Background: Climate change, a pressing global health issue, impacts ecosystems, environments, and human health, leading to disrupted food systems, reduced crop nutritional value, and increased hunger. Objective: This review covers the food insecurity and mental health challenges that are among the complex impacts of climate change. Method: In this review, we bring together the data from existing research from various reliable databases, such as PubMed, Web of Science, and Google Scholar. Our intent is to unravel the complex links between climate change-induced food insecurity and mental health challenges. Results: The review discussed the direct and indirect influence of climate change on mental health, such as the causes of increased stress, anxiety, and depression arising from climate-induced disasters and their socioeconomic effects. The study drives home the crucial requirement for mitigation and adaptation strategies, including going green and transitioning to renewable energy, enhancing agricultural resilience, and providing mental health support to those affected. Thus, this review highlights effective interventions for tackling these interrelated problems. Conclusion: The future vividly demonstrates the necessity of interdisciplinary cooperation, policy alignment, and universal partnership to create a sturdier and environmentally friendly future. Taken together, this review suggests that a strong effort is necessary to address the multifaceted crisis of climate change and food insecurity, including mental health-related issues. Fostering resilience and adaptability will build healthier and more secure communities, mitigating the worst consequences of global warming.

A document by Elif Güzide Emirza. Click on the document to view its contents.

Background: In most Low and Middle-Income Countries (LMICs), enrolment in community-based health insurance (CBHI) is still low. In Sub-Saharan Africa enrolment rate is less than 10%. In 1996, Tanzania introduced Community Health Fund (CHF) which was modified in 2011 whereby the government came up with the improved community health fund (iCHF). The introduction of iCHF was intended to improve service delivery to the population where an electronic integrated management information system was introduced. Objective: This study was set to explore the drivers for implementing the e-claim process of improved Community Health Funds from two districts in Central Tanzania. Methods: An exploratory case study design using a qualitative approach was adopted to explore information on the drivers of the implementation of the iCHF electronic claim process in Mkalama and Iramba districts in Singida region. In-depth interviews were used to collect data from the Eighteen (18) participants including regional health managers, district health managers, Information Technology (IT) officers, facility in charge and iCHF focal persons from dispensaries, health centres and hospitals. Data were analyzed using a thematic content analysis. Results: The drivers for implementing the iCHF e-claim process were adherence to supervision directives and government policy, resource management and client satisfaction but the e-claim system does not attract Health Community Workers (HCWs) to comply with the iCHF e-claim process Conclusion: The iCHF e-claim process is inadequately implemented and does not attract Health care workers (HCWs) due

Introduction Collaboration is crucial for innovative scientific contributions, often facilitated through consortia, which are particularly valuable for translating medical innovations to patient care. Despite the rise in consortia, there is limited literature available on how to establish a consortium. This paper aims to provide a comprehensive business and strategy plan for establishing and maintaining biomedical consortia. Methods We explored academic databases and used a snowball sampling method to expand our literature pool, including papers relevant to consortia design such as business and strategy plans. Thematic analysis identified recurring themes, and critical evaluations informed our recommendations, supplemented by experiences from establishing the Neuropsychiatric International Consortium of Frontotemporal Dementia (NIC-FTD). Discussion Our review and experience highlight three key elements for launching and maintaining a successful consortium: (1) Establishment steps and considerations, (2) Consortium agreement and strategy planning, and (3) Maintenance strategies. This paper offers practical guidance for scientists and physicians in establishing and maintaining effective consortia by providing a Consortium Strategy Plan. Conclusion This paper provides a detailed Consortium Strategy Plan with the aim to aid the successful establishment and maintenance of biomedical consortia and to support innovative scientific collaboration.

