Health policy and planning最新文献

{"title":"How, why, and under what circumstances can supportive supervision programs improve malaria case management? A realist program theory.","authors":"Fatuma Manzi, Jessie K Hamon, Mena K Agbodjavou, Jenna Hoyt, August Kuwawenaruwa, Yusufu Kionga, Christian Agossou, Abdunoor M Kabanywanyi, Christelle Boyi-Hounsou, Abdallah Lusasi, Samwel Lazaro, Ramani Saliou, Augustin Kpemasse, Erik Reaves, Chonge Kitojo, Ahmed Saadani Hassani, Virgile Gnanguenon, Jean-Paul Dossou, Jayne Webster","doi":"10.1093/heapol/czaf020","DOIUrl":"https://doi.org/10.1093/heapol/czaf020","url":null,"abstract":"<p><p>Supportive supervision (SS) programs aim to enhance the quality of care by strengthening the performance of health providers. Commonly part of broader quality improvement efforts, SS programs are increasingly used in low-and middle-income countries to improve malaria case management. Despite substantial investments and some positive outcomes, little is known about what drives their effectiveness. A realist evaluation was conducted in Tanzania and Benin to explain how, why, and under what circumstances SS programs can improve the facility-based management of uncomplicated malaria in children under five. A program theory was developed through a team-based analysis of empirical data collected in both countries at two time points. Data included 218 in-depth and 12 structured interviews with stakeholders, 154 audits of febrile case management decisions, and four health facility audits. Stakeholder perspectives identified three acceptability mechanisms driving SS program outcomes in the studied contexts: the affective attitude, self-efficacy, and burden of the program as perceived by key actors. The pathway through which these mechanisms were perceived to shape malaria case management (diagnosis and treatment) practices was defined by the 1) extent to which the program was integrated into the public health system; 2) frequency with which SS visits were conducted by appropriate supervisors; 3) degree to which supervisors coached, rather than policed, supervisees; and 4) level of collaboration achieved between supervisees and supervisors. The program actors' perception of the program's effectiveness was also found to be crucial to its sustainability. This study explains the dynamics driving SS program outcomes and underscores the role played by the cognitive and emotional responses of program actors. These insights are likely to be transferable to other settings with similar contexts and can help inform the design, implementation, monitoring, and evaluation of new and ongoing SS programs.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718795","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":"Impact of the free healthcare policies in Burkina Faso: Underscoring important nuances.","authors":"Thomas Druetz, Patrick Ilboudo, Marie-Jeanne Offosse, Federica Fregonese, Abel Bicaba","doi":"10.1093/heapol/czaf017","DOIUrl":"https://doi.org/10.1093/heapol/czaf017","url":null,"abstract":"<p><p>The article recently published by TT Aye et al. (2024) in Health Policy and Planning is a major contribution to understanding the medium-term (5 years) effects of the free healthcare policy introduced in 2016 in Burkina Faso. The study makes rigorous use of interrupted time series with a non-equivalent control group and presents a wealth of information on the methodology used. Remarkably, numerous sensitivity analyses were conducted to strengthen the credibility of the results and limit the risk of bias. Three salient conclusions are presented: (1) free healthcare had no effect on the proportion of pregnant women who gave birth in a health center, either immediately or after 5 years; (2) free healthcare led to an immediate and significant increase in the rate of consultations for children <5 years of age and; (3) after this immediate increase, free healthcare led to a gradual decrease in the rate of consultations for children <5 years in the medium term. We believe it is essential to highlight some important nuances regarding these conclusions and highlight some methodological issues.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700312","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":"Implementing the Chinese mandatory antimicrobial stewardship programme: barriers to continuous improvement.","authors":"Xiaomin Wang, Leesa Lin, Xin Xu, Stephan Harbarth, Laith Yakob, Ran Zhang, Xudong Zhou","doi":"10.1093/heapol/czaf019","DOIUrl":"https://doi.org/10.1093/heapol/czaf019","url":null,"abstract":"<p><p>This study aims to investigate the implementation strategy, unintended consequences, and underlying barriers to mandatory antimicrobial stewardship (AMS) programs in China. Face-to-face, in-depth qualitative interviews were conducted in 16 public hospitals in eastern, central, and western China. Hospitals were purposely selected with full consideration to represent both economically developing and developed areas and both secondary and tertiary care hospitals. A total of 111 respondents were interviewed, including 38 doctors, 28 clinical pharmacists, 15 microbiologists, 14 infection prevention and control specialists, 10 experts from medical service departments, and 6 quality improvement experts. A thematic framework analysis was conducted. A common implementation strategy was found among the surveyed hospitals in response to the AMS programs mandated by healthcare authorities. The hospital leadership empowered an AMS team to set AMS-related indicators for each clinical department and each doctor, and adopted core elements of AMS to optimize antimicrobial prescribing. However, the mandatory AMS approach also caused unintended consequences including regulatory circumvention, shift of risk to doctors and patients, and demotivation of healthcare workers. Two key barriers to AMS implementation were identified: 1) poor communication and cooperation between the AMS team and doctors, characterized by a high-power-low-power dynamic within hospital disciplines; and 2) the profit-driven compensation system, which discourages collaboration and resource distribution for AMS implementation. Mandatory AMS programs should intensify AMS training, promote communication and cooperation between the AMS team and doctors, adjust the compensation system to facilitate better AMS implementation, and offer supportive measures that enable the adoption of strict regulations.