Health policy and planning最新文献

{"title":"Local solutions, local governance: the municipal health committee initiative in Majdal Anjar, Lebanon.","authors":"Joanna Khalil, Rouham Yamout, Wesam Mansour, Fouad Fouad, Joanna Raven","doi":"10.1093/heapol/czag096","DOIUrl":"10.1093/heapol/czag096","url":null,"abstract":"<p><p>In fragile and shock-prone settings, where political instability, economic crises, and institutional fragmentation weaken central authorities, strengthening local health governance has become critical for health system resilience. Lebanon represents an example, having faced compounded shocks including economic collapse, the COVID-19 pandemic, and armed conflict, all of which have strained an already fragmented health system. Despite increasing recognition of the importance of sub-national governance, limited empirical evidence exists on how municipal-level health governance structures function in practice under such conditions. This article evaluates the establishment and functioning of a Municipal Health Committee (MHC) as a pilot model of local health governance, analysing factors influencing good governance practices. Using participatory action research and an implementation research design, qualitative data were collected through process documentation and field observations, six critical reflective meetings, and nine key informant interviews. Data were analysed using the TAPIC framework to examine transparency, accountability, participation, integrity, and capacity in the MHC's operations. Findings indicate that the MHC enhanced inclusive participation thereby strengthening local legitimacy and trust. The committee progressively embedded transparency and evidence-informed decision-making, including efforts to generate local health data. However, compliance by formulated ideal and institutional integrity was persistently challenged by political interference, patronage networks, weak enforceability of accountability mechanisms, and financial precarity. Sustained mentorship by the research team strengthened governance practices and enhanced the MHC's ability to implement its mandate effectively. Municipal committees can strengthen equity and resilience in settings through inclusive, evidence-informed processes; however, sustainability depends on local ownership, functional autonomy from political capture, and capacity development.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1461-1472"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669359","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":"Residents' preference trade-offs for critical illness insurance scheme design: a discrete choice experiment in Shandong Province, China.","authors":"Ruoxuan Zhang, Jingbo Zhang, Huohuo Dai, Xin Zhao, Yibo Wu, Hui Li","doi":"10.1093/heapol/czag089","DOIUrl":"10.1093/heapol/czag089","url":null,"abstract":"<p><p>The economic burden of disease remains a significant global public health challenge. In China, the critical illness insurance scheme is a pivotal policy designed to protect households from catastrophic health expenditure. However, evidence on residents' preferences for this insurance is limited. Identifying these preferences is essential for advancing resident-centered policy reform. To address this gap, we conducted a discrete choice experiment to quantify public preferences for critical illness insurance attributes among residents in Shandong Province, China. Through literature review, qualitative interviews, and expert consultation, we designed a discrete choice experiment with six policy attributes: cost, reimbursement ratio, deductible, annual reimbursement limit, scope of reimbursable expenses, and restriction to designated hospitals. An orthogonal design generated choice sets. Data were collected from 360 residents across 3 cities in Shandong Province and analyzed using mixed logit and latent class models. Latent class analysis identified preference heterogeneity across subgroups. Based on model results, we calculated relative importance scores and simulated selection probabilities. A total of 334 valid questionnaires were collected (46.4% male; 53.6% female). Mixed logit analysis identified the reimbursement ratio (32.73%) as the most important attribute, followed by the annual reimbursement limit (23.81%) and scope of reimbursable expenses (23.10%). Latent class analysis revealed two subgroups: a \"Coverage-Intensity Sensitive\" Group (Class 1, n = 125) and a \"Reimbursement-Focused Group\" (Class 2, n = 209). Class 1 prioritized high reimbursement limits (68.3% relative importance), preferring no annual limit. Class 2 emphasized optimizing the reimbursement ratio (45.6%) and hospital flexibility, while accepting higher deductibles. Policymakers should prioritize increasing reimbursement rates and expanding coverage scope, with appropriate premium adjustments. Aligning critical illness insurance design with residents' heterogeneous preferences contributes to more targeted and efficient policy arrangement.