Health Policy And Planning[JOURNAL]
Sun
200 papers
A narrative review on cost considerations in early intervention for deaf and/or hard-of-hearing children in Africa.
Khoza-Shangase K
Health Policy Plan · 2026 Feb · PMID 41058587 · Full text
Early intervention (EI) is essential for the language, social, and educational development of deaf and/or hard-of-hearing (DHH) children. In African countries, however, the implementation of EI remains significantly cons...
Early intervention (EI) is essential for the language, social, and educational development of deaf and/or hard-of-hearing (DHH) children. In African countries, however, the implementation of EI remains significantly constrained by cost considerations and systemic service gaps. This narrative review synthesizes findings from 26 peer-reviewed publications to explore how cost influences access to and sustainability of EI services in Africa. Seven interrelated themes were identified: (i) high out-of-pocket expenses that limit family access to services; (ii) inadequate public funding and heavy reliance on private or donor sources; (iii) cost-effectiveness of early screening and intervention when delivered at scale; (iv) lack of integrated cost data in national health planning; (v) inequitable access to hearing technologies due to procurement and pricing challenges; (vi) opportunities for system-level enablers such as intersectoral collaboration, task-shifting, and community-based delivery; and (vii) structural cost drivers unique to African contexts, including fragmented systems and infrastructure disparities. The findings highlight the need to embed economic evidence into policy planning, establish pooled procurement and subsidy schemes to reduce device costs, and integrate EI services into national insurance and essential health benefit packages. Culturally responsive, community-delivered models, supported by sustainable public financing and regional collaboration, are critical to ensure equity and long-term impact. Addressing these cost-related barriers through coordinated policy and system reforms will be key to achieving universal, inclusive, and sustainable EI services for DHH children in Africa.
Impact of the Family Doctor Contracting System on unmet healthcare needs in Shandong Province, China.
Tan J, Wang J, Xu L … +3 more , Li P, Sun J, Chen C
Health Policy Plan · 2026 Jan · PMID 41017317 · Full text
Unmet healthcare needs are a significant concern in China, possibly due to the underutilization of primary healthcare services. Patients disproportionately seek tertiary hospital services, reflecting the historical under...
Unmet healthcare needs are a significant concern in China, possibly due to the underutilization of primary healthcare services. Patients disproportionately seek tertiary hospital services, reflecting the historical underinvestment in community healthcare and a weak referral system. This misallocation of medical resources burdens the capacity of tertiary hospitals and limits access to necessary healthcare. To address this, the Family Doctor Contracting System (FDCS) was introduced to enhance community health services and reduce unmet healthcare needs. This study empirically analyzes the impact of the FDCS on unmet healthcare needs using data from the 2018 National Health Service Survey in Shandong Province, which included 27 447 individuals aged ≥18 years. An entropy balancing method was employed to address self-selection bias. Logistic regression results show that individuals contracted with family doctors (FDs) are associated with a 1.6% lower probability of experiencing unmet outpatient healthcare needs compared to those who did not participate, although the FDCS had no significant impact on unmet inpatient needs. A potential mechanism is that the FDCS has improved the accessibility of outpatient services. We found that signing up with FDs reduced the likelihood of citing inaccessibility as the main reason for unmet outpatient care needs by 43.7 percentage points, while the impact on unacceptability and unavailability was relatively more minor at 0.5 percentage points. The findings highlight the effectiveness of the FDCS in enhancing the role of primary care and improving access to healthcare. Future policy initiatives should focus on promoting the benefits of the FDCS and encouraging utilization of the FD service while strengthening community-based primary care by providing adequate infrastructure, resources, and training.
What affects the performance of hospital financing interventions in low and lower-middle income countries from the program design and implementation perspective? A scoping review.
Zeng W, Boiangiu M, Trachsel N … +3 more , Jarawan E, Turbat V, Meessen B
Health Policy Plan · 2025 Nov · PMID 41017309 · Full text
Hospitals, as an important component of the health system, consume a substantial amount of health resources and are instrumental in improving population health. While many health financing interventions have been impleme...
Hospitals, as an important component of the health system, consume a substantial amount of health resources and are instrumental in improving population health. While many health financing interventions have been implemented at hospitals, evidence exploring common factors facilitating their implementation in low and lower-middle income countries (LLMICs) remains limited. We conducted a scoping review of existing hospital financing interventions in LLMICs. A combination of search strategies and key informant consultations were used to search for relevant literature. A total of 35 articles spanning six categories of hospital financing interventions were included in the review. The review centered on design and implementation factors associated with hospital financing interventions. Factors affecting a hospital financing intervention's results were numerous and context specific. From the design and implementation perspective, five interconnected factors-governance and accountability, participatory process, proper intervention design, adequate resources and capacity, and monitoring and evaluation-underline the most influential factors across the six categories of hospital financing interventions. Understanding the connections among these factors and making efforts to align them with the country's context make for a more promising intervention. The evidence on specifics across different types of hospital financing implementations remains limited, requiring more implementation studies guided by comprehensive theoretical frameworks to generate more concrete evidence.
