Background Mining workers represent a high-risk occupational population for malaria in the Democratic Republic of Congo. This study aimed to assess the knowledge, attitudes and practices regarding malaria control and prevention among mining workers to inform targeted interventions. Methods A cross-sectional survey was conducted among 606 mining workers in Haut-Katanga Province. Data on socio-demographics and KAP regarding malaria were collected using a structured questionnaire. Multivariate logistic regression was employed to explore potential independent determinants of adequate knowledge and poor practice. P values less than 0.05 were considered statistically significant. Results Totally 485 valid questionnaires were collected, and 365 mining workers (75.3%) were considered to possess adequate knowledge. Multivariate analysis revealed that middle school education level (adjusted OR=0.37; 95% CI: 0.22–0.64; p<0.01) and working in the early morning or evening shifts were significant barriers to achieving adequate knowledge (adjusted OR=0.46; 95% CI: 0.24–0.90; p=0.02). For attitudes, most workers were willing to use insecticide-treated bed nets (99.3%) and spray insecticides indoors (94.7%). Highest self-reported preventive practices were wearing long-sleeved clothing (99.3%) and the use of insecticide-treated bed nets (91.1%). Conclusions Although majority of mining workers demonstrates adequate knowledge of malaria, a significant “knowledge-practice gap” still exists, enhancing the need to promote acceptance and sustained adoption of preventive practices. Corporate policies should move beyond general education toward visual-based training tailored for miners and subsidized preventive tools at home. The implementation of malaria-specific paid sick leave will also be essential to translate positive attitudes into prompt health-seeking behaviors by removing financial disincentives.

Mistreatment of pregnant women during childbirth in health facilities(HFs) is a public concern in Tanzania. The practice poses a number of negative health effects to women and the new-born including long terms disabilities and deaths. However, there is limited empirical evidence on the current prevalence and socio-demographic disparities associated with mistreatment of pregnant women during childbirth services in HFs in Tanzania. This study used secondary data of 5,810 pregnant women aged 15–49 years who gave birth in health facilities drawn from the 2022 Tanzania Demographic and Health Survey. All data were weighted to account for complex sampling design and non-response rate. Outcome variable was mistreatment status of pregnant women during childbirth, dichotomized as yes and no. Independent variables grouped into individual, social and structural determinants in line with Anderson model of health services usage. Descriptive analysis to show distribution of respondents among characteristics in terms frequency and percent, chi-square to determine association and multivariable regression analysis to determine the magnitude of association were performed. A threshold of p-value less than 0.05 was set to determine a significant factor. In Tanzania, the prevalence of women mistreatment during childbirth in the HFs is 24.3

Background:Child anaemia remains a major public health concern in low- and middle-income countries, particularly among children aged <2 years. Given Tanzania's slow progress towards addressing this challenge, despite the implementation of targeted national strategies, we aimed to examine the prevalence and associated factors of anaemia in children aged <2 years. Methods:This cross-sectional study was based on secondary data from the Tanzania Demographic and Health Surveys (2004-2005, 2010, 2015-2016, and 2022). We applied individual sampling weights to ensure national representativeness and used descriptive analyses to estimate the prevalence of child anaemia, both overall and in specific age group distributions (6-23 and 24-59 months), by severity. Then, employed geographic information system mapping to visualise the regional anaemia prevalence among children aged <2 years. Finally, we conducted a multivariable logistic regression analysis to identify risk factors related to child anaemia and sensitivity analyses to check the robustness of our findings. Results:We included 25 590 children aged <5 years with available haemoglobin data, of whom 10 166 were aged 6-23 months. In 2022, 59.9% of children aged <5 years and 73.1% of those aged 6-23 months were anaemic. Using spatial analysis, we found that 16 of 31 regions experienced increased prevalence of anaemia, while the remaining 15 saw slight to moderate declines since 2015. In the multivariable analysis, being male (adjusted odds ratio (aOR) = 1.380; 95% confidence interval (CI) = 1.133-1.681), having low birth weight (aOR = 1.713; 95% CI = 1.076-2.727), being underweight (aOR = 1.438; 95% CI = 1.032-2.005), and not having health insurance (aOR = 1.768; 95% CI = 1.247-2.508) were factors significantly associated with increased risk of anaemia. Conclusion:s Child anaemia in Tanzania has stagnated between 2015-2022, failing to meet national targets. The burden has remained disproportionately high among low birth weight children and those aged <2 years, with those residing in coastal regions and high food production areas being especially vulnerable. Targeted interventions during the first 1000 days of life should be prioritised to break the intergenerational cycle of anaemia.

