Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Scholasticide and Population Health in the Eastern Mediterranean 1 8 4871 10.34172/ijhpm.10011 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 0000-0002-5631-4469 Martin McKee London School of Hygiene and Tropical Medicine, London, UK 0000-0002-0121-9683 Ruth Gibson Stanford University School of Medicine, Palo Alto, CA, USA 0009-0006-8697-312X Karl Blanchet Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland 0000-0003-0498-8020 Fouad Fouad Liverpool School of Tropical Medicine, Liverpool, UK 0000-0002-4124-4058 Roojin Habibi Faculty of Law, University of Ottawa, ON, Canada 0000-0001-7948-0438 AliAkbar Haghdoost Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran 0000-0003-4628-4849 Wahid Majrooh Geneva Centre of Humanitarian Studies, Faculty of Medicine, University of Geneva, Geneva, Switzerland Afghanistan Center for Health and Peace Studies (ACHPS), Geneva, Switzerland Maziar Moradi-Lakeh Institute of Tropical Aquaculture and Fisheries (AKUATROP), Universiti Malaysia Terengganu, Terengganu, Malaysia 0000-0001-7381-5305 Sameen Siddiqi Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan 0000-0001-8289-0964 Dan Werb Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, USA 0000-0003-0614-9386 Vahid Yazdi-Feyzabadi Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran 0000-0002-8009-470X Iman Nuwayhid Department of Environmental Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon 0000-0002-5192-5324 Reza Majdzadeh School of Health and Social Care, University of Essex, Colchester, UK 0000-0001-8429-5261 Journal Article 2026 05 01 The systematic destruction of academic infrastructure, termed scholasticide, has been normalised across the Eastern Mediterranean Region (EMR) over more than two decades. The doctrine has operated through two coexisting modalities: the targeted assassination of individual scholars and the physical destruction of institutions, escalating in scale from selective killings and partial looting to the dismantling of entire academic systems. Drawing on evidence from several EMR countries, we describe a causal cascade through which acute military strikes and chronic structural exclusion, including sanctions, platform over-compliance, and visa barriers, produce generational health workforce depletion, disrupt core public health functions, and cause population-level health harms. We argue that academic institutions constitute a distinct, upstream structural determinant of population health whose destruction is an attack on health systems, not merely on education. We propose five categories of action, implemented through standing regional and international mechanisms, to protect academic infrastructure across the EMR whenever and wherever it is attacked.

https://www.ijhpm.com/article_4871_a9c397afa342c368ba24e7620ee41a94.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 The World Medical Association: The Voice of Physicians in the Turbulence Between Ethical Rigor and Geopolitical Imperatives 1 7 4882 10.34172/ijhpm.9649 EN Meriem Gaddas Research Laboratory LR12SP09 ‘Heart Failure,’ Farhat HACHED University Hospital, Sousse, Tunisia Department of Physiology and Functional Explorations, Farhat HACHED University Hospital, Sousse, Tunisia Faculty of Medicine ‘Ibn el Jazzar’ of Sousse, University of Sousse, Sousse, Tunisia 0000-0002-8836-767X Helmi Ben Saad Research Laboratory LR12SP09 ‘Heart Failure,’ Farhat HACHED University Hospital, Sousse, Tunisia Department of Physiology and Functional Explorations, Farhat HACHED University Hospital, Sousse, Tunisia Faculty of Medicine ‘Ibn el Jazzar’ of Sousse, University of Sousse, Sousse, Tunisia 0000-0002-7477-2965 Journal Article 2025 12 02 This editorial examined the enduring ties between medicine and political power, highlighting how the World Medical Association (WMA) arose in response to recurring ethical crises involving physicians. Created after the Second World War alongside new international institutions, the WMA aimed to protect professional autonomy and defend medical neutrality. Over the decades, it has acted as an ethical counterbalance within global health governance, especially through collaboration with the World Health Organization (WHO). Yet history shows that political pressures have repeatedly compromised medical practice, generating dual-loyalty dilemmas, human rights violations, and scandals that erode public trust. The WMA has sometimes responded firmly—suspending national associations, issuing statements during conflicts, or challenging unethical state policies—though its actual influence remains contested. Internal political divisions have often slowed or limited its actions. Today’s (ie, mid-March 2026) severe degradation of health systems in conflict zones reinforces the need to renew core ethical principles through collective responsibility and vigilance.

https://www.ijhpm.com/article_4882_c348616cd8a86ee661c7c98800678fad.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Applications of the Kirkpatrick Model in Post-secondary Health Sciences Education: A Scoping Review 1 14 4853 10.34172/ijhpm.8857 EN Natasha L. Gallant Department of Psychology, Faculty of Arts, University of Regina, Regina, SK, Canada 0000-0002-1915-2106 Elizabeth Oddone Paolucci Departments of Community Health Sciences and Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada 0000-0002-2446-5270 Chelsea L. Russill Department of Psychology, Faculty of Arts, University of Regina, Regina, SK, Canada Ray Jewett Department of Geography and Planning, University of Toronto, Toronto, ON, Canada Ontario Health, Toronto, ON, Canada 0000-0002-8389-6767 Chantelle Recsky School of Nursing, Faculty of Applied Sciences, University of British Columbia, Vancouver, BC, Canada 0000-0002-5570-1563 Katherine Ford Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada 0000-0002-8620-9360 Dina Idriss-Wheeler Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada 0000-0003-1767-2471 Victrine Tseung School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada Hina Ansari MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada Zeenat Ladak Department of Applied Psychology & Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada 0000-0001-8904-3186 Aida Fernandes IMAGINE Network SPOR, McMaster University, Hamilton, ON, Canada Deborah A. Marshall Departments of Community Health Sciences and Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada 0000-0002-8467-8008 Journal Article 2024 10 18 Background The Kirkpatrick model is commonly used as a systematic approach to evaluate training programs, although its application to health sciences experiential learning programs is not well-established. To inform the use of the Kirkpatrick model in the evaluation of the Canadian Institutes of Health Research’s (CIHR’s) Health System Impact Fellowship National Cohort Training Program (HSIF NCTP), we examined its application in post-secondary health sciences programs. Methods Using the Joanna Briggs Institute’s updated methodology for scoping reviews, we searched CINAHL, EMBASE, ERIC, MEDLINE, PsycINFO, and Web of Science for studies published from 2017 to 2023 that focused on health sciences experiential learning programs held at universities and reported on at least one level of the Kirkpatrick model (ie, reaction, learning, behavior, results). We extracted data on study characteristics and reported outcomes for each of the Kirkpatrick model levels. Results After deduplication, we screened 755 titles and abstracts, we reviewed 97 full texts, and we included 34 studies in our scoping review. Many studies reported outcomes at the reaction or learning levels followed by the behaviour and results levels. Across levels, despite identifying several areas of improvement, learners typically reported favourable perceptions, increased confidence and knowledge, improved performance, and organizational improvements. Conclusion The Kirkpatrick model is a widely used and highly adaptable evaluation model that has been successfully used to evaluate a range of post-secondary health sciences programs. Despite its wide use, evaluators using the Kirkpatrick model should use more robust methodologies to capture long-term behaviour and results associated with the programs. Future work should focus on evaluating a broader spectrum of programs such as doctoral- and postdoctoral-level experiential learning programs and underrepresented healthcare professions such as psychologists and dieticians. Integration of behaviour change and implementation science methodologies within the broader educational evaluation literature is also needed.

https://www.ijhpm.com/article_4853_812214fb8e7066bfa6e32c626c2c688b.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Home Healthcare in South Korea: A Literature Review on Access, Quality, and Cost 1 15 4855 10.34172/ijhpm.9207 EN Dae Hyun Kim Department of Health Management Policy, Georgetown University, Washington, DC, USA 0009-0009-4668-5117 Douglas A. Jones Department of Business Administration, Auburn University at Mongomery, Montgomery, AL, USA Claudia Guerrazzi Young Massey College of Business, Belmont University, Nashville, TN, USA 0000-0002-8020-1202 Radhika Amin School of Medicine, Georgetown University, Washington, DC, USA 0009-0001-9854-940X Journal Article 2025 05 11 Background South Korea faces significant healthcare challenges due to its rapidly aging population, necessitating alternative care models to hospital-based systems. In response, home healthcare has emerged as a promising strategy to support aging in place while maintaining care continuity and system sustainability. Methods This literature review examines home healthcare in South Korea through the lens of healthcare access, quality, and cost, which are the three dimensions of the “Iron Triangle.” Online databases were used to identify papers published from 2010 to 2025, from which 39 documents were selected which examine the impact of home healthcare in South Korea, specifically in terms of access, quality, or cost. Results Results indicate that home healthcare effectively addresses healthcare access disparities, especially for elderly and disabled populations, by overcoming geographic and mobility barriers through integrated care models and remote technologies. Quality of care is enhanced through patient-centered approaches, multidisciplinary collaboration, and proactive home visits, leading to improved clinical outcomes and higher patient satisfaction. Economically, home healthcare demonstrates potential cost savings by reducing hospitalizations and emergency care usage, particularly for patients with chronic conditions and high utilization patterns. Conclusion Sustainability remains contingent upon effective reimbursement and resource allocation policies. Policy implications include expanding healthcare infrastructure, investing in caregiver training, adopting advanced technologies to maximize the effectiveness of home healthcare, and promoting a sustainable and equitable healthcare system in South Korea. Strategic integration of home healthcare within national insurance and long-term care frameworks will be essential to realizing its full system-level benefits.

https://www.ijhpm.com/article_4855_b8a03c5c15fcfa8dae0b03351eb1742f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 The Impact of Rural Clinical Placements on Medical Students’ Career Choices: A Systematic Review 1 11 4861 10.34172/ijhpm.9328 EN Marc-Antoine Schirm Public Health Department, Champagne Sud Hospital, Troyes Hospital, Troyes, France 0009-0008-6062-0662 Jan Chrusciel Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France 0000-0002-8364-6506 Maxime Thorigny Department of Neonatology, Reims University Hospital Alix de Champagne, Reims, France 0009-0003-8661-5347 Aline Hurtaud Department of General Practice, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France 0000-0002-7533-9717 Nathalie Bednarek Laboratory REGARDS, Research Unit 6192, University of Reims Champagne-Ardenne, Reims, France 0000-0002-1908-4617 Stéphane Sanchez Public Health Department, Champagne Sud Hospital, Troyes Hospital, Troyes, France Research Unit 3797 VieFra, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France 0000-0002-0925-6948 Journal Article 2025 07 15 Background The uneven distribution of physicians between urban and rural areas remains a significant public health challenge. Rural clinical placements during medical training are increasingly viewed as a potential lever for enhancing the appeal of rural areas. The aim of this systematic review, supported by a meta-analysis, was to evaluate the real impact of rural placements on medical graduates’ decisions to practice in rural locations. Methods A systematic search was conducted across four databases (PubMed, Embase, Web of Science, and Cochrane Library) covering the data available up to June 2024. Included studies evaluated the impact of rural clinical placements on the professional practice location of medical students or early-career physicians. A random-effects meta-analysis was performed to estimate the relative risk (RR) of rural practice. Additional variables analyzed included practice duration, placement length, participants’ rural background, their satisfaction with the placement, and their stated intention to practice in a rural area. Results A total of 62 studies were selected, with 28 contributing to the meta-analysis, encompassing over 330 000 participants. The pooled analysis showed that students who completed a rural placement were more than twice as likely to establish practice in a rural area compared to their non-exposed peers (RR = 2.683; 95% CI [confidence interval]: 2.255–3.192). This effect was further amplified by factors such as rural background, extended placement duration, and a satisfactory placement experience. A key strength of this review is that it synthesizes actual workforce outcomes rather than relying solely on stated intentions. Conclusion Rural clinical placements have a significantly positive impact on the rural practice decisions of earlycareer physicians, particularly when these placements are of extended duration, well-structured, and accessible. Rural placements should be offered both to students from rural backgrounds, who consistently show the strongest effect, and to urban students who may develop an increased interest in rural practice when exposed to long, immersive placements. These findings support the integration of rural placements into a global policy aimed at achieving a more equitable geographic distribution of healthcare professionals. Although the effectiveness of rural placements is already recognized in international frameworks such as the World Health Organization (WHO) guidelines, their implementation remains uneven across countries.

https://www.ijhpm.com/article_4861_933670f1ac8ba969f32989c312faba75.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Federal Funding and Clinical Trial Sponsorship in Pancreatic Cancer From 2003 to 2022 1 5 4842 10.34172/ijhpm.9255 EN Michael A. Mederos Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA 0000-0001-8098-7746 Mark D. Girgis Department of Surgery, University of California, Los Angeles, Los Angeles, CA, USA Journal Article 2025 06 01 Pancreatic cancer remains one of the deadliest malignancies, with a persistently low five-year survival rate. The Recalcitrant Cancer Research Act (RCRA) of 2012 is one example of legislation aimed at accelerating research in highmortality cancers. This study examines long-term trends in federal funding and clinical trial sponsorship for pancreatic cancer over a 20-year period, spanning before and after the RCRA. We conducted a retrospective analysis of National Cancer Institute (NCI) funding data and pancreatic cancer clinical trials registered on ClinicalTrials.gov between 2003 and 2022. Linear regression with pre- and post-2013 comparisons evaluated changes over time. NCI support for pancreatic cancer increased 3.5-fold – from $78 million in 2003 to $250 million in 2022 (inflation-adjusted). The annual growth rate rose from $7.4 million per year before 2013 to $12.2 million per year after 2013. The share of the NCI’s budget allocated to pancreatic cancer also rose from 0.9% to 3.4%, with no significant shift in slope after 2013 (P = .98). Federally-funded clinical trials declined sharply before 2013, decreasing by 2.8% per year, and then stabilized after 2013, with a nonsignificant slope of –0.95% per year (interaction P = .06). Meanwhile, industry-sponsored trials grew substantially, increasing from 30% to nearly 75%, increasing by 2.0% per year after 2013. Findings were consistent in logistic regression models. These findings suggest that while federal investment in pancreatic cancer research has grown, the expansion of clinical trials has been driven largely by industry, suggesting that federal investment has likely been directed toward foundational and preclinical research. Strengthening public-private collaboration and maintaining federal engagement will be critical to ensuring that research advances align with patient-centered goals.

