ABSTRACT The Pathogen Access and Benefit‐Sharing System, proposed within the WHO Pandemic Agreement , aims to ensure equity but faces significant political and operational challenges. This article argues that existing systems and regional solutions are insufficient, often perpetuating health inequities between high‐income countries and low‐ and middle‐income countries. The core obstacle is their failure to address the fundamental issues of equity and accessibility in the allocation of medical resources. To be effective, the PABS System must establish a rapid and resolute response mechanism. This requires states to cede a limited degree of sovereignty to a central governing body. Drawing on the institutional precedent of the Chemical Weapons Convention, this body should be constituted as a subsidiary body of the Conference of the Parties, employ a weighted voting formula—integrating factors such as population, public health vulnerability index, technological/production capacity, and financial contribution—to mandate the real‐time sharing of pathogens and the equitable distribution of benefits. Integrating this structure into the existing WHO framework is crucial for building a timely, equitable, and rules‐based global response system before the next pandemic arrives.
Health in All Policies (HiAP) seeks to integrate health considerations across sectors to improve population health and equity. This study examines how HiAP has been operationalised through legal instruments in Serbia, assessing the extent to which legislation incorporates health outcomes, intersectoral governance, equity, use of evidence, and mechanisms for monitoring and evaluation. Using an analytical framework inspired by the WHO 2014 HiAP framework, 10 sectors with potential health impacts were prioritised, and 21 key laws were reviewed. Data were extracted directly from legal texts and analysed against five core criteria. Findings indicate that HiAP is conceptually recognised in Serbian legislation but practical integration is fragmented. Health outcomes are most visible in sectors traditionally linked to health, such as education and traffic safety, whereas opportunities to promote health outside these sectors remain underutilised. Intersectoral collaboration is rarely formalised, equity for vulnerable populations-including those experiencing mental health challenges, gender inequities, migration, or language barriers-is limited, and evidence-informed monitoring and evaluation are inconsistently applied. The study highlights the potential of legislation to support HiAP when combined with formalised intersectoral collaboration, clear health objectives, and mechanisms for evidence-informed decision-making. Moving forward, systemic reform is needed, including expanding the scope to 'Health in/for All Policies and Legislation/Regulation', embedding mental health and other priority areas into legal frameworks, promoting stakeholder co-creation, and institutionalising monitoring. Such measures, adapted to diverse political and cultural contexts, can strengthen cross-sectoral integration, standardise policy implementation, and embed health equity across governance domains.
Background The state of S & atilde;o Paulo pioneered the adoption of Social Health Organisations (SHOs) under Complementary Law No. 846/1998 that would allow private non-profit organisations to manage hospitals and health services under government contracts with the aim of gaining efficiency and improving quality of care. Our study evaluates whether the management of hospitals by SHOs is associated with improvements in system performance for patients diagnosed with breast, prostate and colorectal cancer.Methods We analysed 652,734 registered breast, prostate, and colorectal cancer cases diagnosed from 2000 to 2023 across an 80-hospital analytic roster. The primary staggered difference-in-differences analysis compared SHO adopters with directly administered public hospitals, used hospital-quarter observations with equal hospital weighting, and applied outcome-specific mortality follow-up restrictions.Results The restricted primary analyses included 23-24 public hospitals, depending on the outcome. SHO adoption was associated with imprecise changes in diagnosis-to-treatment time (-155.3 days; 95% CI -350.0 to 39.4), consultation-to-diagnosis time (-96.3 days; 95% CI -237.7 to 45.1), 30-day mortality (0.8 percentage points; 95% CI -4.0 to 5.5), 1-year mortality (2.5 percentage points; 95% CI -21.7-26.8), and 5-year mortality (29.6 percentage points; 95% CI -3.6 to 62.8). Estimates changed materially with the control group and weighting approach.Conclusion The study did not provide precise evidence that SHO adoption improved cancer-care processes or mortality. However, the small number of hospitals, incomplete long-term follow-up, sensitivity to weighting and control definitions, and the inability to estimate a joint pre-trends test mean that clinically important effects in either direction cannot be excluded.
Municipal health promotion increasingly relies on intersectoral networks to address complex health challenges amid fragmented health, social and educational systems. However, little is known about how practitioners navigate these networks or how perceived strategies correspond with observed network structures. This convergent mixed-methods study involved 14 health professionals and combined qualitative interviews with egocentric network analysis. Interview data were analysed using deductive content analysis, while the quantitative component comprised descriptive network analysis based on structural measures of connectivity, centrality and clustering. The qualitative findings show that network strategies are adaptive and situational, shaped by resource constraints, organisational routines, and network development rather than by explicit strategic plans. Bonding strengthened trust and existing relationship, clustering enabled task-focused collaboration, formalisation supported continuity through established routines and bridging emerged largely unintentionally through routine coordination. Professionals combined strategies flexibly, resulting in hybrid strategic repertories rather than distinct strategy types. Integration of qualitative and quantitative data revealed only partial alignment between reported strategies and observed structures. Crucially, professionals themselves did not always recognise the structurally prominent brokerage positions they held, indicating that brokerage is an emergent feature of everyday networking. These findings suggest that municipal health promotion cannot be characterised by a single form of professional collaboration. Rather, collaboration must adapt to the task at hand, ranging from information exchange and multiprofessional collaboration to intersectoral collaboration. In order to sustain relationship-based collaboration while retaining the flexibility to respond to local needs and health inequities, municipal health promotion requires institutional support for coordination.
Providing healthcare services in conflict-affected regions like northern Syria is a significant challenge due to ongoing conflict and massive displacement. Mobile clinics offer a flexible solution to meet the urgent healthcare needs of displaced communities. This study aims to develop a comprehensive evaluation framework for the optimal location selection of mobile clinics, integrating fuzzy multi-criteria decision-making approaches, Geographic Information Systems (GIS), and multi-scenario planning. We conducted surveys with 37 medical NGOs actively engaged in the Syrian health sector to identify key criteria for mobile clinic locations. Using the Fuzzy Analytic Hierarchy Process (F-AHP), we weighted these criteria based on their importance. Spatial analysis with GIS provided a visual assessment of each potential location against these criteria, creating risk maps to guide decision-making. We applied the fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) to evaluate and rank 51 candidate locations. Additionally, multi-scenario planning was employed to assess the performance of these locations under four potential conditions: current/continued instability (S1), conflict escalation (S2), flood risk (S3), and post-conflict recovery (S4). The results highlight strategic locations for mobile clinics, providing actionable insights for health authorities, NGOs, and donors. This framework offers a data-driven, adaptable solution for healthcare delivery in crisis zones, enhancing the strategic planning capabilities of humanitarian organisations.