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1388-1400"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455781","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":"Developments in the field of health policy analysis in low- and middle-income countries: a review of published literature 2008-2023.","authors":"Eleanor Beth Whyle, Lucy Gilson, Zubin Cyrus Shroff","doi":"10.1093/heapol/czag079","DOIUrl":"10.1093/heapol/czag079","url":null,"abstract":"<p><p>This review maps the development of health policy analysis (HPA) in low- and middle-income countries (LMICs) since 2008, when Gilson and Raphaely (Gilson L, Raphaely N. The terrain of health policy analysis in low and middle income countries: a review of published literature 1994-2007. Health Policy Plan 2008;23:294-307. https://doi.org/10.1093/heapol/czn019) published a review clarifying the state of the field and tracing its evolution. Subsequent years have seen some progress in capacity strengthening for HPA in LMICs, but the extent of development of the field has not been formally assessed since that time. We used a combination of bibliometric, thematic, and narrative analysis to better understand the nature of the research being undertaken, identify weaknesses in the evidence base, and gauge maturation of the field. Despite the relatively restrictive focus of this review, we identified 629 articles reporting empirical studies of LMIC policy experiences, revealing substantial growth in the volume of published HPA since 2008. However, significant imbalances in knowledge production remain, with low-income country experiences, and those of North Africa and Central Asia still neglected, and with the dominance of HIC authors persisting despite efforts to strengthen the field in LMICs. At the same time, the review finds evidence of maturation, reflected in deeper theoretical engagement, greater methodological diversity, the use of comparative approaches to enable causal explanation and cross-context learning, and the emergence of robust bodies of work on specific health policy issues. Taken together, the findings point to a field that has grown in scale, scope and analytic sophistication, but still requires deliberate nurturing. Purposeful efforts by researchers, funders, and institutions are needed to ensure that HPA realizes its full potential and contributes to progressive policy change. Improving domestic and regional funding, supporting LMIC institutions and researchers, deepening theoretical engagement, and encouraging analytical HPA that enables explanation and cross-context learning are essential to sustaining the development of the field and ensuring that it continues to generate rigorous, relevant insights and contributes to progressive policy change.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1473-1492"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148328808","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":"Catastrophic costs and impoverishment among tuberculosis-affected households in Nepal: results from a national patient cost survey.","authors":"Prajowl Shrestha, Naveen Prakash Shah, Sharad Kumar Sharma, Lok Raj Joshi, Ashish Lal Shrestha, Padmanav Ghimire, Basundhara Sharma, Rajendra Basnet, Ratna Bahadur Bhattarai, Sandesh Neupane, Rabin Gautam, Prasant Vikram Shahi, Barsha Thapa, Kenza Bennani, Bir Bahadur Rawal, Keshab Deuba","doi":"10.1093/heapol/czag095","DOIUrl":"10.1093/heapol/czag095","url":null,"abstract":"<p><p>Tuberculosis (TB) poses a significant economic burden on affected households. Despite the provision of free diagnosis and treatment services, patients and their households experience substantial financial hardship. This study aimed to estimate the catastrophic costs faced by TB patients in Nepal and identify associated factors. We conducted the first national cross-sectional survey of 1000 patients enrolled within the National Tuberculosis Program (NTP). The sample consisted of 600 drug-susceptible (DS-TB) and 400 drug-resistant TB (DR-TB) patients. Data were collected through structured interviews using the standardized TB patient cost survey questionnaire. Costs were categorized as direct medical, direct nonmedical, and indirect. Indirect costs were estimated using the human-capital approach. Catastrophic total costs due to TB were defined as total TB-related costs exceeding 20% of annual pre-TB household income. The mean age of participants was 43 years, and 65% were male. Forty-two percent of participants engaged in informal paid work and 70% had not completed secondary education. One-third of the participants reported having some form of social protection, with just 11% possessing health insurance coverage. Overall, 51% of TB-affected households faced catastrophic costs due to TB, with a higher proportion among DR-TB patients (76%) compared with DS-TB patients (51%). The financial burden was primarily driven by direct nonmedical costs (44%) and indirect costs (39%), substantially exceeding direct medical costs (17%). Factors associated with catastrophic total costs included belonging to a poorer wealth quintile, a DR-TB diagnosis, being the primary income earner, and lacking health insurance coverage. TB-related costs pushed 13% of households below the poverty line, increasing to 31% among DR-TB households. Mitigating this burden requires an integrated approach that aligns early diagnostic interventions with comprehensive social protection. Specifically, combining direct cash transfers for wage replacement with in-kind nutritional support is critical to protect high-risk households and reduce nonmedical financial shocks.