among the most frequently performed procedures globally and in Iran, often regarded as highly effective and cost-efficient. However, its rapid growth, particularly under a fee-for-service model, raise...
Cataract surgery is among the most frequently performed procedures globally and in Iran, often regarded as highly effective and cost-efficient. However, its rapid growth, particularly under a fee-for-service model, raises concerns about supplier-induced demand, where providers may influence patients to undergo potentially discretionary procedures to maintain income. We analyzed administrative data from the Iranian Armed Forces Insurance Organization, covering active and retired military personnel and their families across all 31 provinces. In total, 108 055 cataract surgeries performed by 644 ophthalmic surgeons during the study period were included. As service provision and coverage for armed forces beneficiaries may differ from the general population, through dedicated military hospitals or subsidized services in public hospitals, the findings primarily reflect utilization patterns within this insured population. We employed regression-based methods to examine the relationship between surgeon density and surgery rates. A 10% increase in ophthalmologist density is associated with a 4.9%-6.2% increase in surgery count, 7.3%-7.9% in service volume, and 1.5%-1.9% in service value, indicating both quantitative and qualitative dimensions of inducement. Lagged service variables demonstrated significant persistence, reflecting clinical inertia. Income became a significant determinant only in the dynamic model, highlighting the role of latent demand-side factors. Our findings provide evidence consistent with supply-sensitive utilization patterns predicted by SID theory in Iran's cataract surgery sector. These insights underscore the need for targeted policy interventions, including payment reform, utilization oversight, and equitable workforce distribution, to align provider behavior with clinical necessity and system efficiency.
Macroeconomic fluctuations and the prioritization of healthcare funding by local governments: longitudinal evidence from 5461 Brazilian municipalities.
Arruda H, Codazzi K, Rocha R … +2 more , Suhrcke M, Hone T
Health Policy Plan · 2026 May · PMID 41906640 · Full text
Securing sufficient healthcare funding remains a critical challenge for many low- and middle-income countries (LMICs), especially during periods of economic instability. While economic growth often boosts health system f...
Securing sufficient healthcare funding remains a critical challenge for many low- and middle-income countries (LMICs), especially during periods of economic instability. While economic growth often boosts health system finances in LMICs, little is known about how local governments adjust healthcare spending in response to macroeconomic fluctuations, particularly during recessions. This study analyses a longitudinal dataset of 5461 Brazilian municipalities between 2004 and 2017, using fixed-effect panel regressions to examine the relationship between municipal Gross Domestic Product (GDP) changes and healthcare spending. There is a positive elasticity between the economic conditions, measured by GDP, and municipal financial expenditures, particularly health and social expenditures. A 1% increase in municipal GDP per capita was associated with a 0.06% [95% confidence interval (CI) 0.04-0.09] increase in total municipal expenditures and a 0.12% (95% CI 0.06-0.18) increase in health and sanitation expenditures. However, during recessions, municipal governments reduced health expenditures, particularly for capital investments. Municipalities with lower income per capita and lower private insurance coverage were more vulnerable to these cuts in economic downturns. We find suggestive evidence that the cuts in poorer municipalities and in municipalities relying disproportionately on federal transfers were more pronounced for social and health expenditures, although the difference between municipalities is small. These findings highlight the sensitivity of local finances to economic fluctuations, underscoring the need for policies that protect healthcare funding during economic downturns.
Managing public-private partnerships for health diagnostics: challenges and strategies.
Bennett S, Applegate J, Bunyasi B … +11 more , Nwameme AU, Orata N, Neel A, Paina L, Affram AA, Abankwah DNY, Abseno M, Rodriguez DC, Mitike G, Nonvignon J, Wafula F
Health Policy Plan · 2026 May · PMID 41902391 · Full text
This paper draws upon a process evaluation of a public-private partnership (PPP) for diagnostics in three Sub-Saharan African countries, Ethiopia, Ghana and Kenya. The study sought to identify challenges in managing heal...
