Health systems and reform最新文献

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":"https://doi.org/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

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

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

引用次数: 0

Quantifying the Intangible: Evidence from Nigeria on the Impact of Supervision, Autonomy, and Management Practices on PHC Performance in the Context of Direct Facility Financing. 量化无形资产：来自尼日利亚的证据：在直接融资的背景下，监督、自治和管理实践对初级保健绩效的影响。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-01-27 DOI: 10.1080/23288604.2025.2609358

Brittany Hagedorn, Benjamin Loevinsohn, Oluwole Odutolu

{"title":"Quantifying the Intangible: Evidence from Nigeria on the Impact of Supervision, Autonomy, and Management Practices on PHC Performance in the Context of Direct Facility Financing.","authors":"Brittany Hagedorn, Benjamin Loevinsohn, Oluwole Odutolu","doi":"10.1080/23288604.2025.2609358","DOIUrl":"https://doi.org/10.1080/23288604.2025.2609358","url":null,"abstract":"Previous studies have shown that facility autonomy, especially control over budget allocation, and management practices can have a modest positive effect on health facility performance, but the evidence is limited and often qualitative. Data from the evaluation of the Nigeria States Health Investment Project (NSHIP), a study that examined the effects of direct facility and performance-based financing, offers a novel opportunity to quantitatively examine these relationships in the context of a lower middle-income country. We utilize non-parametric statistics and regression methods to test the hypothesis that autonomy, supervision, and management affected facility performance. Results show that facilities with greater autonomy, more budget control, and better management practices generally outperform their peers on a range of facility readiness and service delivery measures. For example, regressions show that facilities with high autonomy held an additional 2.1 outreach sessions per month and facilities with a business plan offered 1.8 additional outreach services (p < 0.05). Supervision practices, including visit frequency and a quantitative checklist, are associated with 26% higher productivity and up to a 29% increase in equipment availability (p < 0.05). Sensitivity analyses validated that results are robust. We conclude that facility-level autonomy and especially budget control can improve primary healthcare facility readiness and service availability. Further, management practices that are reinforced through supportive supervision and routine monitoring can maximize the benefits that accrue from even small amounts of incremental financing. This shows that these policies and practices can contribute critically to efficiently achieving the goals of universal healthcare policies in the context of limited resources.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"12 1","pages":"2609358"},"PeriodicalIF":1.9,"publicationDate":"2026-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069181","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

Framing Overtreatment as Consumer Fraud: Analysis and Implications of China's First Civil Public Interest Litigation in Healthcare. 将过度治疗定性为消费者欺诈：中国首例医疗民事公益诉讼分析及启示。

IF 1.9

Health systems and reform Pub Date : 2026-12-31 Epub Date: 2026-04-06 DOI: 10.1080/23288604.2026.2648262

Jiayi Jiang, Mushiyi Yang

引用次数: 0

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. 数字化和超竞争研究文化时代的高效和有效的糖尿病护理：西太平洋地区以马来西亚为例的重点回顾。

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-01-06 DOI: 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":"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.","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}

引用次数: 0

Do Pro-Competition Healthcare Reforms Always Bring Health Benefits? Evidence from China. 支持竞争的医疗改革总能带来健康效益吗？来自中国的证据。

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-06-09 DOI: 10.1080/23288604.2025.2507975

Zixuan Peng, Audrey Laporte, Xiaolin Wei, Jay Pan, Peter C Coyte

{"title":"Do Pro-Competition Healthcare Reforms Always Bring Health Benefits? Evidence from China.","authors":"Zixuan Peng, Audrey Laporte, Xiaolin Wei, Jay Pan, Peter C Coyte","doi":"10.1080/23288604.2025.2507975","DOIUrl":"https://doi.org/10.1080/23288604.2025.2507975","url":null,"abstract":"It is already a common practice for many health care systems in the world to opt for mixed markets where different types of health care facilities compete against each other to offer high-quality health care to patients. Nevertheless, little is known about the effects of the interaction between hospitals of the same or different type on patient health outcomes. This study estimated the impacts of aggregate and specific types of hospital competition by hospital-type on the quality of inpatient care using an analysis dataset comprising 267,183 individuals from China. The Herfindahl-Hirschman index was employed to measure the degree of hospital competition, with length of stay, readmission and mortality being used to measure the quality of inpatient care. The Poisson and binomial logistic models combined with the instrumental variable approach were constructed to estimate the impacts of hospital competition. This study generated three key findings: 1) aggregate hospital competition reduced the quality of inpatient care, as evidenced by a rise in the odds of readmission and length of stay; 2) intra-type hospital competition reduced the quality of inpatient care and in general had larger effects on reducing the quality of inpatient care than inter-type hospital competition; and 3) the only exception was in the way that competition between private nonprofit hospitals contributed to better quality of inpatient care. The overarching suggestion is that instead of treating competition as a panacea for improving health, a flexible plan tailored to specific conditions is needed.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2507975"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259534","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

Correcting Market and Government Failures in Tackling the Global Growth of Type 2 Diabetes: Application of WHO's Common Goods for Health Approach. 纠正市场和政府在应对2型糖尿病全球增长方面的失灵：应用世卫组织的“卫生共同产品”方针。

IF 1.9

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-10-07 DOI: 10.1080/23288604.2025.2550883

Agnes L Soucat, Sylvestre Gaudin, Abdo S Yazbeck

引用次数: 0