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Since independence, India has struggled to provide its people with universal health coverage. Whether defined in terms of financial protection or access to and effective use of health care, the majority of Indians remain irregularly and incompletely covered. Finally, and most recently, a new generation of Government-Sponsored Health Insurance Schemes (GSHISs) has emerged to provide the poor with financial coverage. Briefly, the main objective of these new GSHISs was to offer financial protection against catastrophic health shocks, defined in terms of an inpatient stay. Between 2007 and 2010, six major schemes have emerged, including one sponsored by the Government of India (GOI) and five state-sponsored schemes. This new wave of schemes provides fully subsidized coverage for a limited package of secondary or tertiary inpatient care, targeting below poverty populations. Similar to the private voluntary insurance products in the country, ambulatory services including drugs are not covered except as part of an episode of illness requiring an inpatient stay. The schemes have organized hospital networks consisting of public and private facilities, and most care funded by these schemes is provided in private hospitals. Ostensibly, the objective of any health insurance scheme is to increase access, utilization, and financial protection, and ultimately improve health status. Due to lack of evaluations and analyses of household data, the authors of this book do not examine the impact of health insurance in terms of these objectives. This book is not meant to highlight problems of the GSHISs, but rather to raise potential challenges and emerging issues that should be addressed to ensure the long-term viability of these schemes and secure their place within the health finance and delivery system.

Specialist groups have often advised health ministers and other decision makers in developing countries on the use of social health insurance (SHI) as a way of mobilizing revenue for health, reforming health sector performance, and providing universal coverage. This book reviews the specific design and implementation challenges facing SHI in low- and middle-income countries and presents case studies on Ghana, Kenya, Philippines, Colombia, and Thailand.

Indonesia has made improving the access to health workers, especially in rural areas, and improving the quality of health provider's key priority areas of its next five-year development plan. Significant steps and policy changes were taken to improve the distribution of the health workforce, in particular the contracted doctors program and later the contracted midwives program, but few studies have been undertaken to measure the actual impact of these policies and programs. This book is part of the inputs prepared at the request of the government of Indonesia's national development agency, Bappenas, to inform the development of the next national development plan 2010-14. Other inputs include reports on health financing, fiscal space for health, health public expenditure review, and assessments of maternal health and pharmaceuticals. Study findings highlight the importance not only of improving the supply of health care, but also of improving quality, so as to improve health outcomes. Over the period studied, important gains in the determinants of health outcomes have occurred in Indonesia. At the same time, however, the study shows that Indonesia, despite the significant gains, continues to suffer from serious challenges in the number and distribution, and in particular the quality, of its health workers.

The digital economy is booming in China and has become the world’s largest after the United States’. Since China entered the era of the digital economy, its digital technology has radiated into various fields. This study is to examine the impact of China’s digital economy on the provision efficiency of public health institutions and the mechanism of action between them. Specifically, it measures the development level of China’s digital economy, and the provision efficiency of public health institutions from 2009 to 2018. The research also explores the relationship between China’s digital economy and its provision efficiency, through the Tobit-DEA model. An analysis of the regional heterogeneity indicated that the performance of China’s digital economy in the eastern region has a significant positive effect on improving the efficiency of the public health sector. This further confirms that the digital economy has strengthened China’s ability to deal with public health crises during the COVID-19 pandemic. A further mediation effect analysis showed that China’s digital economy optimizes the efficiency of public health provision by improving governmental performance and regulatory quality. This shows that the development of the digital economy promotes the construction of digital government, and thus improves the quality of governmental supervision and governmental performance, which has a significant positive effect on the efficiency of the supply of public health services. During the COVID-19 pandemic especially, government delivery of public health services was critical in addressing public health crises. Therefore, based on the results of our empirical analysis, this study provides policy suggestions for improving the efficiency of public health service provision in the era of the digital economy.

Health systems across Africa are in urgent need of improvement. The public sector should not be expected to shoulder the burden of directly providing the needed services alone, nor can it, given the current realities of African health systems. Therefore to achieve necessary improvements, governments will need to rely more heavily on the private health sector. Indeed, private providers already play a significant role in the health sector in Africa and are expected to continue to play a key role, and private providers serve all income levels across sub- Saharan Africa's health systems. The World Health Organization (WHO) and others have identified improvements in the way governments interact with and make use of their private health sectors as one of the key ingredients to health systems improvements. Across the African region, many ministries of health are actively seeking to increase the contributions of the private health sector. However, relatively little is known about the details of engagement; that is, the roles and responsibilities of the players, and what works and what does not. A better understanding of the ways that governments and the private health sector work together and can work together more effectively is needed. This Report assesses and compares the ways in which African governments are engaging with their private health sectors. Engagement is defined, for the purposes of this report, to mean the deliberate, systematic collaboration of the government and the private health sector according to national health priorities, beyond individual interventions and programs. With effective engagement, one of the main constraints to better private sector contributions can be addressed, which in turn should improve the performance of health systems overall.

