Health policy and planning最新文献

{"title":"Community health worker payment processes: a qualitative assessment of experiences in two Indian states.","authors":"Kheya Melo Furtado, Abha Mehndiratta, Sebastian Bauhoff, Swapna Pawar, Amy Luo, Anushree Jha, Margaret McConnell","doi":"10.1093/heapol/czaf010","DOIUrl":"10.1093/heapol/czaf010","url":null,"abstract":"<p><p>Community health worker (CHWs) remuneration has received some attention in terms of the design of incentives, however, there is a lack of systematic data on the processes by which CHWs are paid. We aimed to study existing payment processes including the role of digitization and its effects on CHW experiences with receiving full and timely compensation, and identify barriers and facilitators to the payment process. We studied payment processes for the Accredited Social Health Activist (ASHA) in India in two states with varying levels of performance and payment systems and conducted 53 in-depth interviews and eight focus group discussions across three categories of respondents (37 ASHA workers, 46 supervisors, and 34 managers/health system leaders). The data was coded thematically using inductive and deductive coding methods organized around five steps of the payment process: (i) recording of work, (ii) claim submission, (iii) claim verification, (iv) claim processing, and (v) payment disbursement. We observed complex sub-processes within each stage of the payment process that adversely impacted payment timelines, CHW workload, and motivation, even where digital tools provide support. Local administrative initiative and positive organizational culture overcame these challenges to standardize and simplify processes for recording work, submitting claims, and maintaining adequate funds, facilitating timely payments. Complete digitization of disbursement through the public financial management system improved timeliness, transparency, and satisfaction among CHWs compared to earlier cash and cheque-based payments. The potential digitization of service delivery records for claim submission was met with mixed perceptions among CHWs and their supervisors. Our study contributes to the body of knowledge on CHW compensation by delineating the processes by which financial incentives are paid and offering insights for low and middle-income countries to improve the efficiency of payment systems.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"483-495"},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425277","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":"Factors influencing the establishment of hospital accreditation programs in low- and middle-income countries: a scoping review.","authors":"Dilantha Dharmagunawardene, Paula Bowman, Mark Avery, David Greenfield, Reece Hinchcliff","doi":"10.1093/heapol/czaf011","DOIUrl":"10.1093/heapol/czaf011","url":null,"abstract":"<p><p>Hospital accreditation programs are globally recognized as an important tool for enhancing quality and safety in health care; however, many programs in low- and middle-income countries (LMICs) are discontinued shortly after their establishment. This scoping review synthesized published evidence on factors influencing the establishment and sustainability of hospital accreditation programs in LMICs, to provide guidance to health stakeholders involved in these processes. Six databases were searched using the terms \"accreditation,\" \"health,\" \"hospital,\" and the country list of LMICs. Screening was undertaken collaboratively for validation. A framework to guide data extraction was developed by amalgamating eight existing classifications, theories, models, and frameworks concerning policy diffusion and implementation. The framework comprised the following domains: antecedent influences (A), contextual factors (C), establishment factors (E), standards, surveyors, stimulants (incentives), and survey-related factors (S-4S), governance (G), legislation (L), execution (implementation; E), and assessment and monitoring (AM), forming the ACES-GLEAM framework. Thirty-two sources were identified, with an increasing publication trend over time. The included studies reported upon a broad range of patterns, innovations, influencers, enablers, and barriers concerning accreditation program establishment in LMICs. Key questions emerged, including the degree of government involvement, incorporation of international standards versus development of bespoke standards, the use of local versus external surveyors, the use of financial and other incentives to promote engagement, and mandatory versus voluntary approaches of program implementation. Resource constraints were recognized as the most important barriers to sustainable establishment, while the influence of global accreditation and donor agencies were viewed as presenting both positive and negative impacts. Health stakeholders are encouraged to reflect upon and apply the ACES-GLEAM framework, incorporating the guiding principles outlined in this paper, to help establish hospital accreditation programs in LMICs in a way that facilitates sustainability and effectiveness over time.