SSM - Health Systems最新文献

{"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":"2025-12-01","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":"Does the DRG reform help alleviate the challenge of \"difficult and expensive healthcare\" in China?","authors":"Dan Qu,&nbsp;Jiahui Chen","doi":"10.1016/j.ssmhs.2025.100098","DOIUrl":"10.1016/j.ssmhs.2025.100098","url":null,"abstract":"<div><div>This paper examines the impact of DRG reform on healthcare outcomes by analyzing city-level data from China from 2011 to 2020. An empirical research model was developed based on the goals of the payment reform. The difference-in-differences analysis revealed that the CN-DRG payment reform significantly reduced the percentage change in rural per capita healthcare expenditures, decreased the average length of hospitalization by about 0.9 days, and increased hospital activity at higher-level hospitals. However, it did not significantly encourage patients to utilize primary hospitals. The robustness tests indicate that the findings remain consistent across various methodologies, offering policymakers valuable theoretical support for advancing DRG reforms.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557368","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 financing and systems in African small and island states: Unique challenges and opportunities in achieving universal health coverage.","authors":"Finn McGuire, Sakshi Mohan, Megha Rao, Juliet Nabyonga-Orem, Ajoy Nundoochan, Issiaka Sombie, Edward Kataika, Simon Bland, Paul Revill","doi":"10.1016/j.ssmhs.2025.100104","DOIUrl":"10.1016/j.ssmhs.2025.100104","url":null,"abstract":"<p><p>While Africa has made substantial health progress, small and island states face distinct vulnerabilities and threats, demanding focused attention. Employing WHO building blocks, this study explores the health systems and financing status of small and island states in Africa, emphasizing their unique challenges in achieving universal health coverage. We undertake a comparative analysis of health systems and financing between African small and island states and larger counterparts within the region. Despite their unique challenges, African small and island states appear to perform comparatively well both in terms of health financing and for a number of key health system inputs. These findings suggest that the hypothesized structural impediments facing small and island states may be less severe than anticipated, or that good policies may have effectively mitigated these challenges within the health sector. However, many small and island states remain understudied, and further health research must be undertaken to better understand the nuances of health systems in these countries.</p>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"100104"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12679919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703498","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":"Protective factors and stressors that influence the mental wellbeing of community health workers in South Asia and Sub-Saharan Africa: A scoping review","authors":"Robinson Njoroge Karuga ,&nbsp;Obaida Karim ,&nbsp;Semonty Jahan ,&nbsp;Anne Ngunjiri ,&nbsp;Caroline Kabaria ,&nbsp;Clement Oduor ,&nbsp;Eunice Omanga ,&nbsp;Judy Wairiuko ,&nbsp;Maaike Seekles ,&nbsp;Laura Dean ,&nbsp;Lilian Otiso ,&nbsp;Linet Okoth ,&nbsp;Nahitun Naher ,&nbsp;Patricia Okoth ,&nbsp;Ranjan Koiri ,&nbsp;Robbinson Nduati ,&nbsp;Sabina Rashid ,&nbsp;Sammy Gachigua ,&nbsp;Selima Kabir ,&nbsp;Stella Gitia ,&nbsp;Blessing Mberu","doi":"10.1016/j.ssmhs.2025.100147","DOIUrl":"10.1016/j.ssmhs.2025.100147","url":null,"abstract":"<div><h3>Background</h3><div>Community health workers (CHWs) are crucial to the achievement of Universal Health Coverage. In their roles, CHWs often experience a range of stressors that can affect their wellbeing. This scoping review aims to understand the stressors and protective factors that influence the mental wellbeing of CHWs in sub-Saharan Africa and South Asia.</div></div><div><h3>Methods</h3><div>We reviewed English literature that we searched in MEDLINE and Scopus databases. We also conducted an online search for grey literature in Google Scholar. Our search returned 11,135 articles. After screening out duplicates and ineligible articles, we included 97 articles that met the inclusion criteria.</div></div><div><h3>Results</h3><div>We categorized findings into interrelated domains: protective factors and stressors, which are mediated by individual characteristics. Protective factors that promote mental wellbeing of CHWs include altruism, social recognition, incentives, psychosocial support, flexibility of their work, and, training. Stressors that create anxiety and hinder mental wellbeing include: gender-based violence, harassment, delayed payment of incentives, unclear career pathways, heavy workload, unrealistic performance targets, stigma, and inadequate supervision. In the review, we developed a conceptual framework for programs and research on the mental wellbeing of CHWs in low and middle-income countries (LMICs).</div></div><div><h3>Conclusion</h3><div>Strengthening mental wellbeing requires policy interventions such as fair remuneration, clear career pathways, capacity building, and psychosocial support. Future research may need to prioritize CHW wellbeing and advocacy for their formal integration into the health workforce to advance universal health coverage and ensure no one is left behind.