Health policy and planning最新文献

{"title":"Correction to: Hospital response to a new case-based payment system in China: the patient selection effect.","authors":"","doi":"10.1093/heapol/czae123","DOIUrl":"https://doi.org/10.1093/heapol/czae123","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894080","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 availability of essential medicines in public health facilities in Afghanistan: navigating socio-political and geographical challenges.","authors":"Margo van Gurp, Sandra Alba, Maida Ammiwala, Sayed Rahim Arab, Sayed Murtaza Sadaat, Fazelrabie Hanifi, Sohrab Safi, Nasratullah Ansari, Maiza Campos-Ponce, Maarten Olivier Kok","doi":"10.1093/heapol/czae121","DOIUrl":"https://doi.org/10.1093/heapol/czae121","url":null,"abstract":"<p><p>During the past two decades, the Afghan government, along with international community, has developed a system aimed at improving access to essential health services under Afghanistan's challenging socio-political and geographical circumstances. In 31 provinces, non-state actors competed for fixed-term contracts to implement a predefined package of health services. In three provinces, the government organised the provision of health services. An independent third party monitored service provision, including access to medicines. This study examines the availability of essential medicines in Afghanistan's public health facilities and how this is shaped by socio-political challenges, geographical barriers, and the organisation of the health system. Between March and July 2021, enumerators collected data at 885 health facilities across Afghanistan. For our analysis, we combined data about medicine availability and the functioning of the health system with publicly available information about geographical and socio-political factors, including security incidents. Using regression analysis, we identified facility, district, and province-level factors related to medicines availability in public health facilities. On average, 70% of 31 selected essential medicines were available in 2021. The availability of medicines varies significantly between provinces and was considerably higher in those where services were contracted out to non-state actors (n=34; 91%) compared to provinces where service provision was organised by the government (n=3; 9%). The most important drivers of variation in medicine availability included geographical barriers, securing and allocating funds on the provincial level, and organising and sustaining physical capacity on the facility level. Insecurity was not a key factor driving variation in medicine availability. Despite the socio-political challenges in 2021, the availability of essential medicines in public health facilities was relatively high. The results suggest that decentralized procurement of medicines by non-state actors and timely payment of funds contribute to medicines availability. Strategies to improve medicines availability should target hard-to-reach areas and lower-level facilities.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854000","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":"Maternal and perinatal mortality: Geospatial analysis of inequality in pregnancy and perinatal mortality in Ethiopia.","authors":"Sisay Mulugeta Alemu, Gerd Weitkamp, Abera Kenay Tura, Kerry Lm Wong, Jelle Stekelenburg, Regien Biesma","doi":"10.1093/heapol/czae122","DOIUrl":"https://doi.org/10.1093/heapol/czae122","url":null,"abstract":"<p><p>While there is ample evidence of the overall reduction in perinatal and pregnancy-related mortality in Ethiopia, it remains uncertain if geographic disparities have diminished. This study aimed to investigate perinatal and pregnancy-related mortality spatial distributions, trends over time, and factors associated with the distribution in Ethiopia. We used data from Ethiopian Demographic and Health Surveys conducted in Ethiopia in 2000, 2005, 2011, and 2016. In each survey, around 15,500 women aged 15-49 were interviewed from about 550 neighborhoods randomly sampled from across the country. Perinatal and pregnancy-related mortality were used as outcome variables. We carried out Optimized Hotspot Analysis using the Getis-Ord Gi* statistic in ArcGIS Pro to identify the time trend of geographical clusters with high (hot spot) and low (cold spot) perinatal and pregnancy-related mortality. In addition, we conducted a Geographically Weighted Poisson Regression in R to examine the factors associated with the spatial distribution of perinatal and pregnancy-related mortality. Perinatal and pregnancy-related mortality exhibited a clustering pattern indicating the presence of geographic inequality, with a decreasing pattern from 2000 to 2016. We detected hotspot areas in developed administrative regions of Amhara, Oromia, and Southern Nations, indicating inequality within large regions. Inequality in perinatal mortality was associated with rural residence, younger age of women, and high birth rate, whereas pregnancy-related mortality was associated with low autonomy, younger age, and anemia. We found that anemia (p-value = 0.01) has a geographically varying relationship with perinatal mortality, while education (p-value = 0.03) and wealth (p-value = 0.01) with pregnancy-related mortality. While there has been a reduction during the study period, geographical disparities in perinatal and pregnancy-related mortality still persist. Therefore, targeting intervention programs in areas where spatial inequalities still persist is essential for effectively utilizing scarce resources.