International Journal of Health Planning and Management最新文献

{"title":"Health Workers in Sub-Saharan Africa: Concurrent Skilled Health Worker Shortages and Under-Employment.","authors":"Pieternella Pieterse","doi":"10.1002/hpm.70001","DOIUrl":"https://doi.org/10.1002/hpm.70001","url":null,"abstract":"<p><p>In 2021, the World Health Organization (WHO) introduced the Health Workforce Support and Safeguards List, updating the 2010 WHO Global Code of Practice on the International Recruitment of Health Personnel. The change introduced a new way of defining what constitutes a country with a critical health worker shortage. The new calculations are based on a combined score of countries' health worker density per 1000 population and the Universal Health Coverage (UHC) service coverage index. It has led to an increase in the number of low- and middle-income countries (LMICs) considered at risk from active recruitment by high income countries (HICs). However, the 2021 WHO Safeguard list review failed to explicitly recognise the main causes of low health worker density in countries on the list. Many included countries are unable or unwilling to invest in their health sectors, which restricts the number of staff that can be hired. These countries experience high unemployment among trained and qualified health workers, despite their high need for health workers. Recent dramatic reductions in international aid and development support, means that LMICs that fail to invest in their health workforce, will face ever greater shortfalls in meeting the basic health needs of their populations. For WHO Safeguard-listed countries establishing bilateral health worker migration agreements, better support is needed to create fair deals that allow them to receive compensation from destination countries for the training costs of their emigrating health workers, which can be used to directly hire additional health workers back home.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distress Financing for Institutional Delivery in India: A Regional Analysis of Economic Inequality, Coping Mechanisms, and Contributing Factors.","authors":"Puja Pal, Juel Rana","doi":"10.1002/hpm.3950","DOIUrl":"https://doi.org/10.1002/hpm.3950","url":null,"abstract":"<p><strong>Background: </strong>Financial hardship is among the significant challenges in the utilization of maternal healthcare services in India. It is further aggravated by the issue of inequality in the distress financing (DF) for institutional delivery (ID) which pushes the poor into a vicious cycle of poverty. The paper examines the pattern of inequality and regional variation in DF for ID in India. It also determines the factor contributing to the inequality in the DF for ID among a few selected states.</p><p><strong>Methods: </strong>The paper uses unit-level data from the fifth National Family Health Survey (NFHS-5) round conducted during 2019-21. The concentration curve (CC) and concentration index (CI) capture the inequalities in DF for ID. Also, the decomposition analysis of CI was performed to capture the contribution of key determinants in explaining the inequality in DF for ID.</p><p><strong>Results: </strong>The study reveals that 16.3% of women in India incurred DF for ID, with the poorest quintile facing the highest burden (21.2%). Significant regional variations exist, with states like Telangana (30%) and Manipur (29.9%) showing the highest DF rates. Borrowing is the primary coping mechanism, particularly among the poorest. The concentration index (CI) analysis indicates that DF dominates among poorer women across states. Decomposition analysis highlights wealth status and education as the major contributors to inequality in DF, with significant regional disparities.</p><p><strong>Conclusions: </strong>Addressing DF for ID requires strengthening maternity benefit schemes like Janani Suraksha Yojana (JSY) to cover indirect costs and ensure timely disbursements while curbing informal charges. Reducing out-of-pocket expenditure (OOPE) through improving accessibility and quality of public hospitals and regulation of private facility fees is essential. Alongside, expanding health insurance for comprehensive maternity care is essential, particularly in high-inequality states like Telangana, Kerala, and Tamil Nadu. Promoting women's education and economic empowerment, could play a critical role in mitigating long-term disparities in healthcare.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pandemic Agreement: What's Next?","authors":"Tiago Correia, Marine Buissonnière, Martin McKee","doi":"10.1002/hpm.70000","DOIUrl":"https://doi.org/10.1002/hpm.70000","url":null,"abstract":"<p><p>The COVID-19 pandemic exposed critical weaknesses in global health governance, prompting the development of the WHO Pandemic Agreement, formally adopted by the World Health Assembly in May 2025. This landmark Agreement seeks to address the shortcomings of the 2005 International Health Regulations by establishing legally binding commitments to enhance pandemic preparedness, equity, and international solidarity. However, the negotiation process revealed deep geopolitical divisions, raising concerns about the Agreement's legitimacy and