Health systems and reform最新文献

Mexico's New Health Reform: El Servicio Universal de Salud. 墨西哥的新卫生改革：全民卫生服务。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-07-06 DOI: 10.1080/23288604.2026.2688285

Michael R Reich

引用次数: 0

Poor Accountability and Corruption in Primary Healthcare in Nigeria: Subnational Governance Deficiencies Matter. 尼日利亚初级保健问责不力和腐败：地方治理缺陷问题。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-03-19 DOI: 10.1080/23288604.2026.2630426

Prince Agwu, Charles Orjiakor, Aloysius Odii, Pamela Ogbozor, Eleanor Hutchinson, Martin McKee, Obinna Onwujekwe, Dina Balabanova

{"title":"Poor Accountability and Corruption in Primary Healthcare in Nigeria: Subnational Governance Deficiencies Matter.","authors":"Prince Agwu, Charles Orjiakor, Aloysius Odii, Pamela Ogbozor, Eleanor Hutchinson, Martin McKee, Obinna Onwujekwe, Dina Balabanova","doi":"10.1080/23288604.2026.2630426","DOIUrl":"10.1080/23288604.2026.2630426","url":null,"abstract":"The formal structures in a health system, characterized by the enforcement of rules and regulations, effective human resource management, and adequate funding, are critical contributors to effective governance and optimal health service delivery. Conversely, shortcomings in these domains could lead to poor accountability and corruption within the system. Therefore, this study assesses the state of Nigeria's subnational governance structures that are conventionally and increasingly responsible for primary healthcare (PHC) delivery. In this qualitative phenomenological study, we conducted and analyzed interviews with senior managers within the PHC system. We found significant informalities and deficiencies in four areas: (a) absence of local interest in strengthening PHC, (b) weak documentation and enforcement of written rules, (c) poor practices and processes of human resource management, and (d) erratic financing of PHC. These deficiencies are seen to encourage the continuation of corruption and weaken institutional capacity to provide effective PHC. We argue that investing in PHC without first addressing these deficiencies as key aspects of subnational governance may result in wasted resources. Based on our findings, we present critical areas to consider for a well-governed PHC system to enhance accountability and address corruption at the healthcare level. The findings of this study are now more important than ever, particularly in light of a Supreme Court ruling on the autonomy of Local Government Areas (LGAs) in Nigeria and the push for state governments to ensure effective PHC services. The study demonstrates critical areas for strengthening the subnational administration of primary healthcare institutions across low- and middle-income countries (LMICs).","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"12 1","pages":"2630426"},"PeriodicalIF":1.9,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147488797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effects, Challenges, and Preconditions for Implementing Direct Health Facility Financing and the Prime Vendor Model in Low-Resource Settings: The Experience from Tanzania. 在低资源环境下实施直接卫生设施融资和主要供应商模式的影响、挑战和先决条件：来自坦桑尼亚的经验。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-09-15 DOI: 10.1080/23288604.2026.2720979

Peter Binyaruka, Douglas Ndeki, Raymond Kiwesa, Regina Joseph, Bakari Salum

{"title":"Effects, Challenges, and Preconditions for Implementing Direct Health Facility Financing and the Prime Vendor Model in Low-Resource Settings: The Experience from Tanzania.","authors":"Peter Binyaruka, Douglas Ndeki, Raymond Kiwesa, Regina Joseph, Bakari Salum","doi":"10.1080/23288604.2026.2720979","DOIUrl":"https://doi.org/10.1080/23288604.2026.2720979","url":null,"abstract":"Primary health care (PHC), while critical to achieving universal health coverage, remains underfunded and often delivers poor-quality care. In response, Tanzania introduced two innovative and complementary reforms-Direct Health Facility Financing (DHFF) and the Prime Vendor Model-to improve PHC financing and commodity availability by decentralizing financial management and granting greater autonomy to align financing with local needs. DHFF involves direct transfer of funds to PHC facility bank accounts, enabling timely access to resources and strengthening local decision-making. The Prime Vendor Model reduces stock-outs of essential drugs by allowing facilities to use available funds in their bank accounts to procure commodities from accredited private vendors when the central medical store is out of stock. This paper presents a critical reflection on the effects of these reforms on PHC autonomy, quality of care, and strategic healthcare purchasing. This analysis draws on a targeted review of the literature and the authors' implementation experience as researchers and ministry officials overseeing the reforms. It also highlights key implementation challenges, including delays in disbursement, rigid financial regulations, and limited facility-level capacity. This paper concludes by outlining key enabling conditions and implementation lessons for other LMICs considering similar reforms, emphasizing the importance of policy integration, strong public financial management systems, capacity building, and navigating political dynamics to ensure successful implementation.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"12 1","pages":"2720979"},"PeriodicalIF":1.9,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ethical Principles for Planetary Health: A Preliminary Inquiry. 地球健康的伦理原则：初步调查。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-03-19 DOI: 10.1080/23288604.2026.2619156

