Health Policy And Planning[JOURNAL]
Sun
200 papers
Intervention co-design to reduce the impact of heat exposure on pregnant and postpartum women and newborns in Burkina Faso.
Kadio K, Congo M, Sana A … +9 more , Filippi V, Roos N, Scorgie F, Kovats S, Nakstad B, Gon G, Chersich M, Hess JJ, Kouanda S
Health Policy Plan · 2025 Aug · PMID 40432496 · Full text
Interventions are needed to reduce the impact of heat on the health and wellbeing of women and newborns in Burkina Faso where seasonal temperatures can be extremely high. In this article, we share our experience and less...
Interventions are needed to reduce the impact of heat on the health and wellbeing of women and newborns in Burkina Faso where seasonal temperatures can be extremely high. In this article, we share our experience and lessons learned from co-designing an intervention to improve maternal and neonatal health, about heat in a rural and an urban district of Burkina Faso. We performed community engagement and a series of workshops with 49 community members (health workers, women group representatives, youth leaders, religious leaders, traditional leader, and mothers-in-law) and 36 implementers, stakeholders and professionals (officials from the Ministry of Health, midwives and related health workers, meteorologists, and environmental health practitioners). Following the discussions and group reflections, emerging intervention priorities were ranked based on their perceived likelihood of success, cost effectiveness, implementation feasibility, and sustainability. The co-design workshops identified behaviour change interventions encompassing raising awareness of the effects of heat through targeted messages on adaptative behaviour to adopt. The effective operationalisation of these interventions was further achieved through co-planning involving health system actors in contact with women and local stakeholders with relevant expertise. We aimed to engage health professionals and community health workers to integrate heat and dehydration messages into their routine work with pregnant and postpartum women with the aim of changing behaviour through communication: educational group talks, interpersonal exchanges in the consultation room and broadcasts of information to the public who attend the clinic (video played on a television set in the waiting room). The co-design workshops were an opportunity to build capacity among facilitators and participants as well as to prioritize and develop interventions to address the impact of heat exposure-amplified by climate change-on pregnant and postpartum women, and on newborns.
Reducing extreme heat impacts on health in pregnant women and infants: a community based intervention in Kilifi, Kenya.
Lusambili A, Scorgie F, Oguna M … +8 more , Chersich M, Luchters S, Gon G, Filippi V, Kovats S, McCawley K, Hess J, Nakstad B
Health Policy Plan · 2025 Oct · PMID 40402548 · Full text
High ambient temperatures affect maternal and newborn health outcomes and wellbeing. The Climate Heat and Maternal and Neonatal Health in Africa (CHAMNHA) consortium conducted formative qualitative research in rural Kili...
High ambient temperatures affect maternal and newborn health outcomes and wellbeing. The Climate Heat and Maternal and Neonatal Health in Africa (CHAMNHA) consortium conducted formative qualitative research in rural Kilifi, Kenya, to examine perceptions of heat risks among women, household members, and community stakeholders. An intervention was co-designed together with community members. This paper presents the development, implementation, and evaluation of a behaviour-change intervention aimed at reducing the burden of heat on maternal and newborn health. The intervention used Digital Audio-Visual (DAV) storytelling (encompassing short videos and a set of photographs) and facilitated group discussions. Intervention groups included pregnant and postpartum women (n = 10), mothers-in-law (n = 10), male spouses (n = 10), and community influencers (n = 40). Researchers and local community health volunteers supported pregnant and postpartum women and their household networks weekly for 4 months. At month five, a structured interview, originally administered at baseline, was repeated to evaluate understandings of heat risks and changes in behaviour (reducing exposure to heat by changing daily schedules, reducing heavy workload, and increasing spousal support). Pregnant and postpartum women reported a better understanding of the effects of heat on their health and the newborn, including the importance of staying hydrated, breastfeeding frequently, and avoiding heavy clothing for newborns. They also reported an increase in mothers-in-law and male spouses assisting with household chores and disseminating heat-health messaging to families. However, women noted that male spouses who supported them with chores sometimes reported being stigmatized by their peers. Community approaches to support pregnant and postpartum women during heat periods are feasible, and key community influencers can be trained to include heat-health messaging in their daily routines. Additional research is needed to examine whether repeated training is required to ensure sustainability. Future heat interventions focusing on maternal and neonatal health should consider factors such as employment, age, and depth of support networks.
Trends and determinants of healthcare-induced poverty in China 2013-2019.
Li L, Guo B, Liu C … +1 more , Yao Q
Health Policy Plan · 2025 Jun · PMID 40324905 · Full text
Healthcare costs are a major driver of poverty, accounting for 44.1% of poverty cases in China. By 2015, nearly 20 million people fell into or returned to poverty due to health issues. In response, the Chinese government...
