Health policy and planning最新文献

{"title":"The health and well-being of adolescents: responding to their priorities.","authors":"David A Ross, Bhavya Nandini, Rajat Khosla, Anshu Mohan","doi":"10.1093/heapol/czag086","DOIUrl":"https://doi.org/10.1093/heapol/czag086","url":null,"abstract":"<p><p>Adolescents aged 10-19 years represent the largest cohort in human history and a critical global resource-yet realizing their potential requires deliberate, sustained investment in their health and well-being. This editorial introduces a six-article supplement in Health Policy and Planning addressing key priorities for adolescent health and well-being policy and programming, with particular attention to young people's own perspectives and evidence from low- and middle-income countries. The supplement opens with findings from the 'What Young People Want Survey', drawing on responses from over 1.5 million young people across 89 countries. Results reveal that adolescents' priorities span multiple domains-especially learning and employability, safety and supportive environments, and health and nutrition-underscoring the necessity of multi-sectoral approaches. Three articles address financing. Together, they demonstrate that integrated health-education interventions can yield returns of at least 11 dollars per dollar invested and that scaling up treatment for adolescent depression and anxiety produces benefit-cost ratios of 15.4 and 13.9 in Colombia and South Africa, respectively-while cautioning that investments must be designed with an explicit equity focus to avoid deepening existing inequalities. Another article presents new World Health Organization and Partnership for Maternal Newborn and Child Health guidance for monitoring adolescent health and well-being holistically across the five domains of the UN conceptual framework, supported by an Excel-based data tool that maximizes use of existing data. The supplement concludes with an early assessment of commitments made at the 2023 Global Forum for Adolescents across four countries, finding that progress is hindered by fragmented systems, funding gaps, and insufficient disaggregated data. The evidence presented in this supplement makes clear that improving adolescent health and well-being is neither aspirational nor unaffordable-it is an investment with compelling returns. Realizing those returns demands that adolescents' voices shape policy and that progress is rigorously monitored.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"41 Suppl 2","pages":"ii1-ii3"},"PeriodicalIF":3.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108862","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":"Meeting the challenges to adolescent well-being: context, returns on investment, and financing.","authors":"Peter Sheehan, Bruce Rasmussen, David A Ross, Anshu Mohan, Susan Sawyer, Bhavya Nandini, Levi Singh, Kim Sweeny, John Symons, Rose September","doi":"10.1093/heapol/czag083","DOIUrl":"https://doi.org/10.1093/heapol/czag083","url":null,"abstract":"<p><p>Adolescents in many countries face serious challenges in realizing the level of well-being that is their human right. Many factors-deep-seated inequality within and between countries, rapid change in skill requirements for employment, climate change, and social media-are driving these deepening challenges. This paper develops three points about the need for an urgent response to this situation. First, there is now evidence that a powerful suite of cost-effective investments is available to improve adolescent well-being. To support this claim, we draw on recent modelling of investments for many low- and middle-income countries (LMICs), as well as on detailed case studies of three countries (India, South Africa, and Colombia). In all these studies, most of the investments are highly cost-effective, with benefit-cost ratios over 6, and in many cases much higher. However, the cost of these investments is substantial, especially for those that involve the education system, raising major financing issues for most countries. Second, the case studies highlight, at least for South Africa and Colombia, the extent to which within-country inequality harms adolescent development. For example, if school quality is poor for low-income groups or regions, schooling can perpetuate rather than arrest inequality, which in turn can lead to disruptive violence for these groups or regions. Third, countries with limited fiscal space, high debt levels, and inequality and violence curtailing growth rates will find it hard to fund the investments needed to transform adolescent well-being. Major reforms to development finance are necessary, such as those outlined at the Fourth International Conference on Financing for Development at Seville in mid-2025, as well as changes to the priority given to domestic investments. Steps to reduce income inequality by new fiscal measures are also important, to fund the investments in adolescent well-being and to make them more effective.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"41 Supplement_2","pages":"ii18-ii28"},"PeriodicalIF":3.