BMJ Global Health最新文献

{"title":"Social franchising in healthcare: a systematic review and narrative synthesis of implementation and outcomes.","authors":"Md Hafizur Rahman, Janet E Perkins, Nasimul Ghani Usmani, Ridwana Maher Manna, Md Refat Uz Zaman Sajib, Ema Akter, Mohammad Sohel Shomik, Anisuddin Ahmed, Shams El Arifeen, Aniqa Tasnim Hossain, Ahmed Ehsanur Rahman","doi":"10.1136/bmjgh-2024-017101","DOIUrl":"10.1136/bmjgh-2024-017101","url":null,"abstract":"<p><strong>Introduction: </strong>The growing prominence of social franchising in healthcare underscores the need to analyse its implementation and impacts; however, substantial research gaps remain. Therefore, we aimed to conduct a systematic review and narrative synthesis of evidence to analyse the social franchise models, implementation and outcomes.</p><p><strong>Methods: </strong>We conducted a systematic literature search in February 2024 on Medline, Embase, PubMed, Web of Science, CINAHL and Scopus using terms related to 'social franchising' in healthcare. We conducted a qualitative narrative synthesis of study findings into five thematic areas: client impact and utilisation, healthcare outcomes, financial sustainability, innovative technologies and awareness activities.</p><p><strong>Results: </strong>From 4184 search results, 47 studies were included in the analysis. We identified 29 social franchises across 25 countries. Social franchises were mostly present in Africa, Asia and Central America. Most franchises focused on sexual, reproductive and maternal health (n=18) and family planning (FP) (n=25), and most included training (n=21), service provision (n=17) and financial support (n=12). Franchising improved client volumes, satisfaction and contraceptive continuation rates and increased access to healthcare. Vouchers and subsidised services reduced the financial burden among clients. Telemedicine and call centres enhanced healthcare delivery, and community outreach and marketing increased awareness and modern contraceptive use. However, franchises struggled to reach poorer populations due to high fees and competition from public services. It often did not improve FP, reproductive healthcare and child nutrition and had limited branding and promotional activities. Additionally, heavy reliance on donor funding threatened long-term sustainability.</p><p><strong>Conclusion: </strong>Social franchising presents a potential strategy for expanding healthcare access and improving service delivery, though outcomes regarding the effectiveness of social franchising vary across regions. More research is needed to evaluate digital technology use and the long-term impact, equity and sustainability of social franchising.</p><p><strong>Prospero registration number: </strong>CRD42022328104.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439544","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":"Successful strategies that address gender-related barriers and promote bodily autonomy within efforts to scale up and sustain postpregnancy contraception: a scoping review.","authors":"Arachu Castro, Rita Kabra, Anna Coates, James Kiarie","doi":"10.1136/bmjgh-2024-016638","DOIUrl":"10.1136/bmjgh-2024-016638","url":null,"abstract":"<p><strong>Introduction: </strong>Acknowledging the integral role of bodily autonomy in advancing gender equality, our study aimed to assess the extent to which strategies used in postpartum and postabortion contraception have effectively equipped women, girls and gender-diverse individuals with the tools, knowledge and resources required to make autonomous decisions that align with their diverse life experiences.</p><p><strong>Methods: </strong>We conducted a scoping review using the databases PubMed, EBSCOhost, EMBASE and SciSpace. We included implementation, evaluation and experimental studies published in any language between 2013 and 2023 and excluded studies not meeting these criteria. We used a WHO scale to determine the level of gender responsiveness.</p><p><strong>Results: </strong>We found 30 implementation, evaluation and experimental studies published in any language between 2013 and 2023. We categorised the strategies following the WHO scale as gender-transformative (4 studies), gender-specific (24 studies) and gender-sensitive (2 studies). None of the studies reported strategies hindering reproductive health and rights. All strategies involved women and girls, and none explicitly targeted gender-diverse people capable of childbearing.