Journal round-up: Health Policy and Planning 36(1)

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This issue has ten articles: seven original research articles, two scoping reviews, and a commentary. The commentary is on health system resilience (ability to maintain services during shock events) and transilience (ability to avoid future imbalances in access to care and health outcomes). The authors propose that COVID-19 is an opportunity to work toward transilient health systems, particularly for low and middle-income countries. While I agree that this would be ideal, I think this is going to be very challenging for health systems that were already stretched before the pandemic started. The scoping reviews are on leadership development programs in sub-Saharan Africa and patient navigation programs in low-income countries. For those who (like me) aren’t familiar with patient navigation programs, these are interventions designed to help vulnerable populations who would normally have difficulty accessing care in the health system.

Many of the research articles are also about treatment-seeking behaviour and access to care. Two of these studies are related to health insurance. The first is about the relationship between public health insurance and birth outcomes in Pakistan. A new health insurance scheme for low-income families has been slowly rolled out since 2016, allowing comparison to districts where it hasn’t been implemented. This policy has increased hospital use by pregnant women and increased the likelihood of births being documented, but their data does not include impacts on health outcomes. The second investigates patterns of socioeconomic inequality in community-based health insurance (CBHI) household premium contributions in Rwanda, finding that the more recent tiered premium system has likely reduced inequalities compared to the previous flat-rate premium system.

Moving to Cambodia, the health equity fund (HEF) system is a social health protection scheme for the poor, providing finances for essential health services in order to improve access. It has been implemented in all public health facilities, includes user fee exemptions, and covers transportation and hospitalization expenditures. An evaluation of HEF demonstrated improved access to public health services and lower catastrophic health expenditures among HEF beneficiary households. The HEF system has narrowed the gap between poor and rich households in healthcare access and reduced reliance on the informal care sector. The authors note that further investment will be needed to achieve universal healthcare.

I was particularly interested in an article on the political factors (beyond the technical evidence) that influence malaria control decisions in sub-Saharan Africa. Qualitative interviews were undertaken with stakeholders in seven countries, finding that the key influencers were: (1) the interests of funders and stakeholders responsible for implementation, (2) the dominant ideas in the international malaria community, and (3) the institutional arrangements governing decision making. They also found that country-level control over malaria programs may be restricted by the small number of funding lenders and a large number of implementers.

A case study combining a policy analysis of the decentralized healthcare system in Peru with data analysis of climate change health hazards found that more cohesion is needed between and within regional department climate change plans. Another paper shows that pregnant women in Nairobi favour facilities with lower technical quality over facilities that are closer and have higher technical quality, demonstrating the importance of interpersonal care and improving women’s delivery experiences. Finally, a qualitative study on barriers to surgical care in Sierra Leone found that cost is a barrier to care, and patients perceive that informal payments to health workers or having a connection to the hospital leads to better care.


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