SSM - Health Systems最新文献

{"title":"Can Indonesia achieve universal health coverage? Organisational and financing challenges in implementing the national health insurance system","authors":"Dwidjo Susilo ,&nbsp;Luh Putu Lila Wulandari ,&nbsp;Evi Sukmayeti ,&nbsp;Augustine Asante ,&nbsp;Stephen Jan ,&nbsp;Hasbullah Thabrany ,&nbsp;Viroj Tangcharoensathien ,&nbsp;Virginia Wiseman ,&nbsp;Marco Liverani","doi":"10.1016/j.ssmhs.2025.100138","DOIUrl":"10.1016/j.ssmhs.2025.100138","url":null,"abstract":"<div><div>Indonesia's National Health Insurance system - the Jaminan Kesehatan Nasional (JKN) - is one of the largest single-payer health insurance schemes in the world, aiming to provide equitable and affordable healthcare to a population of over 280 million. Since its launch in 2014, the JKN has achieved near-universal enrolment, covering 98 % of Indonesians in 2024. However, progress towards universal health coverage – understood as access to the health services people need, when and where they need them, without financial hardship - has been hindered by financing deficits and operational hurdles faced by healthcare providers. In this paper, we examine critical issues affecting the implementation of JKN through the analysis of 20 in-depth interviews and a focus group discussion with government officers and health sector managers at the national and provincial level. Data analysis was guided by a framework combining health systems building blocks and dimensions of access to services. The findings highlight persistent challenges despite the JKN's wide coverage, including difficulties among informal sector workers in paying premiums, regional disparities in service access and health workforce distribution, inefficiencies in provider payment mechanisms, and weak information systems for tracking subsidised members. Interviews also revealed a growing financial and administrative strain on hospitals linked to frequent regulatory changes. To address these issues, we recommend three priority reforms: (1) implement sliding-scale subsidies for informal sector workers; (2) improve provider payment models by introducing cost-sharing for elective services; and (3) adopt participatory policymaking processes to ensure reforms are sustainable and inclusive.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100138"},"PeriodicalIF":0.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public health facility quality and place of delivery in India: A decomposition analysis across wealth groups","authors":"Amit Summan ,&nbsp;Arindam Nandi ,&nbsp;Deepshikha Batheja ,&nbsp;Abhik Banerji ,&nbsp;Ramanan Laxminarayan","doi":"10.1016/j.ssmhs.2025.100140","DOIUrl":"10.1016/j.ssmhs.2025.100140","url":null,"abstract":"<div><div>Institutional delivery rates in India remain low, with significant interstate disparities. There is limited research on how supply-side factors influence maternal delivery choices. This study examined whether improvements in the quality of delivery services can impact maternal delivery location decisions using the Integrated Child Health and Immunization Survey (2015–2016). The national survey covered 1510 public planning units (PU) and 44,571 households. We constructed three indices of quality: physical infrastructure, health staff availability, and equipment and vaccine availability. Using multinomial probit regression, we analyzed the relationship between place of delivery for the household’s youngest child under age two and PU quality. Additionally, we conducted Fairlie decomposition analysis to examine factors contributing to differences in delivery location by income group. Mothers living near higher-quality public health facilities, as assessed by all three indices, were more likely to deliver in public facilities and less likely to choose private facilities or home births. The effects of the equipment and vaccine availability index were the strongest and most consistent across terciles, followed by the health staff index in urban areas and the infrastructure index in rural areas. Households in the bottom two wealth quintiles had access to lower-quality public health facilities. Limited access to quality facilities was linked to lower institutional delivery rates when compared to households in the top three wealth quintiles. Improving the quality of health facilities, particularly in low-income areas, can improve institutional delivery rates in public facilities.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100140"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kenya’s path to Universal Health Coverage: Insights from policy and practice","authors":"Evaline Langat ,&nbsp;Paul R. Ward ,&nbsp;Hailay Abrha Gesesew ,&nbsp;Lillian Mwanri","doi":"10.1016/j.ssmhs.2025.100141","DOIUrl":"10.1016/j.ssmhs.2025.100141","url":null,"abstract":"<div><h3>Background</h3><div>Universal health coverage (UHC) is a globally endorsed commitment aimed at ensuring equitable access to affordable healthcare services. Kenya's journey toward UHC has been marked by significant reforms, including the 2018 pilot phase and ongoing implementation phase (2020–2030). Using qualitative insights from policymakers and practitioners, this study explored Kenya’s progress, challenges, and opportunities to achieve UHC.