Journal of global health reports最新文献

{"title":"Trends and factors associated with immediate postnatal care utilisation in Ethiopia: analysis of the demographic and health surveys, 2011-2019","authors":"A. M. Hussen, A. Semaan, B. Tilahun, Ö. Tunçalp, D. Grobbee, J. Browne","doi":"10.29392/001c.75409","DOIUrl":"https://doi.org/10.29392/001c.75409","url":null,"abstract":"Globally, most maternal deaths occur during the first twenty-four hours after childbirth. Although different interventions have been implemented to improve maternal health care utilisation in Ethiopia, including immediate postnatal care, information regarding the change in immediate postnatal care utilisation over time is lacking. This study aimed to examine the trends of immediate postnatal care utilisation from the year 2011 to 2019 and to identify factors associated with immediate postnatal care utilisation using nationwide demographic and health survey data. The study was conducted using secondary data from Ethiopia Demographic and Health Survey (EDHS) in 2011 (n=4268), 2016 (n=4081), and 2019 (n=2159). The trend analysis was conducted using data from the three surveys, however, only the latest survey data were used for the analysis of factors associated with immediate postnatal care utilisation. Bivariable and multivariable logistic regression analysis was carried out to identify factors associated with immediate postnatal care utilisation. Odds ratio (OR) with a 95% confidence level (CI) was computed and adjustment was made to the survey design (i.e., weight, stratification, and clustering). The percentage of women who received immediate postnatal check increased from 6.4% (95% CI=5.1-8.0) in 2011 to 16.3% (95% CI=14.3-19.0) in 2016 to 33.4 % (95% CI=28.6-39.0) in 2019. Moreover, health facility births and the percentage of women who had four or more antenatal care visits increased in this period. Having less than four (adjusted OR (aOR)=3.33; 95% CI=1.77-6.24) and greater than and equal to four antenatal care visits (aOR=7.19; 95% CI=3.80-13.56), and caesarean delivery (aOR=4.39; 95% CI=2.28-8.46) were factors positively associated with immediate postnatal care utilisation. On the other hand, giving birth at a health facility (aOR=0.04; 95% CI=0.02-0.07) was negatively associated with immediate postnatal care utilisation. The study showed consistent improvements in immediate postnatal care utilisation between 2011 and 2019. Despite the progress, the coverage remains low in Ethiopia, only reaching one-third of those who need it. More tailored and context-specific efforts across the continuum of maternal health care services are needed to improve the utilisation and quality of postnatal care.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47774730","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":"Assessing knowledge and awareness of COVID-19 among traders and sanitary workers in the Cape Coast Metropolis of Ghana","authors":"A. Ussif, D. L. Egbenya, J. Kusi, E. Nyarko, Philip Quartey, Mark B. Ulanja, Isaac A. Boateng, K. Affram, K. M. Tsegah, F. T. Djankpa","doi":"10.29392/001c.77500","DOIUrl":"https://doi.org/10.29392/001c.77500","url":null,"abstract":"Since its emergence, Coronavirus Disease 2019 (COVID-19) has infected over half a billion people, killed over 6 million others, and ravaged the global economy on a scale that is unprecedented in recent history. In response, a global health emergency was launched that led to further disruptions in the ordinary way of life of people. The knowledge, attitudes, and practices (KAP) of people towards COVID-19 are central to infection control policies and the future course of the pandemic. We employed an interviewer-administered, cross-sectional survey to examine the KAP of salespersons in a local market and sanitation workers of a public institution within the Cape Coast Metropolis of Ghana. Results were analysed by frequencies of responses for each KAP item on the questionnaire. Sociodemographic variables that predicted good knowledge of COVID-19 or preventive practices were determined using adjusted odds ratios (aORs). Out of the 206 participants, 123 (59.7%) obtained a knowledge score ≥16.75 out of a total of 21, which was the threshold for good knowledge, while 41.3% were classified as possessing poor knowledge. On good attitudes towards COVID-19 prevention, 141 participants (68.4%) scored ≥10.69 out of 12 to pass the threshold, while 31.6% had poor attitudes. Being female (aOR=6.19, P<0.001) or possessing a high school education (aOR=0.25, P=0.009) significantly predicted high knowledge scores. Being in the 15-30 age group (aOR=6.91, P=0.003) significantly predicted poor attitudes, while possessing a high school education (aOR=0.11, P<0.001) significantly predicted good attitudes. The findings of this study underscore the need for intensified, targeted educational campaign on COVID-19 as the world prepares to live with the disease for the long while.