Health Policy And Planning[JOURNAL]
Sun
200 papers
Time to fully account for cost in monitoring financial protection and universal health coverage in low- and middle-income settings.
Binyaruka P, Borghi J
Health Policy Plan · 2026 Jan · PMID 41251686 · Full text
Financial protection is a core pillar of universal health coverage (UHC), yet current monitoring approaches in low- and middle-income countries (LMICs) largely focus on direct medical costs, neglecting direct transport c...
Financial protection is a core pillar of universal health coverage (UHC), yet current monitoring approaches in low- and middle-income countries (LMICs) largely focus on direct medical costs, neglecting direct transport costs and indirect time costs lost when seeking care. This commentary highlights the importance of fully accounting for these often-excluded costs, which disproportionately affect poorer and rural populations and can significantly hinder access to essential health services and lead to foregone care. We outline five priority areas for action, including improved measurement of transport and time costs through household surveys, methodological advancements in valuing time, increased investment in primary health care to reduce physical access barriers, adaptation of financing schemes and social protection programs to cover non-medical costs, and a multisectoral approach to address structural determinants. Fully integrating these dimensions into financial protection metrics and policies is critical for ensuring more equitable progress toward UHC in LMICs.
Responsibility without autonomy: exploring the emergence of distributed leadership in a district hospital of the Western Cape province, South Africa.
Motshweneng O, Gilson L
Health Policy Plan · 2026 Feb · PMID 41243715 · Full text
Distributed leadership has been proposed to offer value for health systems-by enabling people to work towards collective goals within settings such as hospitals. Yet, there is still limited empirical exploration of its d...
Distributed leadership has been proposed to offer value for health systems-by enabling people to work towards collective goals within settings such as hospitals. Yet, there is still limited empirical exploration of its dynamics in practice, especially in low- and middle-income contexts. To address this knowledge gap, this case study draws on conceptual work in empirically examining leadership in one district hospital in the Western Cape province, South Africa, seeking to identify evidence of distributed leadership and the factors influencing its emergence. Data were extracted from 28 academic theses, policies and strategic documents relating to health leadership, management and governance in the provincial health system (Phase 1) and 12 semi-structured, in-person interviews were conducted with hospital personnel (Phase 2). Phase 1 data provided the context of the case and guided the collection of data in Phase 2. All data were thematically analysed. The analysis reveals that there were pockets of distributed leadership within the hospital, as characterized by chains of multiple leaders working together to co-create shared meaning, take collective decisions and achieve common goals, enabled by relational leadership practices. These pockets supported both routine service delivery and bottom-up service improvement action. However, the unequal distribution of decision-making power, in the context of bureaucratic and professional hierarchies, limited the widespread emergence of distributed leadership. The case study suggests that distributed leadership can emerge in district hospitals with positive consequences for health service delivery, but that efforts to nurture its emergence should both bolster the leadership capabilities of individual leaders and address the bureaucratic and professional hierarchies that characterize the context within which hospital leadership unfolds. To aid the future practice of, and research about, distributed leadership the paper proposes a comprehensive definition of the concept, derived from the combination of wider literature and this study's empirical findings.
Using mHealth to provide sexual and reproductive health services to young people in rural Ghana: health care providers' perspectives.
Laar AS, Harris ML, Thomson C … +1 more , Loxton D
Health Policy Plan · 2026 Jan · PMID 41230701 · Full text
Mobile health (mHealth) technologies are increasingly being used in innovative ways to overcome traditional barriers to the provision of, and access to, sexual and reproductive health (SRH) services among young people in...
Mobile health (mHealth) technologies are increasingly being used in innovative ways to overcome traditional barriers to the provision of, and access to, sexual and reproductive health (SRH) services among young people in rural low-and-middle income countries (LMICs). In rural Ghana, mHealth platforms are now being implemented by health care providers (HCPs) to improve access to SRH information for young people. However, the actual use of these platforms from the perspective of HCPs has not yet been explored. This study investigated HCPs' perspectives on the availability of mHealth platforms in rural Ghana and the perceived benefits of using such platforms to provide SRH information and services to rural dwelling young people. A qualitative exploratory study using semi-structured interviews was conducted with a convenience sample of 20 HCPs across three rural regions of Ghana. Participants were recruited using the snowballing method between May and August 2021. Interviews were audio recorded via Zoom with participants' consent. The data were transcribed verbatim and thematically analysed. All participants had experience providing mHealth-based SRH information and services to young people in rural Ghana. The mobile platforms used included phone calls, text messages, voice messages, Facebook, WhatsApp, and Twitter. These platforms facilitated SRH education on contraception,Human immunodeficiency Virus (HIV), sexually transmissible infections, hygiene, and menstruation. HCPs reported several benefits of using mHealth, including ease and convenience, low cost, anonymity, privacy and confidentiality (especially in light of socio-cultural norms and religious beliefs), reduced healthcare delivery workload, and reduced pressure on limited health infrastructure. The findings suggest that innovative mHealth platforms have the potential to improve young people's access to conventional SRH information and services in rural Ghana. Furthermore, the findings demonstrate the preferred and acceptable use of these platforms among users. The results highlight the acceptability and utility of mHealth, as well as the need for its wider adoption and integration. While the provision of SRH information and services through mHealth is promising, further research is needed to understand the barriers that affect access and delivery for young people in rural communities.
