Health policy and planning最新文献

{"title":"Are global health commitments relevant in low-income countries? Considering discussions at Davos 2026.","authors":"Martina Mchenga","doi":"10.1093/heapol/czag108","DOIUrl":"10.1093/heapol/czag108","url":null,"abstract":"<p><p>At the 2026 World Economic Forum Annual Meeting in Davos, health was positioned as central to economic resilience, productivity, and geopolitical stability. Four themes dominated the global health agenda: artificial intelligence-enabled health systems, investible health system resilience, women's health as an economic investment opportunity, and mental health as a macroeconomic priority. While these agendas reflect important global concerns, they are being advanced during a period characterized by shrinking development assistance, fiscal stress, debt pressures, and uneven institutional capacity across many low-income countries (LICs). This commentary argues that the central question is not only whether these agendas can be implemented in LICs but also whether they represent relevant and efficient priorities within resource-constrained health systems. Drawing on literature from health policy and systems research, health financing, implementation science, and political economy, the paper examines how current global health agendas frequently assume levels of data readiness, financing stability, administrative capability, workforce availability, and governance capacity that are not consistently present in constrained settings. On this basis, neither technological innovation nor investment mobilization can be treated as inherently valuable or as a substitute for contextualized priority setting. Proposed investments should be assessed against domestic disease burdens, societal preferences, system-wide effects, and feasible alternative uses of scarce resources. Durable progress in LICs will depend on strengthening countries' capacity not only to implement reforms but also to determine which reforms warrant priority, allocate resources efficiently, and sustain foundational health system functions, including public financing, workforce development, information systems, regulatory capability, and accountable governance. The commentary concludes by calling for a context-sensitive and system-wide approach to global health agenda-setting.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1591-1595"},"PeriodicalIF":3.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864781","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 Brazilian breast cancer patient navigation program: impact on waiting times and treatment costs.","authors":"Alana Ramos da Silva, Fernando Antonio Slaibe Postali","doi":"10.1093/heapol/czag105","DOIUrl":"10.1093/heapol/czag105","url":null,"abstract":"<p><p>Delays in cancer diagnosis and treatment pose significant challenges to the efficiency and equity of universal health systems. Patient navigation programs have been introduced to improve care coordination and facilitate timely access to treatment; however, evidence on their cost implications remains limited, particularly in middle-income countries. This study evaluates the impact of Brazil's National Breast Cancer Patient Navigation Program on waiting times and treatment costs within the Unified Health System (Sistema Único de Saúde). Exploiting the nationwide implementation of the program in January 2023, we use administrative microdata covering January 2021 to June 2024. Gynecological cancers are used as a comparison group because they affect the same population and rely on similar hospital resources. Causal effects are estimated using the synthetic difference-in-differences approach. The results indicate that patient navigation reduced waiting time between diagnosis and radiotherapy initiation by ∼10 days relative to the comparison group, while effects on surgery and chemotherapy were limited. At the same time, radiotherapy costs increased by about 16.5%, suggesting a short-term expansion in service utilization reflecting previously unmet demand. The effects are heterogeneous across regions, with larger improvements observed in more developed areas. Overall, the findings indicate that patient navigation can improve access to breast cancer treatment but that its effectiveness depends on the availability of healthcare resources.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1568-1579"},"PeriodicalIF":3.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792330","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":"Correction to: Older adults' experiences of health seeking in rural areas in low- and middle-income countries: a systematic review of qualitative studies.","authors":"","doi":"10.1093/heapol/czag102","DOIUrl":"10.1093/heapol/czag102","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1603"},"PeriodicalIF":3.