Health policy and planning最新文献

{"title":"Beyond access to sanitary pads: a comprehensive analysis of menstrual health scheme impact among rural girls in Northeast India.","authors":"Krishnashree Achuthan, Sugandh Khobragade, Vysakh Kani Kolil","doi":"10.1093/heapol/czae117","DOIUrl":"10.1093/heapol/czae117","url":null,"abstract":"<p><p>Menstrual hygiene management (MHM) among girls in rural India poses a substantial challenge for public health, education, and quality of life, exacerbated by limited access to and affordability of menstrual products. In response to these issues, the Government of India initiated the Menstrual Hygiene Scheme (MHS) to enhance access and awareness. This study evaluates the impact of the MHS in Assam and Tripura, designated as \"treatment states\" with consistent pad supply from 2017 to 2021 compared to neighboring \"control states\" with negligible pad distribution. Utilizing data from two National Family Health Surveys, NFHS-4 and NFHS-5, and employing the propensity score matching difference-in-differences approach, we isolated the causal effect of the MHS distribution program. The key findings reveal a significant rise in sanitary pad and hygienic method usage in the treatment states, particularly among girls aged 15-19 years who received pads during the survey period. Their sanitary pad usage increased by 10.6 percentage points [95% confidence interval (CI) (0.046, 0.167)], and adoption of hygienic methods overall saw a 13.8 percentage point [95% CI (0.087, 0.188)] jump. Notably, younger girls aged 15-19 years also experienced a 6.1-percentage point [95% CI (0.004, 0.118)] increase in their understanding of ovulation, showcasing the MHS's potential to go beyond providing products and promoting menstrual health awareness. A rise in reported sexually transmitted infections in both age groups, with a statistically significant 1.8-percentage point [95% CI (0.004, 0.032)] increase for younger girls, warrants further exploration. Disparities in impact were observed, with girls with high media exposure and greater autonomy demonstrating greater improvements in hygienic practices, highlighting the importance of information dissemination and empowering girls. Most socioeconomic groups, except the highest wealth and education levels, witnessed rises in hygienic method usage, indicating the scheme's potential to reduce inequalities while hinting at the need for tailored interventions for marginalized communities.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"218-233"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testing the unintended cost effects of health policies for generic substitutions: the case of China's National Volume-Based Procurement (NVBP) policy.","authors":"Boya Zhao, Jing Wu, Xing Lin Feng","doi":"10.1093/heapol/czae101","DOIUrl":"10.1093/heapol/czae101","url":null,"abstract":"<p><p>Generic substitutions are globally considered to contain health expenditures. Yet it is uncertain whether the costs spill over to other medicines or health services. Contextualizing China's National Volume-Based Procurement (NVBP) policy, which promoted generic substitution, this study tests the changes in patients' utilization of generic medicines and whether the costs shift to other pharmaceutics or health services post-policy. This population-based, matched, cohort study uses claims data from Tianjin, China in 2018-2020. We focus on amlodipine, the most commonly used calcium channel blocker with the largest procurement volume. We build comparable post-policy cohorts: Non-switchers who kept using originator amlodipine, Pure-switchers who loyally switched to generic amlodipine, and Back-switchers who switched back-and-forth; and compare between each matched pair, respectively, their annual healthcare costs and that broken down by components, and patients' use of and adherence to amlodipine post-policy. In all, 1185 Pure-switchers, 1398 Back-switchers, and 2330 Non-switchers were identified (mean age: 63.0 years; 58.5% men). For the matched pairs, Pure-switchers (n = 772) incurred annual total medical costs of CNY 9213.5, 12.2% lower than Non-switchers [n = 1544, absolute difference CNY -1309.3, 95% confidence interval (-2645.8, -19.6)]. The cost reduction only results from amlodipine prescriptions in outpatient encounters and are equally borne by health plans and the enrolees. The costs for Pure-switchers and Non-switchers are not different from other medicines, nor from other items including tests, surgeries, beds, and medical consumables for hypertension-related encounters/admissions. Pure-switchers also had higher daily dosage and better adherence to amlodipine than Non-switchers. The differences between Back-switchers and Non-switchers show similar trends but are less profound. China's NVBP policy is effective in controlling pharmaceutical costs. No unintended cost effects have yet been identified in the short run. Other countries may learn from China on a comprehensive set of auxiliary policies, including listing, bidding, purchasing, and reimbursing, to better promote generic substitutions.