Out of focus: limited representation of men's health needs in regional and global sexual and reproductive health policy.
Shand T, Evoy C, Baker P … +3 more , Shattuck D, Cornell M, Griffith DM
Health Policy Plan · 2026 Feb · PMID 41229304 · Full text
Addressing men's own specific health concerns in the context of sexual and reproductive health (SRH) remains a largely neglected topic, despite growing levels of unmet SRH needs among men and the broader benefits of enga...
Addressing men's own specific health concerns in the context of sexual and reproductive health (SRH) remains a largely neglected topic, despite growing levels of unmet SRH needs among men and the broader benefits of engaging men in the SRH of women and others. A comprehensive policy analysis explored how men are currently addressed and characterized within 37 key global and regional SRH-focused policies. Men's own SRH was found to be a significantly neglected policy issue. Less than half (43%) of the policies provided reference to men's SRH, and only 16% purposefully outlined steps to address men's own SRH needs. This contrasted with 78% of policies addressing women's SRH. Policies rarely provided sex disaggregated data nor targets on men's SRH outcomes. The inclusion of men was typically for solely instrumental reasons-in order to improve women's SRH. Men's SRH was best addressed within language on HIV and sexuality transmitted infections (STIs), particularly for men who have sex with men. Policy coverage was poor on men's SRH needs and roles in relation to contraception, fertility, sexual dysfunction, reproductive cancers, sexual pleasure, healthy relationships. and SRH-related discrimination. Only a quarter (24%) of the policies included a focus on one or more vulnerable male sub-group, with inadequate policy attention to the specific SRH needs of older men, disabled men, men living with serious health conditions, transgender people, and heterosexual men. An absence of focus on men's distinct SRH needs, alongside that of women, limits global understanding and visibility of SRH challenges particular to men, impeding the formulation of policies, programs, and funding priorities that sufficiently address men's needs. It also reinforces SRH as a women's sole burden and entrenches gender inequalities. Health policies should prioritize men's increased access to SRH information and care and better frame SRH as a critical part of men's lives.
Trends and patterns of inequality in modern contraceptive use in urban and rural India: are family planning programmes increasingly reaching the marginalized?
Kumar A, Mondal SK, Munjral A … +2 more , Acharya R, Saggurti N
Health Policy Plan · 2026 Jan · PMID 41220271 · Full text
India has made good progress in the use of modern contraceptives in recent decades, however identifying women who are left behind is important to policy makers for further improving availability, accessibility, and cover...
India has made good progress in the use of modern contraceptives in recent decades, however identifying women who are left behind is important to policy makers for further improving availability, accessibility, and coverage of family planning services to the marginalized population and hence achieving the international and national development agenda. Using five rounds of the National Family Health Survey data conducted between 1992-93 to 2019-21, this study examined the trends and patterns in inequality-by household wealth quintile and women's education-in modern contraceptive prevalence rates (mCPR) and demand for family planning satisfied with modern methods in urban and rural areas. The findings showed a secular trend of increasing rates in the use of modern contraceptives across socioeconomic sub-groups within urban (mCPR among the poorest quintile increased from 32% to 49%, and among the richest quintile from 51% to 60% in 1992-93 to 2019-21, respectively) and rural (mCPR among the poorest quintile increased from 27% to 49%, and among the richest quintile from 49% to 59% in 1992-93 to 2019-21, respectively) areas. Similarly, the inequality over time-measured by the concentration index-in mCPR has declined from 0.311 to 0.158 in urban areas and from 0.247 to 0.143 in rural areas between 1992-93 to 2019-21. Despite the overall decline in inequality, the pro-rich situation persists in contraceptive use in the country, and the extent of the inequality was high for modern reversible methods, both in urban and rural areas. Our findings underscore the increasing availability and accessibility of modern reversible methods, particularly among marginalized populations, along with improved information provided on the range of choices. This will help in achieving the global commitment of universal access to reproductive health, including family planning, and balance the method-mix in a country that is currently dominated by female sterilization.