Measuring and monitoring child health and well-being-an integral part of the climate change agenda.
Requejo JH, Weigel R, Lazzerini M … +6 more , Cerna-Turoff I, Billah SM, Horiuchi S, Black M, Schellenberg J, Child Health Accountability Tracking Technical Advisory Group
Health Policy Plan · 2026 Jan · PMID 41014284 · Full text
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Nursing student training as a novel approach to increasing community-based access to contraception in the Democratic Republic of the Congo: evaluation of outcomes.
Akilimali P, Compta G, Ngondo D … +10 more , Koba T, Kayembe D, Kabasubabo F, Akamba F, Mujani Z, Lusamba P, Binanga A, Hernandez J, Sauter S, Bertrand JT
Health Policy Plan · 2025 Nov · PMID 40974076 · Full text
This study evaluated the scale-up of an innovative approach to increasing modern contraceptive use in the Democratic Republic of the Congo (DRC) on multiple outcomes: fidelity to design, acceptability, sustainability, sa...
This study evaluated the scale-up of an innovative approach to increasing modern contraceptive use in the Democratic Republic of the Congo (DRC) on multiple outcomes: fidelity to design, acceptability, sustainability, satisfaction, adoption by other organizations, and penetration. The intervention consisted of incorporating a family planning (FP) module into the training of third-year nursing students, who then counseled and delivered services during community outreach events as their practicum several times annually in selected provinces. In late 2023, eight different stakeholder groups were interviewed (national-level health authorities, provincial-level health authorities, program managers replicating the model, chief district medical officers, nursing school focal points, nursing students, FP clients, and a parent association), for a total of 1238 persons. It consisted of telephone interviews (for three stakeholder groups), in-depth interviews (for three other groups), in-person interviews (one group), and focus group (one group). Data were triangulated across stakeholder groups for each outcome. The scale-up of the nursing school model achieved many of its desired outcomes regarding fidelity to design, acceptability, satisfaction, penetration, and adoption. Unresolved issues included pervasive contraceptive stockouts, difficulties in accurately capturing data on contraceptive distribution in the national health information system, and sustainability. The DRC model originated from a scarcity of government or donor resources to pay community health workers but has proven to be a promising means of increasing access to contraception. The results of this research will inform the further expansion of the model within the DRC and possibly to other countries facing similar challenges.
Informal health care providers in Nigerian slums: perspectives on how to link them with the formal health system.
Ojiakor I, Onwujekwe O, Hicks JP
Health Policy Plan · 2025 Nov · PMID 40973670 · Full text
Informal healthcare providers (IHPs) play a crucial role in healthcare delivery in urban slums, but the lack of linkages between IHPs and the formal healthcare system results in fragmented, low-quality care. Integrating...
Informal healthcare providers (IHPs) play a crucial role in healthcare delivery in urban slums, but the lack of linkages between IHPs and the formal healthcare system results in fragmented, low-quality care. Integrating IHPs into the formal healthcare system poses challenges that are common across such settings. This study explores the perceptions of healthcare providers and consumers in Nigerian urban slums regarding linking IHPs to the formal healthcare system, while also aiming to identify stakeholder perceptions on how the linkage might best work. Using cross-sectional consumer and provider surveys, we collected data via questionnaires from 1024 households and 255 providers, purposively selected from eight urban slums in Anambra and Enugu states, southeast Nigeria. We estimated overall and subgroup-specific percentages, percentage-point differences, and associated 95% confidence intervals for question responses using logistic regression models and marginal effects methods. Most consumers were female (96%), with a median age of 31 years, reflecting the sampling design and focus on females in households with women of childbearing age and/or young children, and 63% were employed in the informal sector, reflecting the setting. Most providers were IHPs (93%) and private (94%), with the most common job title being patent medicine vendors (54%). We found that 92% (95% CI: 84%, 96%; n/N = 943/1025) of consumers and 87% (95% CI: 60%, 97%; n/N = 221/255) of providers supported linking IHPs to the formal health system. Both groups of respondents primarily favoured (i) training, supervision, and referral as the main strategies and aspects of services to be linked, (ii) having the Ministry of Health lead the linkage, and (iii) managing the linkage through government legislation. There was little evidence for any large differences in consumer or provider views across subgroups based on key sociodemographic characteristics or provider attributes. The study findings offer guidance for future policymaking.