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48263684","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":"Job preferences of Japanese global health personnel: results from a discrete choice experiment","authors":"Eriko Jibiki, T. Bolt, T. Sugishita","doi":"10.29392/001c.75463","DOIUrl":"https://doi.org/10.29392/001c.75463","url":null,"abstract":"The disintegration of the boundary between global and national health due to the emergence of global health issues, such as COVID-19, led to the increasing need to nurture global health experts so as to strengthen global and national health capacity. One approach is to engage in work at health-related United Nations (UN) and international organizations. However, the issue of member states underrepresentation exists, which poses a challenge both in nurturing global health experts and realizing the equitable geographical distribution prescribed in Article 101 of the United Nations Charter. Japan, among other member states, remains underrepresented in UN organizations. This study aimed to understand the job preferences of Japanese experts wishing to work at health-related international organizations and present policy proposals for strengthening capacity development and promoting international dispatch. The discrete choice experiment (DCE) survey was conducted online to determine the job preferences of health/non-health experts and students – (i) who wished to work at health-related international organizations (Seekers), (ii) who are currently working at these organizations (Workers), and (iii) who resigned from these organizations (Resignees). The binary logit main effects model was used to examine the relative importance of various job attributes. DCE analysis showed the relative importance of duty station, salary, work–life balance (WLB), and job satisfaction for all groups and return post and employer’s contribution to welfare benefits for Seekers and Resignees but not for Workers. The “uncertainty-avoidance” characteristics mainly perceived in Seekers and Resignees propose two separate approaches, which entails supporting (i) the few selected ones, and (ii) the majority who are interested but remain uncertain and indecisive to work overseas. The social structural challenge associated with the lack of national organizations and hospitals that value experiences gained at international organizations needs to be addressed by introducing systems such as sabbatical leaves or reemployment systems for returnees. Furthermore, an incentive information package combining both financial and nonfinancial incentives focusing on favorable conditions relating to duty station, salary, WLB, and job satisfaction, which could be achieved at international organizations, could be actively publicized at career development seminars.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48761528","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":"A minimal neonatal dataset (mND) for low- and middle-income countries as a tool to record, analyse, prevent and follow-up neonatal morbidity and mortality","authors":"P. Z. Zala, S. Ouédraogo, Sofia Schumacher, P. Ouedraogo, Flavia Rosa-Mangeret, R. Pfister","doi":"10.29392/001c.75151","DOIUrl":"https://doi.org/10.29392/001c.75151","url":null,"abstract":"Neonatal mortality accounts for the most significant and today increasing proportion of under-5 mortality, especially in sub-Saharan Africa. The neonatal population is a sharp target for intervention for these 2.5 million annual deaths. The limited availability of quality data on morbidities leading up to this mortality hampers the development and follow-up of effective interventions. For leverage, undoubtedly more detailed and standardized data adapted to low and middle-income countries (LMICs) is urgently needed. Drawing on existing databases such as the Swiss Neonatal Network and Vermont Oxford Network, 267 clinical, administrative, and structural variables of neonatal health and healthcare services were selected and submitted for ranking to 42 experts through two Delphi rounds. An empirically limited number of variables with the highest ranking for availability and relevance in low and middle-income countries were field-tested in three centres in Burkina Faso during one year for improvement and practicality. We report the database development process according to the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) recommendations. The final dataset is composed of 73 clinical and 6 administrative patient variables, and 21 structural healthcare center variables. Two-thirds of clinical variables maintain matching definitions with high-income countries. The developed minimal neonatal dataset is standardized and field-tested for relevance and availability in LMICs allowing south-south and some south-north cross-comparison.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44614842","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":"COVID-19 cases treated with classical homeopathy: a retrospective analysis of International Academy of Classical Homeopathy database","authors":"S. Mahesh, P. Hoffmann, Cristiane Kajimura, G. Vithoulkas","doi":"10.29392/001c.77376","DOIUrl":"https://doi.org/10.29392/001c.77376","url":null,"abstract":"The COVID-19 pandemic has posed an unprecedented challenge to global health. Classical homeopathy may have a role to play in alleviating this burden. The objective of this study was to curate data on the treatment effect of classical homeopathy for COVID-19 in a real-world scenario to guide future scientific investigations. Classical homeopaths from the International Academy of Classical Homeopathy (IACH) were asked to provide details on cases they treated by filling out a standardized questionnaire. COVID-19 cases were defined according to World Health Organization (WHO) criteria as suspected/probable/confirmed cases, with intervention provided being either stand-alone classical homoeopathy or combined with conventional therapy for COVID-19. Cases were followed up with main outcomes being ‘improved’, ‘not improved’ or ‘progressed’ post-treatment. Details of the homeopathic remedies used and main symptoms at the presentation were gathered. Factors associated with main outcomes were investigated with correlational and regression analyses. 367 patients (male 166, female 201) met eligibility criteria (mean age 42.75 years). The mean follow-up period was 6.5 (standard deviation, SD=5.3) days. 255 were confirmed COVID-19 cases, with 61 probable and 51 suspected cases, respectively. The most used remedy was Arsenicum album. Over 73% of COVID-19 patients (and about 79% of severe cases) improved under classical homeopathic treatment. The number of remedies required per individual was negatively correlated to improvement (P< 0.01). Fever, the most common symptom at presentation (74.4%), was associated with an increased likelihood of improvement (P<0.01). Improvement was negatively associated with advanced age, but not associated with sex (P<0.01). This study suggests that classical homeopathy was associated with improvement in COVID-19, including severe cases. Despite limitations from study design and data sources, our findings should prompt further studies on the role of classical homeopathy in the management of COVID-19.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46257491","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":"Can providing daily iron-fortified lunches to school-going children living in an impoverished Guatemalan community improve iron status?","authors":"K. Beerman, Llesenia Massey, S. Mcgeehan, Manichanh Ratts, Thomas Mitchell, C. Cotten, Alejandra Perez","doi":"10.29392/001c.75318","DOIUrl":"https://doi.org/10.29392/001c.75318","url":null,"abstract":"Iron deficiency anemia (IDA) remains one of the most common diet-related micronutrient deficiency disorders in the world. Although iron supplementation can effectively improve iron status, it is often a short-term solution to this endemic, chronic health problem. Lucky Iron Fish® (LIF) offers a novel, long-term approach to treat IDA that can be easily utilized in regions of the world where IDA is most prevalent. While the beneficial use of LIF for household preparation of meals has been demonstrated, its use in quantity food production has not been investigated. The purpose of this study was to develop methodology for large-scale iron fortification of cooking water and to assess changes in hemoglobin and hematocrit values in school-going children following 8 months of receiving iron-fortified school lunches prepared with LIF. Laboratory studies were conducted to develop the protocol to prepare iron fortification of cooking water using LIF. Study participants were school-going children from economically, disadvantaged families attending private schools in Jocotenango, Guatemala. Baseline measures (weight, height, hemoglobin, and hematocrit) were taken at the start and completion of the academic calendar. The sample was divided into quintiles based on pre-hemoglobin and hematocrit values where quintile 1 had the lowest baseline hemoglobin and hematocrit values and quintile 5 had the highest baseline hemoglobin and hematocrit values. Paired t-tests were used to determine if there were overall significant pre- and post-differences in iron status values by quintile groupings. A total of 286 (77%) of children between the ages of 5 – 16 (y) completed the study. Post- hemoglobin values were significantly higher than pre-hemoglobin values for those in quintile 1, whereas post-hematocrit values significantly increased for quintiles 1 and 2. Study results suggest that LIF can be used to prepare large quantities of food and that regular consumption of iron-fortified school lunches can improve iron status in children with marginal status. Equally important is the finding that iron-fortified meals do not negatively impact those with healthy iron values.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49120813","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":"The German Development Bank as a policy entrepreneur for social health protection: a case study of the development and implementation of the ‘Sehat Sahulat Programme’ in Khyber Pakhtunkhwa, Pakistan","authors":"S. Khan, K. Cresswell, Aziz Sheikh","doi":"10.29392/001c.75413","DOIUrl":"https://doi.org/10.29392/001c.75413","url":null,"abstract":"The German Development Bank (KfW) supported the Government of Khyber Pakhtunkhwa (GoKP) to design and implement its first social health protection (SHP) scheme, named the Sehat Sahulat Programme (SSP). We described the role of KfW in the evolution of SSP with a view to identifying transferrable lessons for international development agencies working on similar initiatives in socioeconomically comparable contexts. We employed a qualitative instrumental case study design approach. First, we obtained and analysed key programme documents to describe the chronology of events and policy changes. We then undertook in-depth interviews to understand factors influencing policy changes. Finally, we carried out non-participant observations to understand how policy decisions were made and implemented. We employed maximum variation sampling to recruit participants and conducted a thematic analysis of data. SSP was described by GoKP officials as an innovative financing strategy and a flagship project of the government formed by the Pakistan Tehreek-i-Insaf (PTI). First, programme officials reported that KfW was instrumental in both designing and financing SSP, which had plans to provide free health insurance to low-income families and raise revenue through paid enrollment of the wealthy (solidarity). Second, GoKP deviated from this model and covered the entire population of KP free of cost. Through SSP, GoKP envisaged service provision through private hospitals (subsidiarity). In the third year, GoKP included public sector hospitals in the programme. Although planned supplementary insurance products might result in inequitable utilisation, KfW continued supporting SSP and committed funding for piloting outpatient department services for two years, 2023 and 2024. This in-depth case study has highlighted the potentially positive role of international development assistance in introducing innovative financing strategies to promote universal health coverage. However, development partners might have limited control over how things evolve.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45160821","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":"The impact of community-based pulmonary rehabilitation on the health and lives of migrant workers with pneumoconiosis in China: a qualitative study exploring patient experience","authors":"Panpan Ma, Y. Nagamatsu","doi":"10.29392/001c.77349","DOIUrl":"https://doi.org/10.29392/001c.77349","url":null,"abstract":"Globally, China has the highest prevalence and incidence of pneumoconiosis, which mainly occurs among migrant workers employed in dusty work environments. Pulmonary rehabilitation (PR) is recommended as the most effective therapeutic strategy in managing chronic obstructive pulmonary disease, and recent quantitative studies have validated PR’s effect on the health outcomes of patients with pneumoconiosis. However, qualitative evidence regarding PR’s impact on pneumoconiosis patients’ health and lives is lacking in the literature. Therefore, this study aimed to address this knowledge gap by exploring the experience of pneumoconiosis patients in community-based PR (CBPR). A qualitative study based on the phenomenological perspective was conducted. The convenience　sampling method was used to recruit pneumoconiosis patients attending a CBPR program supported by a patient advocacy non-governmental organisation. Web-based semi-structured interviews were conducted using a self-made interview guide. Thematic analysis was performed to analyse the interview data. This study was conducted after gaining ethical approval and informed consent from all participants. Fifteen migrant workers with pneumoconiosis patients aged 49 to 71 years old (median: 54 years old) participated in this study. Four themes were identified from the interview data: triggering of a difficult life, reconstruction of life, sense of empowerment, and gaps in PR. Pneumoconiosis severely impaired participants’ well-being, and it triggered heavy financial strain and care burden in their families. The CBPR program allowed them to restore their physical and psychosocial health, and they achieved reconstructing their lives by leading a PR-centred life. Participating in the CBPR program, pneumoconiosis patients recognised multiple supports and were empowered with enhanced disease-coping abilities and strengthened hope to survive. Overall, participants reflected on their positive experience in the CBPR program, despite their unmet needs and existing barriers in PR. The CBPR program integrating multiple supports empowered the vulnerable migrant workers with pneumoconiosis and facilitated their health transition and life reconstruction experience. To optimise their PR experience and improve their QoL, health service addressing their unmet needs and barriers in PR is needed. PR for pneumoconiosis patients with different sociodemographic characteristics and family-oriented management of pneumoconiosis should be explored in future research.