搜索结果：Global health research and policy

The abrupt withdrawal of humanitarian aid in early 2025 has destabilized health systems across sub-Saharan Africa, yet little is known about the frontline realities of these cuts in refugee-hosting settings. To explore health care practitioners' perspectives and experiences of how reductions in global health funding have affected services and refugee health and to identify practitioner recommendations for sustaining care. This qualitative study used semistructured, in-depth interviews conducted in July 2025 at 6 health facilities within Nakivale Refugee Settlement, Uganda. Participants were health care practitioners representing diverse cadres and facility sizes. Reduction of humanitarian aid. The primary outcomes were health care practitioners' perspectives on the impacts of funding reductions, including changes in service delivery, supply availability, staff conditions, and anticipated future health trends, as well as their recommendations to mitigate harms. Rapid qualitative techniques and thematic analysis were used to analyze responses to obtain actionable implications systematically and efficiently. The 26 participants (mean [SD] age, 30.92 [3.52] years; 16 men [61.5%]) had a mean (SD) duration in practice of 6.80 (2.65) years, with a mean (SD) of 3.09 (1.92) years in Nakivale. Interviews yielded 4 overarching themes and 18 subthemes: (1) reductions in health care services (HIV and tuberculosis services, nutritional support, maternal health, immunization adherence, inpatient and outpatient care, and perceptions of service availability), (2) supply shortages (medical supplies, transportation fuel, and household support), (3) deteriorating staff conditions (staff reduction, workload and burnout, and resilience), and (4) future predictions and recommendations (disease patterns, migration patterns, bridging the funding gap, and general settlement conditions). This qualitative study examined the cascading outcomes of humanitarian aid withdrawal on refugee health care through the voices of frontline practitioners. Their testimonies underscored urgent priorities for restoring and retargeting aid-investing in high-impact levers, strengthening local leadership, and advancing policy reforms-to safeguard refugee health and system resilience, while reminding us of the shared human stakes of humanitarian policy and the global responsibility to act.

The Demographic and Health Surveys (DHS) Program, launched in 1984, provides high-quality population health data that underpins a vast body of global health research. However, the scale and growth patterns of DHS-based publications remain underexplored, particularly as donor funding uncertainties threaten program sustainability. We examine temporal trends in DHS-based research output from 1984 to 2025, quantifying growth patterns and publication delays to inform understanding of the program's global research expansion. A systematic bibliometric review was conducted following PRISMA guidelines across PubMed, Scopus, Web of Science, Dimensions, Wiley, and CINAHL. Eligible peer-reviewed articles using DHS data between 1984 and 2025 were identified. Annual publication counts were analyzed, segmented regression identified growth inflection points, and timeliness was assessed by calculating lag between survey completion and publication. Over 10,000 DHS-based publications were identified. Annual output rose from isolated studies in the 1980s to several hundred annually by the 2010s. Segmentation analysis revealed two rapid growth phases: a 56-publications/year increase from 2004-2012, and a 71-publications/year increase from 2012 to 2024. Despite this growth, median lag from survey completion to publication remained approximately 5 years, with only a modest recent improvement (Kendall's &#x3c4;&#x2009;=&#x2009; -0.623, p&#x2009;<&#x2009;0.001). DHS data have fueled exponential growth in global health research over four decades, confirming their vital role in evidence generation. However, persistent publication delays highlight the need to shorten the pathway from data collection to dissemination through strengthened research capacity in low- and middle-income countries. Sustained funding is essential to maintain this critical evidence source. Main findings: Over 10,000 peer-reviewed studies using Demographic and Health Survey (DHS) data were identified between 1984 and 2025, with publication output increasing markedly after 2004 and accelerating further after 2012. Despite this rapid growth in research output, the median time from survey completion to publication remains about 4 years, although it has improved substantially over time.Added knowledge: This study provides the most comprehensive and up-to-date bibliometric analysis of DHS-based research, documenting four decades of publication growth, identifying key inflection points in output trends, and quantifying improvements in the timeliness of translating DHS data into scientific evidence.Global health impact for policy and action: The findings highlight the critical role of DHS data in generating global health evidence and underscore the need for sustained funding and strengthened research capacity, particularly in low- and middle-income countries to ensure timely translation of survey data into policy-relevant insights.

