Health Policy And Planning[JOURNAL]
Sun
200 papers
Stakeholder perceptions of political and economic factors influencing vaccination in two States with a high burden of zero-dose children in Nigeria.
Akande TM, Bolarinwa OA, Salaudeen AG … +8 more , Dahab M, Adesoro O, Khogali A, Ahmar S, Ahmed T, Makunja S, McGowan CR, Abdelmagid N
Health Policy Plan · 2026 Mar · PMID 41588659 · Full text
Globally, an estimated 22.7 million children are unimmunized or 'zero-dose' (ZD), with 3.1 million in Nigeria. The political and economic environment plays a critical role in influencing the number of ZD and under-immuni...
Globally, an estimated 22.7 million children are unimmunized or 'zero-dose' (ZD), with 3.1 million in Nigeria. The political and economic environment plays a critical role in influencing the number of ZD and under-immunized children. We explored stakeholder perceptions of the political and economic context of vaccination services in Kano and Lagos States, two Nigerian States with a high number of ZD children. We conducted stakeholder mapping, followed by key informant interviews with 84 State, local, and community informants responsible for or influential in immunization. Transcripts were analyzed using a reflective thematic framework approach. We describe the multi-level network of domestic and international actors characterizing Nigeria's immunization policymaking and implementation landscape. Respondents perceived a strong and mutual political commitment by all actors involved in routine immunization. The pivotal role of local influencers further reinforced this commitment, from traditional to religious leaders, to improving uptake in challenging settings. Knowledge of national policies, and thus, perception of their adequacy in addressing under-immunization, was weakest among participants working at the local and community levels. Other reported barriers to policy implementation included bureaucratic delays in fund disbursement, outdated policies, slow dissemination of policies to local levels, and inadequate policy provisions for funding and staffing at the local level. To enhance equitable immunization coverage in Kano and Lagos, our findings suggest a need for meaningful engagement of community actors in policy development, timely policy revisions, and the establishment of mechanisms for expediting fund disbursements and addressing funding shortfalls at the local levels.
Celebrating the 40th anniversary of Health Policy and Planning.
Mills A, Walt G, Gilson L … +1 more , Wiseman V
Health Policy Plan · 2026 Jan · PMID 41574998 · Full text
Abstract loading — click title to view on PubMed.
Self-reported job histories: potential value of the method in health policy and systems research.
Purohit B, Orole F, Hill PS
Health Policy Plan · 2026 Mar · PMID 41562870 · Full text
In the absence of documented health workforce deployment policies and limited access to key job history data, existing health systems research methods are inadequate for examining policy implementation. The analysis of s...
In the absence of documented health workforce deployment policies and limited access to key job history data, existing health systems research methods are inadequate for examining policy implementation. The analysis of self-reported job histories offers a valuable research method for overcoming these limitations; however, its application and usefulness remain largely unexamined in health system and policy research, particularly in the context of health workforce and policy implementation. In this paper, we reflect on our experiences of using self-reported job histories to investigate the experiences of public sector doctors with deployment systems related to recruitment, initial posting, and transfers. We interviewed 33 public sector doctors from two Indian states to gain insight into their experiences with policies and systems related to deployment. The initial interview process revealed a pattern in which the doctors developed a work-life chronology to organize their responses. This was formalized in subsequent interviews, creating structured chronological job histories. Job histories serve as a useful and flexible research method for understanding the complexities of how health workforce deployment systems operate and are experienced by health workers. Commentary by doctors regarding these job histories revealed negative perceptions of transfer practice, disruptions in their career trajectories, and gaps in policy implementation. The recollection process of forming job histories is organic and fluid, rich in qualitative data, and its construction involves making sense of diverse work-related stories of health workers. Job histories offer flexibility for collecting data in a more structured manner through a simple set of quantitative questions. Despite their usefulness, constraints such as the inability to triangulate and recall bias exist. Beyond research, job history analysis has practical implications; it is useful for policy implementers and researchers through a more nuanced analysis of challenges related to effective workforce management systems, thereby improving workforce planning, policies, and systems.
Justice at the interface: advancing community and health system resilience through intersectionality theory.
