Health policy and planning最新文献

{"title":"Understanding informal payments in the health sector in Malawi: results of a multi-district household survey.","authors":"Eric Umar, Maryam Chilumpha, Gertrude Chatha, Martin McKee, Blake Angell, Lucie Sabin, Dina Balabanova","doi":"10.1093/heapol/czag060","DOIUrl":"https://doi.org/10.1093/heapol/czag060","url":null,"abstract":"<p><p>In Malawi, health services are officially free at the point of use, but patients often make informal payments to access services or obtain medicines. These payments undermine equity and trust in the health system. This study examined for the first time the prevalence, types, and determinants of informal payments among Malawians who had recently used health services. We conducted a multi-district cross-sectional household survey in four districts chosen to reflect urban and rural Malawi. Households containing someone who had been hospitalised in the previous six months were interviewed using a structured questionnaire. Descriptive analyses identified the types and prevalence of informal payment, while multivariable logistic regressions identified factors associated with informal payments. Overall, 17% of respondents reported paying for services that are officially free. Informal payments are most often for medicines (52%), consumables (24%) and consultations (24%). Female respondents and those living in urban areas were significantly more likely to report giving informal payments, while those with higher levels of education were less likely. Participants with a good or very good financial situation were more likely to make such payments. Significant geographical variations were observed, with higher probabilities in Mchinji and Mzimba than in the Blantyre district. Nearly one in five Malawians reported making informal payments to access health services, questioning the formal policy that these are free. These findings highlight the need for governance reforms, greater accountability and community awareness to reduce informal payments and promote equitable access to care.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837166","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":"Tailoring Implementation Strategies for the Acute Coronary Syndrome Quality Improvement Programme at Primary Care Level in East, West and Central China.","authors":"Can Liu, Yixuan Wu, Zongbin Wang, Siwei Xie, Zhi-Jie Zheng, Shuduo Zhou","doi":"10.1093/heapol/czag064","DOIUrl":"https://doi.org/10.1093/heapol/czag064","url":null,"abstract":"<p><p>Acute coronary syndrome (ACS) remains a leading contributor to cardiovascular disease burden in China, and ST-segment elevation myocardial infarction (STEMI) is the most severe ACS. To improve early identification and timely treatment of STEMI patients, the Chest Pain Unit (CPU) program was established to strengthen referral pathways to qualified facilities. This study explores key barriers and facilitators to the CPU implementation and proposes context-specific strategies to optimize its delivery and scale-up. We conducted a qualitative study using semi-structured interviews in three purposively selected, representative counties across eastern, central, and western China. A total of 61 key informants from 36 township hospitals, participated in the study. All interviews were audio-recorded, transcribed verbatim, and thematically coded guided by the Consolidated Framework for Implementation Research (CFIR) 2.0 using Atlas.ti 9. Implementation strategies were mapped and refined using Expert Recommendations for Implementing Change. We identified 46 barriers and 50 facilitators, spanning all 5 domains of CFIR. Technical deficiencies, residents' lack of health-seeking awareness, financial difficulties, inefficient awareness campaign, and limited professional knowledge are respectively the most significant barriers for five domains. We developed a three-pronged strategy framework including innovation optimization, external empowerment and internal improvement to inform future practice. Accordingly, the most urgent strategies encompass enhancing technical capacity, expanding financing mechanisms, empowering communities, implementing mass media campaigns, strengthening patient adherence through structured follow-up, and providing continuous practical training. We recommend the proposed strategies should be taken into full consideration to facilitate timely detection and intervention of ACS in primary healthcare context.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856211","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":"The Indian Medical Association's Role in Federal and State Policy Processes in India: A Scoping Review.","authors":"Alessia Montecalvo, Veena Sriram, Kiran Khumbhar, Vikash Keshri","doi":"10.1093/heapol/czag062","DOIUrl":"https://doi.org/10.1093/heapol/czag062","url":null,"abstract":"<p><p>Physician associations play a significant role in shaping health policy at national and sub-national levels. However, the influence of such associations in low- and middle-income countries has not been synthesized or assessed. The Indian Medical Association (IMA), one of the largest physician associations in the world, has a long history of policy engagement at national and state levels across multiple issues. This review aims to assess - for the first time - the empirical literature available on the IMA as a political actor. Adopting a scoping review methodology, the paper sought to identify the policy stances, strategies and influence of the IMA over India's health policy. Nine health, social science, and policy research databases were searched for English-language studies published between 1974 and 2024. Reviewing 37 papers, it finds that the IMA has been active in seven main policy domains: violence against doctors; regulation of the private healthcare sector; restriction of traditional medicine; professional authority or autonomy for physicians; publicly funded health insurance; medical ethics; and partnership in public health programs. It has been reactive against new legislation, reform or regulation in all domains except for violence against doctors. Through interrelated interior and exterior strategies, the organization has been successful in influencing, stalling or limiting legislation. While the IMA holds influence through the size of its membership and its embeddedness in health administration and corporate interests, the tactics of the organization often lack coherence and consistency. Situating these findings in the broader landscape of health governance, our review contributes further evidence for the need to develop more inclusive and transparent pathways for participation in decision-making.