Health systems and reformPub Date : 2025-12-31Epub Date: 2025-01-06DOI: 10.1080/23288604.2024.2417788
Boon-How Chew, Pauline Siew Mei Lai, Dhashani A/P Sivaratnam, Nurul Iftida Basri, Geeta Appannah, Barakatun Nisak Mohd Yusof, Subashini C Thambiah, Zubaidah Nor Hanipah, Ping-Foo Wong, Li-Cheng Chang
{"title":"Efficient and Effective Diabetes Care in the Era of Digitalization and Hypercompetitive Research Culture: A Focused Review in the Western Pacific Region with Malaysia as a Case Study.","authors":"Boon-How Chew, Pauline Siew Mei Lai, Dhashani A/P Sivaratnam, Nurul Iftida Basri, Geeta Appannah, Barakatun Nisak Mohd Yusof, Subashini C Thambiah, Zubaidah Nor Hanipah, Ping-Foo Wong, Li-Cheng Chang","doi":"10.1080/23288604.2024.2417788","DOIUrl":"https://doi.org/10.1080/23288604.2024.2417788","url":null,"abstract":"<p><p>There are approximately 220 million (about 12% regional prevalence) adults living with diabetes mellitus (DM) with its related complications, and morbidity knowingly or unconsciously in the Western Pacific Region (WP). The estimated healthcare cost in the WP and Malaysia was 240 billion USD and 1.0 billion USD in 2021 and 2017, respectively, with unmeasurable suffering and loss of health quality and economic productivity. This urgently calls for nothing less than concerted and preventive efforts from all stakeholders to invest in transforming healthcare professionals and reforming the healthcare system that prioritizes primary medical care setting, empowering allied health professionals, improvising health organization for the healthcare providers, improving health facilities and non-medical support for the people with DM. This article alludes to challenges in optimal diabetes care and proposes evidence-based initiatives over a 5-year period in a detailed roadmap to bring about dynamic and efficient healthcare services that are effective in managing people with DM using Malaysia as a case study for reference of other countries with similar backgrounds and issues. This includes a scanning on the landscape of clinical research in DM, dimensions and spectrum of research misconducts, possible common biases along the whole research process, key preventive strategies, implementation and limitations toward high-quality research. Lastly, digital medicine and how artificial intelligence could contribute to diabetes care and open science practices in research are also discussed.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2417788"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959818","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}
{"title":"Public Policy and Health System Responses to Diabetes Mellitus in Nigeria: A Call for Reform.","authors":"Friday Okonofua, Lorretta Favour Ntoimo, Rosemary Ogu, Maradona Isikhuemen","doi":"10.1080/23288604.2025.2477941","DOIUrl":"10.1080/23288604.2025.2477941","url":null,"abstract":"<p><p>Diabetes mellitus, once a rare diagnosis in precolonial and early post-colonial Nigeria, now has the highest prevalence and fatality rates in sub-Saharan Africa. This increased prevalence is attributed to rising population affluence characterized by sedentary lifestyles and higher consumption of processed and ultra-processed foods. The burden is further exacerbated by a poorly responsive healthcare system. Currently, less than 50% of affected individuals are aware of their condition. Factors such as misconceptions about the disease, a preference for unproven traditional herbal treatments, and the high cost of treatment hinder effective secondary responses. Health system challenges in diabetes management in Nigeria include inadequate implementation of existing policies and guidelines, high out-of-pocket payments, poor quality of healthcare, and limited public education about the disease. To address these issues, we recommend a policy focus on: 1) Implementing actionable policies and guidelines for diabetes prevention and care; 2) Improving the pre-paid care system to reduce out-of-pocket payments; 3) Enhancing the quality of services at all healthcare levels, with the establishment of centers of excellence for specialized diabetes management; 4) Continuing the training, retraining, motivation, and expansion of the workforce responsible for diabetes care; and 5) Health promotion and health awareness aimed at the public to address inaccurate beliefs and practices about diabetes. Addressing these multifaceted factors will help to reduce the rising incidence of diabetes in Nigeria.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2477941"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617895","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}
Health systems and reformPub Date : 2025-12-31Epub Date: 2025-02-04DOI: 10.1080/23288604.2024.2448862
Adrianna Murphy, Daniel Mbuthia, Ruth Willis, Benjamin Tsofa, Mary Gichagua, Peter Mugo, Kara Hanson, Michael R Reich