BackgroundPhysical activity is generally associated with improved adolescent mental health, yet its dose–response relationship remains unclear. This study examined how physical activity relates to stress perception, psychological resilience, and self-efficacy among adolescents.MethodsA cross-sectional survey was conducted in September 2024 among 2,270 students aged 12–15 years from 4 middle schools in Shanghai, China. Multivariable linear regression and restricted cubic spline (RCS) models were used to examine association and dose–response relationships, adjusting for demographic and academic covariates.ResultsHigher physical activity was significantly associated with lower stress perception (B = −0.13, p < 0.001), higher psychological resilience (B = 0.33, p < 0.001), and higher self-efficacy (B = 0.25, p < 0.001). RCS analyses revealed dose–response relationships. At lower physical activity levels, the slopes were −5.65 for stress perception, 8.59 for psychological resilience, and 12.10 for self-efficacy (all p < 0.001), while at higher physical activity levels, the associations were substantially attenuated. Gender-stratified analyses indicated stronger associations in males than in females.ConclusionPhysical activity is associated with better mental health in adolescents, particularly among those with lower activity levels. The findings highlight the importance of targeting less active adolescents in school-based interventions.

In countries without a gatekeeping system, including China, promoting primary healthcare (PHC) utilization can improve system efficiency and reduce healthcare burden. However, evidence on diabetes patients’ PHC utilization and its impact on health outcomes remains limited. This study employs continuity of care (COC) to examine care-seeking behavior at PHC institutions in China and assess its association with clinical outcomes and healthcare costs. We conducted a retrospective cohort study in Yuhuan, Zhejiang Province, China, including 3,672 patients newly diagnosed with diabetes between 2016 and 2019. Data from chronic disease management records, follow-up service records, and electronic medical records from 2020 to 2023 were linked. COC was assessed from 2020 to 2022 using standard measures including the Continuity of Care Index (COCI), Usual Provider of Care (UPC), and Sequential Continuity (SECON), as well as PHC-specific measures: the Primary Healthcare Index (PHCI) and a binary indicator for having the primary healthcare institution as the usual provider of care (PHC-UPC). We evaluated clinical outcomes (hospitalization, glycemic control) and healthcare costs in 2023. Logistic and linear regression models were used to assess association, adjusting for patient demographics and clinical characteristics. The mean PHCI was 0.73. Higher PHCI was significantly associated with decreased outpatient costs (P < 0.001), decreased inpatient costs (P < 0.001), and a lower likelihood of hospitalization (OR = 0.503, P < 0.001). Similarly, having used a PHC-UPC was associated with reduced outpatient and inpatient costs (P < 0.001) and a lower likelihood of hospitalization (OR = 0.708, P < 0.001). However, among patients with poorly controlled diabetes, neither PHCI nor having used a PHC-UPC showed a positive association with glycemic control (OR = 0.496, P = 0.003; OR = 0.629, P = 0.002). Continuity at PHC significantly lowers hospitalization and healthcare costs in China’s non-gatekeeping system. However, no significant improvement in glycemic control among poorly controlled diabetes was observed. Strengthening PHC capacity for personalized diabetes management and timely hospital referrals is essential to optimize outcomes.

Antibiotic resistance genes(ARGs) and pathogens pose a global health challenge, particularly for vulnerable children. However, limited knowledge is on their existence in home environments where children spend majority of time, even less on urban-rural differences. We collected settled dust from children's homes in urban(n = 31) and rural (n = 34) areas of Shanghai, China, and analyzed microbiomes, ARGs and pathogens through metagenomic sequencing. Home dust microbial compositions differed significantly between urban and rural environment. ARGs were widely detected in home environment (rural:758 subtypes; urban:733). Significant urban-rural differences were also observed in ARGs and pathogens composition, diversity, co-occurrence patterns, assembly processes and drivers. Specifically, rural dust was enriched with more differentially abundant ARG subtypes. Urban dust was enriched with clinically critical multidrug-resistant pathogens (e.g. Acinetobacter baumannii), contrasting with rural areas enriched in plant-associated pathogens. Stochastic processes dominated the assembly of ARGs and pathogens, while environmental factors partially explained their variations. Temperature was positively associated with total ARG abundance in both areas. Residential greenness had a positive relationship with ARG abundance in rural but negative in urban settings. Our findings indicated children's homes as reservoirs of antimicrobial resistance, urging vigilance against rural ARG enrichment and urban multidrug-resistant pathogen risks for pediatric health.