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100147"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415482","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":"Bridging the gap: How information sharing practices across health, mental health and social care services shape information continuity in the Australian mental healthcare system","authors":"Timothy Charles Kariotis ,&nbsp;Megan Prictor ,&nbsp;Kathleen Gray ,&nbsp;Shanton Chang","doi":"10.1016/j.ssmhs.2025.100118","DOIUrl":"10.1016/j.ssmhs.2025.100118","url":null,"abstract":"<div><div>Information continuity, where information follows service users across the healthcare system, is an element of continuity of care and is essential for safe and quality care. Information continuity depends on the information practices of both care professionals and service users, such as seeking and sharing information. This paper aims to provide insights into the information practices of care professionals across health, mental health, and social care services in Australia’s mental healthcare system, and how they balance service user privacy with information continuity. Fourteen care professionals were interviewed about seeking and sharing information to provide care for service users. Interviews were analysed inductively and deductively utilising the literature on information continuity, information practices and contextual privacy. Five themes and 14 sub-themes emerged. The lack of a shared information context across different care settings shaped the information practices of care professionals and acted as a barrier to information continuity. Care professionals pieced together information about service users from various sources to understand their needs and to manage risk. Information shared with other care professionals was curated based on a range of factors including, service user consent, risk management and the perceived sensitivity of the information being shared. This study provides new insights into the information practices of care professionals that contribute to information continuity in the mental healthcare system. The findings suggest that ongoing efforts to improve information sharing infrastructure, such as through the adoption of electronic health records, should occur alongside efforts to build relationships and shared information sharing expectations.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100118"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144880317","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":"Facilitators and barriers to social care in adult primary care: A systematic review using the social-ecological model","authors":"Laura Porterfield ,&nbsp;Christen M. Walcher ,&nbsp;Forrest Jones ,&nbsp;Mary E. Jones ,&nbsp;Cathy Z. Xie ,&nbsp;Quratulanne H. Jan ,&nbsp;Zuleica M. Santiago Delgado ,&nbsp;Elizabeth M. Vaughan","doi":"10.1016/j.ssmhs.2025.100122","DOIUrl":"10.1016/j.ssmhs.2025.100122","url":null,"abstract":"<div><h3>Background</h3><div>Social care, the assessing and addressing of patients’ health-related social needs, may expand primary care’s impact. However, more information is needed about what primary care teams require to succeed in social care. The aim of this systematic review was to understand facilitators and barriers to social care in adult primary care settings through the lens of the social-ecological model.</div></div><div><h3>Methods</h3><div>Six online databases were searched for studies in adult primary care contexts that addressed facilitators and barriers to social care and were published 2014 to present. Two authors assessed independently for inclusion using a priori criteria. Data was extracted independently by two authors. Study results were assigned and organized by social-ecological model level (individual, interpersonal, organizational, community, policy).</div></div><div><h3>Results</h3><div>3895 articles were screened and 86 studies included. Organizational factors were the most common level for facilitators (77 %) and barriers (79.1 %). Lack of clinician time, excess workload, lack of community resources, and fee-for-service payment were prominent barriers. Facilitators included social care team members, workflow optimization, EHR integration, resource databases, team training, and community resources.</div></div><div><h3>Conclusions</h3><div>Barriers to social care in primary care are numerous but surmountable through investments in teams, training, infrastructure, and resources. Investing in social services, healthcare structures, and payment systems that support social care work could empower primary care to partner with patients for better health.</div></div><div><h3>Registration</h3><div>The review protocol is registered with the International Prospective Register of Systematic Reviews:</div></div><div><h3>Protocol Registration</h3><div>CRD42024553413</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886214","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":"Disconnected data: mHealth data systems and challenges for primary health care workers in India","authors":"Melari Shisha Nongrum ,&nbsp;Baldeep K. Dhaliwal ,&nbsp;YounJung Na ,&nbsp;Tiameren Jamir ,&nbsp;Surendra Shekhawat ,&nbsp;Krishna Rao ,&nbsp;Sudha Ramani ,&nbsp;Sandra Albert ,&nbsp;Svea Closser","doi":"10.1016/j.ssmhs.2025.100124","DOIUrl":"10.1016/j.ssmhs.2025.100124","url":null,"abstract":"<div><div>Mobile health (mHealth) uses mobile devices and wireless technologies to support health systems and improve healthcare delivery. It has been heralded as a way to streamline data management and move away from paper-based system inefficiencies. This paper examines the transition to mHealth systems in primary healthcare in rural West Garo Hills, Meghalaya, India, focusing on health workers’ experiences with data collection and its implications for healthcare delivery. Through qualitative interviews with 49 participants across the health system, we found that although mHealth platforms were introduced alongside existing paper-based practices to address barriers to care, the transition often exacerbated systemic inefficiencies. Specific challenges included extensive duplication of data entry across paper and digital platforms, poor data management, and a displaced burden of data entry, often at the expense of patient