Refugees often face worse oral health outcomes, such as periodontal diseases and dental caries in host countries due to barriers including language and cultural differences, institutional discrimination, and restricted use of dental health services. This scoping review aims to map and summarise the available studies on refugees' experience of accessing dental health services in the host countries, to identify the main characteristics of the dental health services that refugees access and to explore the barriers and enablers to navigate the dental health service system in their host countries. The Joanna Briggs Institute (JBI) framework was adopted. PubMed, Scopus, Assia, CINAHL and Social Services Abstract were searched. A search strategy was developed using Medical Subject Headings (MeSH) terms and a combination of search operators and syntax used in MEDLINE were adopted for the remaining databases. Data were synthesised using thematic analysis. Fourteen articles were included. Most studies used qualitative methods and Australia seemed to be the country with the highest number of publications surrounding this topic. The included studies showed that refugees frequently encountered substantial obstacles when attempting to access dental services in host countries. Numerous barriers such as language barriers, cultural differences, and lack of health insurance or financial support hindered refugees' ability to access these services. Additionally, many refugees possessed limited knowledge of the dental care system in their new country. As a result of untreated dental problems, refugees suffered from pain and other health complications. This scoping review explored the challenges refugees have experienced in accessing dental health services in host countries, which included the key barriers such as affordability, accessibility, accommodation, availability, awareness, and acceptability. The scarcity of relevant research highlighted the need for a more comprehensive understanding of refugees' experiences accessing dental health services in host countries. Limited data were identified regarding evidence focusing on the characteristics of dental services accessed by refugees in host countries.

Despite spending more than any other nation on medical care per person, the United States ranks behind other industrialized nations in key health performance measures. A main cause is the deep disparities in access to care and health outcomes. Federal programs such as the designations of Medically Underserved Areas/Populations and Health Professional Shortage Areas are designed to boost the number of health professionals serving these areas and to help alleviate the access problem. Their effectiveness relies first and foremost on an accurate measure of accessibility so that resources can be allocated to truly needy areas. Various measures of accessibility need to be integrated into one framework for comparison and evaluation. Optimization methods can be used to improve the distribution and supply of health care providers to maximize service coverage, minimize travel needs of patients, limit the number of facilities, and maximize health or access equality. Inequality in health care access comes at a personal and societal price, evidenced in disparities in health outcomes, including late-stage cancer diagnosis. This review surveys recent literature on the three named issues with emphasis on methodological advancements and implications for public policy.

Background Experiencing violence and conflict during childhood and adolescence can significantly impact mental health, including affecting young people’s social and economic development. We lack research in conflict-affected contexts that directly analyses the perceptions and experiences of young people themselves. We do not understand enough how conflict-affected environments damage the social tissue and connectedness of young people. We need a better understanding of the resources and agency that young people have to access support for their mental health and emotional wellbeing. Methods Based on participatory creative research methods, this article describes which resources young Afro-Colombian people living in the city of Quibdó make use of to improve and support their emotional wellbeing. Drawing on Bronfenbrenner’s ecological systems theory, we explore the social tissue of youth mental health. Results Participants mostly drew on sources of support in their immediate microsystem: family and friends; arts and sports in the neighbourhood; culture and nature; and individual coping strategies in the home. These microsystems bore signs of significant disruption as a result of conflict and violence, increasing individual and collective vulnerability. We identify a disconnect between these young people, their immediate environment (family, school, neighbourhood) and existing support mechanisms offered by the state and community organisations. Conclusions To promote mental wellbeing, we identify the significance of safe spaces where young people are able to talk and connect to others and where trusted persons can connect young people to the wider exosystem of mental health care provision and to social, economic, peacebuilding and wider political processes.

Background Conflict and violence can impact on the mental health of children and young people, who are in a crucial stage of their personal growth. Not much is known about the provision of mental health care to young people in conflict-affected areas. Community-based care can be essential, as state-led services are often scarce in conflict contexts, like Colombia’s Pacific region where this research was conducted. According to the WHO, such care is ideally provided in the form of a network of interconnected services, offered by different actors beyond the formal health sector. This article describes the relationship between the formal and community mental health systems in Colombia’s Pacific region, and identifies ways of improving their interaction. Methods Qualitative data were collected through 98 semi-structured interviews with community organisations, schools, international organisations and state institutions. These interviews aimed to identify the strategies used to promote young people’s mental health and the interactions between the different providers. Boundary spanning theory was used to analyse how different actors and forms of mental health care provision could coordinate better. Results Community organisations and schools use a wide array of strategies to attend to the mental health of children and young people, often of a collective and psychosocial nature. State institutions offer more clinically focused strategies, which are however limited in terms of accessibility and continuity. International organisations aim to strengthen state capacity, but often struggle due to high staff turnover. Although mental health care pathways exist, their effectiveness is limited due to ineffective coordination between actors. Conclusions To make sure that the variety of strategies to improve young people’s mental health effectively reach their beneficiaries, better coordination is needed between the different actors. Mental health care pathways should therefore integrate community organisations, while community connectors can help to manage the coordination between different actors and forms of clinical and psychosocial support.

Natural trails in UNESCO Global Geopark territories show strong salutogenic, inclusive and interactive characteristics as potentials and opportunities for ecosystem health. It is essential to provide information to inform the hiker as to the characteristics of the environment and the attractions and challenges of the route. Based on a network analysis methodology we aimed to identify the indicators of centrality and strength of connection in order to classify the effort index and biomechanical overload of the Araripe UNESCO Global Geopark trails in Brazil. The results showed strong connection and centrality of the variables related to the biomechanical overload in the effort index. In the trail of Pontal de Cruz the altimetric variation and the surface of the ground are highlighted in the biomechanical overload that presented a horizontal course equivalent 2.6 times larger than the presented distance. In Sítio Fundão trail, the surface of the ground also stood out, increasing the exposure in 36% of the presented distance. On the Missão Velha Waterfall trail, the variable that stood out was the biomechanical overload on the knee, equivalent to a horizontal increase of 28% of the measured distance. The methodology presented sought to optimise the mapping, management and consolidation of a network of natural trails aggregated to a high geotouristic, scientific, educational, cultural and well-being potential as presented in the Araripe UGG territory.