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"194-205"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conceptualizing maternal mental health in rural Ghana: a realist qualitative analysis.","authors":"Linda Lucy Yevoo, Ana Manzano, Leveana Gyimah, Sumit Kane, Elizabeth Awini, Anthony Danso-Appiah, Irene A Agyepong, Tolib Mirzoev","doi":"10.1093/heapol/czae116","DOIUrl":"10.1093/heapol/czae116","url":null,"abstract":"<p><p>In low- and middle-income countries, maternal mental health needs remain neglected, and common mental disorders during pregnancy and after birth are routinely associated with hormonal changes. The psycho-social and spiritual components of childbirth are often downplayed. A qualitative study was conducted as part of a wider realist evaluation on health systems responsiveness to examine the interrelationships between pregnant and postnatal women, their families, and their environment, and how these influence women's interactions with healthcare providers in Ghana. Data collection methods combined six qualitative interviews (n = 6) and 18 focus group discussions (n = 121) with pregnant and postnatal women, their relatives, and healthcare providers (midwives, community mental health nurses) at the primary healthcare level. Data analysis was based on the context-mechanism-outcome heuristic of realist evaluation methodology. A programme theory was developed and iteratively refined, drawing on Crowther's ecology of birth theory to unpack how context shapes women's interactions with public and alternative healthcare providers. We found that context interacts dynamically with embodiment, relationality, temporality, spatiality, and mystery of childbirth experiences, which in turn influence women's wellbeing in three primary areas. There is an intricate intersection of pregnancy with mental health impacting women's expectations of temporality, which does not always coincide with the timings provided by formal healthcare services. Societal deficiencies in social support structures for women facing economic challenges become particularly evident during the pregnancy and postnatal period, where women need heightened assistance. Socio-cultural beliefs associated with the mystery of childbirth, the supportive role of private providers and faith healing practices offered women a feeling of protection from uncertainty. Co-production of context-specific interventions, including the integration of maternal and mental health policies, with relevant stakeholders can help formal healthcare providers accommodate women's perspectives on spirituality and mental health, which can subsequently help to make health systems responsive to maternal mental health conditions.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"244-258"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A critical review of literature and a conceptual framework for organizing and researching urban health and community health services in low- and middle-income countries.","authors":"Sanjana Santosh, Sumit Kane","doi":"10.1093/heapol/czae104","DOIUrl":"10.1093/heapol/czae104","url":null,"abstract":"<p><p>Low- and middle-income countries (LMICs) are rapidly urbanizing, and in response to this, there is an expansion in the body of scholarship and significant policy interest in urban healthcare provision. The idea and the reality of 'urban advantage' have meant that health research in LMICs has disproportionately focused on health and healthcare provision in rural contexts and is yet to sufficiently engage with urban health as actively. We contend that this research and practice can benefit from a more explicit engagement with the rich conceptual understandings that have emerged in other disciplines around the urban condition. Our critical review included publications from four databases (MEDLINE, EMBASE, CINAHL, and Social Sciences Citation Index) and two Community Health Worker (CHW) resource hubs. We draw upon scholarship anchored in sociology to unpack the nature and features of the urban condition; we use these theoretical insights to critically review the literature on urban community health worker programs as a case to reflect on community health practice and urban health research in LMIC contexts. Through this analysis, we delineate key features of the urban, such as heterogeneity, secondary spaces and ties, size and density, visibility and anonymity, precarious work and living conditions, crime, and insecurity, and specifically the social location of the urban CHWs and present their implications for community health practice. We propose a conceptual framework for a distinct imagination of the urban to guide health research and practice in urban health and community health programs in the LMIC context. The framework will enable researchers and practitioners to better engage with what entails a 'community' and a 'community health program' in urban contexts.