</div></div><div><h3>Methods</h3><div>Key informant interviews were conducted with 44 stakeholders across seven counties in Kenya. Data were collected in English using a semi-structured interview guide, audio-recorded with consent, and transcribed verbatim. Thematic analysis, guided by the WHO health system framework, identified achievements, challenges, and areas for improvement across six health system building blocks.</div></div><div><h3>Results</h3><div>The pilot phase improved healthcare access for vulnerable populations by eliminating user fees in public health facilities but faced challenges such as staff shortages, inadequate supplies, financial constraints, and limited stakeholder engagement. The implementation phase introduced structural reforms, including Primary Care Networks (PCNs) to strengthen primary healthcare, mandatory social health insurance for financial protection, and legal frameworks to support service delivery and facility autonomy. Despite these advancements, challenges remain, including workforce shortages, financial barriers, and limited stakeholder participation. Sustaining UHC requires strengthened health systems, reduced out-of-pocket costs, and inclusive stakeholder engagement, with political commitment as a key enabler.</div></div><div><h3>Conclusion</h3><div>Achieving equitable, efficient, and sustainable UHC in Kenya demands more than political commitment. It requires strengthened workforce capacity, equitable financing, efficient supply chains, stakeholder engagement, reduced out-of-pocket costs, and strategic private sector involvement within inclusive policies.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100141"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an indicator to measure emergency interfacility referral readiness for maternal and newborn care at national and sub-national levels","authors":"Megan M. Lydon ,&nbsp;Prateek Gupta ,&nbsp;Peter Acker ,&nbsp;Loveday Penn-Kekana ,&nbsp;Emily B. Keyes","doi":"10.1016/j.ssmhs.2025.100137","DOIUrl":"10.1016/j.ssmhs.2025.100137","url":null,"abstract":"<div><h3>Purpose</h3><div>Emergency referral systems are vital to robust and resilient health systems, however, referral system strengthening efforts have been fragmented, often narrowly focused and lacking a clear measurement approach. We aimed to design a comprehensive standardized indicator to assess health facility readiness to refer emergency obstetric and newborn cases to a receiving health facility to improve the quality of referrals.</div></div><div><h3>Methods</h3><div>We first developed an overarching emergency referral system monitoring framework. Through literature review and content analysis, we defined key dimensions for measurement. We mapped existing indicators to the monitoring framework’s dimensions and developed a tool to collect inputs for the emergency referral readiness indicator. We repeatedly sought consultation and feedback from stakeholders throughout the 2.5-year process and piloted the tool in Senegal and Mozambique. We consolidated feedback, adjusted and finalized the indicator.</div></div><div><h3>Results</h3><div>The final health facility assessment tool includes 123 questions across six dimensions. The dimensions include (1) Transportation readiness, (2) Referral efficiency and coordination of care, (3) Care during transport, (4) Financial accessibility of referral, (5) Family-centered referral, and (6) Inter-facility relational dynamics. Health facility responses can be scored by level of readiness (essential, improved or advanced) or by dimension. The pilot study showed that the tool was practical and effective.</div></div><div><h3>Conclusion</h3><div>Referral system strengthening efforts can benefit from the emergency interfacility referral readiness indicator put forward in this work. It considers the complexity of the referral system, yet offers a standardized approach to identify gaps in referral systems, focus efforts, and track progress over time.