Overcoming barriers to pediatric intensive care in low-resource settings: an institutional experience from Northeast India.
Tsanglao WR, Kikon S, Aier T
Health Policy Plan · 2026 Feb · PMID 41218035 · Full text
Developing pediatric intensive care units (PICUs) in resource-limited regions presents several challenges, including significant resource constraints, a shortage of trained personnel, and a lack of standardized care prot...
Developing pediatric intensive care units (PICUs) in resource-limited regions presents several challenges, including significant resource constraints, a shortage of trained personnel, and a lack of standardized care protocols. Prioritizing skills and knowledge development for healthcare professionals, selecting effective yet affordable equipment, and strong leadership have been identified as essential for establishing sustainable pediatric critical care services in low- and middle-income countries (LMICs). In this article, we describe the practical, phased approach undertaken in a charitable hospital setting in Northeast India to establish a PICU, highlighting adaptability, institutional commitment, patient team building, and systematic record-keeping in overcoming these challenges. The lessons drawn from this experience can offer valuable insights for similar healthcare settings in LMICs, demonstrating that high-quality pediatric critical care can be achieved even in resource-constrained environments.
Enrollment or dropout: dynamics of social health insurance participation among Chinese children and their impact on health service utilization and medical expenses.
Xu J, Coyte PC, Kang Z
Health Policy Plan · 2026 Feb · PMID 41216941 · Full text
Since children's participation in social health insurance (SHI) in China is voluntary, fluctuations in enrollment or dropout are inevitable. Using data from the two waves of the China Family Panel Study in 2020 and 2022,...
Since children's participation in social health insurance (SHI) in China is voluntary, fluctuations in enrollment or dropout are inevitable. Using data from the two waves of the China Family Panel Study in 2020 and 2022, this study aims to examine these participation dynamics and their impact on children's health service utilization and medical expenses. Specifically, a balanced panel of 1958 children under the age of 15 was constructed, first-difference and difference-in-difference models were employed to assess the factors influencing children's SHI enrollment or dropout, as well as the impact of these changes on health service utilization and medical expenses. Robustness checks were conducted after excluding new enrollees and dropouts separately. Our analysis showed that between 2020 and 2022, 263 children (13.4%) were newly enrolled in SHI, while 135 (6.9%) dropped out. Maternal SHI enrollment increased the likelihood of children's enrollment and reduced the probability of dropout. Children with commercial insurance were 34% less likely to enroll and 58% more likely to dropout. Compared to children with unchanged participation status, newly enrolled children were about 8% more likely to use outpatient services and had 77% higher medical expenses in the past year, whereas no significant changes were observed among those who dropped out. These findings highlight the dynamic nature of children's SHI participation in China and suggest that passive enrollment policies and parental participation could help promote universal coverage. Improving the reimbursement system, particularly for children's outpatient care, is also recommended.
Understanding determinants of parental HPV vaccine hesitancy under a municipal free vaccination program in Guangzhou, China.
Li A, Wang P, Li J … +2 more , Chen W, Chang J
Health Policy Plan · 2026 Feb · PMID 41213869 · Full text
Despite efforts to promote HPV vaccination, coverage remains suboptimal in China. Following Guangzhou's 2022 free HPV vaccination program for girls aged 9-15, a cross-sectional survey was conducted from May to August 202...
Despite efforts to promote HPV vaccination, coverage remains suboptimal in China. Following Guangzhou's 2022 free HPV vaccination program for girls aged 9-15, a cross-sectional survey was conducted from May to August 2024 among 411 parents of eligible girls in Guangzhou. The questionnaire was developed based on the supply-demand alignment theory. Vaccine Hesitancy Scale and Family Health Scale-Short Form were administered. Generalized linear regression identified factors associated with hesitancy. Overall, 10.7% of parents exhibited high hesitancy. Key determinants included occupation [farmers: β = -3.61, 95% CI = (-6.88, -0.34)], preference for imported over domestic vaccines [β = -1.65, 95% CI = (-3.10, -0.12)]. Higher family health scores [β = 0.25, 95% CI = (0.16, 0.33)], moderate child health status [β = 1.24, 95% CI = (0.10, 2.38)], and satisfaction with community healthcare centers (CHCs) [β = 0.05, 95% CI = (0.02, 0.07)] were less hesitant. Paradoxically, longer CHC wait times (>1 hour) [β = 2.29, 95% CI = (0.27, 4.31)] and difficulty accessing information [β = 2.80, 95% CI = (0.33, 5.27)] correlated with lower hesitancy. The results suggest potential policy-driven tolerance. Besides, this emphasizes the critical need for enhanced service quality in CHCs, targeted health education, and confidence building in national vaccines. These insights offer potential guidance for implementing complementary strategies to achieve equitable HPV vaccine coverage.
