SSM - Health Systems最新文献

{"title":"Assessing catastrophic health expenditures using median out-of-pocket costs for inpatient and outpatient care in Kenya's journey to universal health coverage","authors":"Akim Tafadzwa Lukwa ,&nbsp;Denis Okova ,&nbsp;Robinson Oyando ,&nbsp;Paidamoyo Bodzo ,&nbsp;Plaxcedes Chiwire ,&nbsp;Olufunke Alaba","doi":"10.1016/j.ssmhs.2025.100121","DOIUrl":"10.1016/j.ssmhs.2025.100121","url":null,"abstract":"<div><h3>Background</h3><div>Kenya's transition to Universal Health Coverage (UHC) faces persistent challenges from high out-of-pocket expenditures (OOP), exposing households to catastrophic health expenditures (CHE). With the recent shift from the National Hospital Insurance Fund (NHIF) to the Social Health Insurance Fund (SHIF), understanding the drivers and inequalities of CHE is critical. This study evaluates CHE using a novel median-based approach in the absence of income/consumption data, providing insights for Kenya’s UHC reforms.</div></div><div><h3>Methods</h3><div>We analyzed data from the 2022 Kenya Demographic and Health Survey (KDHS), employing a median-based method to calculate CHE at thresholds of 10 %, 20 %, 30 %, and 40 % of household OOP spending. Survey-weighted generalized linear models (gamma distribution, log-link) assessed determinants of inpatient/outpatient costs, while logistic regression and marginal effects identified CHE predictors. Erreygers Normalized Concentration Indices (ENCI) quantified socioeconomic inequalities.</div></div><div><h3>Results</h3><div>CHE prevalence was high, affecting 88.9 % of households at the 10 % threshold and 70.9 % at 40 %. Key drivers included: Socioeconomic status: Wealthier households incurred higher inpatient costs (richest quintile: KES 40,201 vs. poorest: KES 11,697; p &lt; 0.01), reflecting utilization disparities. Education: Households with secondary-educated heads had 33 % lower outpatient costs (p = 0.04). Vulnerable groups: Widowed/separated households faced 56 % higher outpatient costs (p &lt; 0.01), while high-dependency households had 44 % higher costs (p = 0.02). Insurance: Reduced CHE odds by 76 % at the 10 % threshold (OR=0.24, p &lt; 0.01), though gaps persisted. ENCI revealed pro-poor CHE distribution (−0.13 at 10 % threshold, p &lt; 0.01), with poorer households disproportionately affected.</div></div><div><h3>Conclusions</h3><div>The median-based approach offers a pragmatic solution for CHE estimation where income data are lacking, though results require cautious interpretation. Findings underscore the need for SHIF reforms to: (1) expand benefits to cover outpatient services and diagnostics, (2) target subsidies for low-income and informal workers, and (3) address non-medical costs (transportation vouchers). Strengthening equity-focused financial protection is essential to mitigate disparities and achieve UHC.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100121"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866262","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":"Developing a universal precautions approach to stigma reduction in health care: Insights from clinical and non-clinical health workers","authors":"Carla Treloar ,&nbsp;Louise Maher ,&nbsp;Emily Lenton ,&nbsp;Gemma Nourse ,&nbsp;Adrian Farrugia ,&nbsp;Kate Seear ,&nbsp;Amy Kirwan ,&nbsp;Sophia Schroeder ,&nbsp;Caitlin Douglass ,&nbsp;Loren Brener ,&nbsp;Timothy R Broady ,&nbsp;Virginia Wiseman ,&nbsp;Mark Stoové ,&nbsp;Rob Monaghan ,&nbsp;Elena Cama","doi":"10.1016/j.ssmhs.2025.100125","DOIUrl":"10.1016/j.ssmhs.2025.100125","url":null,"abstract":"<div><div>Amid calls for stigma reduction approaches that go beyond one condition, identity or practice and growing evidence of stigma as a common experience in the general population, we explored the possibility of a “universal precautions” approach. That is, that all people who attend for health care should be considered as worried about how they might be judged. To further develop this approach, semi-structured interviews were conducted with 30 health workers in clinical and non-clinical roles in Australia. Participants were generally supportive of a “universal” approach to stigma reduction (“there’s 1000 s of stigmas out there”) and wanted opportunity for all workers to participate in any programs. Participants were typically aware of the impact of stigma and drew on their own experience or that of family or friends to explain the long legacy of stigma for people’s interactions with health care systems. An element of misconception around stigma (what it looks like and why it can be damaging) was apparent in relation to practices that health workers engage in an effort to protect or care for their colleagues through communications that include irrelevant or judgemental information about patients. Health worker values of non-judgemental care and reflective practice were seen as important to draw upon to frame stigma reduction interventions which needed organisational support and leadership. Using quality standards and accreditation systems to drive further action on stigma reduction was also highlighted. These data will contribute to scoping potential approaches and limitations of a “universal precautions” approach to stigma reduction in health care.