PurposeThis study aimed to identify long-term trends in continuity of care (COC) among hypertensive patients using group-based trajectory modeling (GBTM) and evaluate their association with medical expenses, thereby providing evidence for chronic disease management.MethodsWe analyzed 6-year (2016–2021) reimbursement data of the social health insurance from Yuhuan City, China, including 30,545 hypertensive adults. Continuity of Care Index (COCI) was calculated annually. GBTM was employed to classify patients into trajectory subgroups based on COCI trends, with the best-fitting model selection guided by Bayesian information criterion (BIC), average posterior probability (AvePP). Multiple linear regression assessed the relationship between trajectory groups and annual medical expenses, adjusting for age, gender, insurance type, and Charlson Comorbidity Index (CCI).ResultsFour COCI trajectories were identified: low-level maintenance (52.06%), low-level increase (17.14%), high-level decrease (18.94%), and high-level maintenance (11.87%). Patients in the high-level maintenance group incurred the lowest annual medical expenses (mean range: ¥3,786–¥5,088), while the low-level maintenance group exhibited the highest (mean range: ¥6,450–¥10,321). After adjustment, the low-level maintenance group had significantly higher expenses than the high-level maintenance group (β = 3,049.44 CNY, p < 0.001). Older age, employee insurance coverage, and higher CCI were also associated with increased medical expenses (p < 0.001).ConclusionSustained high continuity of care correlates with reduced medical expenses in hypertensive patients. Long-term COC maintenance should be prioritized in chronic disease management to mitigate healthcare costs. Policymakers should incentivize care continuity through integrated health systems and targeted patient interventions.

PurposeThe purpose of this study is to present the findings of a cross-sectional survey on health state utility (HSU) values, a crucial metric for economic evaluations, and to analyze the primary factors influencing the HSU values of individuals with normal cognition (NC) or mild cognitive impairment (MCI).MethodsA community-based survey was conducted in Haikou City, China, employing cluster random sampling to select participants. The presence of NC and MCI was determined through the administration of the Chinese version of the Mini-Mental State Examination (MMSE). The assessment of HSU was conducted using the Chinese version of the Short Form Six Dimensions version 2 (SF-6Dv2), in conjunction with a questionnaire that collected data on socio-demographic characteristics, health-related behaviors, and health conditions. The HSU values were calculated using the SF-6Dv2 value set, which was developed for the Chinese population. A multiple linear regression model was constructed to identify the factors influencing HSU values.ResultsThe survey indicated that 536 older individuals were identified with NC (mean age 70.7, SD 7.1, 51.4% females), 245 were identified with MCI (mean age 73.0, SD 7.8, 67.4% females). The mean HSU values in NC group and MCI group were 0.792 (SD: 0.174) and 0.720 (SD: 0.199), respectively. The optimal multiple regression model for the MCI group demonstrated a linear relationship between age, depression symptomatology, and MMSE score with HSU, with coefficients of −0.009 (p < 0.001) for age and −0.132 (p < 0.001) for depression symptomatology. And for NC group, the optimal multiple linear regression model included five variables: age, sex, monthly personal income, depression symptomatology, and number of comorbidities.ConclusionThis study presented findings on HSU and its influencing factors in both the NC and MCI groups. The older adult individuals with MCI demonstrated lower HSU compared to their cognitively normal counterparts. The results of the factor analysis indicated that intervention programs designed to enhance the health-related quality of life for older adult individuals with MCI should include strategies to address depression.

After years of development, Europe has accumulated extensive experience in the discipline development and global health degree education, laying a strong foundation for cultivating professionals with a global perspective and practical competencies. European universities have continuously explored and innovated in curriculum development and resource integration, offering valuable insights into establishing a comprehensive global health degree education system. This study reviews global health degree programs at 13 representative universities (ranked approximately among the top 100 medical schools in the QS World University Rankings) and two university alliances in Europe. The results of analysis reveals several key features of global health degree education in Europe, such as a wide variety of program types with shorter program durations, strong emphasis on interdisciplinary and cross-sectoral integration in teaching, resource sharing through university alliances, and extensive internship and employment opportunities. These findings offer the following implications for the development of global health degree education in China: providing diversified degree programs to meet the needs of different groups; strengthening interdisciplinary teaching to enhance the quality of practical education; and establishing platforms for shared teaching resources to promote international exchange and cooperation.

