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Health Policy Plan 2019 Apr 21. Epub 2019 Apr 21.

Institute of Development Studies, Library Road, University of Sussex, BN1 9RE, Brighton, UK.

Stunted growth in children and multisectoral action to address it are dominant ideas in the international nutrition community today, and this study finds that these ideas are increasingly evident over time in nutrition policy in Zambia, with stunting largely displacing other framings of nutrition. This study is based on key informant interviews (70 interviews with 61 interviewees), policy document review, and social network mapping, with iterative data collection and analysis taking place over 6 years (2011-2016). Analysis was based on two established political science theories: policy transfer theory and the Advocacy Coalition Framework. Read More

Health Policy Plan 2019 Apr 21. Epub 2019 Apr 21.

Malawi University of Science and Technology, Thyolo, Malawi.

Malawi has a long history of receiving foreign aid, both monetary and technical support, for its health and other services provision. In the past two decades, foreign aid has increased, with the aim of the country being able to achieve its Millennium Development Goals by the end of 2015. It is currently moving towards achieving the sustainable development goals. Read More

Health Policy Plan 2019 Apr 19. Epub 2019 Apr 19.

UNICEF Eastern and Southern Africa Regional Office, United Nations Complex Gigiri, United Nations Avenue, Nairobi, Kenya.

Integration of parallel health commodities supply chains into one national supply chain is becoming more common globally as national health systems are strengthened and organizations realize the potential for increased effectiveness and cost reduction from integration. UNICEF conducted a 10-week pilot to integrate its supply chain for nutrition commodities into the national Ministry of Health supply chain for medical commodities. This paper is a cost analysis of the integration process in two counties, comparing four scenarios of cost structures before, during and after integration. Read More

Health Policy Plan 2019 Apr 11. Epub 2019 Apr 11.

London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK.

Antimicrobial resistance (AMR) has recently emerged as a salient global issue, and policy formulation to address AMR has become a contested space, with various actors sharing competing-and sometimes contradictory-explanations of the problem and the range of possible solutions. To facilitate national policy setting and implementation around AMR, more needs to be done to effectively engage policymakers in low- and middle-income countries (LMICs). However, there is a dearth of research on differences in issue framing by external agencies and LMIC's national policymakers on the problem of AMR; such analyses are imperative to identify areas of conflict and/or potential convergence. Read More

Health Policy Plan 2019 Apr 2. Epub 2019 Apr 2.

Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU, UK.

To address its persistently high maternal mortality, the Malawi government has prioritized strategies promoting skilled birth attendance and institutional delivery. However, in a country where 80% of the population resides in rural areas, the barriers to institutional deliveries are considerable. As a response, Malawi issued Community Guidelines in 2007 that both promoted skilled birth attendance and banned the utilization of traditional birth attendants for routine deliveries. Read More

Health Policy Plan 2019 Apr 2. Epub 2019 Apr 2.

Department of Global Health, University of Washington, 1510 San Juan Rd, Seattle, WA, USA.

Civil wars, political conflicts, ethnic issues and stagnant social development have resulted in fragile health systems in Northeastern Myanmar. The healthcare provision continues to be fragile and inefficient, with prevalent health inequity. Limited service point, poor financial protection mechanism and gender-based inequity restrain the population's access to healthcare services, not to mention local authority's lacking participation in the making, implementation and evaluation of health policies. Read More

Health Policy Plan 2019 Apr 2. Epub 2019 Apr 2.

Programa de Políticas, Sistemas y Gestión en Salud, Escuela de Salud Pública, Universidad de Chile, Independencia 939, Independencia, Región Metropolitana, Santiago, Chile.

The aim of this study is to evaluate the impact of urgent care centres' (UCCs) implementation on emergency department (ED) and same-day visits in primary care in a Chilean public healthcare network. Quasi-experimental design study assessing changes in patient visits after UCC implementation in a local health district. Ten family health centres (FHC), nine UCCs and three EDs in the Talcahuano Health District, Chile. Read More

Health Policy Plan 2019 Mar 30. Epub 2019 Mar 30.