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856306","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":"Financial Protection in Flux: Longitudinal Evidence on Out-of-Pocket Spending Among Middle-Aged and Older Mexicans During the Seguro Popular-INSABI Transition.","authors":"Jose Eduardo Cabrero-Castro, Marissa Gonzalez, Emma Aguila, Héctor Arreola-Ornelas, Michael Touchton, Felicia Marie Knaul, Alfonso Rojas-Alvarez","doi":"10.1093/heapol/czag059","DOIUrl":"https://doi.org/10.1093/heapol/czag059","url":null,"abstract":"<p><p>Mexico is aging rapidly, placing growing strain on health financing and long-term care systems. Older adults face a double burden: higher healthcare needs due to chronic conditions and multimorbidity, and limited or informal income in later life, leaving them highly exposed to out-of-pocket (OOP) spending. In 2020, the government replaced Seguro Popular (SP) with the Instituto de Salud para el Bienestar (INSABI) to strengthen financial protection, but its implications on older adults remain unclear. We analyzed OOP among 13 616 individuals aged ≥50 years in the Mexican Health and Aging Study, interviewed in 2018 and 2021. Expenditures for hospitalizations, outpatient procedures, medical visits and medications in the previous 12 months were indexed to inflation and converted to 2021 US dollars. Tobit models estimated total and component OOP, including an interaction between insurance category (Uninsured; Social Security - IMSS/ISSSTE/PEMEX/Defense; SP 2018/INSABI 2021; Other) and survey year, adjusting for sociodemographic and health covariates. Between 2018 and 2021 the proportion of older adults reporting no health insurance tripled from 9.5% to 27.2%, while SP affiliation fell from 30.1% to 10.9%. Social Security beneficiaries spent substantially less than the uninsured on total OOP (about US$1 033 less in 2018 and US$539 less in 2021). SP in 2018 and INSABI in 2021 were also associated with lower OOP (-US$291 and -US$298 versus the uninsured, respectively). Only Social Security was associated with a statistically significant reduction in medication-related OOP. Overall, the transition from SP to INSABI coincided with a marked rise in reported uninsurance and persistently high OOP, particularly for medicines, the principal driver of financial burden among older adults. These findings highlight the fragility of recent health financing reforms and the need to ensure sustained, employment-independent financial protection for Mexico's aging population.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837209","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":"Survive and Thrive in Brazil: Estimating the Impact of the Boa Vista Early Childhood Program.","authors":"Alexandra Brentani, Georg Loss, Luana Bessa, Susan Chang-Lopez, Susan Walker, Ana Paula Ferrer, Sandra Grisi, Florencia Lopez Boo, Günther Fink","doi":"10.1093/heapol/czag057","DOIUrl":"https://doi.org/10.1093/heapol/czag057","url":null,"abstract":"<p><p>This study aimed to evaluate the impact of the Survive and Thrive program on neonatal mortality and child development in Boa Vista, Brazil. Between November 2017 and May 2021, the program to support pregnant women as well as mothers of children under age 3 were rolled out in three phases. Neighborhoods were either selected for home visits, or for group meetings held at Social Assistance Reference Centers (CRAS). To allow for an evaluation of the program, the timing of the rollout was randomized at the neighborhood level. To assess the impact of the program on neonatal mortality, we used complete vital registration data from the period 2010 to 2010, and estimated differences in child mortality before and after the program were launched. Impact on child development was assessed through a detailed assessment of 744 children born in 2019 using the CREDI and PRIDI instruments. Home visits resulted in a significant improvement in child development [d=0.28, 95% CI [-0.013, 0.57], p-value 0.06) and reduction of neonatal mortality (RR 0.58, 95% CI [0.36, 0.93], p-value 0.02). No impacts were found for the group meetings. The findings indicate that a home visiting program beginning in pregnancy can significantly reduce neonatal mortality and improve child development in poor urban neighborhoods of Brazil.