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45146222","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":"Evaluating India’s Intensified Diarrhea Control Fortnight: an analysis of the National Family Health Survey, 2015-2016","authors":"David Levine, Xinyu Ren","doi":"10.29392/001c.75428","DOIUrl":"https://doi.org/10.29392/001c.75428","url":null,"abstract":"Oral rehydration solution (ORS) has the potential to avert deaths from diarrheal diseases. Nevertheless, in poor nations only about half of children with diarrhea receive ORS. Since 2014, India has run an annual Intensified Diarrhea Control Fortnight to increase ORS treatment. A key element of the Fortnight plan is the free distribution of ORS to over 100 million homes with young children. We compared ORS usage reported in the 2015/2016 National Family Health Survey in the 3 months before the 2015 and 2016 Fortnights to the 2 months after. We control for state fixed effects and for observable characteristics of the child and household. To reduce data mining, we use a machine learning method – cross-fit partialing-out lasso logistic regression. Our point estimate is that ORS usage rose 1.9 percentage points after the Fortnight, closing about 3% of the gap to universal usage. The increase is not statistically significant at conventional levels. These estimates are inconsistent with government claims that, in 2015, 63% of homes received free ORS. The Fortnight did not achieve most of its goals. The intervention could benefit from more transparent monitoring, a more rigorous evaluation, and improvements in operations.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44148822","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":"The notion of access to health care in a large-scale social health protection initiative: a case study of ‘Sehat Sahulat Programme’ at Khyber Pakhtunkhwa, Pakistan","authors":"S. Khan, K. Cresswell, Aziz Sheikh","doi":"10.29392/001c.75411","DOIUrl":"https://doi.org/10.29392/001c.75411","url":null,"abstract":"Sehat Sahulat Programme (SSP), a health insurance initiative, was launched by the Government of Khyber Pakhtunkhwa (GoKP) in Pakistan to improve access to quality health services. In this paper, we describe the notion of access under SSP, present stakeholders’ views on access-related challenges, and suggest ways forward to realise SSP’s access-related objective in the broader context of its contribution towards Pakistan’s drive to achieve Universal Health Coverage (UHC). We employed a case study design approach using three data sources. We used official GoKP programme documents to capture the chronology of events (policy interventions), in-depth interviews to explore the drivers behind the events and non-participant observations to understand the decision-making and implementation processes. We employed maximum variation sampling. Access to documents and observation sites was gained through the SSP director. We recruited interviewees through direct and indirect approaches and conducted thematic analysis. GoKP engaged the State Life Insurance Corporation (SLIC) of Pakistan as a purchaser. SLIC purchased services from public and private hospitals for SSP patients, up to 600,000 Pakistani Rupees (PKR) per family per year. Considering this insurance coverage, GoKP officials claimed SSP made health care accessible, which the development partners contested. Instead of the narrow finance-centric definition by GoKP, the development partners highlighted the broader dimensions of access, including the services’ acceptability and availability. Tensions existed between the interpretation of the stakeholders on different dimensions of access. For instance, GoKP and SLIC claimed that including private hospitals in SSP improved services’ availability, but development partners noted an under-supply of private providers in remote districts of the province. Bridging such an undersupply, SLIC made inter-district referrals, which the patient advocates noted led to travel costs and geographical barriers. Similarly, GoKP officials claimed SSP had good acceptability. The providers noted that SSP’s acceptability was damaged by limited patient choice, low package rates, and delayed claims payments. This analysis suggests that SSP had challenges with the acceptability and geographical dimensions of access which GoKP needed to address. A key transferrable lesson is that demand-side intervention (insurance) might not improve access with a weak supply side. Therefore, countries contemplating improving access to services enroute to achieving UHC need to address both supply and demand-side considerations.","PeriodicalId":73759,"journal":{"name":"Journal of global health reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47492799","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}