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"259-271"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142566465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A realist evaluation of the implementation of a national tobacco control programme and policy in India.","authors":"Pragati B Hebbar, Vivek Dsouza, Gera E Nagelhout, Sara van Belle, Nuggehalli Srinivas Prashanth, Onno C P van Schayck, Giridhara R Babu, Upendra Bhojani","doi":"10.1093/heapol/czae081","DOIUrl":"10.1093/heapol/czae081","url":null,"abstract":"<p><p>There is a growing interest in studying and unpacking the implementation of policies and programmes as it provides an opportunity to reduce the policy translation time lag taken for research findings to translate into policies and be implemented and to understand why policies may fail. Realist evaluation is a theory-driven approach that embraces complexity and helps to identify the mechanisms generating the observed policy outcomes in a given context. We aimed to study facilitators and barriers while implementing the Cigarettes and Other Tobacco Products Act 2003 (COTPA), a comprehensive national tobacco control policy, and the National Tobacco Control Programme 2008 (NTCP), using realist evaluation. We developed an initial programme theory (IPT) based on a realist literature review of tobacco control policies in low- and middle-income countries. Three diverse states-Kerala, West Bengal and Arunachal Pradesh-with varying degrees of implementation of tobacco control laws and programmes were chosen as case studies. Within the three selected states, we conducted in-depth interviews with 48 state and district-level stakeholders and undertook non-participant observations to refine the IPT. Following this, we organized two regional consultations covering stakeholders from 20 Indian states for a second iteration to further refine the programme theory. A total of 300 intervention-context-actor-mechanism-outcome configurations were developed from the interview data, which were later synthesized into state-specific narrative programme theories for Kerala, West Bengal and Arunachal Pradesh. We identified five mechanisms: collective action, felt accountability, individual motivation, fear and prioritization that were (or were not) triggered leading to diverse implementation outcomes. We identified facilitators and barriers to implementing the COTPA and the NTCP, which have important research and practical implications for furthering the implementation of these policies as well as implementation research in India. In the future, researchers could build on the refined programme theory proposed in this study to develop a middle-range theory to explain tobacco control policy implementation in India and other low- and middle-income countries.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"140-152"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142055407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The long-term effects of cash transfer programmes on young adults' mental health: a quasi-experimental study of Colombia, Mexico, and South Africa.","authors":"Annie Zimmerman, Mauricio Avendano, Crick Lund, Ricardo Araya, Yadira Diaz, Juliana Sanchez-Ariza, Philipp Hessel, Emily Garman, Sara Evans-Lacko","doi":"10.1093/heapol/czae102","DOIUrl":"10.1093/heapol/czae102","url":null,"abstract":"<p><p>Poverty is associated with poorer mental health in early adulthood. Cash transfers (CTs) have been shown to improve child health and education outcomes, but it is unclear whether these effects may translate into better mental health outcomes as children reach young adulthood. Using a quasi-experimental approach that exploits variation across countries in the timing of national CT programme introduction, we examine whether longer exposure to CTs during childhood (0-17 years) reduces depressive symptoms in early adulthood (18-30 years). Based on harmonized data from Colombia, Mexico, and South Africa (N = 14 431), we applied logistic regression models with country and birth-cohort fixed effects to estimate the impact of cumulative years of CT exposure on mental health, educational attainment, and employment outcomes. Our findings indicate that each additional year of CT exposure during childhood is associated with a 4% reduction in the odds of serious depressive symptoms in early adulthood [odds ratio (OR) = 0.96, 95% confidence intervals (CIs): 0.93, 0.98]. We find no consistent effect of years of exposure on completion of secondary school (OR = 1.01, 95% CIs: 0.99, 1.03) and a negative effect on the probability of employment in early adulthood (OR = 0.90, 95% CIs: 0.88, 0.91). These results suggest that longer exposure to CTs may contribute to modest but meaningful reductions in population-level depressive symptoms during early adulthood.