SSM - Health Systems最新文献

{"title":"Between aspirations and realities of participation: Understanding the meanings of community participation in the context of Family Health Centre policy of Kerala","authors":"Sreenidhi Sreekumar ,&nbsp;Sapna Mishra","doi":"10.1016/j.ssmhs.2024.100023","DOIUrl":"10.1016/j.ssmhs.2024.100023","url":null,"abstract":"<div><p>The Government of Kerala in 2017 launched the Aardram Mission aimed at a complete overhaul of the State’s health system. A crucial component of the Mission was the Family Health Centre (FHC) initiative using Comprehensive Primary Health Care. A core strategy of the FHC initiative was its emphasis on strengthening community participation through decentralization and creating newer ways of engagement. The study aimed to examine the meanings attributed to community participation within policy and functionaries of the health system using qualitative content analysis of the FHC policy and narratives of health functionaries. The policy analysis suggested a genuine commitment to community participation by locating FHCs under the leadership of local self-governments and through newer mechanisms like ‘Arogyasena’ volunteers constituted by community cross-sections. However, the narratives of health functionaries’ points to a reductionist view of community participation that excluded communities from priority setting and decisionmaking. Communities were seen as incapable of planning health activities and, therefore, their participation equated with the idea of expressing their needs. Participation was also seen from the perspective of communities as ‘resources’ for implementing activities and as ‘responsible beneficiaries’ who maintain positive health behaviours. Findings from the study suggest the prevailing conflicts between health functionaries’ reductionist views on communities as compared to policies’ aspirations in achieving a transformative idea of community participation. This demands urgent attention and resolution to enable the successful implementation of the FHC initiative as well as achieve the larger goals of social justice and equity.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100023"},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000163/pdfft?md5=93e0b3d427dce831976fd48d997b7f23&pid=1-s2.0-S2949856224000163-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978245","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":"Inequality in financial risk protection in health among displaced populations: The case of Venezuelan women in Brazil","authors":"Iván Ochoa-Moreno,&nbsp;Rodrigo Moreno-Serra","doi":"10.1016/j.ssmhs.2024.100022","DOIUrl":"10.1016/j.ssmhs.2024.100022","url":null,"abstract":"<div><h3>Objective</h3><p>Worsening economic and social conditions in Venezuela have forced many to migrate. Women and girls are particularly at risk of health vulnerability in this context. This study examines healthcare expenditure and financial risk protection inequalities among Venezuelan migrant women in Brazil.</p></div><div><h3>Methods</h3><p>We conducted a survey of 2012 Venezuelan women aged 15–49 who migrated to Brazil between 2018 and 2021. We estimated and decomposed concentration indices to analyse inequalities in out-of-pocket healthcare expenditures (OOPHE) and catastrophic health expenditures (CHE) across the entire socioeconomic distribution. We applied Blinder-Oaxaca decompositions to explain differences in healthcare spending between migrant and Brazilian women.</p></div><div><h3>Results</h3><p>Venezuelan migrant women displayed noticeable disparities in OOPHE and incidence of CHE. Approximately half of our sample of migrants reported no income, no expenditures, and hence no CHE. OOPHE and CHE incidence were concentrated among less poor migrant women, whilst for Brazilian women, CHE was concentrated among the poorer. Location, time since arrival to Brazil, higher education, and income were key contributors to socioeconomic inequality in OOPHE and CHE for migrants. The main explanatory factor for differences in OOPHE between migrants and non-migrants was differences in income profiles.</p></div><div><h3>Conclusions</h3><p>Addressing financial risk protection in health is crucial for displaced populations, especially women and girls. While the public health system in Brazil offers universal healthcare coverage in principle, our results suggest that there is still a significant risk of lack of access to healthcare for Venezuelan migrant women, which may be driven by insufficient financial means.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100022"},"PeriodicalIF":0.