International Journal of Health Planning and Management最新文献

{"title":"Expanding the Public Health Response to Economic Warfare Through a One Health Integration.","authors":"Rosa Ferrinho, Paulo Ferrinho","doi":"10.1002/hpm.70020","DOIUrl":"https://doi.org/10.1002/hpm.70020","url":null,"abstract":"","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974439","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":"Employed but Unpaid, Volunteers or Paradoxical Surplus? Sierra Leone's Unsalaried Health Workforce.","authors":"Pieternella Pieterse, Federico Saracini","doi":"10.1002/hpm.70016","DOIUrl":"https://doi.org/10.1002/hpm.70016","url":null,"abstract":"<p><strong>Background: </strong>In 2016, 36.5% of Sierra Leone's health workforce consisted of unsalaried clinical staff whose payroll inclusion was deferred. The Ministry of Health introduced policies to reduce this percentage, renewing pledges to introduce health workforce planning. This paper focuses on how many unsalaried clinical staff currently work in public health facilities, based on a survey among Sierra Leone's District Health Management Teams. The study also draws on qualitative responses from unsalaried health workers regarding their coping strategies.</p><p><strong>Methods: </strong>A mixed methods approach was used, and this paper reports primarily on the survey conducted among all 16 district health authorities in 2023 and 2024. Findings from qualitative data collected among health workers, salaried and unsalaried, is also reported on.</p><p><strong>Findings: </strong>10 out of 16 districts shared staffing data, representing 55% of the population. Just over half of all Peripheral Health Unit clinical staff was unsalaried, and in 7 out of 10 districts those who were unsalaried outnumbered salaried staff. Only the capital Freetown had a large cohort of salaried clinical health workers, 58% in total. The coping strategy information from unsalaried health workers confirmed their financial hardship and formal, and sometimes informal, income generating activities.</p><p><strong>Discussion/conclusion: </strong>Unsalaried clinical health worker numbers have increased in PHUs since 2016; an estimated 4000-5000 unsalaried clinical staff is in precarious employment, awaiting payroll inclusion. The majority of this 'paradoxical surplus' of health workers is trained to auxiliary cadre, meaning their eventual payroll inclusion will not increase the country's skilled-health-worker-to-population ratio, or improve Universal Health Coverage rates.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800617","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":"Temporal Trends in Patient Choice of Outpatient Care Provider Among Vietnam's Insured Rural Residents, 2006-2020.","authors":"Ardeshir Sepehri, Khac Nguyen Minh, Phuong Hung Vu, Thai Minh Pham","doi":"10.1002/hpm.70013","DOIUrl":"https://doi.org/10.1002/hpm.70013","url":null,"abstract":"<p><p>Much of the existing empirical literature on patient choice of medical care provider in low- and middle-income countries is cross sectional in nature. Comparatively little is known about the dynamic shifts in patient choice of provider, particular under transitions to universal health coverage. Using eight biennial waves of Vietnam's Household Living Standard Survey covering the period 2006-2020 and a multilevel multinomial logit model, this study examined temporal trends in patient choice of provider among the insured rural residents. Patient choice of provider shifted steadily from commune health centres (CHCs) towards public hospitals and private health facilities over the study period. Patients were 3.9 and 8.3 times, respectively, as likely to use higher-level government hospitals and private hospitals over CHCs in 2018-2020 than in 2006-2008, and 2.8-3 times as likely to use district hospitals or private clinics. The shifts were more pronounced for economically better-off patients than the less better-off patients. Relative to 2006-2008, patients in the top three expenditure quintiles were 5.4 times as likely to use higher-level government hospitals over CHCs for a medical treatment in 2018-2020 than patients in the bottom two expenditure quintiles, and by as much as 11.5 times as likely to use private hospitals. These findings call for systemic policy measures that would relocate the entry point to the health system from hospital outpatient departments to grassroots primary care services and to improve public and private hospital accountability as a way of ensuring equitable access to high-quality essential health care for all.