Untreated parasitic infections contribute to anemia during pregnancy. More than half of pregnant women (61.9

Background:In China, most primary health care institutes (PHCIs) support ground-level medical services which are essential to residents' health levels. The Chinese government implemented a health reform in 2009 to strengthen PHCIs through increased fiscal inputs. However, how efficiently these inputs were converted into PHCIs' services remains unclear. We aimed to examine the efficiency of PHCIs' medical services and investigate if any changes occurred following the implementation of the health reform. Methods:We aggregated data from PHCIs from Hainan's 18 districts (2011-21), treating those from the same district as one decision-making unit (DMU). We used three-stage data envelopment analysis (DEA) to assess the efficiencies of these PHCIs, adjusting the approach for environmental factors, managerial ineffectiveness, and statistical errors potentially arising from the background variability of measured data that deviates from the input and output values, allowing all DMUs to be compared in a homogeneous environment. We used the adjusted efficiency scores to evaluate the efficiency of PHCIs in Hainan each year and the Malmquist Productivity Index (MPI) to explore the productivity change of PHCIs over time. Results:After adjusting for environmental factors between 2011-21, technical efficiency (TE) decreased from 0.825 to 0.745, pure technical efficiency (PTE) increased from 0.936 to 0.954, and scale efficiency (SE) decreased from 0.883 to 0.783. Seven districts had full PTE (1.0) and two districts had full TE (1.0) after adjustment. The mean MPI from 2011 to 2021 was 0.9430, indicating a 5.7% decrease in PHCIs' efficiency. After excluding the low productivity index possibly influenced by COVID-19 (2019 to 2021), PHCIs' efficiency decreased by 0.49%, with a mean MPI of 0.9951. Conclusions:The efficiency of PHCIs in Hainan has declined slightly since the health reform. Low level of scale efficiency posed a significant impact on the overall efficiency of the medical services in PHCIs. Among potential inefficient technological performances, future policy formulation might focus more on the imbalanced allocation of resources in less-developed regions and PHCIs' lack of attractiveness to local patients.

Background:Universal health coverage (UHC) and global health security (GHS) should be pursued synergistically to strengthen health systems. However, existing studies found that the efforts toward the two agendas were divergent worldwide. We reviewed the synergy status between UHC and GHS in the Western Pacific Region (WPR) to provide evidence for decision-makers to promote synergy. Methods:We collected the UHC service coverage index (UHC SCI) and the GHS index (GHSI) scores. We created a four-quadrant diagram to discover the gap in UHC and GHS capacities within WPR and divide WPR countries into four groups based on the global mean scores. Further, we adopted global spatial autocorrelation analysis to discover spatial aggregations of high and low scores by calculating Moran's I. In addition, we conducted a correlation analysis to assess the synergy level in WPR and reveal the gap between Pacific Island countries or territories (PICTs) and non-PICTs. We conducted key informant interviews to uncover actual scenarios and address gaps in the quantitative evidence. Results:Compared to the global mean UHC SCI and GHSI scores, nine out of 13 non-PICTs had higher scores, while all 14 of the PICTs had lower scores for both indexes. The Moran's I for WPR countries' UHC SCI and GHSI scores in 2021 were 0.20 and 0.23, respectively (Z-score >2.58; P < 0.01). The correlation coefficients between the two index scores were 0.722 (P < 0.001) at the global level and 0.869 (P < 0.001) at WPR. Within the WPR, the correlation coefficients were 0.859 (P < 0.001) in the non-PICTs and -0.026 (P > 0.05) in the PICTs. Conclusions:The synergy level between UHC and GHS was high in the WPR, but this mainly came from the synergy in the non-PICTs. The two agendas have barely synergised the PICTs. To build a safer and healthier WPR, it is important to pay more attention to the countries that have weaker health capacities in the region and narrow the gap.

