Advanced Treatment Medicinal Products (ATMPs) are innovative treatments aimed at severe diseases. However, patient access varies across European countries. The present research reviews the reimbursement status of the licensed ATMPs in England, Scotland, France, Germany, Italy, Spain, Ireland, Denmark and Sweden and aims to assess the differences in the outcomes of the decisions / recommendations of the different HTA bodies along with their reimbursement status. The Health Technology Assessment (HTA) evaluations and the reimbursement status of all the ATMPs with an active market authorization by March 2026, in the 9 countries in scope were assessed through the official sites of the national HTA bodies. In March 2026, 22 ATMPs held active EU marketing authorizations, with 20 having orphan designation. Only six of them, Yescarta®, Kymriah®, Zolgensma®, Luxturna®, Tecartus® and Libmeldy®—underwent HTA evaluations across the nine countries. AIFA, NICE, and G-BA gave the highest number of positive HTA recommendations for ATMPs, whereas NCPE did not recommend any of the ATMPs reviewed. Of the reviewed ATMPs, Yescarta®, Kymriah®, and Luxturna® were eventually reimbursed in all countries, even if they hadn’t received positive HTA recommendations. Several ATMPs with European marketing authorization had not yet undergone HTA evaluations across the 9 countries. While evaluation gaps for recently approved ATMPs reflect expected administrative timelines, those persisting in Ireland, Denmark, and Sweden suggest deeper structural barriers. Nonetheless, Yescarta®, Kymriah®, and Luxturna® achieved reimbursement across all 9 countries, demonstrating that access is possible even without uniformly positive HTA outcomes.
Healthcare system reforms increasingly promote integrated primary care to address fragmentation, population needs, and system sustainability. Implementing such reforms requires strong political leadership as well as coherent alignment of actions across the micro (clinical integration), meso (professional and organizational integration), and macro (system integration) levels. Despite its strategic importance, system-level integration—defined as a coherent set of political arrangements—remains both conceptually underdeveloped and empirically underexplored. This review aims to synthesize empirical evidence on macro-level governance arrangements and policy design strategies supporting system-level integration in primary care. A systematized narrative review was conducted using Medline, CINAHL, ABI/Inform, Health Medical Collection, and International Political Science Abstracts (up to March 2025). Empirical, peer-reviewed studies (2010–2025) examining macro-level policies or national strategies for integrated primary care within specific national contexts were included. The analysis drew on the Rainbow Model of Integrated Care (RMIC) to assess essential primary care functions and integration domains, and on Knoepfel’s policy analysis framework to examine policy objectives, instruments, and formulation processes. Thirty-four empirical studies were included. The results showed that the RMIC provides valuable descriptive insights into integration domains, while policy analysis perspectives clarify how these domains are operationalized through policy. Policy programs supporting integrated primary care reflect a broad range of goals—emphasizing care coordination, quality of care, accessibility, system responsiveness, and cost reduction—and rely on mixtures of organizational, regulatory, financial, and informational instruments. Policy formulation approaches combine top-down, bottom-up, negotiated, and participatory strategies. However, macro-governance structures and fragmented responsibilities, together with broader political, economic, and social contexts, frequently undermine regulatory alignment, constraining system-level coherence and integration efforts. Overall, these findings reveal persistent knowledge gaps regarding optimal political arrangements and the causal mechanisms enabling systemic integration. System level integration in primary care is dynamic, value driven, and highly context dependent. Advancing integrated primary care requires more coherent policy mixtures, better aligned governance arrangements, and sustained attention to inter actor relationships. Generating new empirical knowledge grounded in a multidisciplinary framework is essential to further enrich the RMIC and support policymakers in designing and implementing integrated primary care reforms with synergistic impacts.