Background: Family doctor contract services are essential to primary healthcare, significantly improving older adults’ health. However, contract rates among older individuals are various. Investigating factors influencing these rates is crucial for optimizing policies and enhancing contract rates. Methods: This study used 2018 data from Wangying Community Health Service Center, encompassing 8,625 older adults. Propensity score matching (PSM) was applied to balance potential confounders between those with and without contracts. Multiple logistic regression analysis explored the effects of gender, age, the number of medical visits, and the number of chronic diseases on contracting behavior. Results: Gender did not significantly impact contracting behavior. However, age, the number of medical visits, and the number of chronic diseases significantly influenced it ( β = 0.457, p < 0.01; β = 0.286, p < 0.05; β = -0.229, p < 0.1). An inverted U-shaped relationship was found between age and contracting behavior ( β = -0.003, p < 0.01). Conclusion: Age, the number of medical visits, and number of chronic diseases are key factors in family doctor contracting behavior among older adults. Enhanced policy support is needed to promote contract signing, improving health security for older individuals.

Background: The evolving complexity of the medical field in developing countries, driven by operational realities and changing patient expectations, creates unique challenges and opportunities. Exploring the theoretical mechanisms and effect of job satisfaction as a mediator, on doctors’ in-role performance and professional intentions, is essential for enhancing healthcare outcomes and retaining skilled professionals. Methods: Cross-sectional correlational design was employed, using structural equation modelling to test the hypothesized model. Data from 2120 doctors were analysed using statistical methods including Matrix Correlation, Exploratory Factor Analysis, and Confirmation Factor Analysis. Python-based data visualization and analysis techniques were also used to explore relationships between variables. Results: In Nigeria, intrinsic factors collectively have a significant positive impact on job satisfaction, whereas in China, this is true only individually. Extrinsic factors significantly influence job satisfaction in both countries. There is a strong relationship between job satisfaction, in-role performance, and professional intentions in both countries. This indicates that job satisfaction not only enhances doctors’ current job performance but also positively affects their future career intentions and commitment to the profession. Both Nigeria and China show similar patterns in ranking career fulfilment drivers, with an intrinsic factor followed by five major extrinsic factors and another intrinsic factor, reflecting shared perceptions in both countries. Conclusion: The dynamics between intrinsic and extrinsic motivators suggest that while both are essential, their relative importance may vary based on external conditions such as economic stability and healthcare infrastructure. Therefore, strategies aimed at improving in-role performance and retention should be multifaceted and context specific.

Background: Numerous national-based indicators aid in designing population-centered chronic disease surveillance. However, there is little consensus on the key indicators and goals for developing a chronic disease surveillance analysis system. Objective: This study aimed to develop evidence-based indicators to measure and improve the health outcomes of chronic disease surveillance systems in Korea. Methods: A scoping review was focused on peer-reviewed literature from 2012 to 2022 using PubMed, Medline, Embase, PsychINFO, CINHAL, Wiley Online, Scopus, and Cochrane Library. Three reviewers evaluated and selected the articles in accordance with comprehensive inclusion and exclusion criteria. Data were synthesized using median descriptive analysis, prioritization, and agreement. There was a consensus meeting to discuss the recommendations, and the findings were analyzed thematically and descriptively. Results: Forty-eight articles were finalized and most of them were published in 2019 (18.8%). The studies on chronic disease-based surveillance systems and related data sources were conducted primarily in Canada (58.3%). The findings were prioritized by prevalence rate, risk factors, data linkage, complex disease, and updated indicators in a current system. The key themes of focus were mortality, survival management, diagnosis, treatment, and healthcare systems. Conclusion: Our preliminary measurement methods need validation through follow-up projects. Chronic disease surveillance will improve public health resource allocation and monitoring in real time. Public health and healthcare systems could be enhanced through timely assessments of population health at the local and regional levels. In Korea, experts will validate the chronic disease-based surveillance system’s development.

The migration of health workers remains one of the most pressing challenges facing many countries in the global South. This short communication seeks to reignite debate on the effectiveness of the 2010 WHO Global Code of Practice as a tool for managing the migration of health workers from the South. While the WHO Code of Practice was effective in reducing the migration of health workers from countries such as Zimbabwe during its first five years of its implementation, demand for health workers in the UK after Brexit and the COVID-19 pandemic has accelerated the rate of migration of health workers from countries facing critical shortages. Clearly, new solutions are needed that strike a balance between the right of the health workers in the South to migrate and the right of citizens in the region to a stable supply of health workers.