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668964","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":"Response to Impact of the free healthcare policies in Burkina Faso: Underscoring important nuances.","authors":"Thit Thit Aye, Hoa Thi Nguyen, Laurène Petitfour, Valéry Ridde, Felix Amberg, Emmanuel Bonnet, Mariam Seynou, Joël Arthur Kiendrébéogo, Manuela De Allegri","doi":"10.1093/heapol/czaf018","DOIUrl":"https://doi.org/10.1093/heapol/czaf018","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648400","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":"Prioritisation of methods for assessing alcohol use in emergency room settings: findings from a qualitative study.","authors":"Petal Petersen Williams, Megan Prinsloo, Jodilee Erasmus, Charles Parry, Richard Matzopoulos, Margaret M Peden","doi":"10.1093/heapol/czaf016","DOIUrl":"https://doi.org/10.1093/heapol/czaf016","url":null,"abstract":"<p><p>Limited alcohol-related injury data in hospital settings globally underscores the need for routine monitoring to inform policy formulation for injury prevention, especially in addressing violence and road traffic injuries. COVID-19, and the related alcohol sales bans in South Africa in 2020-2021 brought the impact of alcohol on trauma presenting to health facilities into sharp focus and highlighted the absence of practical, cost-effective and accurate alcohol diagnostic tools in emergency rooms. This qualitative study aims to identify valuable alcohol-related information for stakeholders to inform a validation study of alcohol diagnostics for injury-related trauma. We conducted five virtual Focus Group Discussions (FGDs) with four groups of stakeholders: clinicians (n=9), academics (n=4), hospital and other operational staff (n=6) and policymakers (n=4). FGDs were audio recorded and transcribed verbatim. Coding and thematic analyses were conducted using NVivo version 12. Results highlighted the belief that alcohol places a burden on the healthcare system and plays a significant role in injury causation and mortality. Currently, robust alcohol assessment in emergency rooms is lacking. Despite acknowledging that quantified blood alcohol levels would not change acute clinical management, there was consensus regarding the need-to-know patients' alcohol usage to inform long-term management and broader public health objectives. Findings support plans to validate the efficacy of selected alcohol diagnostic tools in public hospital settings and to further test their feasibility and utility at a national level.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143648398","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":"Constrained optimization: evaluating possible packages of community health interventions with competing resource requirements in Galmudug, Somalia.","authors":"Robert J Montgomery, Elaine Scudder, Caitlin Tulloch, Muna Jama, Naoko Kozuki, Baris Ata","doi":"10.1093/heapol/czaf014","DOIUrl":"https://doi.org/10.1093/heapol/czaf014","url":null,"abstract":"<p><p>Investment in Community Health Worker (CHW) programs has allowed health systems to reach previously underserved rural and remote populations. As a result, CHWs are often burdened with responsibilities to deliver large packages of services, at times without sufficient human, financial, or health resources. To design a community-level program that saves maternal and newborn lives while operating within resource limitations, we used constrained optimization (a mathematical process for finding the solution to a stated objective while accounting for listed requirements) to construct a model for select villages in Galmudug State, Somalia. After establishing the resource requirements for delivering 25 evidence-based maternal and neonatal interventions, we used the Lives Saved Tool (LiST) and optimization techniques to determine the package of care that leads to the most projected lives saved. With a cadre of 1,450 Female Health Workers and a budget of $435,000 for maternal and neonatal health commodities and programming over one year, we calculated that the optimized set of interventions for Galmudug could avert 15% of the 4,132 projected maternal and neonatal deaths in 2024. We also conducted sensitivity analyses to show how the optimal combination of interventions and the number of lives saved change as the resource levels change. The model provides practitioners with a new tool and accompanying approach to evaluate possible packages of community health interventions with competing resource requirements.