Despite the World Health Organization’s recommendations, the uptake of Intermittent Preventive Treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) in Senegal remains suboptimal, with disparities observed between urban and rural areas. More remains to be known about how malaria service readiness would affect the utilization of IPTp-SP. Data were obtained from seven annual rounds of Demographic and Health Surveys (DHS) and Service Provision Assessments (SPA) in Senegal from 2012 to 2019. Using sample domain linkage to link the databases at the regional level. A malaria service readiness index was calculated to quantify the malaria service delivery capacity within the service environment where women reside. The Heckman selection model was utilized to analyze the relationship between malaria service readiness and IPTp-SP utilization. From 2012 to 2019, the average number of IPTp-SP doses received in Senegal was 1.66 (95

Background Malaria infection during pregnancy is associated with an increased risk of maternal death, as well as adverse birth outcomes. Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is known to improve pregnancy outcomes. However, the coverage of IPTp-SP in antenatal care (ANC) in sub-Saharan Africa remains well below the target. This study aims to estimate to what extent malaria service readiness affects the uptake of IPTp-SP during ANC visits in sub-Saharan African countries. Methods This study included 3267 pregnant women attending ANC for the first time and 2797 pregnant women who had attended ANC more than a month ago in six sub -Sahara n African countries. The readiness of malaria services at each institution includes four indicators: the presence of IPTp-SP guidelines, SP availability, integration of IPTp-SP service into ANC, and provider training on IPTp-SP. The outcome variable indicates whether a pregnant woman received IPTp-SP at her current ANC visit. A modified Poisson regression model estimated the associations between malaria service readiness and IPTp-SP uptake for women eligible for the first and subsequent doses. Results For women eligible for their first dose, visiting an institution with available SP was associated with an increased probability of receiving IPTp-SP (risk ratio (RR) = 1.43; 95% confidence interval (CI) = 1.22 to 1.67, P < 0.001). For women who were eligible for their next dose, the availability of SP (RR = 1.17; 95% CI = 1.04 to 1.32, P = 0.008) and integration of IPTp-SP service into ANC (RR = 1.82; 95% CI = 1.21 to 2.74, P = 0.004) in the institution were associated with increased likelihood of IPTp-SP uptake. Counterfactual predictions indicated that enhanced provider training could boost IPTp-SP uptake in high-uptake countries, while better SP availability and IPTp-SP integration into ANC would significantly impact low-uptake countries. Conclusions For better IPTp-SP coverage, strategies should be customized. High uptake countries should focus on provider training, while low uptake ones should ensure IPTp-SP availability and service integration.

Background: The coverage of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) in antenatal care (ANC) in sub-Saharan Africa, remains well below the target. This study examined the impact of the availability and readiness of malaria services on the uptake of IPTp-SP provided during ANC visits in sub-Saharan countries.

Abstract Introduction Existing research has shown that intimate partner violence (IPV) may hinder maternal access to healthcare services, thereby affecting maternal and child health. However, current studies have ignored whether emotional intimate partner violence (EV) could negatively affect maternal healthcare use. This study aims to evaluate the impact of invisible IPV on maternal healthcare utilization in Pakistan. Methods We analyzed nationally representative data from the Pakistan Demographic and Health Survey database from 2012–2013 and 2017–2018. Exposure to physical intimate partner violence (PV) and EV was the primary predictor. Based on women’s last birth records, outcomes included three binary variables indicating whether women had inadequate antenatal care (ANC) visits, non-institutional delivery, and lack of postnatal health check-ups. A logistic regression model was established on weighted samples. Results Exposure to EV during pregnancy was significantly associated with having inadequate ANC visits (aOR = 2.16, 95% CI: 1.06 to 4.38, p = 0.033) and non-institutional delivery (aOR = 2.24, 95% CI: 1.41 to 3.57, p = 0.001). Lifetime exposure to EV was associated with increased risks of inadequate ANC visits (aOR = 1.48, 95% CI: 1.00 to 2.19, p = 0.049). Lifetime exposure to low-scale physical intimate partner violence (LSPV) (adjusted OR (aOR) = 1.73, 95% CI: 1.29 to 2.31, p < 0.001) was associated with increased risks of having no postnatal health check-ups. Conclusions Pregnant women who experienced EV and LSPV are at greater risk of missing maternal healthcare, even if the violence occurred before pregnancy. Therefore, in countries with high levels of IPV, early screening for invisible violence needs to be integrated into policy development, and healthcare providers need to be trained to identify EV and LSPV.