Reliable HMIS data are vital for maternal health planning, yet completeness remains low. This study examines how capacity-building interventions improve HMIS data completeness for maternal deliveries at Arua Regional Referral Hospital. A mixed-methods study was conducted in 2023 at Arua Regional Referral Hospital. A total of 92 participants were selected through both purposive and simple random sampling. Quantitative data were gathered using a structured mobile questionnaire administered via KoboCollect, while qualitative data were obtained from key informant interviews and a review of HMIS registers, monthly reports, and DHIS2 records. Quantitative analysis was performed in SPSS v26 and R v4.5.1 using descriptive statistics and Spearman’s correlation, with significance set at P < 0.05. Qualitative data were analysed through thematic content analysis using NVivo software. The majority of the enrolled participants were female and predominantly midwives. Supportive supervision and data quality assessments were commonly conducted quarterly, while HMIS training occurred less frequently. Half of the reviewed monthly delivery reports indicated consistency between on-site counts and HMIS submissions. Supportive supervision showed a moderate, significant positive correlation with data completeness (ρ = 0.598, p = 0.040), and data quality assessment also showeda positivesignificant correlation (ρ = 0.714, p = 0.009) with data completeness. HMIS training (ρ = 0.488, p = 0.108) and capacity building (ρ = 0.600, p = 0.453) revealed a positive correlation with completeness. The correlation between capacity building and data completeness was not statistically significant. Supportive supervision and routine data quality assessments are key contributors to improved HMIS data completeness. Strengthening the consistency, coverage, and feedback mechanisms of capacity-building interventions may enhance routine data quality and support evidence-based decision-making in maternal health services.
Abstract Accurate monitoring of oxygen therapy is essential for patient safety, resource management, and financial accountability. However, the high demands of the clinical environment may limit real-time documentation, potentially affecting the accuracy of manual electronic medical record (EMR) entries. Automated monitoring technologies, such as ATAS O₂ (Salvus, Pernambuco, Brazil), have emerged as a potential approach to address such limitations. This study compared oxygen consumption data recorded in the EMR with measurements obtained using ATAS O₂ across 21 hospital beds over a five-month period. The ATAS O₂ system detected a higher number of beds receiving oxygen, total duration (566.90 ± 372.56 vs. 163.61 ± 209.85 h, p < 0.001), number of cycles (138.14 ± 118.65 vs. 12.24 ± 10.00, p < 0.001), mean flow (2.70 ± 1.96 vs. 0.82 ± 0.77 L/min, p < 0.001), total volume (78.41 ± 44.84 vs. 4.72 ± 5.33 m³, p < 0.001), and volume per cycle (1,275.56 ± 2,052.22 vs. 385.78 ± 357.89 L, p = 0.010). These findings indicate systematic discrepancies between manual EMR and automated monitoring systems, highlighting the potential value of integrating automated monitoring technologies into hospital infrastructures.
Blindness affects 1.4 million children worldwide between the ages of 0 and 14 years; in Bangladesh, the prevalence rate is 6.3 per 10,000 children. Thus, this study aimed to develop a framework with an integrated approach to strengthen paediatric eye services in Bangladesh to address childhood blindness. To develop the framework for paediatric eye care services, the study primarily adopted a literature review on existing eye care frameworks including results of authors own previous research work and then conducted three day-long workshops and consultation meetings with experts and stakeholders to finalize the framework. At the initial two workshops, a draft framework was presented and a discussion took place to suggest the necessary measures to strengthen the existing paediatric eye care. After incorporating all the suggestions and measures in the last workshop, the framework was finalized and validated. To design this framework, this study adopted the World Health Organization’s six-building block approach for strengthening the pediatric eye care system. The government of Bangladesh has a strong political commitment to address the prevention of blindness and they have already adopted an action plan called the National Eye Care Plan. Financial support to beneficiaries from the Government and Non-government sectors is crucial to mitigate financial challenges. By desk review, it was found that human resources were inadequate in number and there was geographical uneven distribution of both service facilities and human resources., so task shifting and sharing of human resources based on the geographical location should be ensured. The workshop recommended multiple approaches, which were incorporated into the framework. A large-scale piloting program is required to evaluate the framework’s feasibility and effectiveness in lowering morbidity associated with pediatric eye diseases.