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886233","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":"Can Indonesia achieve universal health coverage? Organisational and financing challenges in implementing the national health insurance system","authors":"Dwidjo Susilo ,&nbsp;Luh Putu Lila Wulandari ,&nbsp;Evi Sukmayeti ,&nbsp;Augustine Asante ,&nbsp;Stephen Jan ,&nbsp;Hasbullah Thabrany ,&nbsp;Viroj Tangcharoensathien ,&nbsp;Virginia Wiseman ,&nbsp;Marco Liverani","doi":"10.1016/j.ssmhs.2025.100138","DOIUrl":"10.1016/j.ssmhs.2025.100138","url":null,"abstract":"<div><div>Indonesia's National Health Insurance system - the Jaminan Kesehatan Nasional (JKN) - is one of the largest single-payer health insurance schemes in the world, aiming to provide equitable and affordable healthcare to a population of over 280 million. Since its launch in 2014, the JKN has achieved near-universal enrolment, covering 98 % of Indonesians in 2024. However, progress towards universal health coverage – understood as access to the health services people need, when and where they need them, without financial hardship - has been hindered by financing deficits and operational hurdles faced by healthcare providers. In this paper, we examine critical issues affecting the implementation of JKN through the analysis of 20 in-depth interviews and a focus group discussion with government officers and health sector managers at the national and provincial level. Data analysis was guided by a framework combining health systems building blocks and dimensions of access to services. The findings highlight persistent challenges despite the JKN's wide coverage, including difficulties among informal sector workers in paying premiums, regional disparities in service access and health workforce distribution, inefficiencies in provider payment mechanisms, and weak information systems for tracking subsidised members. Interviews also revealed a growing financial and administrative strain on hospitals linked to frequent regulatory changes. To address these issues, we recommend three priority reforms: (1) implement sliding-scale subsidies for informal sector workers; (2) improve provider payment models by introducing cost-sharing for elective services; and (3) adopt participatory policymaking processes to ensure reforms are sustainable and inclusive.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100138"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shifting care into the community: Using Ostrom to explore collaborative care delivery with shared resources in English NHS Integrated Care Systems","authors":"Mhorag Goff ,&nbsp;Marie Sanderson ,&nbsp;Donna Bramwell ,&nbsp;Kath Checkland ,&nbsp;Pauline Allen ,&nbsp;Rachel Meacock","doi":"10.1016/j.ssmhs.2025.100157","DOIUrl":"10.1016/j.ssmhs.2025.100157","url":null,"abstract":"<div><div>Enabling the delivery of efficient and effective healthcare services within a constrained financial environment is an enduring challenge. Shifting care from hospital to community settings is therefore a priority in many countries where it is hoped that they will reduce demand on hospital services and overall health system costs. In English Integrated Care Systems (ICSs) this is being done through new collaborative care processes involving community health services such as virtual wards. However, despite their critical role in integrated care, community health services have been relatively under-researched.</div><div>Using Ostrom’s theories of common pool resources, including principles for the use of finite resources for shared action, we examine whether ICSs in England can self-govern shared resources for collaborative services delivery. Drawing on the perspectives of community health services providers and ICS stakeholders who commission and manage them, we find a lack of proportional equivalence between costs and benefits for community health services providers. An enduring lack of visibility of community health services within the system suggest that the conditions for sustained collaboration between providers are not being met. This means that the policy intent for ICSs to facilitate more collaborative care and shift care from hospital to the community may not be realised.