Michael R Reich

引用次数: 0

Expanding Social Health Insurance Coverage for the Informal Sector in Zambia: Lessons and Insights from LMICs. 扩大赞比亚非正规部门的社会健康保险覆盖面：来自中低收入国家的经验教训和见解。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-01-09 DOI: 10.1080/23288604.2025.2592387

Oliver Kaonga, Jackson Otieno, Mark Malema, Mary Mwami, Lukundo Simwinga, Rose Oronje

{"title":"Expanding Social Health Insurance Coverage for the Informal Sector in Zambia: Lessons and Insights from LMICs.","authors":"Oliver Kaonga, Jackson Otieno, Mark Malema, Mary Mwami, Lukundo Simwinga, Rose Oronje","doi":"10.1080/23288604.2025.2592387","DOIUrl":"10.1080/23288604.2025.2592387","url":null,"abstract":"Progress toward Universal Health Coverage (UHC) remains a priority for low- and middle-income countries (LMICs). For countries that have adopted Social Health Insurance (SHI) as a strategy, expanding coverage among informal sector households presents an important pathway to this goal. This scoping review examines strategies and interventions employed in LMICs to improve the enrollment and retention of informal sector households in SHI schemes. The review highlights common barriers, including irregular incomes, limited awareness, administrative challenges, and trust deficits. Potential strategies include designing flexible contribution mechanisms, simplified registration processes, targeted awareness campaigns, leveraging existing community structures, and designing comprehensive benefit packages that balance coverage goals with fiscal sustainability. Our findings emphasize the importance of context-specific and innovative approaches that could include tiered premiums, mobile payment platforms, and partnerships with microfinance institutions to address financial and logistical barriers. However, there is also evidence to suggest that net revenue gains from contributory mechanisms are typically modest, with enrollment expansion often requiring substantial public subsidies and incurring additional administrative costs. For Zambia, integrating some of these lessons into the National Health Insurance Scheme (NHIS) offers a pathway to enhancing coverage among the informal sector and advancing equitable access to healthcare, while acknowledging the fiscal constraints.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"12 1","pages":"2592387"},"PeriodicalIF":1.9,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145947063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Pragmatic Call to Integrate and Regulate Non-State Actors in Fragile Health Systems. 在脆弱的卫生系统中整合和规范非国家行为体的务实呼吁。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-08-18 DOI: 10.1080/23288604.2026.2708910

Augustus Osborne, Abdirasak Sharif Ali, Umaru Sesay

{"title":"A Pragmatic Call to Integrate and Regulate Non-State Actors in Fragile Health Systems.","authors":"Augustus Osborne, Abdirasak Sharif Ali, Umaru Sesay","doi":"10.1080/23288604.2026.2708910","DOIUrl":"https://doi.org/10.1080/23288604.2026.2708910","url":null,"abstract":"In fragile states, healthcare delivery relies on non-state actors like NGOs and private providers. Short-term donor funding has created fragmented services and weak state capacity. However, donor-driven fragmentation is not only a technical coordination problem; it is also a political economy problem shaped by earmarking, attribution pressures, fiduciary risk aversion, donor-controlled contracts, and upward accountability to funders. We propose shifting from state-as-provider to state-as-steward, not as a choice between two mutually exclusive roles, but as a move toward pluralistic health-system stewardship in which the state may continue to provide some services while stewarding a mixed delivery system. This means integrating the \"shadow health system\" of non-state services into national health systems through licensing, contracting, and monitoring providers, while unified standards support coordination. Pooled or jointly governed financing, independent verification, shared reporting metrics, and community accountability are needed to align donor incentives with national priorities. Evidence from Afghanistan, Cambodia, Liberia, and other fragile settings demonstrates that contracting and regulation can improve access and oversight. Where governments lack legitimacy, territorial control, or impartiality, stewardship should be adapted through subnational, regional, hybrid, or independently verified mechanisms. Effective stewardship therefore requires rebalancing power, financing, risk, metrics, reporting, and accountability among donors, ministries, non-state actors, and communities.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"12 1","pages":"2708910"},"PeriodicalIF":1.9,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Antimicrobial Resistance in Somalia: Policy Without Implementation in a Fragile Health System. 索马里的抗菌素耐药性：脆弱卫生系统中缺乏实施的政策。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-10-01 DOI: 10.1080/23288604.2026.2712053