The conflicts that have been ongoing for over a decade in different Sahel countries, including Mali, have a negative impact on the supply and distribution of medicines. This study aims to identify and analyze the key contextual challenges affecting the supply and distribution of medicines in conflict-affected areas in Mali. This study adopts a qualitative study design. First, we conducted 28 interviews with key stakeholders in the pharmaceutical sector in the Mopti and Bamako areas. Such key stakeholders included health professionals, community association members, health authorities, and humanitarian stakeholders. Second, we conducted a thematic analysis, using NVivo software for retrieving and coding the qualitative data. The key contextual factors affecting the supply and distribution of medicines in the study area have been organized under four interlinked themes: (1) insecurity and instability, disrupting transport routes and supply chains; (2) systemic and market dysfunctions, generating price instability and recurrent shortages; (3) technical and infrastructural weaknesses, compromising adequate storage conditions; and (4) insufficient coordination and collaboration among the different stakeholders, which further destabilizes the already fragile pharmaceutical supply system. Together, these factors have considerably weakened the pharmaceutical supply chain's capacity to ensure continuous and equitable access to quality-assured medicines. Insecurity, market disruptions, weak infrastructure, and insufficient coordination severely undermine the supply and distribution of essential medicines in the conflict-affected areas of Mali. Restoring equitable access requires a strong coordination across public, private, and humanitarian actors, sustained investment in logistics and information systems, and the strengthening of regulatory oversight during and after the conflict. Main findings: Medicine procurement and distribution in conflict-affected areas face four interconnected challenges: (1) prevailing insecurity and instability disrupting transport routes and supply chains; (2) systemic and market dysfunctions generating price instability and recurrent shortages; (3) technical and infrastructural weaknesses compromising adequate storage conditions for medicines; and (4) insufficient coordination and collaboration among actors, which further destabilizes the already fragile balance of the pharmaceutical supply system.Added knowledge: Very few studies have focused on assessing and understanding the obstacles to the effective distribution and supply of medicines in conflict zones in sub-Saharan Africa. This is, to the best of our knowledge, the first study conducted in Mali to address this specific issue in conflict areas.Global health impact on policy and action: This study provides new information on medicine distribution and supply to international readers of Global Health Action, health authorities, and humanitarian actors in Mali and in the other Sahel countries that have been facing unprecedented conflicts for over a decade. The findings highlight the determinants of the problem, which is a first essential step towards proposing measures to improve access to healthcare for populations in conflict areas.

Timely and consistent digital payment of health workers is crucial for improving the effectiveness of immunization campaigns and achieving the polio eradication goals by 2026. However, evidence on the enablers and barriers to digital payments in sub-Saharan Africa (SSA) is limited. To explore the enablers and barriers to digital payments for immunization campaign health workers in eight selected SSA countries. An exploratory case study using qualitative methods was conducted in eight SSA countries: four English-speaking (Uganda, Kenya, Nigeria, Ghana) and four French-speaking (Senegal, Ivory Coast, Cameroon, Democratic Republic of the Congo). A scoping review and in-depth interviews were conducted between March and May 2022 in each country. Data were analyzed thematically. Digital payments are rapidly expanding in SSA, including during large-scale immunization campaigns. Key enablers included supportive regulatory frameworks, increasing mobile phone and digital platform coverage, and the benefits of digital payments. Barriers included inadequate telecom infrastructure, cybercrime, challenges with customer registration, higher transaction costs, and payment delays. This study identifies key enablers of digital payments in eight SSA countries, including supportive regulations, growing mobile phone ownership, and expanding digital platforms. Persistent challenges - such as limited infrastructure, verification constraints, and payment delays - affect implementation. Findings, while context-specific, offer valuable insights for policymakers to strengthen digital payment systems, improve verification, and enhance coordination to optimize health worker payments during immunization and public health campaigns. Main findings: Digital payments are expanding rapidly in sub-Saharan Africa due to supportive regulatory frameworks and increased mobile penetration, but persistent telecom infrastructure gaps, registration challenges, and payment delays continue to affect timely remuneration of health workers during immunization campaigns.Added knowledge: This study advances understanding by specifically examining how digital payment systems intersect with the unique financial and operational realities of campaign-based health workers in large-scale immunization efforts in SSA.Global health impact for policy and action: Strengthening digital infrastructure, automating verification processes, and tailoring payment platforms to campaign contexts can reduce delays, improve health worker motivation, and enhance the effectiveness of immunization programs and pandemic preparedness strategies.