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769876","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":"Identifying the 'real cause of death': the complexities of maternal death reviews in Tanzania.","authors":"Kerstin Almdal, Ali Saidi, Karen Marie Moland, Andrea Melberg","doi":"10.1093/heapol/czag053","DOIUrl":"https://doi.org/10.1093/heapol/czag053","url":null,"abstract":"<p><p>Identifying the causes of maternal deaths and contributing factors is essential for improving care. In 2015, Tanzania began implementing the maternal and perinatal death surveillance and response (MPDSR) system, including facility-based maternal death reviews. While most MPDSR studies highlight implementation and technical barriers, less is known about how systemic and institutional dynamics influence these reviews. This study examined stakeholders' experiences and perceptions of MPDSR in Tanzania, focusing on how clinical causes of death and contributing factors were identified. The study is based on five months of ethnographic fieldwork conducted in a Tanzanian region in 2023- 2024. It included 33 days of participatory observation of obstetric care, attending nine facility-based maternal death review meetings and conducting 20 in-depth interviews with health workers and administrative staff. Viewing MPDSR as a travelling model and drawing upon the concept of situated knowledge, we examined how institutional and professional factors influenced these reviews. Reviews were routinized and integrated into the regional health system, offering opportunities for teaching and defining standards of practice. However, participants disagreed on whether the reviews promoted quality improvement or focused on individual fault-finding, on how responsibility should be attributed, and whether reviews could accurately establish the causes of deaths. The facility-based death reviews were influenced by institutional and epistemic hierarchies, with responsibility often placed on individuals at the lowest health system level. While MPDSR aims to promote blame-free learning and quality improvement, the process narrowed attention to individual error, obscured systemic constraints, and hindered understanding of the 'real cause' of maternal deaths. To capture contextual complexity without adding reporting burden, we recommend expanding the free-text narrative fields in the official MPDSR maternal death report forms and increasing frontline representation in district- and regional reviews to strengthen links between facility and higher-level reviews.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728865","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":"Sustaining health systems in sub-Saharan Africa: public-private partnerships in a new era of reduced donor funding.","authors":"Rowan Haffner, Faraan O Rahim, Lara Kendall, Sarah Ali, Rohith Karthik, Ketan Tamirisa, Mahmood Abdelkader, Abebe Bekele","doi":"10.1093/heapol/czag008","DOIUrl":"10.1093/heapol/czag008","url":null,"abstract":"<p><p>Recent reductions in US global health funding have disrupted essential programs in sub-Saharan Africa, highlighting the region's vulnerability to external financing shocks. The suspension of the United States Agency for International Development initiatives has affected disease control, maternal care, and health system operations across 47 countries, raising urgent questions about how to sustain progress without reliable donor support. This commentary examines the potential of public-private partnerships (PPPs)-structured collaborations in which governments and private actors share financing, risk, and managerial responsibility-to strengthen domestic capacity. Drawing on examples from Senegal, Nigeria, and Kenya, we explore how service-, concession-, financing-, and technology-focused PPPs can mobilize additional resources, expand access, and improve service delivery. We also address key challenges, including governance risks, fiscal constraints, and shifting global power dynamics. While not a substitute for aid, well-designed PPPs aligned with national priorities can support more resilient, equitable, and self-reliant health systems in sub-Saharan Africa.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"542-545"},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118748","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":"Understanding the role of 'software' in health system capacity for non-communicable disease response: hypertension care in rural Coastal Kenya.","authors":"Robinson Oyando, Nancy Kagwanja, Brahima A Diallo, Syreen Hassan, Jainaba Badjie, Ruth Lucinde, Noni Mumba, Samson Muchina Kinyanjui, Pablo Perel, Anthony Etyang, Edwine Barasa, Ellen Nolte, Benjamin Tsofa","doi":"10.1093/heapol/czag017","DOIUrl":"10.1093/heapol/czag017","url":null,"abstract":"<p><p>Research on health system capacity to manage non-communicable diseases (NCDs) has largely focused on 'system hardware' such as infrastructure, workforce, and commodities. However, this overlooks the critical role of 'system software' elements, such as relationships, norms, and power, and the complex adaptive nature of health systems. This study aimed to explore how health system hardware and software elements interact to shape the capacity of the health system to deliver hypertension care in Kilifi County in the coastal region of Kenya. We conducted a cross-sectional qualitative study and collected data using document reviews (n = 13) and in-depth interviews with purposively selected front-line health workers (FLHWs) at five health facilities and health managers at county and national levels (n = 37). We applied a framework approach to data analysis, utilizing complex adaptive systems (CAS) theory as our analytic framework. Complex interactions of system hardware and software elements constrained the provision of hypertension care. Frequent medicines stockouts (hardware) stemmed from budgetary gaps, procurement delays, regulatory restrictions, and weak quantification practices (software). To mitigate medicines shortages, facilities employed adaptive responses such as inter-facility borrowing and sourcing from alternative suppliers (software). Access and continuity of care were enabled by organizational norms like dedicated hypertension clinic days (software) but undermined by inadequate consultation rooms, staff shortages (hardware) and limited training and support supervision (software). FLHWs' ideas to improve medication adherence were undermined by staff shortages (hardware) and inadequate support from facility managers (software), weakening service delivery. The application of CAS theory unpacked the hitherto underexplored aspects of health system capacity. System 'software' plays a central role in shaping health system capacity for hypertension care. Therefore, strengthening health system capacity for NCDs requires coordinated investment in both system hardware and software elements. Importantly, system strengthening interventions should consider the CAS nature of health systems to foster conditions for productive emergence.