BMJ Global Health最新文献

{"title":"Surgical task-sharing in Sierra Leone: barriers and enablers from provider and facilitator perspectives.","authors":"Jurre van Kesteren, Mirte Langeveld, Thomas Ashley, Tairu Fofanah, Hendrik Jaap Bonjer, Hakon Angell Bolkan","doi":"10.1136/bmjgh-2024-018512","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-018512","url":null,"abstract":"<p><strong>Background: </strong>To mitigate the critical surgeon shortage in Sierra Leone, a surgical training programme was launched in 2011, training associate alinicians in surgery and obstetrics through task-sharing. While graduates of this programme now perform most surgeries outside the capital, they continue to face significant barriers to integration within the national health system.</p><p><strong>Methods: </strong>We conducted 22 semi-structured interviews with surgical providers (n=12) and facilitators (n=10) to identify barriers and enablers of surgical task-sharing in Sierra Leone's health system. Providers and facilitators were selected from three geographically diverse hospitals with varying healthcare worker densities and also included district medical officers and representatives from the Ministry of Health and United Nations Population Fund. Data were analysed using descriptive qualitative content analysis, categorising themes into institutional, interpersonal, resource-related and sociocultural factors.</p><p><strong>Results: </strong>In total, 18 barriers and 21 enablers to surgical task-sharing were identified. Associate clinicians play a critical role in surgical care in underserved regions, help alleviate physician burnout and foster teamwork. Increasing support from younger doctors and hospital administrators signals growing acceptance. Yet, challenges such as exclusion from the healthcare service scheme, inadequate compensation, lack of training accreditation, reliance on external funding, limited national engagement and medical protectionism contribute to demotivation and attrition. These findings highlight the indispensable role of associate clinicians while emphasising the need for systemic reforms to maximise the impact of task-sharing.</p><p><strong>Conclusions: </strong>Enhancing institutional support, implementing rigorous regulatory frameworks and expanding training opportunities for physicians within the surgical training programme are essential measures to optimise the benefits of task-sharing, sustain the provision of high-quality care and improve surgical outcomes.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144156767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Prevalence, experience and awareness of substandard and falsified medicines among the public and healthcare professionals in Jordan'.","authors":"Maysa M Falah, Eman Daar, Daniel Zahra, Michael James Dillon","doi":"10.1136/bmjgh-2024-018189","DOIUrl":"10.1136/bmjgh-2024-018189","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to assess the awareness, experiences and perspectives on substandard and falsified (SF) medicines among the general public and healthcare professionals in Jordan. SF medicines pose a global public health concern, yet data on their prevalence and associated risks in Jordan remain limited.</p><p><strong>Methods: </strong>A cross-sectional study was conducted between January and June 2023 using a convergent mixed-methods approach. Quantitative data were collected through structured surveys administered to 209 members of the public and 136 healthcare professionals (pharmacists and clinicians) recruited via convenience sampling across Jordan's 12 governorates. Surveys were conducted in English and Arabic. Qualitative data from open-ended responses were analysed thematically.</p><p><strong>Results: </strong>SF medicine awareness was low, with only 24% of the public and 35% of healthcare professionals reporting familiarity with the issue. Of those aware, only 8% (n=17) of the public and 25% (n=34) of healthcare professionals correctly identified SF medicines. Experiences with SF medicines were reported by 17% (n=36) of the public and 26% (n=35) of healthcare professionals, with some respondents describing adverse effects, including severe complications requiring medical intervention. Despite this, 81% of the public and all healthcare professionals who had encountered SF medicines did not report them, citing a lack of awareness of reporting mechanisms. Economic factors and misconceptions about generics were identified as contributing factors to the circulation and use of SF medicines.