Roux J, Doorn N, Hinrichs-Krapels S … +1 more , Copeland S
Health Policy Plan · 2026 Mar · PMID 41549066 · Full text
Current approaches to health system resilience tend to prioritize system-level outcomes (e.g. functionality) while overlooking key underlying social processes, contexts, and power-laden interactions through which resilie...
Current approaches to health system resilience tend to prioritize system-level outcomes (e.g. functionality) while overlooking key underlying social processes, contexts, and power-laden interactions through which resilience is produced. When community resilience is subsumed under health system resilience, without attending to distinct contextual factors, it can lead to fragmented approaches or maladaptive outcomes that misalign with the resilience of communities. Therefore, resilience approaches need to include additional methods that incorporate analyses of power structures and context. We propose intersectionality theory as a methodological lens to investigate the underlying social processes and power dynamics that shape community resilience and health system resilience interactions. An intersectionality approach prompts researchers to distinguish how resilience capacity is derived through the involvement of community actors, their unique intersecting social identities, and their lived experiences. Including an intersectional lens in resilience approaches provides researchers with the tools to identify points of practical constraints that arise at the intersection of communities and health systems, with particular attention on the burdens that are placed on community actors.
Pathways of change for essential newborn care practices and health care seeking: a process evaluation of Mamás del Río, a community-based, maternal and neonatal health intervention in the Peruvian Amazon.
Reinders S, Blas MM, Alva A … +3 more , Huicho L, Ronsmans C, Lange IL
Health Policy Plan · 2026 Mar · PMID 41544655 · Full text
In rural Indigenous communities in the Peruvian Amazon, access to quality care is difficult, home births are frequent, and neonatal mortality remains high. Peru has a large cadre of Community health workers (CHW), yet th...
In rural Indigenous communities in the Peruvian Amazon, access to quality care is difficult, home births are frequent, and neonatal mortality remains high. Peru has a large cadre of Community health workers (CHW), yet their potential is not harnessed. A recent outcome evaluation of a community-based intervention showed improvements in essential newborn care (ENC) for home births and small increases in facility births. To explain these findings, elucidate the pathways of change, and derive policy recommendations, we conducted a mixed-methods process evaluation. Implementation strength, mechanisms of change, and influence of contextual factors were assessed using data collected from women, CHW, traditional birth attendants (TBA), supervisors, and community members. We calculated programme coverage and intervention exposure and explored experiences, perceptions, and birth stories through interviews, focus group discussions, and participant observation using content analysis. Triangulated findings were narratively synthesized and contrasted to hypothesized intervention mechanisms. The programme achieved high coverage of well-trained CHW and TBA supported by intensive supervision. Multiple pathways of change were identified: Trained TBA as main providers of home-based birth care implementing ENC; CHW home visits sensitizing women through educational videos and provision of delivery kits, albeit with less reach and counselling than expected; and supervisor-led, women-only educational meetings. Some CHW proactively facilitated access to facility care, while promotion alone to increase demand appeared insufficient. Pathways of change identified support a causal link between the intervention and observed behaviour changes in the outcome evaluation. Our findings demonstrate the potential of community-based approaches involving CHW and TBA which should be given greater importance in national health policy. To improve impact and sustainability of the Peruvian CHW programme, we provide several context-specific recommendations.
Primary health care networks and impacts in low- and middle-income countries: a systematic review.
Gadeka DD, Aryeetey GC, Bour H … +6 more , Okudzeto H, Addo P, de Siqueira Filha NT, Ebenso B, Elsey H, Agyepong IA
Health Policy Plan · 2026 Mar · PMID 41540717 · Full text
Primary healthcare provider networks (PHCPNs) are increasingly recognized as promising strategies to effectively strengthen health systems in low- and middle-income countries (LMICs). However, there is limited informatio...