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733977","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":"'Silent Losses-Silent Data': Reviewing Stillbirth Data Quality in Low- and Middle-Income Countries Using Data Quality Dimensions.","authors":"Anuj Kumar Pandey, Sutapa Bandyopadhyay Neogi, Diksha Gautam, Benson Thomas M, Jayati Basu, Debashis Basu, Dyah Anantalia Widyastari","doi":"10.1002/hpm.70012","DOIUrl":"https://doi.org/10.1002/hpm.70012","url":null,"abstract":"<p><p>Precise data is crucial for policy decision-making, especially in sensitive outcomes like stillbirth, where each data element have significant effects. Following years of advancement in the healthcare domain, there is a pressing need to improve data-based policymaking by addressing both the social context and emotional dimensions. This holds true for any healthcare condition including stillbirth, which demands the attention of healthcare managers, researchers and policymakers. Conditions such as stillbirth signify more than a birth devoid of vital signs. A mother endures months of discomfort and excruciating labour pain and faces the devastating reality that her baby is no longer alive. The absence of her child's initial cry disrupts her life, causing her to struggle with confusion and sadness on the factors that may have led to this catastrophe. In spite of this significant loss, we typically perceive it as merely one death, often neglecting to acknowledge it adequately. Significant advancements in averting stillbirths can be achieved by viewing it as a loss of life, rather than only perceiving it as the birth of a lifeless infant. Examining stillbirth data and comprehending its causes can aid in formulating strategies to avert future incidents. This publication seeks to compile information on the principal issues associated with the reporting and recording of stillbirths in low- and middle-income countries (LMICs) from the perspective of data quality aspects. Furthermore, it also proposes strategies to enhance each aspect of data quality like harmonising stillbirth definitions, linking routine data systems with surveys, facility audits for better data capture, and increasing funding for stillbirth-related research etc.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733976","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":"Cross-Border Health Governance in Collapse: The Case for Buffer Health Corridors in the Gaza Strip.","authors":"Muhammad Hamza Shah, Bilal Irfan","doi":"10.1002/hpm.70014","DOIUrl":"https://doi.org/10.1002/hpm.70014","url":null,"abstract":"<p><p>The collapse of Gaza's health system has rendered traditional models of health planning and humanitarian coordination functionally obsolete. With fewer than half of Gaza's hospitals partially operational and over 90% of health infrastructure damaged or destroyed, the territory is no longer capable of delivering essential services such as dialysis, obstetric care, or oncology treatment. This letter argues that a permanent, internationally managed cross-border health corridor-anchored via the Rafah crossing-offers a feasible and urgent solution to provide structured, rights-based care amid systemic collapse. Drawing on precedents from Syria, the Democratic Republic of Congo, and global humanitarian law, we outline the legal, operational, and political frameworks necessary to establish such a corridor. The corridor model is presented as not only a response to Gaza's immediate crisis but also a replicable framework for other protracted conflict zones where national health systems have irreversibly failed.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718905","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":"Job Satisfaction of Registered Dietitians Across Workplace Settings and Sectors in Lebanon: A Cross- Sectional Study.","authors":"Mira Daher, Carole Serhan, Mireille Serhan","doi":"10.1002/hpm.70015","DOIUrl":"https://doi.org/10.1002/hpm.70015","url":null,"abstract":"<p><p>Lebanese registered dietitians are employed in various practice settings; however, little is known about their job satisfaction. This cross-sectional study aimed to determine job satisfaction among Lebanese female dietitians working in different professional fields, between the private and the public sector. Job satisfaction was measured with Spector's Job Satisfaction Survey (JSS) as a validated tool. Descriptive statistics were performed on socio-demographic data. The comparison of the nine facets in job satisfaction among eight workplace fields was conducted using the Kruskal-Wallis test. The same test was used for the comparison between the private and the public workplace sectors. In our study, dietitians were found to be satisfied with their job with a median score of 146 and a significant difference among different workplaces (X² = 572.341, p < 0.001), with those working in hospitals being the most satisfied. Participants reported moderate satisfaction in the areas of promotion (facet satisfaction score [FSS] = 14; p = 0.013), supervision (FSS = 14; p = 0.027), operating conditions (FSS = 14, p = 0.004) and co-workers (FSS = 15; p = 0.012). They expressed satisfaction with the nature of their work (FSS = 19; p = 0.003) but dissatisfaction with communication (FSS = 11; p = 0.018). No statistically significant differences were found in the facets of payment (FSS = 14; p = 0.117), fringe benefit (FSS = 14; p = 0.210) and contingent rewards (FSS = 14; p = 0.178). Additionally, satisfaction levels varied significantly between employment sectors (X² = 581.762, p < 0.001), with those in the public sector reporting higher satisfaction 127.50 ± 22.96) compared to those in the private sector (126.50 ± 17.91). Despite the generally positive attitudes towards practicing their profession, this study has provided a deeper understanding of the factors influencing their job satisfaction. It is recommended that all organizations employing dietitians in Lebanon be encouraged to conduct regular job satisfaction assessments. These efforts would contribute to enhancing the well-being of dietitians and better equipping policy-and strategy-makers with the necessary insights to effectively improve workplace conditions.