Newborn technology use in low-resource settings: the role of health professionals' communication in implementation.
Ngaiza GK, Oluoch D, Molyneux S … +3 more , Jones C, English M, Pope C
Health Policy Plan · 2025 Nov · PMID 40966583 · Full text
Neonatal deaths remain a critical public health challenge in many low- and middle-income countries (LMICs), including Kenya. Affordable technologies such as Comprehensive Positive Airway Pressure (CPAP) and phototherapy...
Neonatal deaths remain a critical public health challenge in many low- and middle-income countries (LMICs), including Kenya. Affordable technologies such as Comprehensive Positive Airway Pressure (CPAP) and phototherapy machines can reduce neonatal mortality and are used in these settings. However, their introduction and implementation in resource-constrained health system contexts are poorly understood. This study investigates how communication among health professionals influences decisions to use CPAP and phototherapy devices in Kenyan newborn units. Using a focused ethnographic approach, we conducted unstructured non-participatory observations, semistructured interviews, and document reviews in two newborn units in level five Kenyan referral hospitals. The study participants were all health professionals working in the newborn units. We gathered data in two phases, 6 months apart, and analyzed the data thematically. Data collection and analysis were informed by The Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. We found four interconnected contextual factors that influenced health professionals' communication on the initiation, maintenance, discontinuation, and repair of neonatal technologies. These factors are as follows: First, physical environment, including space availability, newborn unit layout, and the arrangement of cots and incubators. Second, socio-organizational dynamics, such as the team composition, workload, management approach, and workplace culture. Third, technology-specific attributes, particularly the perceived complexity of CPAP and phototherapy's features and functions. Finally, the wider system encompasses administrative burdens from research and donor-supported programs as well as political, financial, and regulatory factors. Stakeholders, including funders, policymakers, local governments, and health professionals, must recognize that interconnected physical, organizational, technological, and wider contexts shape communication, decision-making, and use of life-saving technologies. A tailored approach that considers these complex realities, rather than a one-size-fits-all approach, should contribute to better integration and sustainability of these technologies, leading to improved outcomes in newborn care.
Operationalizing multisector partnerships: a Theory of Action and Reflection tool for zoonotic influenzas.
Abbas SS, Kakkar M, Bloom G … +5 more , Husain L, Shorten T, Wijesinghe PR, Buddha N, Salvador EC
Health Policy Plan · 2025 Nov · PMID 40926631 · Full text
Zoonotic influenzas are major, ongoing public health policy challenge, not the least because of the importance of functional multisector partnerships (MSPs) for their prevention and control. However, despite years of inv...
Zoonotic influenzas are major, ongoing public health policy challenge, not the least because of the importance of functional multisector partnerships (MSPs) for their prevention and control. However, despite years of investment in developing them, many countries have found multisectoral approaches, such as One Health, difficult to operationalize at national and subnational levels. One explanation for the lack of uptake is the limited nature of guidance on the design and adaptation of MSPs that consider local institutional dynamics. In this paper, we describe the process of developing a practical framework for assessment and characterization of MSPs. We use findings from an earlier review of academic and programmatic literature to develop a Theory of Action for multisector One Health partnerships that can nest into the short-term outcomes identified in the Theory of Change for One Health developed by the One Health Quadripartite. This comprises five elements: Characteristics; Starting conditions; Collaborative process; Outputs; and Responsiveness. We develop additional attributes to undertake a detailed characterization of different 'levels' of One Health partnerships. In addition, this Theory of Action allows for multiple outcomes of interest to be recognized and addressed. We then use the Theory of Action to develop a reflection tool to help country programme managers identify the specific characteristics of their respective One Health partnerships; recognize the differences in capacities and expectations of different partners; and use these insights to identify specific ways to strengthen the collaborative process. To our knowledge, this is the first time a detailed characterization of MSPs based upon programmatic attributes has been developed. Such a conceptualization of MSPs can facilitate the design, implementation, and evaluation of One Health and other multisector programmes and increase their relevance to the needs of the local context within which these are based.
Understanding the financial hardships faced by TB and HIV patients during the COVID-19 pandemic: a mixed-method study in Bandung and Yogyakarta, Indonesia.
Fardousi N, Negara SNS, Subronto YW … +11 more , Mashuri YA, Cheng Q, Wulandari LPL, Putra IWCSD, Wahyuningtias SD, Probandari A, Thabrany H, Wiseman V, Ahmad RA, Boettiger D, Liverani M
Health Policy Plan · 2025 Nov · PMID 40926593 · Full text
The COVID-19 pandemic had significant widespread financial impacts, resulting in decreased household income, increased unemployment, and disrupted health services. Despite the higher prevalence of infections of tuberculo...
