INTRODUCTION:The NHS is now facing serious challenges from acute care pressure, reflecting on the emergency department (ED) national waiting time target compliance. Concerns about cancelling elective operations to cope with emergency services have also arisen. However, there is a lack of existing evidence to prove a direct relationship between ED episodes and planned hospital services. Thus, the objective of this study is to investigate the impact of high ED attendances on elective surgical activities. METHODS:Retrospective cross-sectional observational study which includes the five largest health boards in NHS Scotland. All patients who presented to the ED in 2021 are included. Univariate and multivariate regression analysis were used to show relationship between ED attendances and elective surgical services including in- and out-patient waiting lists and clinic activities. Explanatory variables include total ED attendances and attendances that exceeded the national waiting time target. RESULTS:The five health boards recoded a higher patient visit to ED on second and third quarter. Non-compliances to 4 hours waiting time ranges between 6% and 20%. Both Univariate and multivariate regression analysis showed a positive correlation between long ED waiting time (> 8 and 12 hours) and increased patient waiting time for elective surgical service as well as delay in clinic review. DISCUSSION:Prolonged ED waiting times were consistently associated with delay in in- and out-patient elective service. To ensure timely and adequate treatment of patients, policymakers should invest in resources to improve the efficiency of both emergency and elective services and introduce management plans that balance the needs of both services.
Health Technology Assessment (HTA) is an organizational process used to determine the value of health-technologies. There is considerable variation in how HTA is developed globally, with Canada at the forefront of this field, having pioneered the use of HTA and implemented it extensively across healthcare organisations at all levels. This study is relevant for its unique focus on citation networks and author keywords regarding HTA in Canada, providing a holistic view by analysing HTA as an organizational process. By identifying fundamental process elements and differentiating research streams (RSs), it addresses a notable gap in the literature, offering fresh insights and informing policy recommendations to enhance HTA practices. While referring to the Canadian HTA, this study conducts a Systematic Literature Network Analysis to identify the RSs that will be analysed according to a process perspective. This analysis allows highlighting the process components-like stakeholders, phases, and methods-that have played a role in the success of Canada's HTA, as well as pinpointing the ongoing challenges that need to be tackled to create greater value. Analysing documents published in peer-reviewed English-language journals from the Scopus-Elsevier database, we identified seven RSs, including macro-HTA, meso-HTA, micro-HTA, ethical considerations, and patient involvement. For each stream, this study delineates the process elements, that is, the involved stakeholders, process phases, methodologies, and evaluation criteria. It is evident that while expert panels and specialist groups are crucial for technical HTA activities, patients and caregivers play a pivotal role in social and ethical evaluations. The study also highlights future challenges for HTA procedures: integrating qualitative and quantitative considerations, assessing the real impact of macro-HTA outputs, and overcoming barriers to patient involvement. Theoretically, this paper clarifies the differences between streams in terms of HTA process elements, and practically, it assists practitioners in tailoring the HTA process to their specific needs. Policymaking recommendations include considerations regarding the number and intensity of stakeholder engagement.
BACKGROUND:Patient Navigation Programs (PNPs) address fragmentation and socioeconomic barriers in breast cancer care, but sustainable implementation is complex and context dependent. This scoping review systematically maps and synthesises multilevel determinants of breast cancer PNPs to inform strategic planning and health system management for sustainable service delivery across diverse public health contexts. METHODS:Guided by the Arksey and O'Malley methodology framework and reported in accordance with PRISMA-ScR, we conducted a comprehensive search across five databases, covering studies published between January 2000 and December 2025. Implementation determinants were retrospectively mapped using the Consolidated Framework for Implementation Research (CFIR v1.0) as an analytic lens. Dual independent screening and multi-reviewer construct coding were performed, with discrepancies resolved through consensus. RESULTS:Twenty-six studies met the inclusion criteria. Determinants were identified across all five CFIR domains. Outer-setting pressures (e.g., financial and transportation barriers) frequently intersect with inner-setting constraints (e.g., workforce shortages, fragmented service structures). Process-related strategies, particularly stakeholder engagement and structured navigator training, were consistently described as enabling mechanisms that buffered contextual strain-intervention characteristics, including cost, complexity, and adaptability, moderated integration trajectories. Sustainability improved when navigation functions were embedded within routine service structures rather than maintained as externally funded add-ons. CONCLUSION:The implementation of breast cancer PNPs appears to be shaped by dynamic cross-domain interactions. This synthesis suggests that sustainability may be strengthened through alignment of financing arrangements, workforce configuration, service integration mechanisms, and deliberate implementation strategies. A proposed phased implementation pathway offers a practical planning guide for resource-constrained systems.