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100137"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health information sharing between the public and private sectors during Covid in Zambia","authors":"Dell D. Saulnier ,&nbsp;Felix Masiye","doi":"10.1016/j.ssmhs.2025.100136","DOIUrl":"10.1016/j.ssmhs.2025.100136","url":null,"abstract":"<div><div>Information sharing between the public and private sectors of the health system is essential to decision-making during shocks, and understanding the process between sectors can provide information on the health system’s ability to utilize knowledge. The aim of this study was to analyze the process of capturing and registering Covid-19 test information from public and private facilities in Zambia for use in disease surveillance and monitoring. Process mapping was done through document review, key informant interviews, and a workshop to generate information on the process and its challenges. Three pathways for data capture and registration with seven stakeholder groups were identified: tests conducted, test results, and the DHIS2 tracker. The process for sharing information between the public and private sectors was active and functioning, but challenged by fragmentation, limited resources and ownership, and difficulty governing multiple pathways and uses. Unique public-private challenges included an underdefined role for the private sector in public health emergencies and a lack of integration and governance of the private sector in extraordinary circumstances. The findings suggest that implementing a new reporting process for the private sector during a public health crisis was an internal shock itself, which implies that information sharing for decision-making during crises could be improved by engaging and integrating the private sector into emergency preparedness prior to the moment of crisis.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100136"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of work culture delineated by workplace sense of belonging: A comparative qualitative study of clinical support staff","authors":"Petra J. Sprik ,&nbsp;Katherine A. Meese ,&nbsp;Shanequa Roscoe-Nelson ,&nbsp;Leila Sadri ,&nbsp;Samuel O. Boadu ,&nbsp;Feras Olyan ,&nbsp;Laurence M. Boitet","doi":"10.1016/j.ssmhs.2025.100135","DOIUrl":"10.1016/j.ssmhs.2025.100135","url":null,"abstract":"<div><h3>Background</h3><div>Promoting workplace sense of belonging (WSB) is suggested to improve the wellbeing and retention of clinical support staff (CSS), a critical group in healthcare systems. This comparative thematic analysis explored how CSS with and without WSB described their work culture, using the multi-level Job Demands-Resources (JD-R) model. Using an exploratory approach, we aimed to capture the breadth of cultural elements potentially related to WSB among CSS.</div></div><div><h3>Methods</h3><div>An anonymous employee engagement survey from a large academic medical center in the Southeastern United States was analyzed using hybrid thematic analysis. Responses to an open-ended question about work culture were inductively coded, then codes were deductively sorted into multi-level JD-R categories. Matrix coding explored differences in code frequency and content between those who agreed/strongly agreed with a WSB and those who disagreed/strongly disagreed.</div></div><div><h3>Results</h3><div>Among 385 analyzed respondents, 77 % indicated WSB. Respondents described positive and negative elements of work culture; those with WSB highlighted positive aspects more frequently (64 %) and negative aspects less frequently (56 %), whereas the opposite pattern was more pronounced for those without WSB (22 % positive, 89 % negative). Code and content differences emerged across organizational, team, and individual level themes. Those without WSB uniquely described being treated as inferior based on their profession, directly experiencing discrimination, and more intensely experiencing team conflict, among others. Those with WSB more saliently describe workplace diversity, inclusion, and collegial relationships, among others.</div></div><div><h3>Conclusion</h3><div>Findings suggest that work culture experiences differ by WSB, warranting further research to better understand and support this understudied population.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100135"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness and usability of community and facility-based health sector client feedback mechanism in Tanzania public health system. A mixed methods study","authors":"James T. Kengia ,&nbsp;Pius Kagoma ,&nbsp;Ally Kinyaga ,&nbsp;Helga Mutasingwa ,&nbsp;Simon Debere ,&nbsp;Robert Smith ,&nbsp;Marcos Robert Mzeru ,&nbsp;Rashid Mbunda ,&nbsp;Claud Kumalija ,&nbsp;Paul Chaote ,&nbsp;Felix Sukums ,&nbsp;Msafiri Kabulwa ,&nbsp;Eliud Eliakimu ,&nbsp;Rashid S. Mfaume ,&nbsp;Ntuli A. Kapologwe ,&nbsp;Paschal Ruggajo ,&nbsp;Wilson C. Mahera ,&nbsp;Albino Kalolo","doi":"10.1016/j.ssmhs.2025.100133","DOIUrl":"10.1016/j.ssmhs.2025.100133","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Client feedback systems are increasingly becoming important in person-centered health care. The systems provide opportunities to the public to interact with the health care providers and policymakers, present their concerns related to the performance of the health care system in order to improve the quality, equity, and responsiveness in the provision of services, hence increase social accountability. This study aimed to assess the situation of client feedback systems in Tanzania, focusing on the awareness and usability of existing facility- and community-based feedback platforms from the client’s perspective.