Doctors play a key role in providing health information, and their recommendation strongly influences HPV vaccine uptake. This study assessed knowledge, attitudes, and HPV vaccine recommendation practices among medical doctors in Nigeria. An analytical cross-sectional study was conducted among 462 licensed medical doctors practising in Nigeria. Participants were recruited through convenience sampling using an online self-administered questionnaire disseminated via professional networks and doctors’ WhatsApp platforms. The questionnaire assessed knowledge of HPV vaccination, attitudes towards the vaccine, and recommendation practices. Data were analysed using descriptive statistics, chi-square tests, and multivariable binary logistic regression. Adjusted odds ratios (aORs) with 95
Lean healthcare has emerged as a transformative approach to enhance efficiency, reduce waste, and improve patient outcomes in hospital settings. This systematic review aims to identify the key issues and challenges in implementing Lean initiatives in hospitals. Guided by the PRISMA framework, an extensive literature search was conducted across PubMed, Scopus, and Web of Science for literature published between January 2015 and December 2023, ultimately including 15 studies. The review categorises challenges into seven primary themes: resource limitations, organisational resistance, knowledge and training gaps, operational inefficiencies, communication barriers, sustainability concerns, and patient-centric obstacles. Study quality and risk of bias were independently assessed using the Joanna Briggs Institute (JBI) and the Center for Evidence-Based Management (CEBMa) critical appraisal tools. Resource constraints, encompassing financial, infrastructural, and human resource shortages, emerged as the most prominent barrier, reported in 66.7
This article presents a comprehensive analysis of the regulatory framework and administrative procedures affecting the availability of opioid analgesics for palliative care patients in the Republic of Kazakhstan. Based on an examination of national legislation, subordinate regulations, and their implementation in medical and pharmaceutical organizations, the study identifies key regulatory barriers: mandatory use of paper prescription forms of strict accountability, a limited network of pharmacies licensed to dispense controlled medicines, duplication of procedures for authorizing medical personnel, and burdensome interagency paper-based correspondence. Special attention is paid to inconsistencies between existing legal provisions and their practical implementation. These inconsistencies lead to delays in providing patients with adequate pain relief and reduce the effectiveness of palliative care. The article proposes directions for improving the regulatory framework and administrative procedures in the context of ongoing digitalization of the healthcare system.
After the Ebola outbreak in 2013, the Global Health Security Agenda (GHSA) was launched to equip countries to respond to disease outbreaks rapidly. India, a GHSA member, identified field epidemiology (FE) workforce development as critical to strengthening public health systems. The South Asia Field Epidemiology and Technology Network (SAFETYNET) started its India operations in 2018, as an implementing partner to support India’s FE training programs (FETP), through a cooperative agreement with the U.S. Centers for Disease Control and Prevention, Atlanta (CDC), under GHSA. In 2018, SAFETYNET began by providing technical assistance to the three FETP levels (frontline, intermediate, and advanced) of India, through in-person training, mentoring field investigations, including outbreaks, and conducting scientific writing workshops, and has supported 28 FETP cohorts between 2018 and 2024. Collaborating with CDC and various institutions in India, SAFETYNET has supported the conduct of two FETP conferences, six scientific writing workshops, five mentor workshops, and establishment of three new FETP hubs. In 2019, SAFETYNET started the development of a learning management system (LMS). Between 2018 − 2024, FE trainees have conducted and interpreted over 110 outbreak investigations, 70 surveillance evaluations, and 14 epidemiological research studies with SAFETYNET’s guidance. Its scientific writing support has enabled FETP trainees to present 180 accepted abstracts across 16 conferences. The LMS now tracks the progress of nearly 300 trainees in real-time. Through workforce development and cross-institutional partnerships, SAFETYNET has played a key role in enhancing India’s field epidemiology capacity and developing public health leadership.
Quantifying the statistical relationships between national medicine pricing structures and aggregate life expectancy is essential for shaping effective global health policy. This work utilizes an international panel dataset of 60 countries, incorporating 29 multidimensional health and socio-economic indicators, to evaluate the associations with medicine prices while controlling for confounding factors such as healthcare infrastructure, economic status, and environmental risk. Comparative analysis of seven machine learning algorithms identified Random Forest Regressor as the optimal model, achieving an R² of 0.77, RMSE of 2.90, and MAE of 2.02. Ablation experiments contrasting models with only structural controls, only price variables, and the combined specification confirmed that socio-economic factors explain most variance, while pharmaceutical pricing provides incremental predictive value by reducing error at the margin. Model explainability was enhanced through SHapley Additive Explanations (SHAP) and estimation of model-based effect estimates, which enabled category-specific interpretation across 13 therapeutic classes. Higher prices for corticosteroids, gastrointestinal, and respiratory drugs demonstrated negative associations with life expectancy in settings with limited affordability, whereas increased prices for endocrine, psychotropic, and antihistamine medications correlated with improved longevity in resource-rich health systems. Cross-country comparisons, particularly between India and Brazil, highlighted the influence of healthcare coverage and pricing policies in modulating these associations. These findings underscore the utility of explainable artificial intelligence in disentangling complex health-economic relationships and provide evidence to inform pharmaceutical pricing interventions for optimizing population health.
