Health policy and planning最新文献

{"title":"Correction to: Assessing the costs of antenatal care in Eastern Ethiopia: implications for improving the free maternity services policy.","authors":"","doi":"10.1093/heapol/czag061","DOIUrl":"10.1093/heapol/czag061","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"1043"},"PeriodicalIF":3.5,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147928674","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":"Identifying the 'real cause of death': the complexities of maternal death reviews in Tanzania.","authors":"Kerstin Almdal, Ali Said, Karen Marie Moland, Andrea Melberg","doi":"10.1093/heapol/czag053","DOIUrl":"10.1093/heapol/czag053","url":null,"abstract":"<p><p>Identifying the causes of maternal deaths and contributing factors is essential for improving care. In 2015, Tanzania began implementing the maternal and perinatal death surveillance and response (MPDSR) system, including facility-based maternal death reviews. While most MPDSR studies highlight implementation and technical barriers, less is known about how systemic and institutional dynamics influence these reviews. This study examined stakeholders' experiences and perceptions of MPDSR in Tanzania, focusing on how clinical causes of death and contributing factors were identified. The study is based on 5 months of ethnographic fieldwork conducted in a Tanzanian region in 2023-2024. It included 33 days of participatory observation of obstetric care, attending nine facility-based maternal death review meetings and conducting 20 in-depth interviews with health workers and administrative staff. Viewing MPDSR as a travelling model and drawing upon the concept of situated knowledge, we examined how institutional and professional factors influenced these reviews. Reviews were routinized and integrated into the regional health system, offering opportunities for teaching and defining standards of practice. However, participants disagreed on whether the reviews promoted quality improvement or focused on individual fault-finding, on how responsibility should be attributed, and whether reviews could accurately establish the causes of deaths. The facility-based death reviews were influenced by institutional and epistemic hierarchies, with responsibility often placed on individuals at the lowest health system level. While MPDSR aims to promote blame-free learning and quality improvement, the process narrowed attention to individual error, obscured systemic constraints, and hindered understanding of the 'real cause' of maternal deaths. To capture contextual complexity without adding reporting burden, we recommend expanding the free-text narrative fields in the official MPDSR maternal death report forms and increasing frontline representation in district- and regional reviews to strengthen links between facility and higher-level reviews.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"967-978"},"PeriodicalIF":3.5,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728865","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":"Improving medication availability through mobile wallets and pooled community funds: results from the MoPuleesa hypertension intervention in rural Uganda.","authors":"Vasanthi Subramonia Pillai, Caterina Favaretti, Andrew Basenero, John Bosco Ntambara, Ivan Wesva, Kafeero Martin Jonathan, Richard Munana, Juliette Cazier, Till Bärnighausen, Josephine Schwab, Jonas Wachinger, Robert Kalyesubula, Shannon A McMahon, Nikkil Sudharsanan","doi":"10.1093/heapol/czag044","DOIUrl":"10.1093/heapol/czag044","url":null,"abstract":"<p><p>In Uganda, frequent shortages of antihypertensive medications hinder continuity of care, undermining blood pressure management. Building on preliminary ethnographic research, this study evaluates a community-led, mobile-wallet-based pooling intervention-MoPuleesa-designed to improve medication access at a rural clinic in Nakaseke District, Uganda. Over a 7-month period, 183 patients enrolled and were linked to a digital savings platform that required monthly contributions of 5000 UGX (∼USD 1.39) into a communal fund to bulk-purchase medications at a discounted cost. Using survey data, transaction logs, and clinic records, we assessed contribution behavior, risk of adverse selection, equity, changes in medication availability, and patient blood pressure levels. On average, 48% participants contributed each month. Contribution rates showed no significant differences across education levels or medication costs, suggesting minimal equity concerns or adverse selection. Government pharmacies fulfilled only 8% of total prescriptions; however, for contributors, MoPuleesa closed 84% of the remaining medication gap. However, despite improvements in medication supply, we did not observe statistically significant improvements in blood pressure. Our findings demonstrate the feasibility and effectiveness of mobile money pooling in addressing chronic medication shortages. MoPuleesa achieved broad participation and equitable outcomes in a resource-constrained setting and significantly improved medication availability. We conclude that mobile-based fund pooling for medication can significantly improve medication supply and, with improvements in eligibility assessments, could serve as a complementary or intermediate solution to structural barriers in under-resourced health systems.