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1401-1415"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584237","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":"When should a public health emergency of international concern be declared? The case of the 2018-2020 Ebola outbreak in the Democratic Republic of the Congo.","authors":"Bárbara Frossard Pagotto","doi":"10.1093/heapol/czag094","DOIUrl":"10.1093/heapol/czag094","url":null,"abstract":"<p><p>Criticism over the lack of transparency in the decision-making process to determine a public health emergency of international concern (PHEIC) has accompanied the mechanism since the category was first activated. For the 2018-2020 Ebola epidemic in North Kivu and Ituri, Democratic Republic of the Congo, this criticism intensified: it took four emergency committee (EC) meetings and nearly a year for the World Health Organization (WHO) Director-General to declare a PHEIC. The North Kivu case is emblematic of the complexities surrounding such determinations, complexities that the opacity and inconsistent application of the International Health Regulations (IHR) criteria across PHEIC history have made difficult to examine. What shaped the EC's assessment, and what does this reveal about how PHEIC determinations are made? Drawing on documentary analysis and interviews with former EC members, this paper investigates why the declaration was delayed and what shaped the EC's assessment over time. It finds that the EC's deliberations were driven by considerations that lay outside the IHR text, especially the political and operational dynamics on the ground, the financial and reputational stakes for the WHO, and the perceived risks of triggering border restrictions and deepening community resistance. How these considerations were weighed was ideationally driven, structured by the global health security paradigm that has come to shape both response interventions and the construction of certain outbreaks as matters of 'international concern'. The case carries significant implications for the credibility of the PHEIC mechanism and for the recent IHR amendments, which introduced the 'pandemic emergency' category as the highest level of global alert. By examining the interplay between real-time response dynamics and high-level decision-making, this work sheds light on the material and ideational factors that shape the governance of health emergencies, contributing to scholarly and policy debates on emergency response and agenda setting in global health.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1429-1440"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584231","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 political economy of novel food taxes and subsidies in India: insights from stakeholder interviews and a scoping review.","authors":"Amit Summan, Divija Samria, Seshadri Dutta, Ramanan Laxminarayan","doi":"10.1093/heapol/czag093","DOIUrl":"10.1093/heapol/czag093","url":null,"abstract":"<p><p>Fiscal policy tools are cost-effective for curbing unhealthy consumption, but unlike the extensively studied cases of tobacco and alcohol, the political economy of nutrition-based taxes and subsidies remains poorly understood in low- and middle-income countries. We examined the political economy of factors influencing the adoption and implementation of nutrition-based fiscal policies in India using a multi-method qualitative approach, combining a scoping review and key informant interviews. A policy triangle framework was used to identify the context, content, process, and actors affecting policy uptake. Our findings reveal a highly fragmented and contested policy space, shaped by competing commercial, political, and public health interests. Current policies focus narrowly on addressing undernutrition and tend to exacerbate overnutrition. Aggressive industry marketing of processed foods, cultural dietary preferences, and socioeconomic inequities intersect with regulatory gaps, opaque fiscal frameworks, and a fragmented political landscape (inter-ministerial conflict, industry lobbying, and limited policy focus) to hinder policy progress. India's current tax structure nominally taxes processed foods, but definitional ambiguities and loopholes-such as manufacturers circumventing higher tax slabs by adding minimal fruit content-undermine policy effectiveness. Nutrition-based food subsidies remain skewed towards staple crops and sugar, with fruits, vegetables, and other nutrient-rich foods lacking fiscal support to increase consumption. Fiscal policy acceptance can be improved by earmarking health tax revenue for nutrition programmes, incentivizing healthier product innovation to lower costs, and implementing targeted food subsidies to reduce undernutrition. Advancing nutrition fiscal policy in India is as much a political and institutional challenge as a technical one, hinging on clearer, nutrition-aligned tax definitions, stronger coordination between revenue- and health-focused actors, and targeted subsidies for nutritious foods.