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000151/pdfft?md5=339b5e035bbd6c9fd5a48067a0cac979&pid=1-s2.0-S2949856224000151-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141963511","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":"Can high-profile endorsements improve COVID-19 vaccine uptake and reduce hesitancy in Pakistan?","authors":"Hina Khalid ,&nbsp;Uswah Firdous ,&nbsp;Amira Jadoon ,&nbsp;Chad Stecher ,&nbsp;Agha Ali Akram ,&nbsp;Ashley M. Fox","doi":"10.1016/j.ssmhs.2024.100020","DOIUrl":"10.1016/j.ssmhs.2024.100020","url":null,"abstract":"<div><h3>Background</h3><p>While low- and middle-income countries continue to struggle to secure adequate COVID-19 vaccine supply, a potentially greater challenge is to induce adequate demand to overcome widespread vaccine hesitancy; vaccination uptake has historically been a contentious political issue in Pakistan. High-level endorsements by trusted actors are one way to potentially increase public vaccine confidence. <em>Methods:</em> Employing a four-armed randomized trial with 2026 participants in June 2021, we examine whether endorsements by different actors (Prime Minister, prominent religious leader, doctors) influenced participants’ willingness to register for the COVID-19 vaccine.</p></div><div><h3>Results</h3><p>We find high levels of vaccine hesitancy with nearly 35% of participants reporting that they do not intend to vaccinate against COVID-19. Endorsements failed to influence participants' desire to register for vaccination, and only 37 % agreed to register on spot. However, we find that higher trust in government, male gender, and higher income/wealth were associated with participants' willingness to register. A follow-up phone survey was consistent with the main results.</p></div><div><h3>Discussion</h3><p>Our study finds that endorsements appear to have little effect on people’s immediate willingness to register for vaccination. Our findings suggest messaging on its own may be insufficient to overcome widespread social and structural barriers to vaccine uptake.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100020"},"PeriodicalIF":0.0,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000138/pdfft?md5=2edf16478597c5615baaf53452be2f7a&pid=1-s2.0-S2949856224000138-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141852237","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":"“In working with vaccines, you have the impression that you're working with gold, and that it's a protected field”: A qualitative study on childhood vaccination decision-making in crisis-affected settings","authors":"Mervat Alhaffar ,&nbsp;Nada Abdelmagid ,&nbsp;Maysoon Dahab ,&nbsp;Barni Nor ,&nbsp;Francesco Checchi ,&nbsp;Neha s. Singh","doi":"10.1016/j.ssmhs.2024.100021","DOIUrl":"10.1016/j.ssmhs.2024.100021","url":null,"abstract":"<div><h3>Background</h3><p>The governance of childhood vaccination in crisis-affected populations presents distinctive and intricate challenges and has been criticized for being inadequate. In this study, our aim was to investigate the existing practices related to decision-making on vaccination in crisis-affected settings and develop practical suggestions for enhancing these.</p></div><div><h3>Methods</h3><p>We followed a qualitative research approach, conducting 31 remote semi-structured interviews with individuals involved in humanitarian vaccination efforts and stakeholders operating at global, regional, and national levels. We used a thematic approach using a mix of inductive and deductive coding to analyse the data while applying the Governance Analytical Framework (GAF).</p></div><div><h3>Results</h3><p>Our research indicates that decision-making in crisis-affected settings suffers from a lack of structure, documentation, and transparency. Participants highlighted the presence of diverse and conflicting agendas among different stakeholders and the insufficiency of timely, reliable data crucial for effective decision-making. As solutions, participants recommended improved coordination among stakeholders and emphasized the need for meaningful engagement of local actors.</p></div><div><h3>Conclusion</h3><p>The study uncovered a fragmented, disorganised and complex governance landscape of vaccination services in crisis-affected settings spanning multiple levels and involving various actors. To improve this landscape, it is crucial to intensify efforts to ensure fairness, accountability and effectiveness.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100021"},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294985622400014X/pdfft?md5=1e4fedbdd33537431622593b8b2622a2&pid=1-s2.0-S294985622400014X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838861","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":"Identifying enablers and barriers to the control of multidrug-resistant tuberculosis in Abia State, Nigeria: A qualitative study","authors":"Daniel Ogbuabor ,&nbsp;Onuka Okorie ,&nbsp;Nwanneka Ghasi","doi":"10.1016/j.ssmhs.2024.100019","DOIUrl":"10.1016/j.ssmhs.2024.100019","url":null,"abstract":"<div><h3>Objective</h3><p>Drug-resistant tuberculosis (TB) is a significant public health threat in high-burden TB countries, including Nigeria, constraining the achievement of End TB targets. Nonetheless, Nigeria's health system factors shaping the care of patients with multidrug-resistant tuberculosis (MDR-TB) are understudied. The study assessed the enablers and barriers to implementing MDR-TB care and treatment in Abia State, Nigeria.