Healthcare costs are a major driver of poverty, accounting for 44.1% of poverty cases in China. By 2015, nearly 20 million people fell into or returned to poverty due to health issues. In response, the Chinese government launched the national health poverty alleviation project in 2016. This study aims to evaluate the distribution and trends of healthcare-induced poverty from 2013 to 2019. Using data from the China Household Finance Survey (CHFS), we estimated the incidence of household catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE) and analyzed their determinants through multi-level logistic regression models. Subgroup analyses were conducted based on rural/urban location, geographic region, and province. In 2013, 31.83% of households experienced CHE, while 9.56% faced IHE. CHE incidence declined significantly after 2016 [adjusted odds ratio (AOR) = 0.493-0.766, P < 0.001]. IHE incidence initially increased in 2015 (AOR = 1.580, P < 0.001) before declining from 2017 onward (AOR = 0.465-0.607, P < 0.001). The most significant reduction (9.99%-10.95%) occurred among the highest income quartile. CHE and IHE shared similar determinants. Higher odds of CHE and IHE were associated with older age of the household head (AOR = 1.225-2.175, P < 0.001), rural residency (AOR = 1.093-1.199, P < 0.05), the presence of an elderly household member (AOR = 1.237-1.336, P < 0.001), and having more household members in poor self-rated health (AOR = 2.455-4.137, P < 0.001). Conversely, lower odds of CHE and IHE were associated with higher educational attainment (AOR = 0.681-0.879, P < 0.001) and employment (AOR = 0.610-0.708, P < 0.001) of the household head, higher household income per capita (AOR = 0.017-0.860, P < 0.001), and larger household size (AOR = 0.335-0.684, P < 0.001). Households in urban areas and the eastern developed region had lower incidences of CHE and IHE compared to others. In conclusion, China has seen a significant decline in CHE and IHE, particularly after implementing the national poverty alleviation project. However, regional, urban-rural, and income-related disparities persist, underscoring the need for equity-focused interventions.
Assessing the role of long-term care insurance in shaping living arrangements of older adults: evidence from China.
Zhu Z, Bai C
Health Policy Plan · 2025 Jun · PMID 40296673 · Full text
The establishment of long-term care insurance (LTCI) has become one of the key measures adopted by countries worldwide to address growing care needs associated with population aging. While existing studies focus on LTCI'...
The establishment of long-term care insurance (LTCI) has become one of the key measures adopted by countries worldwide to address growing care needs associated with population aging. While existing studies focus on LTCI's impact on medical expenditure and healthcare utilization, its effects on living arrangements of older adults, a core component of long-term care, remain underexplored in China. Living arrangements reflect both the well-being of older adults and their approaches to aging. This study examines the effects of China's LTCI pilots on living arrangements of older adults. Using three-wave panel data from the Chinese Longitudinal Healthy Longevity Survey, we analyzed the rollout of LTCI pilots across different cities from 2014 to 2021, employing a time-varying difference-in-differences approach. Our findings indicate that LTCI significantly increases the likelihood of older adults living alone or only with their spouse and decreases their preference for living with adult children. We provide two explanations for the observed effects: LTCI facilitates aging in place through the provision of home- and community-based services and enhances older adults' health by reducing the incidence of severe illnesses. The effects of LTCI are shaped by policy design, specifically reimbursement structures. These findings offer valuable insights for developing a universal LTCI system in China and other developing countries.
Community detection and management of mild cognitive impairment in Shanghai: a mixed-methods study.
Lu Y, Yu D, Wells Y … +1 more , Liu C
Health Policy Plan · 2025 Jun · PMID 40272923 · Full text
Dementia has been regarded as a priority in public health for healthy ageing. Mild cognitive impairment (MCI) detection and management is one of the strategies to confront the challenge of increasing burden of dementia....