This paper draws upon a process evaluation of a public-private partnership (PPP) for diagnostics in three Sub-Saharan African countries, Ethiopia, Ghana and Kenya. The study sought to identify challenges in managing health PPP projects and potential solutions. We used an extensive document review and 72 recent key informant interviews (KIIs), building on 63 KIIs previously conducted to analyze the African Health Diagnostics Platform (AHDP) project in-depth. Our analysis employed a framework developed by Magalhaes et al based on the broader (non-health) PPP literature that identifies key challenges, strategies and success factors in PPP management across three main stages of PPP implementation. We find considerable alignment between the management challenges identified in the broader PPP literature and AHDP. Certainly, intensive negotiations and high transaction costs; difficulties managing risks and financing; the need for highly complex planning; and challenging stakeholder management all played a role in slowing progress on AHDP. An additional, critical theme concerns lack of capacity for managing health PPPs. The AHDP project generated a number of innovations to facilitate management but overall, if health PPPs are to succeed, more needs to be done to support their implementation. In particular, we propose investment in training government and technical assistance providers in health PPPs; development of repositories of guidance documents to support health PPPs; employment of systems-thinking based planning approaches that illuminate connections across the health system; more sophisticated approaches to stakeholder management; and investment in research that supports modeling of different PPP arrangements and how their progression is influenced by local contextual factors. While evidence on the impact of health PPPs remains scarce, moves toward increased healthcare corporatization in the context of dwindling aid underscores the urgency of building experience and evidence on PPPs in healthcare and other social sectors.
Toward a common lexicon in gender analysis for global health programs and policies.
Morgan R, Kalbarczyk A
Health Policy Plan · 2026 May · PMID 41886606 · Full text
Gender and gender analysis are frequently misunderstood or conflated with sex and gender identity, resulting in inconsistent terminology across cultural, social, and organizational contexts in global public health. This...
Gender and gender analysis are frequently misunderstood or conflated with sex and gender identity, resulting in inconsistent terminology across cultural, social, and organizational contexts in global public health. This ambiguity has proliferated diverse frameworks and scales to assess gender-responsiveness, hindering comparison and implementation. Terms like gender mainstreaming, integration, and analysis are often used interchangeably despite distinct functions. As a methodological musing, this paper proposes normative definitions for commonly used terms-gender-responsiveness, gender mainstreaming, gender integration, gender analysis, gender situational analysis, gender assessment, and gender needs assessment-highlighting what each is/is not and providing usage guidance. This paper is intended as a methodological intervention in global public health and health policy/systems research, where terminological ambiguity can challenge credibility, limit comparability across studies and organizations, and obscure claims about how gendered power relations shape health and health systems. By offering clear definitions and guidance on the appropriate use of these terms, we aim to support a more coherent and rigorous approach to gender-responsive approaches and strategies.
Privatization of maternal care and women's access to quality healthcare: a case study on middlemen in Bangladesh.
Shahrin A, Berry NS, Richards J … +2 more , Janes CR, Halim A
Health Policy Plan · 2026 May · PMID 41873671 · Full text
This study critically examines how the unregulated expansion of private healthcare, coupled with health-system challenges such as corruption, and lack of monitoring and accountability, affects women's experiences of obta...
This study critically examines how the unregulated expansion of private healthcare, coupled with health-system challenges such as corruption, and lack of monitoring and accountability, affects women's experiences of obtaining healthcare in Bangladesh. Based on in-depth qualitative interviews with 31 female patients, 28 biomedical providers, and 12 health administrators and policymakers, we found that the absence of effective regulation, supervision, and accountability, particularly in the private healthcare sector, has fostered an environment where private biomedical providers can engage in harmful practices. These practices are often facilitated by informal actors, popularly known as "dalal" (middlemen or brokers). These middlemen serve as marketing channels for many private healthcare providers, directing socially and economically marginalized women toward unregulated services. This situation can result in harmful medical practices, such as unnecessary hysterectomy surgeries, leading to serious complications like genital fistula. Our findings illustrate that increased access to healthcare providers, without adequate regulation and monitoring, fails to ensure a better quality of care for disadvantaged women and instead exacerbates their health issues while creating financial burdens for families. The presence of middlemen in healthcare is not merely indicative of individual misconduct but reflects broader policy and systemic failures. Addressing their role requires structural reforms that emphasize regulation, public accountability, and quality of care, alongside a critical re-examination of global health metrics that emphasize contact and access over equity and health outcomes.
Local level health governance strengthening for universal health coverage: implementing the Bayang Malusog-Municipal Leadership Development Program in Aklan, Philippines.
Pepito VCF, Chung CA, Capeding TPJZ … +7 more , Comia AA, Faraon ARG, Sedillo DS, Sualog MEC, Prieto-Carolino AC, Padilla PIP, Dayrit MM
Health Policy Plan · 2026 May · PMID 41870188 · Full text
The devolution of health systems development to local governments in the Philippines in 1991 brought with it unintended consequences as local chief executives found themselves with new responsibilities for which they wer...
