SSM - Health Systems最新文献

{"title":"Challenges and opportunities of human resource management activities for neglected tropical diseases in Liberia","authors":"Wede Seekey ,&nbsp;Rosalind McCollum ,&nbsp;Laura Dean ,&nbsp;Hannah Berrian ,&nbsp;Jerry Kollie ,&nbsp;John S. Smith ,&nbsp;Zeela Zaizay ,&nbsp;Karsor Kollie ,&nbsp;Emerson Rogers ,&nbsp;Maneesh Phillip ,&nbsp;Colleen Parker ,&nbsp;Sally Theobald ,&nbsp;Joanna Raven","doi":"10.1016/j.ssmhs.2025.100092","DOIUrl":"10.1016/j.ssmhs.2025.100092","url":null,"abstract":"<div><div>People affected by skin neglected tropical diseases (NTDs) are best cared for by a motivated, well-directed, competent and well-resourced health workforce. There is limited evidence about performance management for health workforce relating to NTD tasks. We explored human resource management relating to skin NTDs, with a focus on performance management. We carried out qualitative and participatory research with health workers across health systems levels in Liberia to explore experiences of caring for people with skin NTDs and views on optimal human resource management (HRM) practices. We conducted key informant interviews with national health systems policymakers (16) and county health workers (32); in-depth interviews with health workers (36); focus group discussions with health workers (4); and photovoice with 15 community health assistants and community health promoters, purposively selected for maximum variation. All interviews and FGDs were transcribed and analysed using thematic framework approach. We found health workers often have strong intrinsic motivation to care for people affected by skin NTDs. However, this is undermined by weak HRM structures particularly in geographic areas where integrated services for NTDs requiring case management have not yet rolled out. The main challenges described include: limited awareness of NTD-related roles, and mental health support provision role, particularly at facility level, gaps in knowledge and skills (how to identify, diagnose and manage skin NTDs), irregular supervision and limited resources to deliver care. Our findings have informed collaborative development of a bundle of HRM approaches to strengthen performance of health workers caring for patients with skin NTDs, including participatory training informed by adult learning-based approaches, supportive supervision, provision of job tasks, NTD manual and related tools, essential resource provision for community health assistants and promoters (CHAs and CHPs) and non-cash awards.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100092"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144184983","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":"A mixed methods evaluation of 99DOTS digital adherence technology uptake among adolescents treated for pulmonary tuberculosis in Uganda","authors":"P. Wambi ,&nbsp;S.N. West ,&nbsp;J. Nabugoomu ,&nbsp;A. Kityamuwesi ,&nbsp;R. Crowder ,&nbsp;L. Kunihira ,&nbsp;E. Wobudeya ,&nbsp;A. Cattamanchi ,&nbsp;D. Jaganath ,&nbsp;A. Katamba","doi":"10.1016/j.ssmhs.2025.100151","DOIUrl":"10.1016/j.ssmhs.2025.100151","url":null,"abstract":"<div><h3>Background</h3><div>Adolescents are at risk of poor adherence to tuberculosis (TB) treatment and subsequently worse treatment outcomes. Digital adherence technologies, including the mobile phone-based 99DOTS platform, can support TB treatment, but there is limited data on their use among adolescents. We evaluated factors associated with uptake of 99DOTS among adolescents with TB.</div></div><div><h3>Methods</h3><div>We conducted an explanatory sequential mixed methods study that utilized quantitative data from adolescents collected at 30 health facilities in Uganda, in-depth and key informant interviews with adolescents diagnosed for TB who were offered 99DOTS, and healthcare workers at participating facilities. Findings were further mapped onto the Capability, Opportunity, Motivation, and Behavior model.</div></div><div><h3>Results</h3><div>Overall, 299/410 (73 %) adolescents were enrolled in 99DOTS. Older adolescents 15–19 years old were more likely to enroll in 99DOTS than younger adolescents 10–14 years [aPR= 1.88, 95 % CI: (1.54–2.33)]. Conversely, adolescents treated at Health Center IV and General Hospitals were less likely to be enrolled compared to Health Center III (aPR= 0.8, 95 % CI, 0.67–0.94, and aPR= 0.71, 95 % CI 0.58–0.85, respectively). Technological savviness among older adolescents, access to training, caregiver involvement, and desire for wellness facilitated uptake of 99DOTS. In contrast, variable mobile phone access, concerns about TB status disclosure, and health worker workload in hospitals were barriers to the uptake of 99DOTS.</div></div><div><h3>Conclusion</h3><div>99DOTS uptake was high among adolescents with TB. Increased access to mobile phones, and appropriate support from care givers and health workers enable adolescents to engage more effectively with digital adherence technologies like 99DOTS.