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"929-941"},"PeriodicalIF":3.5,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13276264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147608752","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 Systems Research section: scope and future.","authors":"Neil Spicer, Bruno Marchal, Prashanth Srinivas, Mishal Khan, Kabir Sheikh","doi":"10.1093/heapol/czag052","DOIUrl":"10.1093/heapol/czag052","url":null,"abstract":"","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":"41 5","pages":"715-718"},"PeriodicalIF":3.5,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147971889","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 analysis of vitamin A supplementation delivery modalities in the DRC, Togo, and Niger: informing sustainable program design.","authors":"Lucia Corball, Kenya Chappel, Hannah Rowett, Arnaud Laillou, Andreas Hasman, Natsuki Kawai","doi":"10.1093/heapol/czag032","DOIUrl":"10.1093/heapol/czag032","url":null,"abstract":"<p><p>This study examines how the costs, health impacts, and efficiency of two-dose vitamin A supplementation (VAS) vary across delivery platforms, population subgroups, and delivery contexts in Togo, Niger, and the Democratic Republic of the Congo (DRC). Using a scenario-based model, it compares provider costs and disability-adjusted life years (DALYs) averted and identifies reallocations that maximize health gains under fixed budget constraints. Costs were estimated from the health provider perspective, and health outcomes were measured in DALYs averted. The results showed that cost-effective scenarios varied significantly across countries; in the DRC and Niger, campaigns delivered high coverage but at a substantially higher cost than routine delivery, whereas in Togo, campaigns were both low-cost and high-coverage. In all countries, the most cost-effective scenarios prioritized children aged 6-23 months. More than two-thirds of the cost-effective scenarios achieved better outcomes at lower cost than countries' current delivery strategies, highlighting significant potential for efficiency gains. A positive, nonlinear relationship between incremental costs and DALYs averted was observed: greater investment generally led to larger health gains but returns diminished as costs increased. A sensitivity analysis showed that facility-based supply shortages negatively affected effectiveness, whereas strengthened routine delivery improved effectiveness. Optimal VAS strategies must be context-specific, balancing the reach of campaigns with the sustainability of routine services. The decision tool provides a practical mechanism for identifying cost-effective delivery strategies tailored to national capacities and constraints.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"863-876"},"PeriodicalIF":3.5,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147432546","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":"Examining supplier-induced demand under regulated fees: dynamic panel evidence from Iran.","authors":"Cyrus Alinia, Hasan Yusefzadeh","doi":"10.1093/heapol/czag026","DOIUrl":"10.1093/heapol/czag026","url":null,"abstract":"<p><p>Cataract surgery is among the most frequently performed procedures globally and in Iran, often regarded as highly effective and cost-efficient. However, its rapid growth, particularly under a fee-for-service model, raises concerns about supplier-induced demand, where providers may influence patients to undergo potentially discretionary procedures to maintain income. We analyzed administrative data from the Iranian Armed Forces Insurance Organization, covering active and retired military personnel and their families across all 31 provinces. In total, 108 055 cataract surgeries performed by 644 ophthalmic surgeons during the study period were included. As service provision and coverage for armed forces beneficiaries may differ from the general population, through dedicated military hospitals or subsidized services in public hospitals, the findings primarily reflect utilization patterns within this insured population. We employed regression-based methods to examine the relationship between surgeon density and surgery rates. A 10% increase in ophthalmologist density is associated with a 4.9%-6.2% increase in surgery count, 7.3%-7.9% in service volume, and 1.5%-1.9% in service value, indicating both quantitative and qualitative dimensions of inducement. Lagged service variables demonstrated significant persistence, reflecting clinical inertia. Income became a significant determinant only in the dynamic model, highlighting the role of latent demand-side factors. Our findings provide evidence consistent with supply-sensitive utilization patterns predicted by SID theory in Iran's cataract surgery sector. These insights underscore the need for targeted policy interventions, including payment reform, utilization oversight, and equitable workforce distribution, to align provider behavior with clinical necessity and system efficiency.