Health systems depend on workforce capacity, role clarity, and leadership support to sustain implementation of complex, team-based service delivery models. Assertive Community Treatment (ACT) is an evidence-based intervention for individuals with serious mental illness that relies on intensive multidisciplinary coordination and high-fidelity implementation. While ACT research has emphasized outcomes and fidelity measurement, less attention has been given to leadership and workforce experiences that shape implementation processes at the organizational level. This mixed-methods study examines leadership and workforce challenges influencing ACT implementation within a publicly funded mental health system. Staff from a single urban ACT program completed surveys and provided qualitative responses addressing role clarity, supervision, training, and implementation strain. Quantitative analyses found no significant associations between staff background characteristics and perceptions of role clarity or preparedness. Qualitative analysis identified five interrelated themes: role ambiguity, supervision gaps, inconsistent training, tension between fidelity standards and real-world practice conditions, and implicit leadership strain. Leadership frequently absorbed unresolved structural gaps by assuming additional responsibilities and managing ongoing operational demands under constrained conditions. Findings suggest that ACT implementation challenges are driven less by individual staff characteristics and more by organizational and leadership strain arising from structural ambiguity. Strengthening leadership support, supervision infrastructure, and training systems may enhance workforce functioning and promote more sustainable implementation fidelity in team-based mental health service delivery models.
Health professional mobility has become a defining feature of 21st-century health systems, highlighting deep structural inequalities within global health labour markets. International movement of health workers can unfairly disadvantage source countries by losing publicly funded training investments, although it offers benefits at both individual and system levels. This narrative review compiles evidence on current patterns, drivers, and impacts of health worker migration, and explores the emerging idea of proportionate co-investment as a framework for fairer global health workforce management. Literature was gathered through database searches of PubMed, Scopus, Google Scholar, and major organisational and government websites. Evidence was presented following SANRA guidelines. The review emphasises dominant South–North migration flows. Widening wage gaps, poor working conditions, and power imbalances allow high-income countries to benefit from “implicit subsidies” in health workforce development. For source countries, this results in service gaps, poor distribution, higher health system costs, and slower progress toward universal health coverage. Current ethical recruitment codes and bilateral agreements are mostly voluntary, fragmented, and inadequate to fix labour-market imbalances. Proportionate co-investment redefines health worker migration as a shared global duty. Destination countries should systematically support health workforce education, retention, and working conditions in source countries. This review advocates a proactive framework grounded in proportionality, predictability, system alignment, and shared governance, drawing on emerging models such as skills partnerships and destination-country financing. Embedding proportionate co-investment could shift global policy from managing health worker losses to sharing responsibilities, promoting ethical mobility, and strengthening health systems worldwide.
Abstract Background Improving the quality of maternity care is essential for reducing maternal mortality. However, gaps in confidence in using clinical skills may affect the quality of maternity care in low-resource settings. This study aimed to assess the status of maternity care practice and confidence in skill use among maternity care providers (hereafter referred to as healthcare professionals) in Dhading district, Nepal, and identify associated factors. Methods We conducted a quantitative cross-sectional study using self-administered questionnaires distributed to 129 healthcare professionals working in 62 health facilities for childbirth in Dhading district, Nepal. The collected information included maternity care experience, training and technical support, and maternity care practice and confidence. Multiple linear regression analysis was used to identify factors associated with confidence in maternity care practice. Results Participants reported relatively high confidence in managing postpartum hemorrhage and eclampsia but lower confidence in abnormal and advanced procedures, with the lowest median confidence scores observed for vacuum extraction and manual vacuum aspiration. Higher confidence was significantly associated with Skilled Birth Attendant (SBA) training attendance, higher total score for maternity care provided within the past 3 months, and better understanding of national maternal and newborn health (MNH) strategies/programs. Conclusions Low confidence was linked to limited Skilled Health Personnel/SBA training, scarce recent experience with high‑risk cases, and weak understanding of national MNH strategies. In low‑volume districts like Dhading, strengthening routine SBA training, providing structured rotations, and integrating simulation‑based training, particularly for high‑urgency emergency skills, may help build confidence and improve maternal care quality.