Dementia has been regarded as a priority in public health for healthy ageing. Mild cognitive impairment (MCI) detection and management is one of the strategies to confront the challenge of increasing burden of dementia. However, MCI is not well recognized or managed in primary care. This study aimed to assess system barriers relating to MCI detection and management in the community. A mixed-methods study was undertaken over the period from October 2020 to October 2022. First, a focus group study (n = 124) in Shanghai explored the experiences of general practitioners (GPs), people with MCI and their informal caregivers, and community health managers using thematic analysis. This was followed by 2 rounds of national Delphi surveys among 22 eligible experts to solicit their consensus on the system conditions needed for community detection and management of MCI. A questionnaire survey based on the Delphi consultations was conducted with GPs (n = 1253) recruited from 56 community health centres (CHCs) in Shanghai to quantify their knowledge, attitudes, and practice (KAP) toward community detection and management of MCI and perceived system barriers. The results were mapped and triangulated in line with the chronic care model (CCM) and the health system building blocks articulated by the World Health Organization. Potential system barriers were identified from eight themes: (i) lack of self-management skills and enablement; (ii) lack of family support; (iii) lack of community support; (iv) unprepared healthcare system; (v) health service delivery deterrence; (vi) inadequate clinical decision support; (vii) lack of case management; and (viii) misaligned clinical information systems. The primary care system in Shanghai is not adequately equipped to handle the task of detecting and managing MCI. Both intrinsic and extrinsic obstacles impede the successful conversion of MCI knowledge into desired actions. A systems approach is needed to confront the challenge of MCI detection and management in China.
Unpacking complexities surrounding tobacco control policy formulation and tobacco industry interference in South Africa: a qualitative study.
Zatoński M, Bertscher A, Gallagher AWA … +1 more , Matthes BK
Health Policy Plan · 2025 May · PMID 40227863 · Full text
South Africa (SA) used to be recognized as a committed leader in tobacco control (TC) having passed effective TC policies in the 1990s, but in recent years, it has been overtaken by other countries. While research sugges...
South Africa (SA) used to be recognized as a committed leader in tobacco control (TC) having passed effective TC policies in the 1990s, but in recent years, it has been overtaken by other countries. While research suggests that the tobacco industry (TI) predominantly uses economic arguments to shape TC policy discussions in SA, TI tactics to influence policy formulation have not been examined in the peer-reviewed literature. In this study, we draw on three frameworks (health policy triangle, 'bit in the middle', and Policy Dystopia Model) and 20 interviews, supplemented with academic and 'grey' literature, to explore TC policy formulation in SA. We focus on SA's 2018 draft TC Bill, which as of January 2025 has not been adopted. We found that despite SA's commitment to protect TC policies from the TI's vested interests, as set out in Article 5.3 of the World Health Organization Framework Convention on Tobacco Control, TI actors interfered throughout the policy formulation process. Participants reported efforts to shape policy alternatives by influencing the impact assessment and generating favourable evidence. To influence deliberation, they lobbied policymakers. To advocate for their preferred outcome, they sought to shape public opinion through campaigns and built alliances, for example, with the non-tobacco business community. The identified strategies were consistent with those observed elsewhere. Some were tailored to the SA context characterised by political corruption, and sensitivity around race and the legacy of Apartheid, as well as rivalry between transnational corporations and local producers. Industry actors also sought to redirect attention to TC areas (illicit trade and taxation) not led by the health sector, likely more susceptible to TI influence. The study demonstrates to policymakers, advocates, and researchers, the importance of not looking at a TC policy in isolation and of being mindful of industry efforts to exploit inherent policy-making complexities.
Compensation preferences of home-based disabled beneficiaries in the long-term care insurance system in Guangzhou, China.
Qian Y, Tuersun Y, Li D … +8 more , Luo L, Kou Y, Yuan W, Li L, Zheng L, Wu M, Wang W, Chen J
Health Policy Plan · 2025 May · PMID 40220141 · Full text
This study explores the preferences and willingness-to-pay of home-based disabled elderly individuals for long-term care insurance (LTCI) compensation mechanisms in Guangzhou, China, using a discrete choice experiment. T...
This study explores the preferences and willingness-to-pay of home-based disabled elderly individuals for long-term care insurance (LTCI) compensation mechanisms in Guangzhou, China, using a discrete choice experiment. The research aims to identify preferred compensation strategies, analyze heterogeneity in preferences, and provide recommendations for policy optimization. Using purposive and cluster sampling, 156 eligible participants were identified, with 96 completing the survey (response rate: 61.5.%). Disabled elderly individuals were defined based on activities of daily living assessments. A conditional Logit model was applied to analyze preferences, and subgroup analyses examined differences by education, gender, activities of daily living status, and caregiving arrangements. Key findings include preferences for medical care over life care, family caregivers over professional ones, and cash subsidies over mixed or proportional reimbursement. Respondents were willing to pay an additional $21.60 for medical care and $25.26 for cash subsidies (1 USD = 7.3 CNY). The average out-of-pocket cost for LTCI services was $27.39 per session, with a sub-average cost of $16.44 for basic care services. Subgroup analyses revealed higher-educated individuals favored medical care, while lower-educated groups prioritized affordability. Severely disabled individuals preferred professional caregivers, such as registered nurses. This study highlights the need to expand medical care services, integrate flexible compensation models, and tailor policies to demographic differences. The findings provide evidence for optimizing China's LTCI system and offer insights for aging populations in low- and middle-income countries.