</p><p><strong>Conclusion: </strong>Awareness of SF medicines in Jordan is critically low among both the public and healthcare professionals. The absence of formal reporting systems and economic constraints exacerbates the issue, increasing the risk of exposure to SF medicines. Urgent interventions, including nationwide education campaigns, the establishment of structured reporting mechanisms and policies addressing financial barriers, are essential to mitigating the impact of SF medicines on public health.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An evaluation of a choice architecture-based intervention on prescribing of TB preventive treatment to people living with HIV in southern Africa (the CAT study): a cluster-randomised trial.","authors":"Kate Shearer, Bareng A S Nonyane, Christiaan Mulder, Emmanuel Kaonga, Rose Nyirenda, Kuzani Mbendera, Clara Sambani, Emilio Valverde, Savaiva Manguambe, Rogerio Chiau, Nicole Kawaza, Juliet Jokwiro, Bongani Dube, Tsitsi Apollo, Jeff Weiser, Violet Chihota, Gavin J Churchyard, Richard E Chaisson, Jonathan E Golub, Christopher J Hoffmann","doi":"10.1136/bmjgh-2024-016921","DOIUrl":"10.1136/bmjgh-2024-016921","url":null,"abstract":"<p><strong>Introduction: </strong>While highly effective for reducing the risk of tuberculosis (TB) disease, TB preventive treatment (TPT) is underused among people living with HIV (PWH). We evaluated the effectiveness of a behavioural economics-based choice architecture approach to increase facility-level TPT prescribing to PWH in Malawi, Mozambique and Zimbabwe.</p><p><strong>Methods: </strong>We conducted a cluster-randomised trial within the IMPAACT4TB 3HP rollout, in which 57 healthcare facilities were randomly assigned 1:1 to choice architecture (intervention) or standard TPT prescribing (control). The aim was to link TPT to antiretroviral therapy (ART) prescribing and to make TPT prescribing the default. The intervention was supported by clinician training and a default prescribing module built into the point-of-care HIV electronic medical record in Malawi and stickers placed in clients' clinical stationery in Mozambique and Zimbabwe. Data were collected in aggregate, and the primary outcome was the facility-level percentage of clients initiating ART who initiated TPT. The CAT study was registered with clinicaltrials.gov where it is listed as completed.</p><p><strong>Results: </strong>Implementation occurred from October 2021 to September 2022 in Mozambique (20 facilities), April 2021 to March 2022 in Malawi (19 facilities) and June 2021 to May 2022 in Zimbabwe (18 facilities), for a total of 29 control arm and 28 choice architecture intervention arm facilities, respectively. Comparing control to intervention facilities, mean TPT prescribing to clients initiating ART was 70.9% vs 86.9% in Mozambique (difference: -16.0%; 95% CI: -38.3%, 6.3%; p=0.15), 56.5% vs 55.5% in Malawi (difference: 1.0%; 95% CI: -14.0%, 16.9%; p=0.89) and 56.2% vs 55.9% in Zimbabwe (difference: 0.2%; 95% CI: -25.2%, 25.8%; p=0.98).</p><p><strong>Conclusion: </strong>The choice architecture intervention did not overcome barriers to TPT prescribing. While the intervention may have led to an improvement in TPT prescribing in Mozambique, no differences were observed in the other countries. Further innovation is needed to ensure that all clients initiating ART are either prescribed TPT or started on anti-TB treatment, as appropriate.</p><p><strong>Trial registration number: </strong>NCT04466293.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inequalities and factors associated with maternal healthcare services utilisation in Mozambique: evidence from the Demographic and Health Survey 2022-2023.","authors":"Nazeem Muhajarine, Nahin Shakurun, Md Sabbir Ahmed, Fernanda Andre, Sergio Chicumbe","doi":"10.1136/bmjgh-2024-018121","DOIUrl":"10.1136/bmjgh-2024-018121","url":null,"abstract":"<p><strong>Background: </strong>Mozambique has one of the highest maternal mortality rates in sub-Saharan Africa. While some progress has been made, further efforts are required to ensure that women in Mozambique have access to high-quality healthcare. A key strategy for reducing maternal and child mortality is to promote adequate access to and utilisation of maternal healthcare services.</p><p><strong>Methods: </strong>We used the population-based, nationwide, cross-sectional Mozambique Demographic and Health Survey 2022-2023 data (n=3808). The survey employed a two-stage stratified sampling design that yielded a nationally representative sample at the household level. Four essential maternal healthcare services outcomes were defined: adequate (at least four visits) antenatal care by a skilled provider, lab-based test services (blood, urine and ultrasound), births with a skilled birth attendant and postnatal care by a skilled provider.</p><p><strong>Results: </strong>Overall, 18.6% of women received <i>all four</i> maternal healthcare services. Maternal healthcare utilisation showed significant inequalities favouring wealthier and more empowered women. Regression model suggests that women who were classified in the highest quintile for empowerment index (adjusted OR (aOR)=2.17, 95% CI=1.41 to 3.33), women in the two highest quintiles for wealth index (richer: aOR=2.37, 95% CI=1.41 to 3.98; richest: aOR=2.60, 95% CI=1.41 to 4.79) and women residing in urban area (aOR=1.35, 95% CI=0.99 to 1.83) were significantly associated with the utilisation of <i>all four</i> healthcare services. Other factors like exposure to media (television/radio/newspaper), husband's educational status, distance to the nearest health facility and province/region of residence also determined maternal healthcare services utilisation.</p><p><strong>Conclusion: </strong>Our findings highlight the need for targeted interventions such as improving women's education, healthcare infrastructure and distance barriers and promoting gender equality to ensure greater service utilisation. These findings could help advance further development and implementation of Mozambique's national strategies, and development assistance, for community-based primary healthcare and women-centred care as they provide the latest evidence on this topic.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of proactive malaria community case management (proCCM) on parasite prevalence and incidence from 2021 to 2023: a randomised controlled trial in Chadiza District, Eastern Province, Zambia.","authors":"Marie-Reine I Rutagwera, Ellen L Ferriss, Bupe M Kabamba, Travis Porter, Chabu C Kangale, Sarah Gallalee, Melody Simataa, John M Miller, Caroline Phiri-Chibawe, Maximillian Musunse, Patrick Nyendwa, Viennah Kapenda, Paul Psychas, Julie R Gutman, Moonga Hawela, Ignatius Banda, Sampa Chitambala-Otiono, Adam Bennett, Busiku Hamainza, Julie I Thwing","doi":"10.1136/bmjgh-2024-017697","DOIUrl":"10.1136/bmjgh-2024-017697","url":null,"abstract":"<p><p>Ensuring prompt and effective case management of malaria remains an ongoing challenge in Zambia, where care is not sought for roughly 40% of febrile children under 5 years of age. To expand access, the Ministry of Health has scaled up routine malaria community case management (mCCM) for all ages over the past decade. As of 2018, nearly a quarter of children who received antimalarials obtained them from a community health worker (CHW), but gaps in treatment seeking remain. Proactive community case management (proCCM), under which CHWs regularly visit households to screen, test and treat individuals for malaria, aims to improve timely case management, avert severe disease and potentially reduce transmission. To evaluate the impact of weekly proCCM on malaria parasite prevalence and incidence in the context of strong routine community case management, we conducted a two-arm cluster-randomised controlled trial, comparing proCCM plus routine passive care to routine passive care only in Chadiza District, Eastern Province, Zambia, between April 2021 and May 2023. Baseline and endline surveys were conducted during peak transmission season to ascertain parasite prevalence, while facility, routine mCCM and proCCM incidence data were collected through routine surveillance systems and weekly household visits, respectively. In the control arm, malaria prevalence decreased from 19.7% in 2021 to 16.0% in 2023, and in the intervention arm, from 18.7% to 13.7%. No significant difference between arms in the change in parasite prevalence was estimated (adjusted relative risk=0.97, 95% CI=0.77 to 1.23). However, there was a small, ongoing decline in malaria incidence each month in proCCM clusters compared with control clusters (adjusted incidence rate ratio=0.98, 95% Bayesian credible interval=0.96 to 0.99). Our study suggests proCCM may modestly reduce malaria incidence over time in some settings with high baseline utilisation of routine facility and community case management. Trial registration number: NCT04839900.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are quality medicines affordable? Evidence from a large survey of medicine price and quality in Indonesia.","authors":"Vinky Maria, William Nathanial Tjandrawidjaya, Ayu Rahmawati, Prih Sarnianto, Yusi Anggriani, Elizabeth Pisani","doi":"10.1136/bmjgh-2024-015416","DOIUrl":"10.1136/bmjgh-2024-015416","url":null,"abstract":"<p><strong>Background: </strong>Since Indonesia implemented one of the world's largest single-payer health insurance schemes in 2014, the price of many common medicines has fallen dramatically. Industry groups warn unsustainably low prices threaten quality, while the government says medicines remain overpriced. We investigate the relationship between the price and quality of essential medicines and the affordability of medicines paid for out of pocket.</p><p><strong>Methods: </strong>We bought over 1000 samples of five common prescription medicines-allopurinol, amlodipine, amoxicillin, cefixime and dexamethasone-online and from randomly selected pharmacies and health facilities in four regions across Indonesia. We recorded the price paid and tested samples for quality using high-performance liquid chromatography. We compared prices with the median and lowest prices for each medicine, tested for correlation between quality and price, and calculated affordability compared with the district minimum wage.</p><p><strong>Results: </strong>Medicines available in the public procurement system were less likely to fail quality testing than other brands/varieties (4.2% vs 8.3%) but the difference was not statistically significant (p=0.086). There was no other relationship between quality and price, or branded status. Branded generic medicines sold at a large variety of price points, from 0.3 to 18.6 times the median price for the medicine and dose (IQR: 0.9-5.0, median 1.4). Unbranded generics traded in a narrower range (range 0.1-2.6; IQR 0.6-1.0, median 0.8). Medicines were most expensive in the region with the lowest wages, but even there, medicines selling at the 25th percentile of available prices cost a maximum of 0.7% of 1 day's wage for a course.</p><p><strong>Conclusion: </strong>In every study district, we found that Indonesian patients working at the minimum wage could access affordable, quality-assured versions of all studied essential medicines. More expensive brands were also widely available, but there was no relationship between price and quality.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Responsible artificial intelligence in public health: a Delphi study on risk communication, community engagement and infodemic management.","authors":"Daniela Mahl, Mike S Schäfer, Stefan Adrian Voinea, Keyrellous Adib, Ben Duncan, Cristiana Salvi, David Novillo-Ortiz","doi":"10.1136/bmjgh-2024-018545","DOIUrl":"10.1136/bmjgh-2024-018545","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial intelligence (AI) holds the potential to fundamentally transform how public health authorities use risk communication, community engagement and infodemic management (RCCE-IM) to prepare for, manage and mitigate public health emergencies. As research on this crucial transformation remains limited, we conducted a modified Delphi study on the impact of AI on RCCE-IM.</p><p><strong>Methods: </strong>In two successive surveys, 54 experts-scholars with expertise in public health, digital health, health communication, risk communication and AI, as well as RCCE-IM professionals-from 27 countries assessed opportunities, challenges and risks of AI, anticipated future scenarios, and identified principles and actions to facilitate the responsible use of AI. The first Delphi round followed an open, exploratory approach, while the second sought to prioritise and rank key findings from the initial phase. Qualitative thematic analysis and statistical methods were applied to evaluate responses.</p><p><strong>Results: </strong>According to the expert panel, AI could be highly beneficial, particularly for risk communication (eg, tailoring messages) and infodemic management (eg, social listening), while its utility for fostering community engagement was viewed more critically. Challenges and risks affect all three components of RCCE-IM equally, with algorithmic bias and privacy breaches being of particular concern. Panellists anticipated both optimistic (eg, democratisation of information) and pessimistic (eg, erosion of public trust) future scenarios. They identified seven principles for the responsible use of AI for public health practices, with equity and transparency being the most important. Prioritised actions ranged from regulatory measures, resource allocation and feedback loops to capacity building, public trust initiatives and educational training.</p><p><strong>Conclusion: </strong>To responsibly navigate the multifaceted opportunities, challenges and risks of AI for RCCE-IM in public health emergencies, clear guiding principles, ongoing critical evaluation and training as well as societal collaboration across countries are needed.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teleneurosurgery between Greenland and Denmark.","authors":"Najannguaq Jørgensen, Thorbjørn Søren Rønn Jensen, Simon Bernth-Andersen, Frank Damborg, Anders Vedel Holst, Kåre Fugleholm, Ramona Åstrand, Alexander Lilja-Cyron, David Kulber, Kylie Tanabe, Marianne Juhler, Torstein R Meling, Tiit Illimar Mathiesen, Jeppe Haslund-Vinding","doi":"10.1136/bmjgh-2024-017994","DOIUrl":"10.1136/bmjgh-2024-017994","url":null,"abstract":"<p><p>The Department of Neurosurgery at the University Hospital of Copenhagen, Rigshospitalet, provides tertiary care for patients from Greenland, where geographical remoteness and weather-related challenges often hinder timely access to neurosurgical interventions. This article presents a new initiative exploring the use of online supervision technology to facilitate neurosurgical care in remote settings. In 2024, a teleneurosurgical collaboration was launched between Queen Ingrid's Hospital in Nuuk, Greenland, and Copenhagen University Hospital, Rigshospitalet. The program involved training local surgeons to perform cranial neurosurgical procedures using smart glasses, enabling real-time supervision from neurosurgeons in Copenhagen. In May 2024, the first patient was successfully operated on using this approach. Real-time visualization and interactive communication, including drawing and zooming features, allowed precise guidance and effective support. The integration of smart glass technology has the potential to enhance the safety of local neurosurgical care in Greenland and reduce the need for prolonged patient evacuation. This initiative supports the broader vision of equitable healthcare delivery and may inspire future applications in other surgical fields and training environments., are.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making health insurance responsive to citizens: learning from six low-income and middle-income countries.","authors":"Anas Ismail, Inke Mathauer, Patricia Akweongo, Mery Concepcion Bolivar Vargas, Sapna Desai, Dinna Prapto Raharja, Modupe Adeoti Ogundimu, Stela Stojisavljevic, Manuela De Allegri, Zubin Cyrus Shroff","doi":"10.1136/bmjgh-2024-018176","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-018176","url":null,"abstract":"<p><strong>Background: </strong>Many low-income and middle-income countries have introduced public health insurance systems, whereby, thanks to government subsidies, selected groups are entitled to receive insurance coverage even if not paying direct contributions into the system. These efforts towards achieving universal health coverage were often undermined by difficulties in enrolment and registration, barriers to health service utilisation or complicated rules around service packages. Governmental and non-governmental accountability initiatives have been established to overcome these barriers in order to make health insurance programmes responsive and to empower citizens. This paper examines evidence and synthesizes lessons from 20 accountability initiatives in six selected countries to understand how these achieved (or not) these goals.</p><p><strong>Methods: </strong>We systematically analysed six final reports and five published papers which were part of a multicountry research programme from 2019 to end of 2022 studying accountability initiatives. Between June 2023 and September 2024, we systematically extracted data and synthesised findings from the reports and papers based on a conceptual framework, adapted from a framework developed by Molyneux, which had been adopted by the country teams to guide their studies. We coded the extracted data and identified the content, context and process factors that enabled or hindered the accountability initiatives in achieving their intended goals. We present and discuss factors that were present in at least two initiatives.