Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 The International Journal of Health Policy and Management (IJHPM) in 2024: Progress and Innovation 1 3 4734 10.34172/ijhpm.9087 EN Mina Moradzadeh Rehabilitation Research Center, Department of Rehabilitation Basic Sciences, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran Vahid Yazdi-Feyzabadi Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Sahar Najafizadeh Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran AliAkbar Haghdoost HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Journal Article 2025 03 15

https://www.ijhpm.com/article_4734_d84611995f19611827f76f1e9eccb486.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Health Benefit Package Revision Is an Art as Much as a Science – Lessons Learned on the Organization of the Appraisal Phase 1 6 4702 10.34172/ijhpm.8819 EN Rob Baltussen Radboud University Medical Center, Nijmegen, The Netherlands Mojtaba Nouhi Ministry of Health and Medical Education, Tehran, Iran Andrew Mirelman World Health Organisation (WHO), Geneva, Switzerland Sameen Siddiqi Aga Khan University, Karachi, Pakistan Cassandra Nemzoff London School of Hygiene & Tropical Medicine, London, UK Gavin Surgey Radboud University Medical Center, Nijmegen, The Netherlands Stella Umuhoza University of Rwanda, Kigali, Rwanda Saltanat Zhetibaeva Ministry of Health, Astana, Kyrgyzstan Baktygul Isaeva Ministry of Health, Astana, Kyrgyzstan Anna Vassal London School of Hygiene & Tropical Medicine, London, UK Journal Article 2024 09 23 Many low- and middle-income countries are designing or revising their health benefit packages (HBPs), with appraisal—prioritizing services for reimbursement—being a critical phase. This occurs in a complex landscape of multiple criteria, multiple stakeholders, limited evidence, budget constraints, and tight timelines, varying across countries. Existing guidance documents do not fully address these complexities, requiring analysts to balance methodological rigor with practical constraints. This editorial highlights four key themes in organizing appraisal: decision-making structures, trade-offs between criteria, final recommendations, and the use of cost-effectiveness evidence, thresholds, and budgets. These emerged as central challenges in HBP revisions in Iran, Kyrgyzstan, Liberia, Pakistan, and Rwanda. We emphasize cross-country learning to address these challenges pragmatically, recognizing that high-quality, legitimate appraisal is as much an art as a science. More detailed documentation of appraisal processes is needed to refine HBP revision guidelines and strengthen priority-setting in health systems.

https://www.ijhpm.com/article_4702_e404cefd13108519c7ea3ea55e742019.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 The United States Withdrawal From the World Health Organization: Implications and Challenges 1 4 4719 10.34172/ijhpm.9086 EN Vahid Yazdi-Feyzabadi Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Ali-Akbar Haghdoost Modeling in Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Martin McKee Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK Amirhossein Takian Centre of Excellence for Global Health, Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran Elizabeth Bradley Vassar College, Poughkeepsie, NY, USA Ruairí Brugha Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland Nir Eyal School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA Institute for Health, Rutgers University, New Brunswick, NJ, USA Sana Eybpoosh Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran 0000-0002-2304-8352 Lawrence Gostin O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA Naoki Ikegami Keio University, Tokyo, Japan Ilona Kickbusch Graduate Institute for International and Development Studies, Geneva, Switzerland Ronald Labonté School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada Russell Mannion Health Services Management Centre, University of Birmingham, Birmingham, UK Ole F. Norheim Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Jeremy Shiffman Paul H Nitze School of Advanced International Studies, Johns Hopkins University, Baltimore, MD, USA Mohammad Karamouzian Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Journal Article 2025 03 05 President Trump’s 2025 decision to remove the United States (US) from the World Health Organization (WHO), echoing his initial 2020 move, raises existential questions about the future of global health governance. This editorial explores the immediate and long-term potential impacts of the withdrawal, noting that it poses a significant threat to the WHO financing. This, in turn, will have adverse consequences for future pandemic preparedness, health inequities, and cross-border collaboration. We also explore the potential role of private philanthropies in bridging the funding gap, against the risk of shifting health priorities away from local needs. For the US, withdrawal means diminished influence on global health policies and weaker alignment with new international regulations. Moving forward, structural reforms within the WHO, equitable contributions from global powers, and renewed US involvement are essential to maintain strong health systems worldwide. Ultimately, a collaborative approach is necessary to uphold collective preparedness against emerging health crises.

https://www.ijhpm.com/article_4719_83e82cc4b64611ff338d72661cd5fc23.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Ending Nuclear Weapons, Before They End Us 1 3 4751 10.34172/ijhpm.9200 EN Kamran Abbasi Editor-in-Chief, British Medical Journal, London, UK Parveen Ali Health Sciences School, University of Sheffield, Doncaster and Bassetlaw Teaching Hospitals, Sheffield, UK Virginia Barbour Editor-in-Chief, Medical Journal of Australia, Brisbane, QLD, Australia Marion Birch University College London, London, UK Inga Blum International Physicians for the Prevention of Nuclear War, Springfield, IL, USA Peter Doherty Department of Microbiology & Immunology, Doherty Institute, University of Melbourne, Melbourne, VIC, Australia Andy Haines London School of Hygiene and Tropical Medicine, London, UK Ira Helfand International Physicians for the Prevention of Nuclear War, Springfield, IL, USA Richard Horton Editor-in-Chief, The Lancet, London, UK Kati Juva Division of Psychiatry, Central Hospital, Helsinki University, Helsinki, Finland Jose F. Lapena Jr. Department of Otolaryngology, Philippine General Hospital, Manila, Philippines Robert Mash Division of Family Medicine and Primary Care, Stellenbosch University, Stellenbosch, South Africa Olga Mironova Russian Cardiology Research and Production Complex, Moscow, Russia Sechenov University, Moscow, Russia Arun Mitra Indian Doctors for Peace and Development, Ludhiana, India Carlos Monteiro Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paolo, Brazil Elena N. Naumova Tufts University, Boston, MA, USA David Onazi International Physicians for the Prevention of Nuclear War, Springfield, IL, USA Tilman Ruff University of Melbourne, Melbourne, VIC, Australia Peush Sahni All India Institute of Medical Sciences (AIIMS), New Delhi, India James Tumwine School of Medicine, Kabale University, Kampala, Uganda Carlos Umaña Costa Rican Ministry of Health, Costa Rica, Costa Rica Paul Yonga CA Medlynks Medical Centre and Laboratory, Nairobi, Kenya Editor-in-Chief, East African Medical Journal, Nairobi, Kenya Chris Zielinski World Association of Medical Editors (WAME), Bellagio, Lombardy, Italy University of Winchester, Winchester, UK Journal Article 2025 04 05

https://www.ijhpm.com/article_4751_104ce1c6270e17e8ce7555fab5d87510.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Addressing Healthcare Waiting Time Challenges in Canada: Insights From Emerging Initiatives 1 5 4790 10.34172/ijhpm.8986 EN Mohammad Hajizadeh School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada Faramarz Jalili School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada Journal Article 2025 01 10 Canada’s public healthcare system faces persistent challenges with waiting times. Prolonged delays lead to adverse physical and mental health outcomes, higher treatment costs, and economic burdens for patients and families. This editorial examines the drivers of extended wait times and policy responses at both provincial and federal levels. Contributing factors include systemic features of the Canadian healthcare system, such as shared federal–provincial jurisdiction, along with staffing shortages, population aging, structural inefficiencies, and poorly integrated health information technology. Provinces have introduced strategies such as digital health solutions, capacity expansion, workforce innovations (including Physician Assistants [PAs]), and expanded scopes of practice for pharmacists. At the federal level, a 10-year $196.1 billion investment announced in 2023 is supporting these initiatives. While such measures indicate progress, wait times remain a significant concern. Achieving equitable and timely access will require coordinated and sustained strategies that address systemic challenges and deliver long-term improvements.

https://www.ijhpm.com/article_4790_00dca3137453851f6229157d56ddc2f6.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Quid Pro Quo? A Critical Perspective on the Global Flow and Spread of Health Innovation 1 4 4802 10.34172/ijhpm.9151 EN Russell Mannion Health Services Management Centre, University of Birmingham, Birmingham, UK Ewen Speed School of Health and Social Care, University of Essex, Colchester, UK Journal Article 2025 04 14 Over recent decades, the exchange of health innovations between high-income countries (HICs) and low- and middle-income countries (LMICs) has grown significantly. Three main types of cross-border flows characterise this global health innovation ecosystem: (i) trickle-down innovation – where innovations originating in HICs gradually diffuse to LMICs, (ii) reverse innovation, where new solutions originating in LMICs are adopted and adapted in HICs, and (iii) reciprocal innovation – where the focus is on bidirectional exchange and learning between HICs and LMICs. Despite embracing multidirectional flows, the contemporary global health innovation ecosystem is fundamentally shaped by neocolonial power imbalances that prevent LMICs from fully benefiting. These dynamics are further intensified by recent cuts to foreign aid and the rise of philanthrocapitalism, both of which concentrate power and influence in HICs. Viewing health innovation through a neocolonial lens reveals how the current innovation ecosystem reinforces historical patterns of dependency and domination in global health.

https://www.ijhpm.com/article_4802_01a7b3067603f1879cd1e44bd338d006.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Governance of Public-Private Partnerships for Primary Healthcare in Low- and Lower-Middle-Income Countries, 2000-2023: A Systematic Review 1 8 4698 10.34172/ijhpm.8442 EN Georgina Dove University of New South Wales, Sydney, NSW, Australia 0009-0006-5211-8571 Adam Craig University of Queensland, Brisbane, QLD, Australia Ben Harris-Roxas University of New South Wales, Sydney, NSW, Australia Angela Kelly-Hanku Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea University of New South Wales, Sydney, NSW, Australia Journal Article 2024 02 01 Background Public-private partnerships (PPPs) in the health sector are established to achieve health outcomes by maximising the combined resources of both public and private sectors. Good governance is core to PPP function and success. This paper explores the factors that enable and constrain governance in the delivery of PPPs for primary healthcare (PHC) in low- and lower-middle-income countries (LLMICs). Methods A systematic search of four literature databases was conducted to identify peer reviewed articles published between 2000 and 2023 related to the governance of PPPs for PHC in LLMICs. A deductive analysis of data extracted from selected articles against the domains of Greer’s TAPIC (transparency, accountability, participation, integrity, and policy capacity) governance framework was conducted to identify commonly reported enabling and constraining factors. Results Of the 4290 records screened, 14 were included. Common enabling factors for governance within each domain of the framework were found: Transparency: unequal and top-down resource allocation, and opaque and resource allocation was a barrier to PPP governance; Accountability and policy capacity: monitoring and evaluation; Participation: partner engagement, covering topics of developing and managing relationships, collaborative activities, and communication; and Integrity: the design of the PPP, covering formal agreements between partners, level of policy direction, and integration within the broader health system. Conclusion The five domains of the TAPIC governance framework provide guidance for considering governance in PPPs. The enabling factors identified in the review help facilitate the successful implementation of a PPP and thus influence the PPP’s impact on health outcomes, through establishing and maintaining healthy working relationships between partners, and defining and documenting systems and processes.

https://www.ijhpm.com/article_4698_22d9e84494961a14ff442b2e8d86b026.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Involving Service Users in Care Regulation: A Scoping Review of Empirical Literature 1 13 4709 10.34172/ijhpm.8509 EN Josje Kok Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands Flora Palimetaki Dutch Health and Youth Care Inspectorate, Utrecht, The Netherlands Nada Akrouh Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands Linda Schoonmade University Library Vrije Universiteit, Amsterdam, The Netherlands Hester Van De Bovenkamp Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands Anne Margriet Pot Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands Dutch Health and Youth Care Inspectorate, Utrecht, The Netherlands North-West University, Vanderbijlpark, South-Africa Journal Article 2024 03 25 Background Ensuring the quality and safety of service delivery extends beyond the realm of health and care professionals, necessitating collaboration among various stakeholders, including external regulatory organizations. The policy agenda of care regulators increasingly features the topic of service user involvement. Despite the extensive research on participatory healthcare, scholarly attention to service user involvement in regulatory practices has been limited. This scoping review delves into the landscape of service user involvement in the regulation of care services of all types and for all different age groups, examining the characteristics and focus of peer reviewed original research. In particular, it addresses a notable knowledge gap by examining how these studies report on the practical utilization of service user input, as well as the regulator’s perspective on service user involvement. Methods We conducted a literature search in PubMed, Embase, CINAHL, APA PsycInfo, and Scopus from inception to July 14, 2023. Thirteen (n=13) empirical studies were included. Results The underlying motives for service user involvement vary, ranging from legal imperatives and political pressure to enhancing institutional legitimacy and regulatory decision-making. Care regulators employ both reactive and proactive involvement methods. Empirical evidence delineates the challenges and benefits of service user involvement, highlighting concerns about bias, time investments, and the need for a distinct skillset for inspectors. Despite the valuable insights gained, there are instances where service user input is downplayed in practice. Conclusion The findings underscore the importance of additional research on users’ preferences for involvement, optimal communication conditions to honor the collected input, and the challenges inspectors encounter in fostering meaningful involvement with service users. Addressing these challenges is crucial for aligning regulatory efforts with the genuine needs and experiences of services users. <br style="font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px;" />

https://www.ijhpm.com/article_4709_71ac4c9e149918612bab282b7c83c5d6.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Scholarly Publications and Opinions Through 366- Day War on Gaza (2023-2024): A Scoping Review and Bibliometric Analysis 1 15 4714 10.34172/ijhpm.8809 EN Emna Ennouri Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia Mohamed Boussarsar Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia Chourouk Ben Mahfoudh Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia Khamis Elessi Evidence-Based Medicine Unit, Faculty of Medicine - Islamic University of Gaza, Gaza, Palestine Helmi Ben Saad Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia Research Laboratory “Heart Failure”, Farhat Hached University Hospital, Sousse, Tunisia Laboratory of Physiology and Functional Explorations, Farhat Hached University Hospital, Sousse, Tunisia Journal Article 2024 09 17 Background The 2023-2024 Gaza Genocide has generated notable scholarly discourse, influenced by various historical, political, and social contexts. These academic writings, rooted in the longstanding “war of words,” illustrate how language serves as a potent weapon in conflicts. The present study aimed to analyze the academic response to the 2023-2024 War on Gaza, focusing on the different perspectives, opinions, and lexical choices in scholarly articles. Methods A scoping review and bibliometric analysis were conducted on articles from PubMed, pertaining to the 2023- 2024 War on Gaza, spanning from October 7, 2023, to October 7, 2024. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were used. Individual relevant papers’ data were systematically extracted using a pre-tested form. Articles were categorized based on their stances as pro-Gaza, pro-Israel, or Neutral. Statistical analyses compared the bibliometric data of pro-Gaza and pro-Israel papers, identifying significant associated lexical fields. Factors explaining the different stances were uncovered. Results Out of 640 articles identified, 221 were included in the review. Among these, 126 (57%), pro-Gaza, 70 (31.7%), pro-Israel, and 25 (11.3%), Neutral. Pro-Gaza papers, often published in high-ranked journals with global affiliations, focused on humanitarian issues, called for a ceasefire and decried the genocide. Conversely, pro-Israel papers, often from local journals and affiliated with Israeli institutions, focused on political and psychosocial aspects, emphasizing selfdefense narratives. Terms independently associated with pro-Gaza positions included “Gaza” in the title, “occupation,” “genocide,” “punishment,” and “ceasefire.” Pro-Israel papers featured “Israel” in the title, references to “October 7,” and mentions of “Hamas.” Conclusion This study highlights that academic narratives are profoundly influenced by historical contexts, media portrayal, official discourses, and the authors’ socio-political environments. These findings underscore the intricate connection between scholarly discourse and the broader context of chronic occupation, revealing significant limitations in current global health strategies and highlighting the need to integrate humanitarian crises into these frameworks.

https://www.ijhpm.com/article_4714_c42121155c942ff6ef017a68f284f6f9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 A Systematic Review and Quality Assessment of Pharmacoeconomic Publications for China Compared to Internationally: Is the Quality of Evidence-base Sufficient for Health Technology Assessment? 1 9 4717 10.34172/ijhpm.8656 EN Zhixin Fan Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Center for Health Management and Policy Research, Shandong University, Shandong Provincial Key New Think Tank, Jinan, China Xu Si Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Center for Health Management and Policy Research, Shandong University, Shandong Provincial Key New Think Tank, Jinan, China Zhongxiang Wang Zhucheng Shiqiaozi Health Hospital, Zhucheng, China Liwei Zhang Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Center for Health Management and Policy Research, Shandong University, Shandong Provincial Key New Think Tank, Jinan, China Junyang Liu Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Center for Health Management and Policy Research, Shandong University, Shandong Provincial Key New Think Tank, Jinan, China Qing He Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Center for Health Management and Policy Research, Shandong University, Shandong Provincial Key New Think Tank, Jinan, China Matthew Franklin Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK Qiang Sun Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Center for Health Management and Policy Research, Shandong University, Shandong Provincial Key New Think Tank, Jinan, China China National Health Development Research Center, Beijing, China Jia Yin Department of Social Medicine and Health Management, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Center for Health Management and Policy Research, Shandong University, Shandong Provincial Key New Think Tank, Jinan, China Journal Article 2024 06 17 Background Pharmacoeconomic evaluations are becoming more important in China, and their research quality directly impacts government decisions, deserving extra attention. To summarize the quality of pharmacoeconomic publications for China compared to internationally and to identify areas for improvement both from a China-specific and international perspective. Methods First, we conducted a systematic review of pharmacoeconomic publications for China, with subsequent reporting quality assessment based on the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Second, we conducted an umbrella review of pharmacoeconomic publications internationally which used a similar quality assessment. We extracted the CHEERS checklist scores for each study and converted them to percentages to facilitate comparison of results. Results CHEERS 2022 instrument was used to evaluate the quality of 154 pharmacoeconomic publications by Chinese scholars. Across these articles, the average quality score was 61.0%, indicating a moderate level of quality on average. There were 27 (17.5%) high-quality articles, 85 moderate quality articles (55.2%) and 42 low-quality (27.3%) articles. Out of 28 scoring items, those included in the methods section such as: health economic analysis plan, characterizing heterogeneity, characterizing distributional effects, approach to engagement with patients and others affected by the study, got low scores. In addition to the generally lower scores of international articles on items 9 (Time horizon), 18 (Characterizing heterogeneity) and 24 (Effect of uncertainty), Chinese articles also scored lower than international articles on items included in the methods and other relevant information section, eg, health economic analysis plan, perspective, discount rate, analytics and assumptions, characterizing distributional effects, approach to engagement with patients and others affected by the study, source of funding, and conflicts of interest. Conclusion The quality of China’s pharmacoeconomic publications has been improving year by year since the establishment of the National Healthcare Security Administration (NHSA) in 2018, but there is still a quality gap with similar international publications which requires further focus and improvement in study conduct and reporting standards for the evidence-base to be sufficient for health technology assessment (HTA).

https://www.ijhpm.com/article_4717_14cab9bc11dc7f9a8e4066079b473867.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Barriers and Facilitators to International Universal Health Coverage Reforms: A Realist Review 1 14 4726 10.34172/ijhpm.8709 EN Liz Farsaci Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland Padraic Fleming Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland Louise Caffrey School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland Sara Van Belle Institute of Tropical Medicine, Antwerp, Belgium Catherine O'Donoghue Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland Arianna Almirall-Sanchez Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland David Mockler Assistant Librarian Reader Services, Trinity College Dublin, Dublin, Ireland Steve Thomas Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland Journal Article 2024 07 17 Background The journey towards universal health coverage (UHC) began decades ago but has recently moved to centre stage in global health discourses with its inclusion in the Sustainable Development Goals (SDGs). As part of this renewed interest, 193 countries have committed to introducing UHC by 2030. However, its implementation often necessitates far-reaching health system reforms. This, coupled with the struggles countries face in relation to health financing, as well as distinct political, social and cultural contexts, means there are significant challenges to UHC implementation. This article contributes new knowledge to these discourses by identifying key contexts and mechanisms that facilitate the successful implementation of UHC reforms, as well as barriers that can impede progress. Methods This realist review identifies key contexts and mechanisms that can facilitate the successful implementation of UHC reforms. EMBASE, MEDLINE and Web of Science were searched (1995-2022), resulting in 957 articles with the protocol published through Prospero (PROSPERO 2023: CRD42023394427). Further theory-driven searches resulted in an additional 988 studies. Descriptive, inductive, deductive, and retroductive realist analysis aided the development of Context-Mechanism-Outcome Configurations (CMOCs), along with stakeholder engagement to confirm or refute results. Causal pathways, and the interplay between contexts and mechanisms that triggered outcomes, were revealed. Results How each country goes about implementing UHC reforms depends on its context. Cohesion across all systems, as well as the functions of financing, governance and service delivery, facilitates these reforms. Implementation can also be facilitated through political commitment, communication between stakeholders in the public health system and the development of a strong primary care sector. Conversely, fragmentation across these functions pose significant barriers to UHC reforms. Conclusion Examining international experiences of UHC reforms supports learning around the mechanisms that support or hinder implementation processes. These learnings can empower policy-makers and health system leaders by providing roadmaps for reform implementation.

https://www.ijhpm.com/article_4726_03a7f0ddcc3d7b52a17d566eacbfa53a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Public Healthcare Procurement Strategies in Response to the COVID-19 Pandemic: A Scoping Review 1 16 4767 10.34172/ijhpm.8556 EN Pierre-André Hudon Département de Management, Faculté de Sciences de l’administration, Université Laval, Québec City, QC, Canada Matthew T. Haren Département de Management, Faculté de Sciences de l’administration, Université Laval, Québec City, QC, Canada Centre de Recherche en Gestion des Services de Santé, Université Laval, Québec City, QC, Canada Centre de Recherche de l’Institut de Cardio-Pneumologie de Québec, Université Laval, Québec City, QC, Canada Jean-Baptiste Gartner Département de Management, Faculté de Sciences de l’administration, Université Laval, Québec City, QC, Canada Centre de Recherche en Gestion des Services de Santé, Université Laval, Québec City, QC, Canada Centre de Recherche de l’Institut de Cardio-Pneumologie de Québec, Université Laval, Québec City, QC, Canada Centre de Recherche du CHU de Québec, Université Laval, Québec City, QC, Canada Centre de recherche du CIUSSS de Chaudière-Appalaches, Québec City, QC, Canada VITAM, Centre de Recherche en Santé Durable, Université Laval, Québec City, QC, Canada Frédéric Bergeron Bibliothèque-Direction des Servicesconseils, Université Laval, Québec City, QC, Canada André Côté Département de Management, Faculté de Sciences de l’administration, Université Laval, Québec City, QC, Canada Centre de Recherche en Gestion des Services de Santé, Université Laval, Québec City, QC, Canada Centre de Recherche de l’Institut de Cardio-Pneumologie de Québec, Université Laval, Québec City, QC, Canada Centre de Recherche du CHU de Québec, Université Laval, Québec City, QC, Canada Centre de recherche du CIUSSS de Chaudière-Appalaches, Québec City, QC, Canada VITAM, Centre de Recherche en Santé Durable, Université Laval, Québec City, QC, Canada Journal Article 2024 04 24 Background The COVID-19 pandemic posed unprecedented public healthcare procurement challenges. The objective of this review was to identify and characterise the scope of the literature on public procurement strategies for healthcare supplies during the COVID-19 pandemic (2019–2023) in relation to the public procurement contexts, systems, and processes and methods (the public procurement ecosystem) worldwide. Methods We performed a scoping review of governmental strategies for the procurement of medical equipment, personal protective equipment (PPE), or medications related to the COVID-19 pandemic. Extracted data were mapped to the fields of the public procurement ecosystem. We used inductive thematic analysis to derive within-field themes, and subsequently, cross-cutting themes through which we structured a narrative synthesis. Results 1909 unique studies were identified through a systematic search, of which 89 met the inclusion criteria. One hundred and ten themes were derived from the extracted data within the 21 fields of the public procurement ecosystem, and from these, 10 cross-cutting themes were identified which served to structure the narrative synthesis. It was clear in this literature that the scale and impact of the COVID-19 pandemic required governments to act well outside of the public procurement processes and methods themselves, to procure and distribute the required supplies. Notwithstanding the significant attention to contextual and system-level responses, there were significant responses at the procurement process and methods level, including rapid and temporary expedited procurement processes and longer-term strategic procurement responses. Conclusion This scoping review of public procurement strategies during the COVID-19 pandemic has demonstrated a focus of the literature not only on the public procurement processes and methods themselves, but also on governmental actions to adapt both structures of public procurement systems and conditions within broader environmental contexts to facilitate procurement goals.

https://www.ijhpm.com/article_4767_32b4c54ec2bc1b13b08626706488225c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 A Systematic Review of Lean Implementation in Hospitals: Impact on Efficiency, Quality, Cost, and Satisfaction 1 17 4774 10.34172/ijhpm.8974 EN Jingjing Wang Institutes of Health Central Plains, Henan Medical University, Xinxiang, China The Second Affiliated Hospital of Henan Medical University, Xinxiang, China Hui Lv The First Affiliated Hospital of Henan Medical University, Xinxiang, China Mingxin Chen School of Public Health, Henan Medical University, Xinxiang, China Chenyang Liu School of Public Health, Henan Medical University, Xinxiang, China Wenjie Ren Institutes of Health Central Plains, Henan Medical University, Xinxiang, China Hui Jiang Institutes of Health Central Plains, Henan Medical University, Xinxiang, China Lizhang Zhang Institutes of Health Central Plains, Henan Medical University, Xinxiang, China Journal Article 2025 01 04 Background Lean healthcare practices are widely used to enhance efficiency, quality, cost-effectiveness, and satisfaction in hospitals. However, no studies have synthesized their effectiveness across these dimensions. This review aims to address this gap by evaluating the impact of Lean implementation on four key themes: Efficiency, quality, cost, and satisfaction. Methods Four online databases were selected for the targeted articles: Scopus, Medline, PubMed, and Web of Science. Additionally, a comprehensive search was conducted using the Google Search Engine, along with a review of the citation list from the retrieved articles, to identify related grey literature and acquire additional articles. The search covered only the period from January 2019 to October 2024. The quality and research methodology of the articles reviewed were evaluated to determine the reliability of these findings. Results A total of 6021 articles were screened, and 60 were included in this study. Our findings were grouped into four themes: (1) Efficiency: 49 studies identified 12 sub-dimensions of efficiency, with the most common variables being waiting time, length of stay (LOS), and patient volumes. (2) Quality: 12 studies reported quality improvements, covering 12 variables, with 30-day readmission rates, counselling sessions, and drug-related indicators being most prominent. (3) Cost: 17 studies examined Lean-driven cost reductions, with operating costs being the most frequently addressed variable, appearing in seven studies. (4) Satisfaction: Key satisfaction indicators included patient satisfaction, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, complaint rates, and nurse satisfaction. Conclusion This is the first review to synthesize the literature on the impacts of Lean implementation across four key themes, while also identifying existing gaps. It highlights the positive outcomes of Lean in hospitals and outlines the primary areas of improvement emphasized by healthcare institutions within each theme.