https://www.ijhpm.com/article_4842_c4616f5a24a66668f11ca4fa80525dc4.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 The Role of Organizational Policies and Protocols in Service Providers’ Delivery of Appropriate Services to Sex Trafficked Persons in Canada 1 6 4863 10.34172/ijhpm.8869 EN Janice Du Mont Women’s College Hospital Research & Innovation Institute, Women’s College Hospital, Toronto, ON, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada 0000-0002-4851-1104 Tonia Forte Women’s College Hospital Research & Innovation Institute, Women’s College Hospital, Toronto, ON, Canada 0009-0000-2330-1867 Sarah Daisy Kosa Women’s College Hospital Research & Innovation Institute, Women’s College Hospital, Toronto, ON, Canada Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada 0000-0002-0887-8884 Sheila Macdonald Ontario Network of Sexual Assault/Domestic Violence Treatment Centres, Toronto, ON, Canada 0000-0002-8840-4282 Robin Mason Women’s College Hospital Research & Innovation Institute, Women’s College Hospital, Toronto, ON, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada 0000-0003-3143-6811 Journal Article 2024 10 23 Organizational policies or protocols have been recommended as a potential means of improving sex trafficking services. Therefore, we examined the role of organizational policies or protocols on service providers’ perceptions of challenges in responding to sex trafficked persons. Data were collected using an online, anonymous, national survey between February and August 2023. The healthcare, social, and community service providers surveyed were asked to what extent they agreed or disagreed with the statements, “There are challenges that prevent me from providing the appropriate care, support, or services to sex trafficked persons” and “There are organizational policies or protocols in my place of work that provide guidance on how to respond to sex trafficked persons.” The analysis included 553 respondents, of whom almost three quarters (72.6%) perceived challenges and less than half (44.9%) reported the availability of organizational policies or protocols. Respondents who worked in an organization with policies or protocols were less likely than those who did not to report challenges in responding to sex trafficked persons (40.9% vs. 55.3%, unadjusted odds ratio = 0.56, P = .003; adjusted odds ratio = 0.64, 95% CI = 0.42, 0.96, P = .03). Our findings highlight the importance of implementing organizational policies or protocols that provide guidance on and facilitate the delivery of appropriate care, support, and services to sex trafficked persons. This may better position service providers to address the serious physical, sexual, and mental health sequalae sex trafficked persons experience.

https://www.ijhpm.com/article_4863_2cfa8f9e50e0f510ede9d12338a5f564.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Economic Burden of Non-medicinal Poisoning From Healthcare Provider Perspective in 2020: A Prevalence-Based Cost-of-Illness Study in Thailand 1 10 4828 10.34172/ijhpm.8928 EN Mu Htay Kywel Master of Science Program in Social, Economic and Administrative Pharmacy, Mahidol University, Bangkok, Thailand Orathai Khiaocharoen Thai CaseMix Centre, Division of Healthcare Information Standards Service, Health Systems Research Institute, Bangkok, Thailand 0000-0002-9273-679X Chatchon Prasertworakul Thai CaseMix Centre, Division of Healthcare Information Standards Service, Health Systems Research Institute, Bangkok, Thailand Tanwa Khattiyod Thai CaseMix Centre, Division of Healthcare Information Standards Service, Health Systems Research Institute, Bangkok, Thailand Sitaporn Youngkong Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand 0000-0002-2448-3954 Arthorn Riewpaiboon Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand 0000-0003-2959-3244 Journal Article 2024 12 01 Background Between 2010 and 2019 in Thailand, hospital admissions due to toxic effects of non-medicinal substances (International Classification of Diseases 10th Revision [ICD-10] codes: T51-T65) ranged from 59.78 to 87.47 per 100 000 population. The objective of this study was to estimate the costs of non-medicinal poisoning from healthcare provider perspective, and identify factors associated with the costs in Thailand for the year 2020. Methods This was a prevalence-based cost-of-illness study conducted from healthcare provider perspective, analysing data from five hospitals (four regional and one provincial) across the Central, North, and Northeast regions of Thailand. We included all patients diagnosed with non-medicinal poisoning (ICD-10 codes: T51-T65) during the fiscal year 2020. Direct medical costs were calculated from hospital databases, estimating the cost per outpatient/emergency visit and the cost per hospital admission. Multiple regression analysis was used to determine the factors affecting these costs. All total costs were converted to international dollar (Int$) for 2020. Results A total of 3260 patients were included (2472 outpatient visits and 788 admissions). The mean age was 39 years, with 51% being male. The mean cost per outpatient visit was Int$ 47, and the mean cost per admission was Int$ 896. Key factors significantly associated with higher costs included patient type (outpatient vs admission), length of stay (LOS), age, insurance scheme, diagnosis group, and the presence of comorbidities. Conclusion This study provided critical, updated data that can inform health policy by emphasizing the economic burden of non-medicinal poisoning. These findings underscore the need for strengthening poisoning prevention and early intervention services and offer essential data for conducting future economic evaluation studies of relevant interventions in Thailand.

https://www.ijhpm.com/article_4828_de3f712d1a02c5fb481a7a99b0da7fa3.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Religion, Politics, and Vaccines: Elaborating the Integrative Public Policy Acceptance (IPAC) Framework Through HPV Vaccine Program Acceptance Among Religious Leaders in Bangladesh 1 13 4829 10.34172/ijhpm.9179 EN Md Towhidur Rahman Government of Bangladesh, Ministry of Public Administration, Dhaka, Bangladesh VaxPolLab, School of Social Sciences, The University of Western Australia, Perth, WA, Australia 0000-0001-8423-9374 Sultan Mahmood ShuHaRi Health, Dhaka, Bangladesh 0000-0001-7585-9731 Katie Attwell VaxPolLab, School of Social Sciences, The University of Western Australia, Perth, WA, Australia 0000-0002-0366-2160 Journal Article 2025 04 24 Background In October 2023, Bangladesh introduced a free, single-dose human papillomavirus (HPV) vaccine for girls aged 9–14 through its national vaccination program to prevent cervical cancer, the second most common cancer among Bangladeshi females, caused by the HPV. Although vaccine hesitancy was not a significant issue before the COVID-19 pandemic, experiences from that pandemic and global literature suggest that the population’s uptake of this vaccine may face barriers due to concerns related to reproductive health, fertility, and cultural and religious beliefs. This is particularly relevant in a country where Islam is the state religion, 91% of the population is Muslim, and religious leaders hold significant influence over public opinion. Methods Building upon the recently developed Integrative Public Policy Acceptance (IPAC) framework, this qualitative study explores the factors shaping religious leaders’ support for the HPV vaccine informing their potential role in promoting it. Semi-structured interviews with leaders from Bangladesh’s five main Islamic traditions were thematically analysed using NVivo 14 with inductive and deductive coding. Results Islamic religious leaders’ varying support for HPV vaccinations in Bangladesh was influenced by their limited awareness of cervical cancer, as well as their religious and social concerns about ingredients, side effects and a fear of promoting promiscuity. Political ideologies also played a significant role, as leaders were less supportive of the program when they perceived the government as ideologically opposed to the beliefs or practices of their specific religious tradition. Conclusion The study’s contribution to the IPAC framework highlights the importance of political consensus in policy acceptance, explaining how partisanship and ideological differences impact public policy compliance. The findings underscore the need for health systems in Muslim majority countries to engage with religious authorities, build political inclusivity and consensus, and align health policies with religious and cultural values.

https://www.ijhpm.com/article_4829_926ec030f29f83ce5318754fdb631a33.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 United Nations Partnerships With the Alcohol Industry 1 12 4831 10.34172/ijhpm.8947 EN June Yue Yan Leung SHORE and Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand 0000-0001-8448-9584 Sally Casswell SHORE and Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand 0000-0002-2211-7096 Journal Article 2024 12 11 Background The alcohol industry builds engagement with United Nations (UN) organisations to enhance its corporate image and influence policy, supported by the UN’s endorsement of public-private partnerships (PPPs). However, the extent of the alcohol industry’s relationships with the UN remains unclear due to limited reporting. Methods We searched the websites of 57 UN-affiliated entities and 18 transnational alcohol corporations (TNACs) for evidence of partnerships or relationships between the UN and the alcohol industry. We summarised the UN entities and TNACs involved in formal partnerships, membership of alliances or stakeholder networks, financial contributions, sponsorship of programmes or projects, sponsorship of events, event participation, and personal relationships with conflicts of interest. Results We identified examples of all the above relationships between various UN entities and the world’s largest TNACs, including an alcohol industry donation towards the World Health Organization (WHO) Foundation, which was created to maximise private sector donations to WHO. The focus of these engagements aligned closely with the alcohol industry’s corporate social responsibility (CSR) initiatives, including drink-driving prevention, education, sustainability, and philanthropy. These activities frequently involved support for low- and middle-income countries (LMICs) and women, which are emerging markets for the TNACs. Sponsorship and participation in intergovernmental events allowed the TNACs privileged access to policy-makers. Limited disclosure by UN entities meant that our findings provided an incomplete picture of relationships with the alcohol industry. Conclusion The UN’s wide-ranging relationships with the TNACs highlight the power of these large corporations in building political influence and the UN’s failure to acknowledge the alcohol industry’s conflicting interests with health. These relationships undermine WHO’s mandate to promote health, placing the integrity and impartiality of the UN system at risk. On top of adequate resources from member states and enhanced transparency measures, the UN requires effective safeguards against alcohol industry influence, in line with those for the tobacco industry.

https://www.ijhpm.com/article_4831_f720ec3e5486f090fd382b68e230b435.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 What Value Do Dutch Citizens Place on Health Interventions That Provide Greater Health Gains to Lower-Income Groups? A Discrete Choice Experiment 1 14 4837 10.34172/ijhpm.9095 EN Iris Meulman Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands 0000-0002-9916-1810 Adrienne Rotteveel Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands 0000-0002-3395-0147 Ellen Uiters Netherlands School of Public & Occupational Health, Utrecht, The Netherlands Mariëlle Cloin Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands 0000-0003-3386-4094 Johan Polder Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands 0000-0002-3231-2178 Niek Stadhouders Scientific Center for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands Department of Health Economics, School of Business and Economics & Talma Institute, Vrije Universiteit, Amsterdam, The Netherlands 0000-0002-7296-2335 Journal Article 2025 03 18 Background Reimbursement decisions for new health interventions focus on maximizing health gains, with limited attention to who benefits from these gains or the impact on income related health inequalities. This study aimed to examine the preferences of Dutch citizens regarding the distribution of health gains of new interventions across income groups. Methods A discrete choice experiment (DCE) was completed by 614 Dutch adults. Respondents were presented with 12 choice tasks. In each choice task, they were asked to choose between two health interventions that differed on the following attributes: total healthy life years gained, distribution of healthy life years gained across income groups, additional costs in terms of health insurance premium increases and whether the intervention was curative or preventive. Preferences were estimated using multinomial logit (MNL) models, relative attribute importance, willingness-to-pay, and willingness-to-trade total health gains. Preference heterogeneity was examined using latent class (LC) analyses. Results Respondents found the distribution of health gains by income the most important attribute in their decision between health interventions (relative importance [RI] = 40.5%, 95% CI: 38.3%–42.7%). Overall, respondents preferred an equal distribution of healthy life years gained across income groups (βhigher income groups = -1.427, 95% CI: -1.547–-1.307; βlower-income groups = -0.315, 95% CI: -0.395–-0.235). A health intervention should yield 14 283 (95% CI: 10 463–18, 102) additional healthy life years or reduce the yearly health insurance premium by €39.96 (95% CI: €29.03–€50.89) if it mainly favors lower-income groups. Preventive interventions were generally preferred over equally effective or more effective curative interventions (βprevention = 0.270, 95% CI: 0.204–0.336). While preferences displayed a similar direction across LCs, the classes differed in the RI assigned to the attributes. Conclusion Our findings suggest societal support for interventions that prioritize preventive programs over equally effective or more effective curative interventions and prioritize interventions that provide equal benefits across different income groups.

https://www.ijhpm.com/article_4837_274a10ffa06e434f2a94df765cac6bf4.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Multiple Chronic Conditions, Delayed Medical Care and Hospitalization: A Comparison Between the United States and Taiwan 1 10 4840 10.34172/ijhpm.9164 EN Chen-Yang Wang Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan 0009-0006-9577-0738 Ching-Ching Claire Lin Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan Population Health Research Center, National Taiwan University, Taipei, Taiwan Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan 0000-0002-4882-2826 Raymond N. Kuo Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan Population Health Research Center, National Taiwan University, Taipei, Taiwan 0000-0003-4980-853X Joshua M. Liao Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA 0000-0002-9788-9074 Journal Article 2025 04 17 Background Delays in medical care can be especially critical for individuals with multiple chronic conditions (MCCs). The United States and Taiwan, with vastly different healthcare systems, offer contrasting contexts for access to care. This study aims to examine the relationship between MCCs, delayed medical care and hospitalization in the US and Taiwan. Methods This analysis used data from the US National Health Interview Survey (NHIS) 2021 (n = 29 482) and the Taiwan Social Change Survey (TSCS) 2021 health module (n = 1604). We estimated multivariable logit regression models and calculated differential effects of MCCs status (no chronic conditions, one chronic condition, MCCs) on outcomes. Precision measures were estimated with delta method. All analyses for the US population incorporated applicable complex survey design and weighting, and for the Taiwan population incorporated weighting when appropriate. Results Compared to those with no chronic conditions, individuals in the US with one chronic condition (2.0 percentagepoints, P < .001) or MCCs (3.6 percentage-points, P < .001) had a higher likelihood of delayed care due to costs. In Taiwan, delayed care was less likely among individuals with one chronic condition (5.6 percentage-points, P = .08) or MCCs (9.5 percentage-points, P = .02), compared to individuals with no chronic conditions. Furthermore, individuals with MCCs or one chronic condition are associated with higher hospitalization in both the US (6.1 percentage-point, P < .001; 1.6 percentage-point, P = .001, respectively) and Taiwan (15.7 percentage-point, P < .001, 3.8 percentage-point, P = .08, respectively), although the differential effect of one chronic condition in Taiwan did not reach statistical significance. Conclusion Analyzing data from two national health systems, this analysis shows differing relationships between MCC status and delayed care, suggesting a possible bidirectional effect. As both regions undergo reforms—US efforts to improve coordination and Taiwan’s rising risk of fragmented care—these findings offer insights relevant to policymakers and health system leaders beyond each country’s context.