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"584-598"},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157089","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 economic cost of outpatient primary care of adults with multimorbidity (HIV, diabetes, and hypertension) in rural South Africa.","authors":"Celeste Claire Holden, Winfrida Mdewa, Theophilous Mathema, Chodziwadziwa Whiteson Kabudula, Kayode Adetunji, Roy Zent, Susan Goldstein, Kerry Glover, Scott Hazelhurst, Michael Klipin, Stephen Tollman, Francesc Xavier Gómez-Olivé, Evelyn Thsehla","doi":"10.1093/heapol/czag016","DOIUrl":"10.1093/heapol/czag016","url":null,"abstract":"<p><p>Sub-Saharan Africa (SSA) is experiencing an epidemiological transition where non-communicable diseases are becoming the leading cause of disability and mortality alongside infectious diseases such as HIV/AIDS. Multimorbidity, the coexistence of two or more long-term conditions, is increasing in SSA. However, the cost of managing multimorbidity is largely unknown. This study aimed to estimate the economic cost of public outpatient primary care for adults with multimorbidity (HIV, hypertension, and/or diabetes, and their associated conditions: cardiovascular disease, and TB) in rural South Africa. This study used a cross-sectional, retrospective cost-of-illness approach to estimate the direct and indirect costs of multimorbidity management in Bushbuckridge, Mpumalanga, in 2022. Data were synthesized from patient-level data from eight public primary healthcare facilities within the Agincourt study site-a rapidly transitioning rural South African setting. Additionally, government reports and an existing study on transport costs and productivity losses conducted within the Agincourt study site were used to estimate the costs of managing patients in the primary care facilities. Results showed that patients with multimorbidity had higher average economic costs per patient compared to those with single conditions. Overall, patients with multimorbidity increase costs above the baseline of a patient with a single condition (R4 900/annum) by between 42% and 83%. Patients with multimorbidity also incur slightly higher costs associated with accessing primary care services compared to those with a single condition. However, our model shows that the additive cost of managing multiple conditions in separate consultations is higher than managing all conditions in one visit. This shows that managing patients within an integrated care model seems to have a cost-limiting effect. However, treatment guidelines for managing multimorbidity in South Africa should be developed to ensure standardized care.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"570-583"},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157123","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":"Multi-actor collaborations in primary health care implementation: a Social Network Analysis of the primary health care strategy in Ghana.","authors":"Dominic Dormenyo Gadeka, Patricia Akweongo, Genevieve Cecilia Aryeetey, Eleanor Beth Whyle, Justice Moses K Aheto, Lucy Gilson","doi":"10.1093/heapol/czag027","DOIUrl":"10.1093/heapol/czag027","url":null,"abstract":"<p><p>Bottom-up theory demonstrates that networks of actors play important roles in policy implementation, yet limited attention has so far been paid to the influence that actor networks might have on the implementation of primary health care (PHC) strategies and outcomes. This study examined the roles actor networks play in the implementation of Community-based Health Planning and Services (CHPS) in Ghana, focusing on the nature and patterns of relations and structure and strength of prevailing collaborations. This was a cross-sectional study using a social network analysis methodology in eight districts across two regions in Ghana. The study population was implementers of CHPS from the community, district, regional, national, and development partners. Data were obtained using a modified pretested closed-ended social network questionnaire. To establish collaborative relationships, knowledge of other actors and the degree of communication on issues related to CHPS implementation were surveyed. Data were analysed using Gephi software version 0.9.2. The analysis demonstrated existing actor networks of Community Health Committees (CHCs), Community Health Officers (CHOs), Community Health Volunteers (CHVs), Sub-district, and district-level networks, including local government actors and political leaders, as well as regional, national, and development partner actors in CHPS implementation. The nature of relations showed isolated networks of CHCs, CHVs, and sub-districts across both regions. Patterns of interactions revealed that CHO networks collaborate with each other, while CHCs primarily collaborate with CHOs. Overall, weak collaborative relationships were noted among the actor networks (network density <10%). The results suggest segmented, decentralized networks with limited involvement of critical actors, including community-level, local government, political leaders, national-level, and development partners in CHPS implementation. The network analysis highlights weak collaborative relationships among actor networks in CHPS implementation, a practice which negatively impacts its implementation experience. The study highlights pathway to strengthen cohesion and improve collaborative relationships in addressing CHPS as a PHC strategy.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"672-683"},"PeriodicalIF":3.1,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147289777","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}