https://www.ijhpm.com/article_4774_d973f82b58417c1473076efef06f128c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 A Bibliometric and Visual Analysis of Cancer Screening Based on the Web of Science Core Collection Database 1 9 4796 10.34172/ijhpm.8554 EN Wanrong Dai Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China Baixu Wu CUHK Business School, Hong Kong, China Jie Sun Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China Wuping Shuai Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China Shuying Han Department of Clinical Pharmacy, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China Journal Article 2024 04 24 Background This study aimed to systematically analyze the current research status, development trends, collaborative networks, and hot topics in the global cancer screening field using a bibliometric method. It sought to reveal the contributions and influences of different countries and institutions and explore potential directions for future research, providing a comprehensive basis for academia and policy-makers to optimize cancer screening strategies. Methods We searched the Web of Science Core Collection on October 15, 2023, using TS = (cancer screening) and DT = (Article), with no restrictions on the language or publication year. Only original research articles directly related to cancer screening were included; abstracts, comments, and non-research literature were excluded. VOSviewer was used for co-occurrence analysis to assess research status and hotspots. CiteSpace analyzed annual publication trends, collaboration networks among countries, institutions, journals, authors, and keywords. Results A total of 5223 articles were retrieved, showing a continuous growth trend in annual publication volume. The USA had the highest output (2418), followed by the UK and the Netherlands. Harvard University was the most productive institution (183). Cancer published the most articles (120), while the New England Journal of Medicine had the most citations (7991). High-frequency keywords included screening (987), colorectal cancer (CRC) (783), mortality (680), women (671), and breast cancer (BC) (669). Cluster analysis revealed seven main research themes: CRC, cervical cancer (CC), lung cancer (LC), BC, cancer screening, human papillomavirus (HPV) vaccination, and lynch syndrome. Hot topics included LC screening and adherence. Future research may increasingly focus on artificial intelligence (AI) and deep learning (DL), aiming to introduce new technologies and optimize screening strategies to improve efficiency and early diagnosis. Conclusion Research on cancer screening is rapidly advancing, with the USA leading in productivity and influence. Current research mainly focuses on CRC, CC, LC, and BC.

https://www.ijhpm.com/article_4796_69d19f3461e9044818142bdeaf36eda1.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 How Organisational and Socio-Cultural Contexts Shape Healthcare Workers’ Intrinsic, Prosocial, and Public Service Motivation in Africa: A Scoping Review 1 13 4780 10.34172/ijhpm.8861 EN Djibrine Diallo Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco Laboratory of Public Health and Management Department, Mohammed VI Center for Research & Innovation, Rabat, Morocco Bruno Marchal Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium Zakaria Belrhiti Mohammed VI International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco Laboratory of Public Health and Management Department, Mohammed VI Center for Research & Innovation, Rabat, Morocco Journal Article 2024 10 21 Background In Africa, the poor quality of care is often attributed to a lack of motivated health workers (HWs). Most reforms implemented in African health systems rely on performance-based financial incentives. Evidence suggests that financial incentives may have adverse effects, such as crowding out autonomous forms of motivation, including intrinsic, prosocial, and public service motivation (PSM). We aim to map conceptual definitions of autonomous motivation and unpack the relationship between context and societal culture in shaping the motivation of HW in Africa. Methods Following guidelines from Arksey and O’Malley, we conducted a scoping review of peer-reviewed publications from 1990 to 2024 using the databases (Web of Science, Scopus, Google Scholar, and PubMed). We used the InterventionContext-Actor-Mechanism-Outcome (ICAMO) heuristic to identify plausible causal pathways linking context and societal culture to HW motivation. Results Scholars defined PSM as a complex dynamic process that stimulates individuals to carry out self-altruistic and prosocial behaviours. Our review showed that autonomous motivation is sensitive to context. Enabling conditions include a positive work environment, community appreciation, and local context. Our review suggests a form of intrinsic motivation (IM) for HW in Africa that may be rooted in collectivistic values, such as the willingness to serve the community to which they belong. When HW perceived a lack of belonging to the community they serve, they reported being disregarded, which reduced their sense of self-efficacy, self-esteem, and trust in their community relationships. Conclusion This review highlights how context and societal culture can reinforce the trust relationship between HW and communities, thereby increasing HWs’ motivation by enhancing their perceived self-efficacy and autonomy. Our findings suggest that exploring the role of decentralisation, trust relationships, and self-efficacy in expressing autonomous motivations are research priorities.

https://www.ijhpm.com/article_4780_369f8a441f894fd14461eca2fa64df3d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 27 Exploring Grassroots Indicators for Pandemic Prevention, Preparedness, and Response: A Systematic Narrative Review 1 17 4826 10.34172/ijhpm.8886 EN Million Tesfaye Eshete Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway Pami Shrestha National University Health System, Singapore, Singapore Charmaine Ang Imperial College London, London, UK José María Valderas Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore 0000-0002-9299-1555 David L. Heymann London School of Hygiene and Tropical Medicine, London, UK Anders Nordström Department for Global Public Health, Karolinska Institutet and Centre for Resilent Health, Stockholm School of Economics, Stockholm, Sweden Kelley Lee Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada Alex Cook Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Clare Wenham London School of Economics and Political Science, London, UK Pablo Perel London School of Hygiene and Tropical Medicine, London, UK J. Jaime Miranda CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia Alberto L. Garcia-Basteiro Centro de Investigação Em Saúde de Manhiça (CISM), Manhica, Mozambique Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain Helen Clark The Helen Clark Foundation, Auckland, New Zealand Helena Legido-Quigley Imperial College London, London, UK George Institute for Global Health UK, London, UK Eivind Engebretsen Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway Journal Article 2024 11 03 Background The COVID-19 pandemic has revealed how conventional top-down, expert-driven indicators often fail to align with local community realities, marginalising their perspectives, concerns, knowledge, and narratives. However, the limitations of pandemic-related and global health security indicators are not unique but reflect recurring patterns across major social metrics. In response, an alternative paradigm advocates for grassrootsinclusive approaches to developing indicators. Our objective is to assess how and why grassroots-inclusive approaches complement top-down approaches to developing indicators, and to synthesise their theoretical and practical contributions to public health. Methods We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. We systematically searched six databases (MEDLINE, Embase, CINAHL, Web of Science, Scopus, and PsycINFO), as well as Google Scholar, to identify relevant articles published from their inception to September 1, 2024. We included peer-reviewed articles, opinion pieces, and book chapters, narratively synthesising their findings. Results This review included 43 studies from various disciplines. Across these studies, communities co-produced indicators through participatory workshops, interviews, and consensus exercises in areas such as environmental sustainability, disaster resilience, public health, well-being, and local development. The reported strengths included greater local relevance, community ownership, and accountability, alongside challenges in sustaining participation, integrating into top-down systems, and addressing data gaps. Notably, no study applied grassroots-inclusive indicators to health security or pandemic preparedness. Conclusion Despite retrieving and analysing articles from various disciplines, no study has specifically applied grassroots-inclusive indicators to health security or pandemic preparedness. However, the evidence clearly shows that it is both feasible and practical to integrate expert and non-expert perspectives when developing indicators.

https://www.ijhpm.com/article_4826_11576c6cf29b67ccbd8b549f6e79cd03.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Determinants of Socioeconomic Inequalities in Well-Being in Canada: Evidence From the Nova Scotia Quality of Life Survey 1 9 4690 10.34172/ijhpm.8643 EN Daniel Keays Sobey School of Business, Saint Mary’s University, Halifax, NS, Canada Mohammad Hajizadeh School of Health Administration, Dalhousie University, Halifax, NS, Canada Journal Article 2024 06 11 There are relatively few studies that have measured and explained socioeconomic inequalities in the well-being of populations. Using unique information available in the 2019 Nova Scotia Quality of Life Survey (NSQLS, n = 9388), this study provides analysis of the determinants of socioeconomic inequalities in well-being of adults aged 18 and above in Nova Scotia, Canada. The population’s well-being was measured using the Canadian Index of Wellbeing (CIW), which encompasses quality of life across eight domains. The Concentration index (C) approach was utilized to quantify and identify factors explaining socioeconomic inequality in well-being. A positive value of the C (0.0294; 95% confidence interval: 0.0267 to 0.0321) indicated pro-rich inequality in well-being among Nova Scotian residents. Results of the decomposition analysis indicated that the concentration of favorable mental health, education levels, and income among high socioeconomic status (SES) groups accounted for over 86% of the observed socioeconomic inequality in the population’s well-being. Our findings demonstrated that inequalities in mental health, education, and income are significant obstacles to reducing inequality in well-being in Nova Scotia, Canada. Thus, policies aimed at alleviating inequalities in these factors may help to reduce socioeconomic inequality in well-being in Nova Scotia, Canada.

https://www.ijhpm.com/article_4690_b4e782163516d592ddc759706fc58a99.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Investigating Indicators to Assess and Support Alcohol Taxation Policy: Results From the International Alcohol Control (IAC) Study 1 8 4708 10.34172/ijhpm.8551 EN Sally Casswell SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand Karl Parker SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand Steve Randerson SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand Taisia Huckle SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand Lathika Athauda Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka Aravind Banavaram Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bangalore, India Sarah Callinan Centre for Alcohol Policy Research (CAPR), School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia Orfhlaith Campbell Queen’s University Belfast, Belfast, UK Surasak Chaiyasong Faculty of Pharmacy, Mahasarakham University (MSU), Kham Riang, Thailand Song Dearak Cambodia Movement for Health, Phnom Penh, Cambodia Laura Romero-Garcia PROESA, Universidad Icesi, Cali, Colombia Gopalkrishna Gururaj National Institute of Mental Health and Neurosciences, Kamataka, India Romtawan Kalapat Faculty of Pharmacy, Mahasarakham University (MSU), Kham Riang, Thailand Khem Karki Department of Community Medicine and Public Health, Institute of Medicine, Kathmandu, Nepal Thomas Karlsson Finnish Institute for Health and Welfare, Helsinki, Finland Mom Kong Cambodia Movement for Health, Phnom Penh, Cambodia Shiwei Liu Chinese Center for Disease Control and Prevention, Beijing, China Norman Maldonado PROESA, Universidad Icesi, Cali, Colombia Juan Felipe González-Mejía PROESA, Universidad Icesi, Cali, Colombia Tim Naimi Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada Keitseope Nthomang Department of Social Work, University of Botswana, Gaborone, Botswana Opeyemi Oladunni Department of Public Health, Adeleke University, Ede, Nigeria Kwame Owino Institute of Economic Affairs, Nairobi, Kenya Juan Herrera-Palacio PROESA, Universidad Icesi, Cali, Colombia Phasith Phatchana Faculty of Pharmacy, Mahasarakham University (MSU), Kham Riang, Thailand Pranil Pradhan Department of Community Medicine and Public Health, Institute of Medicine, Kathmandu, Nepal Ingeborg Rossow Norwegian Institute of Public Health, Oslo, Norway Gillian Shorter Queen’s University Belfast, Belfast, UK Vanlounny Sibounheuang Faculty of Pharmacy, University of Health Sciences, Vientiane, Lao People's Democratic Republic Mindaugas Štelemėkas Lithuanian University of Health Sciences, Kaunas, Lithuania Dao The Son Thuongmai University, Hanoi, Vietnam Kate Vallance Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada Wim Van Dalen Dutch Institute for Alcohol Policy STAP, Utrecht, The Netherlands Ashley Wettlaufer Centre for Addiction and Mental Health, Toronto, ON, Canada Arianne Zamora EpiMetrics.Inc, Manila, Philippines Journal Article 2024 05 08 Alcohol taxation is a key policy to reduce consumption and alcohol harm but evidence on tax design and indicators to assess taxation policy are lacking. Tax design and two indicators: tax as a share of lowest retail price and affordability, were investigated in eight high-income and nine middle-income jurisdictions. Collaborators populated the International Alcohol Control (IAC) study online Alcohol Policy Tool, providing measures of tax design, tax rates; and typical lowest prices available for retail take-away alcohol. These data were used to calculate tax/share of retail price. Affordability of alcohol was assessed against gross national income (GNI) per capita. High-income jurisdictions had higher tax/share and higher affordability on average compared with middle-income jurisdictions. Over the sample as a whole there was no association between these two indicators of tax policy. The tax designs used also varied with high-income jurisdictions more likely to use specific excise tax reflecting potency and middle-income jurisdictions more likely to utilise ad valorem and specific volume based taxes and to use more than one method across a beverage. Increased alcohol taxation to reduce alcohol consumption and harm is established as a high impact policy and is believed to work by affecting affordability. However, less is known about the best taxation methods to reduce affordability or the best measures to monitor and compare alcohol taxation between countries and over time. In this sample of high- and middle-income jurisdictions tax/price share was not found to predict affordability, suggesting the need to further research indicators of alcohol affordability. <br style="font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px;" />

https://www.ijhpm.com/article_4708_cf1f924ac8da40b4650a289e7c69f6c9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Civil Society’s Evidence-Generating Role for Health Policy Decisions: A Thematic Analysis of a Healthcare Information for All (HIFA) Community Online Discussion 1 8 4750 10.34172/ijhpm.8701 EN Unni Gopinathan Cluster for Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway Centre for Epidemic Interventions Research, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway Tarry Asoka Independent consultant, Port Harcourt, Nigeria María Eugenia Aponte-Rueda Venezuelan Breast Cancer Research and Education Foundation (FUVEICAM), Caracas, Bolivarian Republic of Venezuela Genevieve Cecilia Aryeteey School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana 0000-0002-0530-8675 Esha Ray Chaudhuri Independent Patient Advocate, Calgary, AB, Canada Meena Cherian Geneva Foundation for Medical Education & Research (GFMER), Geneva, Switzerland 0000-0003-2450-1638 Praveen Devarsetty George Institute for Global Health, Hyderabad, India Claire Glenton Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway Augustina Koduah School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana Tripti Gupta External Consultant, National Health Systems Resource Centre, New Delhi, India Simon Lewin Department of Health Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Ålesund, Norway 0000-0001-7521-9515 Jacinta Nzinga Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya Velisha Ann Perumal-Pillay Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa Ravi Ram Madhira Institute, Nairobi, Kenya Fatima Suleman Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal (Westville Campus), Durban, South Africa Goran Abdulla Zangana National Health Service (NHS) Lothian, Edinburgh, UK Neil Martin Pakenham-Walsh Healthcare Information For All, Chipping Norton, UK Journal Article 2024 07 14 Civil society actors are widely recognized for advocating the public interest in health policy. However, their role in contributing different types of evidence to inform policy is less explored. To explore this topic, members of the Healthcare Information for All (HIFA) online forum and the Supporting Inclusive and Accountable Health Systems Decisions for Universal Health Coverage (SUPPORT-SYSTEMS) research project conducted a four-week online discussion. The discussion focused on defining civil society, its role in health policy, the types of evidence it provides, and how this evidence is used and valued. Weekly focal questions encouraged HIFA members to share experiences of civil society engagement and the use of evidence in health policy-making. The thematic analysis identified four key messages. First, defining civil society requires critical reflection, as actors differ significantly in their interests, political ties, and influence. These distinctions affect how representative their evidence is and whether it reflects vested interests. Second, policy-making structures can support meaningful civil society participation, thereby strengthening the use of evidence and the legitimacy of policy decisions. Third, civil society provides valuable local and tacit knowledge that complements scientific evidence, though safeguards are needed to prevent bias or misrepresentation. Fourth, political economy factors—such as power imbalances, gatekeeping, and funding constraints—shape the influence of civil society evidence on policy. Overall, the discussion highlighted the diverse roles civil society can play in health policy and the importance of institutional mechanisms to support responsible evidence use. Thematic discussions in communities of practice (CoPs) like HIFA offer a dynamic and inclusive approach to engaging stakeholder knowledge in research projects.

https://www.ijhpm.com/article_4750_281951a15f3f085f72cdf2f56e1046b9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Orphan Drug Approval in Canada, 1999-2022: A Cross-sectional Study 1 5 4798 10.34172/ijhpm.8916 EN Joel Lexchin School of Health Policy and Management, York University, Toronto, ON, Canada Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada Journal Article 2024 11 21 The number of drugs for orphan indications has been increasing significantly in Canada and the federal government recently announced an investment of $1.5 billion dollars over 3 years primarily directed at helping to fund the cost of these drugs. There are claims and counterclaims about what percent of Food and Drug Administration (FDA) orphan drugs are available in Canada and how delayed these drugs are in being approved by Health Canada. This study uses FDA and Health Canada databases and data from three health technology assessment agencies and one drug bulletin to provide objective data about the percent of FDA approved drugs that were also approved by Health Canada, any delays in Canadian approval and the additional therapeutic value of new orphan drugs. Decisions about what drugs should be publicly covered and how long it took to make those decisions were not investigated. From 1999 to 2022, the FDA approved 326 new drugs for an orphan indication and Health Canada approved 231 (70.9%) for the same indication. The median time between FDA and Health Canada approval was 346 days (interquartile range [IQR] 181, 785). The percent rated as major improvements declined from 50% of the total in 2004-2008 to 13.6% in 2019-2022. These findings need to be taken into account as Canada develops an orphan drug policy and decides on criteria for funding this group of drugs. Specifically, when high quality evidence about the additional therapeutic value of orphan drugs is not available at the time of approval, risk sharing funding agreements with manufacturers should be put in place. Manufacturers should understand that if the results of post-market trials do not provide convincing evidence of value, funding will be withdrawn. Finally, the quality of any research plan should be used to prioritize candidates for federal funding.

https://www.ijhpm.com/article_4798_339bca0f24a6744e1f188126856e72e3.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 New Ways of Working to Manage and Improve Quality in Integrated Care Systems in England 1 10 4685 10.34172/ijhpm.8424 EN Mirza Lalani Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK Michele Peters Nuffield Department of Population Health, University of Oxford, Oxford, UK Thavapriya Sugavanam Nuffield Department of Population Health, University of Oxford, Oxford, UK Helen Crocker Nuffield Department of Population Health, University of Oxford, Oxford, UK James Caiels Personal Social Service Research Unit, University of Kent, Canterbury, UK Harriet Hay Picker Institute Europe, Oxford, UK Sarah Gunn Picker Institute Europe, Oxford, UK Helen Hogan Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK Bethan Page Department of Experimental Psychology, University of Oxford, Oxford, UK Cicely Saunders Institute, King’s College London, London, UK Ray Fitzpatrick Nuffield College, University of Oxford, Oxford, UK Journal Article 2024 01 15 Background Integrated care systems (ICSs) in England were formally established in July 2022 to coordinate the planning and delivery of health and care services. A key responsibility was to address the quality of these services. Our study aimed to examine how ICSs approach this responsibility and to identify opportunities and barriers experienced in their early establishment and development. Methods A sample of four ICSs were recruited to participate. Interviews and meeting observations were undertaken in two phases (before and after the inception of ICSs) around 12 months apart. A total of 112 interviews were carried out with senior figures in the four ICSs supplemented by observation of relevant meetings and analysis of relevant documents. Results Regarding quality, ICSs demonstrated several new ways of working. They set-up new structures for quality governance and created whole-system strategies for quality centred on major responsibilities regarding population health and health inequalities. These strategies required new and relevant metrics to assess quality and outcomes and a greater focus upon co-production in the development of services. They aimed to strike a fine balance between longstanding requirements for quality assurance and new responsibilities for quality improvement (QI). New approaches were underpinned by new collaborations between system partners extending beyond healthcare to include Local Authorities (responsible for social care and public health) and local communities. Conclusion To address the many challenges of quality, ICSs have created new ways of working cultivating different kinds of collaborative relationships compared to established hierarchical, siloed and top-down ways of working prior to their formation. A focus on improving population health and reducing inequalities has required a shift from “here and now” urgent problem-solving to working with longer timelines. Such changes require patience in the context of political pressure to devote efforts to more salient problems such as waiting lists.

https://www.ijhpm.com/article_4685_bae31eb50dcd57acc01d3aaf18f1eca5.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Ambition With Uncertainty: Exploring Policy-Makers’ Perspectives on Pathways to Net Zero Healthcare 1 12 4695 10.34172/ijhpm.8440 EN Anand Bhopal Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway Centre for Energy and Climate Transformation (CET), University of Bergen, Bergen, Norway Takemi Program in International Health, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA Kristine Bærøe Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway Ole F. Norheim Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA Journal Article 2024 01 30 Background Over 80 countries have now signed up to the COP26 Health Programme—a World Health Organization (WHO)-led initiative on climate change and health—of which 45 countries have committed to reaching net zero emissions before 2050. Efforts to reduce healthcare’s carbon footprint raise conceptual, ethical and practical challenges for efficient and fair resource allocation. This study investigates how civil servants leading the development and implementation of national net zero healthcare strategies conceptualise the responsibility of health systems to cut emissions and describe potential trade-offs along the way. Methods We undertook 11 online, semi-structured qualitative research interviews between September 2022 – May 2023 with civil servants leading national net zero healthcare strategies. The interview guide explored three main areas: responsibility for emissions, priority setting and international perspectives. Interviews were coded and analysed the data using Malterud’s systematic text condensation (STC). Results Four main themes emerged: obligation to act, leadership, governance, and prioritization. Participants described that the healthcare system should take responsibility for its entire carbon footprint, including harms inflicted beyond national borders. We also found indications of synergistic, multi-scalar health leadership—clinical, civil service, and political—helping to accelerate the net zero healthcare agenda. Participants generally rejected the notion of direct “tradeoffs” between efforts to reduce emissions and patient care, emphasising ways net zero healthcare can leverage societal health improvements more broadly. These empirical findings inform the emerging literature exploring how health systems should account for their environmental impacts. Conclusion Our findings highlight the sincerity of ambitions to deliver net zero healthcare and uncertainties on how to get there. Further work characterising the types of constraints and trade-offs policy-makers face on the path to net zero healthcare systems, including examples of how these have been overcome, could help integrate climate concerns into healthcare decision-making and resource allocation processes.

https://www.ijhpm.com/article_4695_c3a00ad4bc034bfe40220b20c2e74478.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 What Policies Do Local Governments Use to Promote Physical Activity? A Comparative Analysis of Municipalities From 4 EU Countries and Japan 1 11 4689 10.34172/ijhpm.8594 EN Sven Messing Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Physical Activity for Health Research Centre, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland Antoine Noël Racine Université Côte d’Azur, LAMHESS, Nice, France Noriko Takeda Center for Promotion of Higher Education, Kogakuin University, Tokyo, Japan Tanja Onatsu Adults on the Move Program, Jamk University of Applied Sciences, Jyväskylä, Finland Katariina Tuunanen Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeş-Bolyai University, Cluj-Napoca, Romania Antonia Papiu Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeş-Bolyai University, Cluj-Napoca, Romania Leonie Birkholz Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Jean-Marie Garbarino Université Côte d’Azur, LAMHESS, Nice, France Yuko Oguma Sports Medicine Research Center, Keio University, Yokohama, Japan Yoshinobu Saito Faculty of Sport Management, Nippon Sport Science University, Yokohama, Japan Dan Mocan Independent Researcher, Cluj-Napoca, Romania Răzvan Mircea Cherecheș Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeş-Bolyai University, Cluj-Napoca, Romania Anne Vuillemin Université Côte d’Azur, LAMHESS, Nice, France Peter Gelius Institute of Sport Sciences, Université de Lausanne, Lausanne, Switzerland Petru Sandu Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeş-Bolyai University, Cluj-Napoca, Romania Journal Article 2024 05 17 Background As public policies have the potential to change the entire system of physical activity (PA) promotion and to create conducive environments, they are particularly relevant to address the persistently low levels of PA across the world. Furthermore, World Health Organization’s (WHO’s) Global Action Plan on Physical Activity highlights the relevance of local governments as important partners for policy action. However, our knowledge on how local PA promotion policy compares across countries remains limited. Methods We conducted an exploratory study as part of the LoGoPAS project to compare the status quo of local PA policies across five municipalities in five different countries. Using purposive sampling, Jyväskylä (Finland), Nice (France), Erlangen (Germany), Fujisawa (Japan), and Cluj-Napoca (Romania) were selected. Data were collected and analysed via desk research and expert consultation using the CAPLA-Santé, a validated tool designed to assess relevant aspects of local PA promotion policies. Results The analysis showed that the main responsibility for PA promotion varied between municipalities, resting either with the sport or the health sector. A total of 50 relevant PA policy documents were identified, focusing on multiple settings and target groups. Budgets for PA promotion differed across municipalities. Research on PA was reported to have informed policy development in some but not all cases. Across countries, political support was identified as a key driver of local PA promotion. Conclusion LoGoPAS is the first study to apply the CAPLA-Santé outside of France and the first to use it for an international comparative analysis. Results highlight the ability of the tool to provide insights into local PA policy development, contents, and implementation worldwide. While this study provided a cross-sectional in-depth analysis of the status quo in select municipalities, future research could also aim to assess policies at a large scale, ie, for multiple municipalities and/or on a regular basis.

https://www.ijhpm.com/article_4689_c2c1f3ce6e691300fabb4e723ab4486a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Routes of Well-Being, Spiritual Harmony and Recovery in Mental Health: The Community as a Policy-Maker 1 11 4688 10.34172/ijhpm.8390 EN Felipe Agudelo-Hernández Programa de Medicina, Facultad de Ciencias para la Salud, Universidad de Manizales, Manizales, Colombia Ana Belén Giraldo-Álvarez Departamento de Medicina, Facultad de Ciencias para la Salud, Universidad de Caldas, Manizales, Colombia Journal Article 2023 12 16 Background The participatory approach in policy construction is a historical debt to communities. An example of the above is the definition that Colombian Indigenous communities give to mental health or spiritual harmony. Spiritual harmonies are a collective good that implies being in harmony with the spirit and with thought, which is why it is related to the community context, with the territory, identity, autonomy, spirituality, worldview, diverse cultural uses, practices, and customs. The objective of this study was to analyze the process of building a mental health recovery path with multiple community representatives in a Colombian territory. Methods Through a co-production method based on Participatory Action Research, focus groups were developed with representatives of children, youth, indigenous peoples, migrant populations, as well as government sectors such as health, education, and decision-makers in the territory. This study was carried out in 2023 in the District of Riohacha, Colombia, in the last quarter of 2023, within the framework of the construction of a mental health route, led by the District Mayor’s Office. Fifty-nine people participated in the focus groups. Results The necessity of living in safe and supportive environments was emphasized. The route built with the community was based on the definition of the necessary steps to generate a real approach to the context and their perceptions of well-being, mental health and spiritual harmonies. Three main themes were identified: (1) Mental health: a construct of well-being, care and identity, (2) Barriers to an integral approach and ideals of joint construction, and (3) The proposal for a comprehensive mental health route. Conclusion Co-productive methodologies strengthen community autonomy and empowerment, and make the implementation of mental health programs more feasible. In public policies, it is increasingly necessary to have communities that are strengthened in the production of knowledge and in the proposals for implementation.