Remittances, political economy and public health expenditure: evidence from Africa.
Nanziri LE, Kabajulizi J, Gbahabo PT
Health Policy Plan · 2026 Feb · PMID 41206729 · Full text
This article revisits the argument that in the absence of good governance, remittance inflows cause the government to renege on the provision of social services and crowd out public finance where private substitutes exis...
This article revisits the argument that in the absence of good governance, remittance inflows cause the government to renege on the provision of social services and crowd out public finance where private substitutes exist. Using a quantile approach on a sample of African countries for the period 1990-2022, and after controlling for the endogeneity of remittances, the results show a positive contribution of remittances to public health expenditure, which tis annihilated into a non-linear crowd-out of public health expenditure across quantiles in the presence of varied political regimes. This relationship does not change even in the presence of a health shock. The crowd-out of public health expenditure points to an indirect effect of remittances through household consumption, private investment and tax revenue.
Towards a coherent global health architecture: perspectives on integrating global health security and universal health coverage through diplomacy and governance reforms.
Lal A
Health Policy Plan · 2026 Feb · PMID 41172274 · Full text
Within the global health landscape exists a complex interplay between global health security (GHS) and universal health coverage (UHC)-two influential agendas with profound influence on health system strengthening initia...
Within the global health landscape exists a complex interplay between global health security (GHS) and universal health coverage (UHC)-two influential agendas with profound influence on health system strengthening initiatives. There is a need to understand why and how coherence between GHS and UHC is being pursued in health policy and planning, particularly in the wake of the COVID-19 pandemic which profoundly reshaped the field of global health and significant cuts to global health assistance. This paper presents one of the first detailed analyses of contemporary efforts to conceptualize and operationalize GHS-UHC coherence-through the perspectives of key actors responsible for its implementation. The study employed thirty-one interviews with senior officials across four major types of global health actor: multilateral and global health organizations, country governments, donors and international finance institutions, and civil society organizations. It reveals important insights into the way specific actor and geopolitical groups varied in terms of shifting perceptions of GHS and UHC, as well as major factors influencing GHS-UHC coherence (e.g. strategic considerations including motivations and concerns, and structural considerations including enablers and barriers). The analysis suggests that an emerging 'hybrid norm' linking GHS and UHC appears to be well underway. It further contends that strengthening coherence between GHS and UHC not only depends on, but also enhances, three key imperatives: (i) overcoming geopolitical power asymmetries, (ii) leveraging strategic collaboration across actor types, and (iii) pursuing integrative health diplomacy amid overlapping crises. While this study centres on GHS-UHC alignment, its broader objective is to foster a more equitable and resilient global health architecture by tackling the interconnected causes of fragmentation through hybrid normative frameworks. By focusing on the politics of norms underpinning GHS and UHC integration, this work contributes to rethinking how global health institutions collaborate, ultimately helping to build more sustainable global health governance fit to withstand future political, economic, and social challenges.
Assessing the cost implications of integrating and scaling up HIV services for key populations in Kenya and Malawi.
Salas-Ortiz A, Opuni M, Figueroa JL … +7 more , Sánchez-Morales JE, Banda LM, Olawo A, Munthali S, Korir J, DiCarlo M, Bautista-Arredondo S
Health Policy Plan · 2026 Jan · PMID 41172154 · Full text
Limited research has been conducted on strategies to improve the efficiency of HIV services for key populations (KPs). This study investigates ways to enhance healthcare delivery efficiency, focusing on HIV services for...
Limited research has been conducted on strategies to improve the efficiency of HIV services for key populations (KPs). This study investigates ways to enhance healthcare delivery efficiency, focusing on HIV services for KPs. We explore two strategies: expanding service volume and offering multiple HIV services within a single health facility. Using data from the Linkages Across the Continuum of HIV Services for Key Populations Affected by HIV (LINKAGES) program in Kenya and Malawi, we exploit the variation in services provided to assess correlations between different service delivery configurations and their costs. We apply log-log fixed-effects regression models to analyze relationships between the total costs of four HIV services and the volume and range of services delivered. We find that service volume increases correlate with higher total costs, albeit less than proportionally, consistent with possible economies of scale. Negative correlations between service integration and total costs suggest that integrating HIV services for KPs could lead to reduced total costs for some service combinations. These results indicate potential strategies to increase the efficiency of HIV services for KPs, which can inform strategic planning and program execution in Kenya, Malawi, and similar countries.