The devolution of health systems development to local governments in the Philippines in 1991 brought with it unintended consequences as local chief executives found themselves with new responsibilities for which they were not prepared. These unintended consequences were exacerbated with the implementation of the country's Universal Health Care Act in 2019. To address this problem, the Zuellig Family Foundation, a non-profit and non-government organization based in the Philippines with the aim of improving health outcomes, has designed a local level health governance strengthening intervention: the Bayang Malusog (literally Healthy Communities) Municipal Leadership Development Program (BM-MLDP). The BM-MLDP is a 12-month capacity building intervention for local chief executives and local health officials consisting of deep dive immersions, change management and leadership sessions, sustainability of health reform sessions, and co-design sessions to improve population health outcomes. Its implementation on the municipalities of Balete and New Washington in 2022-2023 contributed to improving and sustaining optimal population health outcomes despite resource constraints. This highlights the potential of health governance and capacity building interventions like the BM-MLDP in improving population health outcomes and advancing the implementation of universal health coverage in resource-constrained, devolved healthcare settings.
WHO guidelines on physical activity, sedentary behaviour, and sleep for children under 5: a qualitative study of Mongolian stakeholder perceptions.
Byambaa A, Jones RA, Okely AD
Health Policy Plan · 2026 May · PMID 41845467 · Full text
WHO's '24-hour movement guidelines' provide integrated recommendations for physical activity, sedentary behaviour, and sleep to improve health outcomes in children aged 0-5. This study aimed to examine stakeholders' perc...
WHO's '24-hour movement guidelines' provide integrated recommendations for physical activity, sedentary behaviour, and sleep to improve health outcomes in children aged 0-5. This study aimed to examine stakeholders' perceptions about these guidelines to inform its future adoption, adaptation, and implementation decisions in Mongolia. Key stakeholders involved in young children's health and development were recruited through purposive sampling and snowball methods. Semi-structured interviews spanning 30-50 minutes were conducted with 38 participants using an interview guide in Mongolian language: caregivers (n = 19), kindergarten teachers (n = 14), health and policy professionals (n = 5). Audio-recorded data were transcribed, translated to English, and thematically analysed using deductive thematic analysis. Four main themes were identified: (i) awareness and appropriateness, (ii) understanding of the guidelines, (iii) perceived factors influencing adoption and implementation, and (iv) dissemination and implementation strategies. Stakeholders were mostly unaware of the WHO guidelines but perceived them as useful, feasible and culturally appropriate. Stakeholders identified barriers including competing priorities (e.g. work/family obligations), environmental challenges (lack of child-friendly spaces, cold weather, air pollution), and knowledge and capacity gaps. Stakeholder-recommended strategies for effective dissemination and implementation were kindergarten-based integration, training for caregivers and teachers, and adequate resource provision. Dissemination should use multichannel communication approaches emphasizing benefits, potential consequences of non-adherence, and provide specific, culturally relevant examples. This study provides first examination of stakeholder perspectives on WHO 24-hour movement guidelines in Central Asia. These preliminary findings suggest that successful adoption may require cultural adaptation, stakeholder education, and leveraging existing infrastructure and policy frameworks, though education sector consultation would be needed for comprehensive feasibility assessment.
Pain, policy, and the opioid dilemma in sub-Saharan Africa: a systematic review of access, regulation, and health governance from 1990 to 2024.
Nyarko S, Atinga RA, Mahama JC
Health Policy Plan · 2026 May · PMID 41833448 · Full text
Sub-Saharan Africa (SSA) faces a dual opioid dilemma: widespread undertreatment of moderate to severe pain due to limited access to essential opioid analgesics, alongside increasing concern about misuse and diversion in...
