BMJ Global Health最新文献

{"title":"Strengthening financial protection through multitiered health coverage: evidence from 667 055 low-income households in China.","authors":"Guanping Liu, Zhongliang Zhou, Yangling Ren, Xiaohui Zhai, Yan Zhuang, Zhichao Wang, Ruifeng Cui","doi":"10.1136/bmjgh-2025-019440","DOIUrl":"10.1136/bmjgh-2025-019440","url":null,"abstract":"<p><strong>Introduction: </strong>Low-income households face disproportionate out-of-pocket hardship when accessing healthcare, undermining equity and universal health coverage. To address these challenges, China implemented a three-tiered health coverage system-basic medical insurance, catastrophic medical insurance and medical assistance-but its comprehensive impact on the financial protection remains underexplored.</p><p><strong>Methods: </strong>We analysed Shaanxi Province's Medical Assistance database (2013-2016) to evaluate the impact of China's multitiered health coverage system on financial protection by: (1) estimating the incidence of catastrophic health expenditure (out-of-pocket payments> 25% of annual income) and medical impoverishment (postpayment income <US$1.90/day) before and after reimbursement-lower incidence indicating better protection and (2) assessing income-related inequality and inequity using concentration indices and horizontal inequity indices (ranging -1 to 1, where zero indicates equality/equity, negative values indicate pro-poor and positive values pro-rich distributions). All estimates accounted for household-level clustering.</p><p><strong>Results: </strong>A total of 667 055 households were included. After reimbursement, the incidence of catastrophic health expenditure fell from 58.59% (95% CI: 58.47 to 58.70) to 17.89% (95% CI: 17.79 to 17.97) and medical impoverishment from 41.43% (95% CI: 41.30 to 41.54) to 13.47% (95% CI: 13.38 to 13.55), driven mainly by basic medical insurance and medical assistance. Rural households received larger absolute declines yet remained higher than urban counterparts. Financial protection inequity worsened: the Horizontal Inequity Index for catastrophic health expenditure shifted from -0.0890 (95% CI: -0.0902 to -0.0879) to -0.1717 (95% CI: -0.1746 to -0.1689) and for medical impoverishment from -0.2653 (95% CI: -0.2669 to -0.2640) to -0.5251 (95% CI: -0.5280 to -0.5222), a pattern observed in both urban and rural areas.</p><p><strong>Conclusion: </strong>Our findings underscore the need for a three‑tiered health coverage system-including targeted, equitable reimbursement-to advance universal health coverage. Emerging tools such as big data analytics and artificial intelligence offer new ways to monitor and optimise equity; it is timely to extend equity considerations beyond funding mobilisation to reimbursement.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039098","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 effect of supporting districts to operationalise digital payments for vaccination campaign workers: a cluster randomised controlled trial during the 2022 polio vaccination campaign in Uganda.","authors":"Peter Waiswa, Margaret McConnell, Juliet Aweko, Daniel Donald Mukuye, Charles Opio, Maggie Ssekitto Ashaba, Andrew Bakainaga, Elizabeth Ekirapa-Kiracho","doi":"10.1136/bmjgh-2024-016666","DOIUrl":"10.1136/bmjgh-2024-016666","url":null,"abstract":"<p><strong>Introduction: </strong>A motivated and satisfied health workforce is critical for the success of mass vaccination campaigns targeting diseases like polio. This study examined whether supporting districts to implement electronic cash (e-cash) payments, instead of cash, increased e-cash usage and improved vaccine campaign healthcare workers' (VCHWs) motivation and satisfaction during an oral poliovirus vaccination campaign in 2022 in Uganda.</p><p><strong>Methods: </strong>In November 2022, 54 districts and 2665 VCHWs were enrolled and randomised. Intervention districts received training on navigating the government e-cash platform, user roles, beneficiary data upload and payment report generation. Control districts received standard support. Data collected included mode of payment (cash or e-cash), VCHW motivation (primary outcome) and satisfaction with the payment method. Primary analysis was on an intention-to-treat basis, with 589 (44.1%) VCHWs in control and 765 (57.5%) in intervention districts receiving e-cash.</p><p><strong>Results: </strong>E-cash payments were more common in intervention districts (765/1330, 57.5%) compared with controls (589/1335, 44.1%). VCHWs in intervention districts were more likely to be paid via e-cash (adjusted OR (AOR) 3.15; 95% CI: 0.40 to 10.70; p=0.079). Nearly all VCHWs (97.6%) received payments after campaign completion. There was no significant difference in motivation (AOR=0.82; 95% CI: 0.47 to 1.44; p=0.498) or satisfaction (AOR=1.01; 95% CI: 0.77 to 1.55; p=0.641) between groups. Participants reported e-cash as convenient, transparent, time-saving and cost-saving.</p><p><strong>Conclusion: </strong>Supporting districts to operationalise digital payments increased e-cash usage among vaccination workers, despite delays. However, it did not significantly impact motivation or satisfaction.</p><p><strong>Trial registration number: </strong>NCT05684081.