Research before and during COVID-19 has framed health-system resilience as the capacity to absorb shocks, adapt, transform and learn while sustaining essential functions. Building on this broader literature, including Meredith et al.'s account of local public-health adaptation under political and resource constraints, we propose a worker-patient safety loop from a Taiwan psychiatric hospital perspective: workforce strain can weaken safety-critical care; near misses, adverse events and continuity failures should trigger reporting, organisational learning and corrective action; and the resulting changes should protect workers, patients and care continuity. The loop can be monitored through indicators of workforce wellbeing and safety, safety-event learning, and continuity across settings, supported by digital incident, staffing and handoff systems with safeguards for privacy and data quality. Informed by professional experience and published evidence, this conceptual framework applies to acute shocks and continuing operational pressures. Its proposed domains require prospective empirical validation before they can be treated as established measures of hospital resilience.
Publicly financed healthcare systems must balance technological innovation with fiscal constraints. Reimbursement mechanisms influence institutional decisions regarding the adoption of high-cost surgical technologies. This study evaluated whether current reimbursement designs adequately reflect procedure-level gross surgical profit of robot-assisted gastrectomy within the Japanese National Health Insurance system. A retrospective cost analysis was conducted for curative gastric cancer surgery performed at a tertiary institution in 2024. Gross surgical profit was defined as total reimbursement minus procedure-related costs, including consumables, robot maintenance, and labour costs. Postoperative complication-related costs and total episode-of-care costs were not incorporated into the analysis. Fifty-two gastrectomies were analysed. Open and laparoscopic distal gastrectomy generated positive gross profits, whereas robotic distal gastrectomy resulted in a negative gross margin (-¥87,075 per case). Although robotic total gastrectomy showed a positive gross profit in absolute terms, it remained substantially less profitable than open total gastrectomy. Increased procedure-related costs associated with robotic surgery were only partially offset by higher reimbursement. Sensitivity analyses indicated that gross profit was more responsive to changes in surgical fees and material costs than to maintenance or labour costs. These findings suggest that current reimbursement increments may not fully reflect procedure-related costs associated with robotic gastrectomy and highlight the importance of procedure-specific reimbursement evaluation when introducing high-cost surgical technologies into publicly financed healthcare systems.
Sub-Saharan Africa (SSA) continues to experience a high and uneven disease burden, mainly from HIV/AIDS, tuberculosis, and malaria. As external funding declines, the strategic allocation of domestic public health spending (DPHS) becomes crucial. This study assesses whether directing DPHS towards major diseases and high-burden areas improves health outcomes across 43 SSA countries between 2003 and 2022, using DALYs as the outcome measure. Results show a statistically significant positive relationship between DPHS and DALYs: HIV-specific models yield coefficients of 0.105-0.288 (p < 0.01), and all-cause models yield coefficients of 0.071-0.085 (p < 0.05), while other models are insignificant. The paradoxical positive association-stronger in high-burden settings-suggests that DPHS is reactive, mainly used to address existing disease burdens rather than prevent them. The significant persistence of DALYs, especially in low-burden and high-burden contexts, further indicates that spending is directed towards treatment and case management rather than preventive measures. The DPHS effect on tuberculosis or malaria outcomes in DALYs is slightly greater in low-burden areas. Beyond health spending, factors such as economic growth, inequality, population ageing, and governance substantially influence health outcomes. Overall, the findings highlight that while DPHS remains essential, its current reactive deployment limits effectiveness. A systemic shift is needed towards proactive, preventive approaches with targeted health interventions to reduce the region's disease burden.
Traditional Indigenous medicine has existed for centuries, but only recently has it obtained international recognition. Some countries have been working on the integration of traditional Indigenous healing practices in their national health systems. For example, Bolivia has taken significant steps to prevent the neglect of traditional Indigenous medicine over the last 40+ years, a process that continues today through several policies supported by the national government. The aim of this perspective article was to discuss efforts to prevent the neglect of traditional Indigenous medicine in Bolivia. Through analysis of 12 legal documents, including the Constitution of 2009, decrees, laws and resolutions, we categorised the efforts in 5 points: acknowledging the past, making radical changes to the political constitution, adopting a new approach to health and wellness, regulating traditional medicine, and protecting the environment.