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"877-886"},"PeriodicalIF":3.5,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591874","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":"Privatization of maternal care and women's access to quality healthcare: a case study on middlemen in Bangladesh.","authors":"Afifa Shahrin, Nicole S Berry, John Richards, Craig R Janes, Abdul Halim","doi":"10.1093/heapol/czag012","DOIUrl":"10.1093/heapol/czag012","url":null,"abstract":"<p><p>This study critically examines how the unregulated expansion of private healthcare, coupled with health-system challenges such as corruption, and lack of monitoring and accountability, affects women's experiences of obtaining healthcare in Bangladesh. Based on in-depth qualitative interviews with 31 female patients, 28 biomedical providers, and 12 health administrators and policymakers, we found that the absence of effective regulation, supervision, and accountability, particularly in the private healthcare sector, has fostered an environment where private biomedical providers can engage in harmful practices. These practices are often facilitated by informal actors, popularly known as \"dalal\" (middlemen or brokers). These middlemen serve as marketing channels for many private healthcare providers, directing socially and economically marginalized women toward unregulated services. This situation can result in harmful medical practices, such as unnecessary hysterectomy surgeries, leading to serious complications like genital fistula. Our findings illustrate that increased access to healthcare providers, without adequate regulation and monitoring, fails to ensure a better quality of care for disadvantaged women and instead exacerbates their health issues while creating financial burdens for families. The presence of middlemen in healthcare is not merely indicative of individual misconduct but reflects broader policy and systemic failures. Addressing their role requires structural reforms that emphasize regulation, public accountability, and quality of care, alongside a critical re-examination of global health metrics that emphasize contact and access over equity and health outcomes.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"738-746"},"PeriodicalIF":3.5,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503666","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 care policy at the intersection of HIV and unemployment crises in South Africa: paradoxes and paradigms.","authors":"Manya van Ryneveld, Helen Schneider","doi":"10.1093/heapol/czag024","DOIUrl":"10.1093/heapol/czag024","url":null,"abstract":"<p><p>The community care sector is a major component of social protection systems in South Africa. However, despite considerable investment and policy attention on social protection in South Africa, the community care sector continues to face enormous challenges and pressures. On the one hand, government invests a significant amount in social spending and aims to honour its constitutional responsibilities towards improving the health and social welfare of the country. On the other hand, community-based care workers are socially and economically marginalised, and community care services remain fragmented and often inaccessible to those who need them most. This paper explores how elements of South African policy on the community care sector emerged historically out of policy responses to parallel social crises of HIV/AIDS and unemployment in the period 2000-10. We draw on the theories of John Kingdon (agenda setting) and Nancy Fraser (needs interpretation) as the lenses to analyse data from policy documents, published literature, and key informant interviews. We show the convergence and consolidation of policies across sectors in the study period into a community care sector characterised by competing and unresolved tensions: between constitutional promises of social and economic rights and enduring conceptualisations of social reproductive labour as feminised, devalued, and 'invisibilised' within the private, domestic sphere. This results in a community care sector that has limited effectiveness as an arm of the social protection system, and which continues to be plagued by the structural inequalities that characterise South African society.