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The links between adolescent health and education: pathways, impacts and economic modelling.","authors":"John Symons, Bruce Rasmussen, Gareth Jones, Hafsah Muheed, Bhavya Nandini, Kenisha Arora, Kim Sweeny, Anshu Mohan, Mily Johana Ramírez Ruiz, Peter Sheehan","doi":"10.1093/heapol/czag077","DOIUrl":"https://doi.org/10.1093/heapol/czag077","url":null,"abstract":"<p><p>Health and education are interdependent pillars of human capital development, yet they are often treated in isolation within policy and economic models. This study presents a conceptual and empirical framework that integrates health and education interventions to assess their joint impact on educational attainment, population health, productivity, and economic development. Using a human capital approach, the study models the effects of four school-based health interventions-nutrition, deworming, water, sanitation, and hygiene (WASH), and mental health programmes-on education outcomes in 75 low- and middle-income countries. It also quantifies the long-term health benefits from reduced adolescent pregnancies, due to increased years of schooling, in the form of lower under-five and adult mortality. The immediate health benefits for adolescents of these school-based programmes are not modelled. Using an updated version of an education model combined with an employment benefits model, the study estimates the costs and returns of investing in these interventions from 2025 to 2050. Results show the interventions alone yield over 422 million additional school completions, with economic benefits exceeding US$15.3 trillion and a benefit-cost ratio (BCR) of 7.0. When health benefits of education in the form of reduced mortality are included, benefits rise to over US$25.2 trillion, with a BCR of 11.5. These findings demonstrate the powerful bidirectional relationship between health and education and support the case for integrated investments. The study also outlines methodological advancements in modelling the combined impact of education and health, while acknowledging limitations such as the focus on market-based outcomes and assumptions of uniform intervention effectiveness. Future research should include immediate economic benefits of health interventions, broader dimensions of human development, including equity, institutional quality, and social capital. The findings offer compelling evidence for policymakers to prioritize coordinated, cross-sectoral strategies that yield high returns in both education and health.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"41 Supplement_2","pages":"ii29-ii42"},"PeriodicalIF":3.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Development of the Eldercare Industry in China: The Role of Public Long-Term Care Insurance.","authors":"Zhongbin Huang, Yanan Zhang, He Chen","doi":"10.1093/heapol/czag113","DOIUrl":"https://doi.org/10.1093/heapol/czag113","url":null,"abstract":"<p><p>The public long-term care insurance (LTCI) scheme has emerged as a key policy initiative to promote universal access to long-term care services in China. Drawing on panel data from 310 prefecture-level cities covering 2010-2019, this study used the Callaway and Sant'Anna difference-in-differences (CSDID) approach to estimate the effect of LTCI introduction on organisational entry in the eldercare industry and further examined heterogeneity in the estimated effects by organisational characteristics and policy design. Our findings showed that LTCI introduction was associated with an average increase of 1.50 newly registered eldercare-related organisations per 100,000 population. This finding remained robust across a series of alternative specifications and sensitivity analyses. The estimated effects tended to be larger among enterprises, organisations with registered capital of at least 1 million yuan, and those operating in business scopes closely related to the LTCI benefit package. LTCI was also associated with organisational entry in a broader range of eldercare-related activities, suggesting potential spillover effects across the industry. Regarding policy design, larger estimated effects were observed for schemes covering both employees and residents and for those providing in-kind services only. These findings suggest that LTCI may shape the development of the eldercare industry, while highlighting the importance of population coverage and benefit design in influencing its industrial effects.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074386","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 drivers of fragmentation in health financing in low- and middle-income countries: a conceptual framework and narrative review.","authors":"Sumit Mazumdar, Akseer Hussain, Rodrigo Moreno Serra, Indranil Mukhopadhyay, Satyaki Roy, Thomas Hone, Laura Flamand, Marco Antonio Catussi Paschoalotto","doi":"10.1093/heapol/czag111","DOIUrl":"https://doi.org/10.1093/heapol/czag111","url":null,"abstract":"<p><p>Fragmentation in health financing remains a persistent obstacle to equity, efficiency and financial protection in many low- and middle-income countries (LMICs). This paper develops a conceptual framework to explain how political and administrative arrangements shape fragmentation across the core financing functions of revenue raising, pooling, purchasing and benefit design. We conducted a narrative and conceptual review of literature on political economy analysis, political