OBJECTIVES:Unsafe anaesthesia practices in Mexico have contributed to repeated outbreaks of fatal fungal meningitis, exposing broader health system vulnerabilities. This study aimed to analyse how structural weaknesses in perioperative care, spanning governance, workforce, and institutional practices, reflect deep gaps in health planning, regulation, clinical oversight and hospital management. METHODS:We applied a participatory, role-based systems mapping approach. A two-phase design method combined a survey to identify perceived system failures with structured, guided interprofessional, participatory reflection sessions. Participants from diverse professional groups refined key themes and assessed their impacts on patient safety, workforce practice, and institutional integrity. RESULTS:Four core themes emerged: resource management and operational efficiency; quality control and safety standards; regulatory compliance and institutional integrity; and personnel commitment and professional conduct. Beyond resource and regulatory gaps, the findings highlighted weak institutions, fragmented communication, and improvised workarounds normalised across professional groups. These patterns underscore system-wide deficiencies in national policy and system strategy implementation, health workforce planning, operational management, and organizational accountability. CONCLUSIONS:Catastrophic fungal, fatal meningitis outbreaks in Mexico arose from failures of governance, learning, oversight, culture, supply chains, and frontline practice-and prevention requires coordinated action across the entire sociotechnical system. By situating perioperative safety failures within the broader context of health-system governance, this study demonstrates the value of participatory systems inquiry for linking frontline clinician experiences to policy and organizational priorities. The findings provide a foundation for strategies to strengthen health planning, regulatory oversight, and organizational readiness in complex health systems.
While individual effects of community support and environmental pollution on mental health have been studied separately, the interplay between these factors has not been extensively explored. This paper investigates the impact of environmental pollution on mental health, with a particular focus on the mediating role of community support, using data from the China General Social Survey (CGSS) conducted in 2021. The results of this study suggest that environmental pollution significantly correlates with poorer mental health outcomes. However, strong community support-encompassing social cohesion, collective efficacy, and resource sharing-ameliorates these negative effects. These findings provide empirical support for the Competence Enhancement Model in the context of China, highlighting the need for policies that integrate environmental management with community-based mental health interventions. Strengthening community resilience and fostering supportive social networks may serve as viable strategies for mitigating pollution's mental health burden.
BACKGROUND:This study investigates whether the management of sterilization services in healthcare facilities should be handled internally or outsourced to an external company. In this context, the aim of the study is to identify factors influencing sterilization services, prioritize them, and rank alternative strategies using multi-criteria decision-making techniques. METHODS:We introduce a hybrid method to select the optimal sterilization service for healthcare institutions. This method involves determining criteria and alternatives for sterilization services, collecting data from experts, determining the weights of factors affecting the type of sterilization service using the Bayesian BWM method, and finally identifying the optimal sterilization service using the Fuzzy TOPSIS method. The study is conducted as a real case study at a university hospital in Türkiye. We also conducted a sensitivity and comparative analysis to ensure the robustness and reliability of the proposed decision-making model, and to provide more precise and meaningful outcomes. RESULTS:The results of the study indicate that "Adaptation to technological developments" is the most effective criterion for all participants, and outsourcing sterilization services is the dominant view according to the criteria. CONCLUSIONS:The study highlights the significance of integrating technological advancements into the management of sterilization services within healthcare facilities. It offers decision-makers a comprehensive framework to make informed choices about sterilization service management, thereby enhancing patient care and operational efficiency in healthcare facilities. Additionally, it offers guidance to decision-makers, enabling them to make more suitable decisions and policies in sterilization service management.