https://www.ijhpm.com/article_4688_d1107e520fcd08346ca71e245be25a69.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 The Impact Mechanism of Government Regulation on the Operation of Smart Health Senior Care Service Platform: A Perspective From Evolutionary Game Theory 1 13 4697 10.34172/ijhpm.8646 EN Meng Xiao School of Management, Shenyang University of Technology, Shenyang, China Huan Liu School of Management, Shenyang University of Technology, Shenyang, China Journal Article 2024 06 12 Background Smart health and senior care services have developed rapidly to cater to the aging society, but the corresponding regulations are not perfect. The platform and senior care service enterprises have chosen different strategies due to various factors, resulting in disorderly platform development and inefficient resource allocation. This research attempts to establish a regulatory mechanism to promote the active development of the platform. Methods In order to mitigate opportunistic behaviors in the smart health senior care service platform, drawing from evolutionary game theory, this study establishes a decision-making model involving the government, the platform, and senior care service enterprises, and scrutinizes the evolutionary behaviors and equilibrium strategies of these three parties. Results There are five equilibrium points among the three parties in the game, and the strategy selection shows periodic changes. The cost and level of positive government regulation, the conversion rate of smart aging construction services provided by the platform, penalties for opportunistic behavior by the platform, as well as the benefits of positive cooperation and penalties for passive cooperation by senior care service enterprises, will significantly affect the strategies of all parties involved. Conclusion The research results indicate that establishing a regulatory mechanism for the smart health senior care service platform can promote effective cooperation between platform and senior care service enterprises. Active government regulation is the key to the smooth operation of the platform. Through quantitative analysis, the main strategic choices of participants in the smart health senior care service platform can be explained. This model can provide a reference for formulating policies related to smart senior care.

https://www.ijhpm.com/article_4697_820a247f22bc6f86444a37ec1320b7e3.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Bottlenecks Analysis in the Intervention of Improving Maternal Health in Rural Areas of Tanzania: A Convergent Mixed-Method Approach 1 12 4699 10.34172/ijhpm.8355 EN Hyeyun Kim Korea Institute for Health and Social Affairs, Sejong, Republic of Korea Department of Health Convergence, Graduate School of Ewha Womans University, Seoul, Republic of Korea Jiye Kim Department of Health Convergence, Graduate School of Ewha Womans University, Seoul, Republic of Korea Seohyeon Lee Department of Health Convergence, Graduate School of Ewha Womans University, Seoul, Republic of Korea Minkang Cho Department of Health Convergence, Graduate School of Ewha Womans University, Seoul, Republic of Korea Hyekyeong Kim Department of Health Convergence, Ewha Womans University, Seoul, Republic of Korea Journal Article 2023 11 22 Background Achieving universal health coverage for maternal health (MH) requires a health system that ensures the availability, accessibility, acceptability, and effective use of services. The study aimed to identify bottlenecks that hinder project outcomes of MH in the rural districts of Tanzania. Methods This study employed a convergent mixed-method approach to conduct the bottleneck analysis. Quantitative data were collected to identify indicators of MH utilization, with source including Tanzanian health statistics, health facilities and the women in reproductive age (WRA) survey. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with WRA, their families, community health workers (CHWs), and healthcare personnel (HP) to gain insight into factors influencing healthcare utilization from both a demand and an environmental perspective. Following the Tanahashi steps, the quantitative data were analyzed using descriptive statistics and the qualitative data were analyzed using a thematic approach. The findings from both were integrated to identify bottlenecks toward effective coverage and how bottlenecks affected the utilization of MH services. Results Community awareness and acceptance were observed to be high, however only a limited number of individuals had received MH services. Utilization rates for antenatal care (ANC) and postnatal care (PNC) were 17.4% and 22.0%, respectively. This suggests that efforts to enhance awareness may be inadequate to change social norms and lead to health behaviors. Furthermore, even when women utilize the service, they may not do so in a timely or consistent manner due to low service quality or unsatisfactory experiences. Conclusion To strengthen the logic model, contextual factors such as provider attitudes, service quality, supportive family, and community climate need to be considered to ensure that WRAs are satisfied with and continue to access services. With building supply-side infrastructure, ongoing efforts to change stakeholders’ perceptions of MH services and utilization patterns will be needed to improve the coverage of MH services.

https://www.ijhpm.com/article_4699_007a20eb8531e302385783677da0c4ca.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Learning Care Pathways Framework: A New Method to Implement, Learn, Replicate, and Scale up Care Pathways for and With the Patient 1 17 4704 10.34172/ijhpm.8517 EN Jean-Baptiste Gartner Département de management, Faculté des sciences de l’administration, Université Laval, Québec City, QC, Canada Centre de recherche en gestion des services de santé, Université Laval, Québec City, QC, Canada Centre de recherche de l’Institut Universitaire de Cardio-Pneumologie de Québec, Université Laval, Québec City, QC, Canada Centre de recherche du CHU de Québec, Université Laval, Québec City, QC, Canada VITAM, Centre de recherche en santé durable, Université Laval, Québec City, QC, Canada Centre de recherche du CISSS de Chaudière-Appalaches, Université Laval, Québec City, QC, Canada Célia Lemaire iaelyon School of Management, Université Lyon 3, Lyon, France Institut Universitaire de France, Paris, France André Côté Département de management, Faculté des sciences de l’administration, Université Laval, Québec City, QC, Canada Centre de recherche en gestion des services de santé, Université Laval, Québec City, QC, Canada Centre de recherche de l’Institut Universitaire de Cardio-Pneumologie de Québec, Université Laval, Québec City, QC, Canada Centre de recherche du CHU de Québec, Université Laval, Québec City, QC, Canada VITAM, Centre de recherche en santé durable, Université Laval, Québec City, QC, Canada Centre de recherche du CISSS de Chaudière-Appalaches, Université Laval, Québec City, QC, Canada Journal Article 2024 04 01 Background Although care pathways are a response to the calls for a major change in health system redesign initiatives, very few articles have proposed an implementation method. Indeed, no method exists for large-scale projects of care pathways, as sets of interventions within health systems. Drawing on the systems thinking approach and the pragmatic sociology, we describe the implementation methodology of the Learning Care Pathways (LCP) framework, a method to implement, learn, replicate, and scale up care pathways for and with the patient. Methods The LCP was conceptually developed through a series of literature reviews on key methodological concepts. As a comprehensive, theory-informed approach, the LCP emerged by linking implementation strategies, research methods, learning mechanisms and outcomes dimensions aimed at optimising care pathways. Results Designed around 13 steps grouped into five phases, this framework provides implementation strategies, research methods and learning mechanisms, including levers for patient involvement. The pre-implementation phase enables the selection of the pilot project’s receiving environment and the design of the project. The implementation phase is designed to co-construct and implement an optimised care pathway based on a scientific analysis of the patient journey, the care pathway perceived by professionals, the care pathway from data and integrating knowledge from international clinical practice guidelines. The post implementation phase aims to demonstrate value creation and set up a learning cycle. The replication phase is designed to repeat the method locally to develop horizontal learning and to evaluate scalability. Finally, the scale up phase aims to repeat the method in other territories to accelerate knowledge creation and develop horizontal and vertical learning. Conclusion This framework is of particular interest to policy-makers, healthcare managers, and researchers alike, and must be the subject of several experiments to conduct reproducible research that can lead to national Learning Health Systems (LHS).

https://www.ijhpm.com/article_4704_6abfedd0e450203774e951e53cb01117.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Barriers and Facilitators to the Development and Implementation of Public Policies Addressing Food Systems in Five Sub-Saharan African Countries and Five of Their Cities 1 15 4706 10.34172/ijhpm.8592 EN Celia Burgaz Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium Department of geosciences, environment and society, Université libre de Bruxelles (ULB), Brussels, Belgium 0000-0002-4806-6055 Iris Van Dam Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium Adama Diouf Laboratoire de Recherche en Nutrition et Alimentation Humaine (LARNAH), Université Cheikh Anta Diop, Dakar, Senegal Kouakou Philipps Kouakou Université Alassane Ouattara (UAO), Bouaké, Côte d’Ivoire Olouwafemi M. Mama Laboratoire de Recherche en Nutrition et Alimentation Humaine (LARNAH), Université Cheikh Anta Diop, Dakar, Senegal Sabiba Kou’santa Amouzou Laboratoire de Biochimie des Aliments et Nutrition, University of Kara, Kara, Togo Rebecca Rachel Assa Yao Université Alassane Ouattara (UAO), Bouaké, Côte d’Ivoire Blessing Atwine Economic Policy Research Centre (EPRC), Kampala, Uganda Madina M. Guloba Economic Policy Research Centre (EPRC), Kampala, Uganda Lallepak Lamboni Laboratoire de Biochimie des Aliments et Nutrition, University of Kara, Kara, Togo Pauline Nakitende Economic Policy Research Centre (EPRC), Kampala, Uganda Julien S. Manga Department of Nutrition, University of Montreal, Montreal, QC, Canada Clémence Metonnou Regional Institute of Public Health, Université of Abomey-Calavi (UAC), Ouidah, Benin Célestin Koffi N’dri Université Alassane Ouattara (UAO), Bouaké, Côte d’Ivoire Reynald Santos Regional Institute of Public Health, Université of Abomey-Calavi (UAC), Ouidah, Benin Charles Sossa Regional Institute of Public Health, Université of Abomey-Calavi (UAC), Ouidah, Benin Papa M.D.D. Sylla Laboratoire des Sciences Biologiques, Agronomiques, Alimentaires et de Modélisation des Systèmes Complexes (LABAAM), Université Gaston Berger de Saint-Louis, Saint-Louis, Senegal Tiatou Souho Laboratoire de Biochimie des Aliments et Nutrition, University of Kara, Kara, Togo Stefanie Vandevijvere Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium Journal Article 2024 05 16 Background There is increasing recognition of the role governments play in addressing the health and environmental sustainability challenges within current food systems. This study seeks to understand food system policies designed and/or implemented by selected national and local governments in Africa, and the barriers and facilitators faced when designing or implementing policies to create healthy and environmentally sustainable food systems. Methods From an evidence-based list of proposed policies with double- or triple-duty potential to achieve healthy and environmentally sustainable food systems, a policy mapping was performed in five African countries (Benin, Côte d’Ivoire, Senegal, Togo, and Uganda) and one city in each of these countries (Ouidah, Bouaké, Saint-Louis, Sokodé, and Mbale). Semi-structured interviews were then conducted with policy stakeholders. The interview data were analysed in NVivo 14 using the thematic framework analysis approach, informed by the Health Policy Triangle (HPT). Results The mapping showed that African countries have designed and implemented policies that simultaneously address food insecurity and climate change, mainly through food production policies. Within food environments, countries are focussing on interventions to prevent obesity, mainly food provision or food pricing policies. However, many policy gaps remain. Several technical and political barriers were commonly experienced when designing and implementing food system policies, regardless of the jurisdiction, context or region, such as insufficient financial resources, lack of political will, limited data, and inadequate monitoring and enforcement mechanisms. The major facilitators perceived were supportive public opinion and awareness, international agreements, sound agenda-setting, multi-sector and multistakeholder consultations and partnerships, availability of both financial resources and data, and solid political will. Conclusion This article gives an overview of policies designed and implemented to achieve sustainable food systems, highlighting a strong focus through agriculture on undernutrition and climate change objectives. It also identifies their potential legislative, financial, and practical barriers and facilitators.

https://www.ijhpm.com/article_4706_e989e6903e922a27ede361e6925f80ad.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Selecting Cost-Effectiveness Methods for Health Benefits Package Design: A Systematic Approach 1 9 4712 10.34172/ijhpm.8562 EN Cassandra Nemzoff London School of Hygiene and Tropical Medicine, London, UK Center for Global Development, Washington, DC, USA Sedona Sweeney London School of Hygiene and Tropical Medicine, London, UK Rob Baltussen Radboud University Medical Center, Nijmegen, The Netherlands Anna Vassall London School of Hygiene and Tropical Medicine, London, UK Journal Article 2024 04 29 Background Cost-effectiveness (CE) is a common prioritization criterion in health benefits package (HBP) design. However, to assess CE is a time- and data-demanding process, so most HBP exercises rely wholly or partially on global evidence. Extensive investment has been made in analyses, models, and tools to support cost-effectiveness analyses (CEAs) for HBPs. However, little attention has been paid to how national HBP assessors should both understand and select CE estimates. A structured, national process to select assessment methods is essential for ensuring the accuracy, ownership, and transparency of HBP design. This can be supported by “adaptive” health technology assessment (aHTA) principles, which focus on structured methodological choices based on the time, data, and capacity available. The objective of this paper was to apply aHTA framing to CEA methods selection for HBPs, and to make recommendations on how countries may consider systematically making these choices going forward. Methods We first reviewed the definitions and categorization of different aHTA methods. We then conducted a scoping review of previous HBP assessments to understand how CEA methods used in HBPs fit into the aHTA framework, and a follow-up survey of authors to fill gaps. Results of the literature review and survey were interpreted and narratively synthesized. Results We found that previous HBP assessments used four aHTA methods, sometimes simultaneously: expert opinion (n = 3/20), review (n = 12/20), model adaptation (n = 6/20), and new model (n = 2/20). The literature review and survey found that aHTA methods for HBPs take between 1-13 months; require different data sources depending on the method(s) used; and generally, require capacity in health economics, medicine, public health, and CE modelling. We supplement our report with a discussion of key considerations for methods selection. Conclusion Trading off time, data, and capacity needs for different CE assessment methods can help to support structured, local design of HBP assessments.

https://www.ijhpm.com/article_4712_4bcab12b4115437f94f7e7cf1d75e269.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Who Is Most Likely to Experience Corruption When Seeking Healthcare in Nigerian Healthcare Facilities? 1 11 4713 10.34172/ijhpm.8687 EN Ifunanya Clara Agu Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria University of Nigeria, Nsukka, Nigeria Chukwudi Nwokolo Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria University of Nigeria, Nsukka, Nigeria Obinna Onwujekwe Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria University of Nigeria, Nsukka, Nigeria Martin McKee London School of Hygiene and Tropical Medicine, London, UK Eleanor Hutchinson London School of Hygiene and Tropical Medicine, London, UK Blake Angell University of New South Wales Sydney, The George Institute for Global Health, Newtown, NSW, Australia Dina Balabanova London School of Hygiene and Tropical Medicine, London, UK Journal Article 2024 07 17 Background Experiencing corruption when seeking health services remains a significant problem in Nigeria. An effective response requires knowledge of the individual characteristics of those impacted by corruption when seeking healthcare. This study examined the prevalence of corruption among those seeking health services in Nigeria’s public healthcare facilities and how it varies among different user groups. Methods We used a pre-tested interviewer-administered questionnaire to collect data from 1659 individuals randomly selected from households in two Nigerian states. We collected data on respondents’ socio-demographic characteristics and experiences of corrupt practices. We undertook descriptive and binomial logistic regression analyses. Results Approximately 50% (823) of respondents experienced corrupt practices, such as using connections for faster treatment and bribery when seeking health services. 446 (27%) respondents bribed or made so-called unapproved payments to health providers to obtain health services. Gender was a strong predictor, with male healthcare service users being more likely to experience corrupt practices (%point risk difference = 24; 95% CI = 20, 29) and bribe or make an unapproved payment to obtain healthcare (%point risk difference = 20; 95% CI = 15, 25). Residents in the northern state were (%point risk difference = 30; 95% CI = 26, 35) more likely to experience corrupt practices than residents in the eastern state. People seeking healthcare in urban (%point risk difference = 09; 95% CI = -05, 08) and semi-urban (%point risk difference = 12; 95% CI = 05, 19) locations were more likely to have bribed or made ‘unapproved’ payments to healthcare providers compared to rural residents. Conclusion Health sector corruption, in its various forms, is frequently reported in both northern and southern Nigeria. However, user experience of corruption varies according to socio-demographic characteristics, and this is often insufficiently acknowledged. To combat corrupt practices in both health sectors, anti-corruption initiatives must be tailored to particular groups and settings, addressing specific disadvantages at individual and community levels.

https://www.ijhpm.com/article_4713_daa20b216fa8dbc528237c9fd24eca0d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Obesity and Lifestyle Drift: Framing Analysis of Calorie Menu Labelling in England in News Media 1 14 4723 10.34172/ijhpm.8649 EN Nancy Karreman MRC Epidemiology Unit, University of Cambridge, Cambridge, UK Michael Essman MRC Epidemiology Unit, University of Cambridge, Cambridge, UK Benjamin Hawkins MRC Epidemiology Unit, University of Cambridge, Cambridge, UK Jean Adams MRC Epidemiology Unit, University of Cambridge, Cambridge, UK Martin White MRC Epidemiology Unit, University of Cambridge, Cambridge, UK Journal Article 2024 06 14 Background Successive government public health strategies in England have described structural influences of dietrelated ill health, including obesity, while emphasising the solution of individual-level change in policy documents. This entrenchment of an individualistic policy paradigm, despite communicating a recognition of structural determinants of health on paper, has been termed “lifestyle drift.” The 2020 government strategy, Tackling Obesity, included policies to address structural determinants of health like the physical and digital food environments but ultimately failed to shift responsibility for diet-related ill health onto structural factors. This study uses the contestation of calorie labelling (CL) in the out-of-home (OOH) sector, one of the strategy’s only two implemented measures, in English newspapers to investigate how the policy is framed, and the potential role of media framing in facilitating lifestyle drift. Methods We systematically searched the Factiva database for articles from 12 UK national newspapers that discussed CL between January 2017 and May 2022, and assessed them relative to inclusion criteria. We then used a combination of reflexive thematic analysis (RTA) and framing theory to qualitatively analyse the framing of policy problems and the solutions meant to address them. Results A total of 177 articles met our criteria. We found that media framing often reinforced individualism, personal responsibility, and moralisation of behaviour. It also emphasised perceived mixed and inconclusive evidence of CL’s effectiveness, unfairness to businesses, and unintended consequences, including negative impacts on the economy and people living with eating disorders. Conclusion Despite an initial shift towards framing interventions to address obesity through a structural lens in Tackling Obesity, CL legislation and accompanying news coverage reflected a drift back towards individualism. To enact effective, structural change to address diet-related public health issues, policy discourses and approaches need to move away from individualising and moralising framing of both public health problems and potential solutions.

https://www.ijhpm.com/article_4723_c9919e21ebc01ff6429310bdab8829f7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 “It’s Feeding the Beast”: Lessons for Governance of Public Health Surveillance and Response From an Australian Case Study Analysis 1 11 4722 10.34172/ijhpm.8605 EN Stephanie M. Topp Public Health and Tropical Medicine, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia Alexandra Edelman Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia Thu Nguyen Public Health and Tropical Medicine, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia Emma S. McBryde Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia Sue Devine Public Health and Tropical Medicine, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia Tammy Allen Public Health and Tropical Medicine, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia Jeffrey Warner Public Health and Tropical Medicine, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia Julie Mudd College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia Paul F. Horwood Public Health and Tropical Medicine, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia Journal Article 2024 05 27 Background Public health is a core governmental responsibility, with ministries or departments of health responsible for setting and ensuring adherence to standards, managing performance and instituting reforms as required. Although North Queensland (NQ), Australia has a well-developed health infrastructure, the COVID-19 pandemic exposed significant vulnerabilities in its public health surveillance and response system. Globally, research has highlighted how human and cultural elements (“system software”) influence the effectiveness of infrastructure, governance, and data systems (“system hardware”). This study examines the interaction between these elements to examine specific governance challenges and opportunities for strengthening communicable disease surveillance and response in NQ. Methods Using an embedded case study design, we analysed four disease units—COVID-19, tuberculosis (TB), arboviruses, and sexually transmitted infections (STIs)—through interviews (n = 47), document review, and observations across NQ health services (October 2020–December 2021). Data were mapped against Sheikh and colleagues’ hardwaresoftware framework to examine the nature of governance bottlenecks in this region of northern Australia. Results Two key governance challenges emerged: (1) Accountability deficits—Hospital and Health Services (HHSs) lacked clear reporting or performance monitoring systems within Queensland’s devolved health service governance model, contributing to inconsistent prioritisation of resourcing for communicable disease functions by health service leadership. Within HHSs, public health units (PHUs) faced systemic underfunding, with prevention services accounting for as little as 0.1% of some health service budgets. (2) Data governance failures—Fragmented, siloed data systems, restrictive datasharing norms, and risk-averse culture hindered coordinated surveillance and response efforts. Weak interoperability and mistrust in data-sharing partnerships further compromised system effectiveness. Conclusion This study highlights how political, normative, and structural factors shape public health performance alongside the more commonly assessed functional and technical dimensions. Findings suggest the need to improve performance monitoring systems, leadership, and data governance to build an effective, accountable, and data-driven surveillance and response system in NQ.

https://www.ijhpm.com/article_4722_577d3c780f41564d32e332832a093a34.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Does the New Rural Cooperative Medical Scheme Provincial Pooling Policy Improve Health Equity Among Older Adults? – Evidence From China Longitudinal Healthy Longevity Survey Data 1 11 4718 10.34172/ijhpm.8671 EN Miao Peng Department of Labor and Social Security, School of Public Health, Southeast University, Nanjing, China Dai Baozhen Department of Labor and Social Security, School of Public Health, Southeast University, Nanjing, China Liao Xin Department of Labor and Social Security, School of Public Health, Southeast University, Nanjing, China Journal Article 2024 06 28 Background As global aging increases, health inequalities are becoming more prominent. The purpose of this study is to examine whether increasing the level of fund pooling of the New Rural Cooperative Medical Scheme (NRCMS) helps to improve health and health inequalities among older adults. Methods Data from four periods of the China Longitudinal Healthy Longevity Survey (CLHLS) in 2008, 2011, 2014, and 2018 were used, the population for this paper was a sample of the older adults participating in the NRCMS. A sample of 955 treated participants and 13 477 control participants were included in the analysis after excluding samples with missing information. Time-varying difference-in-differences (DID) model was used to analyze the impact of the NRCMS Provincial Pooling Policy (NRCMS-PPP) on participants’ health and health inequalities. Results The results of the study showed that the NRCMS-PPP had a significant effect on the self-rated health (SH) (estimated coefficient = 0.149, P < .01) and health relative deprivation index (HRDI) (estimated coefficient = -0.018, P = .02). Further exploration of the heterogeneous effect of it revealed that implementation is more effective in improving the health and reducing health inequalities for older population with primary education or living in rural areas. The mediation mechanism suggests that NRCMS-PPP partially mediates through total out-of-pocket medical expenses (TOME) and catastrophic health expenditure (CHE). Conclusion The NRCMS-PPP reduces the probability of the older adults experiencing CHE and reduces their burden of disease costs, thus improving their health and reducing their health inequality. Policy effects vary in terms of educational status and areas of residence.

https://www.ijhpm.com/article_4718_aac6de47f6b6c5ffb14024bae9cf94d1.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 All-Cause and Cause-Specific Excess Mortality During the First Two Years of the COVID-19 Pandemic in NorthEast of Iran: Reiterating the Significance of High-Quality Healthcare Systems 1 9 4731 10.34172/ijhpm.8757 EN Seyedeh Vajiheh Kazemian Community Medicine Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Maliheh Dadgarmoghaddam Community Medicine Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Hamed Tabesh Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Amirreza Khajedaluee Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0002-1314-2337 Mohammad Khajedaluee Community Medicine Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Journal Article 2024 08 13 Background Excess mortality provides a comprehensive measure to assess the true impact of the disease on mortality rates. This study aimed to quantify excess mortality attributable to COVID-19 in northeastern Iran during the pandemic period (2020–2022). Methods This population-based cross-sectional study utilized population and mortality data extracted from electronic systems linked to Mashhad University of Medical Sciences (MUMS). Data analysis was conducted using R Version 4.3.3. A log-linear model was employed to predict expected deaths during the two-year pandemic period, incorporating predictor variables such as the year of interest, the presence of COVID-19, and the population size for each respective year. Excess deaths were calculated as the difference between the expected and observed mortality. Furthermore, by considering the confirmed deaths directly attributed to COVID-19 and the difference between these and the excess deaths, the number of indirect deaths during the pandemic was determined. Results The total count of recorded deaths from all causes exceeded the expected deaths by 31.15% (6750 cases) in the first year and 44.74% (10 078 cases) in the second year. The excess deaths were 1.48 and 1.79 times greater than the official reports of COVID-19 for the first and second years, respectively. It was also found that men experienced increased rates of excess deaths in each of the two years. Moreover, urban residents experienced higher rates of excess death in the same years. Based on cause-specific excess mortality, following infectious diseases, cardiovascular diseases (CVDs) accounted for the largest proportion of excess deaths in both years of the pandemic. Conclusion The overall mortality burden during the COVID-19 pandemic exceeded the official reports, highlighting the undercounting of the number of direct effects and emphasizing the significance of indirect effects. These findings underscore the importance of preparedness and organization of healthcare systems prior to a pandemic.

