Health policy and planning最新文献

{"title":"What is success in global health diplomacy? A qualitative analysis of gendered and global perspectives on success and failure.","authors":"Victoria Haldane, Aloysius Ssennyonjo, Robert Marten, Anders Nordstrom, Magda Robalo, Clare Wenham","doi":"10.1093/heapol/czag097","DOIUrl":"https://doi.org/10.1093/heapol/czag097","url":null,"abstract":"<p><p>Global health diplomacy is central to shaping the international response to health challenges, yet what counts as \"success\" or \"failure\" remains contested. This study explores how gender and geopolitical identity influence perceptions of success and failure among global health diplomacy practitioners. Drawing on qualitative analysis of free-text responses from 136 professionals worldwide, we identify distinct narrative patterns. Women and Global South respondents emphasized normative goals: equity, justice, and structural reform, framing success in terms of inclusion, voice, and redistribution. In contrast, men and Global North respondents often framed success through processes: institutional innovation, efficiency, and procedural legitimacy. Failures were similarly divergent, seen as systemic exclusion and dependency by some, and as governance breakdowns or missed diplomatic opportunities by others. Our findings highlight the plurality of diplomatic worldviews and call for a more reflexive, inclusive approach to evaluating and practicing global health diplomacy that recognizes diverse epistemologies and power dynamics shaping the field.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792280","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":"Understanding informal payments in the health sector in Malawi: results of a multidistrict household survey.","authors":"Eric Umar, Maryam Chilumpha, Gertrude Chatha, Martin McKee, Blake Angell, Lucie Sabin, Dina Balabanova","doi":"10.1093/heapol/czag060","DOIUrl":"10.1093/heapol/czag060","url":null,"abstract":"<p><p>In Malawi, health services are officially free at the point of use, but patients often make informal payments to access services or obtain medicines. These payments undermine equity and trust in the health system. This study examined for the first time the prevalence, types, and determinants of informal payments among Malawians who had recently used health services. We conducted a multidistrict cross-sectional household survey in four districts chosen to reflect urban and rural Malawi. Households containing someone who had been hospitalized in the previous 6 months were interviewed using a structured questionnaire. Descriptive analyses identified the types and prevalence of informal payment, while multivariable logistic regressions identified factors associated with informal payments. Overall, 17% of respondents reported paying for services that are officially free. Informal payments are most often for medicines (52%), consumables (24%), and consultations (24%). Female respondents and those living in urban areas were significantly more likely to report giving informal payments, while those with higher levels of education were less likely. Participants with a good or very good financial situation were more likely to make such payments. Significant geographical variations were observed, with higher probabilities in Mchinji and Mzimba than in the Blantyre district. Nearly one in five Malawians reported making informal payments to access health services, questioning the formal policy that these are free. These findings highlight the need for governance reforms, greater accountability, and community awareness to reduce informal payments and promote equitable access to care.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1080-1087"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147837166","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":"A qualitative study of stakeholders' perceptions towards the implementation of the National Health Insurance Scheme in Zambia: equity and financial sustainability in question.","authors":"Joseph Kazibwe, Jesper Sundewall, Felix Masiye, Lucy Owusu, Phuong Bich Tran, Chitalu M Chama-Chiliba, Björn Ekman, Pia Svensson","doi":"10.1093/heapol/czag074","DOIUrl":"10.1093/heapol/czag074","url":null,"abstract":"<p><p>Low- and middle-income countries are expanding health insurance to enhance financial protection. However, there is scarcity of evidence on the stakeholder perceptions towards health insurance. This study explores stakeholders' perceptions towards the implementation of the National Health Insurance Scheme (NHIS) in Zambia. This qualitative study is based on 21 in-depth interviews with key stakeholders involved in the NHIS implementation in Zambia. We used qualitative content analysis to describe and interpret the manifest and latent meaning of transcribed interviews. The analysis yielded three overarching themes: (i) politics can make or break the scheme; (ii) equity in question: winners and losers; and (iii) pointing at the need for financial sustainability of the NHIS. The themes are supported by 6 subthemes and 18 data categories. Participants perceived the scheme as having contributed to improved quality of care and offering a generous health benefit package. However, implementation is perceived to be hindered by political interference, limited use of empirical evidence, weak institutional coordination, and exclusion of key stakeholders from decision-making processes, low enrolment, operational inefficiencies, inequities and a benefit package misaligned with available resources. The Zambia NHIS is perceived as a promising initiative for expanding access to health and enhancing financial protection. However, it faces numerous challenges ranging from limited enrolment among the poor, vulnerable and informal sector populations to concerns about financial sustainability. Addressing these issues is essential to realize the scheme's potential benefits.