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"206-217"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Actor sensemaking and its role in implementation of the decentralized drug-resistant tuberculosis policy in South Africa.","authors":"Waasila Jassat, Mosa Moshabela, Helen Schneider","doi":"10.1093/heapol/czae105","DOIUrl":"10.1093/heapol/czae105","url":null,"abstract":"<p><p>South Africa has a high burden of drug-resistant tuberculosis (DR-TB). A policy to decentralize DR-TB treatment from specialized central hospitals to more accessible district facilities was introduced in 2011, but to date implementation has been suboptimal, with variable pace, coverage, and models of care emerging. This study explored multilevel policy implementation of DR-TB decentralization in two provinces of South Africa, Western Cape and KwaZulu-Natal. Applying interpretive policy analysis, this paper describes how actors across health system levels and geographies made sense of the DR-TB policy and how this shaped implementation. In an embedded qualitative case study, districts of the two provinces were compared, through data collected in 94 in-depth interviews, and analysed using Vickers' framework of reality, value, and action judgements. Five district cases characterize variation in the pace of implementation and models of DR-TB care that emerged. Individual and collective attitudes for and against the policy were underpinned by different systems of meaning for interpreting policy problems and making decisions. These meaning systems were reflected in actor stances on whether DR-TB care needed to be specialized or generalized, nurse- or doctor-led, and institutionalized or ambulatory. Actors' stances influenced their actions and implementation strategies adopted. Resistance to decentralized DR-TB care related to perceived threats of budget cuts to and loss of authority of central facilities, and was often justified in fears of increased transmission, poor quality of care, and inadequate resources at lower levels. New advances in diagnosis and treatment to address the growing burden of DR-TB in South Africa will have little impact unless implementation dynamics are better understood, and attention paid to the mindsets, interests, and interpretations of policy by actors tasked with implementation. Deliberative policy implementation processes will enhance the quality of discourse, communication and cross-learning between policy actors, and critical for reaching synthesis of meaning systems.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"183-193"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trauma-informed healthcare systems: an evaluation of trauma-informed care training for hospital-based healthcare professionals in the aftermath of the 2023 earthquakes in Türkiye.","authors":"Zeynep Şimşek, Büşra Uğur","doi":"10.1093/heapol/czae118","DOIUrl":"10.1093/heapol/czae118","url":null,"abstract":"<p><p>Disasters are complex global problems with an increasing impact with rising prevalence of associated illness, mortality, and intensifying health inequities. In recent years, there has been an emphasis on integrating trauma-informed care approaches into health policies and protocols. The purpose of the current study was to investigate the benefits of a trauma-informed healthcare training program for hospital-based healthcare providers with a focus on knowledge acquisition, empowerment of professional practice, and personal well-being. The program was implemented in the aftermath of the 2023 earthquakes in southeastern Türkiye. The training consisted of four modules, developed based on psychological trauma theories and behavior change theories, and was evaluated using a mixed-methods approach. Assessments were conducted at the end of the training program, at baseline, and at a 6-month follow-up. A structured questionnaire including items covering the content of the training, trainer effectiveness, and program suitability was administered at the end of the training program. At 6 months, participants completed an 18-item follow-up questionnaire which assessed their understanding of the principles of the trauma-informed care approach. The Maslach Burnout Inventory (MTI) was also administered, and themes regarding the impact of the training program were extracted through in-depth individual qualitative interviews. Data were obtained from 501 program participants. The intervention program was found to improve healthcare workers' understanding of trauma, professional practices, and interpersonal relationships, and significantly reduced symptoms of burnout. These results demonstrate the critical role of trauma-informed training programs in hospitals in disaster-affected regions, especially when assistance to survivors will be enhanced by strengthening healthcare workers' resilience and improving their perceptions of service efficacy and value. The study highlights the need for more widespread adoption of these training initiatives and emphasizes that they may play significant future roles in transforming trauma-informed healthcare systems in disaster-prone countries and regions.