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 Suppl 4","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039048","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":"Health justice in fragile and shock-prone settings: from theory to practice towards building resilient health systems.","authors":"Giulia Loffreda, Shophika Regmi, Joanna Khalil, Thazin La, Ayesha Idriss, Joanna Raven, Sophie Witter, Wesam Mansour","doi":"10.1136/bmjgh-2024-017155","DOIUrl":"10.1136/bmjgh-2024-017155","url":null,"abstract":"<p><p>Health justice is an emerging imperative in global health and health policy and systems research, particularly in fragile and shock-prone settings where inequities are deepened by political instability, conflict and structural violence. This practice paper explores how the ReBUILD for Resilience consortium has sought to operationalise health justice as a guiding principle and embedded practice in four diverse contexts: Myanmar, Nepal, Lebanon and Sierra Leone. Drawing from political philosophy, public health ethics and the capability approach, we outline a framework that positions health justice not only as an aspiration but also as an actionable, community-rooted agenda that centres equity, power redistribution and inclusive governance. Through participatory action research, political economy analysis and embedded learning sites, the ReBUILD teams engaged with communities and health system actors to co-create interventions that respond to local needs while addressing entrenched exclusion and marginalisation. Country experiences demonstrate both the potential and challenges of advancing health justice: from establishing inclusive Municipal Health Committees and revitalising health facility governance to promoting leadership among marginalised groups such as people with disabilities and displaced populations. This paper reflects on tensions around facilitation, participation and positionality and acknowledges the broader political economy, subnational, national and transnational, that shapes opportunities for transformation. We argue that health justice must be pursued through politically astute, reflexive and participatory research approaches, grounded in long-term relationships and a commitment to amplifying community voices. While the road is complex and contested, the pursuit of health justice is essential for building more equitable, inclusive and resilient health systems in the face of protracted crises and global inequities.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039095","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 WHO pandemic agreement: why countries will not use compulsory licensing - and how to fix it.","authors":"WooJung Jon","doi":"10.1136/bmjgh-2025-020856","DOIUrl":"10.1136/bmjgh-2025-020856","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032747","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":"Taxes for tuberculosis: could tobacco and sugar tax revenue fund tuberculosis control interventions?","authors":"Mikaela Coleman, Anna K Coussens, Claire Jacqueline Calderwood, Ingrid Schoeman, Madhavi Bhargava, Pranay Sinha, Ben J Marais, Katharina Kranzer","doi":"10.1136/bmjgh-2025-019770","DOIUrl":"10.1136/bmjgh-2025-019770","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022875","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":"Transforming adolescent sexual reproductive health in Pakistan: a holistic and culturally sensitive strategy.","authors":"Salima Meherali, Hina Najmi, Zahid Ali Memon, Zohra S Lassi","doi":"10.1136/bmjgh-2024-017352","DOIUrl":"10.1136/bmjgh-2024-017352","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022888","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":"Attitudes to malaria vaccination in children: what can be learned from their consistency with the temporal dynamics of COVID-19 vaccination intention? A prospective cohort study in rural Senegal (July 2020-November 2023).","authors":"Valerie Seror, Sebastien Cortaredona, El Hadji Ba, Gwenaelle Maradan, Cheikh Sokhna","doi":"10.1136/bmjgh-2025-019027","DOIUrl":"10.1136/bmjgh-2025-019027","url":null,"abstract":"<p><strong>Introduction: </strong>Several sub-Saharan African countries are launching malaria vaccination programmes for children. We assessed how attitudes to malaria vaccination for children could be better understood by considering the individual dynamics of COVID-19 vaccine intention/uptake over the 2021-2023 campaigns, with a view to highlighting barriers likely to affect malaria vaccine uptake.</p><p><strong>Methods: </strong>We conducted a six-wave telephone-based survey of 600 randomly selected Senegalese households. A latent class mixed model was used to assess temporal changes in COVID-19 vaccine intention/uptake and to identify clusters of individuals sharing similar intention/uptake patterns across the waves. Time-invariant and time-varying correlates were assessed using logistic and probit models. Attitudes to malaria vaccination (wave 6) were compared with the various COVID-19 patterns.</p><p><strong>Results: </strong>Of the 600 households contacted, 558 (93.00%) agreed to participate in the study (558 heads of household and 457 spouses). Very strong positive attitudes to malaria vaccination (65.28% of participants) were associated with higher personal COVID-19 vaccine uptake (p<0.001). With regard to the individual dynamics of COVID-19 vaccination, three temporal patterns were identified: continuously strong intention (34.88% of participants), increasingly strong intention (33.40%) and increasingly less strong intention (31.72%). Along with socioeconomic factors, these patterns were explained by early levels of risk perception and trust in health authorities, and temporal fluctuations of these factors. Households where both surveyed members had continuously strong COVID-19 vaccination intention were also more likely to have strong positive attitudes to malaria vaccination for children (p=0.001).