enforceability. Key provisions include improved surveillance, data sharing, protection for healthcare workers, and equitable access to medical countermeasures. Nevertheless, its effectiveness may be compromised by vague language, unresolved issues, and the absence or abstention of influential states. Implementation is further challenged by political fragmentation, sovereignty concerns, and disparities in national capacities. The Agreement's success will depend on sustained political will, robust accountability mechanisms, and meaningful national adoption. Ongoing debates over the definition of 'pandemic' and the WHO's limited enforcement powers underscore the tension between multilateral cooperation and national sovereignty. While the Agreement represents a significant step forward, it is not a panacea. Its promise lies in its potential to catalyse coordinated global action, but only if supported by genuine commitment and adaptive governance. As the world faces future health threats, the Pandemic Agreement must evolve into a practical tool for resilience, equity, and collective security.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Collaboration Between Primary and Secondary Mental Healthcare via Boundary Spanning: Evaluation of a New Joined-Up Community Mental Healthcare Model in England.","authors":"Lida Efstathopoulou, Jules Mackenzie, Rory Cameron, Adam P Wagner, Julia Jones, Jesus Perez","doi":"10.1002/hpm.3949","DOIUrl":"https://doi.org/10.1002/hpm.3949","url":null,"abstract":"<p><strong>Objectives: </strong>Community mental healthcare requires the collaboration of multiple services to meet the needs of local populations. Accessing mental health care in England often involves the collaboration of primary and secondary healthcare services. This paper presents the findings from an evaluation of 'boundary spanning' processes and practitioner roles aiming to reduce service fragmentation and improve access to mental healthcare.</p><p><strong>Methods: </strong>Forty-one qualitative interviews with professionals across local healthcare providers were conducted in Peterborough (East England) to assess the impact of boundary spanning processes and practitioner roles and were analysed thematically.</p><p><strong>Results: </strong>Structured boundary spanning processes and professional roles were found to facilitate communication and knowledge exchange between primary and secondary mental healthcare services, leading to optimisation of GPs' decisions about individuals' treatment pathways, and to improvements in service accessibility. Yet, effectiveness was reported as conditional on GPs' engagement, as well as the decentralised structure of primary care settings.</p><p><strong>Conclusion: </strong>Community mental healthcare organisations could utilise boundary spanning interventions to flex organisational barriers between primary and mental healthcare and optimise accessibility of service users to mental health services. Boundary spanning processes and professional roles can be used to inform national and local care integration strategies.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Balancing Stakeholder Interests: A Balanced Scorecard Perspective on Performance Appraisal Implementation in China's Public Hospitals.","authors":"Shufang Yao, Shaozhuang Ma, Lishuo Shi, Fang Wu, Elizabeth Reis","doi":"10.1002/hpm.3948","DOIUrl":"https://doi.org/10.1002/hpm.3948","url":null,"abstract":"<p><p>In 2019, the Chinese government initiated a National Performance Appraisal for Tertiary Public Hospitals (the 'National Appraisal'), but limited study has been conducted on its appraisal indicators and its implementation effects. This study aims to assess how well this system balances the interests of key stakeholders in Chinese public hospitals and examines the positive changes and concurrent challenges it has brought to hospital operations. Utilising stakeholder theory and the balanced scorecard, we conducted two rounds of Delphi consultations with experts (N₁ = 46, N₂ = 29). We also analysed archival data from three hospitals' 'National Appraisal' records covering 2018 to 2020. Additionally, we conducted semi-structured interviews (N = 41) with key stakeholders from these hospitals. Kendall's coefficient of concordance was employed in both rounds to gauge the agreement among experts and thematic analysis was applied to analyse data from in-depth interviews with the key stakeholders of the three sampled hospitals. The results show that: (1) The key stakeholders of Chinese public hospitals include patients, hospital executives, health care workers, health authorities, and the public, but the 'National Appraisal' indicators only cover the first three stakeholders; (2) The 'National Appraisal' system adopted a balanced scorecard approach, patient-centre and with emphases on internal process; (3) The 'National Appraisal' had positive impacts on hospitals, clarifying hospital strategy and prioritising the public roles, enhancing health care quality, safety, and efficiency, as well as patient and health care worker satisfaction. However, implementation challenges arise from resource constraints, discrepancy between appraisal indicators and patient needs, misalignment between appraisal indicators and doctor's patient care practices, and the tension between nationwide standardized appraisal and local context. This study significantly contributes to the literature by empirically examining performance appraisal implementation in an under-researched country's public hospitals, offering practical implications and policy recommendations for practitioners, managers, and policymakers.