How effective are community health workers in managing and preventing perinatal depression in sub-Saharan Africa? A systematic review of quantitative evidence.
Feyissa GT, Pouget ER, Soboka M … +2 more , Ibnat R, Wong T
Health Policy Plan · 2026 Jan · PMID 41166530 · Full text
The accessibility to the prevention and management of perinatal depression can be improved by using community health workers. This review was aimed at determining the effectiveness of interventions led by community healt...
The accessibility to the prevention and management of perinatal depression can be improved by using community health workers. This review was aimed at determining the effectiveness of interventions led by community health workers (CHWs) in reducing depressive symptoms and the prevalence of depression during the perinatal period. We conducted a search in PubMed, CINAHL, SCOPUS, and ProQuest Databases of Dissertation and Thesis (PQDT) to locate studies conducted in sub-Saharan Africa. We appraised the quality of eligible studies using standardized critical appraisal instruments from the Joanna Briggs Institute (JBI). We extracted data from the included studies using an a priori prepared data extraction tool. We pooled the findings of the studies using meta-analysis. The initial search yielded 199 studies, out of which we included 16 articles in this review. During the first 3 months after birth, CHW-led preventive psycho-social interventions reduced the risk of depressed mood by 35% [RR = 0.65(0.46,092)] [low-quality evidence]. The interventions reduced the risk of depressed mood by 32% 6-months post-birth [RR = 0.68(0.52, 0.87)] [very low-quality evidence]. The effect of the interventions is sustained through 9-12 months after birth resulting in a reduction in the risk of depressed mood by 38% [RR = 0.72(0.54,0.96)] [low-quality evidence]. Among women with moderate depressive symptoms, compared to usual care, CHW-led therapeutic psycho-social interventions reduced the symptoms by an average of 0.71 [SMD = -0.71 (-0.84, -0.59) units during the first 3 months after birth. The effect lasts 9-12 months after birth [SMD = -0.28 (-0.41, -0.15)] [Moderate-quality evidence]. In conclusion, the work of CHWs may be integrated into the prevention and management of perinatal depression after careful analysis of the feasibility, applicability and meaningfulness of the interventions to local context. High-quality randomized trials may help to inform further optimization of the role of CHWs in reducing the risk of depressed mood and depressive symptoms during perinatal period.
State-church partnerships as an innovative strategy in healthcare delivery for universal health coverage in sub-Saharan Africa: a scoping review.
Amankwah JA, Afriyie EK, Koray MH … +2 more , Akohene KM, Agyei-Baffour P
Health Policy Plan · 2026 Feb · PMID 41162323 · Full text
Universal Health Coverage (UHC) remains a critical goal in sub-Saharan Africa (SSA), where healthcare systems face significant challenges. State-Church Partnership have emerged as an innovative strategy to address gaps i...
Universal Health Coverage (UHC) remains a critical goal in sub-Saharan Africa (SSA), where healthcare systems face significant challenges. State-Church Partnership have emerged as an innovative strategy to address gaps in healthcare delivery, leveraging the extensive networks of Faith-Based Organizations to provide essential services, particularly in remote areas.This scoping review aimed to examine the existing models of State-Church Partnerships in healthcare delivery within SSA, their impact on UHC advancement, the challenges these partnerships face, and the emerging best practices. This review followed Arksey and O'Malley's framework and the PRISMA-ScR guidelines. We systematically searched peer-reviewed databases, including PubMed, Web of Science, Scopus, and CINAHL, for relevant studies published from inception until December 2024. Data were extracted and analyzed thematically using NVivo 12 to identify key themes related to state-church partnership models, their impact on UHC, implementation challenges, and emerging best practices. The review included eight studies which revealed that FBOs contribute between 30% and 70% of healthcare services in some regions, improving access, affordability, and equity. They play a critical role in maternal and child health, HIV/AIDS prevention, and health workforce training. However, challenges such as funding constraints, service quality variability, and limited policy integration hinder their effectiveness. Emerging best practices include enhanced government collaboration, community engagement, and capacity-building initiatives. In conclusion, State-Church Partnerships are vital in strengthening healthcare systems and achieving UHC in SSA. To maximize their impact, formalized policy frameworks, sustainable financing mechanisms, and quality assurance measures are essential. Strengthening state-FBO collaboration can bridge healthcare gaps and ensure equitable healthcare access.