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100151"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145519211","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":"Balancing autonomy and collaboration: Acompañantes’ perspectives on health system partnerships for medication abortion care in three Mexican states","authors":"Laura E. Jacobson ,&nbsp;Blair G. Darney ,&nbsp;Maribel Campos Muñuzuri ,&nbsp;Suzanne Veldhuis","doi":"10.1016/j.ssmhs.2025.100154","DOIUrl":"10.1016/j.ssmhs.2025.100154","url":null,"abstract":"<div><h3>Introduction</h3><div>Acompañantes are feminist activists who accompany pregnant individuals through medication abortions outside of clinical settings. This model is safe, holistic, and destigmatizing. In Mexico, where abortion law varies by state and access to public services is limited, self-managed medication abortion with acompañantes is common. This study examines how acompañantes perceive their relationship with the public health system, exploring collaboration opportunities and challenges.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews with acompañantes from Baja California, Chiapas, and Mexico City—Mexican states with diverse abortion laws, in 2022–2023. The World Health Organization’s Health System Strengthening framework guided the analysis, focusing on stakeholder engagement and innovation. We analyzed the interviews using a qualitative, codebook thematic approach, incorporating both deductive and inductive methods.</div></div><div><h3>Results</h3><div>Seventeen interviews with acompañantes revealed key themes: 1) Acompañantes expressed a tension between operating autonomously and seeing value in collaboration —but not integration— with the formal system for legitimacy, validation, and to improve care experiences for people who access abortion; 2) In a health system where person-centered care is lacking, acompañantes fill this gap and feel a responsibility to do so; and 3) Knowledge gaps, trust issues, and political differences are barriers for acompañantes collaborating with the public health system.</div></div><div><h3>Conclusion</h3><div>Aligning acompañante-supported self-managed abortion with institutional services presents challenges but also opportunities for enhancing care quality and accessibility. Innovative collaborations that respect acompañantes' autonomy and expertise, while addressing systemic barriers, could strengthen health systems and align with WHO guidelines for safe self-managed abortion, including health system referrals if needed or wanted.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100154"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145570987","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":"Clinical, organisational and policy factors influencing the implementation of nurse-led models of long-acting reversible contraception and medication abortion care in Australian general practice: A qualitative exploration","authors":"Jessica E. Moulton ,&nbsp;Noushin Arefadib ,&nbsp;Jessica R. Botfield ,&nbsp;Karen Freilich ,&nbsp;Danielle Mazza","doi":"10.1016/j.ssmhs.2025.100095","DOIUrl":"10.1016/j.ssmhs.2025.100095","url":null,"abstract":"<div><h3>Background</h3><div>Access to sexual and reproductive healthcare in rural and regional areas is often limited, particularly for contraception and abortion care. Nurse-led models of care offer a promising solution, yet their implementation and evaluation in Australian primary care remain underexplored. We therefore examined stakeholders’ perceptions of clinical, organisational and policy factors influencing the adoption of nurse-led contraception and abortion care in rural and regional Australian general practice.</div></div><div><h3>Methods</h3><div>A secondary analysis of qualitative data from a co-design workshop, aimed at developing a nurse-led model of care, was conducted. Participants included consumers, nurses, physicians, practice managers, community and advocacy organisation representatives, academics, and policymakers. The secondary analysis focused solely on data related to clinical, organisational, and policy factors that may influence the implementation of nurse-led contraception (involving contraceptive implant insertion) and medication abortion in rural and regional general practice. The Consolidated Framework for Implementation Research guided data analysis to enrich our understanding of implementation factors.</div></div><div><h3>Results</h3><div>Fifty-two stakeholders participated in the workshop. Five themes were constructed: 1) the influences on nurses' capability to work to their full scope of practice<em>,</em> 2) formalising general practitioner-nurse partnerships for model sustainability, 3) integrating practice-based nurse training, 4) medico-legal implications for collaborative care and 5) leveraging funding models to support nurse-led care.</div></div><div><h3>Conclusion</h3><div>Successful implementation of nurse-led contraception and medication abortion care requires improved funding models to ensure adequate nurse and practice remuneration, strengthened nurse-general practitioner partnerships, and employer support for ongoing nurse education. Policies fostering collaborative, multidisciplinary care will enhance the sustainability and effectiveness of these models in general practice.