Rural primary healthcare centres—particularly Sub-Centres (SCs)—in India play a critical role in ensuring equitable access; however, gaps persist in infrastructure, service delivery, and community engagement. The study aimed to explore the lived experiences of trust and accessibility related to Sub-Centres (SCs) in rural West Bengal, focusing on accessibility, infrastructure, gender dynamics, and institutional trust as key determinants of healthcare engagement. Qualitative, exploratory design was adopted, involving twenty-four participants, four Accredited Social Health Activists (ASHAs), and two Auxiliary Nurse Midwives (ANMs) from two Sub-Centres in the Sovanagar Gram Panchayat area of Malda District of West Bengal. Data were collected through semi-structured interviews and focus group discussions and analysed thematically. Five major thematic domains emerged, (i) Knowledge and Experiences about the Health Centre; (ii) Practice and Accessibility; (iii) Challenges in Service Delivery; (iv) Gender and Power Dynamics; (v) Role in Community Health. While participants valued SCs for affordable and accessible care, persistent constraints such as inadequate infrastructure, irregular doctor availability, limited medicine supplies, and gendered barriers undermined service quality. Women were primary users, yet household hierarchies restricted decision-making autonomy. Despite shortcomings, SCs fostered trust, awareness, and preventive health behaviour through the active mediation of ASHA workers. The findings highlight SCs as socially embedded institutions that extend beyond biomedical functions to serve as public spaces promoting collective well-being. Strengthening SCs requires addressing infrastructural deficits, ensuring consistent medical staffing, empowering ASHA workers, and embedding gender-sensitive and participatory approaches into rural health governance.
Following the 2014–2016 Ebola outbreak in West Africa, the World Health Organization Regional Office for Africa, the Africa Centres for Disease Control and Prevention and the West African Health Organization prioritized establishment and operationalization of Public Health Emergency Operations Centers (PHEOCs) across Member States as strategy for strengthening emergency preparedness and response. Public Health Emergency Operations Centers serve as important platforms for coordinating timely, multisectoral and effective responses to health emergencies. In 2024, Kadoma City in Zimbabwe, established a subnational PHEOC to institutionalize emergency preparedness, strengthen coordination and enhance local health system resilience. This case study documents the establishment process, governance arrangements, early achievements and operational challenges of the PHEOC in Kadoma. Data were derived from institutional document review and key informant interviews. The PHEOC was established through collaboration between Kadoma City Council, the Ministry of Health and Child Care and World Vision Zimbabwe. It is embedded within the Department of Health and Environmental Services, operating in alignment with the national Incident Management System framework. Early achievements included: upgrading infrastructure, equipping the center with core Information Communication and Technology systems and providing capacity-building programs. Despite these advances, the PHEOC faced key constraints including, dependence on external funding, fragmented and largely paper-based information systems and weak digital interoperability with provincial and national PHEOCs. These challenges pose risks to long-term sustainability and operational effectiveness. The experience from Kadoma demonstrates the feasibility of establishing functional subnational PHEOCs in resource-constrained settings through strategic partnerships and institutional integration. It also highlights critical system-level requirements for sustainability, including stable financing, dedicated human resources and interoperable digital infrastructure. As Zimbabwe expands its national PHEOC network, the Kadoma case provides transferable lessons for strengthening decentralized emergency preparedness and transitioning from ad hoc responses to institutionalized public health emergency management. What is already known on this topic: Public Health Emergency Operations Centers are important for coordinating emergency preparedness and response but are often centralized at the national level, with limited evidence on subnational implementation in resource-constrained settings. What this study adds: This study demonstrates that establishing a functional subnational PHEOC is feasible in low-resource settings like Kadoma. It highlights how integration with the national IMS frameworks enhances coherence and operational effectiveness. How this study might affect research, practice or policy: The experience from Kadoma offers a replicable model for other subnational levels aiming to institutionalize emergency response systems. It reinforces the importance of multisectoral collaboration and identifies challenges that must be addressed to sustain PHEOC functionality.