The COVID-19 pandemic had significant widespread financial impacts, resulting in decreased household income, increased unemployment, and disrupted health services. Despite the higher prevalence of infections of tuberculosis (TB) and human immunodeficiency virus (HIV) in poorer populations, research on the financial challenges faced by these populations during the pandemic is still limited. Indonesia recorded the highest COVID-19 cases in Southeast Asia (6 815 156) while contending with the dual burden of HIV and TB. This study investigates the factors influencing out-of-pocket (OOP) payments and catastrophic health spending during the pandemic, alongside patients' challenges and coping mechanisms in Bandung and Yogyakarta, Indonesia. We employed a parallel convergent mixed-methods approach, combining quantitative analysis of OOP costs with qualitative interviews. The determinants of OOP payments were analysed using a two-part cluster-robust regression model. Catastrophic health spending was defined as OOP payments exceeding 10% of a household's annual income. Data on OOP spending were recorded via diaries, while qualitative data were gathered from in-depth interviews with TB and HIV patients and healthcare workers from January to October 2022. The findings indicated that 5.13% [95% confidence interval (CI): 2.99-7.28] of households incurred catastrophically. The median household spent USD 8.48 OOP, with nonmedical expenses comprising the largest share (median USD 5.93). Key predictors of higher costs included facility location in Yogyakarta (OOP costs difference USD 23.84, 95% CI: 9.90-37.77, P < .001), seeking care from public hospitals (USD 17.37, 95% CI: 8.83-25.90, P < .001), and the absence of health insurance (USD 10.49, 95% CI: 2.40-18.58, P = .011). Patients reported that job losses during lockdowns exacerbated financial strain, while coping strategies documented included borrowing, family contributions, and selling assets. This is the first study to focus on OOP spending and the financial hardships experienced by TB and HIV patients in Indonesia during the pandemic, providing insights for targeted policy and preparedness efforts to alleviate the financial burden during large-scale public health crises.
Adolescent mental, sexual, and reproductive health in Ghana: a stakeholder analysis of actors' influence over policy formulation and implementation.
Agblevor EA, Acquah PA, Gyawu B … +3 more , Wallace LJ, Mirzoev T, Agyepong IA
Health Policy Plan · 2025 Nov · PMID 40925607 · Full text
One in five adolescents (aged 10-19 years) live in sub-Saharan Africa. Despite the availability of policies targeted at this age group, policy formulation, implementation, and gains in adolescent health continue to be un...
One in five adolescents (aged 10-19 years) live in sub-Saharan Africa. Despite the availability of policies targeted at this age group, policy formulation, implementation, and gains in adolescent health continue to be underwhelming. Stakeholders or actors are architects of policy, bringing their ideological values, interests, power, and positions to policy formulation and implementation and thus influencing the policy process. We analysed multilevel stakeholder interests, positions, power, and their influence on adolescent mental, sexual, and reproductive health policy formulation and implementation in Ghana, West Africa, using a single-case study design with multiple embedded subunits of analysis. The case was defined as actors, their power, interests, positions, and their influence on policy formulation and implementation processes in adolescent mental, sexual, and reproductive health. A conceptual framework of conflict and synergies between stakeholder interests, power, and positions and their influence on policy formulation and implementation was used to guide the analysis. Data were obtained from key informant in-depth interviews with 19 global and national level and 16 subnational level stakeholders. Focus group discussions were also conducted with 4 district health management teams, 9 groups of frontline health workers, and 20 groups of in and out of school adolescents in four districts in the Greater Accra region of Ghana. The multiple stakeholders in adolescent health, including adolescents themselves, had sometimes synergistic and sometimes divergent and conflicting views on policy agendas, formulation, and approaches to implementation. Unresolved conflicts between powerful stakeholders in the public or bureaucratic arena stalled or hampered policy formulation and implementation, whereas consensus and adequate resourcing moved processes forward. It is important to invest effort in understanding actors, their power, positions, and interests in context to inform policy content and framing to increase the chances of consensus and effective policy formulation and implementation processes.
Script Shift: South African pharmacists' knowledge and perspectives of e-prescribing.
Shaikh RP, Barnard-Ashton P, Bayever DN … +1 more , du Toit LC
Health Policy Plan · 2025 Nov · PMID 40913419 · Full text
This study explored the knowledge and perceptions of pharmacists in Gauteng, South Africa, regarding electronic prescribing implementation. As South Africa commences digital transformation in healthcare, this study ident...