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financing and purchasing mechanisms of primary health care in Southeast Asia region: Findings from a scoping review","authors":"Hsu Myat Mon ,&nbsp;Aungsumalee Pholpark ,&nbsp;Leonard Thomas Sy Lim ,&nbsp;Tsolmongerel Tsilaajav ,&nbsp;Valeria de Oliveira Cruz ,&nbsp;Piya Hanvoravongchai","doi":"10.1016/j.ssmhs.2025.100132","DOIUrl":"10.1016/j.ssmhs.2025.100132","url":null,"abstract":"<div><h3>Background</h3><div>Despite commitment to Primary Health Care (PHC), financing has been a persistent challenge in Southeast Asia, with limited discussions. To address this knowledge gap, this study explores three key financing mechanisms: revenue mobilization, pooling, and purchasing across the region.</div></div><div><h3>Methods</h3><div>A scoping review, with searches in PubMed, Scopus, Embase, and Google Scholar, was conducted. Screening was done via Covidence, with data extracted and analyzed in Excel using a framework analysis.</div></div><div><h3>Results</h3><div>Of 2521 sources, 171 were included. Limited information specific to PHC was found. Revenue mobilization mainly includes out-of-pocket payment, government funding, social insurance contributions, and a mix of government and external funding. Pooling for PHC financing was seen in Thailand, while other countries showed multiple levels of pooling under general health financing. The prevalent purchasing method for public facilities is line-item budgeting, with salaries as the primary payment method for healthcare providers. Some countries employ performance-linked methods and capitation for provider payments. Significant challenges include inadequate budget allocations, financial flow fragmentation, and poor coordination and low capacity for financial management.</div></div><div><h3>Conclusion</h3><div>Financing for PHC is found to be insufficient and inefficient, mainly using traditional mechanisms. Cross-country learning and collaboration can support the development of strategic PHC financing mechanisms.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100132"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving facility-level performance in primary healthcare system through strengthening management and financial resource utilization in Kano State, Nigeria","authors":"Ashiru Adamu Abubakar ,&nbsp;Abubakar Abba ,&nbsp;Olufunke Fasawe ,&nbsp;Tijjani Hussaini ,&nbsp;Nasir Umar ,&nbsp;Amina Bukari ,&nbsp;Glory Ugochi ,&nbsp;Aminu Kabara ,&nbsp;Emma Bassey ,&nbsp;Idris Nuhu Gaya ,&nbsp;Briony Pasipanodya ,&nbsp;Eoghan Brady ,&nbsp;Jacob Novignon ,&nbsp;Bashir Sunusi ,&nbsp;Muhammad Auwal Ibrahim ,&nbsp;Chloe Denavit ,&nbsp;Owens Wiwa ,&nbsp;Abubakar Yerima ,&nbsp;Kabiru Gulma","doi":"10.1016/j.ssmhs.2025.100080","DOIUrl":"10.1016/j.ssmhs.2025.100080","url":null,"abstract":"<div><h3>Background</h3><div>Nigeria's Minimum Service Package (MSP) standards were developed to bolster Primary Health Care (PHC) and Universal Health Coverage. This study assesses the impact of an intervention to get PHC facilities in Kano State meet the MSP standard through enhancing efficient utilization of the Basic Health Care Provision Fund, and strengthening the availability, access, and utilization of minimum PHC services.</div></div><div><h3>Methods</h3><div>This was a longitudinal study involving 49 PHC facilities in Kano State. The Clinton Health Access Initiative provided technical assistance to train facility managers on facility management and supported the deployment of a multidisciplinary team to guide facilities in identifying and addressing facility readiness bottlenecks. The facilities received continuous mentoring support for two years, thereafter, they were reassessed.</div></div><div><h3>Results</h3><div>Facilities providing 24-hour services increased significantly (<em>p</em> &lt; 0.001) from 53.1 % (n = 26) to 79.6 % (n = 39). Skilled healthcare workers increased significantly (p &lt; 0.001) from</div><div><span><math><mrow><mover><mi>X</mi><mrow><mo>¯</mo></mrow></mover><mo>=</mo></mrow></math></span> 11.14 to <span><math><mrow><mover><mi>X</mi><mrow><mo>¯</mo></mrow></mover><mo>=</mo></mrow></math></span>20.80. The availability of functional tracer equipment significantly improved (p = 0.004), but that of tracer drugs was not significant (p = 0.538). The tier-one services provided increased from 84 % to 91 % (p &lt; 0.001). Monthly antenatal care attendance increased significantly (p &lt; 0.001), but quality of care indicators such as the use of partographs did not show a significant increase from baseline (p = 0.286).</div></div><div><h3>Conclusion</h3><div>The interventions towards meeting MSP standards significantly improved infrastructure, staffing, and service availability using existing resources, although quality of care indicators showed limited change in the focal facilities. The findings suggest a promising strategy for the Nigeria's health sector renewal initiative, showcasing the potential to improve resource utilization and health outcomes.