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"234-243"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11800979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Institutionalizing linkages between informal healthcare providers and the formal health system in Nigeria: what are the facilitating and constraining contextual influences?","authors":"Obinna Onwujekwe, Chinyere Ojiugo Mbachu, Irene Agyepong, Helen Elsey","doi":"10.1093/heapol/czaf009","DOIUrl":"https://doi.org/10.1093/heapol/czaf009","url":null,"abstract":"<p><p>With most households in rapidly urbanising LMIC cities using private and informal providers for basic healthcare, the need to establish linkages with the formal sector is paramount in the drive for universal health coverage. Successful and effective linkage of informal healthcare providers to the formal health system requires an understanding of prevailing contextual factors and how they can be modulated to support the linkages. Context plays a pivotal role in shaping the nature and success of any integration efforts. This paper, based on a qualitative study explored the facilitating and constraining contextual influences shaping the linkage of informal healthcare providers into the formal health system in governance, service delivery and data reporting. The research was conducted in Enugu and Anambra states in southeastern Nigeria. In-depth interviews were held with 12 senior healthcare managers, 16 primary healthcare facility managers, 32 informal providers and 16 community leaders. Eight sex-disaggregated focus group discussions were held with health service users. Transcripts were coded in NVivo using a pre-defined coding framework comprising facilitators and constraints at the individual, organisational, and environmental levels. Individual factors that influence linkage of informal providers into the formal health system include personal attitudes towards linkage, capacity of informal providers to deliver quality services, nature of existing relationships between formal and informal providers and trust in the formal health system. Organizational factors include leadership structure, coordination and accountability mechanisms, functional management capacity of the formal health system, and multiple regulatory frameworks. External factors include supportive health policies on integration, sustainable funding for continuous training and supportive supervision, and global agenda/support for integration. This study has provided valuable insights for decision makers and practitioners for harnessing the contextual factors to link informal healthcare providers successfully and effectively to the formal health system to improve access to quality health services in urban slums.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capacity and crisis: examining the state-level policy response to COVID-19 in Tamil Nadu, India.","authors":"Veena Sriram, Girija Vaidyanathan, G S Adithyan, Shambo Basu Thakur, Simran Kaur, Hari Narayanan Gl, Sabah Haque, V R Muraleedharan","doi":"10.1093/heapol/czae096","DOIUrl":"10.1093/heapol/czae096","url":null,"abstract":"<p><p>The capacity of government agencies to develop effective policy responses to external shocks is an important area of focus for health policy processes, as illustrated by the coronavirus (COVID-19) pandemic. However, few empirical studies exploring the subnational capacity of governments and the influence of institutional, organizational and political factors in shaping the policy response to complex emergencies have been conducted. The purpose of this study is to examine the governance capacity to develop and implement a policy response to a major health emergency-COVID-19-in Tamil Nadu, India, and to understand the factors shaping governance capacity during the first and second waves (2020-21). Tamil Nadu offers a useful case for exploring governance capacity due to its long-standing public health institutions and previous experiences with disaster and outbreak response. We utilized three sources of data: (1) a review of key policy documents (n = 164); (2) a review of English-language media articles in the Indian press (n = 336); and (3) in-depth interviews with senior decision makers, technical experts and other stakeholders (n = 10). We present four key findings from this analysis. Firstly, Tamil Nadu's institutional framework enabled state-level governance capacity during an emergency of massive complexity, allowing for flexibility and nimbleness to adapt to evolving dynamics of centralization and decentralization over the course of the pandemic. Secondly, the ability to integrate public health expertise was circumscribed at important phases. Thirdly, while coordination with external experts was utilized extensively, engagement with civil society groups was perceived as limited. Fourthly, the electoral cycle was perceived by some to have constrained governance capacity at a critical point in the pandemic. By analysing the dynamics of state-level capacity in Tamil Nadu during a complex emergency, this study provides important learnings for other contexts globally regarding the drivers shaping capacity to develop and implement policy responses to crises.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"153-164"},"PeriodicalIF":2.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}