https://www.ijhpm.com/article_4840_74249bfb363306265299ac4ec44d3cb6.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 How Does Supermarket Category Management Shape What Is on Supermarket Shelves and Influence Diet and Health? Secondary Analysis of Qualitative Interviews With Retailers and Suppliers 1 12 4844 10.34172/ijhpm.8932 EN Roxanne Armstrong-Moore MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK 0000-0002-1991-3032 Michael Benson Sheffield Business School, Sheffield Hallam University, Sheffield, UK 0000-0003-3523-0124 Martin White MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK 0000-0002-1861-6757 Journal Article 2025 01 27 Background Unhealthy diets drive high rates of non-communicable diseases. Many food environments are dominated by foods high in fat, salt, and sugar (HFSS). Supermarkets are a predominant source of groceries, and the relationships between retailers and their suppliers determine the foods displayed on their shelves. The disproportionate display of less healthy foods suggests that existing regulatory frameworks are sub-optimal for public health. We aimed to investigate the nature of relationships between supermarkets and their suppliers in the UK, and their implications for dietary public health. Methods We undertook secondary analysis of in-depth interviews with UK retailers and suppliers (n = 19), using inductive and deductive approaches to thematic analysis, underpinned by our quest to understand how food retailing drives less healthy diets. Codes and themes were generated and refined, then mapped diagrammatically and are presented in an explanatory narrative. Results Large suppliers are critical to the supplier-retailer relationship, dominating category management and supermarket shelves. The relationship brings mutual benefits for supplier and retailer. Category managers from large suppliers engender indebtedness among retailers by building rapport and trust, and investing financially and materially in retailers. Reciprocity by retailers is enacted with preferential contracts and the award of leading roles in category management (“category captaincy”). Large suppliers thus gain competitive advantage, with preferential access to premium shelf space, driving greater sales. Important positive reinforcing feedback loops maintain the relationship, described as a “virtuous circle.” Yet, there are also countering forces, which act as negative feedback loops. Conclusion Where the retailer-supplier relationship involves the largest manufacturers, it drives the product mix and volumes on supermarket shelves, resulting in a disproportionate dominance of the largest, processed food brands. The nature of this relationship is likely a key factor preventing movement towards an overall healthier food offer to consumers and remains a public health concern.

https://www.ijhpm.com/article_4844_e6cc48e3a8db9b618592a86a57960164.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Improving Primary Healthcare for Elderly Patients: How Chronic Disease Management Intensity Makes a Difference 1 12 4845 10.34172/ijhpm.9152 EN Jia Peng School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China 0009-0009-6919-3852 Di Liang School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China 0000-0003-2569-1605 Shailendra Prasad Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, USA 0000-0003-1168-5917 Sumit Kane Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia 0000-0002-4858-7344 Weijun Zhang David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA 0000-0002-5962-0509 Yuxia Wu Yichuan Street Community Health Service Center of Putuo District, Shanghai, China 0009-0005-8333-8529 Jiayan Huang School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China 0000-0003-4166-6119 Yongsong Luo Health Commission of Yuhuan, Taizhou, Zhejiang Province, China 0009-0008-4055-7555 Yin Dong The People’s Hospital of Yuhuan, Taizhou, China 0000-0002-8359-1138 Journal Article 2025 04 14 Background Since 2009, China has implemented a chronic disease management program within primary healthcare (PHC) institutions in response to challenges posed by an aging population. However, the effectiveness of the program has been reported as mixed, likely due to variations in PHC physicians’ efforts and the support they received from the health system and community. This multi-sector engagement was conceptualized as management intensity in this study, and its impact on the program’s effectiveness was evaluated. Methods This study analyzed 60 885 patients under the chronic disease management program in Yuhuan, Zhejiang province, as of 2023. Management intensity, the primary predictor, was quantified by township-level residual measured based on patients’ length of follow-up after eliminating patient demographics. This approach removed the portion of follow-up length attributable to individual characteristics, leaving the residual serving as a purified exposure variable for management intensity. The outcome measures included outpatient visits, inpatient admissions, outpatient and inpatient expenses, and glycemic and blood pressure (BP) control status. Data sources included chronic disease management registration records, service records of follow-up, and electronic medical records. A two-level mixed-effects regression model was then used to examine how management intensity affected the outcomes. Results Each unit increase in management intensity corresponded to 0.21 more PHC outpatient visits and 0.15 fewer hospital outpatient visits. Meanwhile, higher management intensity was also associated with increased utilization of PHC inpatient services (odds ratio [OR]: 0.98, 95% CI: 0.97-0.98) and decreased utilization of hospital inpatient services (OR: 1.24, 95% CI: 1.18-1.29). Conclusion Greater management intensity correlated with better health outcomes and higher utilization of PHC services. Since multi-sector engagement strongly affected how intensively chronic diseases were managed, it was imperative for health systems and communities to actively participate in and strengthen the program by supporting physicians.

https://www.ijhpm.com/article_4845_1e8eec0db325b87b0f57b5056efd8afb.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Can Prevention-Oriented Communication Via Health Organization Websites Affect Adherence to Breast and Cervical Cancer Screening? An Exploratory Study in Italy 1 9 4846 10.34172/ijhpm.9140 EN Francesca Conte Department of Political and Communication Sciences, University of Salerno, Fisciano, Italy 0000-0001-6822-1502 Daniela Siano Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy 0000-0003-0773-312X Rosa Oro Department of Medicine, Surgery and Dentistry, University of Salerno, Fisciano, Italy Journal Article 2025 04 08 Background Public organizations in healthcare are progressively adopting digital tools to disseminate information regarding the benefits of screening. Nevertheless, no research has hitherto been conducted to investigate the link between the website-based health communications and cancer screening uptake. This study addresses this gap by assessing whether health communications conveyed via the websites of local health organizations improve adherence to breast and cervical cancer screening. Methods We performed thematic content analysis of 97 websites belonging to Italian health organizations based on the OSEC-p model. This latter was developed to measure the compliance of prevention-oriented health communication with the effectiveness requirements indicated in the model. Next, correlation and regression analyses were performed to examine the relationship between the average regional OSEC-p scores and the regional breast and cervical cancer screening adherence rates reported by the National Centre for Screening Monitoring in 2022. Results The findings show that the prevention-oriented health communication via health organizations’ websites can explain the 45% of the variance in female cancer (breast and cervical) screening uptake. Patient engagement tools and information on preventive cancer initiatives are key web-based communication elements that enhance cancer screening adherence. Conclusion This exploratory study is one of the first to highlight the importance of digital health communications for improving cancer screening and public health. It offers insights both for national health policy-makers to optimize health economics through screening campaigns and health organizations managers to enhance the compliance of health communication on websites with the effectiveness requirements defined in the OSEC-p model.

https://www.ijhpm.com/article_4846_ce6babd060aa46c61a5777902cca78af.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Process Evaluation of an Effective Multifaceted Quality Improvement Intervention to Improve Acute Stroke Care: Unpacking the Success Factors and Challenges 1 15 4847 10.34172/ijhpm.9013 EN Tara Purvis Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia 0000-0003-3332-5357 Elizabeth Lynch College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia 0000-0001-8756-1051 Violet Marion Stroke and Critical Care Research, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia 0000-0001-6643-7035 Julie Morrison Stroke and Critical Care Research, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia 0000-0002-6802-6990 Monique F. Kilkenny Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia Stroke and Critical Care Research, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia 0000-0002-3375-287X Sandy Middleton Nursing Research Institute, St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne and Australian Catholic University, Sydney, NSW, Australia School of Nursing Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia 0000-0002-7201-4394 Dominique A. Cadilhac Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia Stroke and Critical Care Research, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia 0000-0001-8162-682X Journal Article 2025 02 01 Background The Shared Team Efforts Leading to Adherence Results (STELAR) program is a multifaceted quality improvement intervention directed at hospital clinicians to improve stroke care. In a stepped-wedge cluster trial (N = 9 hospitals, Australia), STELAR achieved a 17% improvement in adherence to prioritized clinical indicators (composite outcome). We report the critical success factors and challenges that influenced change in care delivery. Methods STELAR included two externally facilitated workshops; (i) feedback of national registry data to identify practice gaps and prioritize indicators; (ii) barrier assessment and action plan development (2017-2018). Hospitals appointed a site coordinator, and identified local change champions. Two months of remote-support followed to implement action plans. The process evaluation included workshop observations (N = 18), document review, satisfaction surveys (N = 51), and semi-structured interviews (external facilitator, N = 9 clinician site coordinators). Qualitative data were mapped to an implementation framework before inductive thematic analysis. Quantitative data were analysed descriptively, with all data triangulated. Results Critical success factors included delivery by knowledge translation experts, external facilitation support/nudging to maintain staff engagement at hospitals, and the use of evidence to self-select prioritized indicators. Involving multidisciplinary staff in action planning and supporting local change champions to lead the implementation fostered capacity building. Reported challenges related to insufficient time when focusing on several prioritized indicators simultaneously within a limited timeframe and having to address strategies that involved working with different clinicians or hospital departments. Staff workload and availability and lack of medical buy-in and management support during the process were wider organizational challenges reported. Conclusion Despite the identified challenges imposed by the limited implementation period, STELAR’s multifaceted attributes underpinned the overall strong positive change in quality of stroke care. Implications for wider adoption include involvement of knowledge translation experts with ongoing support for capacity building, and allowing greater time to work through implementation strategies.

https://www.ijhpm.com/article_4847_038d5463327addf90d282c35be4c5eb1.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Stakeholder Perspectives on the Structural Causes of Drug Shortages in Korea: A Mixed-Methods Study 1 11 4849 10.34172/ijhpm.9451 EN Chungah Kim Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea 0000-0002-9033-3874 Eunja Park Korea Institute for Health and Social Affairs, Sejong, Republic of Korea 0000-0001-5465-8674 Dong-Sook Kim Department of Health Administration, Kongju National University, Gongju, Republic of Korea 0000-0003-2372-1807 Journal Article 2025 09 05 Background Drug shortages are a persistent global challenge. In South Korea, shortages occur within a distinct context characterized by high import dependence, inflexible pricing structures, and a hospital-centric distribution system. This study examined how frontline pharmacists and policy stakeholders perceive the structural causes of drug shortages across policy, supply-chain, and frontline pharmacy practice levels. Methods We employed a sequential mixed-methods design to triangulate institutional perspectives with frontline realities, comprising six focus group interviews (FGIs) (n = 35) with policy stakeholders and a national web-based survey of 223 licensed pharmacists. Qualitative data explored institutional perspectives on structural causes and policy responses, whereas survey data quantified recent shortage experiences, impacts on patient care, and perceived causes. Results Qualitative findings indicated that stakeholders attributed shortages to structural vulnerabilities, including unprofitable drug prices, dependence on imported raw materials, and distribution rigidities. These perceptions were supported by survey findings and aligned with frontline pharmacists’ reported experiences: 97.3% of pharmacists experienced shortages in the past three months, most frequently involving cold medicines and analgesics. Respondents identified raw material shortages (51.1%) and supply chain imbalances (17.5%) as primary drivers. Although pharmacists used coping strategies such as drug substitution, these adaptations were associated with substantial patient inconvenience (49.3%) and increased pharmacist workload (23%), indicating that individual-level responses are insufficient to address systemic failures. Conclusion Drug shortages in Korea reflect systemic vulnerabilities compounded by distribution constraints rather than temporary disruptions. To address these perceived barriers, we propose a graded policy approach: short-term measures should prioritize administrative flexibility and information sharing, medium-term measures should focus on reforming pricing incentives, and long-term measures should strengthen supply chain sovereignty.