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604622","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":"Political commitment and implementation: the health system response to violence against women in Mexico.","authors":"Sophie M Morse, Manuela Colombini, Erin C Lentz, Carolina Dotoreo Soriano, Ana Jocelyn Mejía Morales, Claudia Diaz Olavarrieta, Daniela C Rodríguez","doi":"10.1093/heapol/czaf012","DOIUrl":"10.1093/heapol/czaf012","url":null,"abstract":"<p><p>Violence against women (VAW) is a widespread concern globally and in Mexico, where in 2021, 44% of women over age 15 have experienced some form of intimate partner violence during their relationship and a quarter have experienced sexual violence in the past 12 months. To respond, Mexico passed comprehensive legislation addressing VAW, which outlines the role of the health system in identifying, treating, and referring women experiencing violence; however, implementation of such regulations has been slow and far from successful. Using a conceptual framework of political commitment, we conducted a health policy analysis to evaluate how health policies addressing violence against women in Mexico have been implemented. The political commitment framework includes the dimensions of expressed, institutional, and budgetary commitment. We adopted a multi-methods qualitative case study approach combining document analysis with 25 stakeholder interviews with policymakers and health facility directors in Mexico City. The results show that Mexico exhibits limited expressed political commitment from the president, but some commitment exists among Ministry of Health officials. We document that the mixed findings on expressed commitment are mediated, in part, by internalized social and gender norms that normalize and tolerate violence, which are present in society writ large. We find that institutional commitment exists through policies and institutions. However, monitoring systems for policy implementation were not working as designed, and there was limited effort and capacity to implement these policies, reflecting structural barriers and norms within the health system that shape the treatment of violence survivors. Finally, we found a budgetary allocation for VAW; however, it was unclear if the budget was utilized correctly. While progress has been made in addressing VAW in the health system in Mexico, implementation is lagging due to a lack of political commitment, and thus, policies are likely not reaching their intended beneficiaries: survivors of violence.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582290","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":"Cost-effectiveness of a simplified acute malnutrition program: a secondary analysis of the OptiMA randomized clinical trial in the Democratic Republic of the Congo.","authors":"Stephen C Resch, Ryoko Sato, Kevin Phelan, Cécile Cazes, Abdramane Ombotimbe, Victoire Hubert, Harouna Boubacar, Liévin Izie Bozama, Gilbert Tshibangu Sakubu, Béatrice Kalenga Tshiala, Toussaint Tusuku, Rodrigue Alitanou, Antoine Kouamé, Cyrille Yao, Delphine Gabillard, Moumouni Kinda, Renaud Becquet, Susan Shepherd, Robert M Hecht","doi":"10.1093/heapol/czae106","DOIUrl":"10.1093/heapol/czae106","url":null,"abstract":"<p><p>Acute malnutrition (AM) causes large loss of life and disability in children in Africa. Researchers are testing innovative approaches to increase the efficiency of treatment programs This paper presents results of a cost-effectiveness analysis of one such program in the Democratic Republic of the Congo (DRC) based on a secondary analysis of a randomized controlled trial Optimizing Treatment for Acute Malnutrition (OptiMA), conducted in DRC in 2018-20. A total of 896 children aged 6-59 months with a mid-upper arm circumference (MUAC) <125 mm or with oedema were treated and followed for 6 months. The cost-effectiveness of OptiMA using ready-to-use therapeutic food (RUTF) at a tapered dose was compared with the standard national program in which severe cases (SAM) received RUTF proportional to weight, and moderate cases (MAM) were referred to another clinic for a fixed dose regimen of ready-to-use supplementary food. Cost analysis from the provider perspective used data collected during the trial and from administrative records. Statistical differences were derived using t-tests. The mean cost per enrolled child under OptiMA was $123 [95% confidence interval (CI): 114-132], not statistically different from the standard group [$127 (95%CI: 118-136), P = 0.549], while treatment success (i.e. recovery to MUAC > 125 mm and no relapse for 6 months) under OptiMA was 9% higher (72 vs 63%, P = 0.004). Among children with SAM at enrollment, there was no significant difference in treatment success between OptiMA and standard care (70 vs 62%, P = 0.12), but OptiMA's mean cost per enrolled child was 23% lower ($128 vs $166, P < 0.0001). OptiMA was more effective at preventing progression to SAM among those enrolled with MAM (5 vs 16%, P < 0.0001), with an incremental cost-effectiveness ratio of $234 per progression to SAM prevented. Overall, OptiMA had significantly better outcomes and was no more expensive than standard care. Its adoption could enable more children to be successfully treated in contexts where therapeutic food products are scarce.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"273-286"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604364","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":"Maternal and perinatal mortality: geospatial analysis of inequality in pregnancy related 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":"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 2000, 2005, 2011, and 2016. In each survey, around 15 500 women aged 15-49 years 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 an 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 = .01) has a geographically varying relationship with perinatal mortality, while education (P-value = .03) and wealth (P-value = 0.01) are associated 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":"358-367"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886834/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Capacity and crisis: examining the state-level policy response to COVID-19 in Tamil Nadu, India.","authors":"","doi":"10.1093/heapol/czaf003","DOIUrl":"10.1093/heapol/czaf003","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"444"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143033095","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}