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144146730","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":"Navigating policy and infrastructure inequities in Indigenous primary health care: A qualitative comparative policy analysis of Alberta and Ontario","authors":"Stephanie Montesanti ,&nbsp;Emily Fleming ,&nbsp;Joyla Furlano ,&nbsp;Erynne Sjoblom ,&nbsp;Richard T. Oster ,&nbsp;Pamela Roach ,&nbsp;Amrita Roy ,&nbsp;Lindsay Crowshoe Lynden","doi":"10.1016/j.ssmhs.2025.100109","DOIUrl":"10.1016/j.ssmhs.2025.100109","url":null,"abstract":"<div><div>The capacity of primary health care (PHC) systems to provide high-quality, culturally safe care for Indigenous Peoples depends on strong and sustainable system infrastructure—including physical facilities, human resources, information systems, administrative supports, and equipment. This rapid qualitative policy study examined how PHC infrastructure is funded and resourced for Indigenous populations in Alberta and Ontario, comparing experiences from both provinces. Fourteen semi-structured interviews with key policy actors in both provinces were conducted, which informed the development of policy event timelines and enabled access to relevant provincial policy documents. The findings revealed that despite distinct provincial approaches, both juridictions face structural and juridictional barriers that hinder sustainable PHC delivery. Participants emphasized that salary-based payment models for physicians can support recruitment and rentention within First Nation and Métis communities, but alone are insufficient to address longstanding infrastructure gaps . Key barriers include geographic isolation, inadequate clinical space and technology, and limited clinical resources, which hinder PHC delivery, especially in remote and smaller communities. We identified funding inequities as a continuing barrier across both provinces, particularly concerning limited support for physician travel to rural and remote areas. The study also highlights how partnerships between First Nations and PHC organizationscan mitigate infrastructure gaps when clinical resources are shared. Physician goodwill emerged as a key factor in improving access to PHC in remote regions, highlighting their commitment to go beyond contractual obligations and funding limitations to provide necessary services in Indigenous communities. The study highlights critical opportunities for policy reform, including expanded funding for system infrastructure, population-based funding, increased support for physician travel, and the recognition of Indigenous self-determination in health care planning.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100109"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711499","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":"Developing a predictive model for resource allocation in healthcare: A case study from an Italian Hospital","authors":"Stanislav Russo ,&nbsp;Sergey Zhitikhin ,&nbsp;Virginia Gulino ,&nbsp;Beatrice Ricci ,&nbsp;Marco Nigro ,&nbsp;Edoardo Gallerani ,&nbsp;Elena Lombardo ,&nbsp;Peter Perger ,&nbsp;Emanuele Padovani ,&nbsp;Anselmo Campagna ,&nbsp;Matteo Buccioli","doi":"10.1016/j.ssmhs.2025.100085","DOIUrl":"10.1016/j.ssmhs.2025.100085","url":null,"abstract":"<div><div>The sustainability and efficiency of healthcare systems remain a global challenge, particularly in resource allocation for elective surgeries. This study examines the case of the Rizzoli Orthopedic Institute, a specialized Italian hospital facing significant waiting list imbalances, with approximately 24,000 patients awaiting surgery. The research employs a predictive modeling approach to optimize hospital resource allocation, particularly operating rooms and inpatient beds, to improve surgical scheduling efficiency. By leveraging statistical and computational methods, including historical data analysis and simulation modeling, this study aims to identify an optimal strategy to balance surgical demand and capacity. Over a sequence of 1811 total hip replacement surgeries, our mean calculated operating time was 74.31 min (SD: 19.41), and the estimate of resource demand calculated 1635 total operating hours (or 258 shifts) and 19 bed spaces to clear the current waiting list. Our model indicated potential for 30 % capacity-demand mismatch for this procedure alone. These findings indicate the need for strategic realignment of hospital resources. Key findings indicate that the existing operating-room capacity and bed assignments are insufficient to handle even a single high-volume surgery procedure (total hip replacements) without delays. In real-life practice, hospital managers can use these findings to inform scheduling policy, make staffing assignment priorities, and maybe even plan temporary capacity boosts or off-site sites for surgery.