BACKGROUND:Considering the rapid expansion of hospital operations and the increasing digitisation of medical data, there is a pressing need for efficient and intelligent methods to process and analyse large-scale medical data. METHODS:We integrated the QLoRA algorithm with ChatGLM2-6b, Llama2-7b, and Llama2-13b models, fine-tuning them on a local SQL dataset to optimise query performance. Prompt-Engineering with ChatGPT was further applied for effective SQL execution. RESULTS:Original open-source models showed almost no SQL generation capability (overall EX ≈ 0 for ChatGLM2-6B and Llama2-7B; 0.04 for Llama2-13B). QLoRA fine-tuning substantially improved performance, with QLoRA-Llama2-13B achieving the best results among open-source models (overall EX 0.41 ± 0.030). Proprietary models demonstrated significantly stronger performance. Zero-shot ChatGPT-3.5 achieved moderate accuracy (EX 0.44 ± 0.007), which improved to 0.94 ± 0.017 with few-shot prompting. GPT-4.1 further improved performance, reaching 0.78 ± 0.038 in the zero-shot setting and 0.96 ± 0.011 with few-shot prompting. The few-shot GPT-4.1 results were comparable to those of database engineers (EX 0.97 ± 0.017), with no significant difference (p = 0.42). CONCLUSION:Fine-tuned LLMs and few-shot GPT-4.1 demonstrate substantial improvements in SQL query execution, providing a robust framework for efficient medical data analysis and informed hospital decision-making.
The collection of infectious waste from healthcare facilities (HCF) constitutes a recurring operational challenge. Indeed, despite the inherent health risks posed by the storage and the transportation of infectious materials, most of the existing waste collection systems tends to prioritise cost optimization and to underaddress the safety dimension. Besides, the collection frequency must be tailored to the waste generation rate of each healthcare facility to avoid delays and inefficiencies. Therefore, it is clear that finding the best collection schedule that guarantees safety within HCF, transportation security, and economic profits is both critical and difficult to achieve. In order to more accurately model the described problem, this study introduces the Sustainable and Load-dependent Periodic Vehicle Routing Problem (S-PVRP). The proposed model aims to optimises three objectives: the travelled distance, the transportation risk and the storage risk. Besides, it is designed in a such a way to trigger the collection when a threshold value is reached. To solve the S-PVRP, we design two solution approaches with very well selected ingredients in order to strike a balance between the exploration and exploitation aspects by reasoning upon multiple objectives. An experimental study is carried out to prove the efficiency of the algorithm on multi-objective optimization. The algorithm is tested on several benchmark instances and evaluated via several performance metrics. Indeed, we have compared the performance of our algorithm against state-of-the-art algorithms. The experimental results showed that the proposed approach MX-GAOPT is very competitive and outperforms the competing algorithms in most cases.
OBJECTIVE:To understand how current programmes and policies can be leveraged to improve maternal, infant, and young child nutrition outcomes (MIYCN) in Guinea. DATA COLLECTION METHODS:Study design. This study is part of a larger multiphase mixed methods study design. THEORETICAL FRAMEWORK:A systems framework developed by the United Nations Children's Fund (UNICEF) and an implementation science framework were used to guide this research. Phase 1. An in-depth literature review of current programme and policy documents (2019-2022) targeting MIYCN through the water, sanitation, and hygiene (WASH), health, food, and social protection systems in Guinea was conducted. Phase 2. Semi-structured interviews with stakeholders (n = 20) from each system were completed to explore stakeholders' knowledge related to pertinent programs and policies. Phase 3. Validation of findings was conducted using member checking. DATA ANALYSIS METHODS:Grey literature documents and interview findings were analysed using content analysis guided by the systems framework and implementation science framework, respectively. RESULTS:Policy documents across systems were all multisectoral and more than half (27/32) of evidence-based programme modalities across systems were included in policies. Most (28/32) evidence-based programme modalities were also being implemented in Guinea. Stakeholder interview findings revealed that programme implementation was the most salient barrier to operationalising evidence-based programme modalities. CONCLUSION:Findings from our study indicate that policy and programme frameworks are strong but improved financial planning and vertical and horizontal programme planning may create a stronger enabling environment to support MIYCN in Guinea.