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1088-1101"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015194","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":"'This is not our mandate': a qualitative case study on the resilience of a humanitarian health programme in Lebanon.","authors":"Claudia Truppa, Martina Valente, Giulia Celentano, Catherine Savoy, Luca Ragazzoni, Dell D Saulnier","doi":"10.1093/heapol/czag068","DOIUrl":"10.1093/heapol/czag068","url":null,"abstract":"<p><p>Decision-making in humanitarian crises is rarely based on evidence and often constrained by uncertainty. Humanitarian health organizations such as the International Committee of the Red Cross (ICRC) operate in conflict settings, characterized by multi-layered, complex crises. Understanding how their decision-making processes influence the continuity of humanitarian health operations can provide insight to inform the development of resilience-oriented interventions in these contexts. We conducted a qualitative case study on the ICRC health operations in Lebanon, with the objective of exploring the elements shaping decision-making and understanding how different organizational factors influenced absorptive, adaptive, and transformative capacities in response to disruptive events in a hospital programme. Twenty semi-structured interviews were conducted with ICRC decision makers. Data were analysed through qualitative content analysis. Three themes emerged, describing how decisions were shaped by people and the trust they were able to develop in internal and external relationships; political considerations often overriding public health priorities; and unresolved tensions around the institutional identity and mandate. Resilience capacities were sustained by different factors. Absorptive capacities were primarily sustained by the availability of material resources, as well as operational contingency plans allowing for flexibility in their allocation. Adaptive capacities were strengthened by cohesive social networks among committed team members. Transformative capacities were limited, promoted by the ability to innovate while at the same time constrained by a rigid organizational culture. Our findings suggest that health governance and local leadership need to be strengthened to enable transformative capacities within humanitarian organizations. Through this, accountability and legitimacy can be enhanced, especially amid growing critiques and dramatically contracting funding.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1179-1195"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963598","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":"Does health insurance increase health care utilization? Evidence of ex-post moral hazard from the Social Security Scheme in Thailand.","authors":"Aeggarchat Sirisankanan, Papar Kananurak, Theerathorn Yoongthong","doi":"10.1093/heapol/czag072","DOIUrl":"10.1093/heapol/czag072","url":null,"abstract":"<p><p>Expanding health insurance improves access to care, but it may also increase healthcare utilization and fiscal pressure on public systems. Using multiple waves of the Thailand Socio-Economic Survey, this study applies a difference-in-differences (DD) approach combined with propensity score matching to estimate the causal effect of Social Security Scheme (SSS) coverage. The results show that insurance coverage increases healthcare utilization, consistent with behavioral responses associated with ex-post moral hazard, although part of this increase reflects improved access to necessary care. The magnitude of the effects varies across types of medical expenditures, estimation methods, and study periods. These findings highlight the importance of balancing expanded healthcare access with the financial sustainability of the SSS. Policymakers may consider targeted cost-management measures, efficiency improvements, and strengthened preventive health policies while maintaining equitable access to healthcare services.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1196-1211"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005235","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: Measuring and monitoring child health and well-being-an integral part of the climate change agenda.","authors":"","doi":"10.1093/heapol/czag071","DOIUrl":"10.1093/heapol/czag071","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1353"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148029648","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":"Preference for supplementary voluntary health insurance and heterogeneity in China: a discrete choice experiment.","authors":"Lizheng Xu, Lei Si, Shunping Li, Jiaqi Yuan, Xu Si, Dan Zhang, Stephen Jan, Chaofan Li","doi":"10.1093/heapol/czag080","DOIUrl":"10.1093/heapol/czag080","url":null,"abstract":"<p><p>Understanding the population's preferences for health insurance plays an important role in optimizing insurance scheme design and improving enrollment rate. This study aims to quantitatively investigate preference for supplementary voluntary health insurance (SVHI) from a multi-site survey and examine its heterogeneity in China. A discrete choice experiment was conducted in Shandong, Henan, and Sichuan provinces using multi-stage stratified sampling method. Five SVHI attributes were identified: premium, benefit package, deductible, reimbursement rate, and reimbursement for preexisting conditions. Choice sets were generated using a D-efficient design, grouped into two blocks randomly assigned to respondents, with each set comprising two SVHI options and an opt-out. Data were collected via face-to-face computer-assisted interviews. Mixed logit models were used to estimate preference weights, willingness-to-pay (WTP), and attribute importance scores. Preference heterogeneity was analyzed by disease-related financial risk awareness, numeracy, and health insurance knowledge, demographic, socioeconomic, and health characteristics. Of the 1326 respondents who completed the questionnaire, 1254 were included in the analysis. Reimbursement rate was the most important attribute (34.26%), followed by premium (25.06%), benefit package (17.60%), deductible (17.50%), and reimbursement for preexisting conditions (5.58%). Overall, respondents expressed the highest WTP (USD 48.50) for improving the reimbursement rate from 50% to 90%, while they showed lowest WTP (USD 8.60) for decreasing deductible from USD 2777.78 to 1388.89. Heterogeneity analysis revealed stronger enrollment preferences among respondents with risk awareness, higher health insurance knowledge, higher numeracy, higher educational attainment, higher income, and those living in urban areas. In addition, higher levels of risk awareness, insurance knowledge, numeracy, income, and education were associated with increased WTP for SVHI attributes. Preference heterogeneity by risk awareness and insurance knowledge suggests need for targeted risk information communication and education campaign to promote SVHI uptake and diverse insurance design tailored to socioeconomic differences in preferences for attributes.