Health systems and reform最新文献_第2页

Public Policy and Health System Responses to Diabetes Mellitus in Nigeria: A Call for Reform. 尼日利亚对糖尿病的公共政策和卫生系统反应：呼吁改革。

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-03-12 DOI: 10.1080/23288604.2025.2477941

Friday Okonofua, Lorretta Favour Ntoimo, Rosemary Ogu, Maradona Isikhuemen

{"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":"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.","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}

引用次数: 0

Improving Implementation of NCD Care in Low- and Middle-Income Countries: The Case of Fixed Dose Combinations for Hypertension in Kenya. 改善低收入和中等收入国家非传染性疾病护理的实施：肯尼亚高血压固定剂量联合治疗的案例。

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-02-04 DOI: 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":"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.","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}

引用次数: 0

Financing and Prioritizing Diabetes and Other Non-Communicable Diseases in Ghana: A Qualitative Policy Analysis of the Barriers, Enablers and Opportunities. 加纳糖尿病和其他非传染性疾病的融资和优先事项：对障碍、促进因素和机会的定性政策分析。

IF 1.9

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-10-16 DOI: 10.1080/23288604.2025.2565010

Leonard Baatiema, Kristen Danforth, David A Watkins, Joana Ansong, Adwoa Twumwaah Twum-Barimah, Bruno Meessen

{"title":"Financing and Prioritizing Diabetes and Other Non-Communicable Diseases in Ghana: A Qualitative Policy Analysis of the Barriers, Enablers and Opportunities.","authors":"Leonard Baatiema, Kristen Danforth, David A Watkins, Joana Ansong, Adwoa Twumwaah Twum-Barimah, Bruno Meessen","doi":"10.1080/23288604.2025.2565010","DOIUrl":"10.1080/23288604.2025.2565010","url":null,"abstract":"Diabetes and other chronic NCDs pose a major public health threat in Ghana, and where health systems are less developed and there are numerous competing societal priorities. This qualitative study examines the barriers hindering domestic financing and prioritization of diabetes and other NCDs in Ghana. The study applied Kingdon's multiple stream framework using document reviews and face-to-face interviews with 29 key informants/stakeholders in the diabetes or NCD landscape in Ghana. Data from the document review and key informant interviews were thematically analyzed. The study revealed that at the problem stream level, diabetes and other NCDs are not yet sufficiently perceived by the general population and policy makers as major societal issues. Donors are also focusing on different health priorities. On the policy solution stream, many solutions are being initiated and developed by a rich array of policy entrepreneurs. The recent introduction of an excise tax bill on sugar-sweetened, alcoholic beverages and tobacco products suggests positive developments in the politics stream. The health financing system is advanced institutionally, and the country could rapidly convert a higher prioritization of diabetes into resource allocation if the macro-fiscal context permits it. The study concludes that applying Kingdon's framework provides a nuanced understanding of the barriers, enablers, and opportunities for prioritizing NCDs in Ghana, and finds that policy prioritization will require political commitment from the upper echelon of government. Higher public awareness on the determinants and costs of NCDs would contribute to broad citizen support and the sustainability of the political commitment across successive governments.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2565010"},"PeriodicalIF":1.9,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309987","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

Can a 19^th Century French Medical Debate Provide Guidance on How to Tackle Type 2 Diabetes? 19世纪法国医学辩论能为如何治疗2型糖尿病提供指导吗？

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-02-25 DOI: 10.1080/23288604.2025.2464977

Abdo S Yazbeck

引用次数: 0

Development Assistance for Health and the Challenge of NCDs Through the Lens of Type 2 Diabetes. 从2型糖尿病的角度看卫生发展援助和非传染性疾病的挑战。

IF 1.9

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-07-28 DOI: 10.1080/23288604.2025.2531693

