Springer Science and Business Media LLC

Antimicrobial resistance (AMR) is an increasing threat to global public health that is largely exacerbated by the overuse and misuse of antimicrobial medicines. As the largest antimicrobials producer and user in the world, China has a critical role to play in combatting AMR. By examining Chinese news articles and policy statements, we aim to provide an authentic understanding of public discourse in China on AMR. A search was conducted using two of the most comprehensive digital libraries for Chinese news media documents. Chinese policy documents were retrieved from official Chinese government websites. Records from June 2016 to May 2017 were included. Grounded theory was used to analyze included records, and we followed an iterative thematic synthesis process to categorize the key themes of each document. Across 64 news articles, most articles delivered general knowledge about AMR and debunked AMR-related myths, explored the implications of AMR-relevant policies, and discussed the misuse of antimicrobials in the agricultural sector. All policy documents provided guidance for healthcare workers, encouraging them to better manage antimicrobial prescriptions and usage. While the Chinese media actively educates the public on strategies for AMR prevention, certain news articles risk misleading readers by downplaying the hazards of domestic AMR issues. Further, although several national policies are geared towards combatting AMR, the government faces difficult challenges in overcoming public misconceptions regarding antimicrobial use. Records from the regional level should also be examined to further explore China’s public discourse on AMR.

The medications that are registered and available in a country are meant for the prevention and treatment of ailments and diseases. However, a lack of effective regulatory bodies and operative control mechanisms, especially in developing countries, promotes irrational and inappropriate use of medicines. This study aims to evaluate the availability and rationality of unregistered fixed-dose drug combinations (FDCs) in Nepal. A snowball sampling method with visits to 20 retail pharmacies in each of five major cities in Nepal was used to assess the availability of unregistered FDCs. To justify the rationality of the FDCs obtained from these five cities, the toolkit developed by Health Action International Asia-Pacific (HAI-AP) was used. Altogether, 41 unregistered FDCs were obtained from the five cities. Among the total 41 FDCs, a majority were anti-inflammatory/analgesic/antipyretics. A maximum of eight drugs and a minimum of two drugs per combination were present among the total 41 FDCs, with a majority in the form of tablets followed by suspensions. The cost ranges from a minimum of 3.7 Nepalese Rupees (NRs) (= USD 0.05) to a maximum of 240 NRs (= USD 3.15). None of the FDCs fulfilled all the fundamental requirements as stated in the toolkit; thus, they were categorized as ‘irrational’. Unregistered FDCs are available in the Nepalese pharmaceutical market. All the unregistered FDCs found in our study were ‘irrational’ as per the HAI-AP toolkit. Regulatory authorities should initiate strict monitoring and appropriate regulatory mechanisms to prohibit the use of unregistered and irrational FDCs.

The emigration of physicians from low- and middle-income countries (LMICs) to high-income countries (HICs), colloquially referred to as the “brain drain”, has been a topic of discussion in global health spheres for years. With the call to decolonize global health in mind, and considering that West Africa, as a region, is a main source of physicians emigrating to HICs, this rapid review aims to synthesize the reasons for, and implications of, the brain drain, as well as recommendations to mitigate physician emigration from West African countries to HICs. A literature search was conducted on PubMed, EMBASE and The Cochrane Library. Main inclusion criteria were the inclusion of West African trained physicians' perspectives, the reasons and implications of physician emigration, and recommendations for management. Data on the study design, reasons for the brain drain, implications of brain drain, and proposed solutions to manage physician emigration were extracted using a structured template. The Hawker Tool was used as a risk of bias assessment tool to evaluate the included articles. A total of 17 articles were included in the final review. Reasons for physician emigration include poor working conditions and remuneration, limited career opportunities, low standards of living, and sociopolitical unrest. Implications of physician emigration include exacerbation of low physician to population ratios, and weakened healthcare systems. Recommendations include development of international policies that limit HICs’ recruitment from LMICs, avenues for HICs to compensate LMICs, collaborations investing in mutual medical education, and incorporation of virtual or short-term consultation services for physicians working in HICs to provide care for patients in LMICs. The medical brain drain is a global health equity issue requiring the collaboration of LMICs and HICs in implementing possible solutions. Future studies should examine policies and innovative methods to involve both HICs and LMICs to manage the brain drain.