BACKGROUND:Improving health system performance in decentralised settings requires coordinated governance structures, sustainable financing mechanisms, and targeted equity policies. However, empirical evidence on how these institutional mechanisms interact to influence service delivery, financial protection, and equitable access remains limited in many low- and middle-income countries. METHODS:This study examined the determinants of health system performance in Southwest Nigeria using cross-sectional survey data collected from health sector stakeholders. Robust ordinary least squares regression models with heteroskedasticity-consistent standard errors were estimated to assess the relationships between governance coordination, financing reform implementation, equity-targeted interventions, and three performance outcomes: service delivery effectiveness, financial access protection, and equitable access to care. State fixed effects and stakeholder and organizational controls were included in all models. RESULTS:Governance coordination demonstrated a significant positive association with service delivery effectiveness in the baseline model (β = 0.295, p < 0.01). Financing reform implementation was strongly associated with improved financial access protection (β = 0.311, p < 0.01), while equity-targeted interventions exhibited the strongest and most consistent relationship with equitable access outcomes (β = 0.335, p < 0.01). Expanded institutional models revealed that public trust was positively associated with multiple performance indicators, whereas corruption displayed a negative relationship with financial protection and service delivery outcomes. CONCLUSION:The findings suggest that health system performance improvements are driven by the combined effects of governance coordination, pooled financing mechanisms, and equity-focused policy interventions operating within supportive institutional environments. Strengthening intergovernmental coordination, expanding financial risk-pooling arrangements, and prioritising targeted equity policies may substantially enhance progress towards universal health coverage in decentralised health systems.
Rising out-of-pocket (OOP) health expenditures in the Eastern Caribbean Currency Union (ECCU) underscore persistent gaps in health insurance coverage. This paper develops a Health Insurance Policy Simulation Model (HIPSM) to assess the potential impact of employer health insurance mandates and health insurance tax credits (HITCs) across five small island developing states (SIDS): Antigua and Barbuda, Dominica, Grenada, St. Lucia, and St. Vincent and the Grenadines (SVG). Using social security and insurance data, the model estimates coverage gains, fiscal costs, and labour market effects under varying thresholds and tax credit levels. Results show that employer mandates and HITCs can reduce coverage gaps and OOP expenditure in these countries but are highly sensitive to design characteristics. The findings offer important guidance for SIDS exploring scalable pathways towards universal health coverage through private insurance mechanisms, particularly in the absence of comprehensive public healthcare financing systems.
Health promotion policy is an effective way to improve population health and reduce the burden of chronic disease, yet how implementation of health promotion at policy levels occurs within healthcare remains unclear. Healthcare organizations, on the one hand, aim to improve population health and 'upstream' health determinants through the Quintuple Aim, but, on the other, are complex and dynamic organizations, with a particular emphasis on downstream clinical care services. Many types of practitioners interpret health promotion policies within the healthcare setting and must implement them in their everyday work: policy implementation as an everyday occurrence. Healthy eating policies focused on creating supportive food environments (e.g., cafeterias, cafes) are being adopted by healthcare organizations as a way to improve diets and reduce the burden of chronic disease. An examination of healthy eating policy implementation is essential to better understand how health promotion is integrated into healthcare organizations. This qualitative phenomenological study uses organizational social theory on street-level bureaucrats to interpret the implementation of a healthy eating policy within healthcare food retail services and the relationships between street-level bureaucrats. We conducted 12 in-depth policy key informant interviews and analysed findings using directed content analysis. The findings showed a shift in priorities from leadership to allocate resources for health promotion tasks to make food more accessible and available to staff. Participants considered context as they implemented the policy using local knowledge arising from informal and formal networks and identified other opportunities to influence healthy eating. Studying the actions of healthcare practitioners in everyday policymaking provides essential context and insight into how policy implementation unfolds. Although standards for health promotion are lacking, practitioners can engage in quality improvement initiatives to challenge the status quo and improve food environments.
OBJECTIVES:Unmet need for family planning continues to be a critical barrier to achieving reproductive health goals in Bangladesh, despite advancements in health infrastructure and services. This study examines trends and determinants of unmet need for family planning among married women of reproductive age using data from the Bangladesh Demographic and Health Surveys (BDHS) spanning 2011 to 2022. METHODS:We analysed nationally representative BDHS datasets from 2011, 2014, 2017-18, and 2022 (n = 16,551; 16,795; 18,885; 18,987 married women aged 15-49). Unmet need (spacing/limiting) was the binary outcome. We described trends and subgroup differences, tested bivariate associations (χ2), and fitted separate multivariable logistic regressions for each survey year to estimate adjusted odds ratios (95% CIs). Division-level disparities were mapped, and a Blinder-Oaxaca decomposition (2022) quantified the explained versus unexplained components of rural-urban gaps. RESULTS:Over the past 12 years, the unmet need for family planning has consistently decreased; however, notable disparities persist across geographic divisions, wealth quintiles, and educational attainment. Women with minimal education and rural residency were likelier to report unmet needs; women from affluent homes, metropolitan locations, and those exposed to family planning knowledge via mass media were less likely. CONCLUSIONS:These results highlight the need for thorough, context-specific interventions to close the gaps in family planning programs, guaranteeing proper access and advancement towards sustainable development goals in reproductive health.