Global Health Institute, American University of Beirut, Old Pharmacy Building, Room 202, PO Box 11-0236, Riad El-Solh, Beirut, Lebanon.

War and conflict negatively impact all facets of a health system; services cease to function, resources become depleted and any semblance of governance is lost. Following cessation of conflict, the rebuilding process includes a wide array of international and local actors. During this period, stakeholders must contend with various trade-offs, including balancing sustainable outcomes with immediate health needs, introducing health reform measures while also increasing local capacity, and reconciling external assistance with indigenous legitimacy. Read More

Health Policy Plan 2019 Mar 21. Epub 2019 Mar 21.

College of Public Health, Medical and Veterinary Sciences, James Cook University, James Cook Drive, Townsville, QLD, Australia.

Informal payments for healthcare are widely acknowledged as undercutting health care access, but empirical research is somewhat limited. This article is a critical interpretive synthesis that summarizes the evidence base on the drivers and impact of informal payments in maternal health care and critically interrogates the paradigms that are used to describe informal payments. Studies and conceptual articles identified both proximate and systems drivers of informal payments. Read More

Health Policy Plan 2019 Mar 19. Epub 2019 Mar 19.

Indian Institute of Science Education and Research Thiruvananthapuram, Vithura, Thiruvananthapuram, India.

Health system responsiveness (HSR) has been identified as one of the intrinsic goals of health systems for improvement in health and well-being of population. The HSR deals with the non-medical, legitimate expectations of a population in its interaction with the health system. It becomes essential in case of vulnerable groups like older adults with disability, who are more sensitive and risk-prone to the adversities of healthcare challenges. Read More

Health Policy Plan 2019 Mar 12. Epub 2019 Mar 12.

Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town 7501, South Africa.

Building resilience in health systems is an imperative for low- and middle- income countries. Health service managers' ability to implement health innovations may be a key aspect of resilience in primary healthcare facilities, promoting adaptability and functionality. This study investigated health service managers' perceptions and experiences of adopting health innovations. Read More

Health Policy Plan 2019 Mar 6. Epub 2019 Mar 6.

Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, Keppel Street WC1E7HT, London, UK.

This study explores the relationship between two health financing initiatives on women's progression through the maternal health continuum in Kenya: a subsidized reproductive health voucher programme (2006-16) and the introduction of free maternity services in all government facilities (2013). Using cross-sectional survey data, we ran three multivariable logistic regression models examining the effects of the voucher programme, free maternity policy, health insurance and other determinants on (1) early antenatal care (ANC) initiation (first visit within the first trimester of pregnancy), (2) receiving continuous care (1+ ANC, facility birth, 1+ post-natal care (PNC) check) and (3) completing the maternal health pathway as recommended (4+ ANC, facility birth, 1+ PNC, with first check occurring within 48 h of delivery). Full implementation of the voucher programme was positively associated with receiving continuous care among users of 1+ ANC [interaction term adjusted odds ratio (aOR): 1. Read More

Health Policy Plan 2018 Nov;33(9):C1-C3

Health Policy Plan 2019 Feb 20. Epub 2019 Feb 20.

Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.

Integrating methadone and HIV care is a priority in many low- and middle-income settings experiencing a growing challenge of HIV epidemics linked to injecting drug use. There is as yet little understanding of how to integrate methadone and HIV care in these settings and how such services can be implemented; such a gap reflects, in part, limitations in theorizing an implementation science of integrated care. In response, we qualitatively explored the delivery of methadone after its introduction in Kenya to understand integration with HIV care. Read More

Health Policy Plan 2019 Feb 14. Epub 2019 Feb 14.

Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA.

Financial barriers cause many women in low- and middle-income countries to deliver outside of a health facility, contributing to maternal and neonatal mortality. Savings accrued during pregnancy can increase access to safe delivery services. We investigated the relationship between household saving during pregnancy and facility delivery. Read More

Health Policy Plan 2019 Feb 8. Epub 2019 Feb 8.

Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.