Sub-Saharan Africa (SSA) faces a dual opioid dilemma: widespread undertreatment of moderate to severe pain due to limited access to essential opioid analgesics, alongside increasing concern about misuse and diversion in selected contexts. Opioids are clinically indicated for severe cancer-related pain, advanced chronic illness, major trauma, surgery, and end-of-life care; yet, regional consumption remains disproportionately low relative to documented disease burden, indicating systemic under-provision rather than low need. This systematic review synthesizes evidence on opioid policy, regulation, access, and governance in SSA to examine how legal frameworks, institutional arrangements, political dynamics, and data systems shape medical availability. Following PRISMA and SWiM guidance, we reviewed peer-reviewed and gray literature addressing national drug control laws, regulatory implementation, procurement and supply systems, prescribing authority, and surveillance capacity; 33 studies met inclusion criteria. Across settings, restrictive or ambiguously interpreted legislation, multi-layered administrative controls, fragmented mandates across health and enforcement institutions, weak forecasting and distribution systems, concentrated prescribing authority, professional risk aversion, and chronic data gaps were consistently associated with constrained access. Concurrently, rising political and media attention to non-medical use, particularly of tramadol, has reinforced enforcement-oriented narratives that may further limit reform space. Persistent deficiencies in routine consumption data and unmet need assessment contribute to conservative import quotas and regulatory inertia. Addressing this imbalance requires proportionate, sequenced reform that strengthens data and forecasting systems, clarifies and aligns legal mandates with public health objectives, invests in workforce capacity and supply chains, and embeds safeguards against diversion while correcting avoidable under-treatment.
Cost-effectiveness analysis of vitamin A supplementation delivery modalities in the DRC, Togo, and Niger: informing sustainable program design.
Corball L, Chappel K, Rowett H … +3 more , Laillou A, Hasman A, Kawai N
Health Policy Plan · 2026 May · PMID 41810525 · Full text
This study examines how the costs, health impacts, and efficiency of two-dose vitamin A supplementation (VAS) vary across delivery platforms, population subgroups, and delivery contexts in Togo, Niger, and the Democratic...
This study examines how the costs, health impacts, and efficiency of two-dose vitamin A supplementation (VAS) vary across delivery platforms, population subgroups, and delivery contexts in Togo, Niger, and the Democratic Republic of the Congo (DRC). Using a scenario-based model, it compares provider costs and disability-adjusted life years (DALYs) averted and identifies reallocations that maximize health gains under fixed budget constraints. Costs were estimated from the health provider perspective, and health outcomes were measured in DALYs averted. The results showed that cost-effective scenarios varied significantly across countries; in the DRC and Niger, campaigns delivered high coverage but at a substantially higher cost than routine delivery, whereas in Togo, campaigns were both low-cost and high-coverage. In all countries, the most cost-effective scenarios prioritized children aged 6-23 months. More than two-thirds of the cost-effective scenarios achieved better outcomes at lower cost than countries' current delivery strategies, highlighting significant potential for efficiency gains. A positive, nonlinear relationship between incremental costs and DALYs averted was observed: greater investment generally led to larger health gains but returns diminished as costs increased. A sensitivity analysis showed that facility-based supply shortages negatively affected effectiveness, whereas strengthened routine delivery improved effectiveness. Optimal VAS strategies must be context-specific, balancing the reach of campaigns with the sustainability of routine services. The decision tool provides a practical mechanism for identifying cost-effective delivery strategies tailored to national capacities and constraints.
Aid cut, lives lost: estimating the impact of USAID's withdrawal on maternal mortality in six African countries.
Cummins M
Health Policy Plan · 2026 May · PMID 41807120 · Full text
In January 2025, the US government suspended and subsequently terminated the majority of United States Agency for International Development (USAID) programs. This study estimates the impact of that decision on maternal m...
In January 2025, the US government suspended and subsequently terminated the majority of United States Agency for International Development (USAID) programs. This study estimates the impact of that decision on maternal mortality in six highly vulnerable countries in West and Central Africa: Burkina Faso, Central African Republic, Chad, Mali, Niger, and Nigeria. Using a deterministic model grounded in regional health expenditure elasticities, the analysis projects how the sudden withdrawal of foreign aid affects health spending among populations in humanitarian need, under the assumption that no immediate domestic or external financing substitutes for the lost resources, and the resulting changes in maternal mortality ratios (deaths per 100 000 live births). The results indicate that the funding cuts could cause maternal deaths to increase by 45%, on average, among populations in need. This increase is estimated relative to a baseline of approximately 2900 maternal deaths predicted in 2025, yielding approximately 1000 additional deaths across the countries within a single year. The magnitude of impact varies, with Niger experiencing the largest proportional increase (over 90%) and Nigeria the largest absolute increase (more than 300 additional deaths). Sensitivity analyses confirm that the results are robust to alternative elasticity scenarios. The findings illustrate the degree to which maternal health outcomes in fragile settings are sensitive to financing discontinuities. The results are presented as conditional estimates and are intended to inform ongoing discussions on health financing sustainability, transition planning, and risk mitigation.