https://www.ijhpm.com/article_4849_ec1f764517b7ffb52057af6df18142b7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Effective Partnerships Between Local Councils and Health Departments: Lessons From a Disadvantaged Region of Sydney, Australia 1 13 4852 10.34172/ijhpm.9045 EN Karla Jaques Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, NSW, Australia International Centre for Future Health Systems, Sydney, NSW, Australia Population Health, South Western Sydney Local Health District, Sydney, NSW, Australia 0000-0002-1101-8439 Raquiba Jahan Khan Population Health, South Western Sydney Local Health District, Sydney, NSW, Australia 0000-0002-9303-2567 Christopher Browne Healthy Places, Population Health, South Western Sydney Local Health District, Liverpool, NSW, Australia Maria Beer Collaboration Unit, Population Health, South Western Sydney Local Health District, Liverpool, NSW, Australia 0009-0000-5961-8698 Karen Wardle Health Promotion, Population Health, South Western Sydney Local Health District, Sydney, NSW, Australia 0000-0002-6075-7123 Jennie Pry Healthy Places, Population Health, South Western Sydney Local Health District, Liverpool, NSW, Australia Susan Gibbeson Fairfield City Council, Fairfield, NSW, Australia Edith Barnes Wollondilly Shire Council, Picton, NSW, Australia Tim Hayes Liverpool City Council, Liverpool, NSW, Australia Patrick Harris International Centre for Future Health Systems, University of New South Wales, Sydney, NSW, Australia 0000-0002-4649-4013 Journal Article 2025 02 19 Background Local councils in Australia, established by state governments, are responsible for delivering services, implementing policies, and enforcing regulations that impact community health and well-being. Partnerships between local governments and health agencies can provide a valuable opportunity to advance initiatives to improve health and well-being of communities. This paper explores findings from four case studies of such partnerships in south-west Sydney, Australia. Methods Semi-structured qualitative interviews with 25 key stakeholders were conducted as part of a realist evaluation of these partnerships, focusing on factors at functional, organisational, individual, and external levels that influence their success. Results The findings provide real-world insights into the enablers and barriers of effective intersectoral partnerships. While the interview data generally align with existing literature and the theory of change developed in earlier research phases, key context-specific differences emerged. The interviews reiterated the need for structural support of the partnerships (in the case studies, through a context specific, locally tailored memorandum of understanding [MoU]) however, structures alone were insufficient, partnerships required “actors” to enable implementation (the partnership officers). Beyond the MoU and partnership officers, wider supports provided by partner organisation through governance, management and workplans were also essential. Stakeholders expressed strong support for these partnerships, citing positive outcomes and the importance of their continuation. However, persistent challenges include sectoral interests and institutional silos that hinder collaboration. The findings underscore the complexity of expecting councils to adopt a health-focused mandate or vice versa. Conclusion The study highlights that partnerships, facilitated through MoUs and joint officer appointments, are effective in driving impactful health initiatives. Nevertheless, overcoming organisational silos requires ongoing leadership support and mandates that emphasize the importance of these partnerships. This research emphasizes the critical role of structured collaborations in addressing health determinants and reducing potential inequities within communities.

https://www.ijhpm.com/article_4852_5cf68969fb67aa6082363a6d4e6468e2.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Alignment of Research Efforts With the Diabetic Retinopathy Burden of Disease and Socioeconomic Factors: An Analytical Bibliometric Study 1 13 4856 10.34172/ijhpm.9345 EN Farbod Semnani National Center for Health Insurance Research, Tehran, Iran School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran 0000-0002-8964-419X Seyed Sahab Aarabi National Center for Health Insurance Research, Tehran, Iran School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran 0000-0003-1724-2818 Kiana Hassanpour Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-1788-7352 Payam Kabiri Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran 0000-0002-7634-370X Mojtaba Sedaghat Department of Community Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran 0000-0002-0444-6160 Amirhossein Takian Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran Health Equity Research Centre (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran 0000-0001-7806-5558 Journal Article 2025 07 22 Background Diabetic retinopathy (DR) is a major microvascular complication of diabetes. Given its growing global burden and research inequities, we examined how national DR burden and socioeconomic factors relate to research interest (RI) in DR across low- and middle-income countries (LMICs) and high-income countries (HICs). Methods We retrieved peer-reviewed DR articles published between 2018 and 2022 from Scopus. Spearman’s correlation test and multivariable linear regression were used to assess the associations between the independent variables: (a) socioeconomic factors, including health expenditure per capita purchasing power parity (PPP), current health expenditure (% of gross domestic product [GDP]), research and development (R&D) index, and human development index (HDI); (b) age-standardized years lived with disability (YLDs) rates of DR-related moderate (moderate vision impairment, MVI) and severe vision impairment (SVI) and blindness; and (c) disability-adjusted life years (DALYs) rate for diabetes, with our outcome variable, DR RI, calculated as the ratio of the number of DR publications in the field of medicine and life sciences to the whole output in the same field and country. Sensitivity analyses (2020-2022 RI vs. 2018-2019 burden) were conducted to address temporality. Results In HICs, after adjustment for socioeconomic factors and DR-specific burden (MVI, SVI, or blindness, modeled separately), the diabetes DALY rate was the only variable independently associated with RI: MVI (β = 0.56, 95% CI: 0.16 to 0.95), SVI (β = 0.57, 95% CI: 0.19 to 0.94), and blindness (β = 0.61, 95% CI: 0.21 to 1.02). In LMICs, no significant relationships were found between RI and MVI, SVI, blindness or diabetes DALY rates. These findings remained consistent in sensitivity analyses. Conclusion Our research demonstrates that there is a lack of significant correlation between research efforts and the burden of DR, particularly among LMICs, which may highlight the need to strengthen research infrastructure and realign national health research priorities.

https://www.ijhpm.com/article_4856_06f7c042b76e4b04f698c75b7b2777ea.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Funding Programs Relevant to Spinal Cord Injury Research and Their Approaches to Research Partnerships: An Environmental Scan 1 9 4857 10.34172/ijhpm.8813 EN Zhiyang Shi Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada 0000-0002-4454-8495 Alanna Shwed School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada 0000-0001-6407-7240 Ian D. Graham School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada 0000-0002-3669-1216 Gayle Scarrow Michael Smith Health Research BC, Vancouver, BC, Canada Peter Athanasopoulos Spinal Cord Injury Ontario, Toronto, ON, Canada Vanessa K. Noonan Praxis Spinal Cord Institute, Vancouver, BC, Canada 0000-0003-3226-9218 John Chernesky Praxis Spinal Cord Institute, Vancouver, BC, Canada Kathryn M. Sibley Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada 0000-0002-6212-5437 SCI IKT Guiding Principles Partnership Panel #A full list of the investigators of the IKT Guiding Principles Partnership Panel is provided at the end of the article Heather L. Gainforth Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada 0000-0002-3281-1110 Journal Article 2024 09 19 Background Establishing research partnerships can help close the research-practice gap. The Integrated Knowledge Translation Guiding Principles were developed in a spinal cord injury research context as a resource to facilitate research partnerships. Research funders play a significant role in the spinal cord injury research system. However, how funders define, require, evaluate, support research partnerships is rarely reported. This study identified spinal cord injury research funders in Canada and the United States, identified their approaches to supporting research partnerships, and explored organizational perspectives of principles of partnership. Methods An environmental scan was conducted through five steps: (1) identifying spinal cord injury research organizations that funded the greatest number of spinal cord injury research publications in Canada and the United States between 2017 and 2022; (2) identifying one funding program related to research partnerships of each funder; (3 extracting online information of the programs; (4) interviewing funder informants; and (5) descriptive and deductive content analysis. The five steps were completed between April 2022 and September 2024. An additional data collection was conducted in July 2025 on a relevant National Institutes of Health funding program. Results Sixteen organizations and seventeen partnership-supportive programs were identified. Six programs defined partnerships as researchers and research users engaging throughout the research process. Eleven programs required applicants to describe the partnership in applications and explicitly stated their peer review evaluation criteria. The programs supported research partnerships through remuneration for partners’ engagement (n = 6), facilitating connections between researchers and potential partners (n = 3), and helping applicants prepare applications (n = 4). The programs had few strategies to evaluate awarded partnerships post-grant. Three descriptive categories emerged from the interviews: (1) Varied support for research partnerships; (2) Minimal capacity for partnership evaluation postgrant; and (3) Need for tools and resources to further support research partnerships. Conclusion Differences existed in how spinal cord injury research funders in Canada and the United States defined, required, evaluated, and supported research partnerships. The results provided an initial landscape of funders’ role in the spinal cord injury research system and may inform strategic efforts to optimizing meaningful engagement in a broader health research context.

https://www.ijhpm.com/article_4857_62459f4e225e2f4f196c9d42f4ad7111.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Costing Health Benefit Packages Using the WHO UHC Compendium: A Proof-of-Concept Study in Kyrgyzstan 1 11 4862 10.34172/ijhpm.9333 EN Gerard Joseph Abou Jaoude Institute for Global Health, University College London, London, UK 0000-0001-6022-3036 Charlie Nederpelt Radboud University Medical Center, Nijmegen, The Netherlands 0000-0002-7387-1769 Saltanat Zhetibaeva Ministry of Health, Bishkek, Kyrgyzstan Gavin Surgey Radboud University Medical Center, Nijmegen, The Netherlands 0000-0003-1832-3716 Parisa Kamali Sadeghian World Health Organization, Geneva, Switzerland Neha Misra World Health Organization, Geneva, Switzerland Eliza Aidyldaeva Ministry of Health, Bishkek, Kyrgyzstan Mirlan Atakulov Mandatory Health Insurance Fund, Bishkek, Kyrgyzstan Edil Orozaliev Mandatory Health Insurance Fund, Bishkek, Kyrgyzstan Sven Neelsen World Bank, Washington, DC, USA 0000-0002-1380-891X Christel Vermeersch World Bank, Washington, DC, USA 0000-0001-9652-5546 Baktygul Kambaralieva Japan International Cooperation Agency Kyrgyz Republic Office, Bishkek, Kyrgyzstan Jolene Skordis Institute for Global Health, University College London, London, UK 0000-0002-8633-0208 Tom Palmer Institute for Global Health, University College London, London, UK 0000-0002-9526-0045 Rob Baltussen Radboud University Medical Center, Nijmegen, The Netherlands 0000-0002-8364-2847 Baktygul Isaeva Ministry of Health, Bishkek, Kyrgyzstan Hassan Haghparast-Bidgoli Institute for Global Health, University College London, London, UK 0000-0001-6365-2944 Journal Article 2025 07 17 Background Many countries are defining health benefits packages to progress toward universal health coverage (UHC). Cost estimates are required to ensure packages are affordable and implementable. However, a gap persists between global costing tools and recommendations informing package design and the way services are defined for country-level implementation. To address this, we developed the first health systems-wide costing tool and approach based on the World Health Organization (WHO) UHC Compendium database, which provides structured service definitions and data to facilitate country-level contextualisation and implementation. This paper presents our tool and approach through a proof-of-concept study in Kyrgyzstan. Methods We developed a tool in Microsoft Excel that estimates normative economic costs for over 500 UHC Compendium services using a combination of bottom-up and top-down approaches. Resource use was derived from UHC Compendium metadata, supplemented with publicly available and country-specific data sources to inform input prices and population in need estimates. In Kyrgyzstan, all secondary data were validated and contextualised with national experts. We produced high-level cost estimates for 424 services identified as relevant for Kyrgyzstan and refined estimates for 181 priority services selected by country stakeholders. Sensitivity analyses investigated variations in personnel, medicine and overhead costs and currency fluctuations. Results Delivering all 424 services at current utilisation levels, or low levels of utilisation for services not yet implemented, would cost an estimated US$ 186.97 per capita annually. Providing the 181 priority services would cost US$ 74.41 per capita at current utilisation levels and US$ 189.44 per capita if scaled to full (100%) utilisation. Costs were driven primarily by personnel and medicines. Sensitivity analyses showed costs ranging from US$ 58.76 to 90.05 per capita. Conclusion This study demonstrates the feasibility of using UHC Compendium data to generate country-specific, service-level cost estimates for benefits package design. Other countries can adapt our tool and approach to design affordable and implementable packages in support of UHC goals.

https://www.ijhpm.com/article_4862_3713bdda7149579475f3734e8bd0e14a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Understanding the Factors Shaping the Effectiveness of Chinese Medical Team Programmes in Ghana: A Qualitative Study Using Bardosh’s Framework of Global Health Delivery 1 10 4865 10.34172/ijhpm.9320 EN Emmanuel Kwasi Afriyie School of Public Health, Southern Medical University, Guangzhou, China Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China Komfo Anokye Teaching Hospital, Kumasi, Ghana 0009-0008-7876-412X Samuel Egyakwa Ankomah Komfo Anokye Teaching Hospital, Kumasi, Ghana Department of Management, University of Cape Coast, Cape Coast, Ghana 0000-0001-8803-953X Munawar Harun Koray School of Public Health, Southern Medical University, Guangzhou, China Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China Upper West Region Health Directorate, Wa, Ghana 0000-0003-2764-4829 Sara Sulieman School of Public Health, Southern Medical University, Guangzhou, China Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China Department of Pharmacy Practice, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan 0009-0000-5695-1006 Huijuan Liang School of Healthcare Management, Inner Mongolia Medical University, Hohhot, China 0000-0002-9520-0990 Dadong Wu Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen, China 0000-0003-2166-6832 Dong (Roman) Xu School of Public Health, Southern Medical University, Guangzhou, China Acacia Lab for Implementation Science, School of Health Management, Southern Medical University, Guangzhou, China SMU Institute for Global Health (SIGHT) and Center for World Health Organization Studies, School of Health Management and Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China 0000-0001-7438-632X Journal Article 2025 07 10 Background Chinese medical teams (CMTs) have long been a component of global health engagement in Africa, yet their effectiveness within national health systems remains under-examined. Methods Drawing on Bardosh’s socio-anthropological framework of global health delivery, this qualitative study examines how CMTs function within Ghana’s public healthcare sector. Participants were purposively selected from key institutions in Ghana, including the Ministry of Health (MoH), two tertiary hospitals, and one district hospital hosting CMTs. Eighteen semi-structured interviews were conducted with Ghanaian clinicians, hospital administrators, national policy-makers, and Chinese medical staff. Policy-relevant documents from 2009 to 2024 were reviewed to supplement and triangulate the findings. Results Based on Bardosh’s five domains, the analysis identifies several factors influencing programme effectiveness: the placement and facility-level integration of CMTs (terrain of intervention); cultural and linguistic disconnects affecting patient engagement (community agency); short-term rotations and fragmented collaboration with local staff (field staff strategies); limited adaptability and utilisation of donated medical technologies (socio-materiality); and weak institutional coordination and policy alignment (governance). Two additional themes—patient-centred care and continuity of healthcare delivery—emerged as important dimensions shaping the perceived value and limitations of the CMT model. The findings suggest that effectiveness is shaped not only by operational or resource-related factors but also by the extent to which foreign medical interventions are socially embedded, locally responsive, and institutionally aligned. Conclusion These findings provide insights for the design of international health partnerships seeking to strengthen public health systems in low-resource settings through more participatory, coordinated, and locally embedded models of delivery.

