SSM - Health Systems最新文献

{"title":"A qualitative study of doulas providing emotional support during the perinatal period: An unharnessed opportunity in the United States","authors":"Elysia Larson ,&nbsp;Ronald M. Cornely ,&nbsp;Christina Gebel ,&nbsp;Ebunoluwa Falade ,&nbsp;Caroline Ezekwesili ,&nbsp;Sayida Peprah-Wilson ,&nbsp;Laura E. Dodge ,&nbsp;Clevanne Julce ,&nbsp;Nancy Byatt","doi":"10.1016/j.ssmhs.2025.100077","DOIUrl":"10.1016/j.ssmhs.2025.100077","url":null,"abstract":"<div><h3>Introduction</h3><div>To address unmet mental health needs, support needs to be integrated into settings where individuals seek care. Doula care during the perinatal period offers a community-based setting for exploring opportunities to promote perinatal mental health.</div></div><div><h3>Methods</h3><div>We elucidated doulas’ and perinatal individuals’ views on how doulas can support perinatal mental health through four focus group discussions (FGDs) with doulas (n = 18) and three FGDs with perinatal individuals (n = 10); all participants were living in the United States.</div></div><div><h3>Findings</h3><div>Participants reported two main ways doulas can and do support perinatal mental health: first, by acting as a bridge to mental health services and resources, and second, through providing direct emotional support by listening and validating the client’s experiences and emotions. Doulas suggested that because they spend more time interacting with perinatal individuals than most obstetricians, and because they are often seen as an independent third party, they may be more likely to identify social and emotional challenges. However, many doulas indicated they had a lack of formal training in how to provide mental health support and would benefit from additional training.</div></div><div><h3>Conclusions</h3><div>Doulas often provide social and emotional support along with linkage to additional care or resources. Doula FGD participants described a need for additional skills to provide emotional support and to identify when support from a mental health professional is warranted. Doula engagement has the potential to expand support systems to both provide a supportive environment for perinatal individuals and to facilitate prevention and access to treatment for mood disorders.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848338","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":"Determinants of willingness and ability to pay for an improved community-based health insurance in Rwanda","authors":"Mark Akanko Achaw ,&nbsp;Charles Mulindabigwi Ruhara ,&nbsp;Edouard Musabanganji ,&nbsp;Regis Hitimana","doi":"10.1016/j.ssmhs.2025.100069","DOIUrl":"10.1016/j.ssmhs.2025.100069","url":null,"abstract":"<div><div>The Rwanda Community-Based Health Insurance (CBHI) is the most crucial financial mechanism against catastrophic health expenses in the country, covering over 87 % of the population since its inception in 2003. Although the scheme has expanded significantly in terms of coverage, premium rates have remained unchanged. In 2021, the Rwanda Social Security Board (RSSB), which manages the CBHI, initiated a study to assess the population's willingness and ability to pay higher CBHI premiums and explore strategies for attracting the remaining informal population into the scheme. The study used the Contingent Valuation method to collect responses from a random sample of 6086 households.</div><div>The analysis revealed a strong reputation for the CBHI among the general population, despite some challenges such as recurring drug shortages and the unavailability of certain services in health centers. Regarding the willingness to enroll, many respondents, including non-CBHI members, expressed interest in joining the scheme. Most were willing to pay a maximum premium ranging from RWF 3229 (USD 3.2) to RWF 3817 (USD 3.8), which is higher than the current premium of RWF 3000. The logistic regression model identified key determinants of enrollment, including the age of household heads, household size, healthcare utilization, and economic status. In terms of willingness to pay, the most significant factors were the household's economic status (proxied by their socioeconomic classification, or Ubudehe category), household size, employment status of the head, healthcare utilization, savings habits, and participation in economic activities.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100069"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143816297","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":"Data quality of out-of-pocket payment on institutional delivery in India","authors":"Sanjay K. Mohanty ,&nbsp;Laxmi Kant Dwivedi ,&nbsp;Santosh Kumar Sharma ,&nbsp;Sowmya Ramesh ,&nbsp;Priyanka Gautam ,&nbsp;Suraj Maiti ,&nbsp;Saritha Nair ,&nbsp;S.K. Singh","doi":"10.1016/j.ssmhs.2025.100071","DOIUrl":"10.1016/j.ssmhs.2025.100071","url":null,"abstract":"<div><div>Estimates of out-of-pocket (OOP) payments on health care are increasingly being used in research and policy. In India, these estimates are typically derived from health surveys by the National Sample Survey (NSS). The questions on OOP payment on delivery care have recently been integrated into the last two rounds of India’s National Family and Health Surveys. These surveys differs on content of questions, reporting, and recording of responses that may have a bearing on the reliability of OOP payment estimates. This paper examines issues related to the data quality of OOP payments using recent rounds of two large-scale population-based surveys: the NFHS, 2019–21 and the 2018 National Sample Survey (NSS). Our analysis includes 155,624 births delivered in healthcare facilities from NFHS-5 and 