Alliance for Health Policy and Systems Research

Summary box This commentary examines how recent events, including shifts in development aid and trust in global institutions, create both challenges and opportunities for the Global South to reshape health governance.

IntroductionDiabetes mellitus is a significant global health challenge, requiring innovative strategies to improve management and mitigate complications. Digital health technologies offer promising solutions to enhance diabetes self-care by providing real-time feedback, improving communication and supporting data-driven decision-making. Despite the increasing adoption of digital self-care interventions, there is a lack of comprehensive synthesis of evidence on their impact, accessibility and integration into healthcare systems. This scoping review aims to map existing research on digital self-care solutions for diabetes management, identify knowledge gaps and highlight best practices and key factors influencing adoption.Methods and analysisThe review will follow Arksey and O’Malley’s framework and adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic search will be conducted in Medline, Scopus, Embase, CINAHL and Google Scholar, focusing on studies published from January 2004 to December 2024 in English, French, Arabic, Portuguese, Spanish, Italian, Czech, Slovak and Chinese. Studies reporting on digital self-care solutions for diabetes management will be included, covering experimental and quasi-experimental study designs. Data extraction will cover study and participant characteristics, digital solution features, and barriers and facilitators to adoption. Ethical and equity considerations will also be analysed using established frameworks. Two reviewers will independently screen studies, with discrepancies resolved by a third reviewer.Ethics and disseminationThis scoping review will provide a comprehensive understanding of digital self-care solutions for diabetes management, offering insights to inform future research and enhance self-care practices globally. Findings will be disseminated through peer-reviewed publications, conferences and interest holder engagements to inform clinical practice and policy development. As this study involves the review of existing literature, ethical approval is not required.

SummaryPrimary care is currently a central focus in global health policy; however, renewed attention has not translated into the investment needed to build systems that are fit for the future. As 2030 approaches, many health systems are converging towards primary care models that provide community-based, first-contact access, but they omit the other core functions of comprehensiveness, continuity, and coordination. In this Viewpoint, we argue that these primary care lite models are ill-equipped to manage the increasing burden of multimorbidity; harness technological disruption; and reduce health inequities. We propose a new trajectory towards hybrid models of care that anchor community-oriented outreach workers within multidisciplinary teams that are trained in family medicine. Although artificial intelligence and digital tools can magnify impact and reach, we warn that their uninformed adoption could create digital gatekeepers and deepen disparities. To future-proof primary care, policy makers should invest in integrated models that deliver robust, equitable, and person-centred care that is needed to meet future challenges.

Many low-income and middle-income countries have introduced public health insurance systems, whereby, thanks to government subsidies, selected groups are entitled to receive insurance coverage even if not paying direct contributions into the system. These efforts towards achieving universal health coverage were often undermined by difficulties in enrolment and registration, barriers to health service utilisation or complicated rules around service packages. Governmental and non-governmental accountability initiatives have been established to overcome these barriers in order to make health insurance programmes responsive and to empower citizens. This paper examines evidence and synthesizes lessons from 20 accountability initiatives in six selected countries to understand how these achieved (or not) these goals. We systematically analysed six final reports and five published papers which were part of a multicountry research programme from 2019 to end of 2022 studying accountability initiatives. Between June 2023 and September 2024, we systematically extracted data and synthesised findings from the reports and papers based on a conceptual framework, adapted from a framework developed by Molyneux, which had been adopted by the country teams to guide their studies. We coded the extracted data and identified the content, context and process factors that enabled or hindered the accountability initiatives in achieving their intended goals. We present and discuss factors that were present in at least two initiatives. Governmental initiatives were in most instances established in conjunction with the health reforms that introduced the health insurance programmes they address. Whereas some of these initiatives were effective, many were undermined by poor outreach to citizens, inadequacy of resources, conflicts of interest and power imbalances and lack of fidelity to original design. Non-governmental initiatives often emerged to fill existing gaps in government services and programmes. Many of the non-governmental initiatives had several features which helped them in contributing to citizen empowerment, and these included embeddedness in and being trusted by the local communities, flexibility in operating and reaching out to people and the underlying motivation of people working in them. The effective implementation of accountability initiatives requires transparency, trust-building measures, active outreach and community engagement and adequate resources. These elements can ensure that initiatives achieve their intended goal of enhancing citizens' access to their health insurance entitlements. Further research is needed to understand how best collaboration between governmental and non-governmental initiatives can be fostered to build synergies between the two toward the achievement of common goals.

Background: As the Sustainable Development Goals deadline of 2030 draws near, greater attention is being given to health beyond the health sector, in other words, to the creation of healthy societies. However, action and reform in this area has not kept pace, in part due to a focus on narrower interventions and the lack of upstream action on health inequity. With an aim to guide action and political engagement for reform, we conducted a thematic analysis of concepts seeking to arrive at healthy societies.Methods: This paper drew on a qualitative thematic analysis of a purposive sample of 68 documents including political declarations, reports, peer reviewed literature and guidance published since 1974. Three independent reviewers extracted data to identify, discuss and critique public policy levers and ‘enablers’ of healthy societies, the "how."Results: The first lever concerned regulatory and fiscal measures. The second was intersectoral action. The final lever a shift in the global consensus around what signifies societal transformation and outcomes. The three enablers covered political leadership and accountability, popular mobilization and the generation and use of knowledge.Conclusion: Documents focused largely on technical rather than political solutions. Even as the importance of political leadership was recognized, analysis of power was limited. Rights-based approaches were generally neglected as was assessing what worked or did not work to pull the levers or invest in the enablers. Frameworks typically failed to acknowledge or challenge prevailing ideologies, and did not seek to identify ways to hold or governments or corporations accountable for failures. Finally, ideas and approaches seem to recur again over the decades, without adding further nuance or analysis. This suggests a need for more upstream, critical and radical approaches to achieve healthy societies.

In recent decades, the field of rehabilitation has undergone substantial development, growth, and acceptance. Rehabilitation addresses the impact of health conditions on a person’s daily life by optimizing their functioning and reducing their disability experience. Rehabilitation expands the focus of health beyond preventative and curative care to ensure that people with health conditions can remain as independent as possible and participate in education, work, and meaningful life roles.1) A research definition of rehabilitation has been recently published.2) Scientific and clinical research has generated a body of knowledge that strongly supports the use of many rehabilitation interventions with positive outcomes in various populations and health conditions.

The South African Journal of Physiotherapy is the official scholarly refereed journal of the South African Society of Physiotherapy. It aims to publish original research and facilitate continuing professional development for physiotherapists and other health professions both nationally and internationally.