https://www.ijhpm.com/article_4865_d91caca74114d81fdfc578fca82f8d72.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Medication Dispensing Patterns Following Teleconsultations in France From January 2021 to June 2023: A Retrospective Cohort Study Using the National Health Data System 1 10 4868 10.34172/ijhpm.9215 EN Julie Rigoureau Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France 0009-0002-3429-1996 François Bettega Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France 0000-0002-9736-5289 Marc Chanelière Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France Collège universitaire de Médecine Générale, Université Lyon 1, Villeurbanne, France 0000-0001-7114-5483 Teddy Novais Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France Service Pharmacie, Hôpital des Charpennes, Hospices Civils de Lyon, Villeurbanne, France 0000-0001-6401-1575 Stéphane Sanchez Pôle Territorial Santé Publique, Hôpitaux Champagne Sud, Troyes, France Faculté de Médecine, Université de Reims Champagne Ardennes, Reims, France 0000-0002-0925-6948 Stéphanie Sidorkiewicz Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cite and Université Sorbonne Paris Nord, Inserm, INRAE, Paris, France Department of General Practice, Université Paris Cité, Paris, France 0000-0002-4720-927X Aurélie Moskal Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France Hospices Civils de Lyon, Service des Données de Santé, Lyon, France 0000-0003-4127-4334 Marie Viprey Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France Hospices Civils de Lyon, Service des Données de Santé, Lyon, France 0000-0002-3281-1970 Journal Article 2025 05 15 Background Teleconsultation services grew significantly in France during the COVID-19 pandemic. Reimbursed teleconsultations increased by a hundredfold between 2019 and 2021, establishing it as an emerging healthcare delivery modality. However, medication dispensing patterns following teleconsultations remain largely unexplored. This study aimed to characterize post-teleconsultation medication dispensing patterns between 2021 and 2023. Methods A retrospective cohort study was conducted using data from the French health database. The study included all teleconsultations conducted that resulted in at least one medication dispensing event (TLCs) between January 1, 2021, and June 30, 2023. We described patient demographics, prescriber characteristics, and dispensed medication. Results During the study period, 11 202 364 TLCs (34.3%) out of 33 853 911 resulted in medication dispensing. Among these 11 202 364 TLCs, the patient population predominantly comprised females (64.4%), individuals without long-term medical conditions (86.4%), with a mean age of 42.2 years (SD ± 20.8). Teleconsultations were mainly conducted by liberals’ physicians (86.8%) and health centre-employed practitioners (12.1%). The use of teleconsultation platforms increased fivefold between the first semesters 2021 (4.2%) and 2023 (28.2%). Teleconsultations resulted in medications targeting the nervous system (53.1%), digestive system (28.3%), and respiratory system (21.8%). Two contexts of dispensing emerged: dispensing with chronic indication (42.8% of TLCs) characterized by a long median time and several dispensing, and dispensing with an acute indication (55.6%), characterized by single dispensing with a 0-1 day between teleconsultation and dispensing. Conclusion One third of the teleconsultations resulted in medication dispensing, mainly for young, urban patients with good access to care, in contrast to the objective as described in the French Law. Dispensing patterns revealed two distinct modalities, acute symptomatic and chronic disease management. Certain classes of drugs dispensed (antibiotics, opioids, benzodiazepines) may raise questions about appropriate dispensing practices in teleconsultations.

https://www.ijhpm.com/article_4868_f5e647292cc4e1064968ca62bebe7e47.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Understanding the Factors Involved in the Development and Early Implementation of “Pharmacy First” Services for the Management of Common Conditions in England 1 12 4870 10.34172/ijhpm.9442 EN Mirza Lalani Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK 0000-0001-7851-9062 Isaac Chu Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK 0000-0002-0732-2032 Agata Pacho Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK 0000-0002-0653-5095 Ayodeji Matuluko Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK 0000-0002-9778-8695 Basharat Hussain School of Medicine, University of Nottingham, Nottingham, UK 0000-0002-0443-2869 Claire Anderson School of Pharmacy, University of Nottingham, Nottingham, UK 0000-0002-5406-2296 Nicholas Mays Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK 0000-0001-9808-8466 Rebecca E. Glover Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK 0009-0000-8112-3552 Journal Article 2025 09 01 Background Amidst growing pressures on primary care services in England, the Pharmacy First (PF) scheme was introduced in 2024 to enable community pharmacists (CPs) to manage seven common conditions, including supplying antibiotics, where appropriate, according to patient group directions (PGDs). PF aims to increase timely access to care, reduce general practitioner (GP) workloads, and address health inequalities in terms of access to primary healthcare. This paper, part of a wider evaluation of PF, aims to describe and explain the factors affecting its development and early implementation. Methods Semi-structured (n = 31) qualitative interviews were conducted with policy-makers, representatives of national community pharmacy and general practice bodies and frontline CPs and GPs in England. Analysis was guided by a framework combining Walt and Gilson’s “Policy Triangle” and the Consolidated Framework for Implementation Research (CFIR). Results The study identified a range of factors shaping PF development and implementation. These included policy design complexity, stakeholder engagement, political priorities, and contextual pressures such as funding constraints and workforce shortages. Pharmacists welcomed the clinical upskilling opportunity, while GPs voiced concerns about patient safety and duplication of work. A lack of public awareness, inadequate training access (particularly for independent pharmacies and locum CPs), and poor interoperability between community pharmacy and general practice information systems further hindered rollout. Policy “layering,” with limited consideration of the implications for existing community pharmacy clinical services and the absence of a phased implementation strategy caused confusion among GPs and patients. Conclusion PF illustrates both the potential and challenges of expanding clinical roles in community pharmacy through national policy. Despite political backing and sector-wide engagement, its implementation faced structural, financial, and communication barriers. Realising its full potential requires workforce and integrated information infrastructure, sustainable funding, and clear inter-professional communication and information sharing between general practice and community pharmacy.

https://www.ijhpm.com/article_4870_3c565485bbd2c54bb0ebe05c7ec741fc.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Exploring and Mapping Expert Views on the Mechanisms Contributing to Patients’ Demand for Low-Value Care: A Complex Systems Approach 1 12 4872 10.34172/ijhpm.9099 EN Gillroy R. L. Fraser Department of Health Economics and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands Erasmus Centre for Health Economics Rotterdam (EsCHER), Rotterdam, The Netherlands 0009-0003-7050-3607 G. Ardine De Wit Department of Health Economics and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands 0000-0002-1375-7657 Job Van Exel Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands Erasmus Centre for Health Economics Rotterdam (EsCHER), Rotterdam, The Netherlands 0000-0002-4178-1777 Peter M. A. Sloot Institute for Advanced Study, University of Amsterdam, Amsterdam, The Netherlands Independent Complex Systems Researcher, Noordwijk, The Netherlands 0000-0002-3848-5395 Raymond W. J. G. Ostelo Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Vrije Universiteit, Amsterdam, The Netherlands 0000-0001-7679-7210 Frenk Van Harreveld Department of Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands 0000-0003-3717-2773 Mattijs S. Lambooij Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands Erasmus Centre for Health Economics Rotterdam (EsCHER), Rotterdam, The Netherlands Center for Prevention, Lifestyle and Health, Department Behaviour & Health, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands 0000-0002-1965-3568 Journal Article 2025 03 20 Background Approximately 20% of the total healthcare expenditure in high-income countries is spent on low-value care, ie, care that is unnecessary, potentially harmful, or provides marginal health benefits to patients. Demand for lowvalue care is considered a multifactorial, complex problem, as a multitude of factors have been associated with low-value care use. However, there is limited knowledge on how these factors interrelate and lead to demand for low-value care. Therefore, the aim of this study was to explore and map the factors and their relations contributing to patients’ demand for low-value care using a complex systems approach. Methods Two group model building (GMB) sessions on the topic of low-value care were organised with experts from the Netherlands. Each session’s transcript was thematically analysed, resulting in one causal loop diagram (CLD) per session. These CLDs included determinants, relations between these determinants and feedback loops. Finally, the CLDs were synthesised into one CLD combining the insights from both sessions. Results The final CLD consisted of 42 factors influencing demand for low-value care. It includes biomedical factors, cognitive biases, socio-cultural factors, economic factors, emotions, knowledge-related factors, factors related to the interaction with the provider, and preferences and expectations. By mapping the relations between these factors, we identified 59 connections and nine reinforcing feedback loops potentially influencing demand for low-value care. Conclusion The CLD provides insight into factors, mechanisms and feedback loops influencing patients’ demand for low-value care. It highlights perceived insecurity as a central driver that influences multiple other factors and eventually affects patients’ demand for low-value care. These central factors influencing multiple other factors may be potential leverage points for policies aiming to reduce demand for low-value care. Further research is required to clarify the relative importance of the identified factors, relationships, and feedback loops to determine effective leverage points.

https://www.ijhpm.com/article_4872_02b5b45ce743bc3f285ec4d39b5968c3.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Medical Device Industry Payments to Healthcare Professionals and Organizations in Japan: An Evaluation of Scale, Distribution, and Transparency Practices, 2019-2022 1 13 4873 10.34172/ijhpm.9079 EN Akemi Hara Medical Governance Research Institute, Tokyo, Japan 0009-0001-5175-6153 Sunil Shrestha Department of Research and Academics, Kathmandu Cancer Center, Bhaktapur, Nepal 0000-0002-9174-7120 Hiroaki Saito Medical Governance Research Institute, Tokyo, Japan Department of Internal Medicine, Soma Central Hospital, Fukushima, Japan 0000-0002-0824-454X James Larkin Department of General Practice, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland Frank Moriarty Department of General Practice, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland 0000-0001-9838-3625 Piotr Ozieranski Department of Social and Policy Sciences, University of Bath, Bath, UK 0000-0002-2023-3288 Rajeev Shrestha NIHR Newcastle Patient Safety Research Collaboration, Newcastle University, Newcastle upon Tyne, UK 0000-0003-1822-3969 Tetsuya Tanimoto Medical Governance Research Institute, Tokyo, Japan Navitas Clinic Kawasaki, Kanagawa, Japan 0000-0002-9818-8587 Akihiko Ozaki Medical Governance Research Institute, Tokyo, Japan Breast and Thyroid Center, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan 0000-0003-4415-9657 Journal Article 2025 03 13 Background Financial relationships between the medical device industry and healthcare providers have raised concerns about conflicts of interest (COIs). However, these relationships remain poorly characterized in Japan, despite the country’s large medical device market, which was valued at ¥4.41 trillion ($33.3 billion) as of 2021. This study examined the scale, composition, and temporal patterns of payments from the medical device industry and evaluated current transparency practices. Methods We analyzed publicly disclosed payment data from 117 medical device companies predominantly affiliated with the Japan Federation of Medical Devices Associations (JFMDA) from 2019 to 2022. Payment categories included research and development, academic research support, lecture and consulting fees, information-provision–related expenses, and other payments to healthcare professionals (HCPs) and healthcare organizations (HCOs). We assessed payment magnitude, category composition, company-level concentration, year-to-year changes, and disclosure transparency using an adapted proforma previously applied to European pharmaceutical payment data. Results Total payments amounted to $942.3 million over four years. Academic research support expenses constituted the largest share (33.0%, $310.7 million), followed by information provision–related expenses (25.2%, $237.5 million) and research and development expenses (21.7%, $204.8 million). Payments were highly concentrated, with the top 10 companies accounting for approximately 58% of total amounts. Using 2019 as the pre-pandemic baseline, total payments declined by 30.2% in 2020 and remained below pre-pandemic levels in 2021 (-24.0%), before partially recovering in 2022 (-11.6%). Category-specific trends diverged during the pandemic, with consulting, lecturing, and manuscript-related fees exceeding pre-pandemic levels by 2022, while information provision–related expenses remained substantially reduced. Transparency was limited: 78.6% of companies disclosed payment data with limited standardization, searchability, or data download functionality. Conclusion This multi-year analysis revealed substantial financial relationships between the medical device industry and healthcare stakeholders in Japan, alongside persistent shortcomings in transparency of disclosures. Introducing legally mandated disclosure would improve oversight and align Japan’s system with international best practices.