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142835282","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":"Maternal Health Planning and Prioritization in Chad: Developing a supportive tool.","authors":"Ana Krause, Alexandre Quach, Yamingué Betinbaye, Mindekem Rolande, Florence Mgawadere, Charles A Ameh","doi":"10.1093/heapol/czae120","DOIUrl":"https://doi.org/10.1093/heapol/czae120","url":null,"abstract":"<p><p>The Republic of Chad has one of the highest rates of maternal mortality in the world. With scarce resources to respond to competing demands, pragmatic evidence-based planning tools are needed to aid planning and support priority setting. This action research aimed to develop a tool to support maternal health (MH) planning and prioritization decisions and identify priority regions/provinces for intervention in Chad based on aggregate MH coverage gap scores (Target-Coverage=Coverage Gap). A rapid review was conducted to identify key indicators and relevant national targets. The 2019 Multiple Indicator Cluster Survey and other national surveys were the data sources for selected indicators at the provincial level. Aggregate MH coverage gaps were calculated and displayed using Geographic Information System software to visualize variations by province. Eleven key informant interviews (KIIs) and six focus group discussions (FGDs) were conducted with clinicians and administrators to understand existing MH planning, prioritization, and maternal mortality risks in Chad. Wide provincial variation in aggregate MH coverage gaps was identified (mean score 374.3, SD: 77.4). Indicators contributing the most to coverage gaps include emergency obstetric care, adolescent births, tetanus vaccination, and delivery by skilled health personnel. Two weighting scenarios for the coverage gap scores are also considered. KIIs and FGDs revealed that existing MH planning in Chad differs provincially and by health system level, with no clear prioritization processes identified. Main themes regarding MH risks reported by stakeholders included challenges relating to the health system, policy landscape, country and population-specific factors, along with specific MH threats. Current centralized planning approaches may benefit from greater consideration of provincial differences to support more efficient and equitable resource distribution. This multi-indicator assessment offers an adaptable approach for evidence-based MH resource allocation to prioritize sub-national areas with worst health indicators in resource-limited settings, although further research is needed to test its impact.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824092","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":"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":"https://doi.org/10.1093/heapol/czae117","url":null,"abstract":"<p><p>Menstrual hygiene management among girls in rural India poses a substantial challenge for public health, education, and quality of life, exacerbated by limited access 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\" 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 & NFHS-5, and employing 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 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 points [95 % CI (0.087,0.188)] jump. Notably, younger girls aged 15-19 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":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation science research priorities for Universal Health Coverage:Methodological lessons from the design and implementation of a multi-country modified Delphi study.","authors":"Breanna K Wodnik, Prossy Kiddu Namyalo, Ophelia Michaelides, Beverley M Essue, Sumit Kane, Erica Di Ruggiero","doi":"10.1093/heapol/czae119","DOIUrl":"https://doi.org/10.1093/heapol/czae119","url":null,"abstract":"<p><p>Delphi studies are rapidly gaining prominence in global health research. However, researchers' modifications to the Delphi method are often not well-described or justified, limiting opportunities to systematically learn from these studies when the methods are applied to other topics and settings. This paper aims to describe an approach to implementing a modified Delphi study and reflect on the research process in the context of a multi-country study of implementation science research priorities to advance Universal Health Coverage (UHC). We review trends in the use of the modified Delphi method in global health research, outline our three-phased modified Delphi approach, and share reflections on five decision points for implementing the study: 1) identifying and recruiting participants for the expert panel, 2) addressing participant attrition between rounds, 3) justifying the most appropriate cutoff points, 4) incorporating new items raised by participants in open-ended survey sections, and 5) ensuring maximum variation in perspective in the panel of experts. Insights from this work foster greater understanding of the underlying assumptions for, and interpretation of, 'modified' in modified Delphi studies. This study will encourage critical dialogue about points of methodological contention in Delphi methodology and thus, are relevant for scaling the use of modified Delphi studies in public health, including global health research.