https://www.ijhpm.com/article_4731_7e50d2196370074f979d0da81843965c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Impact of China’s National Volume-Based Drug Procurement: A Multilevel Interrupted Time Series Analysis on Medical Expenditures in Hypertensive Patients 1 14 4727 10.34172/ijhpm.8540 EN Yunxiang Huang Institute of Integrated Traditional Chinese and Western Medicine, and Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China Sichuan Center of Technology Innovation for Real World Data, Chengdu, China Yan Ren Institute of Integrated Traditional Chinese and Western Medicine, and Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China Sichuan Center of Technology Innovation for Real World Data, Chengdu, China Yuanjin Zhang Institute of Integrated Traditional Chinese and Western Medicine, and Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China Sichuan Center of Technology Innovation for Real World Data, Chengdu, China Yulong Jia Institute of Integrated Traditional Chinese and Western Medicine, and Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China Sichuan Center of Technology Innovation for Real World Data, Chengdu, China Qianrui Li Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China Minghong Yao Institute of Integrated Traditional Chinese and Western Medicine, and Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China Sichuan Center of Technology Innovation for Real World Data, Chengdu, China Yuning Wang Institute of Integrated Traditional Chinese and Western Medicine, and Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China Sichuan Center of Technology Innovation for Real World Data, Chengdu, China Fan Mei Institute of Integrated Traditional Chinese and Western Medicine, and Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China Sichuan Center of Technology Innovation for Real World Data, Chengdu, China Kang Zou Institute of Integrated Traditional Chinese and Western Medicine, and Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China Sichuan Center of Technology Innovation for Real World Data, Chengdu, China Huangang Hu Tianjin Healthcare and Medical Big Data Co., Ltd, Tianjin, China Jing Tan Institute of Integrated Traditional Chinese and Western Medicine, and Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China Sichuan Center of Technology Innovation for Real World Data, Chengdu, China 0000-0001-8839-6705 Xin Sun Institute of Integrated Traditional Chinese and Western Medicine, and Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China NMPA Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China Sichuan Center of Technology Innovation for Real World Data, Chengdu, China Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China Journal Article 2024 04 16 Background The National Volume-Based Procurement (NVBP), implemented in China in 2019, aims to reduce patients’ economic burden by lowering drug prices and promoting the use of NVBP drugs in public hospitals. We evaluated the impact of NVBP on medical expenditures among hypertensive patients, analyzing both the overall impact and variations in policy effects across individual hospitals. Methods Using medical records from 1.17 million hypertensive patients across 82 hospitals in Tianjin (2017-2021), we conducted an interrupted time series analysis to assess expenditure changes among hypertensive patients for the treatment of hypertension, dyslipidaemia, type 2 diabetes, and chronic ischemic heart disease (IHD). Multilevel model was employed to estimate the overall impact and hospital-specific variations in policy effects. Results NVBP implementation significantly reduced per-visit outpatient expenditures among hypertensive patients for the treatment of hypertension (-15.61%), dyslipidaemia (-25.77%), and diabetes (-17.59%) by lowering drug expenditures. Although drug expenditures for chronic IHD decreased, non-drug expenditures increased, leading to no significant change in total expenditures for chronic IHD (-8.97%). For inpatient expenditures, no significant changes in total per-admission expenditures were observed for chronic IHD or diabetes hospitalizations. Drug expenditures for diabetes decreased significantly, but diagnostic expenditures increased, while no significant change was found in chronic IHD drug expenditures. At the individual hospital level, significant variations in policy effects were observed. Despite the overall decrease in outpatient expenditures for the treatment of hypertension, dyslipidaemia, and diabetes, only 45.6%, 67.2%, and 46.3% of hospitals, respectively, showed significant decreases, while the remainder exhibited either non-significant changes or increases. Conclusion NVBP effectively reduced outpatient expenditures among hypertensive patients for the treatment of hypertension, dyslipidaemia, and diabetes, suggesting its potential to alleviate patients’ economic burdens. However, the increases in non-drug expenditures and substantial variations in policy effects across hospitals highlight a room for further improvement in policy implementation and overall effectiveness.

https://www.ijhpm.com/article_4727_ebe4c2e35945067f03744b34e067e1eb.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Engaging Councillors to Address Structural and Social Drivers of HIV Infections in Blantyre City: A Formative Study 1 10 4742 10.34172/ijhpm.8550 EN Edna N. Bosire Brain and Mind Institute, Aga Khan University, Nairobi, Kenya Center for Innovation in Global Health, Georgetown University, Washington, DC, USA Victor Mwapasa Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi Emily Mendenhall Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, USA Sara Allinder Center for Innovation in Global Health, Georgetown University, Washington, DC, USA Deborah Hoege Center for Innovation in Global Health, Georgetown University, Washington, DC, USA Pilira Chirambo Department of Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi Emmanuel Kanjunjunju Blantyre City Council, Blantyre, Malawi Gift Kawalazira Blantyre District Council, Blantyre, Malawi Yohane Kamwigira National AIDS Commission, Lilongwe, Malawi Tione Chilambe National AIDS Commission, Lilongwe, Malawi Charles B. Holmes Center for Innovation in Global Health, Georgetown University, Washington, DC, USA Journal Article 2024 04 20 Background Blantyre city is among the jurisdictions in Malawi with the highest rates of people living with HIV and new HIV infections, driven by numerous structural factors. The Malawi National AIDS Commission hypothesized that local elected officials may be uniquely positioned to understand and address structural drivers of HIV infection in their communities. However, these leaders have been disengaged in HIV prevention efforts over time. This formative study aimed to explore city councillors’ understanding of the HIV landscape in Blantyre, including structural drivers of HIV, and to identify opportunities for engaging elected city councillors to address these drivers. Methods Between November-December 2021, we conducted a descriptive qualitative study in Blantyre city, involving 59 purposively sampled participants: 23 city councillors, 14 technical experts, 7 implementing partners, and 15 community leaders. Data were collected through in-depth interviews and analysed thematically using MAXQDA software. Results HIV technical experts and implementing partners were generally knowledgeable about the current HIV epidemic in Blantyre while most councillors and community leaders were not. Nearly all participants referenced structural drivers of HIV transmission in the city, including migration between districts, poverty, substance abuse, and transactional sex. Councillors noted their successes in mobilizing people and identifying resources for projects. However, they reported limited knowledge and training in HIV, no involvement in related programmes in their wards, and had minimal access to HIV data. They suggested access to trainings and data would equip them to better engage with HIV programs. Conclusion Elected leaders in Blantyre have limited access to HIV data and training. However, they demonstrate well-established relationships with ward residents and possess motivation and interest in enhancing their knowledge and capacity to address structural and other drivers of HIV infection—key factors for designing interventions for local leaders.

https://www.ijhpm.com/article_4742_18adfa77d820c84b67db7d6531bdae25.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Interest in Weight Loss Methods Among Adults and Its Predictors: Sociodemographic Factors, Anthropometric Parameters, and Physical Activity 1 12 4746 10.34172/ijhpm.8493 EN Adrian Lubowiecki-Vikuk Institute of Management, SGH Warsaw School of Economics, Warsaw, Poland Anna Bartkowiak Institute of Economic Sciences, University of Wroclaw, Wrocław, Poland 0000-0002-2778-6512 Elżbieta Biernat Institute of International Economic Policy, SGH Warsaw School of Economics, Warsaw, Poland 0000-0002-4675-5017 Adam Kantanista Department of Physical Education and Lifelong Sports, Poznan University of Physical Education, Poznań, Poland Journal Article 2024 03 12 Background The study aims to determine adults’ interest in weight loss methods and their predictors such as anthropometric parameters, physical activity, and sociodemographic factors. Methods A two-step procedure was adopted. First, anthropometric parameters of 1130 Polish adults were taken, and the body mass index (BMI), the waist-to-hip ratio (WHR), and the body fat (BF) percentage were calculated. Next, the participants completed a questionnaire consisting of questions about their interest in different weight loss methods, questions about physical activity, and metric questions. Interest in six arbitrarily selected weight loss methods was measured using a five-point Likert scale. For analysis ordinal logistic regression and omnibus likelihood ratio tests were used. Results The results proved different predictors of adults’ interest in weight loss methods (measured on an ordinal scale). More interest in physical activity and diets as methods of weight loss is observed in underweight individuals (compared to normal body weight status), older, with better economic situation, and higher level of physical activity individuals. In the case of bariatric surgery and liposuction, more interest in this weight loss methods are observed in overweight (compared to normal body weight status), economically well-off participants, and in women (compared to men). More interest of liposuction as a weight loss method is observed in overweight. Interest in dietary supplements to support weight loss (DSSWL) is more in women (compared to men), higher WHR, better economic situation, higher level of education and older individuals. More interest in weight loss drugs is observed in women (compared to men) and economically well-off people. Conclusion The key predictors of interest in weight loss methods are body weight status, gender, and economic situation. These vary in importance depending on the type of weight loss method. Healthcare providers should recommend various weight-management strategies, having regard for the level of interest in weight loss methods and their predictors.

https://www.ijhpm.com/article_4746_d87b4a4f1cfbfb51b06271021fd85b4e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Barriers and Enablers of Value-Based Procurement in Dutch Healthcare Providers 1 14 4732 10.34172/ijhpm.8514 EN Barbara Tip Coppa Consultancy, Arnhem, The Netherlands 0000-0002-0092-7573 Niels Uenk Public Procurement Research Centre, Lunteren, The Netherlands Fredo Schotanus Faculty of Law, Economics and Governance, School of Economics, Utrecht University, Utrecht, The Netherlands Journal Article 2024 03 29 Background Value-based procurement (VBP) is gaining traction in healthcare. This approach to procurement prioritizes obtaining the best health outcomes for patients while considering overall healthcare costs. Despite its recognized potential, VBP remains underutilized in hospitals. Little is known about the barriers and enablers of VBP in hospitals. This study aims to identify barriers and enablers specific to VBP in hospital procurement, utilizing the Theoretical Domains Framework (TDF). Methods This qualitative study comprises semi-structured interviews with 20 Dutch purchasers working at hospitals. The interviews aim to capture diverse perspectives on VBP, with the data undergoing an extensive coding and analysis process. Using redefined domains of the TDF, themes for barriers and enablers are identified. Results We explored the significance of broader barriers and enablers while also pinpointing new and distinctive ones specific to VBP in a hospital context. The newly identified barriers encompass challenges in procurement skills, low strategic priority, environmental context and resources, stakeholder influences, and outcome expectations. Noteworthy barriers include a cost saving focus, resistance to change, influence of the health insurer, and supplier preferences by end-users. Enablers involve stakeholder commitment, positive buyer-supplier relationships, effective storytelling, and demonstrated effectiveness of VBP. Stakeholder influence emerges as an important enabler, emphasizing the importance of the early involvement of medical specialists and other key stakeholders, overcoming resistance and fostering collaboration during VBP adoption in hospitals. Conclusion VBP in healthcare prioritizes optimal patient outcomes and value over costs. Although this is a promising concept, we identified several barriers and enablers for implementing VBP. While facing barriers related to procurement skills and environmental context, successful implementation relies on, among other things, training and stakeholder involvement, including early involvement of key stakeholders such as medical specialists and healthcare insurers, ambassadorship, trust-building, and effective storytelling.

https://www.ijhpm.com/article_4732_b966a6dd1c65ed8cfef6cb229372f3b8.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Assessment of Financial Impact of Expanding the Scope of Drug Usage in South Korea 1 9 4752 10.34172/ijhpm.8812 EN Su-Yeon Yu College of Pharmacy, Kangwon National University, Chuncheon, Republic of Korea Dong-Sook Kim Department of Health Administration, College of Nursing and Health, Kongju National University, Kongju, Republic of Korea Hyungmin Kim Department of Drug Management, National Health Insurance Service, Wonju, Republic of Korea College of Pharmacy, Seoul National University, Seoul, Republic of Korea Junwoo Jo Department of Statistics, Kyungpook National University, Daegu, Republic of Korea Hyunduck Kim Department of Drug Management, National Health Insurance Service, Wonju, Republic of Korea Euna Han College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Republic of Korea Journal Article 2024 09 19 Background The increasing utilization of high-cost drugs with multiple indications poses significant financial challenges to healthcare systems worldwide. This study evaluates the financial impact of expanding drug indications in Korea, focusing on pharmaceutical expenditure trend. Methods This study analyzed claims data from the National Health Insurance Service (NHIS) to examine drug characteristics and annual expenditure. Interrupted time-series analysis assessed monthly expenditure changes following indication expansions. Results We analyzed 57 drugs that expanded their indications between 2012 and 2023. From 2012 to 2022, drug expenditures increased 15-fold (compound annual growth rate [CAGR] 30.8%), a significantly larger rise compared to the 1.9-fold rise (CAGR 6.5%) in total pharmaceutical expenditures covered by the NHIS. Notably, expenditures increased 35-fold for 35 drugs classified under anatomical therapeutic chemical (ATC) code L (antineoplastic and immunomodulating agents) and 375-fold for 26 drugs with risk-sharing agreements (RSAs). Interrupted time-series analysis (n = 27) demonstrated significant monthly expenditure increases before expansion (US$ 0.33 million per month, P = .000). There were significant increases in expenditure between the pre- and post-expansion period (US$ 4.99–5.64 million, P = .000). Moreover, post-expansion trends showed significant additional increases in expenditure: US$ 0.13 million per month (P = .003) at +24 months and US$ 0.07 million per month (P = .037) at +36 months. Conclusion Despite price reduction strategies for multi-indication drugs, expenditure accelerated increase in expenditure post-expansion of indication. This highlights the need for robust post-pricing management for listed drugs. In the long term, a total budget system could ensure predictable and sustainable financing by providing clear financial boundaries within the health insurance budget.

https://www.ijhpm.com/article_4752_f34de9a13d4ae63056676c576d86d210.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 “Pundits Are Saying This Is ‘Anti-poor’”: Competing Framing Strategies for Child Road Safety Policy in the Philippines 1 11 4758 10.34172/ijhpm.8585 EN Sarah N. Champagne Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Adam D. Koon Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Department of Global Health, School of Health, Georgetown University, Washington, DC, USA Allan R. Ulitin Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila, Manila, Philippines 0000-0003-4190-501X Haidee A. Valverde Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila, Manila, Philippines Lamisa Ashraf Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Ma-Ann M. Zarsuelo Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila, Manila, Philippines Connie Hoe Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany Hilton Y. Lam Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila, Manila, Philippines Abdulgafoor M. Bachani Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Journal Article 2024 05 11 Background Child restraint systems (CRS) can lead to a 60% reduction in child deaths, yet few low- and middle-income countries (LMICs) have comprehensive policies to enforce best practice standards. In 2019, the Philippines established such a policy: the Child Safety in Motor Vehicles (CSMV) Act. Methods Drawing on framing theory, this study aims to understand the social dimensions of policy change to identify the Act’s origins, design, and implementation. Three sources of data – 25 articles, 27 key-informant interviews, and field notes – were collected and thematically analysed. Results We present the findings according to two features of the framing process: storytelling and naming. The policy process can be sharply distinguished into two sections: the Act’s passage into law (which was swift and successful) and its implementation (which to date has not been). The Act’s implementation was stymied by three overarching frames – that it is “anti-poor,” “unnecessary,” and a “strategic political distraction.” A media backlash at the time of implementation solidified these frames, leading President Duterte to indefinitely defer enforcement of the Act. Conclusion The CSMV Act emphasises that passing a law is insufficient. The trajectory of the act highlights the combined importance of (a) the framing of policy, (b) framing processes operate throughout a policy’s lifecycle, and (c) the media in creating a narrative. Our findings offer valuable insights for other LMICs implementing evidence-based road safety measures, suggesting that successful implementation requires not only strong legislation but also strategic communication and frame management throughout the policy process. Understanding framing dynamics can help policy-makers anticipate and address potential resistance to life-saving public health interventions.

https://www.ijhpm.com/article_4758_a6e589408bfe078117281f310e86f645.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Key Motivators and Framework for Integrated Care by Family Physician Team Members in Urban China 1 10 4768 10.34172/ijhpm.8781 EN Weizhuo Chen School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China Zihui Xiong School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China Huiyan Fang School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China Wenqi Xiao School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China Ting Ye School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, China Journal Article 2024 09 23 Background This study aimed to develop an analytical framework to investigate the key motivators influencing family physician team members (FPTMs) in delivering integrated care at the primary healthcare (PHC) level within urban China. The objective was to identify critical factors based on cause and effect relationships, with the ultimate aim of enhancing the integration of primary care and public health services. Methods A mixed-methods design was implemented, integrating thematic analysis and the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method. Data were gathered from semi-structured interviews with 24 participants, comprising FPTMs and administrators from Wuhan, Shenzhen, and Shanghai, collected between January and July 2022. The thematic analysis facilitated the construction of an initial framework of motivators, while the DEMATEL method was employed to examine and map the interdependent relationships among these motivators. Results The analysis distilled 64 first-order concepts into 15 second-order themes, which were then categorized into four broader dimensions: Government agencies, PHC institutions, family physician teams (FPTs), and residents. Motivators at the government level, such as resource allocation and the development of information technology (IT) infrastructure, were identified as proactive forces driving change. In contrast, resident-level factors, including trust and adherence, were more reactive, shaped by external conditions and responsive rather than initiators of change. Conclusion The findings emphasize the pivotal role of government leadership in fostering the adoption of integrated care. Key strategies include enhancing interdisciplinary team collaboration, optimizing performance evaluations, and refining incentive structures to boost FPTMs’ motivation. Equally important is the need to encourage residents to engage in proactive health management, promoting a collaborative care model that integrates both FPTMs and the communities they serve.

https://www.ijhpm.com/article_4768_1ab5de0a08eca01e1e8b008520370da3.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Development of the PICCOTEAM Reference Case for Economic Evaluation of Precision Medicine 1 15 4775 10.34172/ijhpm.8756 EN Wenjia Chen Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Dimple Butani Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand Yi Wang Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Janet Bouttell Centre for Healthcare Equipment and Technology Adoption, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK Yah Ru Juang Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Paul Scuffham Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, QLD, Australia Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia Janneke P.C. Grutters Science Department IQ Health, Radboud University Medical Center, Nijmegen, The Netherlands Alec Morton Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Department of Management Science, University of Strathclyde Business School, Glasgow, UK Duke-NUS Medical School, Singapore, Singapore Hwee-Lin Wee Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore Joanne Ngeow Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore Vorasuk Shotelersuk Excellence Center for Genomics and Precision Medicine, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Yue Zhang Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Laura Huey Mien Lim Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Yot Teerawattananon Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Bangkok, Thailand On Behalf Of The Working Group A full list of collaborators of the Working Group is provided in Supplementary file 1 Journal Article 2024 08 13 Background Current economic evaluations (EEs) of precision medicine (PM) often adhere to generic reference cases (RCs) which overlook the unique healthcare paradigms of PM. This study aimed to develop an RC to standardize the conduct and reporting of EEs of PM. Methods A working group comprising 5 core health economists, 22 PM experts, and research staff from Singapore, Thailand, the Netherlands, UK, and Australia who were actively engaged in EE and clinical PM implementation. The RC development comprised four stages: (1) Expert consultation shaping the RC’s scope and structure across nine domains: Population, Intervention, Comparator, Cost, Outcome, Time, Equity and ethics, Adaptability, and Modelling (ie, “PICCOTEAM” framework); (2) A comprehensive literature review on current PM EE approaches and challenges; (3) Obtaining expert consensus and drafting recommendations; (4) A workshop for RC refinement based on stakeholder feedback on relevance and feasibility. Following an experts’ workshop, consensus was reached to tailor PM recommendations for screening, diagnosis, and pharmacogenomics, market-access, and early EEs. Results The PICCOTEAM RC offers 46 recommendations for conventional EEs to guide PM reimbursement, emphasizing expert engagement, iterative study processes, disease-specific outcomes, decision uncertainty analyses, and equity considerations. Additionally, 30 recommendations are provided for early-stage evaluation to enhance PM’s positioning and value proposition, mitigating uncertainty, equity, and ethical issues. Conclusion The PICCOTEAM RC offers a standardized process to conduct and report diverse PM EEs. This will serve as guidance for health departments, researchers, clinicians, editors, and reviewers. Pilot testing and continuous updates are recommended for ongoing relevance and applicability of this RC.

https://www.ijhpm.com/article_4775_2225a34d35646686e25d987554bad0a7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Effects of Hospital Payment Reform of Government Budget Allocation and Social Health Insurance in a Pilot in China 1 8 4781 10.34172/ijhpm.8891 EN Ying Meng School of Public Health, Peking University, Beijing, China China Center for Health Development Studies, Peking University, Beijing, China Binglun Wu Shenzhen Health Development Research and Data Management Center, Shenzhen, China Liqun Wu Shenzhen Health Development Research and Data Management Center, Shenzhen, China Litian Jiang Shenzhen Health Development Research and Data Management Center, Shenzhen, China Weijia Lu School of Public Health, Peking University, Beijing, China China Center for Health Development Studies, Peking University, Beijing, China Huatang Zeng Shenzhen Health Development Research and Data Management Center, Shenzhen, China Vanke School of Public Health, Tsinghua University, Beijing, China Jin Xu China Center for Health Development Studies, Peking University, Beijing, China Journal Article 2024 11 06 Background Government budget allocation (GBA) and social health insurance (SHI) constitute the primary revenue sources for public hospitals in China, with GBA accounting for a substantially smaller proportion compared to SHI. Starting in 2015, a megacity in southern China gradually introduced payment reforms. GBA, previously based on government approved number of staff (input-based), was replaced with an output-based model. Subsequently, SHI payment method was changed from fee-for-service (FFS) to case-based payment. Methods The study adopted a staggered difference-in-differences (DiD) model to assess the effects of reforms on service volume and capacity, as well as hospital efficiency. We used hospital-level panel data of 29 hospitals in the city from 2009 to 2022. Results The GBA reform increased annual outpatient visits by 301 374 per hospital (P < .01) and promoted efficiency (score increase of 0.02, P < .05). In contrast, the SHI reform increased annual inpatient discharges by 2417 per hospital (P < .05) but had no significant effect on efficiency (-0.15, P > .1). Conclusion The output-based GBA reform increased outpatient service volume and the number of healthcare professionals, while the case-based SHI reform raised inpatient discharges. Only GBA was associated with a modest efficiency gain given the distinct incentives of GBA and SHI. Future research should explore strategies for better alignment of multiple funding streams, such as unified purchasing with blended payment models or clearer functional differentiation.

https://www.ijhpm.com/article_4781_26022a5ff7cfd7228fcb7e8cab26b37d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 The Impact of Devolution on Local Health System Financing: A Synthetic Difference-in-Differences Study of Greater Manchester, England 1 14 4786 10.34172/ijhpm.8689 EN Charlie Moss Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK Philip Britteon Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK Yiu-Shing Lau Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK Laura Anselmi Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK Journal Article 2024 07 09 Background Determining the effects of devolution policies through health system financing is pivotal in understanding their impact. Few existing studies have considered total health and care system expenditure, overlooking the transfer of resources through spending in different services locally. We evaluated the impact of devolution in Greater Manchester (GM), an area in England which received devolved health and social care powers from 2016, on the whole system of local public expenditures on health and care. Methods Using data on public health and care spending for 149 local health systems between 2013 and 2020, we estimated synthetic difference-in-differences (DiD). We compared expenditure in total and by services for ten GM localities relative to a weighted combination of localities from the rest of England (excluding London) for four years post-devolution. We analysed expenditures in per capita terms and as a share of total expenditure. We investigated dynamic effects with an event study specification. Results Compared with the synthetic control (SC) group, total annual expenditure on health and care increased in GM post-devolution by an average of £66.58 per-capita (95% CI: 11.85 to 121.30). Total expenditure on public health and social care, managed by Local Authorities, increased by £36.39 (95% CI: 6.99 to 65.80) and expenditure on social care specifically increased in the third and fourth years after devolution. We detected some short-term changes in expenditure managed by the National Health Service (NHS) Clinical Commissioning Groups (CCGs), including reduced expenditure on Continuing Healthcare and increased expenditure on acute healthcare and “other” miscellaneous expenditure. We did not detect a statistically significant effect for public health, primary care, community or mental healthcare. Conclusion Results suggest that additional resources were used to respond to existing pressures on the health system, and that to redirect expenditure substantial increase in resources or re-organisation of services may be required alongside devolution of sufficient powers.

https://www.ijhpm.com/article_4786_1b15876bc4c05cbf0172748e158b695c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Collaborative Development of an Instrument to Monitor Physical Activity Promotion Based on Policy-Makers’ Needs – the TARGET:PA Tool 1 9 4797 10.34172/ijhpm.8720 EN Peter Gelius Institute of Sport Sciences, Université de Lausanne, Lausanne, Switzerland Sven Messing Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Karim Abu-Omar Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Isabel Marzi Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany 0000-0002-0685-4985 Franziska Beck Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany 0000-0002-6360-8828 Wolfgang Geidl Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Eva Grüne Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Antonina Tcymbal Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Anne Kerstin Reimers Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Klaus Pfeifer Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Journal Article 2024 07 24 Background To support policy development, a number of tools are available to inform policy-makers about the current status of physical activity (PA) promotion in a specific country. However, a recent exchange between policy-makers and researchers in Germany revealed two major gaps: First, examples of successful good practice projects are often not selected in an objective and systematic process. Second, there is usually no systematic assessment of “routine practice,” ie, PA promotion activities already taking place on large scale and regular basis. These issues are addressed by the newly developed TARGET:PA tool. Methods The TARGET:PA tool was developed in a co-production process involving researchers from the World Health Organization Collaborating Centre for Physical Activity and Public Health (WHO CC) at FAU Erlangen-Nürnberg and the policy unit in charge of cardiovascular diseases, diabetes and non-communicable diseases at the German Ministry of Health. We documented the development process, details on the structure of the tool itself, and the outputs produced using the tool. Results The development process involved a negotiation process between researchers and policy-makers and the need to adapt to extended decision-making timelines within the ministry. With regard to PA behavior at the individual level, the TARGET:PA tool includes an overview about (1) PA recommendations and (2) national PA prevalence rates. At the organizational/policy level, it contains information on (3) recommendations for PA promotion, (4) routine practice, (5) good practice projects, and (6) policies. Key outputs of the tool are policy briefs as well as scientific background documents. Conclusion The TARGET:PA tool provides added value as it can support the integration of “good” and “routine” practices into the monitoring of PA promotion. While the tool has been developed and tested in Germany, it has the potential to be adapted to other countries, either by directly utilizing the tool or by emulating the collaborative development process to design new instruments adapted to specific contexts.

https://www.ijhpm.com/article_4797_3fe17fcef3cb406f88f32d222f08ee64.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Cross-sectoral Food Systems Policy Action for Nutrition: Lessons From National, Regional, and Global Experience 1 9 4799 10.34172/ijhpm.9052 EN Anne Marie Thow Leeder Centre for Health Policy, Economics and Data, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia 0000-0002-6460-5864 Dori Patay Leeder Centre for Health Policy, Economics and Data, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia 0000-0001-5927-1006 Phillip Baker Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia Penny Farrell Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia Erica Reeve Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, Geelong, VIC, Australia Journal Article 2025 02 25 Background Improving nutrition is a global priority for food systems transformation. The introduction of policy measures across multiple sectors relevant to food systems is critical to this transformation. However, integrating measures to improve nutrition into food system policies across multiple government sectors has proved challenging. Methods A theory-informed qualitative policy analysis was conducted to identify enablers and barriers of “cross-sectoral” policy action for nutrition in government sectors related to the food system. The analysis drew on interview data (n = 43) with policy-makers at global, regional, and national level, in diverse policy sectors, who had experience of engaging successfully across food system policy sectors to improve nutrition. Results Success in cross-sectoral policy related to the achievement of nutrition objectives in a way that also enabled achievement of other sectoral objectives, and involved strategic and constructive policy engagement across sectors. Challenges included the need to overcome diverse sectoral mandates and norms, siloed structures of governance, and fluctuations in political interest to engage effectively across sectors for policy change. Key enablers of cross-sectoral policy for nutrition included: supportive institutional structures, such as platforms for engagement, mandates and incentives; ideas that facilitated constructive engagement between policy sectors, including a shared vision, a long-term approach and effective framing; discursive approaches to engagement that balanced multiple interests across policy sectors; and ongoing learning. Conclusion This analysis provides new insights to strengthen policy engagement and design more effective capacity building for nutrition policy-makers. This includes “soft skills” that enable effective engagement across sectors and strategic approaches to managing diverse interests influencing policy.