Condom use prevalence during the COVID-19 pandemic among female sex workers in Dakar, Senegal: a retrospective, cross-sectional analysis.
Toh WQ, Treibich C, Szawlowski S … +5 more , Cust H, Mbaye EA, Gueye K, Ndour CT, Lépine A
Health Policy Plan · 2025 Aug · PMID 40193087 · Full text
Literature suggests that individuals may trade off health for income in face of an economic shock. Being in a close contact profession, the livelihoods of sex workers were severely affected by the COVID-19 pandemic. Few...
Literature suggests that individuals may trade off health for income in face of an economic shock. Being in a close contact profession, the livelihoods of sex workers were severely affected by the COVID-19 pandemic. Few studies exist on whether prevalence of better-renumerated condomless sex increased among this population in low and middle-income countries and discuss its implications on HIV/STI transmission, specifically during pandemic situations. We reported cross-sectional condom use prevalence estimates of 600 female sex workers in Dakar, Senegal from data collected before (2015, 2017) and during the pandemic (June-July 2020). Condom use prevalence was elicited via list experiments for more truthful estimates. Double list experiment estimates of mean condom use prevalence declined from 78.2% (95% CI: 70.9-85.5%) in 2017 to 65.1% (95% CI: 57.6-72.7%) in 2020. This statistically significant decrease of 13.1 percentage points (P = .014) represents a 16.8% fall in condom use and a 60.2% increase in condomless sex prevalence. The fall in condom use prevalence was largely concentrated amongst the asset-poor, providing some suggestive evidence that economic reasons drove the fall in condom use, reinforcing findings in existing literature regarding the positive relationship between economic shocks and risky sexual behaviours. At the point of the survey, the observed decline in client numbers exceeded the reduction in condom use prevalence, suggesting potential mitigation of HIV/STI transmission risks during the COVID-19 pandemic; nevertheless, the lack of direct comparability between these two metrics warrants cautious interpretation. However, more accurate epidemiological modelling considering the non-sex worker population and longer-term studies on whether condom use prevalence returned to pre-COVID levels after client numbers recovered are required for a comprehensive assessment of the pandemic's short-term and longer-term impact on HIV/STI transmission.
Power dynamics and intersectoral collaboration for health in low- and middle-income countries: a realist review.
Aivalli P, Dada S, Gilmore B … +2 more , Srinivas PN, De Brún A
Health Policy Plan · 2025 Jun · PMID 40186364 · Full text
Intersectoral collaboration (ISC) is a critical strategy in global health for addressing complex challenges requiring multi-sectoral engagement. Although studies examined ISC in low- and middle-income countries (LMICs),...
Intersectoral collaboration (ISC) is a critical strategy in global health for addressing complex challenges requiring multi-sectoral engagement. Although studies examined ISC in low- and middle-income countries (LMICs), gaps remain in understanding how power dynamics between stakeholders influence the effectiveness of ISC in these settings. This realist synthesis examines how, why, for whom, under what context, and to what extent power dynamics shape ISC in LMIC health programmes and policies, offering insights crucial for improving health policy implementation. Five initial programme theories were developed through a scoping review, document analysis, and qualitative study. A systematic search of Medline, Embase, CINAHL, Web of Science, and grey literature (2012-23) yielded 2850 records, with 23 included after screening. This period was chosen to capture contemporary shifts in ISC, following the 2012 UN Political Declaration on NCDs and the WHO's 2013 Health in All Policies (HiAP) framework, which strengthened multi-sectoral governance in LMICs. It also builds on prior reviews, ensuring an up-to-date synthesis of power dynamics in ISC. Data were synthesized using the context-mechanism-outcome framework, generating demi-regularities to refine programme theories (PTs). Findings reveal that power imbalances frequently manifest through hierarchical governance structures, resource disparities, and historical inequities, shaping ISC outcomes. Six refined PTs highlight: (i) inclusive policy development processes mitigate power asymmetries but require intentional facilitation to prevent marginalization of less dominant sectors. (ii) Leadership commitment and shared goal alignment enhance collaboration, yet competing institutional priorities often reinforce power struggles. (iii) Equitable resource allocation acts as both a catalyst for trust and a source of conflict, with donor influence exacerbating dependency dynamics. (iv) Hierarchical communication norms in LMICs undermine transparency, though informal interpersonal networks can circumvent bureaucratic barriers. (v) Ambiguity in roles and mandates amplifies power vacuums, enabling dominant actors to disproportionately influence agendas. Additionally, a sixth PT emerged: (vi) sustained interpersonal relationships counterbalance structural power imbalances, fostering accountability and adaptive problem-solving. These findings demonstrate that power dynamics in ISC within LMICs are mediated by both structural factors (e.g. funding models and institutional hierarchies) and relational mechanisms (e.g. trust and negotiation). Successful collaboration hinges on recognizing and addressing these dual dimensions of power. This synthesis advances the theoretical and practical understanding of ISC, offering policymakers actionable insights to navigate power-related challenges in intersectoral health initiatives.