Primary healthcare provider networks (PHCPNs) are increasingly recognized as promising strategies to effectively strengthen health systems in low- and middle-income countries (LMICs). However, there is limited information on the influence PHCPNs may have on the process and clinical outcomes of health services. This study sought to answer the questions: what is the extent, range, and nature of research on PHCPNs in LMICs, what are the types of PHCPNs described, and what are the processes, e.g. access to care, coverage of health services, quality of care and services, safety of care, and the clinical care outcomes of PHCPNs reported in the published literature? We report on a systematic mixed-methods review on PHCPNs as a strategy to strengthen health systems in LMICs following the PRISMA guidelines. The quality of the included studies was assessed using the ROBINS-I and Mixed Methods Appraisal tools, while a narrative synthesis was employed to describe the results. Fifteen primary studies were found eligible for the review. From the included papers, eight types of PHCPNs were identified across various contexts and countries. We found that the PHCPNs primarily focus on maternal, newborn, and child health outcomes. The study reveals that: (i) PHCPNs contribute to improvements in the process outcomes of health services by enhancing access to care, coverage of health services, quality of care and services, and safety of care, and (ii) they support improvements in clinical outcomes by helping to reduce maternal, neonatal, and perinatal mortalities and stillbirths. This body of literature we reviewed suggests that PHCPNs make a difference in the process and clinical outcomes of health services in LMICs. This review serves as both a mapping and clarification exercise to promote the adoption of PHCPNs and as a foundation for further research, especially in areas of health services beyond maternal, newborn, and child health.
Health systems resilience and private for-profit sector engagement: lessons from the second COVID-19 wave in Uttar Pradesh, India.
Meghani A, Hariyani S, Singh P … +1 more , Bennett S
Health Policy Plan · 2026 Apr · PMID 41527902 · Full text
India's second wave of the COVID-19 pandemic in April-June 2021 involved an explosion of case numbers, with devastating consequences for the country's already strained health systems. This case study examines the private...
India's second wave of the COVID-19 pandemic in April-June 2021 involved an explosion of case numbers, with devastating consequences for the country's already strained health systems. This case study examines the private health market response to the pandemic in Uttar Pradesh, India's most populous state. We analyzed 203 news articles to understand both the experiences of private providers and patients in response to government policies being implemented in the state. This analysis informed our interviews with 20 state-level officials, district-level key informants, and formal and informal private for-profit providers across three districts. We found that private-sector hospitals were rapidly engaged to manage a surge in new infections and severe cases, but private bed capacity quickly filled, causing patients to be turned away. Informal private providers played a vital role in rural areas, serving as round-the-clock care sources. However, the news media reported inadequate medical care from such providers leading to COVID-19-related deaths. Access to reliable information on COVID-19 was challenging and social media became a platform for citizens and providers to share information about available resources, treatment, and COVID-19 management. However, misinformation also spread. While the government attempted to counter misinformation and regulate private hospitals, challenges persisted in providing and accessing accurate information. Oxygen and drug supply challenges also emerged, with private hospitals requiring patients to arrange for oxygen themselves due to scarcity. To address this and rising costs of care, the government issued price caps, monitored overcharging, and regulated drug and oxygen distribution. Government schemes also attempted to provide insurance for both public and private health workers, however, awareness and implementation of such schemes were inadequate. Policymakers should develop mechanisms to engage, or where relevant, integrate all private for-profit providers onto a common platform, strengthen referral linkages amongst them, and support communities of practice to increase awareness of government health policies and improve the implementation of government schemes. Such measures would help facilitate equitable access to care and help manage current health needs and future health emergencies.
Identifying community pharmacists' preferences for attributes of public health interventions in Kenya: a discrete choice experiment.
Mumbi A, Abiiro GA, Kazungu J … +2 more , Nzinga J, Barasa E
Health Policy Plan · 2026 Mar · PMID 41525313 · Full text
Community pharmacies are increasingly recognized as access points for public health interventions (PHIs) such as vaccination, family planning services, and disease screening. In Kenya, evidence suggests the feasibility o...