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1416-1428"},"PeriodicalIF":3.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548793","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":"When digital systems stop working: a qualitative study of misalignment between the implementation of a human resources information system and health zone realities in the Democratic Republic of the Congo.","authors":"Shinomi Takahashi, Yoshimitsu Takahashi, Steve Kibundila Hemedi, Arthur Akawakow, Patou Musumari, Mari Nagai, Sadatoshi Matsuoka, Takeo Nakayama","doi":"10.1093/heapol/czag112","DOIUrl":"https://doi.org/10.1093/heapol/czag112","url":null,"abstract":"<p><p>Digitalized human resources information system (HRIS) is promoted to strengthen health workforce governance, yet its implementation often breaks down in many low-resource settings. We explored barriers and facilitators to HRIS implementation at provincial and health zone levels in the Democratic Republic of the Congo (DRC) and identified intervention points. This qualitative study involved interviews with 46 staff from provincial health divisions and health zones in three provinces of the DRC: Kongo Central, Haut-Katanga, and Kwango, representing different stages of HRIS rollout. Interviews were conducted between August and September 2023. Data were analyzed inductively, and findings were mapped onto the updated Consolidated Framework for Implementation Research (CFIR). Two overarching themes emerged: experiences of HRIS implementation and current situation with workforce management information and information needs. Dissatisfaction with paper- and Excel-based data management and the need for accurate human resource data shaped motivation to use HRIS. The main barrier to continued HRIS use was unresolved login failures, driven by the lack of locally accessible technical personnel. CFIR mapping showed that barriers spanned multiple CFIR domains, including misalignment between HRIS implementation and operational realities and reliance on external rather than domestic financing. Sustainable HRIS implementation requires alignment between system design, local operational realities, and financing structures rather than system introduction alone. In the DRC, seemingly minor technical problems can halt system use, revealing the fragility of HRIS when local technical support and institutionalized funding are absent. Without decentralized support and contextual adaptation, HRIS implementation risks exacerbating such digital divides rather than strengthening governance.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982002","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":"From motivation to governance: structural determinants of community health worker engagement in TB and HIV care in Madagascar.","authors":"Larissa Hecht, Onja Gabrielle Ravololohanitra, Anne Neumann, Michel Tiaray Harison, Norosoa Rakotoherimora, Emmanuel Harizaka Andriamasy, Haingotiana Razafimanantsoa, Julius Valentin Emmrich, Nadine Muller","doi":"10.1093/heapol/czag110","DOIUrl":"https://doi.org/10.1093/heapol/czag110","url":null,"abstract":"<p><p>Community health workers (CHWs) are essential to tuberculosis (TB) and HIV responses, yet many programmes rely on volunteer-based models that assume sustained motivation despite weak system support. CHW motivation is widely understood to be shaped by organizational and health-system conditions. We examine how structural and organizational conditions shape CHW motivation in TB and HIV care in Madagascar, drawing on Self-Determination Theory (SDT), which conceptualizes motivation as shaped by the fulfillment of needs for autonomy, relatedness, and competence. We conducted a convergent mixed-methods study (March - October 2024), combining a survey of 408 CHWs across four regions with qualitative data from five focus group discussions with CHWs (n=26) and 24 interviews with institutional actors. SDT was applied within a socio-ecological framework to analyze how individual, community, and health system factors influence autonomy, relatedness, and competence. CHWs reported strong commitment to community health, yet operated under significant structural constraints: Most CHWs lived in economic poverty, with 74.3% reporting household incomes below 100,000 MGA/month (≈ $22.1), while 95.8% CHWs held additional full-time occupations. Motivation was characterized by value-driven commitment alongside dependence on external incentives. However, economic precarity, fragmented remuneration systems, insufficient training and supervision, lack of occupational protection, and weak institutional integration constrained CHWs' autonomy, relatedness, and competence. Incentive-based approaches enabled short-term participation but generated distortions in task prioritization and undermined trust when payments were inconsistent. CHW motivation emerged as a dynamic outcome of the interaction between strong value-based commitment and programme and health-system conditions. SDT helps explain how fragmented and unreliable support constrains core psychological needs, producing fragile engagement despite high commitment. Strengthening CHW programmes requires the coherent and reliable delivery of predictable remuneration, training and supervision, occupational protection, and formal integration into the health workforce.