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864841","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 Implementation Research and Evaluation section: scope and future.","authors":"Jiangyun Chen, James R Hargreaves, Euphemia L Sibanda","doi":"10.1093/heapol/czag103","DOIUrl":"https://doi.org/10.1093/heapol/czag103","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"41 9","pages":"1495-1499"},"PeriodicalIF":3.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220087","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":"A process evaluation of community-led distribution of HIV self-testing kits in rural communities in Zimbabwe.","authors":"Itai Kabonga, Lindiwe Mancitshana, Sharon Munhenzva, Nancy Ruhode, Mary K Tumushime, Constancia Watadzaushe, Miriam N Mutseta, Cheryl Johnson, Getrude Ncube, Karin Hatzold, Liz Corbett, Miriam Taegtmeyer, Frances M Cowan, Euphemia Sibanda","doi":"10.1093/heapol/czag101","DOIUrl":"10.1093/heapol/czag101","url":null,"abstract":"<p><p>Community-led distribution of HIV self-test (HIVST) kits has potential to combine the benefits of community-based HIV testing with the strengths of community-led interventions. We report the process evaluation from the community-led arm of a cluster-randomized trial in rural Zimbabwe comparing community-led versus community-based HIVST distribution where distributors were paid. Twenty communities were supported to design HIVST distribution models that suited their context. We conducted community meetings where we introduced community-led HIVST, including messages on the benefits of viral load suppression (Undetectable = Untransmissible; 'U = U'). Communities determined how, and by whom, distribution would be done. Communities implemented their distribution model over 4-6 weeks. We conducted in-depth interviews with community members (n = 20), distributors (n = 20), and health workers (n = 20) as well as 12 focus group discussions (n = 91) with community members. We triangulated findings with participant observations during community meetings and implementation and descriptively analysed programme data on HIVST distribution. Qualitative data were analysed thematically. Participant observations found communities collaboratively developed and embraced HIVST distribution, demonstrating strong enthusiasm for participation. Messaging on U = U was met with interest and surprise, as many community members were unaware of this information, and became a key motivator for HIVST implementation and uptake. Across communities, 348 distributors distributed 27 812 kits door-to-door and/or from their homes or other community venues. Communities where model development was led by local leaders-rather than collective processes-expressed lower level of satisfaction and had slow implementation. Health workers supported HIVST distribution well, with opportunities for improvement noted. While distributors felt proud to deliver HIVST, many experienced logistical burdens and need for material support from the programme and community. Communities designed HIVST delivery models that were acceptable and feasible; however, efforts to make community-led models sustainable are critical. Delivering messages on U = U should continue to be prioritized and embedded within community-based HIVST distribution models.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1543-1555"},"PeriodicalIF":3.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701147","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":"Evaluating the impact of conditional micro-incentives on linkage to HIV care in rural South Africa: results from the Home-Based Intervention to Test and Start (HITS) trial.","authors":"Hae-Young Kim, Maxime Inghels, Thulile Mathenjwa, Maryam Shahmanesh, Janet Seeley, Nuala McGrath, Oluwafemi Adeagbo, Dickman Gareta, H Manisha Yapa, Thembelihle Zuma, Adrian Dobra, Till W Bärnighausen, Frank Tanser","doi":"10.1093/heapol/czag088","DOIUrl":"10.1093/heapol/czag088","url":null,"abstract":"<p><p>Timely linkage from HIV diagnosis to care is critical for effective treatment and epidemic control. We evaluated the effectiveness of conditional micro-incentives on linkage to HIV care in the Home-Based Intervention to Test and Start (HITS) trial, a real-world implementation trial in rural South Africa. Of 45 communities in uMkhanyakude, KwaZulu-Natal, 16 were randomized to micro-incentive arms offering food vouchers (R50 [US$3]) conditional on completing home-based HIV counseling and testing (HBHCT) and linkage to care within 6 weeks, and 29 to non-incentive arms. All individuals were eligible for HBHCT, enrolled between February and December 2018, and followed for 1 year. The primary outcome was linkage to care at 1 year among men; secondary outcomes included linkage within the 6-week voucher eligibility period among men and women, and at 1 year among women. Intention-to-treat analyses were performed using Poisson regression adjusted for study arms. Among 13 894 men and 19 884 women eligible for the study (aged ≥15 years), home-based testing uptake was 21% (n = 2867) and 29% (n = 5795), yielding 122 (4.3%) and 375 (6.5%) new diagnoses, respectively. Overall, micro-incentives nearly doubled HIV-positive diagnoses. Among men, micro-incentives did not increase linkage to care within the 6-week voucher eligibility period (risk ratio [RR] = 0.78, 95% CI: 0.51-1.21) or at 1 year (RR = 1.08, 95% CI: 0.86-1.35). Among women, micro-incentives increased linkage to care within 6 weeks by 51% (RR = 1.51; 95% CI: 1.03-2.21), with no residual impact at 1 year (RR = 1.07, 95% CI: 0.91-1.26). In a hyperendemic rural African setting, once-off micro-incentives can substantially increase early linkage to HIV care among women during the incentive eligibility period but are inadequate to significantly improve care engagement among men. Trial Registration  ClinicalTrials.gov NCT03757104.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1527-1542"},"PeriodicalIF":3.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436675","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":"Strengthening data-driven primary health care delivery in Rajasthan, India.","authors":"Saachi Dalal, Ruchit Nagar, Siraj Patwa, Hamid Abdullah, Jeffrey Borkan","doi":"10.1093/heapol/czag015","DOIUrl":"10.1093/heapol/czag015","url":null,"abstract":"<p><p>Digital health information systems have the potential to improve data-driven decision-making and strengthen primary health care delivery in low- and middle-income countries (LMICs). This study examines Rajasthan's public health information systems with an aim to describe data processes and identify key barriers and opportunities for improvement. Using a qualitative approach, we conducted in-depth interviews with 39 stakeholders, including frontline health workers and state health officials. Our findings highlight inefficiencies in parallel paper and digital reporting systems, leading to high health worker burden, redundant data entry, delays in patient care, and poor data accountability. While digital platforms have improved data accessibility and care coordination, challenges such as poor design, interoperability, IT infrastructure limitations, and gaps in digital literacy remain. Lessons from successful digital health implementations in other LMICs suggest that integrated, human-centered, and interoperable systems are critical for sustainable digital transformation. We propose a \"5I Framework\" for policymakers to streamline Rajasthan's digital health ecosystem: (i) Integrated platforms, (ii) Implementable systems co-designed with health workers, (iii) Ink-free transitions away from paper-based systems, (iv) Insights from geospatial and real-time data, and (v) Incentives aligned with workforce needs. Strengthening Rajasthan's digital health systems through these strategies can enhance service delivery, improve public health outcomes, and serve as a model for other LMICs.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1500-1510"},"PeriodicalIF":3.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146194487","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 Enrolment Paradox: Qualitative Evidence on Gendered Barriers to National Health Insurance for Ghana's Poorest Households.","authors":"Richard Akuetteh Adjetey, Abraham Tetteh Teye","doi":"10.1093/heapol/czag119","DOIUrl":"https://doi.org/10.1093/heapol/czag119","url":null,"abstract":"<p><p>Ghana's National Health Insurance Scheme (NHIS) was established in 2004 to extend financial protection to all citizens and replace out-of-pocket payments at the point of care. Yet enrolment remains low among recipients of the Livelihood Empowerment Against Poverty (LEAP) cash transfer programme, Ghana's primary social protection instrument for the poorest households, despite formal premium exemptions. This study examined the lived experiences and enrolment motivations of LEAP household heads in two Ghanaian districts (Shai Osudoku, Greater Accra Region; Amansie West, Ashanti Region). Data were collected between 2017 and 2018. Eight focus group discussions (n=56) and eight key informant interviews were conducted and analysed thematically using NVivo. Two motivators were identified: perceived illness vulnerability and perceived financial benefits. Both operated through pronounced gender structures. Female household heads, especially widows and single mothers, were motivated by guaranteed financial access to care, because economic precarity rendered even minor illness expenditure catastrophic. Male household heads demonstrated lower perceived illness vulnerability, a pattern reflecting culturally enforced norms of masculine resilience rather than genuine health status advantage. Critically, strong motivation to enrol did not guarantee enrolment as structural barriers including premium-adjacent costs, administrative complexity, and documentation requirements blocked motivated but uninsured women from acting on their intent. These findings point to identifiable policy failures. The NHIS categorical exemption structure does not adequately capture situational vulnerability among LEAP women. Enrolment outreach is gender blind. And implementation of the formal LEAP-NHIS linkage is operationally weak. The paper concludes with evidence-grounded policy directions for gender-responsive NHIS reform and stronger integration between social protection and health insurance programmes in Ghana and comparable low- and middle-income country settings.