This study explored the knowledge and perceptions of pharmacists in Gauteng, South Africa, regarding electronic prescribing implementation. As South Africa commences digital transformation in healthcare, this study identifies factors that will facilitate implementation and barriers that will hinder e-prescribing adoption, the findings which may contribute to policy reform. A mixed-methods study using a self-administered questionnaire was used to assess pharmacists' knowledge and perception of electronic prescribing and distributed through email to pharmacists (n = 386). Knowledge and perceptions were measured using a 5-point Likert-scale, where percentage scores were categorized as per Bloom's cutoff point as follows: poor: (<60%), moderate: (60%-79%), good: (≥80%) for knowledge and negative (<60%), neutral (60%-79%), or positive (≥80%) for perceptions. A pilot study (n = 50) was conducted to assess reliability. Quantitative data were analyzed using descriptive statistics and ordinal regression, with significance set at P < 0.05. Thematic analysis was applied to qualitative responses, using an inductive and deductive approach. Integration of the quantitative and qualitative findings in the discussion ensured triangulation of the results. Pharmacists demonstrated moderate knowledge of e-prescribing (60%-79%) and positive perceptions of its usefulness (≥80%). Higher knowledge of e-prescribing was associated with positive perceptions (P < 0.001). Predictors for good knowledge include recently graduated pharmacists (P = 0.010), while pharmacists in management positions had 2.88 higher odds of perceiving e-prescribing as appropriate for the workplace (P = 0.001). Thematic analysis revealed four themes: the benefits of e-prescribing, software design recommendations, facilitators for implementation, and barriers to adoption. Key facilitators included education and training, and a standardized regulatory framework aligned with international standards. Resistance to adoption stemmed from poor knowledge, infrastructural and financial constraints. This study concludes that while pharmacists support electronic prescribing, addressing regulatory, financial, and infrastructural challenges will promote successful implementation.
How are health capital and income inequality linked? Analysis of the 2012-2018 China Labor-force Dynamics Survey.
Tang D, Zhang Z, Gao L … +2 more , Liu X, Peng L
Health Policy Plan · 2025 Nov · PMID 40904200 · Full text
How to alleviate income inequality is a significant challenge faced by all countries worldwide, and disparities in health capital are one of the fundamental causes of income gaps. A thorough exploration of the relationsh...
How to alleviate income inequality is a significant challenge faced by all countries worldwide, and disparities in health capital are one of the fundamental causes of income gaps. A thorough exploration of the relationship between health capital disparities and income gaps holds substantial practical significance. Based on the 2012-2018 China Labor-force Dynamics Survey, we employ OLS models, quantile regression, Shapley value decomposition, and Oaxaca-Blinder decomposition to provide a detailed estimation of the impact of health capital disparities on income gaps of labour. We find that health capital is a crucial driver of income increase, with its impact most pronounced at the 20th income percentile. Additionally, through Shapley decomposition, we find that health capital contributes 12.2% to overall income inequality. Although female, middle-aged and elderly, rural, and low education-level groups exhibit larger income inequality compared to their counterparts, health capital exerts a stronger influence on within-group income inequality for these disadvantaged populations. Furthermore, using Oaxaca-Blinder decomposition, we also find that health capital disparities contribute 12.8%, 12.31%, 9.83%, and 10.66% to the income gaps across gender, age, urban-rural, and education-level groups, respectively. Health capital not only significantly affects within-group income inequality but is also a key determinant of between-group income gaps. Therefore, enhancing investment in health capital, particularly for vulnerable populations, will contribute to promoting income equality and social equity.
The political economy of adolescent mental health in Kenya.
Tele A, Nyamai D, Shawar YR … +6 more , Nyongesa V, Kiogora S, Peterson SS, Obonyo G, Cuijpers P, Kumar M
Health Policy Plan · 2025 Nov · PMID 40879760 · Full text
Adolescent mental health remains a critical yet under-prioritized issue in low- and middle-income countries (LMICs) like Kenya, where resource limitations, stigma, and systemic barriers hinder access to care. While polic...