https://www.ijhpm.com/article_4873_945e01e4dfc83449d9edc77e001e2c0c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Reputation, Co-Regulation, and “Soft Capture”: Corporate Political Activity of the Portuguese Food Industry 1 13 4874 10.34172/ijhpm.9495 EN Sofia Da Costa Epidemiology Research Unit (EPIUnit), Institute of Public Health, University of Porto, Porto, Portugal Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal 0000-0001-5319-816X Mélissa Mialon Inserm, Université Paris Cité, Paris, France School of Medicine, Trinity College Dublin, Dublin, Ireland 0000-0002-9883-6441 Marta Figueira Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal National Healthy Eating Promotion Program, Directorate-General of Health, Lisbon, Portugal 0000-0002-8816-7256 Maria João Gregório Epidemiology Research Unit (EPIUnit), Institute of Public Health, University of Porto, Porto, Portugal Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal National Healthy Eating Promotion Program, Directorate-General of Health, Lisbon, Portugal 0000-0002-0380-7833 Pedro Graça Epidemiology Research Unit (EPIUnit), Institute of Public Health, University of Porto, Porto, Portugal Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal 0000-0002-6262-4658 Journal Article 2025 09 26 Background Corporate political activity (CPA) refers to practices through which commercial actors seek to influence public policy and prioritise their commercial interests. While extensively documented internationally, little empirical evidence exists for Portugal. This study provides the first systematic analysis of the CPA of the food industry in Portugal. Methods We conducted a systematic document analysis, following a protocol developed by INFORMAS (International Network for Food and Obesity/Non-Communicable Diseases Research, Monitoring and Action Support), a network that monitors food environments. This was triangulated with semi-structured interviews and illustrated through two policy examples. Twenty-five food industry actors were selected based on market share, trade association membership, and relevance to policy debates. Publicly available materials (January 2022–December 2023) were collected and coded using Ulucanlar’s CPA framework, distinguishing framing and action strategies. Data were triangulated with 18 interviews conducted between July and December 2024 with informants from academia, government, industry, civil society, public health, and the media. Results We identified 534 examples of framing and 799 examples of action strategies. Framing was dominated by portrayals of corporations as “good actors” aligned with health, sustainability, and national development. Action strategies focused on reputational management, corporate social responsibility (CSR), and the displacement of public health roles. Legal obstruction and overtly adversarial tactics were absent. Large multinational manufacturers and major retailers accounted for the highest number of coded CPA examples, with trade associations also represented among actors engaging in policy-related activities. Interviewees confirmed these patterns and expressed concerns over informal access to policy-makers, weak state capacity, and reliance on corporate-led initiatives. Conclusions The food industry in Portugal primarily relies on reputational and co-regulatory strategies, with limited evidence of overtly confrontational tactics. These findings are consistent with a form of institutionalised influence in which corporate actors engage closely with public authorities and participate in governance processes in ways that may shape the direction and scope of public health policy.

https://www.ijhpm.com/article_4874_fb09f481d40c4d3c0861a46bd2dc52c0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Development of a Claim-Based Hospitalization Appropriateness Screening Tool for Adults in South Korea 1 8 4876 10.34172/ijhpm.9576 EN Hyemin Jung Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea Department of Education and Human Resource Development, Seoul National University Hospital, Seoul, Korea 0000-0001-7339-7983 Haibin Bai Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea 0000-0001-5387-3305 Sanghyun Cho Department of Preventive Medicine, Dankook University Hospital, Cheonan, Republic of Korea 0000-0002-2081-1076 Un-Na Kim Clinical Preventive Medicine Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea 0000-0002-6764-2951 Jin-Seok Lee Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea 0009-0007-2846-2011 Journal Article 2025 11 04 Background Unnecessary hospitalizations undermine the efficient use of healthcare resources and may expose patients to preventable safety risks. This study aimed to develop a computerized screening tool for identifying potentially inappropriate adult inpatient admissions using nationwide health insurance claims data in South Korea. Methods We conducted a retrospective cross-sectional study using the Health Insurance Review and Assessment Service-National Inpatient Sample (HIRA-NIS) (2017–2019) to develop and assess a claims-based hospitalization appropriateness screening tool (HAST) for adult admissions. Based on the adult hospitalization clinical service criteria from the Appropriateness Evaluation Protocol (AEP), we selected only those criteria directly observable in claims data and operationalized them using standardized electronic data interchange codes. The final tool included nine criteria and episodes meeting none of these criteria were classified as potentially inappropriate admissions (PIAs). HAST was assessed through a single-round of expert review for content validity, mortality-based known-groups comparison, and convergent validity against selected SQLape diagnostic groups. Logistic regression models were applied to identify factors associated with PIA. Results The final tool comprised nine screening criteria: (1) receiving general anesthesia, (2) admission to intensive care unit (ICU), (3) receiving hospice care, (4) childbirth, (5) continuous monitoring of vital signs, (6) receiving arterial blood gas analysis (ABGA), (7) application of mechanical ventilator, (8) receiving intravenous injections, and (9) receiving intramuscular injections. Across analytic specifications, 17.5% to 19.2% of admissions were classified as PIAs. PIAs were more frequent among adults aged 20–39 years, females, National Health Insurance (NHI) beneficiaries, and patients admitted to small facilities with fewer than 100 beds. Conclusion HAST offers a feasible, reproducible, and scalable method for monitoring the appropriateness of hospital admissions using routinely collected administrative data. It can be used for large-scale surveillance to support health policy evaluation and system-level quality improvement.

https://www.ijhpm.com/article_4876_77bdfcff53815626ecab7f6a1454f007.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Understanding Heterogeneous Drug Procurement Behaviour of Healthcare Institutions Under Pooled Procurement: Evidence From China 1 9 4877 10.34172/ijhpm.9372 EN Boya Zhao School of Public Health, Peking University, Beijing, China 0009-0001-2017-7802 Zhao Cheng School of Public Health, Peking University, Beijing, China 0009-0004-0616-0897 Xing Lin Feng School of Public Health, Peking University, Beijing, China 0000-0003-3588-1859 Journal Article 2025 08 02 Background While the overall impact of pooled drug procurement on drug procurement has been evaluated, little is known about how healthcare institutions’ pre-policy procurement composition is associated with heterogeneous post-policy procurement responses. This study addresses this gap under China’s National Volume-Based Procurement (NVBP) policy. Methods We used monthly procurement data from January 2018 to December 2020 from four provinces in China, covering both pre- and post-policy periods, as the NVBP policy was implemented in January 2020. Outcomes were procurement volumes, measured as the number of defined daily doses (DDDs), of NVBP-covered drugs (bid-winning and non-winning products) and their clinically substitutable alternatives. All healthcare institutions in the selected provinces were included and stratified by (1) their pre-policy share of bid-winning products among NVBP drugs and (2) their pre-policy share of NVBP drugs among both NVBP and alternative drugs, to assess institutional heterogeneity. Interrupted time series (ITS) analysis was conducted to assess the immediate (level) and long-term (slope) post-policy changes. Results Procurement volumes of bid-winning products increased substantially following the policy (level change: 1275%, P < .01), with smaller increases observed among healthcare institutions with higher pre-policy bid-winning shares (eg, highest-share subgroup: 441%, P < .01), consistent with uniform procurement targets. Although overall procurement of alternative drugs remained stable, healthcare institutions with higher pre-policy NVBP shares experienced significant increases, with level changes of up to 1010.9%, suggesting substitution driven by financial losses. In contrast, healthcare institutions with lower NVBP shares saw notable declines (level change: −34.8% to −65.2%), possibly reflecting demand-side substitution toward lower-priced NVBP drugs. Conclusion Findings highlight that in pooled procurement, procurement behaviour is shaped more by regulatory enforcement and financial incentives than by price-driven demand. Strengthening guidance and oversight of supplier behaviour remains essential to realizing the full benefits of pooled procurement reforms.

https://www.ijhpm.com/article_4877_b71155d90aef3bc38cb92db5a9afe4ce.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Deepening Context in Realist Evaluation: Exploring Adolescent Agency in Sexual and Reproductive Health in Urban India 1 11 4879 10.34172/ijhpm.8837 EN Sara Van Belle Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium 0000-0003-2074-0359 Sana Contractor Independent Consultant, Mumbai, India 0000-0003-2251-6131 Sandhya Gautam Seher - Center for Health and Social Justice, New Delhi, India Journal Article 2024 10 01 Background Although accountability interventions to strengthen adolescent sexual and reproductive health (ASRH) service delivery in marginalized urban neighbourhoods are on the rise, evidence on the underlying mechanisms and context conditions is scarce. We analysed the strategies of two grassroots organizations in India that support adolescent agency in sexual and reproductive health (SRHR) to identify the mechanisms and context conditions in which they work. Methods We used realist evaluation (RE) and a case study design with two sites in Delhi and Mumbai. We used Margaret Archer’s structure-agency-culture (SAC) framework to deepen the analysis of context and of the temporal dynamics of the intervention. Results We found that the organizations used five strategies: (1) mobilization of girls and young women, (2) raising critical consciousness, (3) supporting self-organization and emergent collective action, (4) documenting lived realities and engagement with local governance actors. Organizational and relational mechanisms triggered include trustbuilding in the community and with parents, which enables support, fosters a group identity, and provides a safe space for peer exchange. Enhancing reflexivity, self-efficacy and a sense of place among adolescent girls, the intervention stimulates emergent collective action within the neighbourhood, which in turn contributes to build consensus and enforce accountability with local and sub-national governance actors. We considered causal mechanisms to be historically grounded in practices preceding current ones, and we adopted a view on “context” that includes a longer-term temporal dimension. Conclusion The refined programme theory confirms that organizations will simultaneously engage in consensusoriented and agonistic strategies with state actors in their efforts to achieve social change.

https://www.ijhpm.com/article_4879_606c90a06173d69682feb83037a68fec.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 The Consequences of Performance Measurement Systems in Multilevel Governance Health Systems: The Case of the Italian National Healthcare Service 1 16 4881 10.34172/ijhpm.9384 EN Federico Rotondo Department of Humanities and Social Sciences, University of Sassari, Sassari, Italy 0000-0002-8379-455X Lucia Giovanelli Department of Economics and Business, University of Sassari, Sassari, Italy 0000-0001-7123-243X Nicoletta Fadda Department of Economics and Business, University of Sassari, Sassari, Italy 0000-0002-3106-1346 Russell Mannion Health Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UK 0000-0002-0680-8049 Journal Article 2025 08 05 Background Performance measurement systems (PMSs) have become an essential component of health system reforms globally and are increasingly used to assess, reward and improve provider performance. While PMSs can be valuable tools for achieving desired health outcomes, their effectiveness depends on how they are designed, implemented, and used within complex multilevel governance structures. There is evidence that PMSs may also have unintended negative consequences. Drawing on new empirical evidence, the present study examines the consequences of PMSs implemented in multi-level governance systems through the analysis of the Italian National Healthcare Service (INHS), which exemplifies a decentralised health system with multiple levels of governance. Methods The study employed a mixed methods approach combining quantitative and qualitative methods to examine the functional and dysfunctional consequences of PMSs in the INHS across three governance levels: (i) State-Regions, (ii) Regions-healthcare organisations, and (iii) Healthcare organisations-healthcare professionals. Results We identified three key functional consequences. First, PMSs drive improvement by facilitating benchmarking, advocacy, and collaboration. Second, quantifying activities and services improves objectivity and transparency. Third, national PMSs provide a comprehensive view of performance across multiple dimensions and provide a more holistic understanding of how different aspects of the system interact. We confirmed previously reported dysfunctional consequences of PMSs found in other health systems and identified three new dysfunctional consequences in the INHS: Measurement Overload, Misconsideration, and Exploitation. Conclusion Based on our analysis and existing literature, we propose ten key factors for strengthening performance measurement in the INHS. While this study offers novel evidence on the functional and dysfunctional consequences of PMSs in the Italian system, our research is context-specific, and the applicability of these factors to other multi-level health systems remains an area for future empirical testing.

https://www.ijhpm.com/article_4881_c6ede20e6f597abf4b3f6bb30cee16c7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 What Do Nurses Value Most? Evidence From a Discrete Choice Experiment in Indonesia’s Remote Regions 1 8 4886 10.34172/ijhpm.9538 EN Ferry Efendi Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia Research Center in Advancing Community Healthcare (REACH), Surabaya, Indonesia Kaohsiung Medical University, Kaohsiung, Taiwan 0000-0001-7988-9196 Eka Mishbahatul Mar’ah Has Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia 0000-0002-1786-285X Rifky Octavia Pradipta Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia Research Center in Advancing Community Healthcare (REACH), Surabaya, Indonesia 0000-0002-8729-7665 Mei Chan Chong Department of Nursing Science, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia 0000-0002-8599-3018 Anna Kurniati Ministry of Health, Jakarta, Indonesia 0009-0005-0154-3159 Journal Article 2025 10 13 Background The uneven distribution of nurses across Indonesia’s remote regions remains a major obstacle to achieving universal health coverage and Sustainable Development Goals. Recruitment and retention policies for remote areas are often based on assumptions about what nurses value, while empirical evidence remains limited. This study aimed to examine the job attributes influencing nurses’ preferences for working in remote and very remote areas in Indonesia. Methods A discrete choice experiment (DCE) was conducted among 243 nurses with at least one year of experience in remote healthcare facilities in East Nusa Tenggara, Papua, and West Papua. Job attributes and levels were identified through literature reviews and focus group discussions (FGDs). Six attributes were included: work location, employment status, supporting facilities, basic living facilities, student financial aid, and monthly net income. Preferences were estimated using a conditional logit model, with willingness-to-accept (WTA) estimates supporting policy interpretation. Results Basic living facilities were the most influential factor in shaping nurses’ job preferences. Positions offering reliable access to clean water, electricity, and internet services were significantly more likely to be chosen than those without such facilities (odds ratio [OR] = 2.06; 95% CI: 1.82–2.33). Jobs in very remote areas were also preferred over rural postings (OR = 1.76; 95% CI: 1.52–2.04). In contrast, civil servant employment was less preferred than contractbased positions (OR = 0.56; 95% CI: 0.49–0.64), and direct provision of housing and transportation did not significantly influence job choice (OR = 1.07; 95% CI: 0.94–1.22). A higher monthly income increased the likelihood of selecting a remote posting. Conclusion Nurses’ preferences for remote postings in Indonesia are driven mainly by living conditions, employment security, and location, rather than financial incentives alone. Policies should prioritize basic infrastructure improvements and stable employment arrangements.