Despite substantial investment in women’s health over the past two decades, and enthusiastic government support for MDG 5 and SDG 3, health indicators for women in Mozambique remain among the lowest in the world. Maternal mortality stayed constant from 2003 to 2011, with an MMR of 408; the estimated HIV prevalence for women of 15–24 years is over twice that for men; and only 12.1% of women are estimated to be using modern contraception. This study explores the perspectives of policy makers in the Mozambican health system and affiliates on the challenges that are preventing Mozambique from achieving greater gains in women’s health. We conducted in-depth interviews with 39 senior- and mid-level policy makers in the Ministry of Health and affiliated institutions (32 women, 7 men). Participants were sampled using a combination of systematic random sampling and snowball sampling. Participants were asked about their experiences formulating and implementing health policies and programs, what is needed to improve women’s health in Mozambique, and the barriers and opportunities to achieving such improvement. Participants unanimously argued that women’s health is already sufficiently prioritized in national health policies and strategies in Mozambique; the problem, rather, is the implementation and execution of existing women’s health policies and programs. Participants raised challenges related to the policy making process itself, including an ever-changing, fragmented decision-making process, lack of long-term perspective, weak evaluation, and misalignment of programs across sectors. The disproportionate influence of donors was also mentioned, with lack of ownership, rapid transitions, and vertical programming limiting the scope for meaningful change. Finally, participants reported a disconnect between policy makers at the national level and realities on the ground, with poor dissemination of strategies, limited district resources, and poor consideration of local cultural contexts. To achieve meaningful gains in women’s health in Mozambique, more focus must be placed on resolving the bottleneck that is the implementation of existing policies. Barriers to implementation exist across multiple health systems components, therefore, solutions to address them must also reach across these multiple components. A holistic approach to strengthening the health system across multiple sectors and at multiple levels is needed.

During the early stage of the COVID-19 outbreak in Wuhan, the lockdown of the densely-populated metropolis caused panic and disorderly behavior among its population. Community governance systems (CGSs) were mobilized to lead community engagement to address the challenges and issues brought about by the sudden quarantine measures, still unprecedented in any part of the world during that time. This commentary aims to describe and analyze the roles of the CGSs, its implementation of culturally-tailored strategies and the performance of new functions as called for by the outbreak. We will introduce the community governance structure which has two parallel administrative units of government including the branches of the Communist Party of China (CPC). The pandemic showed that the roles of the CGSs evolved and may continue to be improved in the future. It is important to engage the community and to have community-based approaches in addressing issues brought about by lockdowns. This community experience in Wuhan provides important lessons for the rest of the world.

Community-based health insurance (CBHI) schemes are crucial for households to avoid financial hardship, improve healthcare quality, and engage in health policies. Household satisfaction is a key indicator for assessing healthcare quality and identifying service gaps. However, research on household satisfaction with CBHI in Ethiopia is limited. Therefore, this study aimed to evaluate household satisfaction and associated factors with CBHI schemes in Ethiopia. A comprehensive search of relevant literature was conducted using multiple databases, including PubMed, Google Scholar, Africa Journal Online, and Ethiopian Universities' institutional open-access online repositories. The search was carried out between January 25, 2023, and February 28, 2023. Twelve primary studies, including eight published and four unpublished, were identified and included in the analysis with a total sample size of 5311 participants. A protocol with the registration number CRD20531345698 is recorded on the Prospero database. Two authors, DT and MK, independently extracted the required data using a standardized form. The extracted data were then analyzed using STATA version 17 software. Heterogeneity was assessed using the Cochrane Q-test and I2 tests. Finally, a random-effect model was employed to calculate the overall household satisfaction with CBHI and to determine the associated factors. The meta-analysis showed that the overall household satisfaction with CBHI in Ethiopia was 62.26% (95% CI 53.25–71.21%). The study found regional variations in household satisfaction, with 63.40% in Oromia, 64.01% in Amhara, 49.58% in Addis Ababa, and 66.76% in SNNPs. The study identified several factors associated with household satisfaction and the CBHI scheme, including the availability of drugs (OR 2.13, 95% CI 1.47–2.78), friendly services (OR 3.85, 95% CI 1.60–6.10), affordability of premium (OR 2.80, 95% CI 1.97–3.63), and knowledge/awareness of CBHI (OR 2.52, 95% CI 1.73–3.33). The study provides valuable insights into household satisfaction with CBHI in Ethiopia, with a considerable proportion of enrolees being satisfied. The finding highlights regional variations in household satisfaction and underscores the need for tailored interventions and monitoring to enhance CBHI sustainability and effectiveness. The results suggest that healthcare providers and policymakers should prioritize the availability of drugs, friendly services, affordable premiums, and education to improve household satisfaction with CBHI schemes.