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806744","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":"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":"https://doi.org/10.1093/heapol/czae118","url":null,"abstract":"<p><p>Disasters are complex global problems with 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, behavior change theories, and was evaluated using a mixed methods approach. Assessments were conducted at the end of training program, at baseline, and at six-months follow-up. A structured questionnaire including items covering the content of the training, trainer effectiveness, and program suitability, was administered at the end of training program. At six 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 was also administered, and themes regarding the impact of the training program extracted through in-depth individual qualitative interviews. Data were obtained from 501program participant. 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":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The discrepancy between objective and subjective assessments of catastrophic health expenditure: evidence from China.","authors":"Guo Bingqing, Liu Chaojie, Yao Qiang","doi":"10.1093/heapol/czae115","DOIUrl":"https://doi.org/10.1093/heapol/czae115","url":null,"abstract":"<p><p>The pro-rich nature of catastrophic health expenditure (CHE) indicators has garnered criticism, inspiring the exploration of the subjective approach as a complementary method. However, no studies have examined the discrepancy between subjective and objective approaches. Employing data from the Chinese Social Survey (CSS) 2013-2021 waves, we analysed the discrepancy between objective and subjective CHE and its associated socioeconomic factors using logit regression modelling. Overall, self-rating generated higher CHE incidence (28.35% to 33.72%) compared to objective indicators (9.92% to 21.97%). Objective indicators did not support 17.57% to 23.90% of self-rated cases of household CHE, while 2.73% to 8.42% of households classified with CHE by objective indicators did not self-rate with CHE. The normative subsistence spending indicator showed the least consistency with self-rating (70.66% to 74.28%), while the budget share method produced the most consistent estimation (72.73% to 76.10%). Living with elderly and young children (AOR: 1.069 to 1.169, p<0.1), lower educational attainment (AOR: 1.106 to 1.225, P<0.1), lower income (AOR: 1.394 to 2.062, P<0.01), and lower perceived social class (AOR: 1.537 to 2.801, P<0.05) were associated with higher odds of self-rated CHE without support from objective indicators. Conversely, low socioeconomic status (AOR: 0.324 to 0.819, P<0.1) was associated with lower odds of missing CHE cases classified by objective indicators in self-rating. The commonly used objective indicators for assessing CHE may attract doubts about their fairness from socioeconomically disadvantaged people. The CHE subjective approach can be adopted as a complementary measure to monitor financial risk protection.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824170","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":"Conceptualising 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":"https://doi.org/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 health care 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 health care 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, support the role of private providers in offering 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 system responsive to maternal mental health conditions.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning Analysis of Health System Resilience.","authors":"Kyaw Myat Thu, Sarah Bernays, Seye Abimbola","doi":"10.1093/heapol/czae113","DOIUrl":"https://doi.org/10.1093/heapol/czae113","url":null,"abstract":"<p><p>The emergence of 'resilience' as a concept for analysing health systems - especially in low- and middle-income countries - has been trailed by debates on whether 'resilience' is a process or an outcome. This debate poses a methodological challenge. What 'health system resilience' is interpreted to mean shapes the approach taken to its analysis. To address this methodological challenge, we propose 'learning' as a concept versatile enough to navigate the 'process versus outcome' tension. Learning - defined as \"the development of insights, knowledge, and associations between past actions, the effectiveness of those actions, and future actions\" - we argue, can animate features that tend to be silenced in analyses of resilience. As with learning, the processes involved in resilience are cyclical: from absorption to adaptation, to transformation, and then to anticipation of future disruption. Learning illuminates how resilience occurs - or fails to occur - interactively and iteratively within complex systems while acknowledging the contextual, cognitive, and behavioural capabilities of individuals, teams and organizations that contribute to a system's emergence from or evolution given shocks/stress. Learning analysis can help to resist the pull towards framing resilience as an outcome - as resilience is commonly used to mean or suggest a state or an attribute, rather than a process that unfolds, whether the outcomes are deemed positive or not. Analysing resilience as a learning process can help health systems researchers better systematically make sense of health system responses to present and future stress/shocks. In qualitative or quantitative analyses, seeing what is to be analysed as 'learning' rather than the more nebulous 'resilience' can refocus attention in relation to what is to be measured, explained, and how - premised on the understanding that a health system with the ability to learn is one with the ability to be resilient, regardless of the outcome of such a process.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686822","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}