27,664 cases of hospital-based delivery care recorded in the 75th round of the NSS health survey, 2018. We have used descriptive statistics and a two-part regression model to examine variations of OOP payment across surveys. OOP payments showed variations across socioeconomic and demographic groups in both surveys, with some notable correspondence alongside significant differences. Variations are similar for those availing services from private health centres. After controlling for socio-economic and demographic factors, OOP payments in the NFHS were lower among the poorest and higher among the wealthiest compared to the NSS. State-level variations in OOP payments were also more pronounced between the two surveys. The variations in OOP payment across surveys were possibly due to the structure of questions, recall bias, and variations in the price level. We recommend standardizing survey questions to improve the reliability of OOP payment estimates across surveys.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143807659","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":"Examining the influence of mHealth interventions on quality of life among individuals living with HIV or hypertension: A systematic narrative review","authors":"Danleen James Hongoro ,&nbsp;Andre Pascal Kengne ,&nbsp;Olufunke Alaba","doi":"10.1016/j.ssmhs.2025.100076","DOIUrl":"10.1016/j.ssmhs.2025.100076","url":null,"abstract":"<div><h3>Background</h3><div>The coexistence of communicable diseases like HIV and non-communicable diseases such as hypertension poses significant global health challenges. For individuals managing chronic conditions, maintaining a good Quality of Life (QoL) is essential. Mobile health (mHealth) interventions, propelled by the extensive use of mobile technologies, present innovative approaches to healthcare. Therefore, this review aims to synthesize existing definitions, frameworks, facilitators and barriers to scaling-up health innovation in low-middle-income-countries (LMICs).</div></div><div><h3>Methods</h3><div>We conducted a thorough search across major databases from January 2000 to January 2024, focusing on mHealth interventions targeting HIV and/or hypertension. Peer-reviewed studies employing validated QoL instruments, available in full text and published in English were included.</div></div><div><h3>Results</h3><div>Out of 5082 initially identified articles, 18 met the inclusion criteria after the exclusion of duplicates and irrelevant studies. Our thematic synthesis categorized the studies according to the type of mHealth intervention, and its impact on patients with HIV and/or hypertension, and identified broader trends, challenges, and recommendations. Intervention strategies varied, ranging from simple text reminders and interactive platforms like WeChat to comprehensive telehealth solutions and personalized coaching programs. The impact of mHealth on the QoL of people with HIV showed a spectrum from positive to neutral, influenced by factors such as technology used and patient demographics. For hypertensive patients, mHealth interventions generally improved QoL, although some studies reported neutral impacts. Key trends highlighted the importance of personalization and user engagement in correlating with improved QoL outcomes. Challenges identified included participant dropout, privacy issues, software malfunctions, time constraints, and the difficulty of catering to diverse patient needs. A notable hindrance to evaluating intervention effectiveness was the inconsistency in outcome measurement tools used across studies.</div></div><div><h3>Conclusion</h3><div>mHealth interventions demonstrate potential in improving QoL for individuals living with HIV and/or hypertension. Optimizing these interventions and their integration into existing healthcare systems is essential for maximizing benefits. However, addressing barriers to equitable access and overcoming challenges is crucial for the effective adoption and efficacy of mHealth solutions across these populations.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunities for authentic co-production in integrated care implementation","authors":"Marisa Sklar ,&nbsp;Anna Brubaker ,&nbsp;Lilliana Conradi ,&nbsp;Euan Sadler ,&nbsp;Nicole A. Stadnick","doi":"10.1016/j.ssmhs.2025.100074","DOIUrl":"10.1016/j.ssmhs.2025.100074","url":null,"abstract":"<div><div>This Short Communication proposes opportunities for authentic co-production in integrated care implementation. While there are targeted efforts to implement integrated care across healthcare systems, the extent to which these efforts have prioritized co-production is unknown. Opportunities for authentic integrated care implementation co-production are anchored to five core principles for implementation collaborations: 1) equity in relationship building, (2) reflexivity, (3) reciprocity and mutuality, (4) transformative and personalized, and (5) collaborative relationship structures or procedures.