Adolescent mental health remains a critical yet under-prioritized issue in low- and middle-income countries (LMICs) like Kenya, where resource limitations, stigma, and systemic barriers hinder access to care. While policies and strategies such as Kenya's Mental Health Action Plan (2021-2025) exist on paper, their implementation is constrained by limited resources and a weak mental health service delivery infrastructure. This qualitative descriptive study examines the perspectives of mental health actors and youth advocates on the development and implementation of adolescent mental health policy in Kenya. Using a political economy analysis, we conducted 15 key informant interviews (KIIs) and analyzed observational field notes from a Google Jam board exercise to explore factors that enable or impede the prioritization of adolescent mental health policy and care. Thematic analysis was guided by Shiffman and Smith's policy framework, focusing on four domains: actor power, ideas, political context, and issue characteristics. Findings reveal significant barriers, including the exclusion of adolescents from decision-making, limited family involvement, weak policy formulation, and the destabilizing effects of government transitions. Stigma, poverty, and chronic underfunding further hinder progress, despite ongoing strategic efforts. Comparisons with other LMICs indicate that these challenges are widespread, underscoring the need for localized, inclusive, and well-coordinated approaches. Addressing these issues will require strong political commitment, increased youth-led advocacy, and sustained investment in mental health services. By prioritizing adolescent mental health, Kenya can move toward a more equitable and effective mental health system that supports the wellbeing of its youth.
How to (or how not to)…Enhance equity in the conduct of global health research: dimensions and directions for organizations.
Nambiar D, Chadha N, Buse K
Health Policy Plan · 2025 Oct · PMID 40847570 · Full text
Global health research can either challenge or reinforce power imbalances in knowledge production, funding, agenda-setting, authorship, data access, and capacity-building. These inequities are shaped by colonial legacies...
Global health research can either challenge or reinforce power imbalances in knowledge production, funding, agenda-setting, authorship, data access, and capacity-building. These inequities are shaped by colonial legacies, funding disparities, extractive partnerships, and Global North dominance over Global South priorities. They manifest in research conduct, procedural ethics, and ethics-in-practice. While much literature focuses on individual or project-level strategies, structural, and institutional dynamics-beyond the control of individual researchers-play a critical role. While macro-level structural change may occur slowly, in line with the pace of societal change, meso-level change within organizations is possible. Research organizations and networks are well positioned to integrate equity and influence broader change. Importantly, the meso-level offers a space to challenge Global North-South binaries and foster a shared ethics-of-practice. We reviewed 255 resources from a live Zotero inventory on equity in global health research, shortlisting 42 and identifying over 135 strategies. These were categorized into domains and organized into 14 action groups, mapped onto a three-stage implementation framework-Preparation, Establishing, and Maintaining-drawing from the literature. Our goal was to distil practices applicable across institutions, recognizing that context and resources shape prioritization. The preparation phase involves assessing current practices, reforming partnerships, and promoting inclusive leadership, with attention to gender equity, community engagement, and institutional self-assessment. The establishing phase emphasizes transparent communication, local and Indigenous participation, diverse recruitment, and culturally responsive research design. The maintaining phase focuses on sustaining equity-focused teams, incentivizing inclusive leadership, supporting under-represented researchers, and formalizing equity policies. Our findings offer a phase-wise typology of organizational reforms to embed equity in conduct of global health research. Advancing these strategies requires institutional commitment and donor engagement across all resource settings. Networked organizations and reflexive designs are key to enabling shared learning and equity-aligned transformation.
Psychological constructs and preferences for a complementary inclusive health insurance: a hybrid choice model.
Wang Q, Wang J, Zhang S … +2 more , Yu F, De Allegri M
Health Policy Plan · 2025 Oct · PMID 40836606 · Full text
Many low- and middle-income countries are affected by catastrophic health expenditures due to overstretched public health financing, indicating need for complementary inclusive health insurance solutions. Promoting these...
Many low- and middle-income countries are affected by catastrophic health expenditures due to overstretched public health financing, indicating need for complementary inclusive health insurance solutions. Promoting these solutions requires understanding drivers, including psychological determinants, of health insurance purchase. Yet, relevant evidence is lacking. We employed hybrid choice models to analyze discrete choice experiment data and examine preferences for Huimin Insurance, a widely diffused complementary inclusive health insurance in China. We relied on KuRunData to collect our discrete choice experiment data. We found that people who regarded themselves to be at greater health risk preferred more generous benefits, while they did not value strong government involvement in product operation, design, and publicity. Higher scheme awareness was associated with a greater propensity to purchase coverage, to be willing to pay higher premium, and to accept lower reimbursement rates. High awareness coupled with a low perception of the scheme value resulted in a preference for an expanded package covering prevention and screening services. Stronger value was attributed to the Huimin Insurance among population groups that lack access to other insurance products, such as women and rural residents. By integrating psychological constructs in the decision-making analysis, we provide new evidence to guide design and promotion of appropriate health insurance schemes, especially catastrophic diseases.
Strengthening health research capacity for postgraduate trainees: an indigenous realist evaluation of the 'African Research Initiative for Scientific Excellence' programme.