Several tools have been developed to collect information on health facility preparedness to provide sexual violence response services; however, little guidance exists on how this information can be used to better understand which functions a facility can perform. Our study therefore aims to propose a set of signal functions that provide a framework for monitoring the availability of clinical sexual violence services. To illustrate the potential insights that can be gained from using our proposed signal functions, we used the framework to analyse data from a health facility census conducted in Central Province, Zambia. Read More

Health Policy Plan 2019 Feb 7. Epub 2019 Feb 7.

GroundWork, Hintergass 1, Fläsch, Switzerland.

There are important lessons learned from the 2014-16 Ebola virus disease outbreak in West Africa. However, there has not been a systematic documentation of nutrition lessons specifically. Therefore, this study sought to generate multiple stakeholder perspectives for understanding the nutrition challenges faced during the Ebola virus disease outbreak, as well as for consensus building around improved response strategies. Read More

Health Policy Plan 2019 Jan 30. Epub 2019 Jan 30.

Department of Asian and Policy Studies, The Education University of Hong Kong, Hong Kong.

The rapid diffusion of medical technologies is widely recognized as a key driver of healthcare cost escalation. The excessive duplication of technologies gives rise to the so-called medical arms race. Conventional wisdom tends to explain this phenomenon by external reimbursement mechanisms and hospitals' competitive strategies, but has largely neglected the role played by health regulations that may also affect hospitals' technology adoption decisions. Read More

Health Policy Plan 2019 Jan 29. Epub 2019 Jan 29.

Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Nashville, TN, USA.

Despite numerous international and national efforts, only 12 countries in the World Health Organization's African Region met the Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across sub-Saharan Africa, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Liberia and Zambia were chosen to represent countries making substantial progress towards MDG#4, while Kenya and Zimbabwe represented countries making less progress. Read More

Health Policy Plan 2019 Jan 25. Epub 2019 Jan 25.

Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, Switzerland.

In Tanzania, the health financing system is extremely fragmented with strategies in place to supplement funds provided from the central level. One of these strategies is the Community Health Fund (CHF), a voluntary health insurance scheme for the informal rural sector. As its implementation has been challenging, we investigated different CHF implementation practices and how these practices and the wider health financing context affect CHF implementation and potentially enrolment. Read More

Health Policy Plan 2019 Jan 25. Epub 2019 Jan 25.

Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO, USA.

Since the adoption of the Sustainable Development Goals in 2015, innovation in global healthcare delivery has been recognized as a vital avenue for strengthening health systems and overcoming present implementation bottlenecks. In the recent rapid development of the science of global health-care delivery, emergency care-a critical element of the health system-has been widely overlooked. Emergency care plays a vital role in the health system through providing immediately responsive care and serving as one of the main entry points for those with symptomatic disease. Read More

Health Policy Plan 2019 Jan 18. Epub 2019 Jan 18.

Director, CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Armendáriz 497, 2do piso, Miraflores, Lima 18, Perú.

The use of community health workers (CHWs) has been explored as a viable option to provide home health education, counselling and basic health care, notwithstanding their challenges in training and retention. In this manuscript, we review the evidence and discuss how the digitalization affects the CHWs programmes for tackling non-communicable diseases (NCDs) in low- and middle-income countries (LMICs). We conducted a review of literature covering two databases: PubMED and Embase. Read More

Health Policy Plan 2019 Jan 21. Epub 2019 Jan 21.

School of Public Administration, The University of New Mexico, Social Sciences Building, Room 3008, MSC05-3100, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.

Civil society actors have substantially increased their participation in global and national health policymaking processes since the 1970s. Civil society roles in shaping such significant global health milestones as the Doha Declaration on Intellectual Property Rights, the Framework Convention on Tobacco Control and the recently adopted United Nations Sustainable Development Goals are well documented, but knowledge of civil society actor influence on health policy processes in low- and middle-income countries remains fragmented. This study analyses 24 peer-reviewed research articles published between 2007 and 2016 to identify factors affecting civil society influence in the pre-implementation stages of the policy process. Read More

Health Policy Plan 2019 Jan 9. Epub 2019 Jan 9.

Africa Centre for HIV/AIDS Management, Stellenbosch University, Stellenbosch, South Africa.