</p><p><strong>Conclusions: </strong>This study highlights the importance of integrating gender-transformative activities into postpregnancy contraceptive strategies and underscores the necessity of understanding and addressing local gender norms and the broader health system context to promote bodily autonomy effectively. The findings suggest that success should not be solely measured by contraceptive uptake but also by how well interventions address gender-related barriers.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432660","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":"A behavioural science framework for tackling upstream challenges in health systems.","authors":"Jana Smith, Emily Zimmerman, Wambui Gachiengo Nyabero, Priya Nanda, Olufunke Fasawe, Sanam Roder-DeWan","doi":"10.1136/bmjgh-2024-016897","DOIUrl":"10.1136/bmjgh-2024-016897","url":null,"abstract":"<p><p>Insights from behavioural science can inform a wide range of solutions including policy reforms, infrastructure changes, process reengineering, communications, devices and others. Its application in global health has, however, often focused on narrowly defined issues with linear theories of change that are relatively straightforward to study. Using behavioural science to examine 'upstream' actors in complex health systems holds promise as a complementary and underused approach to improving health systems. Behavioural scientists have missed opportunities to tackle systemic issues and the field of health systems strengthening rarely accounts for human behaviour at the macrolevel of health systems. We present a framework, developed by experts from a range of disciplinary backgrounds in global health and behavioural science that guides (1) the distillation of a health system challenge into concrete, addressable behaviours (specific actors and accompanying actions) and (2) the investigation of contextual factors that influence each behaviour.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432659","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":"Implementation outcomes of tuberculosis digital adherence technologies: a scoping review using the RE-AIM framework.","authors":"Chimweta I Chilala, Nicola Foster, Shruti Bahukudumbi, Mona Salaheldin Mohamed, Miranda Zary, Cedric Kafie, Barbie Patel, Genevieve Gore, Kevin Schwartzman, Ramnath Subbaraman, Katherine L Fielding","doi":"10.1136/bmjgh-2024-016535","DOIUrl":"10.1136/bmjgh-2024-016535","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, tuberculosis (TB) remains one of the leading infectious causes of death, with 1.3 million deaths. Digital adherence technologies (DATs) have the potential to provide person-centred care and improve outcomes. Using the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework, we conducted a scoping review of DAT implementations for TB treatment.</p><p><strong>Methods: </strong>We searched seven databases for papers published between January 2000 and April 2023, using keywords for 'tuberculosis' and 'digital adherence technology'. Articles meeting prespecified inclusion criteria and containing data on RE-AIM domains were included. We defined 'reach' as comprising cellphone ownership and engagement by people with TB (PWTB) with DATs, 'adoption' as engagement by healthcare providers with DAT programmes, 'implementation' as the fidelity of the DAT programme implemented and 'maintenance' as longer-term uptake of DATs.</p><p><strong>Results: </strong>Of 10 313 records, 102 contributed to the synthesis. DATs included short message service (SMS), phone, 99DOTS, video-supported therapy (VST) and pillboxes. For 'reach', across various settings, cellphone access varied from 50%-100% and 2%-31% of PWTB was excluded from accessing DATs due to technology challenges. 36%-100% of PWTB agreed to use a DAT. The weighted mean of DAT engagement over dose-days was 81% for SMS, 85% for phone, 61% for 99DOTS, 87% for pillbox and 82% for VST. Concerning 'implementation', the fidelity of DAT implementations was affected by technological issues such as cellphone coverage, DAT malfunction and provider-facing issues, including failure to initiate intensified patient management following low DAT engagement. Findings related to RE-AIM dimensions of 'adoption' and 'maintenance' were limited.</p><p><strong>Conclusion: </strong>Our findings suggest that the 'reach' of DATs may be limited by a cascade of barriers, including limitations in cellphone accessibility and suboptimal sustained DAT engagement by PWTB. Video and pillbox DATs have higher levels of engagement. Implementation challenges included technological and provider-facing issues. Improving implementation outcomes may be important for TB DATs to achieve a broader public health impact.