care. This was compounded by contextual barriers, including insufficient training, infrastructural limitations, unreliable internet connectivity, and poor offline functionality, rendering digital tools ineffective in some settings. Additionally, community hesitancy complicated data collection efforts, while restricted access to uploaded health data hindered patient follow-ups and delayed early detection of those in need of care. These findings highlight the disconnect between the theoretical benefits of mHealth systems and practical implementation in resource-constrained settings. While mHealth has the potential to enhance data management and strengthen primary healthcare systems, realizing its full benefits requires prioritizing user-centered design, robust infrastructure, ongoing training, and streamlined, interoperable digital platforms to effectively strengthen local health systems.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100124"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866278","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":"Progress and inequality in cervical cancer screening in Lesotho (2009–2024): Decomposing within- and between-group inequality","authors":"Denis Okova ,&nbsp;Plaxcedes Chiwire ,&nbsp;Akim Tafadzwa Lukwa","doi":"10.1016/j.ssmhs.2025.100120","DOIUrl":"10.1016/j.ssmhs.2025.100120","url":null,"abstract":"<div><h3>Background</h3><div>Cervical cancer is a preventable and treatable disease, yet it remains a leading cause of cancer-related morbidity and mortality among women in low- and middle-income countries (LMICs), including Lesotho. Despite its high cervical cancer burden, Lesotho’s cervical cancer screenings (CCS) rates are still low. This study examines trends in CCS uptake over 15 years and evaluates socioeconomic and geographic disparities using data from Demographic and Health Surveys (DHS).</div></div><div><h3>Methods</h3><div>Data from nationally representative Demographic and Health Surveys conducted in 2009, 2014, and 2023/24 were analysed to assess CCS trends among women aged 15–49 years. Lifetime and past-year CCS prevalence were the primary outcomes. Inequalities were quantified using the Erreygers Normalized Concentration Index (ENCI) and Theil index to measure and decompose disparities by socioeconomic status (SES) and place of residence.</div></div><div><h3>Results</h3><div>Lifetime CCS prevalence increased significantly from 6 % in 2009 to 21 % in 2023/24, while past-year screening prevalence rose from 2 % to 9 %. Socioeconomic and rural-urban disparities decreased substantially, with past-year screening among the poorest women achieving near-equity by 2023/24. However, lifetime CCS continued to show slight pro-wealthy and urban biases. The reducing overall inequalities were due to the near elimination of between-group inequalities. However, within-group disparities remained significant, highlighting heterogeneity in access barriers within SES and residence groups.</div></div><div><h3>Conclusion</h3><div>Lesotho has made significant progress in CCS uptake, driven by targeted public health interventions and equity-focused strategies. However, persistent barriers and within-group disparities underscore the need for systemic reforms, including transitioning to organized screening programs, scaling up the integration of CCS with HIV care, and addressing structural and sociocultural barriers to achieve universal and equitable screening access.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100120"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866263","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":"Corrigendum to “Strengths and challenges for implementing non-clinical safe spaces for people experiencing emotional distress and/or suicidal crisis: A mixed-methods study from Australia” [SSM Health Syst. 5 (2025) 100100]","authors":"Scott J. Fitzpatrick ,&nbsp;Grenville Rose ,&nbsp;Melanie Giugni ,&nbsp;Louise A. Ellis ,&nbsp;Alyssa R. Morse ,&nbsp;Cassandra Chakouch ,&nbsp;Erin Oldman ,&nbsp;Benn Miller ,&nbsp;Helen T. Oni ,&nbsp;Michelle Banfield","doi":"10.1016/j.ssmhs.2025.100114","DOIUrl":"10.1016/j.ssmhs.2025.100114","url":null,"abstract":"","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415479","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":"Sustaining gains in laboratory systems, HIV, malaria, tuberculosis programs amidst declining international funding: Key considerations for health integration","authors":"Augustine Onyeaghala ,&nbsp;Theophilus Faruna","doi":"10.1016/j.ssmhs.2025.100145","DOIUrl":"10.1016/j.ssmhs.2025.100145","url":null,"abstract":"<div><div>The efforts to eradicate HIV/AIDS, and other diseases of poverty- Malaria and Tuberculosis have consumed a significant proportion of financial allocation for healthcare. For over two decades, Nigeria has received support from international funding such as the President's Emergency Plan for AIDS Relief (PEPFAR) and other donor agencies. These funds have been used to strengthen Nigeria’s clinical laboratory system, combat the HIV/AIDS epidemic, improve HIV testing and treatment, and reduce HIV-related mortality and morbidity. Declining external funding poses a significant challenge to sustaining these hard-won gains, especially in a nation where budgetary allocation for healthcare is below the projected average. This paper examines the critical challenges that may arise from the reduction or withdrawal of donor funding for HIV and other programs, and provides suggestions on alternative sources of financing. The tips, when integrated into the national health system and implemented, could help to sustain the gains made so far in clinical laboratory systems, the fight against HIV/AIDS, Malaria, and Tuberculosis.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100145"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415520","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}