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144128779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pandemic Performance Measures of Resilience for Healthcare and Education in the Netherlands.","authors":"Sophie Hadjisotiriou, Tom H Oreel, Vincent A W J Marchau, Hubert P L M Korzilius, Jannie Coenen, Vittorio Nespeca, Etiënne A J A Rouwette, Vítor V Vasconcelos, Rick Quax, Heiman F L Wertheim, Marcel G M Olde Rikkert","doi":"10.1002/hpm.3943","DOIUrl":"https://doi.org/10.1002/hpm.3943","url":null,"abstract":"<p><p>During the COVID-19 pandemic, policymakers focused on improving health outcomes and safeguarding healthcare availability, which have led to negative consequences for other societal systems that persist today. The impact of these policies on health and non-healthcare systems depends on the resilience of these systems, that is, the capability of a system to maintain functioning during crises by using its adaptive capacity and transformative response. Policymaking during the COVID-19 pandemic might have benefitted from considering the resilience of non-healthcare societal systems and the impact of policy choices on these systems. However, so far, the development of resilience indicators for complex systems and their application in a pandemic context remains undervalued. Therefore, in this paper, we developed performance measures for the resilience of healthcare and education as showcases for pandemic policymaking. We applied a disaster management model (COPEWELL) to both the healthcare and educational system in the Netherlands. An initial list of performance measures for each system was established based on their national quality registries. To safeguard face and content validity actors ranked these measures for each system, resulting in five performance measures for each. The healthcare resilience measures cover healthcare performance both inside and outside hospitals, and the education resilience measures apply to primary, secondary schools, and higher education. Assessing the added value of multisystem policymaking using such resilience measures is a next step to be taken.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Public-Private Partnership a Significant Factor when Achieving Horizontal Equity in Public Healthcare Resources in Spain?","authors":"J De Haro-García, A Caro","doi":"10.1002/hpm.3944","DOIUrl":"https://doi.org/10.1002/hpm.3944","url":null,"abstract":"<p><p>Achieving horizontal equity in the access and use of public health resources is one of the main goals of the 17 Spanish regions. We analyse geographical inequities in the allocation of human and material resources for specialised care in Spanish hospitals, paying attention to the public-private partnership. We measure inequity using Gini, Concentration and Dissimilarity indices, and Lorenz and Concentration curves, and find that regions having fewer resources in the public sector and less public health spending tend to have higher levels of resources in the private sector, which could contribute to achieve horizontal equity in the public health system.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contributing Factors to Safety: What Hospitalized Patients Can Tell Us? A Cross-Sectional Study.","authors":"Franciely Daiana Engel, Caroline Cechinel-Peiter, Diovane Ghignatti da Costa, José Luis Guedes Dos Santos, Alacoque Lorenzini Erdmann, Elena Bohomol, Chantal Backman, Ana Lúcia Schaefer Ferreira de Mello","doi":"10.1002/hpm.3945","DOIUrl":"https://doi.org/10.1002/hpm.3945","url":null,"abstract":"<p><strong>Background: </strong>Brazil has the second-highest COVID-19 mortality rate worldwide. While there are currently no guidelines for involving patients in their own safety, recognising patients' valuable feedback can be decisive for the safety and quality of healthcare. Thus, this study aimed to describe the patient feedback on factors contributing to safety in patients hospitalised with COVID-19 in Brazil and to examine associations with patient sociodemographic and clinical characteristics.</p><p><strong>Methods: </strong>A cross-sectional study was conducted in nine Brazilian university hospitals. Data collection using the Patient Measure of Safety (PMOS) questionnaire was conducted by telephone with 447 patients who recovered from COVID-19. Descriptive and multilevel linear regression models were used to verify the sociodemographic characteristics associated with PMOS.</p><p><strong>Results: </strong>Patients felt safer when they accessed healthcare resources, when health professionals communicated well, and when they had good teamwork skills. Sociodemographic and clinical factors influenced the patient's perception of safety. A lower perception of safety was observed among patients aged 18-39 years old, of mixed race, and who had more than six symptoms during hospitalisation. Higher perceptions of safety were identified among patients with higher education, who lived in the countryside, and who required admission to the ICU.