</p><p><strong>Prospero registration number: </strong>CRD42022326968.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413419","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":"Contextual factors influencing implementation of tuberculosis digital adherence technologies: a scoping review guided by the RE-AIM framework.","authors":"Shruti Bahukudumbi, Chimweta I Chilala, Nicola Foster, Barbie Patel, Mona S Mohamed, Miranda Zary, Cedric Kafie, Genevieve Gore, Kevin Schwartzman, Katherine L Fielding, Ramnath Subbaraman","doi":"10.1136/bmjgh-2024-016608","DOIUrl":"10.1136/bmjgh-2024-016608","url":null,"abstract":"<p><strong>Introduction: </strong>Digital adherence technologies (DATs) may enable person-centred tuberculosis (TB) treatment monitoring; however, implementation challenges may undermine their effectiveness. Using the reach, effectiveness, adoption, implementation and maintenance framework, we conducted a scoping review to identify contextual factors informing 'reach' (DAT engagement by people with TB) and 'adoption' (DAT uptake by healthcare providers or clinics).</p><p><strong>Methods: </strong>We searched eight databases from 1 January 2000 to 25 April 2023 to identify all TB DAT studies. After extracting qualitative and quantitative findings, using thematic synthesis, we analysed common findings to create meta-themes informing DAT reach or adoption. Meta-themes were further organised using the Unified Theory of Acceptance and Use of Technology, which posits technology use is influenced by perceived usefulness, ease of use, social influences and facilitating conditions.</p><p><strong>Results: </strong>66 reports met inclusion criteria, with 61 reporting on DAT reach among people with TB and 27 reporting on DAT adoption by healthcare providers. Meta-themes promoting reach included perceptions that DATs improved medication adherence, facilitated communication with providers, made people feel more 'cared for' and enhanced convenience compared with alternative care models (perceived usefulness) and lowered stigma (social influences). Meta-themes limiting reach included literacy and language barriers and DAT technical complexity (ease of use); increased stigma (social influences) and suboptimal DAT function and complex cellular accessibility challenges (facilitating conditions). Meta-themes promoting adoption included perceptions that DATs improved care quality or efficiency (perceived usefulness). Meta-themes limiting adoption included negative DAT impacts on workload or employment and suboptimal accuracy of adherence data (perceived usefulness); and suboptimal DAT function, complex cellular accessibility challenges and insufficient provider training (facilitating conditions). Limitations of this review include the limited studies informing adoption meta-themes.</p><p><strong>Conclusion: </strong>This review identifies diverse contextual factors that can inform improvements in DAT design and implementation to achieve higher engagement by people with TB and healthcare providers, which could improve intervention effectiveness.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413335","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":"Spatial profiling of geographical accessibility to maternal healthcare and coverage of maternal health service utilisation in Nepal: a geospatial analysis based on demographic and health survey.","authors":"Heng-Qian Huang-Fu, Li Wang, Biraj Karmacharya, Uttam Kumar Koirala, Chang-Wen Ke, Dan Liang, Chun Hao, Ying-Si Lai","doi":"10.1136/bmjgh-2024-017229","DOIUrl":"10.1136/bmjgh-2024-017229","url":null,"abstract":"<p><strong>Background: </strong>Information on geographical accessibility to maternal healthcare (MHC) and coverage of maternal health service utilisation at high spatial resolution in Nepal are important for evidence-based health planning.</p><p><strong>Methods: </strong>Based on the Nepal Health Facility Registry dataset in 2022, we measured the geographical accessibility to MHC facilities across Nepal. Using data from 2022 Nepal Demographic and Health Survey and other sources, we assessed the relationships between geographical accessibility and the utilisation of the three major healthcare services (ie, four or more antenatal care (ANC) visits, institutional delivery and postnatal care (PNC) check-up), by applying Bayesian geostatistical models. High-resolution maps on coverage of the above services were produced.