Hospitals are increasingly adopting lean principles to improve workflow efficiency; however, their integration into spatial design remains limited in operational management research. This scoping review synthesizes evidence from healthcare operations, architectural planning, and systems engineering to examine how lean thinking can inform hospital layout decisions that enhance operational performance. The findings indicate that inefficient spatial configurations contribute to excessive staff travel, fragmented patient pathways, care-delivery bottlenecks, and overall process delays. Incorporating lean principles into spatial design by minimizing non-value-added movement, aligning processes with functional adjacencies, and creating flexible zones that can adjust to fluctuating demand can significantly strengthen patient flow and resource utilization. This review contributes to operations management theory by synthesizing evidence to underpin an integrated understanding of lean concepts and spatial design strategies, highlighting their potential to support operational resilience. The practical implications of this study include guidance for hospital administrators, facility planners, and designers seeking to translate lean principles into tangible layout improvements. The review also identifies gaps requiring future investigation, particularly empirical assessments of lean-based design interventions, patient-centered evaluations, and long-term performance outcomes. Overall, this study underscores the potential of lean-informed spatial design to advance efficient, adaptive, and patient-centered hospital operations. Critically, this review makes explicit how specific spatial features including functional adjacency planning, decentralized workstation placement, cellular zone layouts, and flexible multi-use spaces operationalize each of the core lean principles and directly link to specific operational outcomes such as reduced travel distances, minimized waiting times, improved throughput, and enhanced resource utilization.
Customer churn is a critical challenge for sustaining revenue and service continuity in the digital healthcare sector. Accurate churn prediction enables healthcare organizations to implement proactive retention strategies, reduce costs and enhance patient engagement. This study compared the predictive performances of three advanced gradient boosting algorithms, XGBoost, LightGBM, and CatBoost, using real-world behavioral, demographic, and transactional data from a digital health platform. Data preprocessing included handling missing values, categorical encoding, and class imbalance adjustment, followed by hyperparameter optimization using the Optuna framework. The results showed that XGBoost slightly outperformed the other two models, whereas optimization significantly improved the overall performance and stability of all algorithms. Feature importance and SHAP analyses revealed that the average session duration, engagement frequency, and transactional behavior were key predictors of churn. The findings confirm that ensemble gradient boosting techniques offer robust, interpretable, and practical predictive tools for reducing churn and enhancing retention in digital healthcare systems. This study contributes to sustainable health service management by supporting data-driven decisions that promote user retention and deliver high-quality care.
This study investigated caregivers’ perceptions of illness and their health-seeking behaviour for children under five in Morogoro Municipality, Tanzania. A qualitative research approach was employed, whereby data were collected through 12 in-depth interviews, 2 focus group discussions, and non-participant observation to explore caregivers’ experiences and healthcare decision-making processes. Guided by the Theory of Planned Behaviour, the qualitative analysis revealed that caregivers hold pluralistic understandings of illness causation, combining biomedical explanations such as poor hygiene and environmental exposure with cultural beliefs in witchcraft and ancestral displeasure. Perceptions of symptom severity influenced caregivers’ responses, often resulting in sequential treatment pathways—starting with home remedies or traditional healers before resorting to biomedical services. Gender norms further constrained decision-making, as male authority over financial resources delayed timely healthcare access. The findings underscore the coexistence of biomedical knowledge and cultural traditions, highlighting the need for culturally sensitive health policies that integrate local belief systems into child health interventions.
Pregnant undocumented immigrants face social and financial barriers to seeking and accessing adequate prenatal care. Through in-depth, semi-structured interviews with promotores, or community health workers, who work with pregnant patients in the Texas Rio Grande Valley (RGV) region, this paper explores the barriers to care experienced by pregnant undocumented immigrants in the RGV and identifies the ways promotores can help facilitate access to quality care for this population. Barriers to care-seeking or access to care for pregnant undocumented immigrants include structural barriers (e.g., lack of transportation), financial barriers, knowledge gaps, and fear related to immigration enforcement. Promotores can help to address these barriers by connecting pregnant patients with social services, educating and empowering them about their rights, and promoting trust in the communities they serve. We conclude that promotor programs are a promising intervention to enhance care-seeking and access to care for pregnant immigrant patients in the RGV and beyond.