This scoping review mapped research trends in migrant health in Korea and evaluated their alignment with global priorities. We conducted a scoping review using the Arksey and O'Malley framework. We searched PubMed, CINAHL, Scopus, KoreaMed, ScienceON, RISS, and KISS for articles published between 2010 and 2021, which defined the review period. The inclusion criteria were studies of adult migrants residing in Korea, primary empirical research, and academic journal articles with full text available in Korean or English. Two reviewers performed inductive coding and assigned each study to one primary subject area for frequency counts. Of 1,669 records, 273 studies met the inclusion criteria. Marriage-migrant women were the most frequently studied group (56.4%), followed by migrant workers (20.5%) and international students (7.0%). Ten subject areas were identified. Mental health (56/273; 20.5%) and health status and quality of life (47/273; 17.2%) were the most common, whereas infection was the least common (6/273; 2.2%). According to World Health Organization priority areas, P4 (tackling the social determinants of health) was the most common (132/273; 48.4%), followed by P1 (promoting health through public health interventions) (73/273; 26.7%). P3 (mainstreaming health policies and fostering partnerships) and P5 (strengthening health monitoring and information systems) were minimally represented (6/273; 2.2% and 11/273; 4.0%, respectively). Migrant health research in Korea is heavily concentrated on individual-level topics and marriage-migrant populations, with limited evidence on policies, monitoring systems, and underserved groups (e.g., refugees and diverse populations). Future studies should diversify the populations examined, standardize national monitoring and linked data infrastructure, strengthen the P3 and P5 priority areas, and include more longitudinal, interventional, and policy evaluation research.

Ensuring the health of agricultural workers, the world's largest labour force, is key for sustainable food production and progress towards the Sustainable Development Goals (SDGs). We conducted an artificial intelligence (AI)-assisted evidence map of research records on global farmer health published from 2015 to 2024. We searched bibliographic databases and screened titles/abstracts using SWIFT-Active Screener, a collaborative review platform that uses machine-learning prioritisation to rank records for human review. We retrieved 32&#x2009;006 records. After manually screening 8533 records and stopping when the tool estimated &#x2265;94% recall of relevant records, we included 1684 studies. We mapped research output by health topic category (non-communicable diseases (NCDs), communicable diseases, injuries and mental health) country income groups and alignment with SDG 3 targets. Despite 98% of the agricultural workforce living in low- and middle-income countries (LMICs), 52% of studies originate from high-income countries (HICs). Research focuses on NCDs (29%) and injuries (26%), with LMICs focusing on pesticide poisoning and HIC on accidents. Mental health emerges as a key topic in HICs, with the proportion of publications nearly doubling from 2021 to 2024 but remains underexplored in LMICs. Key gaps with high relevance to farming populations and climate change, such as heat-related illnesses, occupational injuries and musculoskeletal conditions, are not well represented in SDG 3 indicators. Our findings highlight urgent needs for a more equitable and comprehensive global research agenda that integrates agricultural worker health into sustainability frameworks beyond the SDG era, ensuring the resilience and well-being of food producers worldwide.

The consequences of climate change have detrimental effects on human health. The establishment of functional governance structures is considered crucial for addressing health challenges, as such structures provide the foundation for coordinated and coherent action. At present, no standardised and internationally applicable approach exists for assessing and benchmarking governance structures for climate and health at national level. Therefore, the objective of this study was to develop the PHONIC framework, a tool designed to assess governance structures for climate-resilient and sustainable health systems. We followed a four-step approach: First, we selected a methodology, originally designed for assessing food environment policies, and assessed its applicability to governance structures for health and climate change. This methodology comprises five key stages, as well as a set of indicators and a catalogue of good practice examples. Second, we identified and adapted existing indicators, through online consultations with international experts, and collated good practice examples for the assessment of governance structures for climate-resilient and sustainable health systems. Third, we piloted the framework with national expert groups in two countries, Germany and Kenya. Finally, we evaluated the PHONIC framework's application and revised the methodology based on the findings from the pilot phase. The final PHONIC framework includes a set of ten indicators across three thematic areas: three indicators focused on governance, four on policy development, and three on cross-sectoral collaboration. In addition, we compiled a catalogue of good practice examples for climate-resilient and sustainable health systems, currently comprising 47 examples from 32 countries. The piloting revealed opportunities, such as the participatory process, but also challenges regarding the narrow focus on health systems. The PHONIC framework, with its participatory and adaptable approach, enables the benchmarking and comprehensive analysis of the strengths and weaknesses of governance structures for climate-resilient and sustainable health systems at country level. The potential of the framework could be expanded by including international experts from a broader geographic scope and systematic searches for good practice examples. Decision makers in the health sector can use the outcomes of the PHONIC framework to identify the most relevant areas and actions for improvement of their climate change and health governance.