</div></div><div><h3>Reporting method</h3><div>Reported in line with the Standards for Reporting Qualitative Research (SRQR) checklist.</div></div><div><h3>Patient or public contribution</h3><div>Two consumer representatives contributed to the development of the co-design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100095"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144572695","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":"From fragmented to functional: Improving rehabilitation data in Georgia's health information systems for better decision-making","authors":"Nino Kotrikadze ,&nbsp;Akaki Zoidze ,&nbsp;George Gotsadze","doi":"10.1016/j.ssmhs.2025.100127","DOIUrl":"10.1016/j.ssmhs.2025.100127","url":null,"abstract":"<div><h3>Introduction</h3><div>Integrating rehabilitation data into health information systems (HIS) is critical for effective healthcare decision-making, especially in low- and middle-income countries (LMICs) like Georgia. Despite legal obligations under the Convention on the Rights of Persons with Disabilities (CRPD) and the Georgia Rehabilitation Service Development Strategy (2023–2027), rehabilitation data in Georgia remains fragmented. This study aims to assess the adequacy of the HIS for rehabilitation in Georgia to support the planning, monitoring, and expansion of rehabilitation service developments in the country.</div></div><div><h3>Methods</h3><div>The cross-sectional study design combined a documentary review with qualitative interviews. The documentary review examined legislative/regulatory documents from official bodies. Qualitative data were collected through 24 semi-structured interviews with stakeholders representing six rehabilitation facilities (four providing services under the Universal Health Care Program (UHCP) with government funding and two on a fee-for-service basis) and two policymakers. NVivo 12 was used to analyze interviews through the first deductive (Health Metrics Network framework) followed by an inductive coding approach.</div></div><div><h3>Results</h3><div>Findings reveal that rehabilitation data in Georgia's HIS are inconsistent, lacking standardized definitions or reporting practices. Differences were identified in data collection practices across facilities. The UHCP facilities employ the functional assessment tool but no standardized reporting persist. Multiple recording modules lack standardization, with variations in the volume and type of data reported. Key challenges include the absence of unified coding systems, incomplete data capture, and reliance on unstructured formats, hindering data analysis and integration.</div></div><div><h3>Conclusion</h3><div>Although Georgia has made progress by integrating rehabilitation services into the UHCP, gaps in HIS still limit effective decision-making. Addressing these gaps requires a standardized data collection framework emphasizing programmatic and functional outcomes, patient-centered measures, and the comprehensive use of existing electronic systems. Strengthening HIS via coordinated stakeholder efforts and streamlined data reporting will improve rehabilitation services and serve as a model for other LMICs.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100127"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886234","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":"Nurses' perspectives on barriers to family-centered cardiac care in Pakistan","authors":"Umbreen Dildar ,&nbsp;Saba Khurshid ,&nbsp;Shagufta Perveen","doi":"10.1016/j.ssmhs.2025.100146","DOIUrl":"10.1016/j.ssmhs.2025.100146","url":null,"abstract":"<div><h3>Background</h3><div>Family involvement is a critical component of person-centered cardiac care, contributing to improved patient outcomes and continuity of care. However, integrating family members into hospital-based cardiac care presents various challenges, particularly for frontline nurses. Understanding these barriers from the perspective of nursing staff is vital for informing health system reforms. Therefore, this study aimed to explore the barriers faced by nurses when involving families in cardiac patient care.</div></div><div><h3>Methods</h3><div>An exploratory qualitative study design was conducted with 10 cardiac care nurses (7 females and 6 males; age range 26–46 years) from public and private tertiary hospitals in the twin cities of Pakistan between February 2024 to September, 2024. Participants were selected using purposive sampling. Semi structure interview ewer conducted and thematic analysis was used to identify key themes reflecting nurses’ insights into the challenges of involving families in patient care.</div></div><div><h3>Results</h3><div>Five major themes emerged: (1) lack of institutional guidelines and structured protocols for family involvement; (2) emotional burden and role strain experienced by nurses during family interactions; (3) systemic constraints such as understaffing and time pressure; and (4) communication challenges due to sociocultural differences and unclear role expectations (5) cultural and ethical barriers in nurse-family dynamics. Nurses expressed a desire for clearer policy direction, more training, and institutional support.