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"496-517"},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440749","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":"Can public education campaigns equitably counter the use of substandard and falsified medical products in African countries?","authors":"Janelle M Wagnild, Samuel Asiedu Owusu, Simon Mariwah, Victor I Kolo, Ahmed Vandi, Didacus Bambaiha Namanya, Rutendo Kuwana, Babatunde Jayeola, Vigil Prah-Ashun, Moji Christianah Adeyeye, James Komeh, David Nahamya, Kate Hampshire","doi":"10.1093/heapol/czaf004","DOIUrl":"10.1093/heapol/czaf004","url":null,"abstract":"<p><p>Substandard and falsified (SF) medical products are a serious health and economic concern that disproportionately impact low- and middle-income countries and marginalized groups. Public education campaigns are demand-side interventions that may reduce the risk of SF exposure, but the effectiveness of such campaigns, and their likelihood of benefitting everybody, is unclear. Nationwide pilot risk communication campaigns, involving multiple media, were deployed in Ghana, Nigeria, Sierra Leone, and Uganda in 2020-21. Focus group discussions (n = 73 with n = 611 total participants) and key informant interviews (n = 80 individual interviews and n = 4 group interviews with n = 111 total informants) were conducted within each of the four countries to ascertain the reach and effectiveness of the campaign. Small proportions of focus group discussants (8.0-13.9%) and key informants (12.5-31.4%) had previously encountered the campaign materials. Understandability varied: the use of English and select local languages, combined with high rates of illiteracy, meant that some were not able to understand the campaign. The capacity for people to act on the messages was extremely limited: inaccessibility, unavailability, and unaffordability of quality-assured medicines from official sources, as well as illiteracy, constrained what people could realistically do in response to the campaign. Importantly, reach, understandability, and capacity to respond were especially limited among marginalized groups, who are already at the greatest risk of exposure to SF products. These findings suggest that there may be potential for public education campaigns to help combat the issue of SF medicines through prevention, but that the impact of public education is likely to be limited and may even inadvertently widen health inequities. This indicates that public education campaigns are not a single solution; they can only be properly effective if accompanied by health system strengthening and supply-side interventions that aim to increase the effectiveness of regulation.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"447-458"},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004483","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":"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":"10.1093/heapol/czaf009","url":null,"abstract":"<p><p>With most households in rapidly urbanizing cities in low- and medium-income countries 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 in order to improve access to quality health services in urban slums.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"471-482"},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","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":"Correction to: Indonesian medical interns' intention to practice in rural areas.","authors":"","doi":"10.1093/heapol/czaf008","DOIUrl":"10.1093/heapol/czaf008","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"518"},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407140","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 political economy analysis of health policymaking in Nigeria: the genesis of the 2014 National Health Act.","authors":"Julia Ngozi Chukwuma, Felix Abrahams Obi","doi":"10.1093/heapol/czaf007","DOIUrl":"10.1093/heapol/czaf007","url":null,"abstract":"<p><p>This article explores the ideologies, interests, and institutions affecting health policymaking in Nigeria, and the role of the private sector therein. It covers the period from the late-1950s, the years leading up to independence, to 2014, when the country enacted its first-ever law to govern its healthcare system. The National Health Act (NHAct) was adopted after a decade of preparation and civil society-driven advocacy, making the objective of universal health coverage (UHC) explicit. However, in its final version, the NHAct earmarked only a small share of public funds for UHC, solidifying the country's reliance on private healthcare and out-of-pocket payments. To examine the specific set of ideologies, interests, and institutions defining Nigeria's pathway toward UHC and the contribution of the private sector, we adopted the political economy framework, situating the genesis of the 2014 NHAct within the broader political and economic context of Nigeria's health system reform process since the 1950s. Drawing on qualitative data collected during interviews and focus groups, we found that the deep entrenchment of private-sector healthcare in Nigeria is the result of a path-dependent process. This implies that Nigeria's current reliance on the private sector is influenced by historical patterns, competing interests, and institutional practices that have reinforced the role of private actors over time. We identified three major explanatory factors that have shaped health policymaking in Nigeria. First, since the 1980s, the ideology that private healthcare is the solution to an underfunded and underperforming public healthcare system has been reinforced by leading international organizations. Second, private actors in Nigeria have been in a strong position to influence health policymaking since independence. Third, Nigeria's challenging socio-economic context and the limitations of its federal governance structure have fostered a general level of public distrust in the capacity of the public sector to provide quality healthcare.