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"798-808"},"PeriodicalIF":3.5,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258166","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":"Government-led scale-up of task-shifted mental health services in Lagos State, Nigeria: a mixed-methods descriptive-explanatory case study.","authors":"Abiodun O Adewuya, Bolanle Ola, Olurotimi Coker, Olayinka Atilola, Olushola Olibamoyo, Azizat Lebimoyo, Olabisi Oladipo","doi":"10.1093/heapol/czag033","DOIUrl":"10.1093/heapol/czag033","url":null,"abstract":"<p><p>Mental health conditions remain a leading contributor to global disability; however, treatment coverage in low- and middle-income countries (LMICs) stays below 20%; in Nigeria, services are underfunded and largely excluded from primary health care (PHC). This study documents the institutional processes through which the Transition-to-Scale phase of the Mental Health in Primary Care (MeHPriC) initiative scaled up task-shifted mental health services across Lagos State, Nigeria. A retrospective, mixed-methods descriptive-explanatory case study was conducted across 57 PHCs and five general hospitals. The intervention delivered care for five priority mental, neurological, and substance use conditions using the Mental Health Gap Action Programme (mhGAP) framework; 890 health workers were trained, comprising 400 Community Health Extension Workers (CHEWs), 250 nurses, 150 medical officers, 85 lay counsellors, and 5 district psychiatrists, under structured district-level supervision. Data from service registers, supervision checklists, stock audits, provider and client surveys, key informant interviews, focus groups, and policy documents were analysed using descriptive statistics and hybrid deductive-inductive thematic coding organized around the World Health Organization (WHO) Health System Building Blocks and selected Consolidated Framework for Implementation Research (CFIR) constructs. The initiative was associated with institutional changes across governance (establishment of a Mental Health Desk and a multisectoral Stakeholders Council), workforce supervision (fidelity rising from 13% to 92.3% of facilities conducting weekly case reviews), medicines (six psychotropic medications added to the Essential Medicines List; stockouts reduced by 42%), financing (₦75 million allocated through routine government budgeting), service delivery (64 107 clients screened and 9138 initiated on treatment), and health information systems. Interpreted as incremental strengthening within the mental health subsystem, these findings reinforce the feasibility of mhGAP-aligned task-shifted care when supported by structured supervision and governance, while persistent fiscal and operational constraints underscore the fragility of institutional gains.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"785-797"},"PeriodicalIF":3.5,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147389919","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":"Health system response and recovery in Ukraine after 3 years of war: perspectives of front-line communities and internally displaced persons.","authors":"Mark Hellowell, Kateryna Kalendruz, Tetiana Bondar, Oleksiy Ganyukov, Jarno Habicht","doi":"10.1093/heapol/czag049","DOIUrl":"10.1093/heapol/czag049","url":null,"abstract":"<p><p>Communities affected by war can play a vital role in sustaining and restoring health services, yet their perspectives are under-represented in the evidence base. This study examines the experiences of patients and health personnel in three front-line areas of Ukraine, as well as persons internally displaced due to the full-scale invasion of February 2022. Our findings reveal community perspectives on the effects of war-related insecurity, workforce shortages, and infrastructure damage on health system functions and service availability. Respondents identified health worker shortages-driven by safety risks and resource scarcity-as among the most pressing concerns. Amid these challenges, however, recent health financing reforms, notably the Programme of Medical Guarantees and Affordable Medicines Programme, were often viewed as mitigating factors. Internally displaced persons (IDPs) generally reported positive care-seeking experiences in their host communities, though administrative and information-related barriers continue to limit access for some. Capacity constraints in areas hosting large numbers of IDPs are seen as placing further stress on service availability. Respondents valued the coordinated efforts of humanitarian actors and local authorities in restoring services, helping to maintain trust and social cohesion. Many were sceptical about the feasibility of large-scale reconstruction in the short term, prioritizing instead urgent security measures to protect facilities. However, they also acknowledged the importance of defining a long-term recovery strategy and identified workforce strengthening, integration of humanitarian services, and sustained financial protection as critical priorities.</p>","PeriodicalId":12926,"journal":{"name":"Health policy and planning","volume":" ","pages":"719-730"},"PeriodicalIF":3.5,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13187625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672529","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}