Impact of integrated care models on inpatient costs and health services efficiency: evidence from a difference-in-differences analysis in China.
Li X, Zhou W, Zhang H
Health Policy Plan · 2026 Feb · PMID 41159546 · Full text
Integrated care effectively addresses challenges like high costs and low efficiency in healthcare. This paper investigates the impact of integrated care models in urban China on inpatient costs and health services effici...
Integrated care effectively addresses challenges like high costs and low efficiency in healthcare. This paper investigates the impact of integrated care models in urban China on inpatient costs and health services efficiency, and explores variations by age category, chronic disease status, and healthcare institution. Data is sourced from the insurance claims database in Guangzhou (2012-2015). Seven integrated care models are introduced at different times during the study period. The propensity score matching with staggered difference-in-differences approach is employed to examine the effects of integrated care models on inpatient costs [total inpatient costs and out-of-pocket (OOP) spending] and health services efficiency [length of stay (LOS)]. After matching, 147 healthcare institutions are included, with 44 in the intervention group and 103 in the control group. There are 1721 institution-month-level observations in the intervention group and 3746 observations in the control group. Integrated care models reduce total inpatient costs (6.6%), OOP spending (17.3%), and LOS (3.3%) across all healthcare institutions. For patients aged ≥60 years receiving care in primary/secondary care institutions, there are notable decreases in total inpatient costs, OOP spending, and LOS. However, for patients aged ≥60 years in tertiary care institutions, integrated care models do not significantly affect these three outcomes. Additionally, patients with chronic diseases in primary/secondary care institutions also experience reductions in total inpatient costs, OOP spending, and LOS. Integrated care models in urban China contribute to lower inpatient costs and higher health services efficiency, particularly for older adults and patients with chronic diseases who are receiving care in primary/secondary care institutions. These findings have important policy implications for the implementation of integrated care models in urban China.
Older adults' experiences of health seeking in rural areas in low- and middle-income countries: a systematic review of qualitative studies.
Wang Z, Ma X, Su C … +7 more , Zhang Y, Zou X, Balogun M, Bergman H, Liu X, Sourial N, Vedel I
Health Policy Plan · 2026 Feb · PMID 41147695 · Full text
The global aged population is expected to reach 2.1 billion by 2050 and ∼40% of them will live in rural areas of low- and middle-income countries (LMICs). This systematic review aims to synthesize the qualitative literat...
The global aged population is expected to reach 2.1 billion by 2050 and ∼40% of them will live in rural areas of low- and middle-income countries (LMICs). This systematic review aims to synthesize the qualitative literature on rural older adults' experiences of health-seeking in LMICs as well as explore the factors that influence their experiences during their health-seeking journeys. We searched Embase, MEDLINE, PsycINFO, and CINAHL to identify studies published from 1 January 2002 to 31 December 2024 (PROSPERO registration ID: Blinded For Review). We used a thematic synthesis approach to analyse included studies. Among the 19 studies with 28 articles and 484 participants included, 16 were rated as high quality, 9 as moderate quality, and 3 as weak quality. We identified four primary analytic domains associated with their experiences in health-seeking journeys: (i) individual-depicting the inner world of rural older adults; (ii) interpersonal-navigating the rural social network; (iii) organizational-navigating the rural health care systems, and; (iv) community and macrosystems-economy, society, and public policy in rural areas. Rural older adults in LMICs have experienced unique and multi-level challenges in seeking care. To overcome these challenges, rural older adults demonstrated resilience and creativity (e.g. utilizing informal institutions), to navigate their health-seeking journey. Future research should aim to better understand the resilience and agency in local older adults' health-seeking experiences and provide constructive solutions to overcome identified barriers to care.
Expanding budget space to improve health outcomes in low- and middle-income countries: what role for tax expenditures?
Tagem AME, Tapsoba Y, Barroy H
Health Policy Plan · 2026 Feb · PMID 41126456 · Full text
Recent evidence indicates that budget space for health can be improved through increasing government revenues, expanding the budget's health share, and improving expenditure efficiency through enhancing public financial...