</div></div><div><h3>Conclusion</h3><div>The study underscores the need for health system-level interventions to strengthen the role of families in cardiac care. Addressing the identified barriers can promote more inclusive, equitable, and effective care delivery models that support both patients and health professionals.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100146"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415480","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":"Who gets funded? Global analysis of research funding for newborn health and stillbirth in fragile and non-English speaking countries, 2016–2020","authors":"Lauren E. Allison ,&nbsp;Harriet Ruysen ,&nbsp;María J. Sánchez Alva ,&nbsp;Priyesh Agravat ,&nbsp;Eva M. Loucaides ,&nbsp;Meghan Bruce Kumar ,&nbsp;Alexandra Molina-García ,&nbsp;Ismail Sebina ,&nbsp;Elizabeth J.A. Fitchett ,&nbsp;Neal Russell ,&nbsp;Joy E. Lawn","doi":"10.1016/j.ssmhs.2025.100144","DOIUrl":"10.1016/j.ssmhs.2025.100144","url":null,"abstract":"<div><h3>Context</h3><div>Despite global progress toward the Sustainable Development Goals (SDGs), 2.3 million newborn deaths and 1.9 million stillbirths occur each year, with a disproportionate burden in humanitarian and fragile contexts. We investigated how funding for newborn health research during the SDG period (2016–2020) varied according to country fragility and language.</div></div><div><h3>Methods</h3><div>We conducted a systematic analysis of research grants using the Dimensions database, classifying grants by research theme, stage of the research process, type of funding agency, and classification of donor and recipient countries according to the World Bank's income ranking. The grants were then analyzed according to the Fragile States Index and the official languages ​​of the recipient countries.</div></div><div><h3>Results</h3><div>Between 2016 and 2020, USD 308.2 million was awarded across 1,372 grants involving at least one low- or middle-income recipient country (LMIC). Of this amount, 35% (USD 108.0 million) funded grants involving both an LMIC and a recipient from one of the 30 most fragile countries, while only 19% (USD 57.3 million) was awarded directly to organizations based in the 30 most fragile countries. Among these recipients from fragile states, most funding supported intervention research (USD 33.6 million), with minimal investment in implementation (USD 5.0 ​​million) or basic science (USD 2.8 million). Linguistic disparities were evident: of all grants, recipients from English-speaking countries received the largest amount (USD 115.5 million).</div></div><div><h3>Interpretation</h3><div>Significant inequalities persist in the allocation of funding for research on newborn health and stillbirths. Despite bearing a disproportionate burden of neonatal mortality, organizations in non-English-speaking countries and the 30 most fragile countries have received limited research funding. These disparities contribute to gaps in evidence regarding impact in humanitarian settings, hinder implementation, and exacerbate global inequalities in research and health.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100144"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415481","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":"A scoping review of health co-benefit tests in the setting of a screening or health programme: Limited data to inform their potential use to address inequities","authors":"Tayla Schaapveld ,&nbsp;Karen Bartholomew ,&nbsp;Anna Maxwell ,&nbsp;Erin Chambers ,&nbsp;Katrina Poppe ,&nbsp;Robert N. Doughty ,&nbsp;Tracy Murphy","doi":"10.1016/j.ssmhs.2025.100084","DOIUrl":"10.1016/j.ssmhs.2025.100084","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this scoping review is to assess the extent, range and nature of health co-benefit tests and their application to address inequities in a screening or other health programme setting and to inform their potential use for a AAA screening programme in Aotearoa New Zealand.</div></div><div><h3>Methods</h3><div>Electronic databases (MEDLINE, CINAHL and AMED) were searched to find relevant literature published between August 2009 to August 2024. This was supplemented with studies obtained through examination of reference lists, grey literature, and hand searching of key journals. Articles meeting the inclusion criteria were reviewed for relevance, with key data extracted into a coding system.</div></div><div><h3>Results</h3><div>In total, twenty-four papers were included in our review. Although the addition of co-benefit tests to existing programmes was seen as beneficial by both programme designers and participants, to ensure success in addressing inequities there were factors raised that need to be taken into consideration, including improved co-ordination between specialties, and ensuring pathways are put in place to follow-up participants following their tests.