This paper explores the perspectives of mental health and substance use providers who supported people released from custody during the pandemic in Ontario, Canada, with a focus on service disruptions, adaptations, and experiences. We conducted 20 in-depth qualitative interviews and analysed these using Applied Thematic Analysis. Pandemic public health responses limited the ability of providers to support people released from custody. Policies designed to mitigate viral spread were not tailored to the mental health and substance use context, leading to disruptions in service delivery. This had domino effects for service users and providers. Criminal-legal-involved populations had to isolate and at the same time providers could not reach out to them, leading to increased risks for substance use, overdose, and suicide. Providers in turn felt pressure to help people released from custody, when policy made it exceedingly difficult for them to do so. Still, providers did find silver linings through opportunities to work together and provide better person-centred care. For future pandemic preparedness, decision-makers must consider the unintentional fallout that blanket policies can have on underserved communities and mitigate against unintended consequences. Future research should engage underserved communities to understand their needs during emergencies.
This study investigates the role of complementary clusters of human resource management (HRM) practices in explaining the persistent productivity variations across English NHS hospitals. While prior research has highlighted the importance of individual HRM practices, their impact is often indeterminate. A critical gap remains in the systematic analysis of complementarity, non-linearity, and the interdependencies between these practices. To address this gap, we draw on complementarity theory to propose and test a novel framework. This framework posits that hospital performance is shaped by three distinct effects: indeterminacy, where isolated practices have an inconsistent impact; non-linearity, where practices are effective only above a certain intensity threshold; and complementarity, where synergies between practices amplify their collective impact. We use this framework to explain the significant productivity dispersion observed across hospitals. Using panel data from English NHS hospitals, we employ machine learning techniques to identify distinct HRM clusters and test their significance using correlated random effects models. Our findings confirm that individual HRM practices often have no significant effect until their intensity surpasses a critical threshold. Crucially, we identify several distinct complementary clusters involving incentives, workplace flexibility, training, team quality, and job design. High-performing hospitals are distinguished by their adoption of these synergistic bundles-such as combining job design, team quality, and incentives-whereas persistent low performance is linked to the adoption of incomplete clusters. For instance, workplace flexibility or training only boosts productivity when supported by an effective incentive system, underscoring the powerful non-linear and interdependent effects at play. This study advances the HRM and healthcare management literature by systematically demonstrating the non-linear and complementary nature of HRM practices and by introducing data-driven methods for their analysis. The key implication for policymakers and hospital administrators is the need to prioritise bundles of complementary practices and holistic organisational change over isolated, piecemeal initiatives.
The lack of healthcare trust is strongly associated with low rates of access and utilization of care, adherence to medical advice, and adverse health outcomes, especially among vulnerable populations. We used a descriptive qualitative design and employed thematic analysis to examine the contributing factors to the lack of trust in healthcare among African immigrants in Florida, US. We conducted in-depth interviews with 19 participants selected through purposive and snowball sampling. The interviews were audio-recorded, transcribed verbatim, and thematically analysed using Nvivo14 software. The findings revealed two overarching themes: (a) personal and (b) institutional factors of lack of healthcare trust. Personal factors included language and communication challenges, lack of knowledge, past negative healthcare experiences, fear of losing legal status, and the use of traditional medicine and prayer as a substitute for modern medicine. Institutional factors included providers' lack of knowledge, wrong assumptions and ignorance, lack of diversity in healthcare, repeated tests and burdensome documentation, malpractice, lack of financial transparency and unfair cost, over-medicalisation, racial divide and discrimination, and unfavourable policy conditions. The findings suggest a holistic approach that involves improving healthcare navigation skills among African immigrants; adopting a patient-centred approach; enhancing health literacy; strengthening cultural competency training and education on tropical medicine for healthcare providers; promoting diversity within the healthcare workforce; and engaging in anti-racism practices that ensure provider accountability. It is also critical to promote policies that ensure financial transparency and coordinated care, reduce unnecessary testing and documentation, and promote safe and equitable access to healthcare for African immigrants.