In the early stages of the COVID-19 pandemic, children were not the primary carriers of the infection. However, during the pandemic, children's everyday lives were significantly restricted, making it difficult to gather with one another, play and learn in person. To clarify the status of their rights under 10 selected articles of the Convention on the Rights of the Child (CRC) during the pandemic and to propose policies that enable children to enjoy their rights through the Global Child Rights Dialogue (GCRD) process. Between June 2022 and January 2024, 293 children in Japan, Sweden and Tanzania participated in 46 groups. Using a 'Research with Children' approach, they discussed the status of each CRC article and suggested policy proposals to advance the rights set out in the CRC. Text mining was used to analyse frequently occurring words. Their problem statements and policy proposals were further examined and discussed. All proposals, as outlined in each article, were aggregated and analysed in a single co-occurrence network for each country. The proposals reflected each country's unique circumstances while also including universal demands that transcend national borders. For example, in Japan, school rules disregarded children even before COVID-19, and in Tanzania, the exclusion of children from public transportation due to lower fares had been raised as a problem. Common issues across the three countries included violations of children's rights, particularly restrictions on opportunities to play and learn together. Many of their proposals, such as eliminating gender altogether, were insightful beyond what adults would have considered. Through the GCRD, children clarified the violations of their rights under the COVID-19 pandemic and articulated policy demands to address them. Our study highlights the value of actively engaging children in research, which has implications for public policy and academia globally.

Women's empowerment is critical for achieving gender equality and sustainable development in low-and-middle-income countries (LMICs). Capacity-building interventions, such as vocational training, microfinance, and digital literacy programmes, are frequently employed to foster empowerment. However, wide variation exists in how empowerment is defined, theorised, and measured, limiting comparability across studies. This scoping review mapped the conceptual foundations, theoretical frameworks, and measurement approaches used in capacity-building interventions for women entrepreneurs in LMICs. The review followed Arksey and O'Malley's framework and was reported in line with PRISMA-ScR guidelines. Searches were conducted in PubMed, Scopus, Web of Science, and JSTOR, complemented by grey literature from major development agencies (2010-2024). Eligible studies focused on capacity-building interventions targeting women entrepreneurs in LMICs. Two reviewers independently screened and extracted data, which were synthesised thematically. Of 11,109 records identified, 25&#x2009;met inclusion criteria. Most studies were cross-sectional, conducted in sub-Saharan Africa (48%) and South Asia (32%). While 76% defined empowerment, 60% did not employ any explicit theoretical or conceptual framework. Among those that did, frameworks, such as Kabeer's, Longwe's, and Malhotra et al.'s were used inconsistently. Economic empowerment was the most frequently assessed domain, often measured through income or business performance, while social, political, and psychological dimensions were seldom examined. Indicators were heterogeneous and largely self-reported. Conceptual ambiguity and inconsistent measurement hinder progress in women's empowerment research in LMICs. Future studies should adopt theoretically grounded, multidimensional, and context-sensitive frameworks to capture empowerment as a dynamic process beyond economic gains. Main findings: Capacity-building interventions for women&#x2019;s empowerment in low-and-middle income countries use highly heterogeneous and often atheoretical definitions and indicators, with a dominant focus on economic outcomes and limited attention to social, political, psychological, or process-based dimensions of empowerment.Added knowledge: This review systematically maps how women&#x2019;s empowerment is conceptualised, theorised, and measured across capacity-building interventions in low-and-middle income countries, demonstrating a persistent disconnect between empowerment theory and evaluation practice and highlighting gaps in multidimensional and longitudinal measurement.Global health impact for policy and action: Policymakers, funders, and implementers should move beyond income-only metrics and adopt theoretically grounded, multidimensional, and context-sensitive empowerment frameworks to design, monitor, and scale equitable capacity-building programmes aligned with Sustainability Development Goal 5.