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143785626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal and newborn health prioritization in post-transition Somalia: Analysis of key stakeholder perspectives at the federal level","authors":"Mamothena Mothupi ,&nbsp;Maryan Abdulkadir Ahmed ,&nbsp;Asia Mohamed Mohamud ,&nbsp;Abdirisak Dalmar ,&nbsp;Mohamed A.O. Jimale ,&nbsp;Hawa Abdullahi ,&nbsp;Paul Spiegel ,&nbsp;Naoko Kozuki","doi":"10.1016/j.ssmhs.2025.100072","DOIUrl":"10.1016/j.ssmhs.2025.100072","url":null,"abstract":"<div><div>This case study explored the current drivers of Maternal and Newborn Health (MNH) prioritization in Somalia, a fragile country with very high maternal and neonatal mortality rates. To enhance MNH prioritization and improve outcomes, we need to understand macro contextual and health system factors that influence the level of attention and investment since 2012 with the establishment of the federal government of Somalia. This study consisted of a desk review and 20 semi-structured interviews with stakeholders in MNH policy and implementation, including government, donors, private sector, and non-governmental and multilateral organizations. The Health Policy Analysis triangle guided the analysis of findings, to capture policy content, context, actors, and processes. Our findings show a complex picture for MNH prioritization in Somalia. There is a level of priority for MNH through technical advancements driven by international partners, including development of policies, strategies, and guidelines. However, there is inadequate government ownership of the MNH agenda through poor domestic financial investment and capacity for governance (including partner coordination) in the health sector. The study found gaps in implementation of programs, and competing priorities due to insecurity and other health and social needs. Respondents highlighted a need to address fragmented accountability and oversight processes, and ensure meaningful inclusion of actors such as the private sector and the diaspora and women leaders.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100072"},"PeriodicalIF":0.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to health services utilization among households with free community-based health insurance enrolment in Ethiopia: A qualitative study","authors":"Doris Osei Afriyie ,&nbsp;Kaku Attah Damoah ,&nbsp;Essa Chanie Mussa ,&nbsp;Frank Otchere ,&nbsp;Nyasha Tirivayi","doi":"10.1016/j.ssmhs.2025.100066","DOIUrl":"10.1016/j.ssmhs.2025.100066","url":null,"abstract":"<div><h3>Background</h3><div>To build an integrated social protection programme, Ethiopia introduced a pilot initiative that facilitated community-based health insurance (CBHI) premium exemptions for permanent direct support (PDS) beneficiaries. This study sought to explore the factors that influence access and utilization of health services among PDS beneficiaries following free CBHI enrolment.</div></div><div><h3>Methods</h3><div>We conducted an exploratory qualitative inquiry using semi-structured interviews with 22 key informants and 22 PDS beneficiaries (focus group discussions and in-depth interviews) in two sub-cities of Addis Ababa where a pilot intervention was implemented. Thematic analysis was used to analyse the data.</div></div><div><h3>Results</h3><div>CBHI has facilitated timely access to healthcare services by reducing financial barriers for PDS beneficiaries. However, challenges related to the quality of health services, such as the shortages of commodities and attitudes of health professionals, have hindered optimal use. These challenges often lead to some beneficiaries returning to traditional sources or foregoing formal healthcare services altogether, as their cash transfers are insufficient for the ancilliary out-of-pocket health payments. Inadequate social support, lack of education about health services and insurance use are also key factors that have affected service uptake. A person-centred approach involving greater engagement with social workers could provide awareness and support for beneficiaries to maximize health services utilization.</div></div><div><h3>Conclusion</h3><div>After free enrolment in health insurance, it is crucial to address barriers to accessing healthcare services that are faced by vulnerable populations. There is a need for strengthening social services and primary health care systems and ensuring that health professionals are competent in caring for indigents.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100066"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"You are just like them: The paradoxical position of Nairobi's community health promoters, a photovoice study","authors":"Inviolata Njoroge ,&nbsp;Neele Wiltgen Georgi ,&nbsp;Linet Okoth ,&nbsp;Robinson Karuga ,&nbsp;Sally Theobald ,&nbsp;Laura Dean ,&nbsp;Lilian Otiso ,&nbsp;Rosie Steege","doi":"10.1016/j.ssmhs.2025.100068","DOIUrl":"10.1016/j.ssmhs.2025.100068","url":null,"abstract":"<div><div>Kenya's community health promoters (CHPs) are essential in expanding healthcare access for vulnerable and marginalised populations, particularly in informal settlements. Embedded within these communities, CHPs facilitate culturally sensitive care, improve service access, and contribute to the efficiency of the local health system. Despite global literature on community health workforces, the specific roles CHPs play in informal settlements remain neglected and underexplored. Understanding their realities is vital for creating supportive health policies that address urban transitions and enable CHPs to fulfil their roles.</div><div>This study uses photovoice with six CHPs in Nairobi's Viwandani settlement to document their experiences of marginalisation. Through co-analysis, we mapped the results using White's wellbeing dimensions, creating a framework for CHPs' lived realities in urban informality. Material challenges impacting CHP and community wellbeing include limited housing, water, sanitation, and employment. Social dimensions reveal complex dynamics between CHPs, community members, and government stakeholders, affecting CHPs' impact and community perceptions. Human dimensions reflect CHPs' aspirations, self-perception, and personal struggles, while subjective experiences intersect across all domains.