Efforts to improve the effectiveness of global health aid rarely take full account of the micro-politics of policy change and implementation. South Africa's HIV/AIDS epidemic is a case in point, where the US President's Emergency Plan for AIDS Relief (PEPFAR) has provided essential support to the national AIDS response. With changing political context, PEPFAR has shifted focus several times-most recently reversing the policy of 'transition' out of direct aid to a policy of re-investing in front-line services in priority districts to improve aid effectiveness. Read More

Health Policy Plan 2019 Jan 8. Epub 2019 Jan 8.

The Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD 21202, USA.

The 2014-16 West Africa Ebola epidemic was a watershed moment for global health. The outbreak galvanized global action around strengthening infectious disease prevention, detection and response capabilities. We examined the nascent landscape of international programmes, initiatives and institutions established in the aftermath of the 2014-16 Ebola outbreak with the aim of assessing their progress to date to illustrate the current state of the world's global health security architecture. Read More

Health Policy Plan 2018 Dec;33(10):1145

Health Policy Plan 2018 Dec;33(10):1128-1143

London School of Hygiene and Tropical Medicine, London, UK.

A number of primary studies and systematic reviews focused on the contribution of community health workers (CHWs) in the delivery of essential health services. In many countries, a cadre of informal health workers also provide services on a volunteer basis [community health volunteers (CHV)], but there has been no synthesis of studies investigating their role and potential contribution across a range of health conditions; most existing studies are narrowly focused on a single condition. As this cadre grows in importance, there is a need to examine the evidence on whether and how CHVs can improve access to and use of essential health services in low- and middle-income countries (LMICs). Read More

Health Policy Plan 2018 Dec;33(10):1096-1106

Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA.

Community health workers (CHWs) play a critical role in health promotion, but their workload is often oriented around a single disease. Renewed interest in expansion of multipurpose CHWs to cover an integrated package of services must contend with the debate over how effectively CHWs can perform an increased range of tasks. In this study, we examine whether an existing cadre of HIV-focused paid volunteer CHWs in Iringa, Tanzania, can take on new maternal, newborn and child health (MNCH) promotion tasks without adversely affecting their HIV role. Read More

Health Policy Plan 2018 Dec;33(10):1083-1095

Bureau for Asia/Technical Services, US Agency for International Development, 1300 Pennsylvania Avenue, Washington, DC, USA.

The burgeoning literature on resilient health systems in low- and middle-income countries (LMICs) provides limited insights into the practice of resilience-building. To address this operational shortcoming, we explore the potential of health ministries to become 'learning organizations' to help foster resilience. We adopted a multi-stage, iterative methodology comprising multiple purposive literature searches, the selection and application of a conceptual framework from the 'learning organizations' literature, and expert opinion to expand on the framework with illustrative examples from LMICs. Read More

Health Policy Plan 2018 Dec;33(10):1073-1082

Institute of Social Research, National Autonomous University of Mexico, Mexico City, Mexico.

This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data. Read More

Health Policy Plan 2018 Dec;33(10):1118-1127

World Health Organization, Regional Office for the Eastern Mediterranean, Monazamet El Seha El Alamia Street, Extension of Abdel Razak El Sanhouri Street, Nasr City, Cairo, Egypt.

The excessive use of resources, inefficiency and poor service quality in public hospitals has led developing countries to create reforms in public hospital governance, including autonomization. Hospital autonomy refers to the delegation of administrative rights to the hospital management team. The purpose of the present research is to review different aspects of hospital autonomy reforms in developing countries, such as incentives, preparations, obstacles and facilitators to change prior to implementation, impacts on achieving Universal Health Coverage (UHC) goals, challenges, outcomes and implications for implementation. Read More

Health Policy Plan 2018 Dec;33(10):1065-1072

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Tehran 14155, Iran.

Health equity has become a progressively popular research topic in recent years. Therefore, this study was made to identify the contributions made by socioeconomic determinants in order to quantify their roles to healthcare utilization inequity and to show their status especially after the recent reform in Iran, i.e. Read More

Health Policy Plan 2018 Dec;33(10):1107-1117

Department of Reproductive Health and Research, World Health Organisation, 20, Avenue Appia - Geneva, Switzerland.