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919531","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":"Multi-sectoral governance for health: a scoping review and typology development.","authors":"Matthew Aviso, Harvy Joy Liwanag, Amanda Low, Ali Alshalah, Emma Louise Willoughby, Jasmine Sayed, Natasha Howard","doi":"10.1093/heapol/czag106","DOIUrl":"https://doi.org/10.1093/heapol/czag106","url":null,"abstract":"<p><p>Multi-sectoral governance is widely recognised as necessary to address health challenges, but approaches vary in different settings. We aimed to examine the representation and attributes of multi-sectoral governance for health in the peer-reviewed literature and develop a descriptive typology. We conducted a scoping literature review, using Arksey & O'Malley's method that included 34 articles for analysis. Most were published in 2020-25 (77%), used qualitative methods (68%), and addressed wide ranging health issues across all geographic regions. Multi-sectoral governance for health was assessed to be either single-lead (i.e. when one sector leads) or distributed (i.e. when all sectors share in governance). Single-lead multi-sectoral governance for health was further classified as: (1) deliberate, when the lead sector is clearly tasked with governing collaboration from the outset; or (2) organic, when the lead sector emerges as the sector naturally responsible for governing collaboration. Distributed multi-sectoral governance for health can be further classified as: (1) committed, when all sectors have sustained interest in contributing to collaboration; (2) flexible, when the involvement of sectors shifts depending on changing priorities and available resources; or (3) fragile, when sectors do not commit sufficiently, resulting in sub-optimal collaboration. Our findings can advance thinking on what multi-sectoral governance for health looks like, guide policymakers and other stakeholders to explicitly consider governance arrangements when planning and implementing multi-sectoral governance for health and recommend future research to explore how variations in types of multi-sectoral governance for health relate to its effectiveness.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The unintended consequences of health policy processes: a qualitative systematic review of experience with the 2007 Occupation-Specific Dispensation (OSD) strategy in the South African public nursing sector.","authors":"Dane Witten, Eleanor Whyle","doi":"10.1093/heapol/czag107","DOIUrl":"https://doi.org/10.1093/heapol/czag107","url":null,"abstract":"<p><p>Health policies inevitably produce unintended consequences when introduced into a health system. These consequences can be linked to factors occurring before and throughout a policy's development and implementation. Understanding unintended consequences in relation to these factors can help mitigate its unintended health system impact. Current literature reveals a paucity of information exploring this interaction. Examining the 2007 Occupation-Specific Dispensation (OSD) strategy for nurses in South Africa can help fill this gap. We conducted a health policy analysis exploring the relationship between unintended consequences and the factors which occur in a policy process using a qualitative systematic review and applying a longitudinal lens. We included literature relating to the 2007 OSD in nursing and human resources for health (HRH) from 1994 onwards. In data analysis, we applied the Walt and Gilson (1994) Health Policy Analysis (HPA) Triangle to 1) give an overall description of the OSD policy process in the nursing sector; 2) identify the main unintended health system consequences of the policy for nurses and 3) investigate the relationship between the unintended consequences of the 2007 OSD and its relevant contributing factors occurring before, during and after the OSD's development and implementation. Three main unintended consequences were identified: nursing demoralization; nursing division and a breakdown in the relationship between nursing managers and frontline staff. Our findings suggest that the relationship between unintended consequences and its relevant contributing factors are rooted in the historical and socio-political realities of the health system. Frontline-level actors can help mitigate potential unintended consequences through sharing their historical and socio-political insight. We therefore urge policymakers to include these actors in policy development and implementation processes. Future research should explore the inclusion of frontline knowledge in policy processes as a method to reduce the potential severity and/or number of unintended consequences experienced.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891223","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}