{"title":"Improving Implementation of NCD Care in Low- and Middle-Income Countries: The Case of Fixed Dose Combinations for Hypertension in Kenya.","authors":"Adrianna Murphy, Daniel Mbuthia, Ruth Willis, Benjamin Tsofa, Mary Gichagua, Peter Mugo, Kara Hanson, Michael R Reich","doi":"10.1080/23288604.2024.2448862","DOIUrl":"10.1080/23288604.2024.2448862","url":null,"abstract":"<p><p>Health systems in low- and middle-income countries face the challenge of addressing the growing burden of non-communicable diseases (NCDs) with scarce resources to do so. There are cost-effective interventions that can improve management of the most common NCDs, but many remain poorly implemented. One example is fixed dose combinations (FDCs) of medications for hypertension. Included in WHO's Essential Medicines List, FDCs combine two or more blood pressure lowering agents into one pill and can reduce burden on patients and the health system. However, implementation of FDCs globally is poor. We aimed to identify health systems factors affecting implementation of evidence-based interventions for NCDs, and opportunities to address these, using the case study of FDCs in Kenya. We conducted semi-structured interviews with 39 policy-makers and healthcare workers involved in hypertension treatment policy and identified through snowball sampling. Interview data were analyzed thematically, using the Access Framework to categorize themes. Our interviews identified factors operating at the global, national, county, and provider levels. These include lack of global implementation guidance, context specific cost-effectiveness data, or prioritization by procurement agencies and clinical guidelines; perceived high cost; poor data for demand forecasting; insufficient budget for procurement of NCD medications; absence of prescriber training and awareness of clinical guidelines; and habitual prescribing behavior and understaffing limiting capacity for change. We propose specific strategies to address these. The findings of this work can inform efforts to improve implementation of other evidence-based interventions for NCDs in low-income settings.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2448862"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191466","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}
Health systems and reformPub Date : 2025-12-31Epub Date: 2025-02-25DOI: 10.1080/23288604.2025.2464977
Abdo S Yazbeck
{"title":"Can a 19<sup>th</sup> Century French Medical Debate Provide Guidance on How to Tackle Type 2 Diabetes?","authors":"Abdo S Yazbeck","doi":"10.1080/23288604.2025.2464977","DOIUrl":"https://doi.org/10.1080/23288604.2025.2464977","url":null,"abstract":"","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2464977"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506534","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}
Health systems and reformPub Date : 2025-12-31Epub Date: 2025-02-11DOI: 10.1080/23288604.2025.2457239
Ashley Fox, Victoria Y Fan, Heeun Kim, Minah Kang
{"title":"Rethinking Trust and Public Health Compliance: Introducing a Trust Continuum for Policy and Practice.","authors":"Ashley Fox, Victoria Y Fan, Heeun Kim, Minah Kang","doi":"10.1080/23288604.2025.2457239","DOIUrl":"10.1080/23288604.2025.2457239","url":null,"abstract":"<p><p>Trust in government has emerged as one of the strongest predictors of national performance in fighting COVID-19. This commentary aims to take stock of the vast literature on trust and compliance with public health measures that has emerged during the pandemic to synthesize policy-relevant recommendations about: 1) How to conceptualize trust; 2) Whether trust is always deserved; and 3) How governments can earn (appropriate levels of) trust. Based on a critical reading of the literature, we develop a framework that conceptualizes trust as falling along a continuum ranging from extreme distrust to blind trust with the ideal point- \"informed\" or \"basic\" trust-falling in the mid-point of the continuum. We illustrate the continuum with examples and provide recommendations regarding how governments can build more nuanced disease responses that account for individuals and sub-groups at different rungs on the continuum while (re)building trust. We conclude that trust-building is a long-term project that must continue in non-crisis times.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2457239"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392613","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}
Health systems and reformPub Date : 2025-12-31Epub Date: 2025-01-23DOI: 10.1080/23288604.2024.2437898
Abdo S Yazbeck, Son Nam Nguyen, Maria-Luisa Escobar