Delivering integrated and standardized services to eliminate mother-to-child transmission of sexually transmitted infections: experience of the E-Clinic model in a Chinese pilot district.
Luo Y, Gao S, Chen J … +4 more , Lv D, Mai W, Wang W, Zhu Y
Health Policy Plan · 2025 May · PMID 40176734 · Full text
The elimination of mother-to-child transmission (EMTCT) of syphilis and hepatitis B virus (HBV) is a crucial strategy for preventing and reducing new pediatric infections. Timely and standardized EMTCT interventions for...
The elimination of mother-to-child transmission (EMTCT) of syphilis and hepatitis B virus (HBV) is a crucial strategy for preventing and reducing new pediatric infections. Timely and standardized EMTCT interventions for maternal infections have been demonstrated to be highly cost-effective and efficient. Regrettably, healthcare providers have encountered challenges in delivering these interventions due to the complexity of multidepartment referrals. Baoan district in Shenzhen, Guangdong Province, which serves as one of the six national pilot districts tasked with exploring effective EMTCT strategies, has pioneered the integration of infection management into antenatal care by establishing the E-Clinic (short for the Elimination of mother-to-child transmission Clinic) within the Obstetrics Department. The E-Clinic, through its provision of integrated services, has witnessed increased coverage of syphilis treatment for pregnant women living with syphilis, as well as increased coverage of antiviral treatment for high-risk pregnant women living with HBV. The E-Clinic has been recognized as a best practice for EMTCT by the World Health Organization and has been widely adopted and adapted in over 100 maternal and child healthcare institutions across Guangdong Province. The success of the E-Clinic underscores the importance of government leadership, innovation, and multilevel engagement in promoting standardized EMTCT services, providing insights for implementing EMTCT strategies in other regions worldwide.
First referral hospitals in low-resource settings: a narrative review of expectations for clinical service provision.
Willows TM, Mazhar R, Bhattarai S … +4 more , Tinn CS, Misago N, Ikuzwe JJR, English M
Health Policy Plan · 2025 Jun · PMID 40160002 · Full text
First referral hospitals (FRHs) have an important role to play in helping many countries achieve 'Health for All'. However, their specific role and the clinical services they are expected to provide to achieve this are e...
First referral hospitals (FRHs) have an important role to play in helping many countries achieve 'Health for All'. However, their specific role and the clinical services they are expected to provide to achieve this are evolving. To explore this issue further, we undertook a narrative review to examine the clinical service expectations of FRHs outlined in academic and policy literature, which identified a total of 404 FRH service expectations. At a global level, some categories of services provide extensive specific service recommendations, likely resulting from historical priorities and the influence of vertical programming and professional interests. However, in several important areas we identified few or no recommendations. At the level of individual country case studies undertaken through this review, FRH clinical service recommendations within available policy documents vary considerably. Our findings suggest a disconnect between the ambition for FRH and the difficult, context-specific decision-making needed at the national level on the role of FRHs as a service delivery platform within integrated health systems helping countries achieve universal health coverage.
How, why, and under what circumstances can supportive supervision programs improve malaria case management? A realist program theory.
Manzi F, Hamon JK, Agbodjavou MK … +16 more , Hoyt J, Kuwawenaruwa A, Kionga Y, Agossou C, Kabanywanyi AM, Boyi-Hounsou C, Lusasi A, Lazaro S, Saliou R, Kpemasse A, Reaves E, Kitojo C, Hassani AS, Gnanguenon V, Dossou JP, Webster J
Health Policy Plan · 2025 Jun · PMID 40146205 · Full text
Supportive supervision (SS) programs aim to enhance the quality of care by strengthening the performance of health providers. Commonly part of broader quality improvement efforts, SS programs are increasingly used in low...