Community pharmacies are increasingly recognized as access points for public health interventions (PHIs) such as vaccination, family planning services, and disease screening. In Kenya, evidence suggests the feasibility of pharmacy-delivered PHIs; however, the uptake remains inconsistent. This is partly attributed to poor programme design without taking pharmacy providers preferences into consideration. We employed a discrete choice experiment (DCE) to investigate community pharmacists' preferences for attributes of PHIs delivered in community pharmacies in Kenya. We constructed a Bayesian efficient design and conducted a DCE survey among 663 community pharmacy providers in Makueni, Nairobi, and Kisumu counties in Kenya from January 2025 to March 2025. Panel multinomial mixed logit, generalized multinomial logit, and latent class models were used in the analysis. We also estimated willingness to pay (WTP) and willingness to accept (WTA) estimates using cost and profit margins as the monetary estimates, respectively. We found that community pharmacists were willing to offer PHIs with a low preference for opting out (β = -3.5723, P < 0.01). Preferences for PHIs significantly increased with higher profit margins (β = 0.028, P < 0.01) and decreased with higher cost of equipment (β = -0.00023, P < 0.01). There were higher preferences for PHIs that require moderate training (β = 0.266, P < 0.01) and extensive training (β = 0.141, P < 0.05) compared to no additional training and lower preferences for PHIs with complex interventions compared to simple interventions (β = -0.323, P < 0.01). The WTP estimates showed that providers were willing to pay Khs. 11 738 (USD 90) for moderate training and Kshs. 7327 (USD 56) for extensive training. Moreover, the WTA estimates showed that providers were willing to accept a 10.9% increase in profit margin in order to deliver complex interventions. In addition to this, a three-class latent class model revealed preference heterogeneity among the respondents. These findings can be used to inform the design of PHIs to enhance uptake and acceptability among providers.
Power, interests, and maternal health care: a political economy analysis of service delivery redesign in Kenya.
Nzinga J, Olwanda E, Opondo K … +6 more , Kimutai H, Cooper J, Arwah B, Tsofa B, Barasa E, Croke K
Health Policy Plan · 2026 Apr · PMID 41413900 · Full text
The maternal and newborn health (MNH) service delivery redesign (SDR) in Kakamega County, Kenya, represents the country's first system-level reorganization of MNH services. The reform aimed to improve care quality and re...
The maternal and newborn health (MNH) service delivery redesign (SDR) in Kakamega County, Kenya, represents the country's first system-level reorganization of MNH services. The reform aimed to improve care quality and reduce mortality by centralizing delivery services at designated hubs. Using a political economy lens, we examined how ideology, political dynamics, and institutional structures shaped the agenda-setting, adoption, implementation, and sustainability of SDR. We drew on data from document reviews, stakeholder analysis, semi-structured interviews, and non-participant observation to assess the structural, contextual, and institutional factors influencing the reform. Ambiguity around SDR's purpose contributed to the community's uncertain engagement characterized by neither full endorsement nor resistance, highlighting the need for clearer communication and participation to build ownership. The interaction between formal institutions (county health governance and partnership frameworks) and informal norms (trust, shared interpretation, and relational coordination) created early momentum for implementation, particularly among health system actors. However, limited financial capacity and unclear alignment with national policy priorities undermined progress and long-term viability. Kakamega's experience demonstrates how political incentives, devolved autonomy, and local institutional context jointly shape reform outcomes. Achieving successful implementation of system-level reforms requires integrating local political leadership, strengthening community engagement, aligning with evolving national policies, and securing predictable financing. This study provides practical lessons for future MNH and system-level reforms in Kenya and similar decentralized, resource-constrained settings. Lessons include the importance of balancing formal and informal institutions to ensure both political feasibility and enduring impact.
Untangling the complex web of alcohol policy needs and potential solutions in Brazil: evidence from civil society and political stakeholders.
Valério I, Uny I, Burela A … +4 more , Piazza M, Petticrew M, Fitzgerald N, Sanchez ZM
Health Policy Plan · 2026 Mar · PMID 41410029 · Full text
Implementing evidence-based alcohol policies can reduce the negative impact of alcohol consumption on public health. However, Brazil has permissive alcohol policies and weakly adheres to World Health Organization's recom...
Implementing evidence-based alcohol policies can reduce the negative impact of alcohol consumption on public health. However, Brazil has permissive alcohol policies and weakly adheres to World Health Organization's recommendations as the 'best buys'. To explore stakeholders' perceptions of alcohol policy needs and barriers in Brazil, we conducted semi-structured interviews with 31 stakeholders, including 15 from civil society and 16 policymakers. Civil society participants included non-governmental organization leaders addressing alcohol-related issues, while policymakers comprised civil servants and politicians experienced in alcohol-related harms. Interviews were transcribed verbatim and thematically analyzed using a deductive approach guided by research questions and an inductive approach to identify emergent themes. Most participants supported World Health Organization-recommended 'best buy' policies regulating alcohol's marketing. However, agreement on price and availability control was not unanimous. All participants acknowledged significant political barriers to adopting these policies, including intentional delays in parliamentary voting, industry lobbying, and arguments about infringing on rights such as freedom. Facing obstacles to advancing population-level policies, stakeholders often shifted their focus to individual-level interventions, such as education and treatment. While these were recognized as less effective, educational efforts were highlighted for raising public awareness of alcohol's harms and changing normative beliefs. Participants noted the lack of a formal coalition to reduce alcohol-related harm, despite its perceived necessity. Overall, stakeholders supported population-level alcohol policies but were pessimistic about their implementation due to political barriers. Many, particularly from civil society, emphasized small-scale, targeted interventions as a more feasible alternative to address alcohol-related harm in Brazil.