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700094","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":"Equity in Health Policy for Persons With Disabilities in Brazil: Spatial Distribution of Specialised Rehabilitation Centres.","authors":"Paulo Henrique Dos Santos Mota, Bianca Tomi Rocha Suda, Patricia Marques Moralejo Bermudi, Francisco Chiaravalloti Neto, Aylene Bousquat","doi":"10.1002/hpm.70010","DOIUrl":"https://doi.org/10.1002/hpm.70010","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the spatial distribution of Specialised Rehabilitation Centres (CERs) in Brazil, considering the prevalence of persons with disabilities (PWD), socioeconomic factors, and health financing.</p><p><strong>Methods: </strong>An ecological study design was employed, using descriptive and Bayesian spatial regression analyses on data from 438 health regions in Brazil. The presence or absence of CERs in these regions was the main outcome. Covariates included PWD population, socioeconomic indicators, health service funding, and health system factors.</p><p><strong>Results: </strong>The study revealed that CERs are present in only 32% of health regions, with significant associations between CER implementation and factors such as monthly per capita household income, health expenditure per inhabitant, and regional GDP. Notably, the increase in PWD numbers did not directly correlate with CER implementation at the regional level.</p><p><strong>Conclusion: </strong>The implementation of CERs is influenced by economic and health service factors, not just by the prevalence of PWD. To improve equity in access, it is essential to prioritise CER implementation in regions with higher rehabilitation needs and better utilise available data on disability demographics. Comprehensive, integrated care for PWD requires interdisciplinary and intersectoral actions.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660788","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 Exodus and Its Toll: Sri Lanka's Economic Crisis and the Migration of Doctors.","authors":"Madunil Niriella, Krishanni Prabagar, Pathum Premaratna, Ravini Premaratna, Saroj Jayasinghe, Tiloka de Silva, Nilanthi de Silva, Janaka de Silva","doi":"10.1002/hpm.70011","DOIUrl":"https://doi.org/10.1002/hpm.70011","url":null,"abstract":"<p><p>The migration of qualified medical doctors from low- and middle-income countries (LMICs) to high-income countries (HICs) presents substantial challenges for healthcare systems, particularly in resource-limited settings. This study examines the recent surge in doctor migration from Sri Lanka following its unprecedented economic crisis. We aimed to quantify the economic and systemic impacts of the migration of qualified doctors on healthcare service delivery, medical education, and health equity, and explore feasible policy interventions to mitigate these effects. We conducted a mixed-methods policy analysis using national and international data between 2022 and 2024, including Ministry of Health data, Post-Graduate Institute of Medicine figures and international Medical Council reports. We estimate that nearly 1489 doctors, including specialists, migrated during this period, resulting in a financial loss of approximately LKR 12.5 billion (USD 41.5 million) to the Sri Lankan government and taxpayers. This migration has strained healthcare infrastructure, particularly in rural and underserved areas, led to shortages in critical specialities, disrupted medical education, and exacerbated inequities in access to care. Existing retention mechanisms, such as post-training service bonds, have been largely ineffective. We discuss a range of policy options, including improved enforcement of bonds, strategic use of dual citizenship, bilateral tax-sharing agreements, and investments in working conditions and training infrastructure to retain medical talent. In conclusion, the migration of doctors presents a multidimensional threat to Sri Lanka's public healthcare system. Urgent, evidence-based interventions are essential to preserve the sustainability of free healthcare and medical education systems in LMICs under similar duress.