Gavi's Zero-Dose Learning Hubs: enhanced approach for evidence generation and use from local to global.
Reynolds HW, Corrêa GC, Vollmer N … +4 more , Broekhuysen E, Saville E, Hogan D, Johnson HL
Health Policy Plan · 2026 Apr · PMID 41805772 · Full text
Reaching and fully immunizing zero-dose (ZD) children and missed communities is at the core of the Gavi, The Vaccine Alliance 5.0/5.1 and Immunization Agenda 2030 strategies. This is critical to ensure equitable immuniza...
Reaching and fully immunizing zero-dose (ZD) children and missed communities is at the core of the Gavi, The Vaccine Alliance 5.0/5.1 and Immunization Agenda 2030 strategies. This is critical to ensure equitable immunization coverage and access to other primary health care services and to prevent outbreaks. The diversity of settings where these children live and the complexity of vaccination barriers require a complementary set of activities embedded in national systems. Learning approaches are needed to use evidence to improve equity and reach. Gavi has helped fill this gap with the Zero-Dose Learning Hub (ZDLH) initiative, which is composed of consortia partners in four countries-Mali, Nigeria, Uganda, and Bangladesh-and a global-level consortium. This paper describes the ZDLH design, theory of change, methods, and measures of success. Then, future papers will present ZDLH results, successes and challenges, and recommendations. The ZDLH initiative is prospective and runs through 2025. It features primary evidence generation through rapid assessments, improved monitoring, implementation research in targeted subnational areas where ZD children are located, and country-specific learning agendas and knowledge translation activities to facilitate evidence use. The global-level consortium offers technical assistance to country learning hubs and facilitates synthesis, dissemination, and improves evidence use across low- and middle-income countries. A common measurement, evaluation, and learning plan documents whether evidence is generated and used and how the overall model works to inform future adaptation. Target audiences for evidence are the Gavi Board; Gavi strategy, programme, and country teams; countries' ministry of health and immunization programmes at national and subnational level; and other donors and implementing partners working to improve immunization equity. The ZDLH initiative is a coherent approach to evidence generation and learning, and the implementation experience informs how to better design and support learning systems embedded within National Health Systems.
Government-led scale-up of task-shifted mental health services in Lagos State, Nigeria: a mixed-methods descriptive-explanatory case study.
Adewuya AO, Ola B, Coker O … +4 more , Atilola O, Olibamoyo O, Lebimoyo A, Oladipo O
Health Policy Plan · 2026 May · PMID 41802917 · Full text
Mental health conditions remain a leading contributor to global disability; however, treatment coverage in low- and middle-income countries (LMICs) stays below 20%; in Nigeria, services are underfunded and largely exclud...
Mental health conditions remain a leading contributor to global disability; however, treatment coverage in low- and middle-income countries (LMICs) stays below 20%; in Nigeria, services are underfunded and largely excluded from primary health care (PHC). This study documents the institutional processes through which the Transition-to-Scale phase of the Mental Health in Primary Care (MeHPriC) initiative scaled up task-shifted mental health services across Lagos State, Nigeria. A retrospective, mixed-methods descriptive-explanatory case study was conducted across 57 PHCs and five general hospitals. The intervention delivered care for five priority mental, neurological, and substance use conditions using the Mental Health Gap Action Programme (mhGAP) framework; 890 health workers were trained, comprising 400 Community Health Extension Workers (CHEWs), 250 nurses, 150 medical officers, 85 lay counsellors, and 5 district psychiatrists, under structured district-level supervision. Data from service registers, supervision checklists, stock audits, provider and client surveys, key informant interviews, focus groups, and policy documents were analysed using descriptive statistics and hybrid deductive-inductive thematic coding organized around the World Health Organization (WHO) Health System Building Blocks and selected Consolidated Framework for Implementation Research (CFIR) constructs. The initiative was associated with institutional changes across governance (establishment of a Mental Health Desk and a multisectoral Stakeholders Council), workforce supervision (fidelity rising from 13% to 92.3% of facilities conducting weekly case reviews), medicines (six psychotropic medications added to the Essential Medicines List; stockouts reduced by 42%), financing (₦75 million allocated through routine government budgeting), service delivery (64 107 clients screened and 9138 initiated on treatment), and health information systems. Interpreted as incremental strengthening within the mental health subsystem, these findings reinforce the feasibility of mhGAP-aligned task-shifted care when supported by structured supervision and governance, while persistent fiscal and operational constraints underscore the fragility of institutional gains.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe