BMJ Global Health最新文献

{"title":"Socio-structural influences on unintended pregnancy among girls aged 15-17 years in Papua New Guinea.","authors":"Elke Mitchell, Herick Aeno, Sophie Ase, Priscilla Ofi, Richard Nake Trumb, Agnes Mek, Elissa C Kennedy, Lisa Vallely, Kirsten I Black, Glen D L Mola, Mary Bagita, William Pomat, Angela Kelly-Hanku, Stephen Bell","doi":"10.1136/bmjgh-2024-017679","DOIUrl":"10.1136/bmjgh-2024-017679","url":null,"abstract":"<p><strong>Introduction: </strong>Unintended pregnancy among adolescent girls is a public health priority globally, particularly in Papua New Guinea (PNG), where low contraceptive use among young people has resulted in some of the highest adolescent fertility rates in the Asia-Pacific region. This paper investigates the socio-structural influences on adolescent girls' ability to prevent unintended pregnancies in PNG.</p><p><strong>Methods: </strong>Qualitative research conducted between 2019 and 2021; inductive thematic analysis of in-depth interviews with 19 adolescent girls aged 15-17 years living in rural, peri-urban and urban research sites in PNG.</p><p><strong>Results: </strong>Socio-structural influences were identified that increased the likelihood of unintended pregnancy: barriers to accessing health services for sexual and reproductive health (SRH) purposes; a lack of provision of SRH information and education in school or community settings, leading to misunderstanding of reproduction and fertility, pregnancy prevention and contraception; poor interactions with health service providers that discourage future service use; constrained intergenerational communications about sex, relationships and family planning between girls and adults based on norms and expectations associated with gender, age and marital status; reliance on informal peer and community information sources; lack of availability and accessibility to modern contraceptives; and a lack of adolescent-centred SRH services. Despite this, girls demonstrated agency through attempts to use modern and traditional contraceptive strategies to prevent pregnancy, often with the support of others within their familial and social networks. Their agency was constrained by a lack of school-based and community-based education about sex and relationships, and access to confidential, non-judgemental SRH services, where they can learn about and access modern contraceptives.</p><p><strong>Conclusion: </strong>Adolescent girls' access to contraceptive services-at an earlier age, in time for their first sexual experiences-requires action in policy and community settings to elicit socio-structural change that is supportive of young women's SRH and well-being.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burn injuries among paediatric patients treated at Mexican public hospitals: a retrospective cohort analysis of nationwide hospitalisation data.","authors":"Jose Antonio Garcia Garcia, Diana D Del Valle, Taylor Wurdeman, Kevin Ashi, Jacques Bistre Varon, Juan Carlos Angulo-Lozano, Tanujit Dey, John G Meara, Jaime Shalkow-Klincovstein, Tarsicio Uribe-Leitz","doi":"10.1136/bmjgh-2024-017915","DOIUrl":"10.1136/bmjgh-2024-017915","url":null,"abstract":"<p><strong>Introduction: </strong>Paediatric burns are a leading cause of mortality among Mexican children, yet comprehensive national data are scarce. This retrospective cohort study provides an epidemiological analysis of paediatric burn injuries in Mexico using a nationwide hospitalisation database.</p><p><strong>Methods: </strong>We conducted a retrospective cohort analysis of all paediatric burn patients aged 0-18 years (ICD-10 codes: T200-T329) who were hospitalised in the Mexican public sector using the Ministry of Health's hospital discharge database for 2016, 2018 and 2020. We used descriptive statistics, and logistic and negative binomial regressions to examine associations with mortality, in-hospital infection rates and hospital length of stay. To explore associations between our outcomes and poverty indexes, we integrated state-level poverty data and the corresponding Gini coefficient (a measure of income inequality). In-hospital infections were identified from a categorical variable, indicating whether an in-hospital infection occurred. Additionally, we compared incidence rates and aetiology across states.</p><p><strong>Results: </strong>We identified 11 080 paediatric burns. Most injuries involved males (60%, n=6659), predominantly children under 5 (55.8%, n=6186). Scalds were the most prevalent aetiology (46.5% n=5153). The overall infection rate was 1.5% (n=168), with electrical burns having the highest rate (1.97%, n=9). Mortality was 0.6% (n=65 cases), with the highest rate in firework-related injuries (1.6%, n=5). The majority (66.6%) of firework-related burns occurred during the holiday months of December and January. Longer hospital stays were significantly associated with in-hospital infections (incidence rate ratio (IRR)=2.52, p<0.01) and higher Gini coefficient (IRR=1.91, p=<0.01). In-hospital infection was significantly associated with increased mortality (OR=5.88, p=<0.01).</p><p><strong>Conclusions: </strong>Paediatric burn injuries in Mexico are a critical public health issue, with children under 5 years old being the most vulnerable, and scalds being the predominant aetiology in this age group. This study underscores the need for targeted public health interventions and implementation of burn prevention programmes and regulations, especially regarding scald and firework injuries.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catastrophic health payments in Ghana post-National Health Insurance Scheme implementation: an analysis of service-specific health expenditures.","authors":"James Akazili, Michel Adurayi Amenah, Lumbwe Chola, Martin Amogre Ayanore, John Ele-Ojo Ataguba","doi":"10.1136/bmjgh-2024-018141","DOIUrl":"10.1136/bmjgh-2024-018141","url":null,"abstract":"<p><strong>Background: </strong>Ghana implemented several health reforms in the 1970s and 1990s. Still, several access barriers persist, including high out-of-pocket (OOP) spending, which led to the implementation of the National Health Insurance Scheme (NHIS) in 2003 to achieve Universal Health Coverage and lower OOP spending. This study evaluates the incidence and intensity of catastrophic health expenditure (CHE) among Ghanaian households post-NHIS, considering OOP health spending on different health services.</p><p><strong>Methods: </strong>Data came from the Ghana Living Standards Surveys rounds 6 (2012/2013) and 7 (2016/2017) and the Annual Household Income and Expenditure Survey 2022/2023. Key variables were OOP spending on three health service categories (medical products, outpatient and inpatient) and total expenditure. The incidence and intensity of CHE for various health service categories were calculated using service-specific thresholds. A household incurs CHE for each service when OOP health spending as a share of total expenditure exceeds the service-specific threshold.</p><p><strong>Results: </strong>Overall, at the 10% threshold, CHE headcount for total OOP health spending increased from 1.26% (95% CI 1.11% to 1.44%) to 11.45% (95% CI 10.86% to 12.07%) between 2012 and 2023. CHE gaps were also substantial for overall and service-specific OOP health spending. Medical supplies account for a large share of total OOP health spending, with CHE headcount rising from 1.34% (95% CI 1.18% to 1.53%) to 12.24% (95% CI 11.64% to 12.89%) between 2012 and 2023 at the 10% original threshold. Although the results were mixed, rural, northern and low-income households experienced substantial financial burdens. At the 20% threshold, the CHE headcount for inpatient services increased from 0.84% (95% CI 0.64% to 1.10%) to 4.38% (95% CI 3.83% to 4.99%) for northern dwellers between 2012 and 2023.</p><p><strong>Discussion/conclusions: </strong>Despite NHIS coverage, high-cost services like medical supplies, hospital stays and frequently used outpatient services substantially drive CHE in Ghana, particularly for underserved populations. Addressing them requires prioritised policy interventions to expand NHIS coverage for essential services and improve financial protection, especially for rural and low-income households.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital burden of critical illness across global settings: a point prevalence and cohort study in Malawi, Sri Lanka and Sweden.","authors":"Carl Otto Schell, Raphael Kazidule Kayambankadzanja, Abi Beane, Andreas Wellhagen, Chamira Kodippily, Anna Hvarfner, Grace Banda, Nalayini Jegathesan, Christoffer Hintze, Wageesha Wijesiriwardana, Martin Gerdin Wärnberg, Jayasingha Arachchilage Sujeewa, Mtisunge Kachingwe, Petronella Bjurling-Sjöberg, Isaac Mbingwani, Annie Kalibwe Mkandawire, Hampus Sjöstedt, Wezzie Kumwenda-Mwafulirwa, Surenthirakumaran Rajendra, Odala Kamandani Dzinjalamala, Cecilia Stalsby Lundborg, Kwazizira Samson Mndolo, Miklós Lipcsey, Rashan Haniffa, Lisa Kurland, Markus Castegren, Tim Baker","doi":"10.1136/bmjgh-2024-017119","DOIUrl":"https://doi.org/10.1136/bmjgh-2024-017119","url":null,"abstract":"<p><strong>Introduction: </strong>The burden of critical illness may have been underestimated. Previous analyses have used data from intensive care units (ICUs) only, and there is a lack of evidence about where in hospitals critically ill patients receive care. This study aims to determine the burden of critical illness among adult inpatients across hospitals in different global settings.</p><p><strong>Methods: </strong>We performed a prospective, observational, hospital-based, point prevalence and cohort study in countries of different socioeconomic levels: Malawi, Sri Lanka and Sweden. On specific days, all adult in-patients in the eight study hospitals were examined by the study team for the presence of critical illness and followed up for hospital mortality. Patients with at least one severely deranged vital sign were classified as critically ill. The primary outcomes were the presence of critical illness and 30-day hospital mortality. In addition, we determined where the critically ill patients were being cared for and the association between critical illness and 30-day hospital mortality.</p><p><strong>Results: </strong>Among 3652 hospitalised patients, we found a point prevalence of critical illness of 12.0% (95% CI 11.0 to 13.1), with a hospital mortality of 18.7% (95% CI 15.3 to 22.6). The crude OR of death of critically ill patients compared with non-critically ill patients was 7.5 (95% CI 5.4 to 10.2). Of the critically ill patients, 96.1% (95% CI 93.9 to 97.6) were cared for in the general wards outside ICUs.</p><p><strong>Conclusions: </strong>The study has revealed a substantial burden of critical illness in hospitals from different global settings. One in eight hospital in-patients was critically ill, 19% of the critically ill died in hospital, and 96% of the critically ill patients were cared for outside of ICUs. Implementing the most feasible and low-cost critical care in general wards throughout hospitals would impact a large number of high-risk patients and has the potential to improve outcomes across all acute care specialties.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708047","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":"Artificial intelligence as a tool for enhancing the performance of public health emergency operation centres (EOC).","authors":"Osama Ali Maher, Luca Cegolon, Saverio Bellizzi","doi":"10.1136/bmjgh-2024-016097","DOIUrl":"10.1136/bmjgh-2024-016097","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Norm diffusion in global health governance: the role of think tanks.","authors":"Yiwen Zhang, Yuhang Chen, Yimeng Wu, Fan Wang","doi":"10.1136/bmjgh-2024-017321","DOIUrl":"10.1136/bmjgh-2024-017321","url":null,"abstract":"<p><strong>Introduction: </strong>The theory of norm diffusion provides a fundamental framework for analysing the emergence, cascade and internalisation of norms in global health governance. As think tanks combine policy expertise with sharp responsiveness to emerging crises, this study investigates their specific role in global health governance, thereby providing a comprehensive understanding of their contribution to the norm diffusion mechanism.</p><p><strong>Methods: </strong>We collected reports from 12 globally representative think tanks, covering the period from 15 June 2007 to 31 December 2022. Using the R programming language, we employed both quantitative and qualitative methods, including structural topic modelling and co-occurrence analysis, to identify topic priorities and correlations between key terms.</p><p><strong>Results: </strong>Globally, think tank discussions on health governance norms centre on four primary areas: the global economy and trade, responses to infectious diseases and public health crises, cooperation and aid in global health governance, and the social impacts of health norms. Regionally and temporally, think tanks in the USA, East Asia, Europe and parts of the Global South prioritise health governance norms differently, with these priorities evolving over time in response to varying levels of development and the specific Public Health Emergencies of International Concern (PHEIC) encountered. Moreover, think tanks underscore the pivotal role of the World Health Organization (WHO) and the United Nations (UN) in shaping global health governance, as these international organisations are central to managing health emergencies, setting global standards and coordinating international cooperation.</p><p><strong>Conclusions: </strong>This study found that think tanks serve as norm entrepreneurs, promoters and internalisers at different stages, supporting norm introduction, adoption and integration of global governance health norms. Our findings underscore the potential for policy-makers to harness the expertise and policy recommendations of think tanks to address future health challenges, thereby enhancing the resilience and sustainability of global health systems.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thinking fast and slow: the urgency of crisis response must not lead us to overlook chronic needs such as tuberculosis.","authors":"Peter J Dodd, Kevin Van Zandvoort, Francesco Checchi, Uzma Khan, Mohammad Haqmal, Palwasha Khan, Christopher Finn McQuaid","doi":"10.1136/bmjgh-2024-018012","DOIUrl":"10.1136/bmjgh-2024-018012","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do deferred emergency payment programmes increase use of injury care services in Cameroon? A trauma registry analysis.","authors":"Fanny Nadia Dissak-Delon, Kathleen O'Connor, Mark T Yost, Kibu O Dzemo, Dennis J Zheng, Rasheedat Oke, Cindy S Umoh, Ariane S Christie, Alain Chichom Mefire, Catherine Juillard","doi":"10.1136/bmjgh-2024-017760","DOIUrl":"10.1136/bmjgh-2024-017760","url":null,"abstract":"<p><strong>Background: </strong>Injured patients in Cameroon face high out-of-pocket costs and care discrepancies based on ability to pay. Per government declaration, all Cameroonian hospitals instituted emergency payment deferral (EPD) programmes to mitigate financial barriers to emergency care. Doctors or nurses decide on patients' eligibility for the EPD programme. However, the impact of EPD on care patterns is unclear.</p><p><strong>Methods: </strong>The Cameroon Trauma Registry (CTR) is a prospective, multisite trauma registry collecting injured patient data from four hospitals in Cameroon. Using CTR data from March 2020 to February 2022, we analysed associations between patient participation in EPD programmes and healthcare interventions using univariate analysis and multivariate logistic regression.</p><p><strong>Results: </strong>Of 5287 CTR patients, 58% (n=3081) were emergency payment deferral recipients (EPDR). A greater proportion of EPDR lived in urban residences (89% EPDR vs 87% non-EPDR, p=0.003). EPDR more often presented with a 'serious' or more severe estimated injury severity (70% EPDR vs 59% non-EPDR, p<0.001). Compared with non-recipients, a smaller proportion of EPD recipients, a smaller proportion of EPDR underwent recommended X-rays (48% EPDR vs 51% non-EPDR, p<0.001). However, greater percentages of EPDR received a recommended ultrasound (3% vs 1%, p<0.001) or CT scan (14% EDPR vs 10% non-EDPR, p<0.001). EPDR more often did not receive radiological tests due to inability to pay (12% vs 4%, p<0.001). Moreover, 10% of EPDR did not undergo recommended surgery due to cost while 6% of non-EPDR did not undergo recommended surgery due to cost (p<0.001). Multivariate logistic regression controlling for injury severity and other demographics indicates that EPDR were less likely to undergo surgery (adjusted OR=0.63, p=0.001).</p><p><strong>Conclusion: </strong>Payment deferral programmes were associated with increased use of some imaging tests, but did not fully address the downstream financial barriers that impede health equity in Cameroon.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The long-term impact of the COVID-19 pandemic on tuberculosis care and infection control measures in anti-retroviral therapy (ART) clinics in low- and middle-income countries: a multiregional site survey in Asia and Africa.","authors":"Marie Ballif, Nicolas Banholzer, Lisa Perrig, Anchalee Avihingsanon, Dominique Mahambu Nsonde, Sarah Obatsa, Guy Muula, Eric Komena, Haruka Uemura, Patricia Lelo, Brian Otaalo, Jacqueline Huwa, Patrice Gouéssé, Nagalingeswaran Kumarasamy, Ellen Brazier, Denna Michael, Idiovino Rafael, Richard Ramdé, I Ketut Agus Somia, Marcel Yotebieng, Lameck Diero, Jonathan Euvrard, Oliver Ezechi, Lukas Fenner","doi":"10.1136/bmjgh-2024-017828","DOIUrl":"10.1136/bmjgh-2024-017828","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic challenged healthcare systems, particularly in settings with high infectious disease burden. We examined the postpandemic long-term impacts of COVID-19 on tuberculosis (TB) services at anti-retroviral therapy (ART) clinics in lower-income countries.</p><p><strong>Methods: </strong>Using standardised online questionnaires, we conducted a cross-sectional site survey among ART clinics providing TB services in Africa and Asia from July to September 2023 (site-level information and number of TB diagnoses and tests).</p><p><strong>Results: </strong>Of 45 participating ART clinics, 32 (71%) were in Africa and 13 (29%) in Asia. During the COVID-19 pandemic (2020-2022), 43 (96%) clinics reported implementing social distancing or separation measures, 39 (87%) personal protections for staff members and 32 (71%) protections for patients. Infection control measures were in place in 45% of the clinics before the pandemic (until 2019), 23% introduced measures during the pandemic and 15% maintained them after the pandemic (after 2022). Service provision was affected during the pandemic in 33 (73%) clinics, including TB services in 22 (49%) clinics. TB service restrictions were addressed by introducing changes in directly observed therapy provision in 8 (18%) clinics, multimonth TB drug dispensing in 23 (51%), telehealth services in 25 (56%) and differentiated service delivery in 19 (42%). These changes were sustained after the pandemic at 4 (9%), 11 (24%), 17 (38%) and 12 (27%) clinics, respectively. Compared with 2018-2019, the number of TB diagnoses decreased sharply in 2020-2021 and improved after the pandemic.</p><p><strong>Conclusions: </strong>COVID-19 affected TB care services in ART clinics in Africa and Asia. This was paralleled by a reduction in TB diagnoses, which partly resumed after the pandemic. Infection control measures and alternative modes of service delivery were adopted during the pandemic and only partially maintained. Efforts should be made to sustain the lessons learnt during the COVID-19 pandemic, particularly approaches that reduce the risk of transmission of infectious diseases, including TB, in ART clinics.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financing the introduction of new vaccines to the national immunisation programme in China: challenges and options for action.","authors":"Xinyu Zhang, Shu Chen, Kun Zhu, Shenglan Tang","doi":"10.1136/bmjgh-2024-017970","DOIUrl":"10.1136/bmjgh-2024-017970","url":null,"abstract":"<p><p>Ensuring adequate and sustainable financing of national immunisation programmes (NIPs) is one of the important elements to achieve the Immunisation Agenda 2030. Many middle-income countries ineligible for support from the Global Alliance for Vaccines and Immunisation have relatively slow progress in introducing new critical vaccines, due largely to financial constraints. China has not introduced any vaccines into the NIP since 2008. Its funding for the NIP, relying solely on the government budget, has been decreasing as the number of targeted children has declined. This paper presents the current situation of NIP and identifies main challenges in vaccine introduction in China: fluctuating and insufficient financing, restrictions on using health insurance funds for immunisation, high prices for non-NIP vaccines and the complicated and non-transparent decision-making mechanism to adjust NIP. There are also opportunities for introducing vaccines, such as local pilots to provide free or subsidised new vaccines and reducing domestic vaccine prices. Feasible options to optimise NIP financing in China include increasing government funding, diversifying financing channels such as using health insurance funds, improving the vaccine procurement mechanism and optimising the new vaccine introduction decision-making process.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 3","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}