Gender-based violence policies and practices in humanitarian settings: a qualitative policy analysis, North Ethiopia.
Ferede AT, Mekonen D, Broerse JEW … +3 more , Peters RMH, Deyessa N, Essink D
Health Policy Plan · 2026 Mar · PMID 41408763 · Full text
Gender-based violence (GBV) is a major public health issue, further intensified in humanitarian crises. In Ethiopia's northern conflict (2021-ongoing), the scale of GBV underscores the urgent need for context-sensitive p...
Gender-based violence (GBV) is a major public health issue, further intensified in humanitarian crises. In Ethiopia's northern conflict (2021-ongoing), the scale of GBV underscores the urgent need for context-sensitive policy and service delivery. We conducted a policy analysis of national GBV-related policies within the context of the northern Ethiopia conflict. This was complemented by 9 focus group discussions with relevant stakeholders, i.e., community representatives and 10 key informant interviews with key policymakers at sub-national and national levels. Data were analyzed thematically using the Health Policy Triangle framework. No reviewed policies were contextualized for humanitarian emergencies or inclusive of all GBV forms. Most focused exclusively on sexual violence against women, overlooking other GBV types and male survivors. Policy development was largely top-down, involving government bodies and international actors, with minimal input from frontline providers or affected communities. There was also a lack of consensus on which policies are implemented, driven by poor dissemination, resource constraints, limited prevalence data, and weak coordination. Ethiopia lacks a government-led, humanitarian-specific GBV policy. This hinders a coordinated health response. Strengthening community participation in policy formulation, ensuring inclusive and context-relevant policy content, improving coordination among all governmental and non governmental GBV actors, and addressing funding gaps are critical for effective GBV response in humanitarian settings.
Governing health through security in the Philippines: a realist analysis.
Akhavein D, Conda LEA, Valenzuela S … +4 more , Lao PE, Sheel M, Abimbola S, Apostol GLC
Health Policy Plan · 2026 Feb · PMID 41383105 · Full text
As global framings of health continue to expand their reach, the Philippines, like many other countries, must navigate the overlapping pressures of donors, international institutions, and domestic political agendas in se...
As global framings of health continue to expand their reach, the Philippines, like many other countries, must navigate the overlapping pressures of donors, international institutions, and domestic political agendas in setting priorities. One such framing is the framing of health as a security issue. This study examines how health security framing-how it is interpreted and operationalized-influences priority-setting in the Philippines. Drawing on 25 interviews with government (at national and sub-national levels) and non-government actors and using a realist approach, this study sought to identify the outcomes of health security framing (as triggered or reinforced by mechanisms such as uncertainty, self-protection, self-preservation, self-reliance, and norm-setting) and the context in which the outcomes manifest. Findings show that health security framing reshapes priorities by reinforcing centralized, top-down approaches at both international and national levels. These framings influence not only what is prioritized but also which actors make decisions and how those decisions are justified. At the implementation level, it manifests in health workers facing misaligned operational frameworks, vertical programming, and burdensome reporting requirements tied to donor funding. Security norms become institutionalized with the involvement of military and security actors in health. The study demonstrates that health security is not a static concept, but a dynamic phenomenon co-constructed through global discourses, donor agendas, and domestic governance practices, all of which are shaped by power relations and history. While health security mobilizes resources and political attention, it also introduces trade-offs that risk exacerbating inequities and diverting attention from the structural determinants of health.
Decolonizing global health in an age of fragmentation: reimagining equity for universal health coverage.
Afriyie EK, Mbwoge RN, Koray MH
Health Policy Plan · 2026 Feb · PMID 41378772 · Full text
The global health landscape is undergoing a significant transformation as traditional frameworks of cooperation face fragmentation amid geopolitical tensions. Declining support from Western nations, exemplified by US wit...