</p><p><strong>Conclusions: </strong>This study highlighted the potential for patients to become crucial allies in ensuring safety within hospital settings by providing insights into their care, and how sociodemographic characteristics can influence the perception of safety.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public-Private-Partnerships for Primary Care in India, Pakistan and Bangladesh: Lessons on Pathways and Drivers.","authors":"Shehla Zaidi, A Venkat Raman, Mahbub Elahi Chowdhury, Farooq Azam, Priya Balasubramanium","doi":"10.1002/hpm.3947","DOIUrl":"https://doi.org/10.1002/hpm.3947","url":null,"abstract":"<p><p>Formalised public-private-partnerships (PPPs) for primary care have proliferated in the mixed health systems of India, Pakistan and Bangladesh, managed and funded by the state. This perspective provides a process-based understanding of pathways adopted by home-grown PPPs and underlying drivers to identify lessons for advancement under Universal Health Coverage (UHC). PPPs have been deployed to respond to local primary care needs ranging from diagnostic screening, maternity services, management of government health centres, mobile clinics to urban primary care systems. Partnerships have evolved to include a diverse range of private partners and more purposeful arrangements, with increase in service volumes, innovations albeit less standardised quality of care. The pathway of PPP instigation, rollout and sustaining in South Asia is based on local starting points by sub-national governments, diffusion of practice across states, common interests and shared bureaucratic coalitions. Success drivers include administrative support beyond the health sector, simplified contractual and payment systems providing operational ease and decision space, and the use of relational management and digital monitoring for resolving issues. However, PPPs are constrained by either too little accountability or excessive accountability in contract design, trust deficits between private and government, and fire-walled PPP implementation creates disconnects from national primary care planning and regulation. Donor supported projectized PPP funding and accompanying rules of business makes PPPs implementation more cumbersome. We conclude that future attention must centrally focus on pathways and drivers to impactfully introduce, scale-up and sustain PPPs in South Asia. Emphasis must be on pathways that build on local simplified ideation, progressive adaptation and allowing contextual diversity under a larger UHC planning architecture, as opposed to centralised one-fit and heavily technocratic initiatives. Success drivers must feature in design of PPP initiatives. Furthermore, we contend that international donor assistance should shift from projectized support for PPPs to building public sector competencies for stewardship, private sector engagement skills as well as the more traditional performance management capacity.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Burden of Disease Due to High Body Mass Index and Projections to 2040: A Study Based on the Global Burden of Disease Study 2019.","authors":"Eun-Ji Kim, Yoonseo Park, Sewon Park, Mihajlo Jakovljevic, Munjae Lee","doi":"10.1002/hpm.3946","DOIUrl":"https://doi.org/10.1002/hpm.3946","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of high body mass index (BMI) contributes to an increased risk of various diseases. This study aimed to identify global disease burden trends associated with high BMI from 1990 to 2019 and forecasts up to 2040.</p><p><strong>Methods: </strong>Using data from the global burden of disease (GBD) 2019 study, we analysed the number and ratio of disability-adjusted life years (DALYs) related to high BMI. The data were analysed by sex, ages, socio-demographic index (SDI), world health organization (WHO) region, and disease level. The autoregressive integrated moving average (ARIMA) model was employed to predict high BMI-related disease burden up to 2040.</p><p><strong>Results: </strong>In 2019, the global burden of disease due to high BMI was 1932.54 (95% uncertainty interval [UI]: 1276.61, 2639.74), representing an increase of 0.18 (95% UI: 0.02, 0.42). Disease burden was consistently higher in males, middle-aged and older populations, particularly noting a narrowing gap between those aged 50-69 years and≥ 70 years in the forecast results until 2040. Additionally, regions with a middle SDI and the North Africa and Middle East WHO super-regions exhibited the highest disease burdens. Also, Cardiovascular disease ranked highest among diseases.</p><p><strong>Conclusion: </strong>The rising disease burden associated with high BMI highlights the need for targeted health policies focussing on older populations, low and middle-income countries, and major conditions like cardiovascular disease and diabetes. Addressing these trends requires an integrated, equity-focused approach to health planning and management to mitigate global impacts.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}