Estimation of maternal mortality ratio (MMR) in humanitarian settings ('settings of conflict, displacement and natural disaster') is challenging, particularly where communities have dissolved and geographical areas are inaccessible. During humanitarian events, the reproduction of maternal mortality figures by the media is common, and are often based on inaccurate reports. In light of such uncertainties and challenges, the aim of this article was to review and appraise the methodology and data collection tools used to measure MMR in humanitarian settings. Read More

Health Policy Plan 2018 Dec;33(10):1144

Health Policy Plan 2018 Nov;33(9):1037-1046

Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.

This paper studies the effect on hospital service prices of a health system reform that allows managed selective contracting and regulation as a means for efficiency and price competition. Cross-sectional data about prices and market structure were analysed from a pool of 20 markets which includes 15 million Colombians. A multilevel regression method comparing three different market settings was performed. Read More

Health Policy Plan 2018 Dec;33(10):1055-1064

Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland.

The lack of access to quality-assured surgery in rural parts of sub-Saharan Africa, where the numbers of trained health workers are often insufficient, presents challenges for national governments. The case for investing in scaling up surgical systems in low-resource settings is 3-fold: the potential beneficial impact on a large proportion of the global burden of disease; better access for rural populations who have the greatest unmet need; and the economic case. The economic losses from untreated surgical conditions far exceed any expenditure that would be required to scale up surgical care. Read More

Health Policy Plan 2018 Nov;33(9):1026-1036

Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, UK.

The impact of payment-for-performance (P4P) schemes in the health sector has been documented, but there has been little attention to the distributional effects of P4P across health facilities. We examined the distribution of P4P payouts over time and assessed whether increased service coverage due to P4P differed across facilities in Tanzania. We used two service outcomes that improved due to P4P [facility-based deliveries and provision of antimalarials during antenatal care (ANC)], to also assess whether incentive design matters for performance inequalities. Read More

Health Policy Plan 2018 Nov;33(9):1018-1025

Department of Global Health and Population, Harvard University, T. H. Chan School of Public Health, 655 Huntington Ave., Boston, MA, USA.

Similar to many other countries, Chile is facing the challenges of rapid ageing and the increase in long-term care (LTC) needs for this population. Implementation of LTC systems has been the response to these challenges in other countries, however, Chile still lacks a strategy for addressing LTC needs. This article advocates for the implementation of a LTC system in Chile, demonstrating that this could be an effective and efficient response to cope with the current and future challenges faced by the country. Read More

Health Policy Plan 2018 Nov;33(9):1009-1017

National Institute of Public Health, Phnom Penh, Cambodia.

Unnecessary injections increase the risk of blood-borne infections as well as pose an avoidable financial burden on patients. Perceptions in rural Cambodia that medical drug injections provide the best quality medical care have resulted in a large proportion of the population seeking injections across medical conditions. As private providers have a higher propensity to offer injections, patients pursue more expensive care contributing to a greater financial burden. Read More

Health Policy Plan 2018 Oct;33(8):957-965

Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.

The Association of Southeast Asian Nations (ASEAN) Economic Community (AEC) was inaugurated in December 2015 with the primary aim of achieving a strong and prosperous community through accelerating economic integration. The notion of a single market, underpinned by the free flow of trade in services and skilled labour, is integral to the spirit of the AEC. To facilitate the intra-regional mobility of health professionals, Mutual Recognition Arrangements (MRAs) were signed, for nursing in 2006 and for medicine and dentistry in 2009, and now sit within the AEC objectives. Read More

Health Policy Plan 2018 Oct;33(8):898-905

Department of Health Policy and Management, Seoul National University College of Medicine and Institute of Health Policy and Management Seoul National University Medical Research Center, Seoul, Korea.

Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. Read More

Health Policy Plan 2018 Oct;33(8):948-956

Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, Germany.

User fee reduction and removal policies have been the object of extensive research, but little rigorous evidence exists on their sustained effects in relation to use of delivery care services, and no evidence exists on the effects of partial reduction compared with full removal of user fees. We aimed to fill these knowledge gaps by assessing sustained effects of both partial reduction and complete removal of user fees on utilization of facility-based delivery. Our study took place in four districts in the Sahel region of Burkina Faso, where the national user fee reduction policy (SONU) launched in 2007 (lowering fees at point of use by 80%) co-existed with a user fee removal pilot launched in 2008. Read More

Health Policy Plan 2018 Nov;33(9):999-1008

Department of Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, NY, USA.