https://www.ijhpm.com/article_4799_0de5fb4255ad823341c40b9f48b0e288.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Comprehensive Evaluation of Quality Indicators: Analyzing the Dutch Breast Cancer Audit 1 12 4800 10.34172/ijhpm.8943 EN Elfi M. Verheul Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands Dutch Institute for Clinical Auditing, Leiden, The Netherlands Margrietha Van Der Linde Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands Hester F. Lingsma Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands Elvira Vos Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA Sabine Siesling Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands Linetta B. Koppert Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands 0000-0003-1944-6777 NBCA Consortium# # A full list of the collaborators of the NBCA Consortium is provided at the end of the article Journal Article 2024 10 21 Background Quality indicators (QIs) are widely used to benchmark hospital performance and improve quality of care but are often based on expert opinion rather than data-driven assessment. This study aims to evaluate QIs, using a framework that assesses four criteria: Feasibility, discriminative ability, validity, and reliability. Methods We used data from the Dutch breast cancer registry (NABON Breast Cancer Audit, NBCA) and included all surgically treated breast cancer patients in the Netherlands between 2021-2023. Eighteen QIs were evaluated. Feasibility was determined by QI numerator completeness, with >90% data availability considered feasible. Discriminative ability was assessed by between-hospital variation in QI scores, where an interquartile range (IQR) >10% indicated good discrimination. Validity was evaluated by the impact of case-mix adjustment and considered low when (pseudo-) R² <0.10. The (pseudo-)R² reflects the proportion of variance in QI scores explained by all case-mix variables in a regression model. Reliability was assessed by rankability, the proportion of between-hospital variation not due to chance and, therefore, explainable by quality of care. Rankability >75% was considered high. Results After exclusion of one QI with feasibility <1%, feasibility ranged from 80.2%-100%, and 15 QIs were feasible. Overall, the IQR ranged from 1 to 36, with 8 QIs having an IQR higher than 10, indicating good discriminative ability. The (pseudo-)R² ranged from 0.01-0.53, with 11 QIs showing low case-mix impact. Rankability ranged from 0-69%, with none of the QIs having a high rankability. None of the QIs met all preset criteria, but six QIs met at least three out of four criteria. Conclusion The QIs employed by the Dutch breast cancer registry fulfilled most criteria, but rankability is a concern and requires specific attention, especially for public reporting. Our results show the importance of considering feasibility, discriminative ability, validity, and reliability when evaluating QIs, and these should also be taken into account when developing new QIs.

https://www.ijhpm.com/article_4800_31a82bd18b8f9305acb4ab756415bbc0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Assessing the Economic Benefit of Mass COVID-19 Vaccination Program in Iran: A Real-World Modeling Study 1 14 4789 10.34172/ijhpm.8852 EN Hamidreza Jamaati Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran Saeed Karimi Department of Ophthalmology, Torfeh Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Yunes Panahi Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran Shahnam Arshi Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran Maryam Hajimoradi Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Fatemeh Sadat Hosseini-Baharanchi Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran Fariba Ghorbani Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyed Mohsen Zahraei Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran Fatemeh Nouri Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Ali Akbari Sari Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Mahshad Goharimehr Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Abdolreza Mohamadnia Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran Payam Tabarsi Clinical Tuberculosis and Epidemiology Research Center, National Research Institute for Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Farzaneh Dastan Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran Babak Sharif-Kashani Department of Cardiology, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Majid Marjani Clinical Tuberculosis and Epidemiology Research Center, National Research Institute for Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Farin Rashid Farokhi Chronic Kidney Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-6816-8753 Seyed Mohammad Reza Hashemian Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran Mostafa Noorizadeh Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Bulent Ecevit University, Zonguldak, Turkey Department of Biotechnology, Islamic Azad University of Medical Science, Tehran, Iran Mojtaba Nouhi Health Economic Department, School of Medicine, Shahed University, Tehran, Iran Katayoun Tayeri Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran 0000-0001-7153-1691 Sima Noorali Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Farnaz Ahmadi Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Makan Sadr Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Azadeh Moradkhani Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Science, Tehran, Iran Mahdi Ahmadinia Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Bahamin Astani Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Rajabali Daroudi Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Shadi Shafaghi Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Journal Article 2024 10 15 Background The global challenges posed by COVID-19 vaccinations require careful consideration by decision-makers at both the global and national levels, particularly in developing countries. This study aimed to evaluate the health and economic implications of implementing vaccination programs. Methods Two scenarios, one involving vaccination and the other without, were analyzed using the Markov susceptible-infectious-recovered (SIR) model. For the vaccination scenario, real-world data, such as age-specific vaccination coverage, hospitalization rates, and mortality, were obtained from the Medical Care Monitoring Center (MCMC) and national COVID-19 registry during the Omicron wave in Iran. For the counterfactual non-vaccination scenario, we relied on model-based assumptions using published literature and expert input to estimate infection rates and clinical outcomes in the absence of vaccination. The incremental cost-effectiveness ratio (ICER) of the COVID-19 vaccination program was calculated by comparing the incremental cost per unit of quality-adjusted life year (QALY) generated to a willingness-to-pay (WTP) threshold equivalent to 1 time the gross domestic product (GDP) per capita, approximately US$4091. One-way sensitivity analysis was conducted to ensure the reliability of the results. Results Overall, 2 098 495 extra QALYs were generated by vaccination, incurring a total extra cost of $853.78 million. The vaccination program resulted in an average of 0.035 incremental QALYs at an additional cost of $14.08 per person. The average ICER for adult vaccination was $406.85 per QALY, indicating that it is a highly cost-effective strategy compared to non-vaccination across all age groups. Vaccinating elderly individuals proved to be the most cost-effective approach among all age categories. Conclusion The integrated Markov-SIR model used in this study provides valuable insights into both the health and economic impact of the COVID-19 vaccination program in Iran. These findings support the implementation of vaccination strategies and provide a framework for decision-makers to consider when formulating policies.

https://www.ijhpm.com/article_4789_9e110cd45d11745d58c5b3ac32f5cce4.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Mixed Methods Evaluation of the Impact of Allied Health – Translating Research into Practice (AH-TRIP) Program on the Knowledge Translation Capacity of the Allied Health Workforce 1 11 4805 10.34172/ijhpm.8910 EN Adrienne M. Young Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia Dietetics and Food Services, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia 0000-0002-4498-4342 Alita Rushton Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia 0000-0003-4133-0754 Ashley Cameron Office of the Chief Allied Health Officer, Queensland Health, Brisbane, QLD, Australia Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, QLD, Australia Nina Meloncelli Office of the Chief Allied Health Practitioner, Metro North Allied Health, Brisbane, QLD, Australia Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, QLD, Australia Shelley A. Wilkinson Department of Obstetric Medicine, Mater Mothers’ Hospitals, Brisbane, QLD, Australia School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia Rachelle Pitt Office of the Chief Allied Health Officer, Queensland Health, Brisbane, QLD, Australia Kathryn McFarlane Allied Health, Cairns and Hinterland Hospital and Health Service, Cairns, QLD, Australia Katrina L. Campbell Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, QLD, Australia 0000-0002-4479-1284 Gillian Harvey Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia Ingrid J. Hickman ULTRA Team, Clinical Trial Capability, Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia Journal Article 2024 11 18 Background Knowledge translation (KT) in healthcare is a complex process. Building the KT capacity of the workforce is fundamental to closing the gaps between research and evidence-based practice. This evaluation aimed to describe the impact of a KT capacity building program (Allied Health Translating Research into Practice, AH-TRIP) on allied health professionals and health services and systems, with the secondary aim of identifying barriers and enablers to program impact. Methods Multi methods evaluation using online surveys and semi-structured interviews with 20 program participants and their managers. The interview guide was underpinned by the Framework to Assess the Impact from Translational health research (FAIT). Deductive content analysis was used to categorise impact against FAIT, with barriers and enablers mapped to an implementation framework. Results Six domains of impact were identified: Individual Capacity Building, Workforce Capacity Building, Enhanced Networks, Clinical Practice Change, Patient/Community Benefits, and Economic Benefits. Enablers of impact were program design (flexibility, access to mentors, funding opportunities), local contexts supporting research (manager support, access to local experts), and previous exposure to KT. Consistent barriers included a lack of clinician time and confidence in KT, staff turnover (particularly in regional/rural areas), lack of organisational research culture, and shortterm funding cycles. Conclusion Using FAIT methodology, we have demonstrated significant impact achieved by a KT capacity building program for individual health professionals and the broader allied health workforce and health services and systems. Impact could be further optimised by strategies targeted at managers to create supportive contexts for KT through improving research literacy in health decision and policy contexts and innovative workforce planning.

https://www.ijhpm.com/article_4805_53d74c02ba7b8fd0c30b8e7c3898b351.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Pouring Rights Contracts Between Soda Companies and Public Universities: An Institutional Barrier to SugarSweetened Beverage Reduction 1 12 4806 10.34172/ijhpm.8879 EN Luc L. Hagenaars Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California San Francisco, San Francisco, CA, USA Jennifer Falbe Department of Human Ecology, University of California Davis, Davis, CA, USA Gwyneth M. Manser Geography Graduate Group, University of California Davis, Davis, CA, USA Laura A. Schmidt Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California San Francisco, San Francisco, CA, USA Journal Article 2024 10 31 Background Sugar-sweetened beverages (SSBs) contribute to obesity, cardiometabolic diseases, and plastic pollution. International health agencies have called upon public-sector organizations to use responsible procurement policies to reduce SSB consumption. Many US public universities cannot do so because of “pouring rights contracts” (PRCs) with Coca-Cola or PepsiCo that grant companies monopoly rights to sell their beverages on campus. Methods We investigated why universities participate in PRCs using participant observation of a consortium conducting beverage research on all 10 University of California (UC) campuses. We also conducted two rounds of interviews with public university staff in California whose work involved PRCs (n = 26 and n = 25). Results PRCs were polarizing. University managers in health and sustainability generally opposed them, dining managers held mixed opinions, and managers in athletics, procurement, contracts, and business partnerships were generally supportive, valuing the discretionary funding streams PRCs provide. These supportive managers tended to form small, but influential coalitions who internally supported the continuation of PRCs, benefiting from reduced transaction costs for their departments because PRCs streamlined contracting and procurement. These supportive managers often had a market orientation that valued economic freedom, contradicting opinions held by opponents of PRCs who stressed that PRCs create a monopoly. Supportive managers also assumed that consumers, not soda companies, are responsible for SSB-related harms, despite acknowledging that PRCs “hook” students on soda. Conclusion PRCs are an institutionalized barrier to responsible beverage procurement by concentrating interests favorable to PRCs within the university, even when PRCs contradict the broader, but diffuse, interests of the wider campus community. This suggests that health-harming industries only need to target small, strategically positioned groups of stakeholders within public-sector organizations to achieve corporate capture of public procurement. More responsible procurement policies require public-sector organizations to bolster the financial transparency of contracting managers, request for proposals (RFP) processes, and procurement contracts.

https://www.ijhpm.com/article_4806_503fd616be3553f16295257d4f7bf286.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Licensing Issues at Primary Clinics Resulting From the Omnibus Law in Indonesia: A Case Study From Surabaya City 1 9 4808 10.34172/ijhpm.9006 EN Lilik Djuari Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Community Medicine Coordination Bureau, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Samsriyaningsih Handayani Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Sulistiawati Sulistiawati Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Community Medicine Coordination Bureau, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Shafira Meidyana Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Community Medicine Coordination Bureau, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Raudia Faridah Humaidy Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Community Medicine Coordination Bureau, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Arya Ivan Mahendra Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Ahmad Cholifa Fahruddin Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia Brahmaputra Marjadi Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia School of Medicine, Western Sydney University, Campbelltown, NSW, Australia 0000-0003-0898-3737 Journal Article 2025 01 24 Background Anecdotal evidence has indicated that Indonesian primary care clinics struggle to meet new licensing requirements under the new Omnibus Law in 2020. This study aimed to analyse the challenges associated with clinic licensing under this Law and identify potential practical solutions. Methods This was a sequential exploratory mixed-method case study in Surabaya, the second-largest city in Indonesia. Participants were recruited using convenience sampling from a District Health Office WhatsApp group of 38% of primary clinics in Surabaya (85/223). We used a quantitative survey to assess primary clinics’ compliance with the new requirements. Subsequently, survey participants and key stakeholders were invited to two-phase focus group discussions (FGDs) where survey findings were reported and discussed. Quantitative data were analysed descriptively, and qualitative data were thematically analysed; both were synthesised at the final data analysis. Results The survey response rate was 35% (30/85 clinics in the WhatsApp group). Compliance with the new regulation varied, with 17% of the clinics still awaiting license approval and 27% needing to obtain waste management permits. Eighteen survey participants and six key stakeholders participated in the FGDs. Five key challenges in primary clinic licensing were identified: regulation shifting, knowledge and perception, weakness in system design, time, and cost. Conclusion The more complex licensing requirements have caused delays in license issuance for a convenience sample of primary clinics in this study. Ineffective communication and a lack of understanding between clinics, local government agencies, and external consultants have exacerbated these issues, leading to a heavy burden on clinic resources. To mitigate these challenges, policy-makers should prioritize simplifying sequential requirements, enhancing interagency coordination, and establishing clear communication channels—ensuring regulatory changes align with on-the-ground capacity and needs. By addressing these gaps, the licensing process can become more efficient and transparent, ultimately supporting clinic sustainability and healthcare access.

https://www.ijhpm.com/article_4808_89da93894567ece726d835541e56d6cc.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Developing Integrated Extended Pharmacist Roles and Services for Equitable Access and Outcomes in Primary Healthcare: A Realist Evaluation 1 16 4811 10.34172/ijhpm.9127 EN Tara N. Officer School of Nursing, Midwifery, and Health Practice, Victoria University of Wellington, Wellington, New Zealand 0000-0002-2322-2525 Janet McDonald Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand Kirsten Smiler Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand Lynne Russell Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand 0000-0002-5360-5391 Jonathan Kennedy Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand Eileen McKinlay Centre for Interprofessional Education, Division of Health Sciences, University of Otago, Dunedin, New Zealand Marianna Churchward Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand 0000-0003-3203-7855 Ausaga Fa’asalele Tanuvasa Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand 0000-0001-6487-6982 Jacqueline Cumming Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand Mereana Pere Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand Mona Jeffreys Health Services Research Centre, Victoria University of Wellington, Wellington, New Zealand Caroline Morris Department of Primary Health Care & General Practice, University of Otago, Wellington, New Zealand Journal Article 2025 04 01 Background Pharmacists’ roles have been moving from dispensing towards more patient-focused extended clinical care, signalling changes in health service policy and delivery. This paper evaluates the development of practice pharmacists’ roles and services in primary healthcare (PHC) settings in New Zealand (Aotearoa), how services were implemented, and how pharmacists, patients, and other PHC professionals responded to role and service developments. Methods We applied a realist evaluation methodology, identifying context (C) into which initiatives are introduced, mechanism (M) triggered or attenuated by the context, and resulting outcome (O). CMO configurations were developed, tested and refined through rapid realist review, key informant interviews, six case studies, and a national survey. Although not every project stage is fully documented in this paper, each contributed to the final theories. The desired outcome was defined as: Practice pharmacists are integrated within PHC teams, and their services are accepted and utilised by patients. Practice pharmacist services are equitably accessible throughout Aotearoa and contribute to equitable health outcomes. Results Four programme theories, based on 22 CMO configurations, showed how contexts and mechanisms at national, service, role, and patient levels could enable or attenuate reaching the desired outcome; for example, through a burning platform for change, supportive colleagues and infrastructure, well-fitting roles, and patient awareness, or conversely through, disjointed leadership, limited understanding and role uncertainty, and lack of access to practice pharmacists. Funding, regardless of source, operated across all levels as context and mechanism. Conclusion Practice pharmacist services operate within multiple contexts and levels; their development and implementation requires a systems view. Opportunities exist to achieve the desired outcome by strengthening enabling contexts or reducing barriers within attenuating contexts. Policy-makers now need to focus on equitable service distribution, sustainable ways to fund and employ practice pharmacists, and the equity impact of patient copayments.

https://www.ijhpm.com/article_4811_87d4bfc878dc656a1560488f0bef10cf.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Longitudinal Trends in Medicine Supply, Price and Utilisation in Primary Care Facilities in Rural Southwestern China Under National Essential Medicines Policy (2012-2017): Disparities Across Facilities and Medicines 1 14 4812 10.34172/ijhpm.8991 EN Zhaohua Huo Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China Xuechen Xiong School of Public Health, The University of Hong Kong, Hong Kong SAR, China Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China Ge Bai School of Public Health, Fudan University, Shanghai, China Jianchao Quan School of Public Health, The University of Hong Kong, Hong Kong SAR, China Allen TC Lee Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China Linda CW Lam Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China 0000-0002-7252-970X Li Luo School of Public Health, Fudan University, Shanghai, China Journal Article 2025 01 13 Background The long-term impacts of the National Essential Medicines Policy (NEMP) in remote and rural areas of China remain underexplored. This study investigates the longitudinal trends in medicine supply, affordability, and utilisation in a rural county in Southwestern China from 2012 to 2017. Methods A quasi-experimental design was employed to analyse 108 111 purchase records covering 650 medicines from seven township health centres (THCs) and 73 village clinics. Drug supply was assessed by the available number of medicine types, utilisation by sales volume, and affordability using a Drug Price Index (DPI) based on a fixed basket of 344 medicines. Interrupted time-series analysis was then conducted to evaluate trends during the first-stage NEMP and to identify changes following the implementation of second stage in November 2015. Results Medicine number in rural primary care facilities increased steadily (+5.1 quarterly) during the first stage of NEMP, but exhibited abrupt and sustained drops (-2.1 quarterly) following the second-stage NEMP. DPIs exhibited gradual increases throughout both policy stages (+0.2% quarterly), while overall drug sales remained stable. Disaggregated by medicines, traditional Chinese medicines (TCMs) exhibited a faster increase in the available number than Western (chemical or biological) medicines and were associated with slower growth in DPI. By facility levels, village clinics experienced continuous declines in the number of Western medicines, accompanied by sharp increases in DPI. THCs also revealed a rising DPI in Western medicines, which consistently dominated overall drug sales. Conclusions Primary care facilities in rural Southwestern China experienced relatively stable medicine supply and utilisation, alongside rising medicine prices, over the long-term implementation of NEMP. Significant disparities and structural changes across facility tiers and medicine categories underscore the urgent need to address the pressing challenges of the declining availability and increasing costs of Western medicines in rural village clinics.

https://www.ijhpm.com/article_4812_55a1e8740e7d4fb3d5faf2576f0fdc58.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Association Between the Type of Dental Care Setting and the Risk of Dental Implant Failure in Korea: A Retrospective Nationwide Population-Based Cohort Study 1 9 4827 10.34172/ijhpm.9238 EN Yu-Rin Kim Department of Dental Hygiene, Silla University, Busan, Republic of Korea Seon-Rye Kim Institute of Health Medical Education Convergence Research, Kangwon National University, Gangwon-do, Republic of Korea Minkook Son Department of Physiology, Dong-A University College of Medicine, Busan, Republic of Korea Department of Data Sciences Convergence, Dong-A University Interdisciplinary Program, Busan, Republic of Korea Journal Article 2025 05 26 Background In Korea, the introduction of reimbursable dental implant procedures has intensified competition among dental practices, albeit with an increase in consumer complaints related to implant failures. Our study aimed to evaluate the association between the dental implant failure risk and the dental care setting. Methods This retrospective cohort study used data from the Health Screening Cohort (HEALS) of the Korean National Health Insurance Service (NHIS) to analyze the risk of dental implant failure from January 1, 2016, to December 31, 2019. The risk of dental implant failure according to the dental care setting was assessed using inverse probability of treatment weighting (IPTW) adjusted Cox regression analysis. The covariates included demographic, socioeconomic, and clinical factors. The hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated. Among 44 220 cases, additional analyses were performed by stratifying implant procedures in private dental practice (n = 40 502) into quartiles to assess the risk of failure according to procedural volume. Results Hospital-based dental clinics exhibited a lower implant failure risk compared with private dental practices (HR: 0.35, 95% CIs: 0.30–0.41) and group dental practices (HR: 0.34, 95% CIs: 0.20–0.58). Private dental practices with the top 10% and 5% procedural volume showed a higher failure risk (HR: 1.23, 95% CIs: 1.09–1.38; HR: 1.38, 95% CIs: 1.23–1.54, respectively) relative to practices handling the remaining 90% and 95%. Conclusion The risk of dental implant failure was lower in hospital-based dental clinics compared with private and group dental practices, indicating the need for more systematic and thorough postoperative care to improve implant safety in settings associated with higher failure risk.

https://www.ijhpm.com/article_4827_40c831ed01765c19e33d5f0c00e6e86c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Co-creating Inclusive and Non-ableist Public Health Policies With Persons With Disabilities; Comment on “How Did Governments Address the Needs of People With Disabilities During the COVID-19 Pandemic? An Analysis of 14 Countries’ Policies Based on the UN Convention on the Rights of Persons With Disabilities” 1 4 4692 10.34172/ijhpm.8694 EN Janet Njelesani Department of Occupational Therapy, New York University, New York City, NY, USA Journal Article 2024 07 11 In their study, Shikako et al analyzed how national policies during the COVID-19 pandemic either supported or neglected the rights of persons with disabilities, aiming to inform the development of inclusive policies that align with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). They concluded that the differences in policies across countries during the COVID-19 pandemic indicate a need for greater alignment and standardization of policy responses for individuals with disabilities. While the study revealed disparities across countries and underscored the importance of disability-inclusive policy, this commentary provides actionable insights to guide governments in creating equitable policies that uphold the rights of persons with disabilities during crises and beyond. Specific recommendations in accordance with the UNCRPD include the establishment of permanent consultative committees, adopting a shared understanding of disability, addressing intersectionality and structural barriers, and utilizing non-ableist participation methods so that a diverse range of perspectives are incorporated and lived experiences shape the policies that impact them.

https://www.ijhpm.com/article_4692_be1d7fea7307c747b03476425a4e6a09.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Palestine Is Freeing Us All Before Palestine Is Free; Comment on “The Rhetoric of Decolonizing Global Health Fails to Address the Reality of Settler Colonialism: Gaza as a Case in Point” 1 3 4691 10.34172/ijhpm.8677 EN Yipeng Ge Independent Researcher, Ottawa, ON, Canada Journal Article 2024 06 30 This commentary piece on the editorial piece by Eivind Engebretsen and Mona Baker entitled “The Rhetoric of Decolonizing Global Health Fails to Address the Reality of Settler Colonialism: Gaza as a Case in Point” explores the interconnected contexts of settler colonialism affecting health in occupied Turtle Island (also known as Canada) to Palestine. Addressing true and authentic health equity work means sharpening our politics and rhetoric beyond decolonizing “global health” as epistemically colonial and towards meaningful solidarity work and framings of liberatory or revolutionary health. There is a moral obligation to contextualize and historicize, rather than depoliticize. This ultimately means supporting through unwavering solidarity for collective liberation through the Indigenous resistance and resurgence movements in Turtle Island to Palestine if we are serious about decolonizing global health. Moving towards rhetoric and actions for collective liberation must be the focused goal of all who care deeply about true and authentic health equity work towards just and life-affirming systems for health for all.

https://www.ijhpm.com/article_4691_19b1d572afa0c21b037da06425874f3b.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 The Equity Imperative: Transforming Research Coproduction for Impact; Comment on “Research Coproduction: An Underused Pathway to Impact” 1 4 4693 10.34172/ijhpm.8875 EN Kathleen P. Conte OHSU-PSU School of Public Health, Portland State University, Portland, OR, USA Homelessness Research and Action Collaborative, Portland State University, Portland, OR, USA Marisa Zapata Homelessness Research and Action Collaborative, Portland State University, Portland, OR, USA Toulan School of Urban Studies and Planning, Portland State University, Portland, OR, USA Journal Article 2024 10 29 Coproduction is not a new idea in implementation research, health research, or research in general. There is substantial scholarship that establishes its importance and provides guidance and examples for adoption. Given this, why do editorials like Rycroft-Malone and colleagues’ recent paper, “Research Coproduction: An Underused Pathway to Impact,” continue to be published, and also, necessary? In this commentary, we discuss the importance of equity—not equality—as the underlying paradigm of coproduction research. We argue that it is the incomplete understanding and adoption of this equity paradigm by researchers and their institutions that inhibit coproduction from being fully realized and thus, impactful. We offer examples of what such a paradigm shift might look like, including futures thinking that yields difficult questions that must be addressed to dismantle systemic barriers to power redistribution.

https://www.ijhpm.com/article_4693_ccac716a7980d5ef541ab4063063db31.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Navigating Towards a Well-Being Economy: Need for a Robust Theory of Change; Comment on “Can a Well-Being Economy Save Us?” 1 3 4694 10.34172/ijhpm.8873 EN David G. Legge School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia Journal Article 2024 10 28 In his recent editorial, Professor Labonté1 surveyed international initiatives calling for a well-being global economy. Most of these initiatives offer glowing visions but implausible theories of change. The 1974 United Nations call for a New International Economic Order (NIEO) provides a case study of an earlier instance of well-being economics (although not labelled as such). The NIEO included specific institutional and regulatory initiatives directed to achieving a fairer and more liveable world. However, it was defeated through the rise of neoliberalism from the 1980s as well as internal contradictions within the movement for a NIEO. The history of the NIEO provides useful lessons regarding the political dynamics of global transformation. Any policy initiatives, directed towards reforming the global economy for the well-being of people and planet, need to be based on a robust theory of change.

https://www.ijhpm.com/article_4694_77bfe09cf944aaf2a18ed528f7636851.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 The Conditions for a Path Beyond Capitalism; Comment on “Can a Well-Being Economy Save Us?” 1 3 4696 10.34172/ijhpm.8912 EN Lina Brand-Correa Faculty of Environmental and Urban Change, York University, Toronto, ON, Canada Journal Article 2024 11 19 In this commentary I aim to contribute to Ronald Labonté’s recent editorial “Can a Well-Being Economy Save Us?” on the role of well-being economies in providing for everyone’s needs within the limits of our planet. In particular, I add a couple of lessons from the COVID-19 pandemic that can provide the required inspiration to plot a path beyond capitalism – one that is based on hope that change is possible, one where our understanding of well-being is detached from economic growth, one where demand and excess are challenged and one where we go beyond the market to meet our needs.