William Savedoff, Abdo S Yazbeck, David H Peters, Son Nam Nguyen

{"title":"Development Assistance for Health and the Challenge of NCDs Through the Lens of Type 2 Diabetes.","authors":"William Savedoff, Abdo S Yazbeck, David H Peters, Son Nam Nguyen","doi":"10.1080/23288604.2025.2531693","DOIUrl":"10.1080/23288604.2025.2531693","url":null,"abstract":"Non-communicable diseases (NCDs) represent the largest burden of disease, even in low-and middle-income countries (LMICs). The long latency period, chronicity, and common environmental, behavioral and genetic etiologies of NCDs-as shown through the example of Type 2 diabetes mellitus (T2DM)-expose health system failures to undertake multi-sectoral public health actions, address early detection, and provide integrated care. Development assistance for health (DAH), with its focus on donor priorities, often exacerbates such health system challenges. DAH has mainly focused on infectious diseases along with conditions related to reproductive health. Some programs show how DAH could help LMICs reorient health systems by focusing on neglected areas like economic and social policies, along with environmental and behavioral drivers of diseases like T2DM. Furthermore, in an era of declining resources for DAH, external support needs to be catalytic, supporting reforms more than financing services. Orienting limited DAH to address NCDs could support the necessary transformation of service organization, financial allocation criteria, data generation and use, health promotion, and training of care providers. DAH could also strengthen the public institutions and policies that prevent NCDs like T2DM through economic policies, environmental regulation, and health promotion interventions that address social and behavioral risk factors. Four broad categories of actions can guide DAH to better orient health systems to address NCDs: \"First, do no harm,\" help transform health systems, think outside the box, and match tools to needs. Several existing assistance modalities are also presented to show specific ways that this reorientation can be implemented.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2531693"},"PeriodicalIF":1.9,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735885","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 Health Systems Approach to Nurse-Led Implementation of Diabetes Prevention and Management in Vulnerable Populations. 在弱势群体中以护士为主导实施糖尿病预防和管理的卫生系统方法。

IF 1.9

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-06-09 DOI: 10.1080/23288604.2025.2503648

Patricia C Underwood, Brielle Ruscitti, Tam Nguyen, Cherlie Magny-Normilus, Katherine Wentzell, Sharon A Watts, Diana Bowser

{"title":"A Health Systems Approach to Nurse-Led Implementation of Diabetes Prevention and Management in Vulnerable Populations.","authors":"Patricia C Underwood, Brielle Ruscitti, Tam Nguyen, Cherlie Magny-Normilus, Katherine Wentzell, Sharon A Watts, Diana Bowser","doi":"10.1080/23288604.2025.2503648","DOIUrl":"10.1080/23288604.2025.2503648","url":null,"abstract":"Diabetes mellitus is seventh-leading cause of death in the United States, and has a substantial economic burden, contributing $237 billion in direct medical costs. The incidence rate of type 2 diabetes (T2DM) is expected to continue to increase, disproportionally impacting vulnerable groups. The increasing prevalence and disproportionate burden emphasize the need for health systems to effectively integrate and implement large- and small-scale, culturally tailored nurse-led diabetes prevention programs (DPP) and diabetes self-management education programs (DSME). This two-stage analysis uses a health system approach to provide a synopsis of evidence-based nurse-led DPP and DSME implementation across various health system settings. Using the results from an integrative review, a health system focused framework was developed and applied to two case studies highlighting specific aspects of how successful large- and small-scale nurse-led interventions are integrated into health systems across varying vulnerable populations specifically Veterans, Asian Americans and Haitians. Case study results use examples to show large-scale implementation of DSME across the federal Veterans Health Administration (VHA) improves diabetes self-management and access for Veterans and smaller-scale DPP and DSME programs within community health centers targeting vulnerable populations impact health literacy and diabetes self-management. These examples demonstrate key steps toward improving access and outcomes for diabetes management and the critical role of nurse-led diabetes interventions as a priority across the health system and the importance of financial and organizational support for DPP and DSME programs to overcome access barriers to improve diabetes interventions and management.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2503648"},"PeriodicalIF":1.9,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259533","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

The Impact of Regularization Policies on Health Access: Examining Female Venezuelan Migrants' Access and Utilization of Healthcare Services in Colombia. 正规化政策对保健服务的影响：调查委内瑞拉女性移民在哥伦比亚获得和利用保健服务的情况。

IF 1.9

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-06-09 DOI: 10.1080/23288604.2025.2510769

Diana M Bowser, Priya Agarwal-Harding, Brielle Ruscitti, Donald S Shepard, Arturo Harker Roa