Mutua MN, Nakidde C, Mukumbang FC
Health Policy Plan · 2025 Oct · PMID 40831401 · Full text
International research partnerships are crucial to strengthening research capacity (RCS) efforts. However, little is known about how such partnerships work to enhance the capacity of postgraduate trainees. We applied an...
International research partnerships are crucial to strengthening research capacity (RCS) efforts. However, little is known about how such partnerships work to enhance the capacity of postgraduate trainees. We applied an Indigenous realist evaluation (RE) approach to examine how the 'African Research Initiative for Scientific Excellence' (ARISE) programme works to strengthen the capacity for trainees. The Indigenous RE integrates critical and scientific realism paradigms with the Postcolonial Indigenous paradigm, focusing strongly on power, relationality, and decolonization. We used a multi-case study design to investigate two cases of innovation- and laboratory-based research projects led by African principal investigators (PIs). We conducted realist-informed interviews and observations with PIs, interviews with collaborators and partners, and storytelling with students. Realist thematic analysis helped to identify context, intervention, mechanism, and outcomes (CIMO). Deductive, inductive, abductive, and retroductive reasoning were applied to generate programme theories through an iterative and rigorous theory-building process. Findings show that trainees who are committed and self-driven, based in a research-intensive university that provides complementary opportunities and where there is demand for multidisciplinary research, will improve their skills, secure additional funding, and transition from master's to PhD programmes. This is because the RCS resources would inspire, challenge, empower, activate a sense of agency, and provide the trainees with eye-opening experiences. However, trainees would secure jobs outside Africa (brain drain) if career opportunities in specialized fields are limited locally. If trainees are junior faculty staff and fully funded, and their university provides protected time, RCS resources would inspire, motivate, and empower them, resulting in increased research outputs and career growth. RCS efforts targeting (post)graduate trainees need to consider 'inter alia' the university contexts (e.g. availability of complementary resources and protected time), the individual traits and readiness for postgraduate training, and the broader ecosystem, which determines if the trainees' skills benefit Africa's research and development.
Bridging care hierarchies through regional global budget payment: evidence from county medical communities in Zhejiang Province, China.
Liu X, Lyu H, Jin H
Health Policy Plan · 2025 Sep · PMID 40804026 · Full text
A hierarchical medical system anchored in primary healthcare is a critical mechanism for global healthcare systems to alleviate financing pressures and enhance health outcomes. Leveraging panel data from Zhejiang Provinc...
A hierarchical medical system anchored in primary healthcare is a critical mechanism for global healthcare systems to alleviate financing pressures and enhance health outcomes. Leveraging panel data from Zhejiang Province (2017-2022), this study evaluates how regional global budget payment reforms, implemented within county medical communities, influence the progression of the hierarchical medical system. The reforms were associated with a 3.0% (90% CI: -6.3 to 0.3, P < 0.1) reduction in patient volumes at county-level hospitals and a 30.2% (95% CI: 3.1-57.4, P < 0.05) surge in downward referrals to primary institutions. Concurrently, primary facilities saw an 8.3% (95% CI: 0.56-16.0, P < 0.05) increase in outpatient visits and 6.9% (95% CI: 0.15-13.7, P < 0.05) revenue growth. From the perspective of health performance, there was a 1.33% (95% CI: -2.57 to -0.09, P < 0.05) reduction in premature mortality from major chronic diseases. Mechanism analysis reveals that the regional global budget payment reshapes the incentives for both county-level hospitals and primary healthcare institutions. Under cost-containment pressures, county-level hospitals strategically redirect non-critical patients to primary healthcare institutions through formal referral protocols, while the latter are financially incentivized to provide healthcare services. These findings demonstrate how payment reforms can recalibrate provider behavior in vertically integrated systems, offering an explorable pathway for building people-centered, integrated healthcare systems through health insurance leverage.
An integrated rehabilitation workforce within secondary healthcare in Pakistan: a qualitative study with physiotherapists.
Teague K, Abbas S, Arsh A … +4 more , Muhammad D, Darain H, Pryor W, Strachan DL
Health Policy Plan · 2025 Sep · PMID 40802554 · Full text
Understanding how an integrated rehabilitation workforce can be supported and strengthened is crucial to address gaps in access and quality of rehabilitation below tertiary hospitals. We explored how physiotherapists in...