https://www.ijhpm.com/article_4696_d040f468ab017958487beae0ad0e7f0e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 The Rights of People With Disabilities in Policy Development; Comment on “How Did Governments Address the Needs of People With Disabilities During the COVID-19 Pandemic? An Analysis of 14 Countries’ Policies Based on the UN Convention on the Rights of Persons With Disabilities” 1 3 4705 10.34172/ijhpm.8736 EN Olaf Kraus De Camargo Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada Journal Article 2024 07 30 Shikako et al analysis highlights that needs of persons with disability (PwD) were often overlooked, with policies primarily focused on general population health measures rather than specific accommodations for PwD. This commentary suggests adopting universal design principles in policy development to ensure inclusivity and advocate for maintaining services essential for PwD even during crises. It emphasizes the importance of involving PwD in policy-making processes and enhancing data collection for better policy analysis and concludes with recommendations for creating more inclusive policies, stressing the need for international collaboration and the integration of PwD needs into all policy levels.

https://www.ijhpm.com/article_4705_071398c6ffceffb022d1c51ed6bc7f94.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Reflections on Co-Production as a Mode of Knowledge Production; Comment on “Research Coproduction: An Underused Pathway to Impact” 1 3 4700 10.34172/ijhpm.8909 EN Carole A. Estabrooks Faculty of Nursing, University of Alberta, Edmonton, AB, Canada Journal Article 2024 11 18 Rycroft-Malone et al.’s editorial on research co-production highlights the potential of a coproduction mode of research to narrow the gap between knowledge production and use. This commentary critiques implicit assumptions within the argument and challenges the view that traditional (Mode 1) science bears the primary responsibility for delayed implementation and questions the inherent superiority of co-production. It also highlights the importance of political and policy considerations in considering research uptake. ‘Mode 3’ knowledge production (integrating Modes 1 and 2 discovery) offers a potentially more advanced framework that recognizes systems and organizational perspectives. A deeper, multi-layered exploration of the influence of socio-political and policy contexts is needed to understand the full potential of co-production on knowledge utilization.

https://www.ijhpm.com/article_4700_4d955aa2483cf30a00d07832d4fe853e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Prioritizing the Journey and the Destination; Comment on “Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens” 1 4 4707 10.34172/ijhpm.8907 EN Theresa Schmidt Independent Researcher, Alexandria, VA, USA Jacqlyn Riposo Independent Researcher, Alexandria, VA, USA Journal Article 2024 11 16 McDonald and colleagues’ paper on “Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens” describes seven goals for using patient-reported measures (PRMs) to promote diagnostic excellence and describes roadmaps to plan the development and implementation of PRMs. Incorporating more patient voices into diagnostic measurement and measure development can improve the patient-centricity of processes and outcomes. Additionally, organizations beginning their measure development journeys may find road-mapping tools helpful, especially the focus on setting goals and engaging stakeholders. However, the authors do not offer suggestions for prioritizing measure concepts for development, and the long timeframes of the examples may dissuade some organizations from engaging in measurement to begin with. Real-world examples of measure development processes and potential applications of emerging technologies are important complements to aspirational roadmap goals and processes.

https://www.ijhpm.com/article_4707_85e060304b1c0f4036c04068b907b2a6.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Features of Remote Patient Monitoring Systems That Implement Integrated Care: A Perspective Aligned With Current Challenges for Digital Health Technologies; Comment on “Towards A Framework for Implementing Remote Patient Monitoring From an Integrated Care Perspective: A Scoping Review” 1 4 4703 10.34172/ijhpm.8724 EN Ana Londral Value for Health CoLAB, Lisbon, Portugal Comprehensive Health Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal Department of Physics, Nova School of Science and Technology, NOVA University of Lisbon, Lisbon, Portugal Journal Article 2024 07 25 This commentary elaborates on the model proposed by Miranda et al for implementing remote patient monitoring (RPM) from an integrated care perspective. It stresses the complexity of RPM deployment as a digital health technology (DHT) and discusses essential features that developers and procurement managers should take into consideration in RPM systems to facilitate the implementation of integrated care practices. Furthermore, three major challenges for DHT implementation that align with the proposed RPM-based integrated care model are discussed: (1) the success of DHT in implementing a healthcare strategy requires elements of service innovation that align to the context of care delivery; (2) evidence generation methods influence the adoption of DHT and need an evolutive and multi-stakeholder perspective; (3) governance and policy strategies are crucial since they profoundly influence digital health priorities, investments, and resource allocation within organizations and healthcare systems.

https://www.ijhpm.com/article_4703_fa4ce9cf2f0d65b652641488ab4e287b.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 A Holistic Response to Musculoskeletal Health: Implications for Global Health Policy; Comment on “From Local Action to Global Policy: A Comparative Policy Content Analysis of National Policies to Address Musculoskeletal Health to Inform Global Policy Development” 1 3 4710 10.34172/ijhpm.8798 EN Dorothy Lall Community Health Department, Christian Medical College, Vellore, India Journal Article 2024 09 11 This commentary is in response to the paper titled “A Comparative Policy Content Analysis of National Policies to Address Musculoskeletal Health to Inform Global Policy Development” by Schneider et al. This well-done policy content analysis identifies key themes and transferable principles to guide policy development for musculoskeletal health. In this commentary, I argue that the findings of this policy analysis should be used to develop global policies within the current framing of non-communicable diseases (NCDs), especially considering the growing burden of multimorbidity. The second point concerns the application of the building blocks framework and limitations in the use of the framework. Lastly, in this paper, I miss the needed emphasis for a global health policy that specifies primary healthcare and universal health coverage for a life course approach and an equitable response.

https://www.ijhpm.com/article_4710_357506a8144936a189939db0f1587f65.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Depoliticization, Colonialism, and the Imperative to Disrupt Denial; Comment on “The Rhetoric of Decolonizing Global Health Fails to Address the Reality of Settler Colonialism: Gaza as a Case in Point” 1 5 4715 10.34172/ijhpm.8761 EN Zvika Orr Selma Jelinek School of Nursing, Jerusalem College of Technology, Jerusalem, Israel Anna C. Zielinska Department of Philosophy, Université de Lorraine, Nancy, France Archives Henri-Poincaré, CNRS, Nancy, France Sciences Po Paris, Nancy, France Journal Article 2024 08 15 This article builds on Engebretsen and Baker’s editorial to explore recent developments in medical neutrality, the depoliticization of healthcare, and political intervention in the context of the war in Gaza. We examine how international health organizations have increasingly, though insufficiently, taken a political stance, criticizing the detrimental structural forces affecting Palestinians’ life and health. Concomitantly, many Israeli healthcare professionals and organizations have shifted from a declared neutral stance to endorsing the state’s official narrative. Additionally, we analyze the connections between settler colonialism, Israeli and US policies, medicine, and international health organizations. While the discourse of decolonization provides valuable historical context for understanding the ongoing oppression of Palestinians, it often obscures critical issues, particularly the atrocity of the October 7 attack. We conclude by discussing the shift from literal denial to interpretive and implicatory denial, emphasizing the role of international health professionals and organizations in confronting these pervasive forms of denial.

https://www.ijhpm.com/article_4715_a31d0d9e8e598661c7fc912c3f6a698b.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Commercial Determinants Drive Political Determinants of Health in a Neoliberal Society; Comment on “Energy as a Social and Commercial Determinant of Health: A Qualitative Study of Australian Policy” 4716 10.34172/ijhpm.8711 EN Linda A. Selvey School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia Journal Article 2024 07 18 Energy policies have a major impact on the health and well-being of the population. However, Australia’s energy policies rarely consider health and well-being in their policies. In Australia and in many other countries, energy policies, while developed by governments, are heavily influenced by commercial entities within the fossil fuel industry. This means that Australia’s energy policy does not reflect what climate science tells us is necessary for a safe climate. Australia’s environmental laws are insufficient to protect both nature and the environment. Environment and climate advocates have been urging the Australian government to strengthen these laws while industry, particularly the mining industry have been pushing to weaken them. This clearly demonstrates the strong intersection between commercial and political determinants of health.

https://www.ijhpm.com/article_4716_c33a8fcab5eaa4aa812d376f40b2e211.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Choosing to Implement Value-Based Healthcare Initiatives: A Strategic Decision for Achieving Better Performance in Improving Population Health; Comment on “Reflections on Managing the Performance of Value-Based Healthcare: A Scoping Review” 1 3 4728 10.34172/ijhpm.9050 EN Ana Paula Beck Da Silva Etges National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil PEV Healthcare Consulting, Porto Alegre, Brazil Programa de Pós-graduação em Epidemiologia da Escola de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil Journal Article 2025 02 22 Operational effectiveness is about improving what is being done, reducing errors and harms, and improving efficiency, while strategy involves making decisions and choices. Implementing value-based healthcare (VBHC) also means matching previous strategies and performance literature to guide building sustainable organizations in healthcare businesses. This commentary paper explores answers for: What does it mean to have a high-performance, sustainable, and impactful health organization? By describing frameworks about leadership and social capital, this piece argues that the healthcare system’s sustainability involves making choices that set as a strategy implementing VBHC principles, cause implications on regulatory, organizational, and individual levels, and result in structuring systems that contribute to achieving high performance on improving population health. The argumentation suggests that achieving a high-performance, sustainable, and impactful health organization can be translated into positively impacting population health with financial accountability, and systems internal processes may serve as roads to achieve that impact on society.

https://www.ijhpm.com/article_4728_936658d5c2aa9f88409db4ac3bd2d2aa.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Principles and Pragmatics for Building Trust in Authority; Comment on “Placing Trust at the Heart of Health Policy and Systems” 1 3 4711 10.34172/ijhpm.8964 EN Stephen David Reicher School of Psychology and Neuroscience, University of St. Andrews, St. Andrews, UK Journal Article 2024 12 22 McKee et al make a powerful plea for placing trust-building at the core of public health initiatives. I endorse that call and propose one general principle along with four practical guidelines for building trust between the public and the authorities. The general principle is that trust is rooted in shared identity and that, therefore, the task of building trust is rooted in building a sense of shared identity both amongst the public and between the public and authorities. The four guidelines are (1) trust the people!; (2) recognise and respect difference; (3) engage with the public; and (4) understanding and support trump blame and punishment. Details and justifications for each of these guidelines is provided in Supplementary file 1.

https://www.ijhpm.com/article_4711_ce9697dd284ddbdb52d69fc65ad441af.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Evolving a Healthcare System With a Coordinated Approach for Patient-Reported Measurement of Diagnostic Quality Comment on “Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens” 1 3 4733 10.34172/ijhpm.8905 EN Karen S. Cosby Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD, USA Journal Article 2024 11 15 Quality metrics for improving care are deeply embedded in healthcare systems. Patient-reported measures (PRMs) have now been implemented for many conditions and are a high priority for the Centers for Medicare and Medicaid Services (CMS).1 However, the development of PRMs specific to diagnostic quality remains largely exploratory. Early progress in acquiring and analyzing diagnostic PRMs reveals that patients offer a novel and valuable source of information about their diagnostic journeys. To fully understand and learn from patient experiences, work needs to include varied clinical settings, sites, and conditions. This work requires and deserves focused commitment and coordinated effort with a unifying strategic vision optimally facilitated by a national, or international, coordinating center.

https://www.ijhpm.com/article_4733_9a4b72543f5ac25222e3c294e9adb55e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Aligning Public Health With a Well-Being Economy: Opportunities and Challenges in Addressing Root Causes of Health Inequities; Comment on “Can a Well-Being Economy Save Us?” 1 4 4725 10.34172/ijhpm.8877 EN Lindsay McLaren Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada Journal Article 2024 10 30 Labonté offers important critical optimism around the idea of a well-being economy, which is gaining considerable international momentum and offers a much-needed alternative to the current political economic paradigm of neoliberal capitalism and its significant social and ecological consequences. Because of its focus on systems and structures that constitute “root causes” of poor health and health inequities at the population level, a well-being economy aligns strongly with stated tenets and value commitments of public health. It thus provides an important opportunity for public health communities to engage and mobilize as a collective around this important vision. For this to happen, however, public health communities must overcome a reluctance to engage with political economy and take seriously the field’s commitment to the public’s health. In this commentary I reflect on these opportunities and challenges in the Canadian public health context.

https://www.ijhpm.com/article_4725_ba383eb54d9af15209ce4388118c1199.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Broadening the Boundaries of Integrated Care in Response to Necessity: Where Are the Limits for Each Sector, and Who Should Pay for What?; Comment on “The Effect of Integrated Care After Discharge From Hospitals on Outcomes Among Korean Older Adults” 1 3 4729 10.34172/ijhpm.9084 EN Jonathan Stokes MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark Journal Article 2025 03 13 Impacts of integrated care interventions, particularly on utilisation and financial outcomes, can be mixed, sometimes quite disappointing when compared to expectations. Positive deviants come along occasionally, but it is extremely difficult to unpick exactly why one intervention might “work” where others have not. Choi and Yoo evaluated a programme in Korea, which appears to have increased time older patients discharged from hospital spend at home, reduced their odds of a subsequent emergency admission, and decreased total expenditure, although re-admissions increased. The programme stands out particularly in its breadth of non-traditional care activity, home-based primary care and long-term (social) care services, but also broader activities such as nutrition support (eg, meal delivery), movement assistance, lifestyle education, housekeeping, and even home repair. In this commentary, I discuss this broadening of interventions to capture more social determinants of health, ask where boundaries of each sector/ service should lie, and who should pay for what.

https://www.ijhpm.com/article_4729_b7f4aa4d798bc2c0d05db05e389dca0e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Confronting “Socio-Political Inertia” on the Long and Winding Road to “Healthy Societies” Comment on “How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks” 1 4 4736 10.34172/ijhpm.9150 EN Harvy Joy Liwanag Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore Natasha Howard Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK Journal Article 2025 04 14 The vision to create “Healthy Societies” is a reiteration of “Health for All” first made in the Declaration of Alma-Ata almost half a century ago. We contend that this long journey is due to “Socio-Political Inertia” that has prevented societies from transforming even in the presence of enabling policies. The analysis of policy documents by Nambiar et al could help set the stage for understanding how best to advance healthy societies, but the aspirations expressed in documents require active engagement and implementation to enable societal change. We first draw inspiration from the convergence of multiple streams in Kingdon’s model in exploring how to chart the journey toward healthy societies. We then argue that the vision of healthy societies should be articulated in ways that speak to the different societies that will own it and build coalitions to turn this vision into reality.

https://www.ijhpm.com/article_4736_d6e889558c12b5d7a2a15fffe8197041.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Rethinking Healthy Societies: A Critical Commentary on Policy Levers and Enablers; Comment on “How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks” 1 4 4739 10.34172/ijhpm.9059 EN Hanan Khalil Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia Journal Article 2025 02 28 The pursuit of healthy societies has long been a global aspiration, yet the pathways to achieving them remain fraught with challenges. The paper “How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks” provides an insightful thematic analysis, identifying key policy levers and enablers necessary for transformative change. This commentary critically examines the paper’s approach, highlighting the need for a more profound engagement with political and economic structures. Additionally, the commentary highlights the role of civic engagement and evidence-based policy-making in overcoming systemic inertia. Ultimately, achieving healthy societies requires a paradigm shift—one that moves beyond technical solutions towards an equity-driven and justiceoriented framework.

https://www.ijhpm.com/article_4739_188be44235a56944625a748e8f805049.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Acting on the Evidence: The Challenges Facing Policy and Practice; Comment on “Barriers and Opportunities for WHO “Best Buys” Non-Communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review 1 4 4740 10.34172/ijhpm.9022 EN David J. Hunter Newcastle University, Newcastle, UK Journal Article 2025 02 07 Even in situations where there exists robust evidence on what works and what needs to change to tackle deep-seated and persistent public health challenges, the lack of sustained progress across polities globally remains a cause for concern. Adopting a political economy perspective to better understand why the adoption and implementation of policies to tackle non-communicable diseases (NCDs) continues to be deficient, Loffreda and colleagues’ systematic review of facilitating and inhibiting factors sheds valuable light on the subject. The adoption of a political economy approach is long overdue since it gets to the nub of identifying enablers and barriers to change and how to tackle the latter while strengthening the former. However, whether such an approach will be welcomed by policy-makers or be rejected merits further exploration if research is going to stand any chance of being heeded and acted upon.

https://www.ijhpm.com/article_4740_523e8e26d9235c3b4056403156bd2f8f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Critical Reflections on Public Health, Policy and Social Change Toward Healthy Societies; Comment on “How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks” 1 3 4748 10.34172/ijhpm.9135 EN Matthew Fisher Stretton Health Equity, Stretton Institute, University of Adelaide, Adelaide, SA, Australia Journal Article 2025 04 07 Nambiar and colleagues in this journal identify the main conceptual frameworks offered by public health on how to build healthy societies, drawn from key documents published over a span of 50 years. In their analysis they point to strengths and limitations of these frameworks and offer suggestions for their improvement. In this commentary, I argue that both the frameworks on offer and Nambiar and colleagues’ critique are missing important perspectives on well-being itself, on the role of the democratic State, and on the “community arena” and the “policy arena” as two related but distinct arenas for political and social change toward healthy societies.

https://www.ijhpm.com/article_4748_38272a00021062eb8f17d17a5d332911.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Real-World Application of Unhealthy Commodity Industries’ Corporate Political Activity Research; Comment on “Corporate Political Activity: Taxonomies and Model of Corporate Influence on Public Policy” 1 4 4743 10.34172/ijhpm.9077 EN Francisca Pulido Valente Public Health Unit of Amadora, Amadora-Sintra Local Health Unit, Lisbon, Portugal Hilson Cunha Filho Medicine Department, Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal Journal Article 2025 03 10 Taxonomies are essential tools for structuring evidence in public health, particularly in rapidly evolving fields like the Commercial Determinants of Health (CDoH). Ulucanlar et al addressed an important gap by proposing taxonomies to systematically document and classify corporate political activity (CPA) across unhealthy commodity industries. In this commentary we reflect on the broader relevance of these frameworks for CDoH research and discuss their real-world applicability through a case study of the Portuguese alcohol industry. Drawing from our empirical findings, we highlight both the practical strengths and challenges we encountered, and propose an additional use: employing CPA taxonomies as communication tools to translate complex corporate strategies into accessible narratives for broader public health audiences. Finally, we identify opportunities for refinement, including developing complementary quantitative metrics and the integration of CPA surveillance into routine public health systems.

https://www.ijhpm.com/article_4743_f7823e7f575926025f60d5e21daf30b8.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Future Best Buys Can and Should Do More; Comment on “Barriers and Opportunities for WHO ‘Best Buys’ Non-Communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review” 1 4 4745 10.34172/ijhpm.9047 EN Safura Abdool Karim Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA Centre for the Programme of Aids Research in South Africa, University of KwaZulu-Natal, Durban, South Africa Marlyn Faure Ethox Centre, Oxford University, Oxford, UK Journal Article 2025 02 20 Over a decade has passed since the World Health Organization (WHO) proposed a set of “best buys” for the prevention of non-communicable diseases (NCDs). Loffreda and colleagues’ review describes how, despite the costeffectiveness of these interventions, their adoption is often complex and governments face many challenges in both implementing and maintaining NCD prevention policies. Industry opposition and the commercial determinants of health (CDoH) remain significant challenges to an effective NCD response. In addition, the best buys may operate inequitably and are often unable to respond to the interrelated challenges posed by the global syndemic of obesity. We suggest that the next revision of the best buys adopts a more integrated approach that prioritize structural interventions, equity-focused strategies, and mechanisms to counteract industry interference.

https://www.ijhpm.com/article_4745_b08974411add406d2b09ea23d72a9b0e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Ways to Build a Greener Healthcare System; Comment on “A Review of the Applicability of Current Green Practices in Healthcare Facilities” 1 3 4744 10.34172/ijhpm.9157 EN Rui Wu School of Business, Nanjing Normal University, Nanjing, China Yiming Liang School of Business, Nanjing Normal University, Nanjing, China Journal Article 2025 04 15 Green practices have become the responsibility of healthcare system in the current warming planet. The article by Soares and colleagues reviews the literature on circular economy implementation in the European Union (EU) and its application in healthcare system. In this commentary, we complement the findings by discussing ways to build a greener healthcare system and introducing life cycle assessment (LCA), a method to quantify the environmental impacts of products and services in healthcare. LCA is useful to compare the environmental impacts of different clinical products and pathways. Within the healthcare system, avoiding overdiagnosis and overprescribing, improving building energy efficiency, and fleet electrification are important green practices. In addition, we cannot ignore the differences in regional energy system when comparing the carbon footprint of different healthcare systems.

https://www.ijhpm.com/article_4744_01748af5340adf846851b7acdba5d2ac.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Re-evaluating the Conceptual Framework of Health System Resilience: Insights From Economic Sanctions; Comment on “Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic” 1 6 4741 10.34172/ijhpm.8691 EN Haniye Sadat Sajadi Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran 0000-0003-0897-4080 Reza Majdzadeh Interdisciplinary Research and Practice Division, School of Health and Social Care, University of Essex, Colchester, UK Journal Article 2024 07 10 Health system resilience in the context of economic sanctions (ES) is an underexplored area. We used data from recent studies on the impact of ES on the health systems to cross-reference and assess the applicability of the conceptual framework of health system resilience (CFHSR). Reviewing the interventions implemented under ES and aligning them with the CFHSR and COVID-19 responses, we found that the CFHSR domains encompass most strategies from the ES and COVID-19 studies. However, CFHSR does not cover several strategies related to equity and teamwork. Additionally, monitoring the consequences is missing from the experiences of COVID-19 and ES. The CFHSR appears to be reasonably effective in categorizing strategies for both COVID-19 and ES. Nonetheless, its domains can be further refined. Specifically, incorporating an intersectional equity lens could enhance this conceptual framework. The next step is to develop a practical guide to apply CFHSR to strengthen health system resilience.

https://www.ijhpm.com/article_4741_20d6270bcb97aa94a1447b97c2970e31.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 No Time Like the Present: Centring Politics in the Global NCD Policy Agenda; Comment on “Barriers and Opportunities for WHO ‘Best Buys’ Non-Communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review” 1 3 4747 10.34172/ijhpm.9145 EN Lana M. Elliott Centre for Justice, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia Stephanie M. Topp College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia Journal Article 2025 04 10 The World Health Organization’s (WHO’s) non-communicable disease (NCD) Best Buys provides a comprehensive package of technically sound policy advice in response to the growing global burden of NCDs. However, despite these policy mechanisms being touted as beneficial to countries’ health and economic bottom lines, uptake has remained slow and globally disparate. Loffreda and colleagues’ analysis draws attention to the importance of political economy forces in shaping governments’ responses to NCDs and, in particular, their uptake of the NCD Best Buys. In building on this work, we examine the history and instances of contemporary application of the NCD Best Buys to consider the limitations of these technocratically framed policy recommendations. In doing so, we highlight the risks present in focusing on the technical – while negating the contextually nuanced political – dimension of policy adoption. We thus advocate for greater political engagement in policy design and implementation as well as a revitalised “doubleloop” approach to NCD policy learning, where policy and system feedback is not solely used to reify policy advice but rather interrogate the assumptions underpinning such.

https://www.ijhpm.com/article_4747_47387353a4cb7053b59cdf2c78732797.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Co-production of Diagnostic Excellence – Patients, Clinicians, and Artificial Intelligence; Comment on “Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens” 1 3 4749 10.34172/ijhpm.8973 EN Sumant R. Ranji Division of Hospital Medicine, Department of Medicine, San Francisco General Hospital, San Francisco, CA, USA Division of Clinical Informatics and Digital Transformation, Department of Medicine, University of California San Francisco, San Francisco, CA, USA Benjamin I. Rosner Division of Clinical Informatics and Digital Transformation, Department of Medicine, University of California San Francisco, San Francisco, CA, USA Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA Journal Article 2024 12 31 Patients often experience long journeys within the healthcare system before obtaining a diagnosis. Though progress has been made in measuring the quality of diagnosis, existing measures largely fail to capture the diagnostic process from the patient’s perspective. McDonald and colleagues’ paper presents 7 overarching goals for the use of patientreported measures (PRMs) in diagnostic excellence and presents visual roadmaps to guide the development, implementation, and evaluation of these measures. To accelerate the real-world use of PRMs, organizations should initially prioritize the use of patient-reported metrics that are already in development, such as patient-reported experience measures. Pairing PRMs with artificial intelligence (AI) techniques, such as “diagnostic wayfinding” (a dynamic diagnostic refinement process that also includes analysis of electronic health record data and metadata to characterize the diagnostic journey), should also improve diagnostic performance. Ultimately, combining PRMs with technological advancements holds the potential to achieve true co-production of diagnostic excellence.

https://www.ijhpm.com/article_4749_e342d5548862522f0a78e075272efccc.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Finding the Right Balance: Challenges in Optimising the Promise of Complexity Research for NCD Best-Buys Implementation and Adoption; Comment on “Barriers and Opportunities for WHO ‘Best Buys’ Non-communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review” 1 3 4753 10.34172/ijhpm.9040 EN Pragati B. Hebbar Center for Commercial Determinant of Health, Institute of Public Health Bengaluru, Bengaluru, India Upendra M. Bhojani Center for Commercial Determinant of Health, Institute of Public Health Bengaluru, Bengaluru, India Prashanth Nuggehalli Srinivas Centre for Health Systems, Institute of Public Health Bengaluru, Bengaluru, India 0000-0003-0968-0826 Journal Article 2025 02 17 There is a growing interest in complexity research. A recent systematic review by Loffreda et al attempted to study the barriers and opportunities for the adoption and implementation of the “best buys” for non-communicable diseases (NCDs) from a political economy perspective. In this commentary we take forward the discussion on the NCD best-buys by comparing the findings of the article with one of the risk factors of tobacco use and its control in India. We reflect on the challenges in actualizing the promise of research methods and approaches while studying such complex interventions like the NCD best buys. The balance of studying complexity while still keeping the findings translatable at country levels. Future research could potentially use a comparative lens focusing on either industry/ government or actor behaviour across the different risk factors to facilitate cross learning, anticipate and pre-empt adverse policy decisions and implementation outcomes.

https://www.ijhpm.com/article_4753_73f548869fbbe8154405872e47624e0e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Advancing Applications of System Dynamics in Critical Food Systems Research; Comment on “Using System Dynamics to Understand Transnational Corporate Power in Diet-Related Non-communicable Disease Prevention Policy-Making: A Case Study of South Africa” 1 3 4755 10.34172/ijhpm.9128 EN Andrew D. Brown School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia 0000-0002-6385-3225 Simone Sherriff Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia Benjamin Wood Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia Steven Allender Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia Fiona Mitchell Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia Yin Paradies Alfred Deakin Institute, Faculty of Arts and Education, Deakin University, Geelong, VIC, Australia Jennifer Browne Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia Journal Article 2025 04 01 This commentary commends Milsom et al for their critical and rigorous application of qualitative system dynamics to unpack corporate power in food policy-making. Their use of Critical Realism, best practice qualitative methods, and feedback loops exemplifies the maturation of system dynamics applications in public health research. We reflect on how their work aligns with broader debates about power and social theory in system dynamics and how it offers a blueprint for trustworthiness and reflexivity in qualitative modelling. Drawing on our team’s work with Aboriginal communities in Australia, we highlight the value of culturally grounded, participatory modelling in amplifying the voices of communities experiencing historical and ongoing oppression. We support the authors’ call to advance toward simulation modelling and stress the importance of engaging with both system dynamics and communitybased knowledge to realise the transformative potential of systems-informed, community-led research in reshaping food policy and practice.