Rickettsial diseases, including scrub typhus and murine typhus, are major yet persistently under-recognised causes of acute febrile illness in Southeast Asia. Limited diagnostic capacity, ecological complexity, and non-specific clinical presentation have historically contributed to the underestimation of their burden. We synthesised 25 years (2001-2025) of integrated epidemiological, clinical, diagnostic, molecular, ecological, and treatment research conducted across Southeast Asia. Evidence from prospective surveillance, hospital-based cohorts, seroepidemiology, molecular characterisation, in vitro isolation, genomic analyses, and randomised clinical trials was reviewed to identify convergent findings and policy-relevant lessons. Rickettsial infections account for 10%-25% of hospitalised acute febrile illness cases in many endemic settings and are important causes of central nervous system infection, severe disease, and adverse pregnancy outcomes. Diagnostic advances include calibrating IFA and ELISA cut-offs, evaluating rapid diagnostic tests and LAMP assays, developing highly sensitive real-time PCR platforms, and genomic analyses revealing extensive strain diversity. Whole-genome sequencing and multilocus typing demonstrate high recombination and weak geographic structuring of the core genome despite antigenic heterogeneity. Randomised trials confirm doxycycline as first-line therapy for scrub typhus, while azithromycin shows inferior efficacy for murine typhus. Integrated One Health investigations have clarified ecological drivers and vector-host dynamics, and community engagement initiatives have improved awareness in high-risk populations. Sustained regional investment has transformed rickettsial research from fragmented studies into an integrated surveillance, diagnostic, and translational research framework. This experience provides a transferable model for addressing neglected vector-borne diseases and strengthening febrile illness management in endemic settings. Continued support for laboratory capacity, genomic surveillance, and clinical research is essential to maintain progress and improve regional health system resilience.

ObjectivesThe purpose of this study was to determine the prevalence of type 2 diabetes, hypertension, and mental health conditions among female sex workers with HIV in Santo Domingo, Dominican Republic.MethodsWe conducted a cross-sectional survey, blood draw, and medical exam with women (n&#x2009;=&#x2009;200) recruited by peer navigators. We determined prevalence and used multivariable logistic regression to assess the relationship between conditions.ResultsMean participant age was 46.1 years (SD: 9.15). Most participants (89.0%) were virally suppressed. Diabetes prevalence was 7.0% and hypertension was 63.0%. Nearly half reported moderate-to-severe depressive symptoms (46.0%) and over half (65.8%) anxiety. Women with moderate-to-severe depressive symptoms were over 4 times more likely to be virally unsuppressed (adjusted odds ratio [aOR]=4.17 [95% CI: 1.37-12.68]) and over 3 times more likely to have diabetes (aOR=3.45 [95% CI: 1.00-11.91]).ConclusionFindings indicate the need for holistic, integrated healthcare models to address multiple health conditions and support overall wellbeing. Understanding the Burden of HIV, Noncommunicable Diseases, and Mental Health Conditions Among Female Sex Workers with HIV in the Dominican RepublicPeople with HIV are aging and increasingly developing noncommunicable chronic diseases (NCDs), which are leading causes of death in Latin America and the Caribbean. We conducted a study with female sex workers with HIV in Santo Domingo, Dominican Republic to determine the prevalence of type 2 diabetes, hypertension, and mental health conditions. We used statistical analysis to describe the levels of each condition and determine the relationship between mental health conditions, viral suppression, and NCDs. Mean participant age was 46.1 years (SD: 9.15). Nearly all participants (89.0%) were virally suppressed. Diabetes prevalence was 7.0% and hypertension was 63.0%. Nearly half reported moderate-to-severe depressive symptoms (46.0%) and over half (65.8%) anxiety. Women with moderate-to-severe depressive symptoms were over 4 times more likely to be virally unsuppressed (adjusted odds ratio [aOR]=4.17 [95% CI: 1.37-12.68]) and over 3 times more likely to have diabetes (aOR=3.45 [95% CI: 1.00-11.91]). Findings indicate the need for holistic, integrated healthcare models to address multimorbidity and support overall wellbeing. Future research is needed to develop and test such models.

One Health approaches are vital for zoonotic disease control, yet its effective implementation requires fundamental health system reforms for successful multisectoral coordination. Evidence on operational-level barriers and system requirements is urgently needed. This pre-implementation study examined One Health implementation barriers in Ghana across human, animal, and wildlife health sectors, using structured intersectoral dialogue to prioritise barriers and develop collective solutions for policy development. A two-phase mixed-methods study was conducted in Ghana's three largest metropolitan areas. Phase 1 involved interviews with 101 frontline and national stakeholders, with data analysed using reflexive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR). Phase 2 convened a participatory workshop (n&#x2009;=&#x2009;16) for individual ranking, collective voting and consensus dialogue to prioritise barriers and formulate policy recommendations. Data were analysed using framework analysis, supported by descriptive statistics, and triangulated across phases. Ten implementation barriers were identified. Critically, eight (80%) reflected Outer Setting determinants (e.g. policy gaps, system structure, and workforce architecture), while two represented Outer-Inner Setting interactions; no barriers were purely organisational. Initially, sectoral priorities (human: leadership; animal: finance; wildlife: service delivery) converged through dialogue. Participants reframed financial constraints as symptoms of a weak system structure, establishing this as the root barrier. Extreme workforce imbalances (e.g. three wildlife officers nationally) emerged as critical constraints, representing a health service planning failure that makes conventional coordination models operationally infeasible. Participants jointly recommended coordination frameworks with clear mandates and interoperable data systems, subsequently acknowledging workforce gaps as a priority omission. This study illustrates how participatory cross-sectoral dialogue can shift stakeholder perspectives from sector-specific constraints to systemic governance reform. Findings indicate that sustainable One Health implementation requires addressing both governance fragmentation and workforce architecture across ministerial boundaries, challenging assumptions that organisational capacity alone suffices. These insights directly inform Ghana's national One Health policy development and offer methodological and empirical guidance for multisectoral health system reforms in low- and middle-income countries facing similar implementation challenges.