The global health landscape is undergoing a significant transformation as traditional frameworks of cooperation face fragmentation amid geopolitical tensions. Declining support from Western nations, exemplified by US withdrawal from the World Health Organization and cuts to programs like the President's Emergency Plan for AIDS Relief, has exposed the profound instability of an aid architecture built on colonial dependencies. The COVID-19 pandemic, marked by vaccine nationalism, was a stark litmus test of this systemic failure for low- and middle-income countries (LMICs). This commentary argues that the current geopolitical fragmentation, while a crisis, also presents a critical opportunity to dismantle colonial legacies and reimagine global health equity not as a donor-driven ideal, but as a practice of shared power and sovereignty. We first document the rise of alternative pathways, critically examining China's health diplomacy and India's pharmaceutical disruption, while highlighting robust, LMIC-led initiatives like the African Medicines Agency and local mRNA vaccine production in Rwanda and Thailand. In response to the fractured status quo, we then propose a new global health compact built on four interdependent pillars: (i) Epistemic Justice, valuing local knowledge systems; (ii) Structural Audacity in Financing, such as taxing multinational corporations for reparative funding; (iii) Governance for Agency, ceding decisive power to LMICs; and (iv) Open Knowledge and Innovation, by dismantling restrictive intellectual property regimes. Achieving this decolonized future requires concrete action from all stakeholders. We conclude with a blueprint urging high-income countries to cede power, LMICs to invest in local capacity, funders to provide untied financing, and researchers to practise equitable collaboration. This actionable agenda is the foundation for a truly equitable global health system capable of achieving Universal Health Coverage.
Facilitators and barriers of public-private partnerships for universal health coverage in sub-Saharan Africa: a scoping review.
Otchere G, Fusheini A, Gauld R … +3 more , Ankomah SE, Sullivan T, Penno E
Health Policy Plan · 2026 Jan · PMID 41346084 · Full text
Universal health coverage (UHC) provides a platform for attaining 'Health for All'. Attaining UHC requires substantial investment and resources in the health sector. This can be challenging for many sub-Saharan African (...
Universal health coverage (UHC) provides a platform for attaining 'Health for All'. Attaining UHC requires substantial investment and resources in the health sector. This can be challenging for many sub-Saharan African (SSA) countries. Public-private partnerships (PPPs) could be a potential solution. The implementation of healthcare PPPs for developing health system capacities for UHC presents both significant opportunities and notable challenges. This scoping review, part of a broader review on PPPs, examines the facilitators and barriers of healthcare PPPs and their impact on UHC. The review was guided by Arksey and O'Malley's guidelines for conducting a scoping review. PubMed, Medline (Ovid), Global Health (Ovid), Web of Science, Scopus, and EconLit were searched for peer-reviewed English language publications from January 2013 to December 2023. Nineteen studies were eligible for the final analysis following screening of 944 studies. Identified key facilitators of PPPs for UHC included well-established institutional structures, robust accreditation systems, accountability mechanisms, and political will and support. These factors contributed to improving primary healthcare delivery, which is a critical dimension for UHC. Key barriers identified were limited capacity of implementing partners, regulatory inadequacies, and insufficient funds. These barriers negatively affected the performance of healthcare PPPs, which translates into systemic inequities in access to essential health services, impeding progress towards achieving UHC. Considering contract management capacity of implementers, sources and flow of funds, and regulatory frameworks are highly recommended for UHC to be realized using PPPs.
Out-of-pocket healthcare expenditures in older Mexican people based on their social security status.
Salinas Escudero G, García Peña C, García Hernández H
Health Policy Plan · 2026 Feb · PMID 41332197 · Full text
Out-of-pocket health expenditures (OOPEs) represent a financial strain that can increase the risk of impoverishment, especially in older people. Universal health coverage is the primary strategy to ensure financial prote...