Recent evidence indicates that budget space for health can be improved through increasing government revenues, expanding the budget's health share, and improving expenditure efficiency through enhancing public financial management (PFM), with government revenue mobilization being the most substantial. Government revenue mobilization can be achieved by broadening the tax base, a key component of which is the rationalization of tax expenditures. Tax expenditures are preferential tax treatments, relative to a baseline tax regime, intended to achieve specific objectives by providing financial support to specific beneficiaries. They may, however, result in huge revenue losses, which could be otherwise invested in priority sectors, including health. In addition, tax expenditures ultimately exacerbate inequality, while also creating complexities that foster tax avoidance and evasion, all of which contribute to deteriorating health outcomes. In the context of scarce public finances in low- and middle-income countries, rationalizing tax expenditures can create the necessary fiscal space for development. This paper provides a first comprehensive analysis of the 'health costs' of tax expenditures by analysing the relationship between tax expenditures and health outcomes, with a focus on under-five and maternal mortality. Using data from 55 developing countries from 2000 to 2022, we find that an increase in tax expenditures leads to higher under-five and maternal mortality, especially in low-income countries. The results are robust to several instrumental variable strategies, alternative measures of tax expenditures, and alternative methods. We also find that PFM, through the quality of public administration, transparency in the public sector, and the efficiency of revenue mobilization, mitigates the corrosive effects of tax expenditures. A key implication of our findings is that understanding the 'health costs' of tax expenditures is a necessary precursor to eliminating wasteful tax expenditures, the benefits of which can contribute to expanding the budget space for health and improving health outcomes.
Understanding disruption in the social contract between the medical profession and society in India: a tale of mismatched expectations?
Samant M, Santosh S, Dutta S … +3 more , Joshi M, Calnan M, Kane S
Health Policy Plan · 2026 Jan · PMID 41123489 · Full text
A harmonious relationship between the medical profession and the society it serves is essential for any country's health system to fulfill its mandate. Society offers trust, respect, authority, and professional autonomy...
A harmonious relationship between the medical profession and the society it serves is essential for any country's health system to fulfill its mandate. Society offers trust, respect, authority, and professional autonomy to doctors, and in return, expects doctors to provide good care and prioritize people's welfare. However, in many parts of the world, we observe growing dissatisfaction, increasingly expressed violently, with the medical profession. Understanding what explains this growing dissatisfaction is necessary to initiate measures to maintain and improve this important social relationship and social contract. Using India as a case, and drawing on insights from qualitative, in-depth interviews with purposively selected doctors, journalists, legal experts, police, patients and patients' rights activists, and social commentators, we demonstrate how a range of mismatched expectations-regarding the organization of the medical profession, the structure of healthcare provision, the status and identity of doctors in society, and fair compensation for care provides-are contributing to the disruption of this critical social relationship. We argue that these dynamics can be meaningfully examined through the lens of the 'social contract' between the medical profession and the society it serves. Our analysis also shows how these mismatched expectations are highly contentious and how they are rooted in the increasingly market-logic-based organization of healthcare. For researchers across the world, our study offers a novel approach to researching the relationship between the medical profession and society, and, for policy makers and health system leaders in India, our findings offer practical entry points to develop policy interventions to help restore, recalibrate, and secure this important social contract.
Job preferences and trade-offs in rural health workforce retention: a discrete choice experiment from western China.
Chen D, Zhang Z, Ma S … +3 more , Yin J, Zhao L, Jiang L
Health Policy Plan · 2026 Feb · PMID 41108156 · Full text
The shortage and uneven distribution of primary healthcare workers in rural China have long persisted, with many studies focusing predominantly on salary and working conditions improvement. A discrete choice experiment i...
The shortage and uneven distribution of primary healthcare workers in rural China have long persisted, with many studies focusing predominantly on salary and working conditions improvement. A discrete choice experiment involving 183 rural primary healthcare workers in Sichuan Province revealed the critical role of Bianzhi (a state-controlled employment system) in workforce retention. Findings demonstrated that Bianzhi dominated job preferences (β=0.964), with practitioners willing to sacrifice 18.2% of their monthly income to exchange for it. Beyond Bianzhi, near location, housing allowances, opportunities for continuing education, and children's education support significantly influenced job choices. Female workers exhibited 1.189 times greater sensitivity to workplace proximity than males (P < 0.001), while those with school-age children required 12.64% additional compensation for remote postings. Policy simulations indicated that combining Bianzhi with children's education support outperformed salary incentives alone. The study advocates optimizing rural healthcare workforce strategies by narrowing the gap between Bianzhi and non-Bianzhi positions, complemented by gender-sensitive and family-friendly measures. For other LMICs, it highlights the importance of understanding the true needs of health workers with different employment statuses.
A digital adaptation of the WHO's Self-Help Plus psychological intervention to alleviate stress among community health workers: a mixed-methods evaluation of the SAMBHAV program in rural India.