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144650897","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":"Waiting for Specialists: A Multi-Priority and Multi-Speciality Analysis.","authors":"Pedro G Rodrigues, Maria João Bárrios, Marta S G Mendes","doi":"10.1002/hpm.70007","DOIUrl":"https://doi.org/10.1002/hpm.70007","url":null,"abstract":"<p><p>Manageing waiting times for specialist consultations is a critical challenge for healthcare systems worldwide. This study examines how hospitals manage outpatient specialist consultations through multi-priority systems, analysing nearly a million consultations across 29 medical specialities at a major Portuguese hospital (2010-2019). Using fixed-effects models with Driscoll-Kraay standard errors, we investigate how operational factors affect waiting times for first consultations across three priority levels. Each additional day spent in triage adds 0.52 days to urgent consultation waits (p < 0.10) but 1.41 days for routine cases (p < 0.01), demonstrating how delays cascade through the system. Staffing changes primarily benefit routine consultations, reducing waiting times by 1.88 days per additional specialist (p < 0.05). Our analysis reveals sophisticated cross-priority effects: backlogs in higher-priority cases significantly increase waiting times for lower-priority consultations, with each additional high-priority case increasing normal-priority waits by 0.15 days (p < 0.001), showing how hospitals actively protect urgent access while systematically manageing delays for routine appointments. Provider-initiated cancellations disproportionately affect lower-priority cases (0.03 days, p < 0.01), whereas urgent consultations show resilience to scheduling disruptions. A 2017 policy reform reducing maximum waiting times triggered speciality-specific adaptations. Despite increased waiting times across all priority levels (p < 0.05), cardiac units implemented operational adjustments: enhanced triage efficiency (-30.88 days, p < 0.001), improved backlog management (-0.25 days, p < 0.001), and optimised capacity utilization (-0.18 days, p = 0.056). These findings show how hospitals balance clinical prioritisation with system efficiency, as speciality-specific constraints shape access outcomes. We highlight the need for targeted resource allocation and sophisticated triage systems that adapt to changing pressures while maintaining clinical priorities.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620850","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":"Inequality in Health Insurance Coverage in a Pluralistic Health Insurance System: Evidence From India.","authors":"Pragyan Monalisa Sahoo, Himanshu Sekhar Rout","doi":"10.1002/hpm.70008","DOIUrl":"https://doi.org/10.1002/hpm.70008","url":null,"abstract":"<p><strong>Background: </strong>Persistent inequality in financial protection mechanisms in healthcare continues to be a major challenge within India's pluralistic health insurance system, disproportionately disadvantaging marginalised groups.</p><p><strong>Methods: </strong>Our study uses NFHS 4 and 5 household data to investigate inequality in health insurance coverage prevalence and transition across socioeconomic and demographic strata. It categorises health insurance coverage based on the number and type of coverage, considering factors such as the provider, pooling mechanism, and target population. We employ descriptive statistics and the concentration index to assess the prevalence of health insurance coverage. To delve deeper into the factors influencing enrolment in different types of coverage, we created 24 mutually exclusive groups at the intersection of sex-income-marriage-caste. These categories, along with other explanatory variables, are analysed for their influence on the enrolment of coverage using multinomial logistic regression models.</p><p><strong>Results: </strong>Although the proportion of health insurance coverage increased from NFHS 4 to NFHS 5, 59.01% of the sample population still lacked coverage, indicating insufficient progress. Both surveys reveal significant disparities in coverage based on state-level, social, economic, and demographic factors. While the role of social and demographic determinants remains relatively modest, the distributional gradient of insurance prevalence across economic strata and state categories was high. India's pluralistic health insurance system has resulted in the population being covered under different coverage mechanisms. However, among these various types of coverage, the majority of sample households were only single, predominantly under SHI.</p><p><strong>Conclusions: </strong>The study investigated disparities in health insurance coverage across various social, economic, and demographic segments in India, revealing that inequalities are influenced by a combination of state-level, socioeconomic, and demographic factors. These findings call for a unified and inclusive health financing framework that can address systemic fragmentation. Moving towards a 'One Nation, One Insurance' model offers a transformative pathway to ensure equitable, efficient, and universal health coverage for all Indians. Addressing these determinants presents potential policy tools for improving coverage imbalances, thereby offering opportunities for targeted interventions to mitigate disparities.</p>","PeriodicalId":47637,"journal":{"name":"International Journal of Health Planning and Management","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609896","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}