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"459-470"},"PeriodicalIF":2.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065278","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":"Condom use prevalence during the COVID-19 pandemic among female sex workers in Dakar, Senegal: a retrospective, cross-sectional analysis.","authors":"Wen Qiang Toh, Carole Treibich, Sandie Szawlowski, Henry Cust, Elhadj A Mbaye, Khady Gueye, Cheikh T Ndour, Aurélia Lépine","doi":"10.1093/heapol/czaf023","DOIUrl":"https://doi.org/10.1093/heapol/czaf023","url":null,"abstract":"<p><p>Literature suggests that individuals may trade off health for income in face of an economic shock. Being in a close contact profession, the livelihoods of sex workers were severely affected by the COVID-19 pandemic. Few studies exist on whether prevalence of better-renumerated condomless sex increased among this population in low and middle-income countries and discuss its implications on HIV/STI transmission especially during pandemic situations. We reported cross-sectional condom use prevalence estimates of 600 female sex workers in Dakar, Senegal from data collected before (2015, 2017) and during the pandemic (June-July 2020). Condom use prevalence was elicited via list experiments for more truthful estimates. Double list experiment estimates of mean condom use prevalence declined from 78.2 percent (95% CI: 70.9-85.5 percent) in 2017 to 65.1 percent (95% CI: 57.6-72.7 percent) in 2020. This statistically significant decrease of 13.1 percentage points (p=0.014) represents a 16.8 percent fall in condom use and a 60.2 percent increase in condomless sex prevalence. The fall in condom use prevalence was largely concentrated amongst the asset-poor, providing some suggestive evidence that economic reasons drove the fall in condom use, reinforcing findings in existing literature regarding the positive relationship between economic shocks and risky sexual behaviours. At the point of the survey, the observed decline in client numbers exceeded the reduction in condom use prevalence, suggesting potential mitigation of HIV/STI transmission risks during the COVID-19 pandemic; nevertheless, the lack of direct comparability between these two metrics warrants cautious interpretation. However, more accurate epidemiological modelling considering the non-sex worker population and longer-term studies on whether condom use prevalence returned to pre-COVID levels after client numbers recovered are required for a comprehensive assessment of the pandemic's short-term and longer-term impact on HIV/STI transmission.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795252","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":"Power dynamics and intersectoral collaboration for health in low and middle income countries: A realist review.","authors":"Praveenkumar Aivalli, Sara Dada, Brynne Gilmore, Srinivas Nuggehalli Prashanth, Aoife De Brún","doi":"10.1093/heapol/czaf022","DOIUrl":"https://doi.org/10.1093/heapol/czaf022","url":null,"abstract":"<p><p>Intersectoral collaboration (ISC) is a critical strategy in global health for addressing complex challenges requiring multi-sectoral engagement. While studies examined ISC in Low- and Middle-Income Countries (LMICs), gaps remain in understanding how power dynamics between stakeholders influence the effectiveness of ISC in these settings. This realist synthesis examines how, why, for whom, under what context and to what extent power dynamics shape ISC in LMIC health programmes and policies, offering insights crucial for improving health policy implementation. Five Initial Programme Theories (IPTs) were developed through a scoping review, document analysis, and qualitative study. A systematic search of Medline, Embase, CINAHL, Web of Science, and grey literature (2012-2023) yielded 2,850 records, with 23 included after screening. This period was chosen to capture contemporary shifts in ISC, following the 2012 UN Political Declaration on NCDs and the WHO's 2013 Health in All Policies (HiAP) framework, which strengthened multi-sectoral governance in LMICs. It also builds on prior reviews, ensuring an up-to-date synthesis of power dynamics in ISC. Data were synthesized using the Context-Mechanism-Outcome framework, generating demi-regularities to refine Programme Theories (PTs). Findings reveal that power imbalances frequently manifest through hierarchical governance structures, resource disparities, and historical inequities, shaping ISC outcomes. Six refined