Shrivastava R, Singh A, Ranjan A … +12 more , Tugnawat D, Sen Y, Singh R, Verma B, Maheshwari NK, Parmar H, Verma N, Sharma K, Rathore D, Malviya A, Bhan A, Naslund JA
Health Policy Plan · 2026 Jan · PMID 41103014 · Full text
Psychological distress and risk of burnout among community health workers (CHWs) in low- and middle-income countries represent a serious global public health concern and threat to efficient health system functioning and...
Psychological distress and risk of burnout among community health workers (CHWs) in low- and middle-income countries represent a serious global public health concern and threat to efficient health system functioning and resilience. This mixed methods study aimed to test the acceptability, feasibility and preliminary effectiveness of a digital adaptation of the WHO's evidence-based Self-Help Plus (SH+) psychological intervention among CHWs, called Accredited Social Health Activists (ASHAs), in rural India. A total of 40 ASHAs, all women, were recruited from Sehore district, Madhya Pradesh, from October 2022 to March 2023. The intervention, a culturally adapted, digitized version of the WHO's evidence-based SH+ intervention, called SAMBHAV, was delivered via smartphone app. Psychological distress was measured using the Kessler-10 at baseline, 6- and 12-week follow up. The System Usability Scale and Client Satisfaction Questionnaire-8 were used to assess usability and satisfaction with the digital intervention, respectively. Focus group discussions were used to assess acceptability. From baseline to 12-week follow-up, psychological distress levels significantly reduced (mean decrease of 2.5 points, P = .043), indicating improved psychological health and psychological distress management capacity. The intervention demonstrated favorable acceptability (mean = 20.45) and usability (mean = 69.31), though challenges related to user interface and app navigation were identified. Qualitative feedback supported these findings, with ASHAs describing the intervention as practical, easy to learn, and effective in reducing their psychological distress while empowering them to assist others in managing tension. These findings highlight that the WHO's SH+ intervention can be adapted for different low resource contexts and tailored to meet the needs of specific target groups, specifically for alleviating psychological distress among frontline CHWs. Future research is needed to determine the benefits of scalable brief digital self-help interventions in promoting the well-being of frontline health workers and its resulting impacts on service delivery and health system functioning.
Assessing the costs of antenatal care in Eastern Ethiopia: implications for improving the free maternity services policy.
Tolossa T, Gold L, Lau EHY … +2 more , Dheresa M, Abimanyi-Ochom J
Health Policy Plan · 2026 Jan · PMID 41058590 · Full text
Most sub-Saharan Africa (SSA) countries are implementing free maternity services starting from the first antenatal care (ANC) visit to postnatal care. However, out of pocket (OOP) health expenditures significantly affect...
Most sub-Saharan Africa (SSA) countries are implementing free maternity services starting from the first antenatal care (ANC) visit to postnatal care. However, out of pocket (OOP) health expenditures significantly affect the utilization of maternal services in SSA. Limited evidence exists on the costs incurred for ANC health service utilization in this region. This study aimed to assess the costs of ANC service utilization among adolescent and adult women in Eastern Ethiopia. Data were collected from pregnant women participating in the Kersa Health and Demographic Surveillance Site (KHDSS). The study prospectively followed 394 pregnant women across two rounds, collecting both direct medical and indirect costs of ANC service utilization. Direct medical and non-medical costs were summed up to give OOP health expenditures. Catastrophic health expenditure (CHE) and intensity were assessed using the budget share approach at different thresholds. All costs were converted to 2023/2024 USD and compared between adolescent and adult women. A total of 390 women were included in the final analysis. The total amount of OOP payment due to ANC service utilization was 35.7 USD among adolescents compared to 28.5 USD in adults. Adolescents spent 32.6 USD on direct medical costs compared to 24.9 USD for adult women, and 19.3 USD on direct non-medical costs compared to 19.8 USD in adult women. There was a significant difference in the proportion of women who incurred OOP payments, 85.7% of adolescents versus 66.7% of adults (P-value < .001). CHE incidence among adolescents was 46.8% and 15.6% compared to 28.7% and 9.3% among adult women at 5% and 15% threshold, respectively. Overall, adolescent women faced higher financial hardship than adult women. This highlights the need to expand financial protection beyond direct medical costs and to develop targeted financial protection mechanisms specifically for adolescents in resource-limited settings. Furthermore, strengthening the implementation and ensuring the sustainability of the Free Maternal Services policy could help reduce disparities in service utilization between adolescent and adult women.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe