Health Research Policy and Systems最新文献

{"title":"Investigating the trustworthiness of research evidence used to inform public health policy: a qualitative interview study on the use of predatory journal citations in policy documents.","authors":"Marc A Albert, Manoj M Lalu, Agnes Grudniewicz","doi":"10.1186/s12961-024-01282-9","DOIUrl":"10.1186/s12961-024-01282-9","url":null,"abstract":"<p><p>Evidence-based policymaking has increased policymakers' capacity to make scientifically informed health policy decisions. However, reaping the benefits of this approach requires avoiding untrustworthy research - potential sources of which are predatory journals. In this study, we sought to understand how research cited in policy documents is sourced and evaluated, and identify factors that may be contributing to the citation of predatory journals or other less trustworthy evidence. To this end, we conducted semi-structured interviews with individuals who have prepared public health policy documents. These interviews were thematically analysed, and five key overarching themes were generated regarding the process of deciding how to develop policy documents (e.g. which individuals to involve) and how this may impact which information is included; obstacles such as limited evidence that may hinder policy document development; and concerns around transparency throughout the development process. Our findings highlight that in many cases, information cited in policy documents is sourced and evaluated with variable rigour. This may contribute to the citation of untrustworthy research in policy documents. Certain steps can be taken to help minimize any potential negative impact of relying on such sources (e.g. improving transparency), but a better understanding of policymakers' perspectives regarding how taking these steps would impact their decision-making process may be required to ensure successful implementation.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"7"},"PeriodicalIF":3.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can integrated care interventions strengthen primary care and improve outcomes for patients with chronic diseases? A systematic review and meta-analysis.","authors":"Yuqi Zhang, Jonathan Stokes, Laura Anselmi, Peter Bower, Jin Xu","doi":"10.1186/s12961-024-01260-1","DOIUrl":"https://doi.org/10.1186/s12961-024-01260-1","url":null,"abstract":"<p><strong>Background: </strong>An increasing number of people live with chronic disease or multi-morbidity. Current consensus is that their care requires an integrated model bringing different professionals together to provide person-centred care. Although primary care has a central role in managing chronic disease, and integration may be important in strengthening this role, previous research has shown insufficient attention to the relationships between primary care and integration. This review summarizes primary care involvement in integrated care interventions and assesses the effect of those interventions on a range of measures of primary care functions and wider outcomes.</p><p><strong>Methods: </strong>We searched Medline and Embase using terms for \"integrated care\", \"chronic disease\" and \"multimorbidity\". We included integrated care interventions involving different levels of care organizations or different care sectors. Risk of bias was appraised, and the contents of integrated care interventions assessed using the Sustainable intEgrated care modeLs for multi-morbidity: delivery, FInancing and performancE (SELFIE) conceptual framework. Effectiveness of integrated care interventions was assessed using meta-analysis of primary care functions (access, continuity, comprehensiveness and coordination) and wider outcomes (patient health and mortality, hospital admissions and costs). Sub-group analyses were conducted for different types of primary care involvement.</p><p><strong>Results: </strong>From 17,752 studies screened, 119 studies on integrated care were identified, of which 69 interventions (58%) involved primary care. Meta-analyses showed significant beneficial effects on two measures of primary care function: access (effect size: 0.17, 95% CI 0.05-0.29) and continuity (effect size: 0.32, 95% CI 0.14-0.50). For wider outcomes, the only statistically significant effect was found on costs (effect size: 0.02, 95% CI 0.02-0.03).</p><p><strong>Conclusions: </strong>Integrated care interventions involving primary care can have positive effects on strengthening primary care functions, but these benefits do not necessarily translate consistently to wider outcomes.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"5"},"PeriodicalIF":3.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation research logic model in the design and execution of eHealth innovations for maternal and newborn healthcare in Ethiopia.","authors":"Dabere Nigatu, Muluken Azage, Eyaya Misgan, Daniel A Enquobahrie, Tegegn Kebebaw, Enyew Abate, Esubalew Alemneh, Mirkuzie Woldie, Tsinuel Girma","doi":"10.1186/s12961-024-01259-8","DOIUrl":"https://doi.org/10.1186/s12961-024-01259-8","url":null,"abstract":"<p><strong>Background: </strong>The use of eHealth innovations is becoming increasingly important in improving health outcomes, especially for maternal and newborn health. However, planning and executing these innovations can be challenging due to their complex nature. To provide guidance and clarity on implementation approaches, researchers need to use implementation research (IR) tools. We conducted IR to recognize the challenges in implementing eHealth innovations in the context of maternal and newborn healthcare using the implementation research logic model (IRLM). Therefore, this paper aims to describe the practical application of IRLM to design, execute and evaluate eHealth innovations that improve maternal and newborn care in public facilities in Ethiopia.</p><p><strong>Methods: </strong>We employed rapid review, formative assessment and process evaluation of an eHealth innovation in selected healthcare facilities serving maternal and newborn care. The eHealth innovation we developed and deployed was named 'ADHERE' (Antenatal Care, ChilDbirtH CarE and Postnatal CaRE), representing the continuum of maternal care. The rapid review was conducted as an initial step using the Consolidated Framework for Implementation Research (CFIR). We employed a mix of data collection methods: interview/discussion, eHealth system or document review and direct observation. Furthermore, we executed various stakeholder engagement activities: two co-creation workshops and on-site iterative discussions. We applied the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to capture ongoing implementation learnings.</p><p><strong>Results: </strong>We developed IRLM of the eHealth innovation implementation for three contexts: urban, peri-urban and remote public healthcare facilities. The model depicted the mechanism of interaction between implementation determinants and implementation strategies to produce the intended implementation outcomes. The IRLM helped to identify more than 35 implementation barriers or facilitators for eHealth interventions and to develop over 17 mitigation strategies for the study contexts. The initial IRLM was refined through ongoing implementation learnings and the mitigation strategies that were executed.</p><p><strong>Conclusions: </strong>The IRLM is a comprehensive and effective guiding tool for the development, implementation and evaluation of innovations in various low- and middle-income contexts. Researchers and implementing partners should adapt and use it.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"4"},"PeriodicalIF":3.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming dementia research into practice: a multiple case study of academic research utilization strategies in Dutch Alzheimer Centres.","authors":"Eden Meng Zhu, Martina Buljac-Samardžić, Kees Ahaus, Robbert Huijsman","doi":"10.1186/s12961-024-01266-9","DOIUrl":"https://doi.org/10.1186/s12961-024-01266-9","url":null,"abstract":"<p><strong>Background: </strong>Non-pharmacological dementia research products, such as social and behavioural interventions, are generated in traditional university settings. These often experience challenges to impact practices that they were developed for. The Netherlands established five specialized academic health science centres, referred to as Alzheimer Centres, to structurally coordinate and facilitate the utilization of dementia research knowledge. This study leverages implementation science to systematically explore the research utilization strategies used by academic researchers from each Alzheimer Centre, on the basis of the \"knowledge-to-action\" (KTA) framework that includes knowledge creation, adaptation, dissemination and implementation.</p><p><strong>Methods: </strong>Individual semi-structured qualitative interviews were conducted with 29 respondents across the five Alzheimer Centres in the Netherlands. Participants were selected through purposive (snowball) sampling. Interviews were conducted in-person and virtually through Microsoft Teams, and all were audio-recorded and transcribed verbatim. Data analysis was guided by the dimensions of the KTA framework.</p><p><strong>Result: </strong>There was a high variation in the strategies used across the five Alzheimer Centres to bring non-pharmacological dementia research into practice. Selected strategies in each Centre were influenced by the typology of research products produced and the Centres' organizational heritage. The knowledge creation and adaptation phases were mainly facilitated by funders' guidance towards research impact and research product co-creation with patients and implementing organizations. Dissemination and implementation phases were often facilitated through utilizing support from university-based technology transfer offices to facilitate implementation and valorization and establishing and strategically leveraging formal infrastructure, such as public-private partnerships and professional collaborative networks.</p><p><strong>Conclusions: </strong>Successful research utilization requires evolving researcher competencies to meet environmental demands and facilitating co-creation with research end-users and implementing partners. Understanding external determinants influencing research utilization in the Dutch dementia research ecosystem is crucial for capacity-building and aligning cross-sector agendas. The KTA framework appears to reveal the intricacies of research utilization, guiding future studies to explore strategies employed across various contexts.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"3"},"PeriodicalIF":3.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholder perspectives on facilitators and barriers to implementing a zero-dollar copay program for chronic conditions study.","authors":"Debra Winberg, Elizabeth Nauman, Lizheng Shi, Brice L Mohundro, Kelly Louis, Eboni G Price-Haywood, Tiange Tang, Alessandra N Bazzano","doi":"10.1186/s12961-024-01278-5","DOIUrl":"https://doi.org/10.1186/s12961-024-01278-5","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2D) remains a pressing public health concern. Despite advancements in antidiabetic medications, suboptimal medication adherence persists among many individuals with T2D, often due to the high cost of medications. To combat this issue, Blue Cross and Blue Shield of Louisiana (Blue Cross) introduced the $0 Drug Copay (ZDC) program, providing $0 copays for select drugs. This study sought to explore barriers and facilitators to the successful implementation of Blue Cross's ZDC program (updated version).</p><p><strong>Methods: </strong>Focus group discussions and interviews were conducted with health plan leadership, health coaches and providers who participate in the health plan organization's healthcare quality improvement program. Focus group discussions and semi-structured interviews were conducted between October 2022 and July 2023. Discussion guides were developed collaboratively and tailored to each participant group. Interviews were recorded, transcribed and analysed using NVivo^® qualitative analysis software. A descriptive, qualitative analysis was conducted, resulting in the identification of seven codes and subsequent candidate themes.</p><p><strong>Results: </strong>In total, 15 participants were interviewed: 6 were Blue Cross administrators, 5 were health coaches and 4 were Quality Blue providers. Overall, participants had positive feedback on the ZDC program and perceived that it has significant benefits for patients and the health system but could be improved, and four themes related to implementation barriers and facilitators, effectiveness and potential areas of improvement were identified: (1) the ZDC program reduces friction for patients, prescribers and the health system; (2) the program is aligned with the values of health systems, insurers and providers, facilitating implementation success; (3) expanding coverage (drug classes and conditions) and education (for providers and patients) could maximize program benefits; and (4) coronavirus disease 2019 (COVID-19) did not negatively impact program administration because the $0 copay was programmed at the benefit level.</p><p><strong>Conclusions: </strong>The ZDC program aligns goals and can benefit patients, providers and patients. The program can have the largest potential if it is expanded to include new medications and new conditions, and if there is more education for patients and providers. Regardless of challenges, reduced-copay programs have the potential to improve medication adherence, improve HbA1C control and improve overall health outcomes. Trial Registration This study was approved by the Tulane University Institutional Review Board, IRB #2020-1986.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"6"},"PeriodicalIF":3.6,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11702045/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Policy analysis of self-care program: a qualitative study protocol.","authors":"Mohammadjavad Mohammadzade, Mostafa Amini-Rarani, Fereshteh Zamani-Alavijeh, Saeed Karimi","doi":"10.1186/s12961-024-01280-x","DOIUrl":"10.1186/s12961-024-01280-x","url":null,"abstract":"<p><strong>Background: </strong>Over the recent years, the self-care program has been a significant policy in the field of health. The WHO recommended self-care for every country and economic setting for reaching universal health coverage, promoting health, keeping the world safe and serving the vulnerable. Conducting a policy analysis study can be useful in closely examining the self-care program's content, process, context and actors.</p><p><strong>Methods: </strong>A qualitative policy analysis will be conducted in four phases to analyse the self-care program, focussing in Iran. The first phase will involve a scoping review to identify policies related to self-care worldwide. In the second phase, a qualitative study will be conducted to determine the status of the self-care program in Iran. The third phase will involve analysing the self-care program in Iran using the policy triangle framework of Walt and Gilson (1994). In the final phase, initial policy recommendations related to the self-care program will be formulated, and validation and finalization of the initial recommendations will be carried out in a panel of experts.</p><p><strong>Discussion: </strong>To thoroughly examine the self-care program's content, process, context and actors, a policy analysis study can be helpful. Therefore, this study will aim to analyse the self-care program using policy analysis approach. By identifying the challenges of the program's content, process, context and actors, corrective solutions to improve the program's current status, as well as policy recommendations appropriate to the country's context, will be provided. In addition, policy-makers in various authorities at the national, regional and provincial levels would benefit from the results of this study.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"2"},"PeriodicalIF":3.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11697853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution of health policy and systems research in 11 low- and middle-income countries and the role of the Alliance for Health Policy and Systems Research: a bibliometric analysis for 1999-2020.","authors":"Nino Paichadze, Emma K Cook, Heather E Rosen, Sara Kurtovic, Adnan A Hyder","doi":"10.1186/s12961-024-01254-z","DOIUrl":"10.1186/s12961-024-01254-z","url":null,"abstract":"<p><strong>Objectives: </strong>Given the rapid growth of the field of health policy and systems research (HPSR), it is important to monitor the research environment, especially the evolution of HPSR research outputs in low- and middle-income countries (LMICs). The objective of this study was to generate quantitative metrics to assess the production of HPSR publications and the role of the Alliance for Health Policy and Systems Research (the Alliance) grant-funded projects in 11 LMICs over the past 20 years.</p><p><strong>Methods: </strong>We conducted a systematic literature search for HPSR literature from 1999 to 2020 pertaining to 11 target LMIC countries, including grey literature. We analysed the frequency of publications over time, by country and by thematic area. We then used a database of the Alliance's previous grantees to analyse authorship by Alliance-funded investigators.</p><p><strong>Results: </strong>HPSR publications across all 11 target countries increased steadily over the past two decades and the rate of publication increased by an average of 34% per year. The majority of HPSR publications during the study period were in health systems (23%) and health workforce (19%) thematic areas. Nineteen per cent of HPSR publications during this time were authored by Alliance-funded investigators. There was extensive heterogeneity between countries both in number of publications and in proportion of publications authored by Alliance-funded investigators.</p><p><strong>Conclusions: </strong>Growth in the HPSR research environment reflects the expanding prominence of the HPSR field and increased HPSR research capacity in the 11 target countries. Alliance-funded investigators made an important contribution to the growth in HPSR output in these countries.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"23 1","pages":"1"},"PeriodicalIF":3.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11694382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the potential of introducing an electronic death registration system in South Africa.","authors":"Carmen Sant Fruchtman, Natasha Kallis, Sudarshan Govender, Debbie Bradshaw, Daniel Cobos, Diane Morof, Pamela Groenewald","doi":"10.1186/s12961-024-01275-8","DOIUrl":"10.1186/s12961-024-01275-8","url":null,"abstract":"<p><strong>Background: </strong>Despite South Africa's well-established Civil Registration and Vital Statistics system (CRVS) and good completeness of death registration, challenges persist in terms of the quality of cause of death information and the delayed availability of mortality statistics. The introduction of an electronic medical certification of cause of death (eMCCD) system may offer opportunities to improve both the quality and timeliness of this information.</p><p><strong>Methods: </strong>This study used an exploratory mixed methods design to investigate perceptions surrounding an electronic solution for registering deaths in South Africa. We conducted 14 key informant interviews from 23 key informants invited, surveyed 208 out of 250 targeted health workers and engaged with more than 500 South African health professionals in a participatory workshop about the acceptability of introducing an eMCCD. Mentimeter was used to obtain feedback from the participants. Rapid qualitative analysis methods were used to analyse the key informant interviews and descriptive statistics for the survey and workshop data. During the interpretation phase, qualitative and quantitative data were integrated according to key themes that emerged from the data.</p><p><strong>Results: </strong>During the qualitative interviews, the underlying factors mentioned as contributing to inadequate mortality data quality included insufficient MCCD training, diseases subjected to stigma, limited access to and quality of patient health information, and a significant proportion of deaths occurring outside medical facilities. More than 80.8% of the surveyed health professionals (168/208) rated the importance of mortality statistics as high, but the current quality was rated as low or very low by 29.3% (61/208). An eMCCD appeared to be acceptable to most workshop participants who registered on Mentimeter and was perceived as a means to strengthen the timeliness of mortality information. However, 43.0% (68/158) of the workshop participants who responded to this question on Mentimeter saw poor internet use as the main barrier to introducing an online system.</p><p><strong>Conclusions: </strong>Our results shed light on critical aspects surrounding cause of death information in South Africa, as well as the challenges faced in maintaining the quality of such data. The findings suggest that the implementation of an eMCCD system could provide opportunities to strengthen the cause of death information in South Africa if it is designed to integrate into the current system and provide supplementary functionalities.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"177"},"PeriodicalIF":3.6,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel social-network-analysis-based approach for analyzing complex network of actors involved in accessibility of anti-cancer medications in Iran.","authors":"Kamran Bagheri Lankarani, Leila Zarei, Esmaeil Alinezhad, Adel Sadeghdoost","doi":"10.1186/s12961-024-01274-9","DOIUrl":"10.1186/s12961-024-01274-9","url":null,"abstract":"<p><strong>Background: </strong>The access to anti-cancer medications is influenced by policies formed via the convergence of various stakeholders. The aim of this study is to identify and analyse the stakeholders involved in formulating and implementing policies related to the accessibility of anti-cancer medications in Iran and their interactions that are relevant to the outcomes of these policies for the first time.</p><p><strong>Methods: </strong>To achieve the objectives, a novel multistage social network analysis (SNA)-based approach that includes three phases is proposed. First, the actors were identified by a team consisting of multidisciplinary knowledgeable experts through 15 comprehensive interviews. Then, the influence relationships of these actors were comprehensively analysed through in-depth interviews with nine key informants involved in pharmaceutical policies through a structured questionnaire. Finally, a novel network of actors was determined accordingly, and a SNA-based approach proposed to reveal the intrinsic roles and various aspects of the importance of the network's actors.</p><p><strong>Results: </strong>The study identified a total of 45 actors, which were then classified into 4 categories on the basis of their public or private nature and their foreign or domestic origin. This established network helped in creating a comprehensive view of the main actors, and can help policymakers to solve the problems related to access to anti-cancer medications more effectively and prevent the creation of these problems in the future. In this way, the network identified specific actors that can benefit from increased attention and dialogue. The computational results revealed that the Iran Food and Drug Administration (IFDA), Pharmaceutical Importer Companies (PharIc) and Pharmaceutical Manufacturing Companies (PharMC) were highly important actors in terms of their connectivity to other actors. Additionally, law enforcement agencies (LEA) have shown limited effectiveness within this network.</p><p><strong>Conclusions: </strong>This study highlights the importance of complex relationships among various actors and proposes a novel SNA-based approach to analyse them. Regarding the main steps of the proposed approach and the findings, it is imperative for pharmaceutical policy plans to involve a diverse group of experts from the beginning, prioritizing the preferences of stakeholders, and providing a patient-centred approach to prevent the worsening of resource shortages.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"178"},"PeriodicalIF":3.6,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the inherent resilience of health districts in a context of chronic armed conflict: a case study in Eastern Democratic Republic of the Congo.","authors":"Samuel Lwamushi Makali, Patricia St Louis, Hermès Karemere, Alice Wautié, Enrico Pavignani, Christian Molima Eboma, Rosine Bigirinama, Corneille Lembebu, Denis Porignon, Ghislain Bisimwa Balaluka, Philippe Donnen, Elisabeth Paul","doi":"10.1186/s12961-024-01252-1","DOIUrl":"10.1186/s12961-024-01252-1","url":null,"abstract":"<p><strong>Background: </strong>In South Kivu (Eastern Democratic Republic of the Congo [DRC]), health districts (HDs) affected by chronic armed conflicts are devising coping mechanisms to continue offering healthcare services to the population. Nonetheless, this alone does not suffice to make them fully resilient to such conflicts. This study aims to explore the characteristics of these HDs' resilience.</p><p><strong>Methods: </strong>This study uses mixed methods (triangulation) and an extreme case study design to compare a HD with no history of armed conflict (Idjwi, Case 1) and another one experiencing armed conflict (Fizi, Case 2) in South Kivu. The Kruk et al. (BMJ 23:357, 2017) index was employed as a theoretical framework for exploring resilience characteristics. Qualitative data were collected through a document review using a pre-set review grid and semi-structured individual interviews with purposively sampled key stakeholders. They were subjected to deductive-inductive thematic analysis. Quantitative data were collected using a Likert scale questionnaire (administered to stakeholders in the selected HDs using non-probabilistic methods - purposive and snowball sampling). These data were subsequently analysed for comparative descriptive purposes.</p><p><strong>Results: </strong>Recurring short-term shocks as well as chronic stress factors whether or not linked to chronic armed conflicts were identified. According to most respondents (> 98%), essential components of a resilient HDs were prior knowledge of the strengths and weaknesses as well as the public health risk posed by the crisis (awareness), together with community and non-health actors' involvement during the crisis (Integration). Common resilience mechanisms (e.g. epidemic management plan, crisis management committee) were identified, and Case 2 implemented additional mechanisms, including DRC armed forces involvement, community healthcare sites and mobile clinics, specific warning system, and regular socio-demographic monitoring of displaced persons alongside promotion of activities for social cohesion strengthening.</p><p><strong>Conclusions: </strong>For meaningful resilience to emerge, HDs must be better resourced in \"normal\" times. If this condition is fulfilled, quality of care could improve and spare capacity could be created to withstand disturbances.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"175"},"PeriodicalIF":3.6,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}