</p></div><div><h3>Methods</h3><p>This is a qualitative interview study adopting a phenomenological approach. We interviewed twelve participants comprising health workers and TB policymakers with roles in MDR-TB patient management at the national (n = 2) and state (n = 10) levels in May 2022. We used maximum variation sampling to purposively select participants based on their roles, availability, and consent. The data were analysed thematically.</p></div><div><h3>Results</h3><p>The factors enhancing care for patients with MDR-TB include using a certificate of readiness, community involvement, donor financing, availability of treatment centre, effective facility-community linkage, treatment support, multidisciplinary care team, training service providers, availability of oral drugs, expansion of diagnostic facilities, data tool availability, review meetings, and data-focused supervision. In contrast, the factors constraining MDR-TB management are poor implementation of infection control policy, donor dependence, delayed initiation of treatment, poorly motivated health workers, health worker stigma, shortage of personal protective equipment, and role conflict in data management.</p></div><div><h3>Conclusion</h3><p>The findings highlight critical health systems strengths and weaknesses in MDR-TB control. MDR-TB care policies must build on the enablers and address the barriers to strengthen the care for patients with MDR-TB.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100019"},"PeriodicalIF":0.0,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000126/pdfft?md5=6cce08a04eeb6745c9d9987ca3836765&pid=1-s2.0-S2949856224000126-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141623182","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":"Burden of out-of-pocket payment for maternal healthcare and its catastrophic effects in the era of free maternal and child health policy in Ghana","authors":"Kennedy A. Alatinga ,&nbsp;Gilbert Abotisem Abiiro ,&nbsp;Edmund Wedam Kanmiki ,&nbsp;Emmanuel Kofi Gyan ,&nbsp;Vivian Hsu ,&nbsp;Cheryl A. Moyer","doi":"10.1016/j.ssmhs.2024.100018","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100018","url":null,"abstract":"<div><h3>Background</h3><p>Ghana introduced a free maternal healthcare policy within its national health insurance program in 2008. Despite this, there are reports of significant out-of-pocket (OOP) payments for maternal healthcare in Ghana. This study examines OOP payments for maternal healthcare services and their catastrophic effects, including the correlates of catastrophic OOP payments.</p></div><div><h3>Methods</h3><p>Cross-sectional quantitative data were collected from 414 mothers through health facility exit interviews in two regions of Ghana. Catastrophic OOP payments were computed by expressing total health expenditure as a percentage of household total expenditure and non-food expenditure at various thresholds (5 %, 10 %, 20 % and 25 %). The correlates of catastrophic OOP payments were assessed using logistic regression models.</p></div><div><h3>Results</h3><p>The median OOP payments for maternal healthcare was GH₵866.5(US$109.3). The median non-medical OOP cost (GH₵479[US$ 59.9]) was higher than the median medical OOP cost (GH₵296.5[US$ 37.1]). The median OOP cost was higher for delivery (GH₵454[US$56.8]) compared to ANC (GH₵356.5[US$44.5]) and PNC (GH₵21.5[US$2.6]). Non-medical supplies comprise 58 % of the total OOP payments. About 73 % and 90 % of respondents spent more than 5 % of their annual household total and non-food expenditure on maternal healthcare, respectively. Rural areas and care at private facilities were significantly associated (AORs&lt;1; p-values&lt;0.05) with lower probabilities of incurring catastrophic OOP expenditure. Tertiary education was associated (AORs&gt; 1; p-values&lt;0.05) with a higher probability of incurring catastrophic OOP payments.</p></div><div><h3>Conclusion</h3><p>OOP payments for maternal care are still prevalent in Ghana. We call for a reform of Ghana’s free maternal healthcare policy to include non-medical supplies within its benefit package.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100018"},"PeriodicalIF":0.0,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000114/pdfft?md5=2a1868c44c0c514b15c3e1393716fc31&pid=1-s2.0-S2949856224000114-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141542351","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":"Mind the data gaps: Comparing the quality of data sources for maternal health services in Cameroon","authors":"Miriam Nkangu ,&nbsp;Julian Little ,&nbsp;Mwenya Kasonde ,&nbsp;Roland Pongou ,&nbsp;Raywat Deonandan ,&nbsp;Sanni Yaya","doi":"10.1016/j.ssmhs.2024.100016","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100016","url":null,"abstract":"<div><h3>Background</h3><p>Numerous sources of routine data exist but there is limited information on how they relate or complement each other to improve data availability and the quality of data collected. This paper compares data coverage and completeness on selected maternal health service indicators between (1) a performance-based financing(PBF) database, (2) the national health information system, and (3) health facility registers in selected districts in Cameroon.