</div><div>We highlight practically and theoretically that CHPs occupy a paradoxical role as healthcare providers within an environment and health system that fails to meet their needs and those of their communities. Our framework provides a unique contribution to knowledge that can support health systems decision-makers in thinking differently about the role of CHPs and the support needed for transforming urban health systems. CHPs' vulnerabilities should be recognised and addressed as they are crucial to creating a just and sustainable urban health system.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100068"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shattered assumptions: Unravelling of the social contract between the medical profession and society in India","authors":"Sayak Dutta ,&nbsp;Mayuri Samant ,&nbsp;Sanjana Santosh ,&nbsp;Michael Calnan ,&nbsp;Sumit Kane","doi":"10.1016/j.ssmhs.2025.100070","DOIUrl":"10.1016/j.ssmhs.2025.100070","url":null,"abstract":"<div><div>Incidents of violence against doctors are increasing across the world. Beyond concerns of physical security, this raises questions about the state of the social contract between medicine and society. We analyse the situation in India as a case using the ‘assumptive worlds’ framework to understand how doctors are coping with the situation and situating themselves within a rapidly changing health system and society. Interviews were conducted with forty-two purposively selected medical and non-medical (patients, journalists, lawyers, police) participants over eighteen months. We found that professional autonomy, respect for doctors, and trust in doctors and their altruism – key aspects of doctors’ assumptive worlds – are constantly challenged by assertive patients, an antagonistic society, and an apathetic administrative and regulatory system. The rise in violent attacks is creating a deep sense of being unfairly targeted and unjustly treated. To reconcile themselves with these developments, doctors in India are having to, often with anguish, reimagine their assumptive worlds and reshape their identities. Doctors are, however, unwittingly adopting a siege mentality. We conclude that the Indian medical profession’s response to these societal developments needs to instead be critical, and self-reflective, and that change must begin from within the medical profession.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100070"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143783482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unlocking adolescent and youth health - Insights from adolescent youth-friendly services in Migori County, Kenya: A cross-sectional mixed-methods study","authors":"Lillian Njoki Nyaga ,&nbsp;Eunice Muthoni Mwangi","doi":"10.1016/j.ssmhs.2025.100067","DOIUrl":"10.1016/j.ssmhs.2025.100067","url":null,"abstract":"<div><h3>Background</h3><div>The provision of adolescent and youth-friendly services (AYFS) can be facilitated by various strategies, including capacity building of health care providers (HCPs), coordination of AYFS, community engagement, and networking of AYFS stakeholders. Adolescents and youth face various health challenges including but not limited to adolescent pregnancies, HIV infections, sexual and gender based violence, strategies that would help curb these challenges is paramount. Although various studies have evaluated AYFS utilization and integration in Kenya, scant data exist on strategies facilitating or hindering the provision of the AYFS in accordance with the Kenya 2016 AYFS guidelines. The aim of this study was to document the implementation of AYFS strategies and how they affect the provision of AYFS in Migori County, Kenya.</div></div><div><h3>Methods</h3><div>This cross-sectional study targeted 159 public health facilities and 455 HCPs in Migori County. The study utilized Taro Yamane’s formula to determine a sample size of 114 health facilities with a target population of 455HCPs, from which a sample of 213 HCPs was drawn. The data were collected from the 210 providers using a structured questionnaire, whereas the qualitative data were collected from three health facility-in-charges using a key informant interview guide. Statistical significance was set at p &lt; 0.05 for quantitative data.</div></div><div><h3>Results</h3><div>Bivariate analysis reported positive and significant associations between capacity building, coordination of actors and activities, stakeholder networking, and community engagement and the provision of the AYFS, with p = 0.001, r = .548; p = 0.001, r = .482; p = 0.001, r = .390; and p = 0.001, r = .460, respectively. There was a 10.092-fold ( CI 4.007–25.417) increase in the odds of providing AYFS among workers who were trained on the AYFS compared with those who were not trained; a 2.987-fold (CI 1.124–7.937) increase in the odds of providing an AYFS when the coordination of AYFS actors and activities was performed compared with that where coordination was not performed; and a 4.979-fold ( CI 1.844–13.441) increase in the odds of providing AYFS when there was community involvement compared with that where there was no community involvement. The networking of stakeholders (<em>p = 0.135) was</em> not found to be significant in the provision of the AYFS.</div></div><div><h3>Conclusion</h3><div>Policy interventions should prioritize healthcare worker training initiatives, foster effective coordination mechanisms, and promote community involvement. These strategies demonstrate substantial increases in AYFS provision, emphasizing the need for sustained investment and commitment. Prioritizing these factors can catalyze transformative policy actions toward youth-centric healthcare services.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100067"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}