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144166236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of informal health providers in the management of neglected tropical diseases in Liberia: A participatory investigation","authors":"Hannah Berrian ,&nbsp;Laura Dean ,&nbsp;Shahreen Chowdhury ,&nbsp;Zeela Zaizay ,&nbsp;Sally Theobald ,&nbsp;Wede Seekey ,&nbsp;Jerry Kollie ,&nbsp;John Solunta Smith Jr ,&nbsp;Colleen Parker ,&nbsp;Emerson Rogers ,&nbsp;Rosalind McCollum","doi":"10.1016/j.ssmhs.2025.100131","DOIUrl":"10.1016/j.ssmhs.2025.100131","url":null,"abstract":"<div><h3>Background</h3><div>Informal health providers (e.g. traditional and faith healers) are the first point of contact for many persons affected by skin Neglected Tropical Diseases (NTDs) due to varying beliefs and perceptions, yet, they are typically not considered within interventions designed to support persons affected. Despite this neglect, most informal providers are already using their existing roles within communities to support persons affected with care. We sought to investigate the role of informal providers in the management of NTDs in Liberia using participatory approaches to understand and identify ways to improve equitable and effective care for people affected by skin NTDs.</div></div><div><h3>Methods</h3><div>Qualitative and participatory data were collected from two purposively selected counties in Liberia: Grand Gedeh and Lofa. Key informant interviews (6), photovoice (16), and vignettes (32) with traditional and faith healers and informal drug sellers sought to understand their roles in providing care for people affected by skin NTDs. Analysis was conducted using a thematic framework approach.</div></div><div><h3>Findings</h3><div>Health beliefs influenced care seeking from informal providers and/or biomedical care. Informal providers provide persons affected with holistic support, including physical, psychosocial, spiritual, social and financial. This care, based on their respective underlying health beliefs and cultural norms, is driven by perceptions of poor quality of the formal or biomedical health system. During care provision, traditional and faith healers emphasised referring persons affected to the health facility as part of their roles.</div></div><div><h3>Conclusion</h3><div>Understanding the roles of informal providers in the management of skin NTDs is important in reducing the burden of NTDs. Informal providers are trusted by their communities and seen as a primary contact to provide care. They expressed willingness to collaborate with the formal health system. Training them on identification and referral, and basic psychosocial support would enhance early referral and collaboration between formal and informal health systems.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100131"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute febrile illness in remote and rural communities: Perspectives of health providers and managers in Chattogram, Bangladesh","authors":"Marco Liverani ,&nbsp;Sharmin Ahmed ,&nbsp;Aninda Sen ,&nbsp;Rusheng Chew ,&nbsp;Arjun Chandna ,&nbsp;Shayla Islam ,&nbsp;Richard J. Maude ,&nbsp;Akramul Islam ,&nbsp;Yoel Lubell","doi":"10.1016/j.ssmhs.2025.100090","DOIUrl":"10.1016/j.ssmhs.2025.100090","url":null,"abstract":"<div><div>Acute febrile illness is a major public health issue in tropical regions, particularly in remote and rural areas where healthcare access is difficult. In these areas, patients often seek care too late or rely on self-medication, leading to increased risks of complications and death. This qualitative study examined challenges and opportunities for managing acute febrile illness in Chattogram Division, Bangladesh. The research involved interviews with 35 stakeholders across the health sector in Bangladesh, including health managers and frontline health workers, and international experts. Findings show that referral barriers, health seeking behaviour and financial considerations influence case management and outcomes in complex ways. Community health workers are vital in managing local health issues, but they have limited ability to address the evolving concerns about febrile illness. Gaps in the referral system and inadequate emergency care resources further complicate the situation. Many episodes of fever remain undifferentiated and are often managed with presumptive antibiotic treatment, which may be inappropriate and contributes to antimicrobial resistance. This study highlights the pressing need for an integrated approach to febrile illness management in rural Bangladesh, one that accounts for the changing epidemiology of infectious diseases, health seeking behaviour, and the limitations of the existing healthcare infrastructure. Expanding the ability of community health workers to manage patients with non-malarial febrile illnesses, stronger triage and referral systems, and addressing the financial and logistical barriers to care are critical steps toward improving health outcomes in these regions.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"5 ","pages":"Article 100090"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144138562","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}