Background/Objective: Compared to most of the South Asian nations Sri Lanka enjoys commendable health outcomes. The Sri Lankan health system is a combination of both private and public sectors. The number of private health institutions have grown rapidly in recent years. The aim of this study was to examine pricing/fees variations across private healthcare sector in Sri Lanka. Method: This study explored whether there are pricing/fees variations in hospitals and clinician’s , across ten of the most commonly performed surgical/medical procedures within eight leading private hospitals distributed across three provinces in Sri Lanka. Results: Findings revealed that the pricing/fees variations were statistically significant (P <.001) across all eight hospitals and between three provinces, for ten procedures tested for both hospital fees and total fees. Pricing variations of the clinician’s fees were statistically significant (P <.001) across all ten procedures, except for one. Conclusion: Unilateral price/fees fixing by private healthcare providers and the subsequent information asymmetry could be the main reason for the significant pricing/fees variations that exist between hospitals within and outside provinces/regions in hospital and clinician’s fees. Policy makers can consider bench marking the mean values of the prices/fees charged by the clinicians against the national per capita income of the population to refine policy parameters on pricing.

Introduction: Reflection and learning about the use of virtual care in healthcare delivery has become a central goal for health systems internationally. Insights drawn in the aftermath of the COVID-19 pandemic have led to vast changes to embed virtual care in health care delivery. This study explored the methodologies used to manage change that encompasses virtual care and factors contributing to success. Methods: A systematic review and narrative synthesis was undertaken. Eligible articles were those reporting structured change management processes in the context of virtual care published between 1 st January 2019 –31 st December 2023, identified by searching four electronic databases (Scopus, MedLine, PsycInfo and Business Source Premier). Data were extracted and synthesised from the eligible studies. Results: A total of 17 articles were included; studies focused on changes occurring within hospital settings and in community health centres, often within a single organisational unit, institution, or hospital network. Studies described using various methodologies for managing change during the introduction of large digital systems, embedding new digital tools, the introduction of new technologies and workflow or process design changes resulting from virtual care. Discussion: Structured change methodologies were often integrated in a strategic change framework with process improvement methods utilised to support the change process. Managing change relating to the technology with attention to the clinical and people aspects of change was considered a key gap and challenge in the context of virtual care change. Change leadership and the integration of technical and clinical teams were identified as key enablers.

Covid-19 demanded new ways of working. In this paper, we present the experience of the Vaxi Taxi, a community-orientated model of care developed when Emergency Medical Services (EMS) pivoted in response to the Covid-19 pandemic, converting its ambulances into mobile vaccination units in the Western Cape, South Africa. Using a five-year long embedded research approach, we drew on traditions of organizational ethnography and critical action research. Data collection included documenting observations and reflections in a research diary during implementation. In addition, in-depth interviews, focus group discussions and a series of sensemaking discussions with academic research team members were done. Our analysis draws on the Everyday Health Systems Resilience framework (EHSR) which understands resilience as an emergent process underpinned by system capacities (cognitive, behavioral and contextual) that can be nurtured through response to stress and shock. Responses take the form of absorptive, adaptive or transformative strategies. We consider the Vaxi Taxi as adaptive resilience strategy that nurtured system capacities which may have transformative potential in future. For health practitioners, it highlights the value of creative problem-solving to generate ‘slack in the system’ and creating ‘spaces of unlearning’ in supporting adaptive strategies. However, the experience also highlighted that the relational work to support meaningful community relationships that enable trust take time. Routine EMS operations don’t support this trust building, and this requires alternative approaches. Finally, the paper represents a rare empirical example of an adaptive response to crisis tracked over time, and thus offers globally relevant lessons to the still-small EHSR literature.