</p><p><strong>Results: </strong>The geographical accessibility showed high in the central and southern Terai belt but low in the northern mountains, with average travel-mode adjusted travel time for ANC, institutional delivery and PNC 26.74, 40.72 and 29.09 min, respectively. Negative correlations were found between geographical accessibility with four or more ANC visits (OR 0.76, 95% Bayesian credible interval, BCI 0.65 to 0.90), institutional delivery (OR 0.76, 95% BCI 0.64 to 0.90) and PNC check-up (OR 0.87, 95% BCI 0.76 to 0.99), respectively. Population-weighted coverages for four or more ANC visits, institutional delivery and PNC check-up were estimated 83.25% (95% BCI 80.43% to 85.35%), 84.26% (95% BCI 81.30% to 86.08%) and 73.19% (95% BCI 69.43% to 76.09%), respectively, across Nepal. The northern mountains and southeastern Terai showed low coverage for the three healthcare services, while the central, eastern and western hilly regions exhibited good coverage.</p><p><strong>Conclusion: </strong>Geographical accessibility is important in utilisation of maternal health services in Nepal. The high-resolution maps enable an evidence-based assessment for better health planning.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413420","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":"Pacific priorities for the prevention of violence against women and girls.","authors":"Stephanie Copus Campbell, Kyllie Cripps, Sara E Davies, Jane Fisher, Asher Flynn, Saui'a Louise Mataia Milo, Nalini Singh, Jacqui True","doi":"10.1136/bmjgh-2024-017046","DOIUrl":"10.1136/bmjgh-2024-017046","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405639","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":"Seasonal influenza surveillance and vaccination policies in the WHO South-East Asian Region.","authors":"Saleh Haider, Md Zakiul Hassan","doi":"10.1136/bmjgh-2024-017271","DOIUrl":"10.1136/bmjgh-2024-017271","url":null,"abstract":"<p><p>The WHO South-East Asia Region (SEAR), with its high population density, is recognised by epidemiologists as a critical reservoir for the emergence and global dissemination of novel influenza strains, making it a potential epicentre for future influenza pandemics. Despite this significant risk, most SEAR countries lack comprehensive seasonal influenza vaccination policies, resulting in low vaccine uptake across the region. This review analysed the latest WHO National Influenza Programme factsheets from the 11 SEAR member states and supplemented this with extensive manual literature searches using electronic databases and government websites. As of October 2022, only three countries-India, Bhutan and Thailand-had established seasonal influenza vaccination policies. Among them, Bhutan and Thailand have policies that cover all five WHO-recommended high-risk groups. While national influenza surveillance systems are in place across SEAR, only India and the Democratic People's Republic of Korea claim full population coverage. Influenza vaccine production capacity is limited to Bangladesh, India and Indonesia. The region's varied climatic conditions and insufficient local data have further obscured the true burden of influenza. Thailand offers a successful model for other countries in the region, beginning with the most vulnerable groups and gradually expanding coverage. To effectively develop and implement national influenza vaccination policies, SEAR countries must close the evidence gap by strengthening surveillance systems to provide accurate, timely data and prioritise context-specific research, leverage existing vaccine infrastructure, enhance public education and finally engage with local and international stakeholders to establish strong international cooperation to support these efforts and improve pandemic preparedness.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405641","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":"Safeguarding healthcare workers in Gaza and throughout occupied Palestine.","authors":"Mohammed Yunus Khanji, Larissa Fast, Amira Nimerawi, James Smith, Mohammed Ejaz Faizur Rahman, Omar Abdel-Mannan, Karl Blanchet, Bertrand Taithe, Róisín Read, Rohini J Haar, Yasmin Kader, Naomi C Green, Neve Gordon","doi":"10.1136/bmjgh-2024-017245","DOIUrl":"10.1136/bmjgh-2024-017245","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405640","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":"Extending a parallel cluster randomised trial into a stepped-wedge cluster randomised trial: implications for interpretation.","authors":"Karla Hemming, Monica Taljaard","doi":"10.1136/bmjgh-2024-018087","DOIUrl":"10.1136/bmjgh-2024-018087","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"10 2","pages":""},"PeriodicalIF":7.1,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405637","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}