</div></div><div><h3>Conclusions</h3><div>While the concept of including co-benefit tests to existing health programmes to address inequities is widely supported, there remain notable gaps in the literature which warrant further investigation. Findings from this review have highlighted the need for more research to be undertaken, with a focus on Indigenous health, inequities and specific settings such as rural health. Future studies should include views of both participants and staff members and not only focus on the acceptance and feasibility of adding co-benefit tests, but also explore the benefits, challenges and sustainability after they have been implemented in a health programme.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144072328","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 medicine sellers have become the hospital now': Health service responses to violence against women during the Ebola and COVID-19 outbreaks in Sierra Leone","authors":"Rose Burns ,&nbsp;Janet Seeley ,&nbsp;Maseray Fofanah ,&nbsp;Tehsie Momoh ,&nbsp;Shelley Lees ,&nbsp;Neha Singh ,&nbsp;Manuela Colombini","doi":"10.1016/j.ssmhs.2025.100102","DOIUrl":"10.1016/j.ssmhs.2025.100102","url":null,"abstract":"<div><h3>Introduction</h3><div>Outbreaks and violence against women (VAW) are interlinked public health challenges, yet health system responses for VAW during outbreaks remain poorly understood. We sought to understand how and to what extent health services for VAW in Sierra Leone were delivered by health providers and communities during the 2014–2016 Ebola outbreak and the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>Thirty-seven in-depth interviews and four focus group discussions were conducted in Freetown and Kambia in Sierra Leone in 2022 with health providers, outbreak actors, community members, and women who had experienced physical or sexual violence during the Ebola or COVID-19 outbreaks. Data were analysed thematically.</div></div><div><h3>Findings</h3><div>Many participants described the exacerbation of long-term health system challenges during the outbreaks, with survivors of violence facing under-resourced, broken or corrupt government health services. Especially during the Ebola outbreak, systems of care for VAW survivors were reconfigured with the role of informal health actors such as medicine sellers and traditional healers amplified. VAW providers described adaptations to health service delivery and ways that they tried to cope with difficult working conditions: plugging gaps in commodity supplies, adopting infection prevention and control protocols or making personal sacrifices so that systems functioned. Whilst VAW health services faced significant challenges continuing to provide care, they were overlooked by the outbreak response.</div></div><div><h3>Conclusions</h3><div>The outbreaks, especially Ebola, meant ‘normal’ service delivery challenges for VAW were heightened. These findings highlight the need to integrate VAW services into outbreak preparedness and response efforts, including through leveraging informal actors.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100102"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723076","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 system resilience in the Pacific: A scoping review of Fiji’s COVID-19 response","authors":"Johanna Thomas-Maude ,&nbsp;Sharon McLennan","doi":"10.1016/j.ssmhs.2025.100119","DOIUrl":"10.1016/j.ssmhs.2025.100119","url":null,"abstract":"<div><div>In mid-2021, Fiji recorded one of the highest rates of COVID-19-related deaths in the world, amidst a rapidly disintegrating health care system. This scoping review examines Fijian health system responses to the COVID-19 pandemic, exploring both the vulnerabilities and adaptive strategies that emerged during the crisis. Using a systematic search strategy to identify studies relating to how the Fijian health system responded to the COVID-19 pandemic, and what insights could be drawn about adaptive practices and resilience in this context, 71 papers were included. The findings demonstrate that while Fiji experienced significant workforce shortages, infrastructure constraints, and disruptions to routine healthcare, the pandemic response was also characterised by rapid policy adaptations, innovative use of some digital technologies, and strong community-led initiatives. However, challenges with public trust and culturally inclusive governance remain key areas for consideration. By applying a health system resilience framework that explores the tangible and intangible dimensions of health systems, this review offers insights relevant both for Fiji and the region. Strengthening local capacity, investing in sustainable infrastructure, and embedding Indigenous and other local knowledge in public health strategies are crucial steps toward building resilient Pacific health systems and preparing for future crises.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144841049","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}