</p><p><strong>Conclusion: </strong>Further investigation would be necessary to assess the generalisability of using individual dynamics of COVID-19 vaccination as a reference for studying attitudes to newly offered vaccines. As regards the real-world dynamics of uptake of the four scheduled malaria vaccine doses, targeting of parents who need incentives to address barriers to compliance could be improved by accounting for their dynamics of COVID-19 vaccination.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421156/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022880","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":"Women and clinicians' views, preferences and experiences of caesarean section and vaginal birth in India: a qualitative substudy of the 'Misoprostol or Oxytocin for Labour Induction' (MOLI) trial.","authors":"Kate Lightly, Shuchita Mundle, Jaya Tripathy, Pradeep Deshmukh, Beverly Winikoff, Andrew Weeks, Carol Kingdon","doi":"10.1136/bmjgh-2024-018393","DOIUrl":"10.1136/bmjgh-2024-018393","url":null,"abstract":"<p><strong>Introduction: </strong>Caesarean use in India continues to rise and significant disparities exist. However, women and clinicians' views are under-researched. This paper aims to explore women and clinicians' views and preferences for mode of birth in two government hospitals in urban central India.</p><p><strong>Methods: </strong>This qualitative study involved 53 semistructured interviews with high-risk women before and after induction of labour and eight focus groups with clinicians and researchers in two government hospitals in Maharashtra state. All women were recruited to the 'Misoprostol or Oxytocin for Labour Induction' (MOLI) randomised controlled trial (NCT03749902) and were induced for hypertensive disorders in pregnancy. Data were analysed using the framework approach to thematic analysis.</p><p><strong>Results: </strong>Interactions between women, clinicians and families played an important role in women's birth experiences. Most women strongly preferred vaginal birth. While a vaginal birth was important to women for their long-term health and well-being, the safety of the baby was the priority. Both women and clinicians justified caesarean use to promote fetal safety. Contrary to clinicians' perceptions, women clearly understood their caesarean indications. The busy clinical environment was an important factor influencing the clinician's decision and threshold for caesarean. Three themes arose from the data: (1) women's preference for vaginal birth: a matter of 'Trouble for two hours or trouble for two months'; (2) clinicians' perspectives about caesarean use: 'Don't take a risk'; and (3) knowledge through experiences and interactions: 'The pain didn't come'.</p><p><strong>Conclusion: </strong>Women strongly preferred 'normal delivery' but accepted caesarean birth to promote fetal safety. Clinicians felt labour and vaginal birth were often risky and prioritised fetal safety in this under-resourced context. Women who had a caesarean birth understood their indication for caesarean but, compared with vaginal birth, reported that caesarean caused them additional short- and long-term anxiety, health and social concerns.</p><p><strong>Trial registration number: </strong>NCT04037683.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005811","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":"From preparedness to solidarity reimagining global health security post-COVID-19.","authors":"Augustus Osborne","doi":"10.1136/bmjgh-2025-021178","DOIUrl":"10.1136/bmjgh-2025-021178","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005894","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":"Health systems strengthening in the Democratic Republic of Congo: the importance of surgical data.","authors":"Achim Mambu Vangu, Michel Nlandu Kambu, Joenel Mfundu Mbuangi, Andrew J M Leather, Elizabeth H Tissingh","doi":"10.1136/bmjgh-2024-017759","DOIUrl":"10.1136/bmjgh-2024-017759","url":null,"abstract":"<p><p>World Health Assembly resolutions have recently placed emphasis on emergency, critical and operative care to achieve universal health coverage. This will require a move away from vertical health programmes and a stronger emphasis on health systems strengthening, including data systems. There has also been an increased recognition of the need for data to advance the global surgery agenda. We share our efforts in the Democratic Republic of Congo (DRC) to strengthen surgical data collection, analysis, interpretation and dissemination sustainably. Working with individuals, institutions and systems, we outline interventions used to strengthen the health system and lessons learnt. Our work has highlighted the negative consequences of vertical programmes with demanding data management processes and the importance of taking a systems-level approach to improving surgical data and ultimately surgical outcomes.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 9","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999547","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}