Supportive supervision (SS) programs aim to enhance the quality of care by strengthening the performance of health providers. Commonly part of broader quality improvement efforts, SS programs are increasingly used in low-and middle-income countries to improve malaria case management. Despite substantial investments and some positive outcomes, little is known about what drives their effectiveness. A realist evaluation was conducted in Tanzania and Benin to explain how, why, and under what circumstances SS programs can improve the facility-based management of uncomplicated malaria in children <5 years. A program theory was developed through a team-based analysis of empirical data collected in both countries at two time points. Data included 218 in-depth and 12 structured interviews with stakeholders, 154 audits of febrile case management decisions, and 4 health facility audits. Stakeholder perspectives identified three acceptability mechanisms driving SS program outcomes in the studied contexts: the affective attitude, self-efficacy, and burden of the program as perceived by key actors. The pathway through which these mechanisms were perceived to shape malaria case management (diagnosis and treatment) practices was defined by the (i) extent to which the program was integrated into the public health system; (ii) frequency with which SS visits were conducted by appropriate supervisors; (iii) degree to which supervisors coached, rather than policed, supervisees; and (iv) level of collaboration achieved between supervisees and supervisors. The program actors' perception of the program's effectiveness was also found to be crucial to its sustainability. This study explains the dynamics driving SS program outcomes and underscores the role played by the cognitive and emotional responses of program actors. These insights are likely to be transferable to other settings with similar contexts and can help inform the design, implementation, monitoring, and evaluation of new and ongoing SS programs.
Impact of the free healthcare policies in Burkina Faso: underscoring important nuances.
Druetz T, Ilboudo P, Offosse MJ … +2 more , Fregonese F, Bicaba A
Health Policy Plan · 2025 May · PMID 40126875 · Full text
The article recently published by Aye et al. (2024) in Health Policy and Planning is a major contribution to understanding the medium-term (5 years) effects of the free healthcare policy introduced in 2016 in Burkina Fas...
The article recently published by Aye et al. (2024) in Health Policy and Planning is a major contribution to understanding the medium-term (5 years) effects of the free healthcare policy introduced in 2016 in Burkina Faso. The study makes rigorous use of interrupted time series with a nonequivalent control group and presents a wealth of information on the methodology used. Remarkably, numerous sensitivity analyses were conducted to strengthen the credibility of the results and limit the risk of bias. Three salient conclusions are presented: (I) free healthcare had no effect on the proportion of pregnant women who gave birth in a health center, either immediately or after 5 years; (II) free healthcare led to an immediate and significant increase in the rate of consultations for children <5 years of age; and (III) after this immediate increase, free healthcare led to a gradual decrease in the rate of consultations for children <5 years in the medium term. We believe it is essential to highlight some important nuances regarding these conclusions and highlight some methodological issues.
Implementing the Chinese mandatory antimicrobial stewardship program: barriers to continuous improvement.
Wang X, Lin L, Xu X … +4 more , Harbarth S, Yakob L, Zhang R, Zhou X
Health Policy Plan · 2025 Jun · PMID 40112085 · Full text
This study aims to investigate the implementation strategy, unintended consequences, and underlying barriers to mandatory antimicrobial stewardship (AMS) programs in China. Face-to-face, in-depth qualitative interviews w...
This study aims to investigate the implementation strategy, unintended consequences, and underlying barriers to mandatory antimicrobial stewardship (AMS) programs in China. Face-to-face, in-depth qualitative interviews were conducted in 16 public hospitals in eastern, central, and western China. Hospitals were purposely selected with full consideration to represent both economically developing and developed areas and both secondary and tertiary care hospitals. A total of 111 respondents were interviewed, including 38 doctors, 28 clinical pharmacists, 15 microbiologists, 14 infection prevention and control specialists, 10 experts from medical service departments, and 6 quality improvement experts. A thematic framework analysis was conducted. A common implementation strategy was found among the surveyed hospitals in response to the AMS programs mandated by healthcare authorities. The hospital leadership empowered an AMS team to set AMS-related indicators for each clinical department and each doctor, and adopted core elements of AMS to optimize antimicrobial prescribing. However, the mandatory AMS approach also caused unintended consequences including regulatory circumvention, shift of risk to doctors and patients, and demotivation of healthcare workers. Two key barriers to AMS implementation were identified: (i) poor communication and cooperation between the AMS team and doctors, characterized by a high-power-low-power dynamic within hospital disciplines; and (ii) the profit-driven compensation system, which discourages collaboration and resource distribution for AMS implementation. Mandatory AMS programs should intensify AMS training, promote communication and cooperation between the AMS team and doctors, adjust the compensation system to facilitate better AMS implementation, and offer supportive measures that enable the adoption of strict regulations.
Response to the letter 'Impact of the free health care policies in Burkina Faso: Underscoring important nuances'.
Aye TT, Nguyen HT, Petitfour L … +6 more , Ridde V, Amberg F, Bonnet E, Seynou M, Kiendrébéogo JA, De Allegri M
Health Policy Plan · 2025 May · PMID 40098488 · Full text
Abstract loading — click title to view on PubMed.