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223887","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 infrastructure investments in Zambia: leveraging geospatial evidence to inform planning and prioritization.","authors":"Emmanuel Katyoka, Kutha Banda, Jason Wamulume, Patson Mwanza, Fredrick Mumba, Ibrahim Abdallah, Hilda Shakwelele, Olatubosun Akinola, Rabson Zimba","doi":"10.1093/heapol/czag099","DOIUrl":"10.1093/heapol/czag099","url":null,"abstract":"<p><p>In many low- and middle-income countries, inequities in maternal health outcomes are linked to disparities in spatial access to essential health services. In Zambia, significant portions of the rural population reside >5 km from the nearest health facility. This contributes to the 'three delays' of maternal mortality: delay to seek care, delay to reach a health facility, and delay to receive care from a skilled health provider. Consequently, at 187 per 100 000 live births, Zambia's maternal mortality ratio is above the global target of <70. This paper describes the application of a geospatial prioritization approach used by the Ministry of Health to guide investments in new maternal health infrastructure (mothers' waiting homes and maternity annexes) and upgrades to existing facilities. Using cross-sectional data from 692 public health facilities in Eastern and Southern Provinces, the approach integrates routine service and maternal mortality data from the national Health Management Information System , with facility infrastructure assessments and geospatial analysis. Facilities were screened using binary eligibility criteria based on recorded maternal deaths and then ranked using a weighted scoring model reflecting infrastructure readiness gaps for continuity of maternal care. Findings indicate widespread facility coverage for labor and delivery services, contrasted against inadequate capacity for the recommended 48-hr postnatal observation care. Maternal deaths were concentrated in 28% of facilities in Eastern and 19% in Southern Province. Applying the prioritization framework reduced the potential scope of infrastructure investment from 606 facilities to 27 high-priority sites, lowering projected investment costs from US$41.8 million to ∼US$2 million. The approach demonstrates how targeted infrastructure investments, informed by geospatial and routine health system data, can improve equity and continuity of care and optimize impact from limited resources. This applied framework offers a practical and scalable model for evidence-informed infrastructure planning in resource-constrained settings.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1596-1602"},"PeriodicalIF":3.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706371","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":"Evidence on information, access frictions, and experience in public healthcare use in rural Bangladesh: a cluster-randomized field experiment.","authors":"Mohammad Asif Hasan Khan","doi":"10.1093/heapol/czag109","DOIUrl":"10.1093/heapol/czag109","url":null,"abstract":"<p><p>In rural Bangladesh, many households continue to rely on private and informal providers even when public healthcare options are available at low or zero monetary cost. This paper studies whether the barrier is mainly misinformation, access frictions, or trust and uncertainty about public care. A cluster-randomized field experiment was conducted with 2320 households across 580 neighborhoods and three sequential treatment arms. Information provision sharply increases awareness of public care options but has limited effects on actual utilization. In contrast, encouraging a one-time experience with public care produces significant increases in public uptake, substitution away from informal providers, and meaningful reductions in out-of-pocket spending, especially on medicines. Households induced to use public care reduced total health spending by ∼601 Bangladeshi taka (USD 5.46 at 2023 exchange rate; 32% of the control group mean) relative to nonusers (95% CI 373-829 taka; P < 0.001), with most of the reduction driven by lower medicine expenditure. The findings suggest that improving beliefs alone is insufficient and that lowering uncertainty through a first successful experience is a key lever for shifting healthcare demand toward public options.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1580-1590"},"PeriodicalIF":3.5,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906180","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}