Understanding how an integrated rehabilitation workforce can be supported and strengthened is crucial to address gaps in access and quality of rehabilitation below tertiary hospitals. We explored how physiotherapists in two provinces in Pakistan perceive enablers and constraints to their rehabilitation performance at individual, workplace, health systems, socio-cultural, and political levels. Using a qualitative approach based on social ecological theories of health-worker performance and semi-structured interviews, 31 in-depth interviews with physiotherapists were conducted at secondary care hospitals in Khyber Pakhtunkhwa and Sindh provinces. Four intersecting themes were generated. (i) The capacity to perform as a rehabilitation professional is mediated by factors operating at different levels of the worker ecology. The experience of these factors has implications for (ii) the livelihoods and wellbeing of rehabilitation workers and (iii) the quality of care these workers perceive is delivered. (iv) Respondents' insightful and diverse suggestions for positive opportunities for change, towards strengthening and expanding integration of rehabilitation services within the health system, have policy and practice implications. Findings suggest an interdependence between context, rehabilitation workers, and the quality of care they deliver. The perspectives of these workers draw attention, beyond staff numbers and distribution, to the real-world challenges of practicing effectively in the context of local and systemic constraints and facilitators. These insights will be valuable to current efforts to integrate rehabilitation into health care settings beyond tertiary hospitals.
Enhancing health system efficiency in China: considering the interaction between use of primary care and the demand for secondary and tertiary care.
Jing R, Tang J, Song Y … +1 more , Ni C
Health Policy Plan · 2025 Sep · PMID 40799119 · Full text
This study examines the substitution effects and complementary dynamics between outpatient and inpatient services across different levels of hospital care in China's tiered healthcare system. The data of this study origi...
This study examines the substitution effects and complementary dynamics between outpatient and inpatient services across different levels of hospital care in China's tiered healthcare system. The data of this study originated from official administrative medical insurance reimbursement records from 2013 to 2019, with a final sample size of 1 520 263 patients. Using individual-level data and controlling for regional variations through fixed-effects models, we identify significant patterns in healthcare utilization that provide actionable insights for enhancing system efficiency. We have found a notable substitution effect: increased utilization of primary care services was negatively associated with the demand for secondary and tertiary care, thereby supporting ongoing health policy reforms. Additionally, outpatient services at primary care facilities could reduce the demand for both outpatient and inpatient services at higher-level hospitals. The homogeneity of outpatient services further facilitated substitution across care levels, allowing primary and secondary care to increasingly manage clinical cases previously handled by tertiary hospitals. Finally, we explored the complementary relationship between outpatient and inpatient services within the same care level, emphasizing highlighting how financial incentives contribute to induced hospitalization in China's healthcare system. These findings suggest that healthcare policies must be adjusted to address systemic inefficiencies and realign financial incentives in order to improve resource allocation and patient care.
The impacts of removing pharmaceutical co-payments for chronic conditions at primary care level: a pilot study in rural China.
Lu W, Powell-Jackson T, Mills A … +6 more , Wei Q, Xu H, Yuan B, He P, Meng Q, Xu J
Health Policy Plan · 2025 Sep · PMID 40796165 · Full text
The underutilization of primary care (PC) presents a substantial challenge in enhancing the people-centeredness, quality, and efficiency of health services for patients with chronic diseases. Pharmaceutical copayments ha...
The underutilization of primary care (PC) presents a substantial challenge in enhancing the people-centeredness, quality, and efficiency of health services for patients with chronic diseases. Pharmaceutical copayments have been considered a key barrier to patient access in low- and middle-income countries. It is unclear whether the removal of pharmaceutical copayment can lead to better care and management of chronic diseases. This study sought to evaluate the impact on healthcare utilization and spending of a policy that waived fees for essential pharmaceuticals at PC facilities, piloted county-wide from 2014 in rural China. Using individual claims data from 2010 to 2017, we applied a synthetic difference-in-difference approach to estimate the policy's effects. Our sample included 9115 patients with hypertension and/or diabetes from the pilot county and 30 675 patients from the other counties in the same municipality. The policy led to a significant increase of 0.69 in the number of PC visits per patient per year (95% CI: 0.46-0.91), equivalent to a rise of 44.1%. Annual spending per person on outpatients at PC facilities increased significantly due to the policy, by 58 yuan (95% CI: 36-80), equivalent to a rise of 40.5%. As for outpatient visits at hospitals, there was a 25.8% significant reduction in the number of visits per year (-0.56; 95% CI: -0.95 to -0.16) and a nonsignificant increase in spending (45 yuan; 95% CI: -111 to 21). The annual number of admissions and spending on inpatients per person in all facilities remained stable. Using claims data, we have demonstrated that targeted removal of copayment for essential medicines successfully shifted outpatient visits and expenditure from hospitals to PC facilities but did not affect hospitalization and inpatient expenditure. Further research may be attempted to see if removing pharmaceutical copayments on people with less severe NCDs could reduce hospitalizations.
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