Prioritization of methods for assessing alcohol use in emergency room settings: findings from a qualitative study.
Petersen Williams P, Prinsloo M, Erasmus J … +3 more , Parry CD, Matzopoulos R, Peden MM
Health Policy Plan · 2025 May · PMID 40098485 · Full text
Limited alcohol-related injury data in hospital settings globally underscore the need for routine monitoring to inform policy formulation for injury prevention, especially in addressing violence and road traffic injuries...
Limited alcohol-related injury data in hospital settings globally underscore the need for routine monitoring to inform policy formulation for injury prevention, especially in addressing violence and road traffic injuries. COVID-19 and the related alcohol sales bans in South Africa in 2020-21 brought the impact of alcohol on trauma presenting to health facilities into sharp focus and highlighted the absence of practical, cost-effective, and accurate alcohol diagnostic tools in emergency rooms This qualitative study aims to identify valuable alcohol-related information for stakeholders to inform a validation study of alcohol diagnostics for injury-related trauma. We conducted five virtual focus group discussions (FGDs) with four groups of stakeholders: clinicians (n = 9), academics (n = 4), hospital and other operational staff (n = 6), and policymakers (n = 4). FGDs were audio recorded and transcribed verbatim. Coding and thematic analyses were conducted using NVivo version 12. Results highlighted the belief that alcohol places a burden on the healthcare system and plays a significant role in injury causation and mortality. Currently, robust alcohol assessment in emergency rooms is lacking. Despite acknowledging that quantified blood alcohol levels would not change acute clinical management, there was consensus regarding the need-to-know patients' alcohol usage to inform long-term management and broader public health objectives. Findings support plans to validate the efficacy of selected alcohol diagnostic tools in public hospital settings and to further test their feasibility and utility at a national level.
Constrained optimization: evaluating possible packages of community health interventions with competing resource requirements in Galmudug, Somalia.
Montgomery RJ, Scudder E, Tulloch C … +3 more , Jama M, Kozuki N, Ata B
Health Policy Plan · 2025 May · PMID 40066997 · Full text
Investment in community health worker (CHW) programs has allowed health systems to reach previously underserved rural and remote populations. As a result, CHWs are often burdened with responsibilities to deliver large pa...
Investment in community health worker (CHW) programs has allowed health systems to reach previously underserved rural and remote populations. As a result, CHWs are often burdened with responsibilities to deliver large packages of services, at times without sufficient human, financial, or health resources. To design a community-level program that saves maternal and newborn lives while operating within resource limitations, we used constrained optimization (a mathematical process for finding the solution to a stated objective while accounting for listed requirements) to construct a model for select villages in Galmudug State, Somalia. After establishing the resource requirements for delivering 25 evidence-based maternal and neonatal interventions, we used the Lives Saved Tool and optimization techniques to determine the package of care that leads to the most projected lives saved. With a cadre of 1450 female health workers and a budget of $435 000 for maternal and neonatal health commodities and programming over 1 year, we calculated that the optimized set of interventions for Galmudug could avert 15% of the 4132 projected maternal and neonatal deaths in 2024. We also conducted sensitivity analyses to show how the optimal combination of interventions and the number of lives saved change as the resource levels change. The model provides practitioners with a new tool and accompanying approach to evaluate possible packages of community health interventions with competing resource requirements.
Political commitment and implementation: the health system response to violence against women in Mexico.
Morse SM, Colombini M, Lentz EC … +4 more , Soriano CD, Morales AJM, Olavarrieta CD, Rodríguez DC
Health Policy Plan · 2025 May · PMID 40056153 · Full text
Violence against women (VAW) is a widespread concern globally and in Mexico, where in 2021, 44% of women aged ≥15 years have experienced some form of intimate partner violence during their relationship and a quarter have...
Violence against women (VAW) is a widespread concern globally and in Mexico, where in 2021, 44% of women aged ≥15 years have experienced some form of intimate partner violence during their relationship and a quarter have experienced sexual violence in the past 12 months. To respond, Mexico passed comprehensive legislation addressing VAW, which outlines the role of the health system in identifying, treating, and referring women experiencing violence; however, implementation of such regulations has been slow and far from successful. Using a conceptual framework of political commitment, we conducted a health policy analysis to evaluate how health policies addressing VAW in Mexico have been implemented. The political commitment framework includes the dimensions of expressed, institutional, and budgetary commitment. We adopted a multi-methods qualitative case study approach combining document analysis with 25 stakeholder interviews with policymakers and health facility directors in Mexico City. The results show that Mexico exhibits limited expressed political commitment from the president, but some commitment exists among Ministry of Health officials. We document that the mixed findings on expressed commitment are mediated, in part, by internalized social and gender norms that normalize and tolerate violence, which are present in society writ large. We find that institutional commitment exists through policies and institutions. However, monitoring systems for policy implementation were not working as designed, and there was limited effort and capacity to implement these policies, reflecting structural barriers and norms within the health system that shape the treatment of violence survivors. Finally, we found a budgetary allocation for VAW; however, it was unclear if the budget was utilized correctly. While progress has been made in addressing VAW in the health system in Mexico, implementation is lagging due to a lack of sustained political commitment, and thus, policies are likely not reaching their intended beneficiaries: survivors of violence.