In the UK, many migrant women are subject to the No Recourse to Public Funds condition, which restricts access to welfare and can result in liability for maternity care charges, contributing to poverty, delayed care, and health inequities. This mixed-methods study examined health and social care professionals' knowledge, confidence, resources, and training needs when supporting women with this status during pregnancy and early motherhood. Focus groups with 16 health and social care professionals and an online survey of 65 professionals and students were conducted across maternity, social care, and voluntary sector settings in England; data were analysed thematically and descriptively. Findings showed wide variation in the support provided, driven by limited understanding of immigration rules, available perinatal support, and maternity charging, alongside inconsistent access to specialist advice. Professionals reported low to moderate confidence in supporting women and responding to charging-related questions, with substantial variation in preparedness across roles and settings. Although most respondents wanted to improve their understanding, only 14% had received prior training. These findings highlight how policy complexity and workforce knowledge gaps may contribute to inconsistent care and inequities during pregnancy and early motherhood, underscoring the need for clearer guidance, workforce training, and improved cross-sector coordination. The resulting realist programme theory will inform co-designed, evidence-based guidance and training relevant to public health systems supporting migrant populations.

Despite global commitments to eliminate mother-to-child transmission of HIV and syphilis, political and resource prioritization remains uneven across low- and middle-income countries. This has led to disparities in financial investment, policy implementation, and health outcomes. This study examines the factors shaping political prioritization of prevention of mother-to-child transmission (PMTCT) in Ghana, Mozambique, and Sudan using the Shiffman and Smith framework to understand how political, institutional, and contextual forces interact to influence national responses. A qualitative, cross-country comparative policy analysis was conducted based on document review from 3 data sources. Across countries, we included 21 government documents, 22 documents from non-governmental organizations, and 15 peer-reviewed articles selected through theoretical sampling. Both inductive and deductive thematic analyses were applied, with the latter guided by the Shiffman and Smith framework. Political prioritization of PMTCT was influenced by interrelated domains including actor power, ideas, political context, information systems, and financial resources. Ghana and Mozambique achieved higher prioritization through cohesive advocacy networks, effective issue framing, strong political commitment, reliable data, and sustained donor support. In contrast, Sudan's limited progress reflected low political commitment due to fragmented leadership, weak coordination, inadequate data, and chronic resource constraints. The findings illustrate that progress depends not only on individual determinants but also on their interaction within national policy systems. Political prioritization of PMTCT results from the interaction of multiple interlinked factors rather than any single determinant. Strong advocacy, effective framing, reliable data, and sustained funding within supportive political environments foster commitment, as seen in Ghana and Mozambique. Coordinated advocacy, credible evidence, and predictable investment are essential to strengthen the PMTCT program by translating the global elimination goals into actionable national strategies.