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1102-1114"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13548177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345133","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 policy processes section: scope and future.","authors":"Sudha Ramani, Yusra Ribhi Shawar, Eleanor Beth Whyle","doi":"10.1093/heapol/czag076","DOIUrl":"https://doi.org/10.1093/heapol/czag076","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"41 7","pages":"1045-1048"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792297","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":"COVID-19 kit distribution in six Latin American countries: bureaucratic autonomy, populism, and evidence-based policymaking.","authors":"José Antonio Requejo Domínguez, Kevin Croke, Veronika J Wirtz","doi":"10.1093/heapol/czag069","DOIUrl":"10.1093/heapol/czag069","url":null,"abstract":"<p><p>During the COVID-19 pandemic, governments varied widely in the extent to which policy decisions aligned with scientific evidence. We examine decision-making regarding the public distribution of COVID-19 kits containing ivermectin in six Latin American countries in 2020 and 2021, despite international scientific authorities advising against using these medicines outside of clinical trials. We focus on institutions, ideology, and interests. Theories emphasising the centrality of institutions predict that autonomous scientific institutions are more likely to resist political pressure to adopt ineffective interventions. Theories focused on ideology suggest that populist leaders may favour highly visible policy responses, including ineffective treatments, even when these diverge from expert advice. A third approach emphasises the relative power of interest groups favouring or opposing kit distribution. Using the comparative case study method, we analyse policy processes across Guatemala, Peru, Mexico, Costa Rica, Colombia, and Argentina. We find that neither bureaucratic autonomy, nor populism, nor interests alone explains policy variation. Instead, the findings are consistent with a conditional relationship in which populist leaders are more likely to favour kit distribution, but autonomous National Medicines Regulatory Agencies appear to moderate the influence of populist political pressures. Countries with non-populist leaders but low institutional autonomy were also likely to distribute kits if powerful political actors favoured such policies. These findings suggest that institutional design and political context jointly shape the capacity for evidence-informed decision-making during public health emergencies. Strengthening the autonomy of regulatory agencies may help support evidence-based evaluation of emerging health technologies during future crises.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1165-1178"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147981460","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":"Climate-related health threats in Tanzania: a multilevel analysis of key policies, strategies, and community response.","authors":"Aloyce Paul Urassa, Marceline Francis Finda, Fredros Oketch Okumu, Katharina Kreppel","doi":"10.1093/heapol/czag066","DOIUrl":"10.1093/heapol/czag066","url":null,"abstract":"<p><p>Tanzania faces increasing climate-sensitive health threats, including vector-borne diseases, waterborne infections, and malnutrition. Effective preparedness at both national and community levels is critical for health system resilience and livelihood security. This study applied a multilevel mixed-methods approach to assess Tanzania's policy structures and community-level experiences related to climate-health preparedness. Between January 2024 and May 2025, we conducted a concurrent mixed-methods study. At national level, we reviewed climate-health policy documents, mapped 30 key stakeholders, and conducted 15 semistructured interviews with representatives from government ministries, research institutes, development partners, and nongovernment organizations. At community level, we surveyed 388 adults and conducted eight focus group discussions in four councils in southern Tanzania. Data were analysed and triangulated across all sources. Tanzania has developed several climate-health policies and community initiatives. However, gaps remain in cross-sectoral coordination, financing, and policy implementation. National stakeholders cited challenges in translating strategies into community-level action. Among community respondents, 77% acknowledged climate change and 97% reported exposure to hazards such as floods, drought, or extreme heat. Health impacts included malaria surges, diarrhoeal disease, and food scarcity. While 73.7% had received some government assistance, access to reliable health and climate information was limited. Households relied mainly on personal observations and informal networks. Communities and institutions jointly emphasized four priorities: strengthened risk communication, climate-smart agriculture, resilient health facilities, and inclusive early warning systems. Strengthening multilevel governance, financing mechanisms, and community-driven adaptation planning is essential to improve Tanzania's preparedness for climate-related health threats.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1126-1139"},"PeriodicalIF":3.5,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147941309","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}