</p></div><div><h3>Method</h3><p>Data on antenatal care, skilled birth delivery and family planning were collected from 2010 to 2020 in three purposively selected districts (Buea, Limbe and Tiko) in the southwest region of Cameroon. The coverage and completeness of data from the performance-based financing database, the district health information system (dhis2, a national system) and health facility registers were compared. Data sources for the performance-based financing database and the district health information system are based on data generated from health facilities.</p></div><div><h3>Results</h3><p>Among the 90 health facilities in the three districts, 13 (14.5 %) facilities could not be accessed due to ongoing political conflict. Therefore, data were collected from 77 health facilities. Of the 77 facilities, half were public, a third private, and the remainder para-public (13 %) or confessional (5 %). Approximately seven registers at each health facility included data on maternal and child health. Problems of these data included incomplete coverage, misplacement of records, and incomplete data in the records identified. There was inconsistency across all sources. dhis2 collected antenatal care only for the first and fourth visits and PBF collected data for any antenatal care visits without specifying the visit number and health facility collected data for all antenatal care visits.</p></div><div><h3>Conclusion</h3><p>The introduction of dhis2 and PBF programs has strengthened the availability of data in electronic format. Generally, we noted important gaps and heterogeneity in data reporting as well as incomplete data across health sectors and districts. There is need to transform the way data are collected at health facilities and there is also need for capacity building and better data governance to improve data quality and use. This will ensure that reliable, consistent, accurate, and actionable data are available to inform policy towards achieving Universal Health Coverage.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100016"},"PeriodicalIF":0.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000096/pdfft?md5=3cca369aaa1358fc423675d2e4a2c0a2&pid=1-s2.0-S2949856224000096-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141542350","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":"De facto health governance policies and practices in a decentralized setting of Ghana: Implication for policy making and implementation","authors":"Samuel Amon ,&nbsp;Jana Gerold ,&nbsp;Patricia Akweongo ,&nbsp;Susan E. Bulthuis ,&nbsp;Samuel Agyei Agyemang ,&nbsp;Moses Aikins","doi":"10.1016/j.ssmhs.2024.100017","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100017","url":null,"abstract":"<div><h3>Background</h3><p>Current Universal Health Coverage (UHC) considerations confirm the need for strong governance in improving health sector performance. However, empirical evidence on the effects of decentralized health system governance remains limited in Low-and-middle-income countries (LMICs). This paper assesses the <em>de facto</em> health governance policies and practices of the decentralized health system of Ghana and its implications, for better policy formulation and implementation.</p></div><div><h3>Material and methods</h3><p>The study employed a cross-sectional design, comprising of systematic literature review (SLR) and in-depth interviews on health governance components. The literature review (n=103) was performed to document the factors that affect health governance management and policy uptake. A total of 32 purposively sampled key health system actors were individually interviewed face-to-face between January and February, 2018. Thematic content analyses of literature and interviews were done.</p></div><div><h3>Results</h3><p>Tension regarding power relationships exists between the policies governing the health sector of Ghana, which has rendered the decentralization reform effort in health governance policies and practices uncoordinated, incoherent and sometimes contradictory. Implication of the <em>de facto</em> decentralized health governance policies and practice include: limited involvement of sub-national level in policy development; weak interaction between policy formulators and implementers; and political interference in policy implementations compromising evidence-based policy formulation.</p></div><div><h3>Originality/value</h3><p>Drawing on diverse literatures and opinions of key health actors, this paper contributes to knowledge on health governance practices in a decentralized and resource constrained health system, and offers practical accounts of the implications of the <em>de facto</em> health governance system of Ghana for health policy formulation and implementation.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100017"},"PeriodicalIF":0.