Leukemia is a major global public health challenge, particularly among adolescents and young adults (AYAs) aged 15-39&#x202f;years, who face distinct biological and social vulnerabilities. This study aimed to systematically assess long-term trends in leukemia burden and quality of care among Chinese AYAs from 1990 to 2021, and to project future trajectories to inform targeted prevention and control strategies. Data were obtained from the Global Burden of Disease (GBD) 2021 database. Temporal trends in incidence, prevalence, years of life lost (YLLs), and years lived with disability (YLDs) among AYAs were analyzed across 204 countries and territories. A Bayesian age-period-cohort (BAPC) model was applied to project incidence and prevalence from 2022 to 2036. A Quality of Care Index (QCI), constructed using principal component analysis, was used to evaluate healthcare performance across different Socio-demographic Index (SDI) regions. In 2021, the age-standardized incidence rate (ASIR), prevalence rate (ASPR), YLL rate (ASYLLR), and YLD rate (ASYLDR) for leukemia among Chinese AYAs were 3.64, 17.41, 133.55, and 1.87 per 100,000, respectively. The ASYLLR remained moderately elevated compared to high-income Asia-Pacific nations. From 1990 to 2021, China showed a distinct divergent pattern, with ASPR increasing by 145.9% and ASYLDR by 33.6%, while ASYLLR declined by 52.4%. Males consistently experienced a higher burden than females (incidence sex ratio: 1.62:1). The highest premature mortality burden occurred in the 20-24 age group, while the fastest incidence growth was observed among those aged 25-29&#x202f;years. Acute lymphoblastic leukemia accounted for the greatest burden, whereas chronic lymphocytic leukemia showed the fastest growth despite low incidence. Projections indicated a modest decline in ASIR but a substantial 70.6% increase in ASPR between 2022 and 2036. China's Quality of Care Index (QCI) reached 74.3%, substantially above the global average (55.2%) and comparable to high-middle SDI regions (71.0%). However, multidimensional analysis revealed specific areas needing improvement, particularly in long-term survivorship care. Leukemia burden among Chinese AYAs is characterized by rising morbidity alongside declining mortality. These findings provide a national-level reference for macro-level policy formulation and underscore the need for strengthened prevention, improved long-term survivorship care, and more integrated health system responses. Future research should focus on subnational analyses to generate locally actionable evidence.

While most individuals in Canada have some form of drug coverage, many public and private plans leave a substantial role for direct payment by individuals. For contraceptives, cost-sharing (deductibles and copayments) and the exclusion of some contraceptives from formularies often leads to access gaps and inequity. How universal, first-dollar contraceptive coverage policies change patient and public costs compared with a mixed public-private system is unclear. To evaluate whether patient out-of-pocket (OOP) costs and payer type changed after the implementation of a universal coverage policy for contraceptives, compared with a mixed public-private insurance system. This controlled interrupted time-series analysis examined aggregate monthly contraceptive prescription data, with British Columbia (BC) as the intervention province and a synthetic control modeled using other provinces. The analysis included all contraceptives dispensed to reproductive-aged females (15-49 years) in 10 Canadian provinces who had contraceptives dispensed between April 1, 2021, and March 31, 2025, using a national prescription database. This period covered 2 years before and 2 years after the policy's implementation on April 1, 2023. Policy change in BC implementing free coverage for contraception by the public payer. The main outcome was the monthly proportion of contraception dispensed and estimated costs, stratified by age, majority payer type, and contraception type. Costs are given in Canadian dollars (currency exchange rate of CAD $1&#x2009;=&#x2009;US $0.73 as of April 30, 2026). During the 48-month study period, 2&#x202f;791&#x202f;157 contraceptive prescriptions were dispensed in BC (1&#x202f;341&#x202f;289 before policy implementation and 1&#x202f;449&#x202f;869 after). In the prepolicy period, 38.7% (95% CI, 38.0%-39.1%) of these prescriptions were paid OOP, 49.2% (95% CI, 48.6%-49.8%) by private insurance, and 12.0% (95% CI, 11.3%-12.7%) by public insurance. When the policy was introduced, the OOP share immediately decreased by 24.9 (95% CI, -26.3 to -23.5) percentage points. The highest prepolicy OOP share (44.6%) was in individuals aged 20 to 29 years, who also had the highest prepolicy costs. Compared with controls, by 2 years postpolicy, the OOP share was 29.5 (95% CI, 38.2-26.1) percentage points lower (33.4 [95% CI, 37.1-29.6] percentage points lower for ages 20-29 years), reaching 9.6% (95% CI, 8.7% to 10.4%) of contraceptives being paid OOP. At 2 years, OOP per-capita costs decreased by $8 per capita (ages 15-19 years: -$7 per year; 20-29 years: -$11 per year; 30-39 years: -$7 per year; 40-49 years: -$6 per year), or a mean of -$43 per year per contraceptive user. In this controlled interrupted time-series analysis, a public drug plan providing universal, first-dollar contraception coverage was consistent with substantially reduced OOP payments, with the largest reductions among individuals aged 20 to 29 years. Contraception may be uniquely sensitive to gaps in mixed public-private insurance systems; these findings suggest that universal, first-dollar contraceptive coverage mandates are a highly effective policy measure to improve access to contraceptives, especially for young adults who often lack comprehensive drug insurance coverage.