In Africa, about 33 000 cases of obstetric fistula occur each year. Women with fistula experience debilitating incontinence of urine and/or faeces and are often socially ostracized. Worldwide, Uganda ranks third among countries with the highest burden of obstetric fistula. Read More

Health Policy Plan 2018 Nov;33(9):975-987

Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street, Baltimore, MA, USA.

Health policy and systems research (HPSR) is vital to guiding global institutions, funders, policymakers, activists and implementers in developing and enacting strategies to achieve the Sustainable Development Goals. We undertook a multi-stage participatory process to identify priority research questions relevant to improving accountability within health systems. We conducted interviews (n = 54) and focus group discussions (n = 2) with policymakers from international and national bodies (ministries of health, other government agencies and technical support institutions) across the WHO regions. Read More

Health Policy Plan 2018 Nov;33(9):988-998

Options Consultancy Services, 3 Lower Thames Street, London, UK.

Supportive supervision is an important element of community health worker (CHW) programmes and is believed to improve CHW motivation and performance. A group supervision intervention, which included training and mentorship of supervisors, was implemented in Ethiopia, Kenya, Malawi and Mozambique. In three of the countries, this was combined with individual and/or peer supervision. Read More

Health Policy Plan 2018 Nov;33(9):1047-1054

The George Institute for Global Health, University of New South Wales, Missenden Rd, Sydney, Australia.

Chronic kidney disease (CKD) is a significant and growing driver of the global non-communicable diseases (NCD) burden, responsible for 1.2 million deaths in 2016. While previous research has estimated the out-of-pocket costs of CKD treatment and resulting levels of catastrophic health expenditures, less is known about the impact of such costs on access to, and maintenance of, care. Read More

Health Policy Plan 2018 Oct;33(8):937-947

Department of Endocrinology, Institute of Geriatric Medicine, Liyuan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.

Based on the high prevalence and undiagnosed rate of diabetes mellitus in China in recent years, the aim of this work was to evaluate the availability, price and affordability of pharmacotherapy for diabetes in public hospitals in Hubei province, China. In 2016, a cross-sectional survey was conducted using World Health Organization/Health Action International (WHO/HAI) methodology. Information on the availability and prices of 20 antidiabetic drugs was collected from 34 public hospitals representing three levels of care. Read More

Health Policy Plan 2018 Oct;33(8):920-927

School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.

Maternal and child mortality rates remain unacceptably high globally, particularly in sub-Saharan Africa. A popular approach to counter these high rates is interventions delivered using mobile phones (mHealth). However, few mHealth interventions have been implemented nationwide and there has been little evaluation of their effectiveness, particularly at scale. Read More

Health Policy Plan 2018 Oct;33(8):928-936

Centre for Development and the Environment (SUM), University of Oslo, Postboks 1116, Blindern, Oslo, Norway.

The growth of global public-private partnerships for health has opened up new spaces for civil society participation in global health governance. Such participation is often justified by the claim that civil society organizations, because of their independence and links to communities, can help address democratic deficits in global-level decision-making processes. This article examines the notion of 'civil society engagement' within major public-private partnerships for health, where civil society is often said to play a particularly important role in mediating between public and private spheres. Read More

Health Policy Plan 2018 Oct;33(8):906-919

Department of Health Care Management, Faculty of Law and Economics, University of Greifswald, Greifswald, Germany.

Since the end of its internal conflict in 1998, Cambodia has experienced tremendous developments in the social, economic and health sectors, with the government embarking on substantial reforms in health financing. Health equity funds that have improved access to public health services for poor people have gradually been extended to the entire country. Using the World Health Organization's methods for the analysis of healthcare expenditure and household survey data from the 2004, 2009 and 2014 Cambodian Socio-Economic Survey, we assessed trends in reported illness, utilization of healthcare services and associated financial burden on households. Read More