Background: Linguistic concordance between healthcare providers and patients is critical for ensuring quality healthcare. Professional interpretation can be expensive and challenging to access. This scoping review aimed to explore the evidence on the role and education of medical students as interpreters in caring for patients with limited language proficiency (LLP), and to determine the benefits and risks associated with this practice. Methods: A scoping review using the Joanna Briggs Institute methodology was conducted. Six literature databases were searched systematically between 1946 – 02 Aug 2023. All publications discussing the use of medical students as interpreters in healthcare settings were included. Retained documents were analyzed using Covidence, with coding by two raters and regular team discussions. A thematic analysis framework was used. Results: Thirteen articles met the eligibility criteria. Multilingual medical students are frequently asked to interpret in healthcare settings. This was found to be advantageous in reducing communication barriers, improving care quality, and contributing to students’ clinical experience. Concerns were raised regarding the lack of knowledge on the professional obligations of interpreters. Interpretation training programs for medical students have been implemented at selective healthcare centres and demonstrated successful results in providing care to LLP patients. Conclusions: Medical students play an important role in addressing language barriers in healthcare institutions when serving LLP patients, by combining their unique position in the healthcare team with their medical, linguistic, and cultural competency skills. Academic institutions stand to benefit from offering interpretation training programs and integrating medical students as a resource towards delivering language-concordant care.

Background: Low contraceptive prevalence rates among women of reproductive age in low-income countries, including Nigeria, continue to impede efforts to improve women’s reproductive health through family planning services. This qualitative study examines the barriers to accessing family planning clinics. Methods: In-depth interviews with 30 women aged 15 to 49 were conducted at a secondary and a tertiary health facility, Lagos. Results: The research identifies two key themes: the impact of geographic proximity and the challenges faced at the clinic in accessing family planning services.” Women living far from clinics face transportation barriers. Long waiting times, stigma and privacy are issues identified, particularly in government clinics. Despite challenges, respondents praised nurses and expressed satisfaction with services. Conclusions: The study offers contemporary insights into the specific challenges faced by women in Lagos State, aiming to inform targeted interventions and policy recommendations. The study, however, suggests that even with the removal of proximity barriers, stigma remains a limiting factor for interventions, adding a novel perspective to the discourse on reproductive health in low-income settings. Addressing these barriers in a holistic manner is vital for empowering women to make informed reproductive choices, ultimately improving maternal and child health outcomes.

Pairing assistance (PA) of health professionals between county hospitals and township health centers is one of the key components of the reform of medical alliances in China to strengthen the development of health workforce in primary health care (PHC). This study aims to examine the effect of PA on healthcare utilization for patients with chronic diseases in rural areas. Two waves of National Health Services Survey (2013 and 2018) were used. A total of 13893 and 22725 rural residents with chronic diseases were included in the 2013 and 2018 waves, respectively. Multiple logistic regressions were used to examine the associations between PA and outpatient and inpatient service utilization in PHC. Chow test was used to examine the difference between PA in two models. Among rural patients with chronic diseases, two-week outpatient visits increased from 22.69% to 27.54%, and annual hospitalization admission increased from 20.72% in 2013 to 25.44%. PA was associated with a significant decrease in outpatient visits (p<0.001) in 2018 after controlling for individual and county characteristics. Patients in PA counties were 1.45 times (95% CI 1.10-1.90) more likely to use PHC outpatient care in 2013, but the difference disappeared in 2018 (OR=0.85, 95% CI 0.71-1.01). PA did not reverse the downward trend in the share of PHC outpatient visits. PA under medical alliances in China provides a potential model for building integrated people-centered health systems for other low- and middle-income countries.

The objective of this study was to explore the dynamics of efficiency and productivity of Greek public hospitals during the crisis, as well as to review the effect of implemented policies on hospital efficiency before and the implementation of the claw-back for hospital pharmaceutical expenditure. We implemented Data Envelopment Analysis and decomposed the Malmquist productivity index (MPI) to investigate the fluctuations of the Greek public hospital productivity frontier and therefore their technical efficiency between 2009 and 2019. The MPI components allowed us to capture the frontier shift, as well as pure efficiency changes and scale efficiency changes. Through the period 2009-2019 hospital inputs were reduced drastically. Doctors were reduced by 54% while beds were reduced by 15%. Hospital expenditure was decreasing between 2009 and 2015 but increased by 23% since due to fixed hospital budgets and the “claw-back”. Moreover, output seems to have increased. Patient discharges increased by 14% while diagnostic procedures were reduced by 10% between 2009 and 2016 but have been continuously rising since. Nonetheless, under variable returns to scale (VRS) average hospital efficiency was stable (~75%) for most of the period under study while declining since 2016. Policymakers in Greece have always chosen to implement cost- or input-oriented policies, instead of opting to improve outputs and quality of services. Our analysis indicated that fixed-budget-oriented reforms have impacted hospital efficiency negatively by creating a counterincentive to adopting best practices and improving hospital efficiency. Highlights Technical Efficiency under CRS was stable in Greece (0.70) over the period 2012-2016, and declined to 0.51 in 2019. Hospital Fixed Budget reforms had a negative impact on hospital efficiency. During the economic crisis 2009-2019 hospital inputs were reduced drastically Memorandum Policies introduced by Troika focused exclusively in reducing cost and not improving efficiency.

With the development of medical treatment partnership and “internet + medical service” in China, this study proposes a remote patient perceived value satisfaction model (RPPVSM) with online medical service for specialties from the perspective of patient perceived value. Taking Shanghai Pulmonary Hospital Specialist Alliance (SPHSA) as the research subject, RPPVSM was constructed based on ACSI and TAM. Structural Equation Modeling (SEM) was modified to have a better degree of fitness and validation outcomes of the hypothesis as follows: Perceived ease of use has a significantly positive impact on perceived value with coefficient being 0.248; perceived usefulness has a significantly positive impact on the satisfaction with coefficient being 0.577; perceived value has a significantly positive impact on satisfaction with coefficient being 0.163. Perceived synergy has a significantly positive impact on perceived value with coefficient of 0.547; perceived ease of use will have a significantly positive impact on satisfaction through the perceived value variable with coefficient of mediation being 0.094; perceived synergy has a significant impact on satisfaction through perceived value with mediation coefficient being 0.196. The results suggest that the inclusion of the patient’s perception value index in the medical information platform is conducive to the construction of RPPVSM.

Abstract Objective This study aims to explore the spatiotemporal disparities in the equalization of basic medical and health services in China, in order to provide reference and guidance for promoting the equalization process of basic medical and health services and ensuring the fair enjoyment of citizens’ right to life and health. Methods Based on the theory of Structure-Process-Outcome(SPO), a comprehensive evaluation index system of equalization level was constructed with 22 core indicators of basic medical and health services, from the three dimensions of medical and health investment, health service utilization, and medical service effectiveness. The Generalized Principal Component Analysis (GPCA) model was used to calculate the equalization level of basic medical and health services in 31 provinces, municipalities, and autonomous regions from 2011 to 2021. Furthermore, the kernel density estimation and Moran’s I model was employed to analyze the correlation and disparity at the spatial level. Results 1. From a national perspective, the level of equalization of basic medical and health services in China has significantly improved from 2011 to 2021. The mean score of national equalization level increased from -0.605 to 0.174, with an increase of 128.75%.

As the Universal Health Insurance Plan (RAMU) is being implemented in Mali, community-based health insurance (CBHI) — one of the pillars— must innovate to meet the challenge of universal health coverage. An experimental CBHI was tested in central Mali between 2017 and 2021. This innovative CBHI professionalizes and organizes risk sharing on a larger scale, moving from municipalities to circles (department). A mixed-method study was carried out to assess the acceptability of this innovation among elected representatives of CBHI offices. In April 2021, 118 questionnaires were administered, followed by 43 qualitative interviews from the same sample in October 2021. Sekhon el al. (2017) seven dimensions of acceptability was used as the conceptual model. More than half of individuals (58%) reported above-average acceptability. Elected officials feel well supported in their activities by the Technical Union of Malian Mutuality (UTM), the umbrella organization of CBHI. They show some confidence in their ability to perform their duties effectively despite varying levels of commitment that often fall short of expectations and needs, which they justify by their volunteer status. Elected officials note that the system is very effective despite the nonoptimal conditions linked to the prevailing insecurity. Professionalization appears to be an unavoidable condition for the performance of the innovation, as well as the new community assembly. However, elected officials are concerned about the sustainability. The UTM will play an important role in continuing its support and fulfilling its functions as a delegated management organization within the framework of the RAMU.