Aniso Mohamed Abdi, Hibo Hassan Mohamed, Ilyas Abdullahi Khalif, Ahmed Mohamed Omar, Nour Ahmed Dahir

{"title":"Antimicrobial Resistance in Somalia: Policy Without Implementation in a Fragile Health System.","authors":"Aniso Mohamed Abdi, Hibo Hassan Mohamed, Ilyas Abdullahi Khalif, Ahmed Mohamed Omar, Nour Ahmed Dahir","doi":"10.1080/23288604.2026.2712053","DOIUrl":"https://doi.org/10.1080/23288604.2026.2712053","url":null,"abstract":"Antimicrobial resistance (AMR) is quietly becoming Somalia's next health catastrophe. While the world focuses on immediate crises, an estimated 8,400 deaths annually are directly attributed to AMR, with another 32,700 linked to AMR complications. These numbers place Somalia among the top 10 countries globally for AMR-related mortality, surpassing deaths from maternal disease, cardiovascular conditions, and infectious disease combined. Yet Somalia has a national action plan. The problem is not policy; it is implementation. Despite developing an AMR National Action Plan aligned with global strategies, Somalia's fragile health system, weak governance, limited laboratory capacity, and unregulated antibiotic markets have created a perfect storm for untreated resistance to flourish. Community-level drivers, including self-medication, over-the-counter antibiotic access, and incomplete treatment courses, remain unaddressed. This commentary argues that AMR in Somalia is fundamentally a governance failure, not a biomedical one. We identify critical barriers: absent laboratory surveillance systems, inadequate infection prevention and control, lack of Water, Sanitation, and Hygiene (WASH) infrastructure, and missing community engagement strategies. Addressing AMR requires integrated, system-level approaches including strengthening multisectoral coordination, investing in diagnostic capacity, embedding community voices into policy design, and securing sustainable financing. Without urgent action to bridge the policy-implementation gap, AMR will become an unmanageable health security emergency in Somalia.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"12 1","pages":"2712053"},"PeriodicalIF":1.9,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Global Mega-Challenges and International Collaboration in Science, Education, and Health. 科学、教育和卫生领域的全球重大挑战和国际合作。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-03-19 DOI: 10.1080/23288604.2026.2627652

Harvey V Fineberg

引用次数: 0

A Health System Approach to Address Diabetes. 解决糖尿病的卫生系统方法。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-01-27 DOI: 10.1080/23288604.2026.2612754

Pablo Villalobos Dintrans, Abdo S Yazbeck, Barbara McPake, Michael R Reich

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Challenges to Achieving Universal Health Coverage Through Public Financial Management Reforms: Insights from the Implementation of Single Nodal Agency Reform in India. 通过公共财政管理改革实现全民健康覆盖的挑战：来自印度实施单一节点机构改革的见解。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-07-21 DOI: 10.1080/23288604.2026.2693357

Mita Choudhury, Nitya Chutani

{"title":"Challenges to Achieving Universal Health Coverage Through Public Financial Management Reforms: Insights from the Implementation of Single Nodal Agency Reform in India.","authors":"Mita Choudhury, Nitya Chutani","doi":"10.1080/23288604.2026.2693357","DOIUrl":"https://doi.org/10.1080/23288604.2026.2693357","url":null,"abstract":"Public Financial Management (PFM) reforms are being increasingly recognized for their potential to enhance health financing systems and advance progress toward Universal Health Coverage (UHC). Although theoretical frameworks have outlined the pathways through which PFM reforms operate, empirical evidence on their effectiveness in specific low- and middle-income country (LMIC) contexts remains limited. This paper examines the reform of the Single Nodal Agency (SNA) system in India, aimed at improving budget execution in centrally funded schemes, including the flagship health sector scheme, the National Health Mission (NHM). The study analyzes the gains and challenges associated with the reform and highlights the institutional features that are critical to its effectiveness. The study draws on an assessment of SNA implementation in two Indian states, Bihar and Odisha, using qualitative evidence from key informant interviews conducted across multiple administrative levels between February 2023 and February 2024. This was supplemented with data provided by state finance departments and NHM implementing agencies. Results indicate that the reform has achieved its intended gains in cash management, expenditure transparency, and improved alignment of central fund releases with scheme expenditures at the sub-national level. However, weak budget credibility, coupled with constraints in digital connectivity and limited personnel capacity to manage financial transactions, is likely to exacerbate inequities in access to scheme funds. The increased emphasis on spending has heightened compliance pressures on fund utilization, while attention to actual health system outcomes remains limited. In sum, a conducive institutional environment is essential for reaping benefits through PFM reforms in LMICs.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"12 1","pages":"2693357"},"PeriodicalIF":1.9,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0