In January 2024, new reimbursement policies took effect, allowing marriage and family therapists (MFTs) and mental health counselors (MHCs) to independently bill Medicare for diagnostic and mental health treatment services. We sought to understand how and whether these policy changes have impacted access to mental health services among rural Medicare beneficiaries. We conducted interviews with leaders of rural health systems and relevant mental health organizations regarding perceptions about Medicare reimbursement for MFTs and MHCs and the potential impact on access to rural mental health services. We screened and recruited 14 participants for 45 to 60&#xa0;min individual interviews in July and August 2024. We used directed thematic analysis to develop and iteratively refine themes, identifying patterns in participant responses. Interviewees generally felt that expanding the pool of mental health providers recognized by Medicare would improve the access and quality of mental health services among rural Medicare beneficiaries. However, interviewees frequently described workforce shortages, the chronic difficulty of hiring mental health providers in rural areas, and low Medicare reimbursement rates as challenges that may limit the policy's effectiveness. The inclusion of MFTs and MHCs in Medicare reimbursement policies may represent a meaningful advancement in expanding rural access to mental health services. Workforce shortages and reimbursement challenges may inhibit the policy's potential impact.

The Transforming Outcomes through Research in Cancer Healthcare in Victoria (TORCH-VIC) is a comprehensive population-based cohort that links cancer diagnoses recorded in the Victorian Cancer Registry with administrative health data to capture the complete cancer journey from pre-diagnosis through long-term outcomes. Established in 2022, TORCH-VIC provides real-world evidence on healthcare utilisation, patterns of care, costs, and outcomes across the cancer continuum in Victoria, Australia. TORCH-VIC comprises adults aged 18 years and over diagnosed with colorectal, lung, melanoma, prostate, breast cancer, and lymphoid leukaemia in Victoria, Australia, between January 2010 and December 2021, identified through the Victorian Cancer Registry. Cross-jurisdictional linkage of 11 data collections was performed by the Centre for Victorian Data Linkage for state datasets (hospital admissions, emergency presentations, radiotherapy, outpatient services, elective surgery, costs, and deaths) and the Australian Institute of Health and Welfare Data Linkage Unit for national datasets (Pharmaceutical Benefits Scheme (PBS), Medicare Benefits Schedule (MBS), National Death Index). Annual refresh ensures ongoing data currency. The dataset contains 222,332 unique individuals with 237,089 cancer diagnoses, stored securely in the Secure Unified Research Environment (SURE). Linkage rates exceed 98% for PBS and MBS data, with comprehensive inpatient hospital coverage (98.7%). The dataset captures over 250 million healthcare interactions across four phases: pre-diagnosis pathways, diagnosis, interventions, and outcomes. Data domains include socio-demographics, mortality, comorbidities, healthcare services, medicines, and costs. Mortality is comprehensively captured through linked state and national death registries (35.0% of cohort deceased). Loss to follow-up is minimal (1%), occurring primarily among individuals who emigrate or are ineligible for Medicare, with national datasets ensuring continued follow-up for those who relocate interstate within Australia. TORCH-VIC enables research on cancer epidemiology, health service delivery, disparities in access, supportive care utilisation, survivorship, and healthcare costs. Applications span health services research, policy evaluation, and outcomes assessment. With ethics approvals secured, 2026 enhancements will add screening registers, immunisation data, and additional cancer types. Researchers interested in collaboration should contact the corresponding author to discuss projects within the study scope and ethics requirements.

One Health (OH) is a comprehensive approach that recognizes the human-animal-environment interconnection to health and is applied to prevent and control zoonoses-diseases transmitted between animals and people. Using a multiple-method case study, we examined zoonoses networks, resource management mechanisms, and coordination strategies among policymakers and decision-makers of Peru's human, agricultural, and environmental systems at national and sub-national levels. Social network analysis revealed collaborations between the human and agricultural systems, with limited connection with environmental systems. Only a few links were reported between national and sub-national government levels. Qualitative analysis identified structural barriers, including insufficient regulatory mechanisms for funding cross-sectoral activities. Public financing structures created siloes and resource disparities across systems, hindering sustained multisectoral collaboration. There is a need to regulate the role of environmental systems, including forest protection services, in OH initiatives. Local regulations were used to formalize work agreements with local organizations and compel participation in multisectoral activities. A nationwide OH policy that mandates multisectoral engagement and coordination is needed, as are mechanisms to engage and empower local authorities, community leaders, and farmers in local surveillance systems. Future policy research should assess the evolution of OH policy networks to inform sustainable collaboration strategies.