Factors influencing the establishment of hospital accreditation programs in low- and middle-income countries: a scoping review.
Dharmagunawardene D, Bowman P, Avery M … +2 more , Greenfield D, Hinchcliff R
Health Policy Plan · 2025 Apr · PMID 39963954 · Full text
Hospital accreditation programs are globally recognized as an important tool for enhancing quality and safety in health care; however, many programs in low- and middle-income countries (LMICs) are discontinued shortly af...
Hospital accreditation programs are globally recognized as an important tool for enhancing quality and safety in health care; however, many programs in low- and middle-income countries (LMICs) are discontinued shortly after their establishment. This scoping review synthesized published evidence on factors influencing the establishment and sustainability of hospital accreditation programs in LMICs, to provide guidance to health stakeholders involved in these processes. Six databases were searched using the terms "accreditation," "health," "hospital," and the country list of LMICs. Screening was undertaken collaboratively for validation. A framework to guide data extraction was developed by amalgamating eight existing classifications, theories, models, and frameworks concerning policy diffusion and implementation. The framework comprised the following domains: antecedent influences (A), contextual factors (C), establishment factors (E), standards, surveyors, stimulants (incentives), and survey-related factors (S-4S), governance (G), legislation (L), execution (implementation; E), and assessment and monitoring (AM), forming the ACES-GLEAM framework. Thirty-two sources were identified, with an increasing publication trend over time. The included studies reported upon a broad range of patterns, innovations, influencers, enablers, and barriers concerning accreditation program establishment in LMICs. Key questions emerged, including the degree of government involvement, incorporation of international standards versus development of bespoke standards, the use of local versus external surveyors, the use of financial and other incentives to promote engagement, and mandatory versus voluntary approaches of program implementation. Resource constraints were recognized as the most important barriers to sustainable establishment, while the influence of global accreditation and donor agencies were viewed as presenting both positive and negative impacts. Health stakeholders are encouraged to reflect upon and apply the ACES-GLEAM framework, incorporating the guiding principles outlined in this paper, to help establish hospital accreditation programs in LMICs in a way that facilitates sustainability and effectiveness over time.
Community health worker payment processes: a qualitative assessment of experiences in two Indian states.
Furtado KM, Mehndiratta A, Bauhoff S … +4 more , Pawar S, Luo A, Jha A, McConnell M
Health Policy Plan · 2025 Apr · PMID 39953777 · Full text
Community health worker (CHWs) remuneration has received some attention in terms of the design of incentives, however, there is a lack of systematic data on the processes by which CHWs are paid. We aimed to study existin...
Community health worker (CHWs) remuneration has received some attention in terms of the design of incentives, however, there is a lack of systematic data on the processes by which CHWs are paid. We aimed to study existing payment processes including the role of digitization and its effects on CHW experiences with receiving full and timely compensation, and identify barriers and facilitators to the payment process. We studied payment processes for the Accredited Social Health Activist (ASHA) in India in two states with varying levels of performance and payment systems and conducted 53 in-depth interviews and eight focus group discussions across three categories of respondents (37 ASHA workers, 46 supervisors, and 34 managers/health system leaders). The data was coded thematically using inductive and deductive coding methods organized around five steps of the payment process: (i) recording of work, (ii) claim submission, (iii) claim verification, (iv) claim processing, and (v) payment disbursement. We observed complex sub-processes within each stage of the payment process that adversely impacted payment timelines, CHW workload, and motivation, even where digital tools provide support. Local administrative initiative and positive organizational culture overcame these challenges to standardize and simplify processes for recording work, submitting claims, and maintaining adequate funds, facilitating timely payments. Complete digitization of disbursement through the public financial management system improved timeliness, transparency, and satisfaction among CHWs compared to earlier cash and cheque-based payments. The potential digitization of service delivery records for claim submission was met with mixed perceptions among CHWs and their supervisors. Our study contributes to the body of knowledge on CHW compensation by delineating the processes by which financial incentives are paid and offering insights for low and middle-income countries to improve the efficiency of payment systems.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe