In developing countries, many organizations are attempting to implement interventions to improve adolescent mental, sexual, and reproductive health (ASRH). A key challenge in these efforts is the efficient utilization of available resources. However, there is a considerable lack of efficiency studies, particularly in high resource-constrained settings such as Niger. Addressing this gap, the present study assessed the delivery of adolescent mental, sexual, and reproductive health services in Niger, while evaluating the technical efficiency and its determinants within public health facilities providing adolescent sexual and reproductive health services. A cross-sectional survey was conducted at 160 rural and urban health facilities in Niamey and Maradi, from May 31 to June 24, 2022. Descriptive frequency analysis assessed the availability of mental and sexual/reproductive health services. Stochastic frontier analysis (translog function) measured technical efficiency, while fractional logit regression identified influencing factors. Over 89

Adolescence is a critical phase of life, with sexual, reproductive, and mental health being essential to overall well-being. Despite global and national initiatives to improve adolescent health, substantial gaps persist in service delivery, especially in low-resource settings like Burkina Faso. Primary healthcare (PHC) facilities play a pivotal role in addressing adolescent mental, sexual, and reproductive health (AMSRH) needs. However, evidence on the technical efficiency of these facilities in delivering AMSRH services remains limited. This study evaluates the technical efficiency of PHC facilities in Burkina Faso in providing AMSRH services and identifies key factors influencing efficiency. A cross-sectional survey was conducted in 132 PHC facilities across the West-Central and Hauts Bassins regions of Burkina Faso from September to October 2022. Data on facility characteristics, resource availability, and service delivery were collected. Technical efficiency of ASRH services was assessed using Stochastic Frontier Analysis (SFA) with a Translog production function, while a truncated regression identified determinants of efficiency. The analysis included inputs such as laboratory tests, consultation rooms, and trained providers, with efficiency scores ranging from 0 to 1. Data analysis was performed using STATA 16. Of the surveyed facilities, 77

BACKGROUND: In Bangladesh, sub-district hospitals (SDHs) are the first referral point for inpatient primary healthcare (PHC) services of the public providers in both rural and municipal corporation areas. These facilities also provide both outpatient and emergency healthcare services to the population at a minimum user fee. The efficient use of resources in primary-level healthcare facilities is essential for delivering quality healthcare services. Therefore, our aim was to estimate the technical efficiency (TE) of the SDHs in Bangladesh. METHODS: We used an output-oriented data envelopment analysis (DEA) method to estimate the variable returns to scale (VRS) and constant returns to scale (CRS) TE of a total of 423 SDHs using data from the Local Health Bulletin -2017. To measure TE, we used workforce and inpatient beds as inputs and the number of inpatients and outpatients served by the hospitals in a month as output. We applied the Simar and Wilson model to find how the other internal and external characteristics of these hospitals influenced estimated TE score. We compared our DEA results with stochastic frontier analysis (SFA) and performed sensitivity analysis. RESULTS: The average VRS and CRS TE of the SDHs were estimated to be 58.9% and 53.4%, respectively. Of the 423 SDHs, 15 were fully efficient in CRS, 30 were in VRS and 60 were scale efficient, while the rest operated below the efficiency frontier. The population density per bed, ratios of bed occupancy, ratios of beds to physicians, ratios of physicians to nurses, and administrative division had a significant positive influence, while lengths of stay and ratios of beds to nurses had a significant negative influence on the SDHs efficiency scores. The mean TE demonstrated that the SDHs, on an average, could improve their output by 42% using the existing level of input mix. The results were consistent in the sensitivity analysis. CONCLUSIONS: The average TE of the SDHs was half of the best score, suggesting there is scope for overall improvement among the inefficient SDHs by learning from the efficient SDHs. The Ministry of Health and Family Welfare (MOHFW) of Bangladesh allocates resources to SDHs based on the number of beds rather than based on an assessment of needs. The MOHFW could improve its monitoring system to investigate why some facilities are performing well using similar resources while others do not and adjust the allocation system to take into account the quantity and quality of care.

This study evaluates the impact of Kazakhstan’s transition from a Diagnosis-Related Group (DRG) based payment system to global budgets (GB) in rural hospitals, addressing a gap in the literature on post-DRG health financing reforms. Using an interrupted time series design, we assess longitudinal policy effects in the absence of a control group, focusing on the immediate hospital response to GB implementation amid concurrent payment reforms. Monthly hospital-level administrative data are analysed to examine changes in both the level and trend of key performance indicators following the reform. The introduction of GB was associated with reductions in overall hospital admissions and surgical cases, suggesting improvements in resource utilisation. Although the average length of stay declined in line with theoretical expectations, the effect size was modest, indicating that efficiency gains were only partially realised. The Kazakhstani experience highlights that GB can serve to mitigate some of the inefficiencies observed under DRG systems, but effective implementation requires investments in management capacity, infrastructure, data systems, and well-calibrated incentives. These findings offer lessons for other low- and middle-income countries considering similar health financing reforms, emphasising the need for foundational support to translate payment innovations into measurable improvements in efficiency, quality, and equitable access in rural health systems.

Introduction In Bangladesh, government provision of primary care in rural areas has seen the development of services for non-communicable diseases, particularly hypertension and diabetes (given their substantial rise in recent decades). However, in the context of cities, which are characterised by a plurality of providers that have sprung up to meet the demands of a rapidly growing urban population, such provision is very limited. Methods and analysis We will conduct a mixed-methods study, based on the RE-AIM framework, to understand the (1) reach, (2) effectiveness, (3) adoption, (4) implementation and (5) maintenance (the five RE-AIM domains) of a health systems intervention to strengthen management processes for hypertension and diabetes within government and non-governmental organisation (NGO-run) primary care facilities. To evaluate the effectiveness of the intervention, we will use a quasi-experimental, difference-in-differences design. We will recruit 20 purposively selected urban government-run and NGO-run primary care facilities across Dhaka North and South City Corporation areas. Ten facilities will be purposively allocated to an intervention group and receive training and guidance materials on diabetes and hypertension care, based on the WHO Package of Essential Non-communicable (PEN) Disease Intervention for Primary Care, and the use of an e-health application for patient records. The remaining facilities will be allocated to the existing care group and receive no intervention inputs, with identical data collection processes carried out in both groups. We aim to collect data on 50 patients visiting each facility during a baseline period and at 6 and 12 months after implementing the intervention. We will estimate the average treatment effect on the treated (ATT) for the intervention at 6 and 12 months after implementing the intervention on a primary outcome that measures how many of eight key management processes are appropriately carried out for each patient visit at a study facility (with the appropriateness of each management process determined by assessing criteria based on how patients should be managed according to the intervention guidelines). We will also estimate the ATT for the intervention at 6 and 12 months after implementing the intervention on each of the appropriate management processes making up the primary outcome as separate secondary outcomes. Alongside this design, we will collect a range of additional quantitative and qualitative data to evaluate the other RE-AIM domains, using sequential mixed methods approaches, focusing on understanding potential facilitators and barriers in relation to these domains. Ethics and dissemination Ethics approval has been received from the Research Governance Committee at the University of Leeds, UK (MREC 21-008) and from the Bangladesh Medical Research Council (BMRCAIREC/20 I 9-2022/485). We will use a variety of channels to share our findings with policy makers, service providers, academicians and relevant stakeholders.

Abstract Background Strengthening urban primary healthcare (PHC) systems in low- and middle-income countries (LMICs) is essential to effectively serve the growing urban poor. Such reforms should incorporate patient opinions to ensure accessible and affordable services. However, there is limited evidence on patient preferences for PHC providers in these settings. We aimed to conduct a systematic review of the evidence on the attributes reported by patients when choosing PHC providers in urban LMICs. Methods A search was performed across MEDLINE, Embase, Global Health, Web of Science, PsycINFO, and Scopus bibliographic databases, as well as grey literature sources, from their earliest entries until March 30, 2024. Studies examining the revealed or stated preferences of populations for PHC providers in urban LMIC settings were included. We descriptively analysed and compared these studies, assessing their methodological quality using checklists for Conjoint Analysis studies and the Mixed Methods Appraisal Tool. Results Our findings are reported according to PRISMA guidelines. The search yielded 5,089 citations, of which 28 met the eligibility criteria for this review. We identified 203 attributes across selected studies. The most frequently reported attributes were cost of services (n = 25) and distance/proximity (n = 24), followed by provider behaviour/attitude (n = 19) and quality of care (n = 17). Most studies identified the availability of medicine/equipment, distance/proximity, healthcare provider type, and quality of care as the most valued attributes. Eighteen studies examined preference heterogeneity, considering socioeconomic factors such as education, gender, age, severity of illness, and income, with severity of illness being the most significant factor. Conclusions Prioritising patient preferences in health system reforms is essential for equitable and sustainable healthcare in rapidly urbanising LMICs. Our review highlights the most valued attributes in preference studies, which will help policymakers and researchers tailor better PHC interventions to meet urban community needs and guide future studies on PHC preferences in similar settings.

Community-based Health Planning and Services (CHPS) was initially designed to address the healthcare needs of Ghana’s rural communities. However, with urban population growth and the subsequent healthcare demands of the urban poor, the CHPS policy was extended to urban areas. There is a significant gap in our understanding of the wealth-related disparities, correlates, and utilization levels of healthcare services under the urban CHPS. This study is a pioneering effort to fill this gap, aiming to quantify the utilization level, identify correlates, and measure wealth-related inequality in healthcare services provided by the CHPS in poor urban settings. The survey was conducted in four poor urban communities in the Greater Accra Region of Ghana using a quantitative analytic cross-sectional survey design with multistage cluster sampling, ensuring a representative sample of 3543 respondents (97.9

BackgroundGlobally, adolescent health remains a public health priority given that adolescents often face unique vulnerabilities to health issues like mental disorders, substance abuse, and sexual health risks. In developing countries like Ghana, primary healthcare facilities (PHCs) are often the first point of contact for addressing these issues. However, there is a lack of literature examining the capacity of PHCs to address adolescent sexual and reproductive health (ASRH) issues. This study aims to fill this gap in the literature by assessing the availability and readiness of ASRH services within Ghana's PHCs.MethodsThe study utilized a multi-stage sampling approach to select 67 PHCs across four districts in the Greater Accra region, reflecting Ghana's broad demographic diversity. We employed the WHO's Services Availability and Readiness Assessment (SARA) tool to measure the availability and readiness of ASRH services. This framework focused on key domains including service availability and readiness, assessing aspects such as HIV testing, family planning, and availability of contraceptives and necessary staff training. Data analysis was conducted using Stata version 17.0, analysing frequencies and percentages to capture the extent of service provision across the selected facilities.ResultsThe study highlighted significant disparities in the availability and readiness of essential ASRH services (HIV services, family planning, contraceptive pills, IUCD provisions, and male condoms) across selected districts and facility types. In Shai Osudoku, 65% of facilities offered a full range of selected ASRH services, the highest among the districts, whereas Ningo Prampram had the lowest at just 16%. In terms of facility types, 57% of CHPS facilities, 59% of health centres, and 44% of clinics provided all the selected ASRH services. Urban areas reported a 51% provision rate of these services, slightly less than the 54% observed in rural areas. Additionally, readiness disparities were evident: only 21% of urban facilities had adequate service guidelines compared to 29% in rural areas, and a higher percentage of rural facilities (46%) had trained staff, compared to 23% in urban areas.ConclusionThis study examined the availability and readiness of ASRH services in PHCs across the Greater Accra region, revealing significant disparities by location and facility type. Particularly, rural and public facilities demonstrated a higher availability of ASRH services compared to urban and private facilities. These findings suggest an uneven distribution of resources and highlight a potential urban underutilization of public health services. Moreover, the study identified a critical lack of service guidelines and trained staff across many facilities, emphasizing the need for enhanced training and resource allocation to improve service readiness. Targeted interventions are necessary to elevate the quality and accessibility of ASRH services, ensuring equitable health care delivery across all regions. Future research should expand to other regions to validate these findings and inform nationwide health strategies.

Primary healthcare (PHC) facilities have become essential in promoting adolescent healthcare, yet they face resource limitations that hinder their effectiveness. Ensuring the efficient use of available resources has therefore become pertinent. This study assessed the technical efficiency of primary health care facilities in providing adolescent mental sexual and reproductive health (AMSRH) services. Data was collected from 53 PHC facilities drawn from rural and urban locations in four districts in the Greater Accra region using a multi-stage sampling design. Stochastic Frontier Analysis (SFA) was employed to estimate the technical efficiency of each facility in optimizing outputs given available inputs. The findings revealed significant variation in efficiency, ranging from 0.91 to 0.04 with an average score of 0.60. Rural facilities and government-owned health facilities were more efficient compared to their urban and private counterparts. Facilities offering a wider scope of services to adolescents were also more efficient. However, the provision of adolescent mental health services was limited. Efforts should improve efficiency in the use of AMSRH services by properly aligning resource allocation to needs while expanding the range of services available to adolescents.

BACKGROUND:Non-communicable diseases (NCDs) are significant public health concern globally, and the burden is disproportionately high among urban populations. This study aims to compare the social determinants, NCD risk, and NCD prevalence among different wealth categories and to determine the factors associated with hypertension, obesity, and diabetes among the urban population of Nepal. METHODS:This study used urban population data from cross-sectional STEP wise approach to NCD risk factor surveillance (STEPS) survey of 2019, resulting in a sample of 3460 individuals of 15-69 years for inclusion in the analysis. We used bivariate analysis to compare the social determinants, NCD risk and NCD prevalence among urban poor, urban middle and urban rich and multivariate logistic regression to determine the association between social determinants, NCD risks and obesity, hypertension and diabetes among urban population. RESULTS:The study found significant differences in hypertension, obesity and diabetes by gender, ethnicity, education, employment, smoking habits, and cholesterol levels between the three wealth groups. Among the urban poor, low education, unemployment and smoking habits were more prevalent, while high cholesterol was more prevalent among the urban rich. The significant factors associated with overweight and obesity after Bonferroni correction included Hilly region with higher odds of overweight (AOR=2.33, 95% CI=1.45-3.75,). In contrast, being from Karnali (AOR= 0.36, 95% CI=0.22-0.58) and Sudurpaschim (AOR=0.42, 95% CI=0.26-0.66) provinces were associated with lower odds of overweight and cholesterol, while cholesterol was associated with higher odds of obesity (AOR=1.01, 95% CI=1.01-1.02). Disadvantaged janajatis had the lower odds of overweight (AOR = 0.52, 95% CI = 0.36-0.78). Factors that remained significantly associated with hypertension and pre-hypertension after Bonferroni correction included: age, with higher odds of hypertension (AOR=1.03, 95% CI=1.02-1.04); men, who had higher odds of both pre-hypertension (AOR=1.68, 95% CI=1.19-2.36) and hypertension (AOR=2.23, 95% CI=1.56-3.47). Being obese (AOR = 5.12, 95% CI = 2.95-8.87, p = 0.001) and overweight (AOR = 1.69, 95% CI = 1.19-2.39, p = 0.003) were significantly associated with hypertension. Similarly, urban population residing in the hilly region had higher odds of diabetes (AOR=6.44, 95% CI=3.31-11.10) compared to the mountain region; those living in the Tarai region had higher odds of pre-diabetes (AOR=5.07, 95% CI=2.44-10.5) and diabetes (AOR=5.96, 95% CI=3.12-19.86). Respondents with high cholesterol higher odds of both pre-hypertension (AOR=1.00, 95% CI=1.00-1.02) and hypertension (AOR=1.03, 95% CI=1.02-1.04), pre-diabetics (AOR=1.00, 95% CI=1.00-1.02) and diabetics (AOR=1.03, 95% CI=1.02-1.04). CONCLUSION:The findings indicate significant disparities in education, employment, and lifestyle habits across wealth groups; urban poor lacked education and employment. Factors such as ecological region, province, gender and age were associated with an increased risk of various health conditions such as being overweight, pre-hypertension, pre-diabetes, and diabetes. Improved health outcomes among urban populations interventions targeting increased access to education, additional investment in specific areas where outcomes are worst, and interventions to improve equitable access to healthcare are needed.

Objective:Adolescent smoking is a critical form of psychoactive substance misuse, particularly in low- and middle-income countries like Egypt, where youth tobacco use remains a public health concern. This study explored current and potential school-based smoking prevention interventions in a conservative low- and middle-income country context, to identify strategies which enhance adolescents' capability, opportunity, and motivation to avoid smoking initiation. Methods:A qualitative study was conducted in three public preparatory schools (boys', girls', and mixed gender) in Asyut, Upper Egypt. Data was collected through 40 semi-structured interviews with school staff, 16 focus group discussions with 76 pupils (aged 12-13), and analysis of 172 school documents. Creative tools including picture-elicitation and story-making were used with pupils. Data was analysed using the framework approach, guided by the Capability-Opportunity-Motivation-Behaviour model. Results:Seven meta-themes were identified. Key strategies included educating pupils on the broad consequences of smoking, including health, appearance, fitness, finances, relationships, addiction, religious values, and equipping them with refusal and coping skills. Interventions should promote smoke-free school and home environments, model non-smoking behaviour, and leverage peer influence. Motivational strategies such as storytelling, real-life examples, reward schemes, and accessible extracurricular alternatives were also emphasised. Barriers included limited resources, cultural taboos, and misinformation around e-cigarettes. Conclusion:School-based smoking prevention interventions in low- and middle-income country settings must be proactive rather than reactive, multi-dimensional and culturally appropriate. Applying the Capability-Opportunity-Motivation-Behaviour model can help schools design integrated interventions that build psychological capability, reshape opportunities, and strengthen both reflective and automatic motivation in early adolescence. The findings have direct implications for public health practice, school policy, and substance misuse prevention programming in resource-constrained and socially conservative settings.

IntroductionTo effectively tackle antibiotic resistance (ABR) a One Health approach is required, focusing on the human, animal and environmental sectors together, and that public education and engagement programs must be part of the overall approach. However, there has been limited research on such programs in low−/middle-income countries (LMICs). Here we describe our plans to evaluate a community-engagement program, known as the community dialogue approach, that takes a One Health approach to tackling ABR in rural communities in Bangladesh, and involves community-led and community-based education and discussion forums. Members of our team previously developed this approach and used it to address other health issues in other LMIC contexts, while our team has previously adapted it for this topic and setting.MethodsWe will use a pragmatic, non-blinded, two-arm, parallel-group, cluster-randomized, controlled trial to primarily evaluate whether the intervention can improve (1) the level of correct and appropriate knowledge about antibiotics, ABR, and antibiotic usage from a One Health perspective, (2) levels of awareness about the existence of antibiotics and ABR, and (3) the relative frequency of self-reported and observable indicators of best practices related to antibiotic usage. Within Cumilla district, we will randomize 50 clusters of villages in a 1:1 ratio. In intervention community clusters trained community volunteers will deliver a set of 11 health education and discussion forums across a 12-month period, while control community clusters will receive no inputs. We will collect outcomes at baseline (pre-randomization) and endline (following the final community dialogue) via two repeated cross-sectional household surveys (each aiming to survey 2,200 participants across all clusters). We will also conduct nested process evaluation and costing studies.DiscussionCommunity engagement approaches have successfully addressed other health issues in low resource settings, but there is limited evidence on using community engagement approaches to address ABR in low resource contexts, particularly in Bangladesh. We will closely involve the Bangladeshi health system in this research to ensure feasibility and facilitate scale-up via an embedded approach.Clinical trial registrationhttps://doi.org/10.1186/ISRCTN93756764, identifier ISRCTN93756764.

Access to safe, timely and affordable surgical care is lacking globally. Less than 6

Pooling resources is the preferred method for paying for healthcare due to its' uncertain and often costly nature. Universal health coverage is based on extending pooled payment mechanisms to the population to ensure access to comprehensive health services but can achieved in a number of ways. Historically, high income countries adopted an incremental model that expanded insurance to different population groups or a universal approach based on country residency. Approaches in low income countries are more diverse and include single pool approaches to unify funding, mechanisms focused on coverage for the poor, basic schemes available to the un-covered population and focused use of taxation to provide universal basic services. All approaches require substantial government involvement including financing.

Objectives We explored how key sociodemographic characteristics were associated with correct knowledge about antibiotics and antibiotic resistance (ABR) and appropriate usage of antibiotics from a One Health perspective among rural community members in Bangladesh.Design Cross-sectional single-period survey.Setting Rural villages in Cumilla district, Bangladesh.Participants Eligibility criteria: aged ≥18. Across 50 clusters of villages, we approached 2160 community members and 2187 (98.8%) agreed to participate.Primary and secondary outcome measures Primary outcomes: we collected two knowledge outcomes measuring the number of correctly answered binary/multiple-choice questions about (1) antibiotics and ABR and appropriate usage of antibiotics in relation to human illness and (2) antibiotics and ABR and appropriate usage of antibiotics in relation to animal health and the environment. Secondary outcomes: self-reported awareness of (1) antibiotics and (2) ABR.Results Several sociodemographic characteristics were associated with variation in both knowledge outcomes. Education showed the strongest associations, with higher education levels associated with higher knowledge scores. For example, compared with having no formal/incomplete primary education, having higher education was associated with 10 percentage points (95% CI 8 to 12) and 6 percentage points (95% CI 3 to 8) higher mean knowledge scores for the knowledge outcomes 1 and 2, respectively. Having worked in the last month compared with not having worked was also weakly positively associated with both knowledge outcomes, and being female compared with being male was also weakly negatively associated with both knowledge outcomes.Conclusions Better public education is required to tackle ABR in Bangladesh but correct knowledge about antibiotics and ABR and appropriate usage of antibiotics in relation to humans, animals and the environment varies in relation to individuals’ education level, sex and working status. To maximise their effectiveness, interventions to tackle ABR must be flexible given recipients’ sociodemographic characteristics and pre-existing knowledge levels.

BACKGROUND:Efficiency in the use of financial and other resources for providing adolescent sexual and reproductive health (ASRH) policies and programs is an important factor that can affect provision of and access to services in resource-constrained contexts of developing countries with limited capacity. However, very few studies have been conducted to understand this situation. Our study, therefore, estimated technical efficiency scores for health facilities that offer primary ASRH care services in Niger and the relationship between the capacity of these health facilities and their level of technical efficiency. METHODS:The data used for this study were collected from a survey of 71 primary healthcare facilities providing ASRH in Niger from January 28 to March 15, 2022. A stochastic frontier analysis technique based on the Cobb-Douglas production function specification was used for analysis. A Tobit model estimation was used to examine the relationship between health facility capacity and the level of technical efficiency. RESULTS:The average technical efficiency in production of primary care ASRH services of the health facilities in the sample was 58% implying high levels of technical inefficiency. Disaggregated analysis revealed that the average score was greater in health facilities where the primary caretaker or head of the institution was female (60%) rather than male (53%). Primary healthcare facility capacity was assessed in four dimensions of operational capacity, managerial capacity, adaptive capacity and leadership capacity. There was a positive association between health facility capacity and the technical efficiency score. However, the levels of association differed from one dimension of health facility capacity to another. CONCLUSIONS:There is much room for improving the efficient use of financial and other resources in primary healthcare facilities that provide ASRH in Niger. Potential interventions include giving women more responsibility for these facilities and strengthening the ASRH production capacity of these facilities.

Strengthening and reforming the urban primary healthcare (PHC) system is essential to efficiently deliver need-based healthcare services to the rapidly increasing urban poor population. Such reforms of PHC system need to emphasize the opinion of patients in co-designing services in order that delivery of services can be accessed effectively by the urban population in a timely and low-cost way. Hence, it is important to identify the preference of urban population while choosing healthcare providers. The aim of this proposed protocol is to summarize a planned systematic review of existing evidence on the attributes considered for choosing PHC providers in urban settings of low- and middle-income countries (LMICs), as classified by the World Bank. An inclusive literature search will be conducted in electronic databases including Pubmed/MEDLINE, Embase, Global Health, Cochrane Library, Web of Science, and Scopus. Databases will be searched from the earliest date of entry until March 30, 2024. Database search will be supplemented by manual search of citations, reference lists, and grey literature sources. Following the pre-set inclusion and exclusion criterion, two researchers will independently screen all the retrieved studies in Covidence. Any discrepancies will be resolved through a discussion between two researchers, and if disagreements persist, a third reviewer will be consulted. The methodological quality of included studies will be appraised using checklist for Conjoint Analysis studies and the Mixed Methods Appraisal Tool (MMAT). An Excel-based data extraction table will be developed, piloted, and refined during the review process. Preference attributes will be identified and analyzed according to their types. The systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines. The identification of attributes, their influence on preference, and heterogeneity with socioeconomic characteristics of the population will help the policymakers and researchers to design targeted PHC interventions. Such evidence will be also useful to design choice experiment studies to quantify the preferred attributes of PHC providers in urban context of LMICs. PROSPERO CRD42023409720.

Urban slums are human habitats with poor habitation qualities that are vulnerable to infectious diseases and public health crises. Low coverage from formal healthcare services providers created opportunity for informal providers to thrive in urban slums. This study examined the nature of relationship between informal and formal healthcare services providers in urban slums and explored opportunities for strengthening collaborations between them. Reconnaissance research method, a qualitative research approach for exploring under-researched terrains, guided the interview of 104 slum healthcare stakeholders across eight purposively selected slums in Enugu and Onitsha cities, in southeastern-Nigeria. Findings show that informal healthcare service providers are dominant in urban slums, and many of them cooperate and compete with formal providers. Supervision of informal providers in slums is inadequate, and the formal providers report that the informal providers find acceptance, despite their lack of adequate training and professionalism. Authorities governing health systems in slums are encouraged to establish a mechanism to profile informal providers, delineate the scope of services, and bridge the gap through the creation of referral channels. Subsequent studies may explore what character any mechanism created to institutionalize the collaboration toward improving healthcare services delivery should take and what challenges could undermine it.

BackgroundAdolescent mental health (AMH) is a critical issue worldwide, particularly in West Africa, where it is intensified by socio-economic, cultural, and security challenges. Insecurity and the presence of mining sites expose adolescents to hazardous environments, substance abuse, and adulterated alcohol, further aggravating their mental health. Despite these severe issues, research on AMH in this region remains limited. This study aims to analyze the provision of AMH services in Burkina Faso, Ghana, and Niger, highlighting the unique challenges these countries face within the broader West African healthcare context.MethodsThe study adopted a multi-stage, stratified sampling design to collect data from primary healthcare centers (PHCs) in the three countries. Using STATA.17, Descriptive analysis was conducted on the data related to availability of AMH services, types of mental health disorders treated, resources available, and OPD attendance rates. The analysis also incorporated factors such as the rural-urban divide and the presence of national guidelines for AMH services.ResultsThe findings reveal a significant shortfall in the provision of AMH services across the region, with less than 30% of PHCs across all the countries offering these services. The study also highlights a pronounced rural-urban disparity in AMH service availability, a general absence of national guidelines for AMH care, and low OPD attendance rates.ConclusionThe study highlights the urgent need for comprehensive policy reform and targeted interventions to enhance AMH services in West Africa. Key policy reforms should include the development and implementation of national guidelines for AMH care and integration of AMH services into primary healthcare. Additionally, efforts should focus on capacity building through the training of mental health professionals, increasing public awareness to reduce stigma, and ensuring equitable resource allocation across rural and urban areas. Improving AMH care is essential not only for the well-being of adolescents but also for driving broader socio-economic development in the region.