https://www.ijhpm.com/article_4886_8164d892d7aea8f1875df07f4d82ffd0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Strategic Uncertainties Surrounding Mosquito-Borne Disease Policy-Making in the Netherlands: A Game Theoretic Analysis 1 10 4887 10.34172/ijhpm.9091 EN Henk Broekhuizen Health and Society Group, Department of Social Sciences, Wageningen University and Research, Wageningen, The Netherlands Department of Epidemiology, Health Promotion, and Policy Advice, GGD Twente, Enschede, The Netherlands 0000-0002-2816-3552 Femke Bekius Department of Methodology, Nijmegen School of Management, Radboud University, Nijmegen, The Netherlands 0000-0003-4357-7371 Pauline A. De Best Department of Viroscience, Erasmus Medical Center, Rotterdam, The Netherlands National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands 0000-0003-2501-0793 Marleen Bekker Health and Society Group, Department of Social Sciences, Wageningen University and Research, Wageningen, The Netherlands 0000-0002-7431-4374 Journal Article 2025 03 17 Background One Health decisions are challenging due to substantive and strategic uncertainty. This study aims to map and interpret strategic uncertainties surrounding a specific One Health issue (mosquito-borne disease [MBD] policy) in the Netherlands. Methods We used a game-theoretic framework to identify games from 26 interviews with key actors about strategic uncertainty. For each game we identified the context (where the game is played), the actors (who is playing), the content (what are the issues and outcomes), and the process (how the game has developed and what strategies were employed). Games with the same set of actors and overlapping content were clustered together. Results We identified 15 games, centered mostly around trade-offs between domains (human health, animal health, and the environment) and dilemma’s inherent to prevention policy. We identified three game clusters. Multi-level governance forms the context around MBD policy. It consists of a game involving issues around climate adaptation, infectious disease policy, and biodiversity. This game is played across time and hierarchical levels (local, regional, national), giving rise to cascade dynamics. In this governance context, actors deal with responsibilities around invasive mosquito control. This second cluster is characterized by a dilemma between acting (and bearing the cost) and waiting for someone else to act; and a game represented by a central notification hub. Finally, the zoonotic structure was developed to bridge domains and gives rise to a various games representing the tension between actors’ own and shared interests, power and information asymmetries, and acting versus not acting for their own benefit. Conclusion We argue for an actor-centered approach and more awareness of strategic uncertainties among involved actors in MBD policy to reduce strategic risks inherent in the identified game archetypes. We provide policy recommendations for anticipating, reducing or dealing with the associated strategic risks towards better MBD prevention.

https://www.ijhpm.com/article_4887_0b081776bae790b4ee7c059c23b96b3a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 How Intersectoral Priority Setting Can Support Action on Social Determinants of Health: A Qualitative Case Study From Pakistan’s Federal Health Ministry 1 12 4888 10.34172/ijhpm.9208 EN Wafa Aftab Bergen Center for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan Takemi Program for International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA 0000-0001-5040-5215 Ole F. Norheim Bergen Center for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA 0000-0002-5748-5956 Inger Lise Teig Bergen Center for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway 0000-0003-0093-1684 Sameen Siddiqi Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan 0000-0001-8289-0964 Jesse B. Bump Bergen Center for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Takemi Program for International Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA 0000-0003-1014-0456 Journal Article 2025 05 11 Background Intersectoral actions can improve population health and reduce health inequities by addressing social determinants of health. Priority setting methods are used by health ministries to rationalize resource allocation within the sector, but not for intersectoral actions. Methods We conducted a qualitative case study of an intersectoral priority setting exercise—a novel use of priority setting methods—undertaken by Pakistan’s Federal Ministry of Health between 2019–2022. Drawing on theories of agenda setting and priority setting, we examined the priority setting process through key informant interviews. We explored the perceived appropriateness of the priority setting approach and the challenges encountered during its implementation across sectors. Results Our findings reveal that the process of intersectoral priority setting is deeply influenced by its political and institutional context. According to respondents, existing institutional structures and norms in Pakistan are not optimally suited to support intersectoral actions for health, although there is growing recognition of their importance. Regardless of sector, all respondents view engaging in intersectoral actions as part of the health ministry’s responsibility for population health. Priority setting, thereby, is viewed as a way of clarifying the health ministry’s intersectoral agenda. However, intersectoral priority setting methods are seen as underdeveloped in terms of available evidence, standardized economic and policy evaluation, and deliberative mechanisms. Respondents suggest that to implement the prioritized intersectoral agenda, the health ministry must effectively navigate the political space outside the health sector, such as by highlighting shared benefits, grounding the intersectoral agenda in local needs, and leveraging the political dynamics of other sectors. Moreover, this political engagement must be complemented by competence in evidence generation and communication to influence cross-sectoral policy dialogues. Conclusion Using a priority setting approach, health ministries can systematically advance intersectoral health agendas by building political coalitions around shared priorities supported by rigorous evidence and analysis.

https://www.ijhpm.com/article_4888_0b846c55b4bde6baae8c12a2e53ae8c7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Applying Abstract Text Mining as a Complement to PRISMA in Reviewing the Scope of Healthcare’s Circular Economy; Comment on “A Review of the Applicability of Current Green Practices in Healthcare Facilities” 1 7 4833 10.34172/ijhpm.9410 EN Amin Esmaeili Industrial and Systems Engineering Department, Kennesaw State University, Marietta, GA, USA 0000-0002-1589-150X Journal Article 2025 08 17 Efforts to reduce the healthcare sector’s carbon footprint and greenhouse gas (GHG) emissions have brought increased attention to the adoption of the circular economy (CE) in recent years. These efforts aim to lower carbon-intensive products while improving efficiency, waste reduction, and healthcare resilience. Soares et al conducted a scoping review examining CE applicability in healthcare and identified strategies to enhance its implementation. In this commentary paper, a novel abstract text mining (ATM) approach is introduced as a complement to the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Using this approach, the search terms employed by Soares et al were expanded, article abstracts were extracted, and scope areas were mapped with the assistance of a well-established machine learning technique—latent Dirichlet allocation (LDA) topic modeling. Comparison of the ATM results with those reported by Soares et al revealed three additional scope areas: alternative treatment pathways, pharmaceutical footprint reduction, and the utilization of emerging technologies.

https://www.ijhpm.com/article_4833_41071a1452b40720449779a233716395.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Advancing Public Health Through Internationally Coordinated Medical Device Registries; 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 4 4834 10.34172/ijhpm.9383 EN Herbert Mauch Cochlear AG, Basel, Switzerland 0000-0002-0186-7859 Journal Article 2025 08 05 This commentary draws on findings from Hoogervorst et al1 to underscore the urgent need for internationally coordinated medical device registries, addressing the fragmentation and inconsistency currently limiting their utility in Europe. It advocates for registries governed by academic specialty societies to ensure scientific integrity, transparency, and clinical relevance. Such registries can significantly enhance post-market surveillance, support regulatory compliance and accelerate real-world evidence (RWE) generation. The importance of standardized data collection, regular outcome reporting, and contributor recognition to foster engagement and improve data quality is highlighted. By complementing randomized controlled trials (RCTs), registries can detect rare adverse events, inform clinical guidelines and drive innovation. Actionable recommendations for governance, data harmonization and interoperability are given, emphasizing that now is the time for academic societies to lead this transformation for the benefit of patients and healthcare systems globally.

https://www.ijhpm.com/article_4834_40cb228987243c91b2dd0b7c9c4a0856.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Rethinking Human Resources for Health Planning in Labour Markets Disrupted by Conflict-Affected and Fragile Settings; Comment on “Human Resources for Health in Conflict Affected Settings: A Scoping Review of Primary Peer Reviewed Publications 2016–2022” 1 4 4835 10.34172/ijhpm.9534 EN Roomi Aziz Centre for Global Health and Intersectional Equity Research, University of Essex, Colchester, UK 0000-0003-2073-4565 Journal Article 2025 10 11 In a world still grappling with exploring the underlying dynamics of challenges confronting human resources for health (HRH), how must the HRH research and planning ensue in conflict-affected settings (CAS)? Onvlee and colleagues undertake a scoping review to respond to this important question, using the World Health Organization’s (WHO’s) Health Labour Market (HLM) framework, to leverage upon available evidence. This commentary appraises the conceptual and methodological contributions of the review, while questioning the suitability of HLM to analyse HRH challenges in disrupted health systems. It argues that CAS-specific HRH planning exacts frameworks and approaches more attuned to political economy, contextual fragility, and structural inequalities, which shape healthcare workers’ vulnerabilities and responses in CAS. The commentary identifies five gap questions for future scholarship, calling for intersectionality-driven, politically informed and context-specific research approaches for HRH evidence, transcending supply and demand framing of HRH, to inform HRH policies in conflict-affected and fragile settings.

https://www.ijhpm.com/article_4835_20546457187cf3d52ea86538403e47cc.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Paying Attention – and Respect – to the Agency of Conflict-Affected Health Workers; Comment on “Human Resources for Health in Conflict Affected Settings: A Scoping Review of Primary Peer Reviewed Publications 2016–2022” 1 4 4839 10.34172/ijhpm.9580 EN Enrico Pavignani Institute for Law, Politics and Development (DIRPOLIS), Sant’Anna School of Advanced Studies, Pisa, Italy Journal Article 2025 11 05 The review stands out for its methodological rigour, clear results, and frank recognition of its limitations. However, the picture proposed by it is incomplete. Two aspects of great consequence are discussed in this commentary as a complement to the review. First, the political agency of human resources for health (HRHs) must always be considered. Among them, many take sides in a variety of roles, overt or not, as militants, activists, supporters, and researchers. Second, without including the informal practices adopted by HRH to survive and deliver in hostile environments, the health labour market cannot be understood. Arguably, these two key dimensions were not prominent in the review because the HRH literature prefers to focus on formal technical aspects easier to study and more likely to be published. Some of the reasons behind their neglect are suggested by this commentary, which concludes with a few remarks about how this drawback might be corrected.

https://www.ijhpm.com/article_4839_4b0a0290ad7df100b77e86839989a75e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Amplifying the Voices of Healthcare Workers in Conflict Settings; Comment on “Human Resources for Health in Conflict Affected Settings: A Scoping Review of Primary Peer Reviewed Publications 2016–2022” 1 4 4850 10.34172/ijhpm.9492 EN Aula Abbara Department Infectious Diseases, Imperial College London, London, UK Syria Public Health Network, London, UK 0000-0002-7049-8399 Munzer Alkhalil David Nott Foundation, London, UK Syria Public Health Network, London, UK 0000-0003-2156-8802 Journal Article 2025 09 25 Attacks on healthcare are increasing globally, often with impunity and limited accountability with profound impacts on healthcare workers, the populations they serve and the wider health system, with effects that last well beyond the end of hostilities. Healthcare workers face impacts both on their personal and professional lives, with additional strains on their families which can lead them to emigrate, even where they may hold idealistic resolve to remain. This exodus (as well as the killing or detention) of their colleagues, places strains on the remaining healthcare workers and health system at a time when needs are at their highest. The cessation of such attacks, the naming of perpetrators and enforcing legal accountability are essential. To mitigate the long-term impacts on the health system, policies which build resilience into the production, distribution, retention, and demand components of health labour market (HLM) dynamics must be implemented in ways which are contextualised and dynamic.

https://www.ijhpm.com/article_4850_549406198764950208345d143aa67c7d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Medical Devices and Real-World Data: Can We Improve Surveillance?; 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 4 4858 10.34172/ijhpm.9557 EN Marta Alcalde-Herraiz Health Data Sciences, Botnar Research Centre, University of Oxford, Oxford, UK 0009-0002-4405-1814 Daniel Prieto-Alhambra Health Data Sciences, Botnar Research Centre, University of Oxford, Oxford, UK Department of Medical Informatics, Erasmus MC University, Rotterdam, The Netherlands 0000-0002-3950-6346 Journal Article 2025 10 22 Hoogervorst et al systematically reviewed European cardiovascular and orthopaedic medical device registries to assess their preparedness for regulatory decision-making. The authors found high heterogeneity between data sources, limited transparency, and incomplete patient/procedure data, hindering cross-registry comparisons and regulatory reliability. Despite these limitations, registries remain essential for post-marketing surveillance, as exemplified by the case of “Metal on Metal” hip implants. In this commentary, we highlight emerging or ongoing initiatives focused on improving real-world evidence for medical devices, such as the UK’s Medical Devices Outcomes Registry (MDOR), which seeks to address current limitations by developing a centralised database with linkage to electronic health records (EHRs). Parallel initiatives, including Sentinel, Data Analytics and Real-World Interrogation Network (DARWIN EU®), National Evaluation System for Health Technology (NEST), and Guidance and Tools for Real-World Evidence Generation and Use for Decision-Making in Europe (GREG), seek to strengthen real-world evidence through common data models (CDMs) and federated analytics. Specifically, NEST and GREG focus on enhancing real-world data methods and guidelines for medical devices and drug-device combinations. Overall, all these initiatives represent major progress towards more robust and transparent systems for medical device surveillance.

https://www.ijhpm.com/article_4858_aea94dc1e6d1dd330cbc2c4a480934d6.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Enhancing Health Service Delivery to Care for Our Aging Population and Their Caregivers; Comment on “Developing a Conceptual Framework for an Age-Friendly Health System: A Scoping Review” 1 3 4859 10.34172/ijhpm.9569 EN Jill I. Cameron Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada 0000-0003-4161-1572 Journal Article 2025 10 31 Karami and colleagues’ scoping review proposes a conceptual framework for age-friendly health systems based on Van Olmen’s 10-element model. The scoping review mapped existing literature on health service delivery for older adults using Arksey and O’Malley’s methodology. They generated a framework that prioritizes person- and family-centered care to reduce harm, improve satisfaction, and enhance value. Key components include strong governance, trained multidisciplinary teams, integrated service delivery across settings, and active involvement of older adults and caregivers in decision-making. The framework aligns with existing age-related models like PRISMA (Program of Research to Integrate the Services for the Maintenance of Autonomy) and the Universal Model of Family-Centered Care. Future research should focus on operationalizing and implementing core components of Karami’s framework. Co-design is an emerging methodological approach used to develop models of care. It can be used to formally engage older adults, families, and professionals to operationalize core components of Karami’s framework with the goal of improving health service delivery for our aging population.