Out-of-pocket health expenditures (OOPEs) represent a financial strain that can increase the risk of impoverishment, especially in older people. Universal health coverage is the primary strategy to ensure financial protection. The Mexican health system is based on social security. Therefore, the objective of this research is to analyze the relationship between OOPEs and social security status over time among Mexican adults aged 50 and older. A secondary analysis was made using data from the 2012, 2015, 2018, and 2021 waves of the Mexican Health and Aging Study. Multivariable linear regression models were performed to identify the relation between social security and OOPE. Individuals without social security reported the lowest mean expenditures. In contrast, older people with social security stability showed a steady increase in spending throughout the period, reporting the highest mean expenditures on total OOPE. Other variables, such as education, work, economic situation, multimorbidity, disability, and self-rated health status, show a greater relation with OOPE in contrast with social security. Our findings indicate that older adults with stable social security coverage reported the highest OOPE. This finding contrasts with international evidence on the protective role of health insurance. These findings may be attributed to four factors: (i) the challenging epidemiological profile of older adults characterized by chronic diseases and disability, (ii) the structural and organizational changes in the Mexican health system following the political transition in 2018, (iii) a decline in healthcare access among older adults during the COVID-19 (coronavirus disease) outbreak, and (iv) the longstanding oversaturation and low health resources in the health system.
The impact of official development assistance for health on health outcomes: a rapid systematic review.
Chagoma N, Sweeney R, Mazumdar S … +1 more , Suhrcke M
Health Policy Plan · 2026 Mar · PMID 41332186 · Full text
Low- and middle-income countries (LMICs) have received substantial amounts of Official Development Assistance for Health (DAH) to address domestic health funding gaps and improve access to universal healthcare. However,...
Low- and middle-income countries (LMICs) have received substantial amounts of Official Development Assistance for Health (DAH) to address domestic health funding gaps and improve access to universal healthcare. However, the effectiveness of DAH in improving health outcomes remains contested, with varying findings across studies due to differences in methodologies, data sources, and target populations. This systematic review synthesizes the existing evidence on the impact of DAH on health outcomes in LMICs, highlighting both the positive and negative effects, and identifying key mechanisms through which aid influences health. A total of 61 studies were included in the review, with a primary focus on maternal and child health outcomes. Despite methodological differences, the weight of evidence indicates a generally positive impact of DAH, particularly in countries with higher governance standards and better economic conditions. Our findings underscore the importance of contextual factors, such as governance and proximity to aid-funded projects, in shaping the effectiveness of health aid. To maximize the impact of DAH, policymakers need to strengthen donor coordination, align aid with national health priorities, and reinforce domestic health systems. Future research should focus on refining causal inference methods and exploring innovative aid-delivery mechanisms to sustain long-term health improvements.
Public policies addressing unhealthy diets in the South-East Asia region: identifying and countering the arguments that undermine policy implementation.
Wood B, Sievert K, Sharma N … +6 more , de Silva PA, Sacks G, Gupta R, Mialon M, Shabnam F, Reeve E
Health Policy Plan · 2026 Feb · PMID 41329162 · Full text
In South-East Asia, government implementation of policies recommended for addressing unhealthy diets has generally been slow and fragmented, largely due to food industry opposition and a lack of effective cross-sectoral...
In South-East Asia, government implementation of policies recommended for addressing unhealthy diets has generally been slow and fragmented, largely due to food industry opposition and a lack of effective cross-sectoral policy action. To help government policy-makers and other interest-holders address these issues, this study aimed to identify key arguments that undermine implementation of policies for addressing unhealthy diets in the region, and to propose a set of counter-strategies. We conducted semi-structured interviews with 15 interest-holders based in India, Indonesia, Sri Lanka, and Thailand, and performed a scoping review of diverse literature. Data analysis was guided by the 'Policy Dystopia Model', initially used to study the corporate political activity of the tobacco industry. Identified arguments were categorized into six themes: (i) questioning the policy design and development process; (ii) misrepresenting or distorting the supporting evidence, and/or presenting counter evidence; (iii) exaggerating and/or fabricating unintended consequences for health and equity; (iv) raising concerns about effects on the economy; (v) querying the policy's compatibility with trade and investment agreements and national laws; and (vi) raising concerns about restrictions on personal 'freedom'. To help counter these arguments, along with key material and structural factors that may increase their salience, we proposed the following set of counter-strategies: (i) develop a communication strategy to counter opposing arguments; (ii) implement governance measures to mitigate corporate influence on public health policy, research, and practice; (iii) implement governance measures to enable effective health-promoting intersectoral and interdepartmental coordination; and (iv) strengthen research, advocacy, and capacity-building on the determinants of health. Successful implementation of these counter-strategies will require extensive organization and collaboration among diverse interest-holders in South-East Asia and beyond.