{"title":"The Impact of Regularization Policies on Health Access: Examining Female Venezuelan Migrants' Access and Utilization of Healthcare Services in Colombia.","authors":"Diana M Bowser, Priya Agarwal-Harding, Brielle Ruscitti, Donald S Shepard, Arturo Harker Roa","doi":"10.1080/23288604.2025.2510769","DOIUrl":"10.1080/23288604.2025.2510769","url":null,"abstract":"The Venezuelan humanitarian crisis has led to the displacement of over 7.7 million migrants, with Colombia hosting around one-third. Colombia has been praised for its progressive policies for Venezuelan migrant integration, and the government's Estatuto Temporal de Protección para Migrantes Venezolanos (ETPMV), introduced in February 2021, provides one of the region's most comprehensive regularization policies, permitting 10 years of residency and access to social protection services, including health insurance. We assessed the impact of the ETPMV on self-reported health insurance enrollment and formal healthcare utilization using two telephone surveys with 4,423 female Venezuelan migrants in 2020 and 2023. We used a difference-in-differences methodological approach, accounting for differences in levels of migrant health system integration across municipalities measured by a municipal enrollment index derived from secondary data. We find that the ETPMV significantly increases health insurance enrollment for female Venezuelan migrants and that while uninsured individuals experience a significant decline in healthcare utilization from 2020 to 2023, insured individuals experience no significant change. Additionally, the effect of insurance varies by municipal enrollment index, with greater impacts of insurance in areas with lower levels of regularization and health insurance enrollment. These results highlight the success of ETPMV in enhancing access to healthcare for Venezuelan migrants, with insurance enrollment providing a protective effect against declines in healthcare utilization compared to uninsured individuals. These findings underscore the importance of comprehensive regularization policies to address migrant health needs, while emphasizing the importance of continued efforts toward integration.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2510769"},"PeriodicalIF":1.9,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376018/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Indigenous Leadership and Advocacy in Pro-Equity Eligibility Criteria for New Diabetes Medicines in Aotearoa New Zealand [Policy Report]. 新西兰奥特罗阿新糖尿病药物公平资格标准中的土著领导和倡导[政策报告]。

IF 1.9

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-12-08 DOI: 10.1080/23288604.2025.2592386

Jade Tamatea, Leanne Te Karu, Corina Grey, Rawiri McKree Jansen, Anthony Jordan, Belinda Loring, Papaarangi Reid

{"title":"Indigenous Leadership and Advocacy in Pro-Equity Eligibility Criteria for New Diabetes Medicines in Aotearoa New Zealand [Policy Report].","authors":"Jade Tamatea, Leanne Te Karu, Corina Grey, Rawiri McKree Jansen, Anthony Jordan, Belinda Loring, Papaarangi Reid","doi":"10.1080/23288604.2025.2592386","DOIUrl":"https://doi.org/10.1080/23288604.2025.2592386","url":null,"abstract":"Ethnic inequities in the receipt of medicines are influenced by a range of factors including inequities in the social determinants of health, barriers to accessing health care, and differences in quality of care. Policy decisions about medicines funding and eligibility play an important role in contributing to equity in access and equity in outcomes. This policy report analyzes the 2021 policy decision in Aotearoa New Zealand to use ethnicity as an explicit eligibility criterion for access to publicly funded sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists for type 2 diabetes. Advocacy for this policy decision was driven by Indigenous health experts, based on strong evidence of persisting ethnic inequities in diabetes prevalence, access to treatment, and outcomes. The impact this policy has had so far on inequities in receipt of diabetes treatment indicates that using explicit ethnicity-based eligibility criteria may help overcome some barriers to access to diabetes care, even in universal health care systems.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2592386"},"PeriodicalIF":1.9,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710258","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

Overweight, Obesity and Diabetes: Global Trends and a Better Future? 超重、肥胖和糖尿病：全球趋势和更美好的未来？

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-06-23 DOI: 10.1080/23288604.2025.2518797

Barbara McPake

{"title":"Overweight, Obesity and Diabetes: Global Trends and a Better Future?","authors":"Barbara McPake","doi":"10.1080/23288604.2025.2518797","DOIUrl":"https://doi.org/10.1080/23288604.2025.2518797","url":null,"abstract":"The related overweight, obesity and diabetes epidemics are more than five decades old and have progressed inexorably. A billion people in the world are now obese, and nearly a billion are diabetic. The belief that diabetes is caused by overweight and obesity has led to public health advice focused on lifestyle change as the main preventive approach. This advice has shifted over time, and some parts of the public health community have started to switch from a lifestyle to an environmental perspective. There is a growing but not yet conclusive evidence base that rather than diabetes being caused by overweight and obesity, the three conditions have a common third cause, and difficulties in controlling weight and blood glucose emerge in tandem. New classes of medications, including semaglutides and tirzepatides, effectively address these processes. They are in the early stages of development but have accumulated a safety record over the last decade. They are largely currently available only to those who can afford their relatively high cost, but new generations of related medications are capable of becoming lower cost, and wider access to them could transform the overweight, obesity and diabetes pandemics. There is a marked absence of enthusiasm for their potential role in the public health community. This appears to reflect stigmatized attitudes to overweight and obesity, which contrast with attitudes to diabetes. A successful medical treatment may be the key to resolving that stigma and reversing the three pandemics.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"11 1","pages":"2518797"},"PeriodicalIF":0.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478130","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

Politics, Political Science and the Pandemic. 政治、政治科学和流行病。

Health systems and reform Pub Date : 2025-12-31 Epub Date: 2025-06-30 DOI: 10.1080/23288604.2025.2521182

Kevin Croke

引用次数: 0