https://www.ijhpm.com/article_4859_7aa685b3b1dc1d6780bf36f7340078c9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 What Is Not Conceptualized Is Not Measured: Towards Healthier Societies; Comment on “How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks” 1 4 4867 10.34172/ijhpm.9184 EN Erica Di Ruggiero Social and Behavioural Health Sciences Division, Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada 0000-0002-8935-7908 Journal Article 2025 04 26 Global geopolitical conflicts, pandemics, the climate crisis or rising inequities within and between countries alongside other intersecting crises all impede the pursuit of healthier societies. This commentary highlights gaps in how framing and measurement approaches reflect narrower biomedical conceptualizations of health. These gaps also relate to whether and how power is analysed, and how interventions that contribute to the (re)building of healthier societies are designed, implemented and evaluated. Dominant measurement approaches in health that prioritize individual measurement of problems and solutions at the expense of whole-of-society intersectoral interventions, and their governance are among some of the reasons. More holistic and explicit measurement equity and well-being (as opposed of disease) are required. Theory-informed research that interrogates values, social norms and ideologies, power asymmetries and that centres the study of complex context-sensitive policy and program interventions should inform future inquiries.

https://www.ijhpm.com/article_4867_9ac5a6d86e8924182271bd820acbce0e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 The International Advanced Practice Nurse Integration Model: A Response to Recent Commentaries 1 3 4836 10.34172/ijhpm.9777 EN Joshua Porat-Dahlerbruch Department of Acute & Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA Israel Implementation Science and Policy Engagement Centre, Ben-Gurion University of the Negev, Be’er Sheva, Israel 0000-0002-8273-9399 Tatyana Miller Herzog Hospital, Jerusalem, Israel 0009-0001-8347-2251 Judith Shamian Israel Implementation Science and Policy Engagement Centre, Ben-Gurion University of the Negev, Be’er Sheva, Israel International Council of Nurses, Geneva, Switzerland 0000-0002-9849-324X Moriah Ellen Israel Implementation Science and Policy Engagement Centre, Ben-Gurion University of the Negev, Be’er Sheva, Israel Department of Health Policy and Management, Guilford Glazer Faculty of Business & Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada 0000-0001-7127-7283 Journal Article 2026 01 21

https://www.ijhpm.com/article_4836_768e78024aa8fdb9b8fe87be86f64745.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 More Convergence on Coercion: Reflecting on Vaccine Mandates in 2026; A Response to Recent Commentaries 1 4 4864 10.34172/ijhpm.9991 EN Katie Attwell VaxPol Lab, School of Social Sciences, The University of Western Australia, Perth, WA, Australia Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA, Australia 0000-0002-0366-2160 Adam Hannah School of Political Science and International Studies, University of Queensland, Brisbane, QLD, Australia 0000-0002-5063-5755 Journal Article 2026 04 29

https://www.ijhpm.com/article_4864_a68259547f3d25ab3c0a5c0adb4e3498.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Integrated Care in an Era of Continual Reform: England’s ICS Experience; A Response to Recent Commentary 1 3 4875 10.34172/ijhpm.10005 EN Mirza Lalani Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway 0000-0001-7851-9062 Michele Peters Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway 0000-0002-0076-5981 Journal Article 2026 05 09

https://www.ijhpm.com/article_4875_cf040fc71060367913e81ac1eb050aea.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Beyond Rhetoric: A Response to Recent Commentaries 1 2 4878 10.34172/ijhpm.10022 EN Eivind Engebretsen Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway 0000-0001-9455-110X Mona Baker Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway 0000-0001-5724-6229 Journal Article 2026 05 14

https://www.ijhpm.com/article_4878_aa108f56a10e75c1f20f27723ecac85f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Beyond the Hospital Walls: Integrating Clinical Wisdom and Global Equity Into the Circular Healthcare Paradigm – A Response to Recent Commentaries 1 3 4885 10.34172/ijhpm.10027 EN Sandra C. Buttigieg Department of Health Systems Management and Leadership, Faculty of Health Sciences, University of Malta, Msida, Malta 0000-0002-0572-2462 Ana Luísa Soares Medical Physics Service, Portuguese Oncology Institute of Porto, Porto, Portugal 0009-0009-3323-8465 Bartosz Bak Radiotherapy Department II, Greater Poland Cancer Center, Poznan, Poland 0000-0003-4567-4917 Sonya McFadden Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK 0000-0002-4001-7769 Ciara Hughes Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK 0000-0002-1064-6775 Patricia McClure Faculty of Life and Health Sciences, Ulster University, Newtownabbey, UK 0000-0002-7649-6247 Jose Guilherme Couto Radiography Department, Faculty of Health Sciences, University of Malta, Msida, Malta 0000-0002-8262-2828 Isabel Bravo Medical Physics and Radiobiology Group, Research Center (IPOP), Portuguese Oncology Institute of Porto, Porto, Portugal 0000-0001-6445-6443 Journal Article 2026 05 26

https://www.ijhpm.com/article_4885_6c35083f355f10ab32ebed269a58169e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 America First and Global Health Last: Assessing the Policy’s Ripple Effects on Tropical Disease Control and Health Sovereignty in Sub-Sahara Africa 1 3 4830 10.34172/ijhpm.9631 EN Stephen Olaide Aremu Global Health and Infectious Diseases Control Institute, Nasarawa State University, Keffi, Nigeria 0000-0002-7473-7254 Journal Article 2025 11 24

https://www.ijhpm.com/article_4830_7e712eefe0de44f5509b2329b9196827.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Institutional Decoupling in China’s Blood Donation Reform: Bridging the Gap Between Policy Intentions and Implementation Realities 1 4 4832 10.34172/ijhpm.9536 EN Renqi Luo College of Humanities & Social Sciences, Huazhong Agricultural University, Wuhan, China 0000-0003-4318-7912 Jingrong Lu College of Humanities & Social Sciences, Huazhong Agricultural University, Wuhan, China 0009-0001-8285-3685 Journal Article 2025 10 13

https://www.ijhpm.com/article_4832_0a934ecab584f7a4cd0220a7caeccbcc.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Ageism and Health System Responsiveness to Older People: An Agenda for Action and Research 1 5 4838 10.34172/ijhpm.9615 EN Thi Vinh Nguyen Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia 0000-0003-2640-1446 Sumit Kane Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia 0000-0002-4858-7344 Journal Article 2025 11 17

https://www.ijhpm.com/article_4838_bdeeecd97342dada47213d06bbd67c2c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 17 Prioritizing Health in War and Conflict: The 2025 War in Iran and the Call for Global Peace 1 4 4841 10.34172/ijhpm.9428 EN Azam Raoofi Center of Excellence for Global Health (CEGH), Department of Global Health, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran 0000-0002-6889-4835 Elham Ehsani-Chimeh National Institute for Health Research (NIHR), Tehran University of Medical Sciences (TUMS), Tehran, Iran Center of Excellence for Global Health (CEGH), Department of Global Health, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran 0000-0001-6084-7930 Amirhossein Takian Center of Excellence for Global Health (CEGH), Department of Global Health, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran Department of Health Management, Policy, and Economic, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran 0000-0001-7806-5558 Journal Article 2025 08 25

https://www.ijhpm.com/article_4841_05ee45de8d877c3949760a94fa691533.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Engaging the Influence of Global Private Actors in Health in Sub-Saharan Africa 1 5 4843 10.34172/ijhpm.9541 EN Rene Loewenson Training and Research Support Centre, Harare, Zimbabwe 0000-0002-9928-540X Sharifah Sekalala School of Law, University of Warwick, Coventry, UK 0000-0002-5434-5245 Tatenda Chatikobo School of Law, University of Warwick, Coventry, UK 0000-0003-2936-7415 Journal Article 2025 10 14

https://www.ijhpm.com/article_4843_022400dffec5b4477f760ca0e7449d73.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Building Better Public Health Policy Knowledge: The Case for Pluralism 1 4 4851 10.34172/ijhpm.9659 EN Patrick Harris International Centre for Future Health Systems, University of New South Wales, Sydney, NSW, Australia Centre for Health Equity Training, Research and Evaluation, Population Health and Epidemiology Unit, South Western Sydney Local Health District, Liverpool, NSW, Australia 0000-0002-4649-4013 Journal Article 2025 12 06

https://www.ijhpm.com/article_4851_5d40954183d62a82257835477ccad3d2.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Beyond the Contract: The Role of Relational and Contractual Governance in Outcome-Based Payment Models 1 4 4854 10.34172/ijhpm.9433 EN Maud A. Van Den Berg Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands 0000-0002-7462-1470 Hilco J. Van Elten Department of Accounting, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands 0000-0003-3909-5521 Kees T.B. Ahaus Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands 0000-0001-9973-3746 Journal Article 2025 08 26

https://www.ijhpm.com/article_4854_0c6b6f19684ed9b6ff07575fcf81c98d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Paving the Way to Universal Health Coverage in Tanzania 1 6 4880 10.34172/ijhpm.9191 EN Zaheer Rik Munshi The College, University of Chicago, Chicago, IL, USA 0009-0002-3601-0115 M. Connor Blue University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA 0009-0000-9515-6195 Faraan O. Rahim Harvard Medical School, Boston, MA, USA 0000-0003-1305-0720 Erick Mahatara School of Medicine, KCMC University, Moshi, Tanzania 0009-0009-9394-5399 Raghuram Reddy Department of Humanities, Health and Society, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA Ketan Tamirisa University of California, San Francisco, San Francisco, CA, USA 0009-0000-1388-0324 Arnav Ajay Jadav University of California, San Francisco, San Francisco, CA, USA Perisa Ashar Duke University, Durham, NC, USA 0000-0002-9213-0229 Anzibert Rugakingira The World Bank Tanzania, Dar es Salaam, Tanzania 0000-0002-1133-9494 Journal Article 2025 05 03

https://www.ijhpm.com/article_4880_2fe5a27cde066c0b65acb8f2c1717464.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Digital Transformation of Healthcare in Lebanon: A Strategic Response to Health System Fragility 1 4 4860 10.34172/ijhpm.9482 EN Mohamad Ali Hijazi Department of Pharmaceutical Sciences, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon 0000-0002-9829-235X Journal Article 2025 09 19

https://www.ijhpm.com/article_4860_f0bf4a2da952528910047c31b6c2e951.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Beyond the Flames: Public Health Management and Policy Implications From the Wang Fuk Court Fire Disaster in Hong Kong 1 3 4869 10.34172/ijhpm.9671 EN Eliza Lai-Yi Wong The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China 0000-0001-9983-6219 Eng-Kiong Yeoh The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China 0000-0002-1721-9450 Samuel Yeung-Shan Wong The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China 0000-0003-0934-6385 Journal Article 2025 12 10

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Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Global Health 2050: Beyond the Modular Approach 1 8 4884 10.34172/ijhpm.9695 EN Elisabeth Paul Research Center on Health Policies & Systems – International Health, School of Public Health, Université libre de Bruxelles, Brussels, Belgium 0000-0002-3928-4093 Sandy Tubeuf Institute of Economic and Social Research, Université catholique de Louvain, Louvain-laNeuve, Belgium Institut de Recherche Santé et Société, Université catholique de Louvain, Louvain-la-Neuve, Belgium 0000-0001-9001-1157 Garrett W. Brown School of Politics and International Relations, University of Leeds, Leeds, UK 0000-0002-6557-5353 Lieven Annemans Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium 0000-0001-8305-7210 David Bell Independent Researcher, Lake Jackson, TX, USA 0000-0002-7010-6340 Valéry Ridde CEPED, INSERM, Institut deRecherche Pour le Développement (IRD), Université Paris Cité, Paris, France 0000-0001-9299-8266 Joachim Sturmberg School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia 0000-0002-2219-6281 Journal Article 2025 12 22

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Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Eroding University Autonomy and Emerging Ethical Risks: Lessons From a Corruption Case Involving the University of Tokyo and the Japan Cosmetic Association 1 3 4848 10.34172/ijhpm.9561 EN Akihiko Ozaki Breast and Thyroid Center, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan Clinical Training Center, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan Medical Governance Research Institute, Tokyo, Japan 0000-0003-4415-9657 Yudai Kaneda Breast and Thyroid Center, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan 0000-0001-8302-9439 Masahiro Kami Medical Governance Research Institute, Tokyo, Japan Journal Article 2025 10 23

https://www.ijhpm.com/article_4848_3e9f0fc9b2f89e043bc6233994dfcf76.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Interplay of Institutional Infrastructure, Governance, and Cultural Values in Health System Resilience: Insights From Iran 1 2 4866 10.34172/ijhpm.9935 EN Seyed Hasan Emami-Razavi Department of General Surgery, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Secretariat of the Supreme Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran 0000-0003-1870-3540 Sanaz Bordbar School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 0000-0003-4421-8151 Shiva Mafimoradi Secretariat of the Supreme Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran 0000-0001-9043-3405 Tahereh Rostami Hematologic Malignancies Research Center, Research Institute for Oncology, Hematology and Cell Therapy, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Azadeh Kiumarsi Department of Pediatric Hematology & Oncology, School of Medicine, Children’s Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran 0000-0001-5492-8830 Journal Article 2026 04 14

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Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 15 1 2026 12 01 Public Health Crisis and Health Policy Challenges in Iran: Safeguarding Civilian Health Amid Regional Instability 1 2 4883 10.34172/ijhpm.9865 EN Fangwei Xue Shandong First Medical University, Jinan, China 0009-0003-7068-2190 Peilin Han Shandong First Medical University, Jinan, China Journal Article 2026 03 10

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