Background: Antimicrobial resistance (AMR) is a global public health threat that requires actions through One Health intervention. This study aims to trace the historical development of One Health research on AMR to provide evidence supporting future research and actions. Methods: A bibliometric analysis is conducted with One Health articles in the field of antimicrobial resistance (AMR-OH articles) retrieved from the Web of Science Core Collection (WoSCC). AMR-OH articles refer to articles in the field of AMR that simultaneously involve elements from human health and at least one other domain, including animals, environment, or plants. Three research periods were identified based on the development of global actions in combating AMR. Descriptive analysis of publications, keyword cluster analysis, annual trending topic analysis, and co-authorship analysis were conducted using R software, VOSViewer, and Pajek. Results: The results indicated that the percentage of AMR-OH articles among all AMR articles increased from 5.21% in 1990 to 20.01% in 2023. Key topics in the current AMR-OH articles included the mechanism of AMR, AMR epidemiology, and public health control strategies. Epidemiological research initially focused on human and animal health and then shifted to environmental factors in the third period. Research at the molecular level focused on the mechanisms of AMR transmission in various domains, along with the dynamics and diversity of antibiotic resistance genes (ARGs). The co-authorship analysis suggested a significant increase in cooperation among low- and middle-income countries in the third period. Conclusion: The scope of epidemiological research on AMR has expanded by including human, animal, and environmental areas. Moreover, genetic and molecular level research represents the forefront of this field, offering innovative tools to combat AMR in the future. This study suggests further research to translate existing findings into practical implementation of the One Health strategy, and to support globally consistent action in combating AMR.

Background:After the coronavirus disease 2019 (COVID-19) pandemic, the global community's increased focus on pandemic preparedness has driven efforts such as the Pandemic Treaty proposed by the World Health Organization (WHO) and the Pandemic Fund managed by the World Bank. While these initiatives will enhance countries' capabilities in pandemic preparedness, synergies could be achieved by exploring the intersections between universal health coverage (UHC) and global health security (GHS). This is particularly relevant for developing countries like Cambodia. As it transitions to higher income status and reduces its reliance on external funding, the synergistic development of UHC and GHS will help Cambodia maximise health investment and align with its population health goals. We aimed to identify synergies and dis-synergies between UHC and GHS and recommend implementations that the government can consider moving forward. Methods:We conducted a rapid review of policy documents based on the World Health Organization (WHO) Health System Framework and undertook consultations with key stakeholders in Cambodia. Results:Our findings show the synergies between the two agendas in Cambodia resulted from having a central coordinating authority through the Ministry of Health (MoH), an extensive primary care network, and intersecting human resources that drive both UHC and GHS. We also identified potential dis-synergies such as vertical programmes and funding sources, inadequate regulation and engagement of the private sector, and underutilisation of information and data. Recommendations include cross-consultations between departments within the MoH when developing policies in GHC or UHC, and training programmes to increase awareness of the synergies between UHC and GHS. Conclusions:Our findings reinforce those of previous case studies in Bangladesh, Ethiopia, and Ghana, offering recommendations for building resilient health systems by integrating UHC and GHS.

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ObjectiveThis article aimed to evaluate the efficiency trends and influencing factors of essential public health services in Hainan Province after the healthcare reform launched in 2009 in China.MethodsThe efficiency of essential public health services (EPHS) at primary health institutions was assessed using data envelopment analysis (DEA), and the efficiency change was analyzed by employing the Malmquist productivity index (MPI). We used Tobit regression to identify the influence of environmental factors on the efficiency of public health services. The bootstrap method was adopted to reduce the impact of random errors on the result.ResultsThe bootstrapping bias-corrected efficiency revealed that the average values of technical efficiency, pure technical efficiency, and scale efficiency were 0.7582, 0.8439, and 0.8997, respectively, which meant that the EPHS in Hainan Province were not at the most effective state. The average bias-corrected MPI was 1.0407 between 2010 and 2011 and 1.7404 between 2011 and 2012. MPIs were less than 1.0000 during other periods investigated, ranging from 0.8948 to 0.9714, indicating that the efficiency of EPHS has been decreasing since 2013. The Tobit regression showed that the regression coefficients of per capita GDP, population density, the proportion of older people aged over 65, and the proportion of ethnic minority population were 0.0286, −0.0003, −0.0316, and − 0.0041 respectively, which were statistically significant (p < 0.05).ConclusionThere was a short-term improvement in the efficiency of EPHS in Hainan after the launch of the new round of health reform. However, this trend has not been sustained after 2013. In particular, equalized financial investment in essential public health could not fulfill the needs of poor counties. This has resulted in the inability to improve scale efficiency in some counties, which in turn has affected the improvement of overall EPHS efficiency. Therefore, to promote EPHS efficiency sustainably, it is suggested that under this model of provincial control of counties, the equity of resource allocation should be effectively improved while further advancing the technology of service delivery.