{"title":"How Health Systems World-wide Fail Type 2 Diabetics.","authors":"Abdo S Yazbeck, Son Nam Nguyen, Maria-Luisa Escobar","doi":"10.1080/23288604.2024.2437898","DOIUrl":"10.1080/23288604.2024.2437898","url":null,"abstract":"<p><p>For over 50 years, health systems the world over have failed people with type 2 diabetes mellitus (T2DM). The WHO documents a quadrupling of people with diabetes in a 34-year period to 422 million in 2014, the overwhelming majority of whom were T2DM. This happened despite extensive scientific literature on the causes of, as well as proven treatments for, this disease. Using a health systems prism to review the extensive medical and nutritional T2DM published research, we identified three main shortcomings of health systems in T2DM: (i) failure in early detection; (ii) failure in understanding the actionable lifestyle drivers; and (iii) subsidizing the causes of the disease. Although small-scale success stories in T2DM control exist, the lack of documented evidence of any country-wide health system's successful attempt to address this epidemic is alarming. The immense and ever-growing health and economic burdens of T2DM should provide all the motivation needed for national and global efforts to counteract the political-economy constraints standing in the way of successful whole-of-system approaches to T2DM.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2437898"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029998","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}
Health systems and reformPub Date : 2025-05-01Epub Date: 2025-04-09DOI: 10.1080/23288604.2025.2468564
Etsuko Kita
{"title":"Ryoichi Sasakawa: Personal Reflections on His Life and Legacy.","authors":"Etsuko Kita","doi":"10.1080/23288604.2025.2468564","DOIUrl":"https://doi.org/10.1080/23288604.2025.2468564","url":null,"abstract":"","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 2","pages":"2468564"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030112","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}
Health systems and reformPub Date : 2025-05-01Epub Date: 2025-04-09DOI: 10.1080/23288604.2025.2484858
Michael R Reich
{"title":"Introduction to the Special Issue on Global Health History and Japan.","authors":"Michael R Reich","doi":"10.1080/23288604.2025.2484858","DOIUrl":"https://doi.org/10.1080/23288604.2025.2484858","url":null,"abstract":"","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 2","pages":"2484858"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046000","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}
Health systems and reformPub Date : 2025-05-01Epub Date: 2025-04-09DOI: 10.1080/23288604.2025.2478681
Jesse B Bump
{"title":"Global Health and Its Limitations: An Historical Perspective.","authors":"Jesse B Bump","doi":"10.1080/23288604.2025.2478681","DOIUrl":"https://doi.org/10.1080/23288604.2025.2478681","url":null,"abstract":"<p><p>Humanitarian themes, such as rights and entitlements to universal well-being, feature prominently in narratives of global health, even as many recent authors have pointed to systematic imbalances of power, unfair governance structures, and unwanted influences as evidence of ongoing colonial interference in the health affairs of many low- and middle-income countries. This article employs an historical perspective to analyze major forces that have shaped the development of global health, and which remain as obstacles to its objectives. These include macroeconomics, geopolitics, and the activism and resources of the HIV/AIDS pandemic that led to global health in its current form. Through an examination of this history and its effects, I argue that the humanitarian goals of global health will not be realized without dramatic changes to the field. Particularly in the failure to engage economic relationships and trade policy, global health limits its attention to downstream consequences of resource inequalities, where its goal of a more egalitarian, more healthy world is difficult, if not impossible, to achieve.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 2","pages":"2478681"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061315","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}
Health systems and reformPub Date : 2025-05-01Epub Date: 2025-04-09DOI: 10.1080/23288604.2025.2475556
Taro Yamamoto
{"title":"Overview of International Health in Postwar Japan.","authors":"Taro Yamamoto","doi":"10.1080/23288604.2025.2475556","DOIUrl":"https://doi.org/10.1080/23288604.2025.2475556","url":null,"abstract":"<p><p>This commentary traces the emergence and evolution of international cooperation in the medical and public health fields in postwar Japan. It examines how trends in the nature of its international cooperation efforts reflected economic and social trends over three time periods between the end of World War II and the end of the twentieth century. In the first period, Japan's approach to international cooperation was both limited and influenced by its own reconstruction. In the second period, Japan sought to reenter the international community by making contributions towards world peace and international health. In the third period, Japan's remarkable economic growth enabled it to become a major source of overseas development assistance around the world. The paper includes short profiles of eight Japanese innovators in international health cooperation (and mentions numerous others who were similarly active in the field). Over the years, these and many other individuals built Japanese international health agencies and shaped the country's changing approaches to international health.</p>","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 2","pages":"2475556"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044116","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}