Health policy and planning最新文献

{"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":"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}

{"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":"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":"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}

{"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":"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 health planning and prioritization in Chad: developing a supportive tool.","authors":"Ana Krause, Alexandre Quach, Yamingué Betinbaye, Mindekem Rolande, Florence Mgawadere, Charles A Ameh","doi":"10.1093/heapol/czae120","DOIUrl":"10.1093/heapol/czae120","url":null,"abstract":"<p><p>The Republic of Chad has one of the highest rates of maternal mortality in the world. With scarce resources to respond to competing demands, pragmatic evidence-based planning tools are needed to aid planning and support priority setting. This action research aimed to develop a tool to support maternal health (MH) planning and prioritization decisions and identify priority regions/provinces for intervention in Chad based on aggregate MH coverage gap scores (Target-Coverage = Coverage Gap). A rapid review was conducted to identify key indicators and relevant national targets. The 2019 Multiple Indicator Cluster Survey and other national surveys were the data sources for selected indicators at the provincial level. Aggregate MH coverage gaps were calculated and displayed using geographic information system software to visualize variations by province. Eleven key informant interviews (KIIs) and six focus group discussions (FGDs) were conducted with clinicians and administrators to understand existing MH planning, prioritization, and maternal mortality risks in Chad. Wide provincial variation in aggregate MH coverage gaps was identified (mean score 374.3, SD: 77.4). Indicators contributing the most to coverage gaps include emergency obstetric care, adolescent births, tetanus vaccination, and delivery by skilled health personnel. Two weighting scenarios for the coverage gap scores are also considered. KIIs and FGDs revealed that existing MH planning in Chad differs provincially and by health system level, with no clear prioritization processes identified. Main themes regarding MH risks reported by stakeholders included challenges relating to the health system, policy landscape, country and population-specific factors, along with specific MH threats. Current centralized planning approaches may benefit from greater consideration of provincial differences to support more efficient and equitable resource distribution. This multi-indicator assessment offers an adaptable approach for evidence-based MH resource allocation to prioritize subnational areas with worst health indicators in resource-limited settings, although further research is needed to test its impact.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"380-390"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Learning analysis of health system resilience.","authors":"Kyaw Myat Thu, Sarah Bernays, Seye Abimbola","doi":"10.1093/heapol/czae113","DOIUrl":"10.1093/heapol/czae113","url":null,"abstract":"<p><p>The emergence of 'resilience' as a concept for analysing health systems-especially in low- and middle-income countries-has been trailed by debates on whether 'resilience' is a process or an outcome. This debate poses a methodological challenge. What 'health system resilience' is interpreted to mean shapes the approach taken to its analysis. To address this methodological challenge, we propose 'learning' as a concept versatile enough to navigate the 'process versus outcome' tension. Learning-defined as 'the development of insights, knowledge, and associations between past actions, the effectiveness of those actions, and future actions'-we argue, can animate features that tend to be silenced in analyses of resilience. As with learning, the processes involved in resilience are cyclical: from absorption to adaptation, to transformation, and then to anticipation of future disruption. Learning illuminates how resilience occurs-or fails to occur-interactively and iteratively within complex systems while acknowledging the contextual, cognitive, and behavioural capabilities of individuals, teams, and organizations that contribute to a system's emergence from or evolution given shocks/stress. Learning analysis can help to resist the pull towards framing resilience as an outcome-as resilience is commonly used to mean or suggest a state or an attribute, rather than a process that unfolds, whether the outcomes are deemed positive or not. Analysing resilience as a learning process can help health systems researchers better systematically make sense of health system responses to present and future stress/shocks. In qualitative or quantitative analyses, seeing what is to be analysed as 'learning' rather than the more nebulous 'resilience' can refocus attention on what is to be measured, explained, and how-premised on the understanding that a health system with the ability to learn is the one with the ability to be resilient, regardless of the outcome of such a process.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"428-435"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}