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;The study employed a concurrent mixed-method design using both quantitative and qualitative methods. Quantitatively, surveys were administered in July 2023 to 1009 clients who received either inpatient or outpatient services from 109 health care facilities in 20 councils across 10 regions of Tanzania mainland to gather structured data on satisfaction levels, perceptions of feedback mechanisms, and suggestions for improvement. Qualitative data were collected through Focus group Discussion (FGD) to get in-depth healthcare workers and or clients’ perspectives and experiences. These methods provided nuanced information, contextual insights, and a deeper understanding of the client feedback process. Combining these approaches yielded a comprehensive, multi-dimensional view of the client feedback mechanism landscape. We used Generalized Linear Mixed Model and thematic analysis for quantitative and qualitative data respectively.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Our findings revealed that, the majority of the clients were aware of their right to provide feedback (79.78 %), and in particular familiar with the suggestion box (82.95 %) followed by phone calls (34.49), nevertheless most of them never provided feedback (67.3 %). Phone calls (83.75) and SMS (44.10 %) were the most preferred platforms to provide feedback. Comparatively, clients attending higher level health facilities, clients who visited facilities 4–5 times or more, those who received services for 45–60 min or more and those who were aware of existence of client feedback system than their counterparts were significantly more likely to provide feedback. Moreover, in qualitative findings availability of real time feedback, authenticity, user-friendliness of the system, digitalization, clarity in referral pathway and information use to support decisions and quality improvement was important factors to enhance usability.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Improving the usability of client feedback system is essential to attain person-centered health care and advance universal health coverage. The majority of the clients attending heath care facilities are aware of their right to provide feedback, nevertheless, most of them never provide feedback. Our study, have shed light on the need to invest on user friendly syst","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100133"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financing and purchasing mechanisms of primary health care in Southeast Asia region: Findings from a scoping review","authors":"Hsu Myat Mon ,&nbsp;Aungsumalee Pholpark ,&nbsp;Leonard Thomas Sy Lim ,&nbsp;Tsolmongerel Tsilaajav ,&nbsp;Valeria de Oliveira Cruz ,&nbsp;Piya Hanvoravongchai","doi":"10.1016/j.ssmhs.2025.100132","DOIUrl":"10.1016/j.ssmhs.2025.100132","url":null,"abstract":"<div><h3>Background</h3><div>Despite commitment to Primary Health Care (PHC), financing has been a persistent challenge in Southeast Asia, with limited discussions. To address this knowledge gap, this study explores three key financing mechanisms: revenue mobilization, pooling, and purchasing across the region.</div></div><div><h3>Methods</h3><div>A scoping review, with searches in PubMed, Scopus, Embase, and Google Scholar, was conducted. Screening was done via Covidence, with data extracted and analyzed in Excel using a framework analysis.</div></div><div><h3>Results</h3><div>Of 2521 sources, 171 were included. Limited information specific to PHC was found. Revenue mobilization mainly includes out-of-pocket payment, government funding, social insurance contributions, and a mix of government and external funding. Pooling for PHC financing was seen in Thailand, while other countries showed multiple levels of pooling under general health financing. The prevalent purchasing method for public facilities is line-item budgeting, with salaries as the primary payment method for healthcare providers. Some countries employ performance-linked methods and capitation for provider payments. Significant challenges include inadequate budget allocations, financial flow fragmentation, and poor coordination and low capacity for financial management.</div></div><div><h3>Conclusion</h3><div>Financing for PHC is found to be insufficient and inefficient, mainly using traditional mechanisms. Cross-country learning and collaboration can support the development of strategic PHC financing mechanisms.