PTs highlight: (1) Inclusive policy development processes mitigate power asymmetries but require intentional facilitation to prevent marginalization of less dominant sectors. (2) Leadership commitment and shared goal alignment enhance collaboration, yet competing institutional priorities often reinforce power struggles. (3) Equitable resource allocation acts as both a catalyst for trust and a source of conflict, with donor influence exacerbating dependency dynamics. (4) Hierarchical communication norms in LMICs undermine transparency, though informal interpersonal networks can circumvent bureaucratic barriers. (5) Ambiguity in roles and mandates amplifies power vacuums, enabling dominant actors to disproportionately influence agendas. Additionally, a sixth Programme Theory emerged: (6) Sustained interpersonal relationships counterbalance structural power imbalances, fostering accountability and adaptive problem-solving. These findings demonstrate that power dynamics in ISC within LMICs are mediated by both structural factors (e.g., funding models, institutional hierarchies) and relational mechanisms (e.g., trust, negotiation). Successful collaboration hinges on recognising and addressing these dual dimensions of power. This synthesis advances theoretical and practical understanding of ISC, offering policymakers actionable insights to navigate power-related challenges in intersectoral health initiatives.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143788202","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":"Delivering integrated and standardised services to eliminate mother-to-child transmission of sexually transmitted infections: experience of the E-clinic model in a Chinese pilot district.","authors":"Yali Luo, Shuang Gao, Jiahong Chen, Dingyan Lv, Weizhen Mai, Wei Wang, Yuanfang Zhu","doi":"10.1093/heapol/czaf006","DOIUrl":"https://doi.org/10.1093/heapol/czaf006","url":null,"abstract":"<p><p>Eliminating mother-to-child transmission (EMTCT) of syphilis and Hepatitis B Virus (HBV) is crucial for preventing and reducing new pediatric infections. Timely and standardized EMTCT interventions for maternal infections have been demonstrated to be highly cost-effective and efficient. Regrettably, healthcare providers have encountered challenges in delivering these interventions due to the complexity of multi-department referrals. Baoan district in Shenzhen, Guangdong province, where serves as one of the six national pilot district tasked with exploring effective EMTCT strategies, has pioneered the integration of infection management into antenatal care by establishing the E-Clinic (short for the Elimination of mother-to-child transmission Clinic) within the Obstetrics department. The E-Clinic, through its provision of integrated services, has witnessed increased coverage of syphilis treatment for pregnant women living with syphilis, as well as increased coverage of antiviral treatment for high-risk pregnant women living with HBV. The E-Clinic has been recognized as a best practice for EMTCT by the World Health Organization, and has been widely adopted and adapted in over 100 maternal and child healthcare institutions across Guangdong province. The success of the E-Clinic underscores the importance of government leadership, innovation, and multi-level engagement in promoting standardized EMTCT services, providing insights for implementing EMTCT strategies in other regions worldwide.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772225","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":"First Referral Hospitals in low resource settings: a narrative review of expectations for clinical service provision.","authors":"Tamara Mulenga Willows, Rosanna Mazhar, Suraj Bhattarai, Chit-Su Tinn, Nadine Misago, Jean Jacque Roger Ikuzwe, Mike English","doi":"10.1093/heapol/czaf021","DOIUrl":"https://doi.org/10.1093/heapol/czaf021","url":null,"abstract":"<p><p>First referral hospitals (FRH) have an important role to play in helping many countries achieve 'Health for All'. However, their specific role and the clinical services they are expected to provide to achieve this are evolving. To explore this issue further we undertook a narrative review to examine the clinical service expectations of FRH outlined in academic and policy literature, which identified a total of 404 FRH service expectations. At a global level, some categories of services provide extensive specific service recommendations, likely resulting from historical priorities and the influence of vertical programming and professional interests. However, in several important areas we identified few or no recommendations. At the level of individual country case-studies undertaken through this review, FRH clinical service recommendations within available policy documents vary considerably. Our findings suggest a disconnect between the ambition for FRH and the difficult, context-specific decision making needed at national level on the role of FRH as a service delivery platform within integrated health systems helping countries achieve universal health coverage (UHC).</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752393","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}