settlements, decentralisation, decision-space and health financing reforms, complemented by illustrative reviews of reforms in Mexico and India. The framework distinguishes two proximate domains - political organisation and administrative organisation - and examines how they interact with political settlements to produce, maintain or reduce fragmentation. We define fragmentation as the division of financing functions across schemes, actors or levels of government without sufficient coordination to secure cross-subsidy, equity, efficiency and financial protection. The framework also clarifies that political drivers do not affect all financing functions in the same way: electoral incentives often shape visible benefit expansion, interest groups are especially important for purchasing and payment rules, and federal or decentralised arrangements strongly influence revenue allocation, pooling and implementation discretion. The Mexico and India illustrations show how reforms can expand coverage while leaving important forms of fragmentation in place. The paper provides a practical roadmap for applying political economy analysis to health-financing fragmentation and for identifying politically feasible reforms in pursuit of universal health coverage.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016553","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":"Mapping policy gaps and governance challenges in Kenya's hand hygiene environment: a health policy triangle analysis.","authors":"Naomi Njeri, Joash N Moitui, Blessing Mberu, Sheillah N Simiyu","doi":"10.1093/heapol/czag092","DOIUrl":"10.1093/heapol/czag092","url":null,"abstract":"<p><p>Hand hygiene is an effective public health measure for preventing infectious diseases. Sustained hand hygiene practice requires an enabling environment that constitutes access to hand hygiene products and services, clear and effective policy provisions, financing, monitoring, and coordination mechanisms. This paper analyses Kenya's national hand hygiene policy landscape and identifies the underlying governance barriers and systemic opportunities for strengthening hand hygiene policy and practice in Kenya. Guided by the Health Policy Triangle (HPT) framework, this study systematically examined the context, content, process, and actors shaping Kenya's hand hygiene policy landscape. Primary data was collected through Key Informant Interviews (KIIs) with 11 strategic stakeholders involved in policy development, implementation, regulation, and programme delivery. Secondary data was through a comprehensive review of 20 policy instruments, including national policies, strategies, protocols, roadmaps, and binding legal documents. In Kenya, policies are formulated at the national level and devolved to the County level for implementation, with support from state and non-state actors. The analysis showed that Kenya lacks a standalone, hand hygiene policy document. However, hand hygiene provisions are present in policy documents which cover hand hygiene in several settings such as rural areas, schools, and health facilities. This reflects fragmented policy presence rather than complete absence. Barriers hindering effective implementation include weak inter-sectoral coordinating mechanisms, inadequate financing, and a lack of data. These gaps create governance and operational fragmentation, undermining the sustainability of hand hygiene interventions. To transition to an enabling environment, Kenya should establish explicit national hand hygiene standards with clear definitions and minimum requirements, secure dedicated, and sustainable financing mechanisms, ensure national-County coordination, and integrate standardized hand hygiene indicators into the national and sub-national health information systems. These reforms will support more coherent governance, evidence-informed planning, and accountability for hand hygiene implementation.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1441-1460"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148445922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Health Economics Section: scope and future.","authors":"Peter Binyaruka, Neha Batura, Beverley M Essue","doi":"10.1093/heapol/czag090","DOIUrl":"10.1093/heapol/czag090","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"41 8","pages":"1353-1357"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148989730","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":"Community caregivers and innovative financing: a qualitative analysis of Thailand's Ubolratana Hospital model using the consolidated framework for implementation research.","authors":"Sila Tonboot, Pantitra Singkheaw, Attakorn Raksasataya, Noppawan Poonpipat, Sirilakkhana Phrawong, Watcharapong Rintra, Charoonrat Srisespimp, Wiroj Wannapira, Supasit Pannarunothai","doi":"10.1093/heapol/czag091","DOIUrl":"10.1093/heapol/czag091","url":null,"abstract":"<p><p>Thailand's healthcare system faces challenges in delivering effective community-based care for dependent patients in rural areas; while access has expanded over more than four decades, services remain fragmented and effective coverage from community to higher-level care is still lacking. The Ubolratana Hospital model in Khon Kaen Province represents an innovation, combining a full-time 24-hr