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000102/pdfft?md5=37b2fa217785259b23fb0e9d3ce0a6ae&pid=1-s2.0-S2949856224000102-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480480","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 the utilization of facility births during a national health system strengthening initiative: A mixed-methods assessment from rural Guinea-Bissau","authors":"Sabine Margarete Damerow ,&nbsp;Helquizine da Goia Mendes Lopes ,&nbsp;Giuliano Russo ,&nbsp;Morten Skovdal ,&nbsp;Jane Brandt Sørensen ,&nbsp;Ane Bærent Fisker","doi":"10.1016/j.ssmhs.2024.100015","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100015","url":null,"abstract":"<div><h3>Background</h3><p>There is growing focus on improving maternal-perinatal survival through health system strengthening (HSS). Despite such efforts, facility birth coverage often remains low in low-income settings. We explored factors influencing facility birth utilization during a national HSS initiative in rural Guinea-Bissau.</p></div><div><h3>Methods</h3><p>Using an explanatory sequential mixed-methods approach nested in the Bandim Health Project’s rural Health and Demographic Surveillance System (HDSS), we conducted 258 structured and 12 in-depth interviews with women who had recently given birth. Data were analysed using descriptive statistics and thematic network analysis guided by theories of social practice.</p></div><div><h3>Findings</h3><p>In the structured interviews, most women reported that they had planned a facility birth (171/258, 66 %), and 28 % reported access barriers (73/258). However, only half of the interviewed women actually gave birth at a health facility (128/258, 50 %), suggesting that facility births frequently remained unattainable. In the in-depth interviews, women described multiple “prerequisites” that needed to be met to access facility births such as financial means for out-of-pocket payments (OOPs). Despite official user fee waivers, OOPs were reported by 71 % of the structured-interview participants with facility births (91/128) but only three of these women referred to OOPs as barriers.</p></div><div><h3>Conclusions</h3><p>Our findings suggest that the women do not feel entitled to free-of-charge facility births, which may explain underreporting of financial barriers. Ubiquitous OOPs are further suggestive of ‘commodification’ of facility births, such that individual ability to pay remains key to utilization. Our findings raise equity concerns and call for closer monitoring of the implementation of HSS initiatives.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100015"},"PeriodicalIF":0.0,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000084/pdfft?md5=cd14bb65b92e4a8c2d3897a87864d446&pid=1-s2.0-S2949856224000084-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141542349","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":"The process of developing and piloting a tool in the Maldives and Zimbabwe for assessing disability inclusion in health systems performance","authors":"Hannah Kuper ,&nbsp;Phyllis Heydt ,&nbsp;Shaffa Hameed ,&nbsp;Tracey Smythe ,&nbsp;Tapiwanashe Kujinga","doi":"10.1016/j.ssmhs.2024.100014","DOIUrl":"https://doi.org/10.1016/j.ssmhs.2024.100014","url":null,"abstract":"<div><p>There are 1.3 billion people with disabilities globally. On average, they experience greater healthcare needs and more barriers accessing healthcare. Yet, health systems have failed to adequately include people with disabilities. The purpose of this study was to develop and pilot-test a tool for assessing disability inclusion in health system performance. We presented the “Missing Billion” disability-inclusive health system framework, which includes 4 system-level components and 5 service delivery components, and outputs and outcomes. We developed a tool, consisting of 48 indicators related to the framework components. We consulted international experts, who considered the framework and indicator set to be logical and comprehensive. The tool was pilot-tested in the Maldives (2020) and Zimbabwe (2021), working with local researchers to collect relevant data through document review and key informant interviews. The pilot data demonstrated that collecting data on the indicators was feasible. The tool highlighted areas where the health systems were performing well in terms of disability inclusion (e.g. governance) and other areas where there were large gaps (e.g. leadership) or lack of data (e.g. accessibility, outputs and outcomes). The indicators were updated and refined. We established a process for undertaking the assessment, highlighting the importance of leadership and ownership by the Ministry of Health, to facilitate data collection and implementation of recommendations. In conclusion, this new tool for assessing disability inclusion in health systems performance can help to identify key issues and guide and monitor action.</p></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"3 ","pages":"Article 100014"},"PeriodicalIF":0.0,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949856224000072/pdfft?md5=1f1a30c36cb46067adc58920c31ade04&pid=1-s2.0-S2949856224000072-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480479","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}