</p><p><strong>Results: </strong>Governmental initiatives were in most instances established in conjunction with the health reforms that introduced the health insurance programmes they address. Whereas some of these initiatives were effective, many were undermined by poor outreach to citizens, inadequacy of resources, conflicts of interest and power imbalances and lack of fidelity to original design. Non-governmental initiatives often emerged to fill existing gaps in government services and programmes. Many of the non-governmental initiatives had several features which helped them in contributing to citizen empowerment, and these included embeddedness in and being trusted by the local communities, flexibility in operating and reaching out to people and the underlying motivation of people working in them.</p><p><strong>Conclusions: </strong>The effective implementation of accountability initiatives requires transparency, trust-building measures, active outreach and community engagement and adequate resources. These elements can ensure that initiatives achieve their intended goal of enhancing citizens' access to their health insurance entitlements. Further research is needed to understand how best collaboration between governmental and non-governmental initiatives can be fostered to build synergies between the two toward the achievement of common goals.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"7 Suppl 6","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic health and impact of sickle cell disease and vaso-occlusive crises in India: results from B-VOCAL study.","authors":"Dipty Jain, Tulika Seth, Shashank Udupi, Suman Jain, Seema Bhatwadekar, Nandakumar Menon, Rabindra Jena, Ravindra Kumar, Bharat Parmar, Anil Goel, Ashvin Vasava, Anupam Dutta, Priyanka Samal, Riya Ballikar, Deepa Bhat, Tuphan Kanti Dolai, Jina Bhattacharyya, Disha Shetty, Manish Mistry, Shomik Ray","doi":"10.1136/bmjgh-2024-017887","DOIUrl":"10.1136/bmjgh-2024-017887","url":null,"abstract":"<p><strong>Background: </strong>Sickle cell disease (SCD) with vaso-occlusive pain crisis (VOC) has a major impact on healthcare resource utilisation and poses a significant financial burden for the patients. This study examines the economic implications of managing VOC in individuals with SCD in India, from the perspectives of patients, healthcare system and society.</p><p><strong>Methods: </strong>This cross-sectional, observational study included 1000 patients with SCD across 14 centres enrolled from November 2021 to June 2022. Data were collected systematically using a structured electronic case record form. Employing a cost-of-illness approach, the study assessed the economic impact of SCD and VOC management, including assessing patient/caregiver costs, healthcare provider costs and societal burdens extrapolated to the larger SCD population in India.</p><p><strong>Findings: </strong>Patients incurred substantial out-of-pocket expenses, with a median (IQR) annual expenditure of INR 22 080/US$267 (IQR: INR 36 990/US$447.7), representing 14.65% (26.53) of their annual household income. Overall, catastrophic healthcare expenditure (CHE) for total annual average SCD care with VOC management was experienced by 624 patients (62.40%). Moreover, 334 patients (33.4%) experienced CHE of >25% of the annual household income. Patients with SCD with VOC had significantly higher median annual healthcare expenditures and used a higher median percentage of their yearly household income on healthcare compared with those without VOC (19.82% vs 6.08%; p<0.001). Cost incurred by healthcare providers for VOC management in different healthcare facilities (outpatient department/emergency department/intensive care unit) was similar across different reimbursed facilities (government tertiary care hospitals, non-governmental organisation-operated healthcare centres and government-subsidised healthcare setups). The estimated societal burden for VOC management in 1 year for 1000 patients visiting different healthcare facilities was around INR 35 119 074 (~US$0.42 million).</p><p><strong>Interpretation: </strong>These findings highlight the considerable economic strain on both patients and healthcare providers in SCD and VOC management, which is similar to the other non-communicable diseases emphasising the urgent need for targeted interventions to improve financial hardships among patients.</p><p><strong>Funding: </strong>The study was funded by Novartis Healthcare Private Limited.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 5","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}