community caregiver cadre integrated within a hospital-led local healthcare team with five adaptive diversified funding streams. This qualitative implementation research, guided by the Consolidated Framework for Implementation Research (CFIR), examined the determinants of adoption and sustainment of the model over its 6-year operation. The CFIR-informed interview guide was used as the key data collection and analytical framework across its five domains [innovation, outer setting, inner setting, individuals (roles and characteristics), and implementation process]. We conducted semi-structured interviews with key informants spanning hospital administrators, physicians, nurses, community caregivers, sub-district primary care unit personnel, local government officials, community leaders, and family members between March and May 2025. Data were analysed using framework analysis combining deductive CFIR coding with inductive sub-coding. Adoption was facilitated by a hospital-initiated caregiver role, sustained inner-setting leadership embodied in a long-tenured 'social engineer' hospital director and his successor team, a three-stage community-led caregiver selection process, and Buddhist-integrated spiritual care; sustainment relied on a coordinated multi-level care process and the continuity of care centre's reflective evaluation. Outer-setting barriers included fragmented public health financing, the 2022 decentralization of sub-district primary care units to provincial administrative organizations, and donor-funding uncertainty. Since 2020 the model has been progressively scaled under Ramathibodi Faculty of Medicine sponsorship to 22 districts across 15 provinces (53 villages, cumulative investment >10 million baht). The Ubolratana experience therefore offers a practical, rather than directly replicable, framework whose diffusion depends on cultivating local leadership, building trust, and adapting innovation components to local conditions.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1375-1387"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455786","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":"Exploring the roles of informal healthcare providers in urban settings to improve access and quality of care for the urban poor: experience from Bangladesh, Ghana, Nepal, and Nigeria.","authors":"Dominic Dormenyo Gadeka, Bryony Dawkins, Noemia Teixeira de Siqueira Filha, Asiful Haidar Chowdhury, Abhigyna Bhattarai, Chinyere Mbachu, Md Badruddin Saify, Henry Okudzeto, Mattheus Rodrigues Da Silva, Sushil Chandra Baral, Zahidul Quayyum, Genevieve Cecilia Aryeetey, Rumana Huque, Obinna Onwujekwe, Bassey Ebenso, Helen Elsey, Irene A Agyepong","doi":"10.1093/heapol/czag087","DOIUrl":"10.1093/heapol/czag087","url":null,"abstract":"<p><p>Though informal healthcare providers (IHPs), often defined as unregistered and not formally trained, are heavily utilized by low-income urban residents and present an opportunity to address the urban primary care gap, these providers are rarely prioritized or integrated into health systems. This paper explores IHPs' role in urban settings across four rapidly urbanizing low- and middle-income countries: Bangladesh, Nepal, Nigeria, and Ghana, to enhance understanding of their potential within health systems and promote their integration to improve access and quality of care for the urban poor. We studied published and unpublished articles and policy documents to compare informal provider types, roles, services, and target populations in each country. We then present case studies illustrating how these providers support healthcare for urban poor. A narrative synthesis was applied to describe the included documents/literature and results, while quantitative data were analysed using STATA version 16. OpenStreetMap basemaps were employed to illustrate informal providers' locations within urban areas. Our findings show that across the four countries, there is substantial evidence that informal providers contribute significantly to health service delivery by bridging the care gap, particularly for socially and economically disadvantaged urban populations. They serve as the first point of contact, offering a wide range of health services, including preventive, curative, and restorative services. However, they are loosely defined and lack robust standards, protocols, professional training, and accreditation. Informal providers play a critical, though varied, role in the delivery of healthcare across the countries studied, facilitating access to care where it might otherwise be unavailable or unaffordable. Initiatives to strengthen the informal sector, e.g. linking or integrating with the formal sector, have the potential to improve healthcare access and quality for the urban poor.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1358-1374"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404516","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: Examining supplier-induced demand under regulated fees: dynamic panel evidence from Iran.","authors":"","doi":"10.1093/heapol/czag098","DOIUrl":"10.1093/heapol/czag098","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1493"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148706326","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}