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100132"},"PeriodicalIF":0.0,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance and challenges of Accredited Social Health Activists (ASHAs) in delivering key Maternal and Newborn Health (MNH) services in India: A systematic review and meta-analyses","authors":"Sukriti Chawla ,&nbsp;Chandan Kumar ,&nbsp;Montu Bose ,&nbsp;Shikha M. Shrivastav","doi":"10.1016/j.ssmhs.2025.100134","DOIUrl":"10.1016/j.ssmhs.2025.100134","url":null,"abstract":"<div><h3>Background</h3><div>Accredited Social Health Activists (ASHAs), a cadre of community health workers in India, have played a significant role in improving key maternal and newborn health (MNH) services since their inception in 2005 under the National Rural Health Mission (NRHM). However, persistent inequalities in the coverage of these health services and the expanding engagement of ASHAs within the health system necessitate a revisit to their performance and the challenges they face. This study synthesizes existing evidence on ASHAs' performance in MNH services.</div></div><div><h3>Methods</h3><div>A comprehensive search of bibliographic databases, including PubMed, Scopus, Embase, and Web of Science, yielded a total of 9140 studies. Of these, 38 studies were included in the systematic review, and 31 in the meta-analyses. Random-effects models were used to estimate the pooled effect size (Relative Risk) of ASHAs in delivering three key MNH services: antenatal care visits, institutional deliveries, and postnatal care.</div></div><div><h3>Findings</h3><div>The meta-analyses suggest that ASHAs have a positive, albeit marginal, impact on improving key MNH services. Qualitative studies revealed both enablers and barriers to ASHA’s performance, which were classified into individual, cultural, and health system-related factors.</div></div><div><h3>Interpretation</h3><div>The study highlights that fostering a supportive environment is crucial for enhancing ASHAs’ impact on MNH service coverage. Given significant interstate disparities, regionally adaptive strategies are required. Additionally, the scope of ASHAs' responsibilities should be periodically reviewed to ensure the provision of holistic and culturally sensitive maternal care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100134"},"PeriodicalIF":0.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of informal health providers in the management of neglected tropical diseases in Liberia: A participatory investigation","authors":"Hannah Berrian ,&nbsp;Laura Dean ,&nbsp;Shahreen Chowdhury ,&nbsp;Zeela Zaizay ,&nbsp;Sally Theobald ,&nbsp;Wede Seekey ,&nbsp;Jerry Kollie ,&nbsp;John Solunta Smith Jr ,&nbsp;Colleen Parker ,&nbsp;Emerson Rogers ,&nbsp;Rosalind McCollum","doi":"10.1016/j.ssmhs.2025.100131","DOIUrl":"10.1016/j.ssmhs.2025.100131","url":null,"abstract":"<div><h3>Background</h3><div>Informal health providers (e.g. traditional and faith healers) are the first point of contact for many persons affected by skin Neglected Tropical Diseases (NTDs) due to varying beliefs and perceptions, yet, they are typically not considered within interventions designed to support persons affected. Despite this neglect, most informal providers are already using their existing roles within communities to support persons affected with care. We sought to investigate the role of informal providers in the management of NTDs in Liberia using participatory approaches to understand and identify ways to improve equitable and effective care for people affected by skin NTDs.</div></div><div><h3>Methods</h3><div>Qualitative and participatory data were collected from two purposively selected counties in Liberia: Grand Gedeh and Lofa. Key informant interviews (6), photovoice (16), and vignettes (32) with traditional and faith healers and informal drug sellers sought to understand their roles in providing care for people affected by skin NTDs. Analysis was conducted using a thematic framework approach.</div></div><div><h3>Findings</h3><div>Health beliefs influenced care seeking from informal providers and/or biomedical care. Informal providers provide persons affected with holistic support, including physical, psychosocial, spiritual, social and financial. This care, based on their respective underlying health beliefs and cultural norms, is driven by perceptions of poor quality of the formal or biomedical health system. During care provision, traditional and faith healers emphasised referring persons affected to the health facility as part of their roles.</div></div><div><h3>Conclusion</h3><div>Understanding the roles of informal providers in the management of skin NTDs is important in reducing the burden of NTDs. Informal providers are trusted by their communities and seen as a primary contact to provide care. They expressed willingness to collaborate with the formal health system. Training them on identification and referral, and basic psychosocial support would enhance early referral and collaboration between formal and informal health systems.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100131"},"PeriodicalIF":0.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}