https://www.ijhpm.com/article_4755_d298d541be1e6e0a9181407cb7298b9d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 The Missing Link: Why Value-Based Healthcare Needs Healthcare and Management Science to Unite Efforts; Comment on “Reflections on Managing the Performance of Value-Based Healthcare: A Scoping Review” 1 4 4754 10.34172/ijhpm.9121 EN Dorine Van Staalduinen Martini Hospital, Groningen, The Netherlands Santeon, Utrecht, The Netherlands Paul Van Der Nat Radboud University Medical Center, Nijmegen, The Netherlands Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands Santeon, Utrecht, The Netherlands Journal Article 2025 03 28 Value-based healthcare (VBHC) has emerged as a widely embraced strategy to address pressing healthcare challenges, including workforce shortages, rising healthcare costs, and inconsistent care quality. A scoping review by van Elten et al shows that despite their expected importance of integrating VBHC with performance management systems, very few articles provide concrete examples of this integration. Drawing on existing performance management literature, the authors explore possible reasons for why VBHC practitioners and researchers have largely overlooked this topic. This commentary critically engages with their review by examining their conceptual definitions, offering alternative explanations for the apparent lack of performance management in VBHC, and suggesting directions for future interdisciplinary research.

https://www.ijhpm.com/article_4754_57513c14045538348dd60f24c359ddc1.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Achieving Diagnostic Excellence in Prenatal Diagnosis Through Patient-Reported Measures; Comment on “Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens” 1 5 4757 10.34172/ijhpm.8921 EN An Chen School of Public Health, Zhejiang Chinese Medical University, Zhejiang, China Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland Oona Tchitcherin Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland Kirsi Väyrynen Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland Paulus Torkki Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland Seppo Heinonen Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland Aydin Tekay Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland Journal Article 2024 11 25 McDonald and colleagues’ work “Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens” emphasizes the critical role of patient-reported measures (PRMs) in achieving diagnostic excellence, with a focus on equity. PRMs capture patients’ experiences, symptoms, and concerns throughout the diagnostic process, enhancing accuracy and addressing uncertainties. In contexts like maternity care, PRMs have been applied to reveal and reduce communication gaps and alleviate anxiety, offering crucial support for improving diagnostic experiences and outcomes. This commentary explores the application of McDonald and colleagues’ visions and roadmaps to prenatal diagnosis, specifically focusing “prenatal screening and testing” (PreST), a complex process where diverse patient populations face challenges in understanding and responding to sequential test results. Tailored diagnosis-related PRMs can provide healthcare providers with tools to enhance shared decision-making, equitable communication, and patient satisfaction, leading to more inclusive and personalized diagnostic pathways.

https://www.ijhpm.com/article_4757_2c398d2cf6e904924c1baa27cdea8820.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Demystifying Commercial Influences on Health: Applying Systems Dynamics Methodologies to Policy Processes; Comment on “Using System Dynamics to Understand Transnational Corporate Power in Diet-Related Non-communicable Disease Prevention Policy-Making: A Case Study of South Africa” 1 4 4759 10.34172/ijhpm.9174 EN Marsha Orgill The Children’s Institute, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Lori Lake The Children’s Institute, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Zakaria Belrhiti International School Mohammed VI of Public Health, Mohammed VI University of Sciences and Health (UM6SS), Casablanca, Morocco Mohammed VI Center for Research and Innovation, Rabat, Morocco Mumta Hargoven Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK Journal Article 2025 04 22 In their study on which we provide commentary, the authors applied a qualitative systems dynamics methodology to explore how transnational corporate power has led to policy inertia in the prevention of diet-related noncommunicable disease (RD-NCD) in South Africa. This commentary explores the potential of systems thinking and causal loop diagrams to deepen understandings of – and responses to – the commercial determinants of health (CDOH). We reflect on the application of causal loop diagrams in policy processes and provide reflections that proposed strategies for change will need to take into account recent shifts in global discourse, funding streams and the balance of global power.

https://www.ijhpm.com/article_4759_4c998520eb116dfde885fa2ff1c7b287.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Managed Competition in Healthcare (?); Comment on “Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands” 1 3 4766 10.34172/ijhpm.9094 EN Juraj Nemec Faculty of Economics and Administration, Masaryk University Brno, Brno, Czechia Journal Article 2025 03 18 This article comments on the paper by Stadhouders et al titled “Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands.” Its main aim is to respond to the fact that the paper, without discussion, assumes that competitive reform stimulates the efficient allocation of funds. To achieve this goal, this article discusses existing knowledge related to the author’s assumption, highlighting that there is no uniform theory regarding the capacity of market forces to regulate healthcare markets. It also argues that market-based healthcare reforms may be very risky in countries with limited state regulatory capacity and widespread corruption.

https://www.ijhpm.com/article_4766_f6867d3a4e5951e364a25b1bfd222bff.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Active Purchasing: Empirical Insights From the Dutch Healthcare System and Lessons for Low- and Middle-Income Countries; Comment on “Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands” 1 4 4762 10.34172/ijhpm.9169 EN Xiaohui Hou Health, Nutrition, and Population Global Practice, World Bank Group, Washington, DC, USA Yanfang Su Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA Evans School of Public Policy and Governance, University of Washington, Seattle, WA, USA Journal Article 2025 04 18 Stadhouders et al critically examines the assumptions behind managed competition, revealing that competitive systems alone may not drive efficiency gains through fund reallocation. Their findings from the Dutch hospital sector suggest limited or low reallocation of funds between providers and highlight the need for monitoring resource allocation progress, understanding barriers and adjusting incentives for better functioning healthcare markets. For low- and middle-income countries (LMICs) undergoing health reforms, the Dutch experience underscores the importance of tailoring purchasing models to local contexts. LMICs should enhance data use for more strategic decision-making as well as building regulatory framework and institutional capacity for stronger implementation. Future research should explore how purchasing models interact with diverse health system characteristics to inform system-specific reforms.

https://www.ijhpm.com/article_4762_3c91b44e71166da30f8dd66daf07aed2.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Why Must We Keep Discussing Strategic Purchasing and Managed Competition?; Comment on “Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands” 1 3 4764 10.34172/ijhpm.9248 EN Scott L. Greer School of Public Health, University of Michigan-Ann Arbor, Ann Arbor, MI, USA European Observatory on Health Systems and Policies, Brussels, Belgium Journal Article 2025 05 29 Stadhouders and colleagues’ new measure answers an important question: Do strategic purchasing and managed competition redirect healthcare resources, and, if so, when, how, and to what? Applying it to the Netherlands, they find that they do not. This commentary first examines logical problems in arguments for strategic purchasing and managed competition, and then briefly reviews other evidence of their very limited success from, in particular, the Netherlands and England. It then raises the question of why strategic purchasing and managed competition continue to be advocated despite the poor logic of the arguments behind them and substantial evidence that they do not work.

https://www.ijhpm.com/article_4764_541030df81ef58495fac232f655b8861.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 The Future of Transforming Healthcare Systems Into Circular Economy Models; Comment on “A Review of the Applicability of Current Green Practices in Healthcare Facilities” 1 3 4765 10.34172/ijhpm.9176 EN Edda Weimann Department of Information Systems, School of IT, University of Cape Town, Cape Town, South Africa Department of Child Health, School of Medicine and Health, Technical University of Munich, Munich, Germany Journal Article 2025 04 22 The healthcare sector is both a guardian of health and a significant contributor to global carbon emissions and environmental degradation. In their scoping review, Soares et al explore the applicability of circular economy (CE) principles within healthcare facilities, identifying eight areas for intervention. While their work provides a valuable synthesis, this commentary highlights future points of interest such as vulnerable populations, a call to broaden governance frameworks, and to move from an overly Eurocentric to a more global scope. Low- and middle-income countries (LMICs) face major barriers to implementing CE models in healthcare, including weak policy frameworks, a lack of holistic recycling chains, awareness and training, as well as limited incentives. Stronger government leadership is needed to develop CE policies, foster multi-sector collaboration among private investors, governments, academia, non-governmental organisations, and international partners. Drawing on public health and child health perspectives, and informed by work in net-zero hospital initiatives, this commentary argues for a more transformative, equitable, and globally inclusive vision of circular healthcare. Organisations like Health Care Without Harm (HCWH) can support implementation through technical expertise, advocacy, and capacity-building.

https://www.ijhpm.com/article_4765_4f1daa6b8d5065f3c9cc4e76cfba171f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Are Corporate Political Actors Aware of the Health Risks Associated With Their Products?; Comment on “Corporate Political Activity: Taxonomies and Model of Corporate Influence on Public Policy” 1 3 4769 10.34172/ijhpm.9104 EN Emanuel Orozco Health Systems Research Centre, National Institute of Public Health, Morelos, Mexico Journal Article 2025 03 21 The analytical model proposal by Ulucanlar et al for the analysis of corporate political activity (CPA) establishes that corporate actors are aware of the high incidence of non-communicable diseases (NCDs) associated with their products and protect themselves against the consequences. This model helps to identify the strategies used by various corporate entities to influence public policies and protect their interests. The CPA analytical model applies a critical approach to commercial determinants of health that allows us to understand how corporate actors take advantage of their systems-based management of power. Due to its inherent complexity, this analysis presents several unanswered questions requiring along with theoretical and empirical challenges. The situation described in this commentary points to the importance of monitoring the CPA at a global and local level, identifying opportunities that favor the regulation of political influence, to reduce the influence of the commercial determinants of health on the NCDs.

https://www.ijhpm.com/article_4769_37622be8f7ed7432153a86708564d82a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Bridging Environmental Impact and Patient Outcomes; Comment on “A Review of the Applicability of Current Green Practices in Healthcare Facilities” 1 3 4763 10.34172/ijhpm.9138 EN Connie Cai Ru Gan Griffith Institute for Human and Environmental Resilience (GIHER), Griffith University, Brisbane, QLD, Australia Hansoo Kim School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia Journal Article 2025 04 08 The intersection of healthcare sustainability and clinical practice presents complex challenges in implementing circular economy (CE) principles. This commentary examines Soares and colleagues review of green practices in healthcare facilities while identifying significant gaps in the current discourse. While healthcare facilities are adopting sustainability measures like renewable energy and efficiency improvements, the implementation faces significant operational challenges, particularly in embedding environmental considerations in the clinical decision-making and care delivery process. The analysis discusses that overdiagnosis and low-value care contribute substantially to healthcare’s environmental footprint, exemplified through screening cases that demonstrate the delicate balance between clinical necessity and resource utilisation. We emphasize the need for context-specific approaches that acknowledge operational realities and stakeholder diversity within healthcare governance. We advocate for an integrated approach that places health outcomes at the center of climate initiatives, recognising that public health interventions must equally consider environmental impacts. Ultimately, we call for a paradigm shift that moves beyond siloed environmental initiatives toward systemic integration that complements rather than competes with clinical responsibilities.

https://www.ijhpm.com/article_4763_e0ef1d9ef5675465d73c2f3c034633b0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 The Application of Corporate Political Activity Taxonomies to Explore the Lobbying of Ultra-Processed Sugary Food and Drink Industries in Chile; Comment on “Corporate Political Activity: Taxonomies and Model of Corporate Influence on Public Policy” 1 3 4776 10.34172/ijhpm.9154 EN Yanela Aravena-Rivas Department of Epidemiology and Public Health, University College London, London, UK Journal Article 2025 04 14 Unhealthy commodities industry actors use different practices, including political practices, to influence policy-making in industry-friendly ways that may result in increased ill health and health inequalities. Ulucanlar and colleagues formulated a comprehensive evidenced-based model and taxonomies to study the corporate political activities of unhealthy commodity industries. This commentary reflects on the process of applying these taxonomies to the study of lobbying of ultra-processed sugary food and drink industries in Chile, a country from the global south that faced strong opposition during the discussion and implementation of legislation to create healthier food environments. The taxonomies were a useful tool to identify and classify the different claims and actions used by ultra-processed sugary food and drink industries when lobbying Chilean authorities. However, there were some challenges in their use that need to be considered when using these taxonomies in similar settings.

https://www.ijhpm.com/article_4776_27b6d7ba3284cea218e2a134262ec083.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Rowing Against the Tide: Building Healthier Societies Is Difficult; Comment on “How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks” 1 3 4777 10.34172/ijhpm.9089 EN José-Ramón Repullo-Labrador National School of Public Health, Madrid, Spain Journal Article 2025 03 16 The article by Nambiar et al reviews the literature on the influence of policies from outside the health sector, proposing Policy Levers and Enablers to enhance their positive contribution. The regulatory and fiscal lever has a central role, but it should be better articulated with the set of vectors of good governance. Intersectoral action is a complex but necessary axis of work. And it is necessary to change the way of measuring progress and social well-being, but the purpose exceeds the scope and legitimacy of the health sector. In a hostile political environment, it would be advisable to draw up more defensive strategies to defend achievements and avoid setbacks.

https://www.ijhpm.com/article_4777_691a6d71c0d9cf4d84d36b91961d4a3c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Why Substantial Budget Reallocations Are Not and Should Not Be a Major Factor in Active Purchasing in Dutch Healthcare; Comment on “Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands” 1 3 4778 10.34172/ijhpm.9115 EN Fredo Schotanus School of Economics, Utrecht University, Utrecht, The Netherlands Journal Article 2025 03 26 This commentary discusses the study by Stadhouders et al, which analyzes budget reallocations among Dutch healthcare providers as a result of one form of active purchasing. The study assumes that healthcare purchasers aim to shift substantial funds from inefficient to efficient providers, yet finds little evidence of such shifts. This commentary explains more explicitly why substantial volume shifts are not and should not be a major factor in the Dutch context, citing factors such as the scarcity of underperforming providers, strong regional dependencies, data quality limitations, and patient reluctance to change provider. More promising avenues for active purchasing include fostering active collaboration and improving contractual arrangements.

https://www.ijhpm.com/article_4778_f05961a1b1ec79e973c4a6e0133fd7ca.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Integrated Dementia Care in the DementiaNet Program: Health Economic Reflections on Interpretation, Assessment, and Evaluation; Comment on “Effects of DementiaNet’s Community Care Network Approach on Admission Rates and Healthcare Costs: A Longitudinal Cohort Analysis” 1 4 4785 10.34172/ijhpm.9301 EN Ansgar Wübker Hochschule Harz, Wernigerode, Germany RWI – Leibniz Institute for Economic Research, Essen, Germany Journal Article 2025 07 02 This commentary discusses the study by Remers et al. The authors analysed the impact of the Dutch DementiaNet programme on hospital admissions and healthcare costs for individuals with dementia. Using detailed claims data of over 38 000 insured individuals, the study found that participation in DementiaNet networks was associated with fewer hospital admissions and care days, as well as reduced hospital costs. Furthermore, participation in DementiaNet was linked to increased outpatient healthcare expenditure, while overall healthcare costs remained stable. This commentary seeks to place the findings within health economic theory. It posits that DementiaNet could reduce information asymmetries, transaction costs and disincentives in dementia care. Through its network- and primary care–based approach, DementiaNet plausibly improves care coordination, which might enable earlier interventions. This could account for the shift in costs from inpatient to outpatient care. Additionally, the commentary addresses methodological considerations, limitations, and directions for future research.

https://www.ijhpm.com/article_4785_a979b637d3e0e47687c5c1b384dc6c9f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Integrated Community-Based Health and Social Care Interventions for Older People: A Key Policy Priority for All Countries; Comment on “The Effect of Integrated Care After Discharge From Hospitals on Outcomes Among Korean Older Adults” 1 3 4784 10.34172/ijhpm.9057 EN Peter Lloyd-Sherlock School of Healthcare and Nursing Sciences, Northumbria University, Newcastle upon Tyne, UK Journal Article 2025 02 27 This paper situates Choi and Yoo’s study within broader sets of policy challenges related to rapid increases in numbers of older people in need of long-term care (LTC). These challenges include a need to fundamentally transform health services and to develop fully integrated systems of health and LTC for older people. The paper argues that Korea’s Integrated Pilot Project (IPP) is a key step in this direction, along with similar interventions in Thailand and Brazil. Choi and Yoo’s study adds to a wider body of evidence that these interventions enhance health system efficiency at the same time as improving the lives of older people and their family caregivers.

https://www.ijhpm.com/article_4784_705f275746b1fa4f55c7a4da0dc8281d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 A Call for Broadening the Analysis of Corporate Political Activities: Insights From Social Media as a Commercial Determinant of Health; Comment on “Corporate Political Activity: Taxonomies and Model of Corporate Influence on Public Policy” 1 4 4787 10.34172/ijhpm.9155 EN Teresa Leão EPIUnit ITR, Institute of Public Health of the University Porto, University of Porto, Porto, Portugal Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal Journal Article 2025 04 15 Corporate political activities of unhealthy commodity industries have been identified and categorised in terms of framing and action strategies. This commentary discusses the relevance of systematically and comprehensively applying these taxonomy models to other commercial determinants of health, with special attention to their joint activities and health implications. The social media industry is an especially relevant case to be analysed due to its direct and indirect health effects, namely those associated with digital marketing of unhealthy commodities, mis and disinformation, and social polarisation. Interferences in research, lobbying, and corporate social responsibility actions are examples of the strategies used by this industry to prevent and obstruct regulators’ efforts, limiting the control of the marketing of unhealthy products, the spread of mis/disinformation, and the promotion of violent speech and attitudes.

https://www.ijhpm.com/article_4787_5d96d71124105801b541b3e0d5420a9e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Embedded Research Fellows: Charting New Paths for Impact; Comment on “Early Career Outcomes of Embedded Research Fellows: An Analysis of the Health System Impact Fellowship Program” 1 3 4770 10.34172/ijhpm.9024 EN Patrick Feng Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada Journal Article 2025 02 07 With more PhDs working outside of academia, embedded research programs are emerging as one way to broaden the skills of students and bridge the gap between theory and practice. Limited data has been collected on the impact of these programs. The paper by Kasaai et al provides a glimpse into the early career paths of alumni from Canadian Institutes of Health Research’s (CIHR’s) Health Systems Impact (HSI) Fellowship. The results suggest demand for embedded researchers is high and their career prospects are promising. Beyond that, the paper raises several issues that warrant further attention. First is the evolution towards learning health systems (LHSs) and the role embedded researchers might play in this. Second is the potential of embedded researchers to span the worlds of academia and practice. Third is how to measure impact in non-academic research roles. This commentary explores these issues and suggests ways that embedded researcher programs can contribute to each.

https://www.ijhpm.com/article_4770_3e9637069bf19b27789d78b32a71d33b.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Systems Thinking in Public Health; Comment on “Using System Dynamics to Understand Transnational Corporate Power in Diet-Related Non-communicable Disease Prevention Policy-Making: A Case Study of South Africa” 1 4 4794 10.34172/ijhpm.9065 EN Martin McKee Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK Christina Pagel Clinical Operational Research Unit, University College London, London, UK Journal Article 2025 03 05 Milson and colleagues illustrate the value of a systems approach to nutrition policy in South Africa. We respond to their call to use systems approaches, and especially, causal loop diagrams (CLDs), more widely in public health. We begin with examples of how systems approaches have provided valuable perspectives on health-related problems and continue with an example of where this approach could have been used but was not, England’s response to the COVID-19 pandemic. We show how an effective response would have required integrated health, economic, and social policies, yet the British government adopted a siloed approach. We conclude by noting that examples of how systems thinking, and specifically CLDs, have been used to support pandemic responses. We conclude by emphasising the need to embed systems thinking in public health policy-making to enhance resilience and preparedness for future crises.

https://www.ijhpm.com/article_4794_cb95990bf27a1d2bff1c4065d2e1fea3.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 We Should Pay More Attention to Cross-sectoral Cooperation, Incentives and Practice-Oriented Evaluation; Comment on “The Effect of Integrated Care After Discharge From Hospitals on Outcomes Among Korean Older Adults” 1 3 4783 10.34172/ijhpm.9088 EN Eva Blozik Institute of Primary Care, University of Zürich, Zürich, Switzerland Institute of Primary Care, University Hospital of Zürich, Zürich, Switzerland Journal Article 2025 03 15 In their study, Choi and Yoo analysed a pilot project of the Koran government providing integrated care of older adults discharged from hospitals. The pilot project resulted in reduced length of home stay, cost reduction in total expenses and emergency visits for participants compared to controls, but increased hospital readmissions. This commentary provides actionable insights for stakeholders and researchers interested in testing, implementing and monitoring integrated care services in routine care settings. An essential requirement is that barriers and success factors of such projects need to be addressed in scientific evaluations. Also, understanding implementation projects as a continuous quality improvement process may increase knowledge gain and practical relevance of innovative initiatives. Furthermore, heterogeneity across healthcare providers, patient populations, and regions should be considered an asset from which different solutions can emerge. Regulatory authorities are in the position to create a framework so that stakeholders have the required scope for action.

https://www.ijhpm.com/article_4783_6feb124866bb519d771ab87aabc892d9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Rethinking Hospital Sustainability: Circular Economy and Health Literacy; Comment on “A Review of the Applicability of Current Green Practices in Healthcare Facilities” 1 3 4801 10.34172/ijhpm.9297 EN Patrizio Zanobini Department of Health Sciences, University of Florence, Florence, Italy Chiara Lorini Department of Health Sciences, University of Florence, Florence, Italy Guglielmo Bonaccorsi Department of Health Sciences, University of Florence, Florence, Italy Journal Article 2025 07 01 Climate change poses critical dangers to both environmental and human health, highlighting the need for sustainable healthcare strategies. In their recent paper, Soares et al explore how circular economy principles can be implemented in hospital settings in order to reduce environmental impact. This commentary expands on their work by highlighting a complementary but underexplored dimension: organizational health literacy (OHL). OHL emphasizes patient education and engagement, recognizing that informed and empowered patients are key to more efficient healthcare use. By enhancing patients’ understanding of their health conditions and care options, OHL helps prevent unnecessary procedures, tests, and hospital visits, thereby indirectly reducing resource consumption and supporting sustainable practices such as minimizing waste, conserving energy, and promoting telemedicine. In this way, OHL directly supports the operationalization of circular economy interventions described by Soares et al, ensuring their effectiveness and long-term sustainability. Merging OHL with circular economy practices represents a holistic pathway towards sustainable, equitable, and resilient healthcare delivery.

https://www.ijhpm.com/article_4801_c2713f0b03ef8ed72a3ccb9b37a0bdb9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Towards Implementation of Equitable and Effective Non-Communicable Disease Policies; Comment on “Barriers and Opportunities for WHO ‘Best Buys’ Non-Communicable Disease Policy Adoption and Implementation From a Political Economy Perspective: A Complexity Systematic Review” 1 4 4795 10.34172/ijhpm.9064 EN Valerie A. Luyckx University Children’s Hospital, University of Zurich, Zurich, Switzerland Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland Renal Division, Brigham and Women’s Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa Randall Lou-Meda Kidney Health Program, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala Journal Article 2025 03 04 Non-communicable diseases (NCDs) have been the leading global causes of death and disease burden over the past two decades, but policies and actions to reduce these burdens have been insufficient. Many NCDs are preventable through the implementation of the World Health Organization (WHO) Best Buys – which initially focused on cardiovascular disease, cancer, respiratory disease, and diabetes. Implementing these interventions is complex, requiring transparent and appropriate policy development, policy implementation, and tracking of impact. Barriers to successful implementation are multiple and highly contextual, suchcountry fragility, loci of power, and external pressures. Implementation research is required to identify local barriers and develop strategies to optimize policy implementation to maximize success. Success relies on availability of robust data to permit priority setting, especially where resources are limited, and equitable allocation of healthcare resources to tackle the leading burdens of disease in local contexts. Policy-making must look beyond health to ensure a multisectoral approach to enhancing well-being and sustainability. Global solidarity is required to ensure no countries and no diseases are left behind.

https://www.ijhpm.com/article_4795_48a95c3448391c5ad3028fbdaade1bda.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Collaboration and Governance in Integrated Care Systems: A Moroccan Perspective on Lessons From England’s ICS; Comment on “New Ways of Working to Manage and Improve Quality in Integrated Care Systems in England” 1 3 4809 10.34172/ijhpm.9299 EN Abdeslam Baalla Interdisciplinary Research Laboratory in Economics, Finance and Organizational Management, Faculty of Law, Economic and Social Sciences, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco Tarik Jellouli Interdisciplinary Research Laboratory in Economics, Finance and Organizational Management, Faculty of Law, Economic and Social Sciences, Sidi Mohamed Ben Abdellah University of Fez, Fez, Morocco Journal Article 2025 07 02 Lalani et al explores how integrated care systems (ICSs) in England are redefining quality management through collaboration, co-production, and a focus on population health. This commentary examines the relevance of these principles for Morocco, where universal health coverage (UHC), the expansion of social protection, and Territorial Health Groups (GSTs, Groupements Sanitaire Territoriaux) aim to improve care coordination and reduce health inequalities. ICS-inspired strategies could strengthen Moroccan reforms by promoting decentralized governance, community engagement, and co-production, with GSTs serving as regional coordination platforms. However, financial constraints, centralized institutions, and political pressures to prioritize visible outcomes require local adaptation. Strengthening regional quality committees, addressing social determinants, and empowering community health workers (CHWs) could help align Morocco’s reforms with ICS principles.

https://www.ijhpm.com/article_4809_7294d140a69f19cab7c5603d9a2defe2.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Supporting Healthcare Workers on the Frontline of Conflicts; Comment on “Human Resources for Health in Conflict Affected Settings: A Scoping Review of Primary Peer Reviewed Publications 2016–2022” 1 4 4810 10.34172/ijhpm.9457 EN Andrew MY Lim Emergency Department, Prince of Wales Hospital, Hong Kong SAR, China Kevin KC Hung Emergency Department, Prince of Wales Hospital, Hong Kong SAR, China Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Chinese University of Hong Kong, Hong Kong SAR, China Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong SAR, China Chi Shing Wong Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Chinese University of Hong Kong, Hong Kong SAR, China Chunlan Guo Department of Geography and Resource Management, Chinese University of Hong Kong, Hong Kong SAR, China Joyce TK Ching Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Chinese University of Hong Kong, Hong Kong SAR, China Emily YY Chan Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Chinese University of Hong Kong, Hong Kong SAR, China Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong SAR, China Colin A. Graham Emergency Department, Prince of Wales Hospital, Hong Kong SAR, China Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), Chinese University of Hong Kong, Hong Kong SAR, China Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong SAR, China Journal Article 2025 09 10 The rising trend of conflict-related deaths, the repeated attacks on healthcare facilities, and violations of the International Humanitarian Law (IHL) seen in recent conflicts are not only worrying but also deserve our collective attention and efforts. The scoping review on human resources for health in conflict-affected settings (CAS) from 2016 to 2022 by Onvlee and colleagues provides a timely reminder of the need for immediate relief and the longer-term support needed to provide healthcare in these extremely challenging settings. In this article, we reflect and elaborate on some of the key findings from Onvlee et al, including attacks on healthcare, the performance of healthcare workers (HCWs), and long-term strategic planning for the health workforce in CAS.

