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Health Systems and Reform Journal @hsrjournal.bsky.social · 11h

The authors call for urgent research into physician practices, testing availability, and system financing, and argue that improving treatment outcomes, not just coverage, must become the priority. Read more: bit.ly/4kRa5wt

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Health Systems and Reform Journal @hsrjournal.bsky.social · 11h

Other contributing factors include: ➡️High physician workloads, leaving little time for patient education or treatment review ➡️Poor dietary compliance characterised by carbohydrate-rich diets ➡️A policy focus on screening and treatment rates, with little attention to what happens after

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Health Systems and Reform Journal @hsrjournal.bsky.social · 11h

One likely culprit is therapeutic inertia: physicians are slow to adjust treatment when control isn't achieved. This is compounded by the fact that HbA1c testing (the standard tool for monitoring glycemic control) is unavailable in most public facilities👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 11h

Sri Lanka outperforms most low- and middle-income countries on testing, diagnosis, and treatment, yet the majority of treated patients never achieve control. The biggest losses in the care cascade happen after treatment begins👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 11h

Why does Sri Lanka, a country with strong health service coverage, still see only 1 in 5 adults with diabetes achieving glycemic control? This study by Ravindra P. Rannan-Eliya and colleagues explores this question using national survey data. 🧵

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Health Systems and Reform Journal @hsrjournal.bsky.social · 21/09/2026

Challenges remain. Funds often arrive late, spending rules leave facilities little flexibility, most facilities have no dedicated accountant, and lengthy approval processes slow down purchases from private vendors👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 21/09/2026

The results: 88% of facility in-charges report greater autonomy in planning and budgeting, and availability of essential medicines rose from 69% to 94% in the pilot regions between 2014 and 2018. Funds are now allocated by need, equity, utilization, and performance👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 21/09/2026

Direct Health Facility Financing changed this by sending operating funds straight to facility bank accounts. The Prime Vendor Model then lets facilities use those funds to buy medicines from accredited private wholesalers whenever the central medical store is out of stock👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 21/09/2026

Before the reforms, facility funds sat in district bank accounts and district managers spent them on facilities' behalf, often out of step with local priorities. When the central medical store ran out of stock, facilities bought ad hoc from private pharmacies at higher prices👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 21/09/2026

Can direct facility financing fix primary care's funding and stockout problems? In this commentary, Peter Binyaruka, Douglas Ndeki, Raymond Kiwesa, Regina Joseph, and Bakari Salum reflect on two complementary reforms Tanzania scaled nationally in 2017/18. 🧵

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Health Systems and Reform Journal @hsrjournal.bsky.social · 08/09/2026

And it has to fit the context. Where governments lack legitimacy or territorial control, stewardship should be subnational, hybrid, or independently verified. Read more: bit.ly/4gSxRHt

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Health Systems and Reform Journal @hsrjournal.bsky.social · 08/09/2026

But regulation alone won't fix it. Donor bypass is a political economy problem: funders seek attribution, minimize fiduciary risk, and protect branded programs. Real reform means rebalancing financing and accountability.👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 08/09/2026

The authors propose shifting Ministries of Health from state-as-provider to state-as-steward. This means mapping providers, licensing, contracting, integrating data, and coordinating financing rather than letting services run as a fragmented parallel system.👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 08/09/2026

This began as an emergency workaround. But when these providers operate outside national priorities, standards, and shared data systems, a useful stopgap hardens into a permanent architecture of fragmentation.👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 08/09/2026

In fragile and conflict-affected settings, the state barely delivers health care. NGOs, faith-based groups, and private providers do. Together they form a de facto "shadow health system."👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 08/09/2026

Can better coordination of non-state health providers help fragile states move toward universal health coverage? This commentary by Augustus Osborne, Abdirasak Sharif Ali, and Umaru Sesay makes the case for rethinking who steers health care in fragile and conflict-affected settings. 🧵

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Health Systems and Reform Journal @hsrjournal.bsky.social · 10/08/2026

As shown by this case study, PFM reforms can expand fiscal space and improve efficiency, but they only translate into better health when the institutional environment is right, and when health ministries actively push for those resources to reach the sector. Read more: bit.ly/4za6MIb

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Health Systems and Reform Journal @hsrjournal.bsky.social · 10/08/2026

The benefits are also unevenly spread. Poor digital connectivity and limited staff capacity mean some agencies race to book spending "first come, first served," risking deepened inequities in fund access across districts.

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Health Systems and Reform Journal @hsrjournal.bsky.social · 10/08/2026

But better fund flows don't automatically mean better health. Weak budget credibility persists: approved budgets increasingly outstrip actual funds available, creating a fiscal squeeze that pushes agencies to protect salaries over training and supplies.

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Health Systems and Reform Journal @hsrjournal.bsky.social · 10/08/2026

The gains were real: ➡️Near-elimination of idle floats ➡️Stronger cash management ➡️Greater expenditure transparency ➡️Faster central releases In Bihar, the time to release central funds fell from 2–3 months to under one month.

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Health Systems and Reform Journal @hsrjournal.bsky.social · 10/08/2026

The Single Nodal Agency (SNA) reform consolidated everything into a single state-level bank account. Downstream accounts were closed, lower-level agencies moved to zero-balance subsidiary accounts with defined drawing limits, and all spending was tracked in real time.

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Health Systems and Reform Journal @hsrjournal.bsky.social · 10/08/2026

Before the reform, funds under India's National Health Mission flowed through thousands of bank accounts across multiple tiers of government. The result: a fragmented system where idle balances ("floats") piled up and less than 60% of available funds were actually spent.

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Health Systems and Reform Journal @hsrjournal.bsky.social · 10/08/2026

Can reforming how public money flows help a country move toward universal health coverage? In this article, Mita Choudhury and Nitya Chutani examine India's Single Nodal Agency (SNA) reform, introduced in 2021 to strengthen budget execution under Centrally Sponsored Schemes🧵

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Health Systems and Reform Journal @hsrjournal.bsky.social · 27/07/2026

But there are uncertainties: no new funding, no operational payment mechanism yet, and untested governance for inter-agency collaboration. If the reform succeeds, Reich argues, it will offer important lessons for the United States. Read more: bit.ly/4bgjLhk

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Health Systems and Reform Journal @hsrjournal.bsky.social · 27/07/2026

Rollout is phased: from January 2027, coverage starts with seven priority areas including emergency, maternal, and cardiovascular care. From July 2027, it expands to diagnostics like MRI, CT, and ultrasound👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 27/07/2026

Access comes through a national identity card, a cellphone app, and a shared electronic medical record. A single fee schedule lets one subsystem reimburse another. Mexicans living in the US will also be able to register and receive care👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 27/07/2026

The SUS takes a different path from past reforms: instead of merging institutions or creating new agencies, it connects existing public providers (IMSS, ISSSTE, IMSS-Bienestar, and others) into a single network👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 27/07/2026

In this editorial, Michael R. Reich examines El Servicio Universal de Salud (SUS), the reform announced by President Claudia Sheinbaum in April 2026 🧵

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Health Systems and Reform Journal @hsrjournal.bsky.social · 18/07/2026

Individuals and organizations around the world are invited to submit Research Articles, Commentaries, Policy Reports, and Editorials on this important topic! 📖 Read more: bit.ly/44ylTNN

bit.ly

Health Systems Research for a New Era: Launch Editorial

Published in Health Systems & Reform (Vol. 12, No. 1, 2026)

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Health Systems and Reform Journal @hsrjournal.bsky.social · 18/07/2026

3️⃣ What competencies do current and emerging researchers most urgently need to develop? 4️⃣ What defines and differentiates the field of health systems research?

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Health Systems and Reform Journal @hsrjournal.bsky.social · 18/07/2026

They propose four broad questions to guide the collection: 1️⃣ What distinctive contributions can the field of health systems research make? 2️⃣ What are the research priorities for the field, and how should they be set? 👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 18/07/2026

In this editorial, Michael R. Reich, Corrina Moucheraud, Pablo Villalobos, Veronika J. Wirtz, Abdo Yazbeck, and Yarlini Balarajan reflect on how cuts in global health funding are reshaping the field of health systems research👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 18/07/2026

📢 Health Systems & Reform has launched an open discussion and Article Collection on the theme of "Health Systems Research for a New Era: Foundations, Frontiers, Futures.”🧵

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Health Systems and Reform Journal @hsrjournal.bsky.social · 25/06/2026

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Health Systems and Reform Journal @hsrjournal.bsky.social · 25/06/2026

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Health Systems and Reform Journal @hsrjournal.bsky.social · 25/06/2026

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Health Systems and Reform Journal @hsrjournal.bsky.social · 25/06/2026

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Health Systems and Reform Journal @hsrjournal.bsky.social · 25/06/2026

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Health Systems and Reform Journal @hsrjournal.bsky.social · 16/06/2026

Read more to discover how stakeholder engagement, transparency, and context-specific evidence can be integrated to inform national decisions in low-resource settings: bit.ly/3HW85Vd

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Health Systems and Reform Journal @hsrjournal.bsky.social · 16/06/2026

Participation was broad and meaningful: ➡️Civil society organizations ➡️Local government ➡️Health professionals & NGOs ➡️Patients’ groups Over 17 consensus workshops were held across Zanzibar’s islands.

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Health Systems and Reform Journal @hsrjournal.bsky.social · 16/06/2026

Including political/public acceptability as a criterion, alongside cost-effectiveness, equity, budget impact, and disease burden, was a key innovation. This helped ensure that proposed interventions were not only sound but also feasible.

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Health Systems and Reform Journal @hsrjournal.bsky.social · 16/06/2026

The method covers 5 phases: ➡️Planning ➡️Defining criteria & mapping interventions ➡️Financing ➡️Analysis & priority setting ➡️Implementation & monitoring

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Health Systems and Reform Journal @hsrjournal.bsky.social · 16/06/2026

The article presents a 10-step method for setting priorities in health care, designed to be transparent, inclusive, and rooted in local realities. It was used to revise Zanzibar’s Essential Health Care Package (EHCP) from 2019 to 2022.

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Health Systems and Reform Journal @hsrjournal.bsky.social · 16/06/2026

How can countries make fair decisions about which health services to fund, especially when resources are limited? A study led by Omar Mwalim, Sanaa Said, Subira Suleiman, and colleagues explores this question through Zanzibar’s health system.👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 25/05/2026

➡️ Insurance provided the strongest protective effect in municipalities with fewer regularized migrants and lower baseline health system integration, exactly where vulnerable populations need it most👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 25/05/2026

➡️ The policy's impact varied dramatically by municipality. In low-integration areas, uninsured women experienced a 26% decline in healthcare use, while insured women actually increased usage by 22%👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 25/05/2026

However, enrollment didn't automatically translate to health services use. While insured women maintained stable health services utilization (72% both years), uninsured women saw a 16% decline in accessing formal health services👇

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Health Systems and Reform Journal @hsrjournal.bsky.social · 25/05/2026

The study surveyed 4,423 female Venezuelan migrants before (2020) and after (2023) ETPMV implementation using telephone interviews. During this time, health insurance enrollment increased 134% from 2020 to 2023. Mid-level integration municipalities saw the biggest change from just 19% to 54%👇

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