Correction to: Can medical consortiums bridge the gap in health inequity in China? A propensity score matching analysis.
Health Policy Plan · 2026 Jan · PMID 41313309 · Full text
Abstract loading — click title to view on PubMed.
Barriers to raising taxes on tobacco products in Uganda: a political economy analysis.
Zakumumpa H, Paina L, Ssegujja E … +2 more , Ssempala R, Ssengooba F
Health Policy Plan · 2026 Feb · PMID 41311099 · Full text
Raising taxes on tobacco is considered the most effective measure for reducing tobacco consumption. Although Uganda ratified WHO's Framework Convention on Tobacco control which recommends levying taxes on tobacco product...
Raising taxes on tobacco is considered the most effective measure for reducing tobacco consumption. Although Uganda ratified WHO's Framework Convention on Tobacco control which recommends levying taxes on tobacco products by up to 75% of their retail price, in Uganda taxes on tobacco stagnated at 35% between 2017 and 2024. There is little in-depth research interrogating the political economy underpinning tobacco tax policy in Uganda. The aim of this study is to apply political economy analysis in exploring barriers to implementing WHO's recommended tobacco tax rates in Uganda. Our qualitative study entailed key informant and in-depth interviews with 34 purposively selected participants. Data were analysed by thematic approach. Tobacco industry narratives are dominant among policy elite with a strongly entrenched notion that raising taxes will bring economic harm such as 'killing off' the tobacco industry and by implication diminish government tax revenue. Participants identified tobacco industry interference in tobacco tax policy in Uganda through both 'soft' tactics such as sustained lobbying of policy elite in the executive and legislative arms of government and 'hard' tactics through litigation. Contrary to recommendations of having a 'single spine' or uniform tax on tobacco, Uganda continues to implement a differential tax structure for tobacco products. The paucity of non-industry-funded-research on effects of raising tobacco taxes was observed while the attrition of civil society champions in advocacy campaigns for raising taxes ensured that there was no sustained counterbalance to the tobacco industry in Uganda which the later exploited to promote the narrative that taxes needed to be maintained at a low level where they would not cause 'economic harm'. Our findings highlight the need for strengthening civil society advocacy in order to sustain the momentum on raising tobacco taxes in Uganda.
Integrating systems and implementation science in modeling and evaluating complex health interventions: methodological reflections from service delivery redesign in Kakamega, Kenya.
Alonge O, Ji T, Chen M … +1 more , Igusa T
Health Policy Plan · 2026 Feb · PMID 41296770 · Full text
Intervention evaluation is critical for determining the value of health interventions; however, real-world implementation frequently falls short of achieving anticipated large-scale impacts. This evidence-to-practice gap...
Intervention evaluation is critical for determining the value of health interventions; however, real-world implementation frequently falls short of achieving anticipated large-scale impacts. This evidence-to-practice gap often arises from challenges in capturing the complexity inherent in intervention implementation. This complexity may stem from the intervention itself, the dynamic and interrelated processes of dissemination, implementation, and sustainment, or the constraints of real-world settings characterized by interconnected systems. Integrating implementation science, which employs theories, models, and frameworks to understand the adoption and integration of evidence-based interventions, with systems science, which provides tools to model and analyze complex systems, offers a promising pathway for addressing these challenges. However, practical guidance on combining these approaches to evaluate dynamic interactions between interventions and implementation contexts, while simultaneously capturing system-level learnings, remains limited. In this methodological musing, we reflect on our experience integrating systems and implementation science to develop a conceptual and quantitative model for scenario evaluation of a maternal health service delivery redesign initiative in Kakamega, Kenya. We use four research objectives as a touchstone for organizing our reflections, explicated by three steps of an evaluation process: (i) developing a qualitative systems model using implementation frameworks and causal loop diagrams; (ii) constructing and parameterizing a quantitative computational model; and (iii) conducting scenario analyses to explore "what-if" strategies and inform adaptive planning. These reflections highlight the potential strengths of an integrated approach and offer practical considerations for researchers and practitioners evaluating complex health interventions through quantitative modeling and scenario development.
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