https://www.ijhpm.com/article_4810_c109cfd7a8e9c00ce2133fc31ec846ac.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Lost in Green Transformation; Comment on “A Review of the Applicability of Current Green Practices in Healthcare Facilities” 1 4 4813 10.34172/ijhpm.9222 EN Anna K.S. Von Eiff Independent Researcher, Münster, Germany Wilfried Von Eiff Center for Hospital Management, University of Münster, Münster, Germany Center for Health Care Management and Regulation, HHL Leipzig Graduate School of Management, Leipzig, Germany Kerckhoff Clinic, Heart-Lung Center, Bad Nauheim, Teaching Hospital of the University Clinic Gießen-Marburg, Gießen, Germany Journal Article 2025 05 17 This commentary refers to the scoping review “A Review of the Applicability of Current Green Practices in Healthcare Facilities” by Soares et al and intents to bring in additional aspects influencing the green transformation in healthcare and to propose concrete means that could be helpful to move forward towards carbon footprint reduction as well as resource saving. The authors aim to help to identify how circular economy (CE) can be implemented in current hospitals. Following up on this, we would like to enrichen the discussion by three thematic areas we pose as questions: (1) Is the green transformation a prominent part of the strategic agenda of hospital? (2) What impact on the green transformation is caused by legal interventions? (3) Which concrete means help to achieve carbon footprint reduction, resource saving and have a self-financing capability? Our comment is based on practical experience with green pilot projects in German hospitals.

https://www.ijhpm.com/article_4813_2bb9c81bec5918a705f234d1ab3089b7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Rethinking Reallocations: Conceptual Limits of the Market Activity Index as a Measure of Competition and Purchasing; Comment on “Measuring Active Purchasing in Healthcare: Analyzing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands” 1 3 4814 10.34172/ijhpm.9322 EN Misja C. Mikkers Health Technology and Services Research (HTSR), Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, Enschede, The Netherlands Centre for Healthcare Operations Improvement and Research, University of Twente, Enschede, The Netherlands Journal Article 2025 07 14 Stadhouders et al1 introduce the Market Activity Index (MAI) to assess the performance of healthcare systems, concluding that low budget reallocations in the hospital sector cast doubt on the effectiveness of managed competition and purchasing. We argue that while the MAI is a valuable descriptive tool, its interpretation as a proxy for competition is conceptually problematic. The index captures realized revenue flows, which may result from patient mobility, exogenous shocks, or administrative changes, rather than insurer behavior. Furthermore, selective contracting may be used for objectives such as risk selection rather than provider efficiency, particularly in segments of the market with low utilization. Without a normative benchmark or ability to disentangle strategic from structural effects, the MAI risks conflating system dynamics with market failure. We conclude that the MAI is best viewed as a measure of budgetary volatility, not a standalone indicator of competitive intensity or purchaser effectiveness.

https://www.ijhpm.com/article_4814_f4fb169e565b7532ec7c5e1af1bb7d6a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Reflections on Corporate Political Activity Taxonomies in the Context of Non-communicable Diseases and Mental Health; Comment on “Corporate Political Activity: Taxonomies and Model of Corporate Influence on Public Policy” 1 4 4815 10.34172/ijhpm.9124 EN Téa Collins Department of Noncommunicable Diseases and Mental Health, World Health Organization, Geneva, Switzerland Amanda Karapici Department of Noncommunicable Diseases and Mental Health, World Health Organization, Geneva, Switzerland Journal Article 2025 03 29 This commentary examines Ulucanlar et al1 taxonomies on corporate political activity (CPA) through the lens of non-communicable diseases (NCDs) and mental health. While the study provided a useful framework for understanding harmful corporate strategies impacting public health, this commentary offers further insights into the applicability of these taxonomies to the NCD and mental health agendas. In addition, it proposes priorities for future research to explore how political ideologies and economic structures shape unhealthy commodity industry’s (UCI’s) influence on NCD policies, investigate industry funding of science and professional training, overcome the barriers to implementing the World Health Organization (WHO) “Best Buy” interventions,2 and improve governance mechanisms for multisectoral and multistakeholder coordination. This commentary underscores the importance of tailoring NCD policy responses to the unique challenges posed by UCIs while fostering accountable engagement with the broader private sector.

https://www.ijhpm.com/article_4815_f042a81634cc5af49976e167f840d774.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 From Registry to Reality: Opportunities to Enhance Post-market Surveillance of High-Risk Medical Devices; Comment on “Quality and Utility of European Cardiovascular and Orthopaedic Registries for the Regulatory Evaluation of Medical Device Safety and Performance Across the Implant Lifecycle: A Systematic Review” 1 3 4817 10.34172/ijhpm.9446 EN Jessica N. Holtzman Division of Cardiology, University of California, San Francisco, CA, USA Rita F. Redberg Division of Cardiology, University of California, San Francisco, CA, USA Journal Article 2025 09 14 Both the US Food and Drug Administration (FDA) and European Medical Device Regulation maintain the authority to require post-market surveillance for novel, high-risk medical devices. Yet, the current post-market surveillance system has several limitations. In their systematic review, Hoogervorst and colleagues highlight opportunities for improvement in the European medical device registries for the cardiovascular and orthopedic fields by standardised reporting of structural and methodological characteristics. Currently, there is heterogeneity in the governance, data collection, data reporting, and auditing of post-market surveillance registries, which limits their utility. Innovation in post-market surveillance mechanisms should include developing consensus around standardized safety outcomes by health condition, using artificial intelligence to identify patterns of harm in large or unstructured databases, continuing to invest in active surveillance networks to ensure the safety and effectiveness of high-risk medical devices, and educating physicians and care providers around adverse event reporting mechanisms. More resources and prioritization of post-market surveillance globally is needed to prioritize patient safety.

https://www.ijhpm.com/article_4817_51e653bb125f812457e8dbce151efdc0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 What Defines an Age-Friendly Health System?; Comment on “Developing a Conceptual Framework for an Age-Friendly Health System: A Scoping Review” 1 4 4816 10.34172/ijhpm.9374 EN Margaret Wallhagen Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA Journal Article 2025 08 17 To address some of the changing needs of the increasing number of older adults, theories and conceptual frameworks designed to make environments and healthcare settings more welcoming to, and supportive of, older adults, have been proposed. Most recently, significant attention has been given to the concept of an “age-friendly health system.” While the concept of age-friendly environments is not new, how such environments are operationalized varies, few data are available on outcomes, and there remains debate about the essential nature of key components of an age-friendly environment. This commentary discusses the conceptual framework proposed by Karami and colleagues published in the 2023 edition of the International Journal of Health Policy and Management. Questions are raised about the meaning of age-friendly and how it can be integrated into a life-span perspective of health.

https://www.ijhpm.com/article_4816_712f2e99d361f3290d621a21e8605475.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 How to Disrupt Harmful Corporate Political Activity?; Comment on “Corporate Political Activity: Taxonomies and Model of Corporate Influence on Public Policy” 1 6 4818 10.34172/ijhpm.9118 EN Luc L. Hagenaars Amsterdam Public Health, Amsterdam, The Netherlands Public & Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands Joreintje D. Mackenbach Amsterdam Public Health, Amsterdam, The Netherlands Epidemiology & Data Science, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands Upstream Team, Amsterdam UMC, Amsterdam, The Netherlands Journal Article 2025 03 27 Ulucanlar and colleagues’ model of corporate political activity by unhealthy commodity industries identifies cross-industry framing and actions that block public health policies. While the model helps to understand policy inertia around the prevention of commercially-driven diseases, it needs expansion into broader theories on policy change and framing to help understand how policy breakthroughs can be achieved. We substantiate this viewpoint by introducing four established policy theories, and by situating Ulucanlar and colleagues’ model within our application of the Punctuated Equilibrium Theory (PET), a theory that explicitly focuses on disruption of policy inertia. We outline how Ulucanlar and colleagues’ taxonomy can help investigate the strength of an industry’s policy monopoly and identify when and how an industry’s power might be crumbling. We further situate Ulucanlar and colleagues’ model within the concept of metaphorical framing, arguing that more robust grounding of the model in frameworks on morality can effectively challenge framing strategies of unhealthy commodity industries.

https://www.ijhpm.com/article_4818_05ccefde8f9845fb289fed3a07351f90.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Establishing a Dedicated Fund to Improve Patient Access to Cancer Medicines: Key Considerations and Policy Implications for Thailand; Comment on “Scoping Review of International Experience of a Dedicated Fund to Support Patient Access to Cancer Drugs: Policy Implications for Thailand” 1 4 4819 10.34172/ijhpm.9153 EN Jong Hyuk Lee College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea Journal Article 2025 04 14 Thai policy-makers should carefully design a well-structured, managed-access cancer drug fund (CDF) that aligns with the country’s socioeconomic system and complements existing institutional and policy frameworks. Developing this framework requires a clear and evidence-based definition of innovative cancer drugs, grounded in measurable clinical benefits such as overall survival (OS) and cost-effectiveness. It also requires careful consideration of alternative policies to address the challenges posed by high-priced cancer drugs. In addition, strategies are needed to incorporate cost-ineffective yet life-saving drugs with no therapeutic alternatives into the healthcare system in a fair and transparent manner. It also requires rigorous evaluation of the effectiveness of the CDF, supported by empirical evidence and underpinned by robust operational and data governance frameworks. Such a framework could serve as a foundation for Thailand’s future efforts to balance innovation, affordability, and equity in cancer care.

https://www.ijhpm.com/article_4819_05ed9c6b81671b99d0f67ef5736ad9a1.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Advancing Nurse Practitioner Integration in Health Systems: Contextualizing Porat-Dahlerbruch’s Taxonomy for Global Adaptation; Comment on “Development of a Taxonomy of Policy Interventions for Integrating Nurse Practitioners Into Health Systems” 1 4 4820 10.34172/ijhpm.9398 EN Doris Grinspun Registered Nurses’ Association of Ontario (RNAO), Toronto, ON, Canada Journal Article 2025 08 11 This commentary examines the contribution of Porat-Dahlerbruch and colleagues’ taxonomy of policy interventions for integrating nurse practitioners (NPs) into health systems. Developed through stakeholder interviews in Israel, the taxonomy proposes a structured, multi-level framework—macro, meso, and micro—for guiding NP integration. It bridges the gap between theory and practice, providing policy-makers, educators, administrators, and researchers with a practical, evidence-informed tool for reform. The commentary highlights the taxonomy’s alignment with global implementation frameworks and identifies opportunities for further development, including cross-national validation, end-user engagement, robust evaluation metrics, digital health integration, and explicit equity strategies. By embracing these opportunities, the taxonomy can evolve into a global resource for strengthening NP roles and advancing interprofessional collaboration. As NPs become increasingly essential to primary and advanced care, especially in underserved settings, strategic integration is imperative for building resilient and equitable health systems.

https://www.ijhpm.com/article_4820_3ab03ea013632de13f795b31f1de831a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Bridging Levels of Influence: Insights on Policies for Integrating Nurse Practitioners Into Health Systems; Comment on “Development of a Taxonomy of Policy Interventions for Integrating Nurse Practitioners Into Health Systems” 1 4 4821 10.34172/ijhpm.9270 EN Efrat Shadmi The Cheryl Spencer Dapartment of Nursing, The Azrieli Advanced Nursing Center, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel Ruth Palan Lopez William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA Journal Article 2025 06 09 A taxonomy of policy interventions for integrating nurse practitioners (NPs) into health systems is a valuable tool for addressing implementation barriers across macro (policy), meso (organizational), and micro (clinical) levels. In this commentary we highlight how academic institutions serve as vital conduits between policy, education, and clinical implementation. We explore the role of universities in aligning NP workforce development with system needs through research, interprofessional training, and policy engagement. We highlight macro–meso mismatches, particularly when educational capacity outpaces organizational readiness to employ NPs. Advancing NP roles requires coordinated efforts across sectors, and academia, through evidence generation, cross-level engagement, and training innovation, plays a central role in operationalizing the taxonomy and strengthening the contribution of advanced nurses to healthcare systems. Nonetheless, we recognize that academic institutions can at times be inflexible and therefore suggest considering hybrid academic-professional training structures. We conclude with a set of recommendations for research and policy.

https://www.ijhpm.com/article_4821_b18af8acb6f02bfc602a44f7c0c29cdc.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Optimizing Performance Monitoring of Value-Based Healthcare: The Role of Generic Patient Population Dashboards; Comment on “Reflections on Managing the Performance of Value-Based Healthcare: A Scoping Review” 1 5 4822 10.34172/ijhpm.9251 EN Marieke Sijm-Eeken Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands Jurrien Burren Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands Céline Van Lint Department of Quality and Patient Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands Journal Article 2025 05 31 Value-based healthcare (VBHC) provides a framework for enhancing health outcomes relative to costs, however its implementation depends on robust and inclusive performance monitoring systems. In their recent scoping review, van Elten et al examined the role of performance management in VBHC but adopted a narrow focus on patient-perceived outcomes. This commentary extends their findings by highlighting two key recommendations: expanding performance measurement beyond patient-perceived value to include provider experience, innovation, and transparency, and implementing generic patient population dashboards to streamline VBHC monitoring. Drawing on practical implementation experience at Dutch academic hospitals, we propose broadening literature search criteria to include cross-organizational studies and grey literature from established VBHC organizations. Furthermore, we outline criteria—identified through co-design sessions with healthcare professionals—for selecting generic indicators and designing dashboards that support efficient, organization-wide VBHC monitoring. These insights seek to enhance the theoretical and practical understanding of VBHC monitoring while promoting the advancement of transparent, value-driven healthcare systems.

https://www.ijhpm.com/article_4822_873bdb61ea74857d6bb6de3994696b05.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Narrative Preparedness; A Response to Recent Commentary 1 2 4701 10.34172/ijhpm.9001 EN Eivind Engebretsen Sustainable Health Unit, University of Oslo, Oslo, Norway Mona Baker Sustainable Health Unit, University of Oslo, Oslo, Norway 0000-0001-5724-6229 Journal Article 2025 01 21

https://www.ijhpm.com/article_4701_8e0c0aea2569f7029bb4dffa805594f3.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 From Transaction to Transformation: Building Trust in Health Systems; A Response to Recent Commentaries 1 2 4737 10.34172/ijhpm.9188 EN Martin McKee Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK May CI Van Schalkwyk Centre for Pesticide Suicide Prevention, University of Edinburgh, Edinburgh, UK Rachel Greenley Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK Govin Permanand Division of Country Health Policies and Systems, World Health Regional Office for Europe, Copenhagen, Denmark Journal Article 2025 04 29

https://www.ijhpm.com/article_4737_4ef2cdd9abadcde533ba8c7e539b76aa.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 From Aspiration to Action: Aligning the Pandemic Agreement with Equity in Vaccine Access; A Response to Recent Commentaries 1 2 4738 10.34172/ijhpm.9192 EN Luciana Correia Borges School of Public Health, University of Nevada, Reno, Reno, NV, USA Henrique Zeferino De Menezes Department of International Relations, Federal University of Paraiba, João Pessoa, Brazil Eric Crosbie Ozmen Institute for Global Studies, University of Nevada, Reno, Reno, NV, USA Journal Article 2025 05 03

https://www.ijhpm.com/article_4738_e64a39caf94a3ab65640dbbcb3894526.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 More Than a Watchdog: Harnessing State, Civil Society and Academia to Tackle Unhealth Commodity Industries; A Response to Recent Commentaries 1 3 4756 10.34172/ijhpm.9260 EN Elizabeth Bennett College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia Stephanie M. Topp College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia Alan Rob Moodie Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia Journal Article 2025 06 04

https://www.ijhpm.com/article_4756_c22672ff2f86b77dc055660e14a20fae.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Well-Being Economies: A Harder but Still Important Health Advocacy Goal; A Response to Recent Commentaries 1 2 4761 10.34172/ijhpm.9311 EN Ronald Labonté School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada Journal Article 2025 06 29

https://www.ijhpm.com/article_4761_566f2ab0597b6dd4f10a9a21abf836ae.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Reinforcing the Research Coproduction Impact Pathway: A Response to Recent Commentaries 1 2 4760 10.34172/ijhpm.9302 EN Chris McCutcheon Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada Ian D. Graham School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada Anita Kothari School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada Jo Rycroft-Malone Faculty of Health and Medicine, Lancaster University, Lancaster, UK Journal Article 2025 06 28

https://www.ijhpm.com/article_4760_70e6bf9754b3475570e2afa102b77d14.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Blueprints for Change: Integrating Systems Thinking into Musculoskeletal Health Policy; A Response to Recent Commentaries 1 3 4782 10.34172/ijhpm.9387 EN Carmen Huckel Schneider Leeder Centre for Health Policy, Economics and Data, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia Helen Slater Curtin School of Allied Health, and enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia Deborah Kopansky-Giles Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada Lyn March Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, NSW, Australia Sarika Parambath Leeder Centre for Health Policy, Economics and Data, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia Saurab Sharma Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia James J. Young Center for Muscle and Joint Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada Swatee Jain Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia Andrew M. Briggs Curtin School of Allied Health, and enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia Journal Article 2025 08 06

https://www.ijhpm.com/article_4782_c78359a36ab965770ca33264f4217112.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 27 Next Frontiers in Embedded Research Career Pathways; A Response to Recent Commentaries 1 3 4825 10.34172/ijhpm.9680 EN Meghan McMahon Canadian Institutes of Health Research, Institute of Health Services and Policy Research, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Bahar Kasaai Canadian Institutes of Health Research, Institute of Population and Public Health, Montréal, QC, Canada 0000-0001-7264-7151 Rhonda Boateng Canadian Institutes of Health Research, Institute of Health Services and Policy Research, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Nida Shahid Canadian Institutes of Health Research, Institute of Health Services and Policy Research, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada 0000-0002-8627-6483 Richard H. Glazier Canadian Institutes of Health Research, Institute of Health Services and Policy Research, Toronto, ON, Canada Institute of Clinical Evaluative Sciences, Toronto, ON, Canada MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada University of Toronto Department of Family and Community Medicine, Toronto, ON, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada Journal Article 2025 12 07

https://www.ijhpm.com/article_4825_e7ea82cb0aa236ed4063bf935ab94a0f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 How Can We Prevent a Resurgence of Vaccine Nationalism? 1 4 4735 10.34172/ijhpm.9038 EN Qi Shao Department of Situation and Policy, Huaibei Normal University, Huaibei, China 0000-0003-1322-9886 Journal Article 2025 02 15

https://www.ijhpm.com/article_4735_147981a472d2c34e095baeb286c65d5b.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Mapping Global Voices for Empowering Informal Healthcare Providers to Build a Sustainable Community-Based Primary Healthcare Model in Low- and Middle-Income Countries (LMICs) 1 4 4730 10.34172/ijhpm.8859 EN Dhiman Debsarma Council for Social Development, New Delhi, India Sourindra Mohan Ghosh Council for Social Development, New Delhi, India Bikramaditya Kumar Choudhary Jawaharlal Nehru University, New Delhi, India Journal Article 2024 10 20

https://www.ijhpm.com/article_4730_9cd4007665c220282894e064427cdfbe.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Kenya’s Healthcare Crisis: Consequences of Delayed Deployment of Medical and Dental Graduates to Internship Centres 1 4 4772 10.34172/ijhpm.9034 EN Kosasia O’Neil Wamukota AIC Kijabe Hospital, Kijabe, Kenya Journal Article 2025 02 12

https://www.ijhpm.com/article_4772_e57223508961cdc5c6cc804298870fae.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Antiretroviral Therapy-Associated Weight Gain in Mexico, a Country Prone to Comorbidities 1 4 4771 10.34172/ijhpm.9004 EN Andrés Tapia-Maltos Plan de Estudios Combinados en Medicina (PECEM), Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico Brenda Crabtree-Ramírez Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico Journal Article 2025 01 22

https://www.ijhpm.com/article_4771_1e4a0a437989b771bb1d6bc64e0854c9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Comprehensive National Strategy for HPV Prevention and Treatment in Iran 1 3 4773 10.34172/ijhpm.9020 EN Shahabodin Babaeifard Department of Oral and Maxillofacial Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Maryam Barkhordar Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran Leyla Sharifi Aliabadi Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran Mohadese Marzban Independent researcher, Tehran, Iran Hossein Rouzbahani Independent researcher, Tehran, Iran Ghazal Razani Hematologic Malignancies Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran Ghasem Janbabai Cell Therapy and Hematopoietic Stem Cell Transplantation Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran Journal Article 2025 02 06

https://www.ijhpm.com/article_4773_7b70d289f73ef73e7a80f92ef3893f87.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Towards a Sustainable Healthcare System: A Concept Paper for a National Hybrid Financing Model for Malaysia 1 6 4788 10.34172/ijhpm.9223 EN Mohd Arshil Moideen Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia Wan Nadiah Wan Mohd Abdullah Yaakob Independent Researcher, Kuala Lumpur, Malaysia Khasnur Abd Malek Primary Care Medicine Department, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia Journal Article 2025 05 18

https://www.ijhpm.com/article_4788_6cbd8e71ce7d91b12ae2b343683ba8fa.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 The Public Health Perils of Search Engine Marketing: Insights for Research and Regulation 1 4 4793 10.34172/ijhpm.9180 EN Alessandro R. Marcon Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada Marco Zenone Health Law Institute, Faculty of Law, University of Alberta, Edmonton, AB, Canada Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada Journal Article 2025 04 24

https://www.ijhpm.com/article_4793_0cbd519cd76a953915f68443763ae42f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 How Can We Witness the Publication of Ethical Research in the Future? A Viewpoint 1 4 4791 10.34172/ijhpm.9254 EN Sara Dakhesh Department of Medical Library and Information Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran Shahnaz Khademizadeh Department of Knowledge and Information Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran Abdolhossein Farajpahlou Department of Knowledge and Information Science, Shahid Chamran University of Ahvaz, Ahvaz, Iran Hamid Farhadirad Department of Educational Science, Faculty of Education and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran Journal Article 2025 06 01

https://www.ijhpm.com/article_4791_7bd9414723dd5d9f9f6ca22c57cdd356.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Geopolitical Malpractice and the Health Toll of Western Military Interventions in the Eastern Mediterranean Region 1 5 4792 10.34172/ijhpm.9314 EN Mohammad Karamouzian Centre On Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Journal Article 2025 07 09

https://www.ijhpm.com/article_4792_9e03c14c6027ace33ae16bc953e89b7d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 A Causal Layered Analysis of Oral Health Disparities and Policy Strategies for Vulnerable Iranian Populations 1 5 4803 10.34172/ijhpm.9245 EN Shervan Shoaee Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Kerman Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran Afshin Sarafinejad Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Clinical Informatics Research and Development Lab, Clinical Research Development Unit, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran Journal Article 2025 05 27

https://www.ijhpm.com/article_4803_bcd14f14a2c319b1b37e81b76897e8da.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Professional Development of Nurse Anesthetists in China 1 5 4804 10.34172/ijhpm.9083 EN Xi Zhang Kiang Wu Nursing College of Macau, Macau SAR, China School of Nursing, Hunan Normal University, Changsha, China Aimei Mao Kiang Wu Nursing College of Macau, Macau SAR, China Journal Article 2025 03 13

https://www.ijhpm.com/article_4804_c9af0b02f007c9c91064abfba440f3e7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Building Parental Trust in Childhood Vaccination: Lessons From Iran’s COVID-19 Response 1 3 4807 10.34172/ijhpm.8960 EN Shahin Mafinezhad Department of Pediatrics, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran Zainab Alimoradi Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran Hasan Namdar Ahmadabad Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran Journal Article 2024 12 18

https://www.ijhpm.com/article_4807_8f5948ced42b86262d357ad558a5c2c0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 27 Replenishing Hope: The Time for Country-Led Integration Is Now 1 3 4824 10.34172/ijhpm.9284 EN Nicola Watt Deutsche Gesellschaft für Internationale Zusammenarbeit, Bonn, Germany Diana Yousef Global Institute for Disease Elimination, Abu Dhabi, UAE Alan Brooks Bridges to Development, Geneva, Switzerland 0000-0002-4666-1934 Elizabeth Juma World Health Organization Africa Regional Office, Brazzaville, Congo 0000-0003-3157-2637 Kristin Saarlas Task Force for Global Health, Decatur, GA, USA Kazim Sanikullah World Health Organization Western Pacific Regional Office, Manila, Philippines Magid Al-Gunaid Eastern Mediterranean Public Health Network, Amman, Jordan Michael Byrne The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland Melanie Renshaw African Leaders Malaria Alliance, Dar es Salaam, Tanzania Simon Bland Global Institute for Disease Elimination, Abu Dhabi, UAE Ngozi A. Erondu Global Institute for Disease Elimination, Abu Dhabi, UAE Journal Article 2025 06 24

https://www.ijhpm.com/article_4824_97219c33c94dae4d7c414af714bfc4fa.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 First They Came for Science 1 2 4721 10.34172/ijhpm.9035 EN Mohammad Karamouzian Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Journal Article 2025 02 12

https://www.ijhpm.com/article_4721_4e769e8afb0e367f8873a60d81d5a687.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Health Transformation Plan for Universal Health Coverage in Iran: Reflections From the Past 1 2 4724 10.34172/ijhpm.8817 EN Sameen Siddiqi Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan Journal Article 2024 09 23

https://www.ijhpm.com/article_4724_162b08dcd379c67efc47bfcd5028f135.pdf

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Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 14 1 2025 12 01 Practice of Offering a Small Pouch of Tobacco for Free With a Big Pouch of Pan Masala: A Strategic Move to Circumvent Gutkha Regulations 1 2 4823 10.34172/ijhpm.9537 EN Vinay Kumar Gupta Department of Public Health Dentistry, King George’s Medical University, Lucknow, India Nishita Kankane Department of Public Health Dentistry, King George’s Medical University, Lucknow, India Seema Malhotra Community Health Centre, Lucknow, India Journal Article 2025 10 13

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