Factors Influencing the Implementation of a Disability Package for Children with Developmental Disabilities: A Policy Analysis

BackgroundThe present goal of the World Health Organization (WHO) 2021–2030 roadmap for Neglected Tropical Diseases is to eliminate schistosomiasis as a public health problem, and reduce its prevalence of heavy infections to less than 1%. Given the evolution and impact of schistosomiasis in the Ngamiland district of Botswana, the aim of this study was to analyze the control policies for the district using the Policy Triangle Framework.MethodsThe study used a mixed method approaches of an analysis of policy documents and interviews with 12 informants who were purposively selected. Although the informants were recruited from all levels of the NTD sector, the analysis of the program was predominantly from the Ngamiland district. Data were analyzed using Braun and Clarke’s approach to content analysis.ResultsThe study highlights the presence of clear, objectives and targets for the Ngamiland control policy. Another theme was the success in morbidity control, which was realized primarily through cycles of MDA in schools. The contextual background for the policy was high morbidity and lack of programming data. The implementation process of the policy was centralized at the Ministry of Health (MOH) and WHO, and there was minimal involvement of the communities and other stakeholders. The policy implementation process was impeded by a lack of domestic resources and lack of comprehensive policy content on snail control and no expansion of the policy content beyond SAC. The actors were predominately MOH headquarters and WHO, with little representation of the district, local level settings, NGOs, and private sectors.ConclusionsThe lack of resources and content in the control of environmental determinants and exclusion of other at-risk groups in the policy, impeded sustained elimination of the disease. There is a need to guide the treatment of preschool-aged children and develop national guidelines on treating foci of intense transmission. Moreover, the dynamic of the environmental transmissions and reorientation of the schistosomiasis policy to respond to the burden of schistosomiasis morbidity, local context, and health system context are required.

BackgroundDespite the adoption of various policies and strategies in recent decades, the Iranian health system has not succeeded in protecting households against catastrophic health expenditures (CHE) and impoverishment. Accordingly, this qualitative study aimed to critically analyze current policies for reducing CHE.MethodsThis qualitative study was conducted as a retrospective policy analysis based on a document review and semi-structured interviews with key informants between July to October 2022. Two theoretical frameworks were used, including the Analysis of Determinants of Policy Impact (ADEPT) model and Walt and Gilson’s “Policy Triangle framework.” The country's related documents were searched through databases. In total, 35 participants were interviewed. Interviews and documents were analyzed using directed content analysis in MAXQDA v12 software. Interobserver reliability, peer check, and member check were done to confirm the trustworthiness of the data.ResultsTwelve main themes and 42 sub-themes emerged from the data. The findings revealed that policy accessibility, policy background, and a clear statement of goals influenced the policy process. However, resources, monitoring and evaluation, opportunities, and obligations negatively affected the implementation process. In addition, a policy analysis based on the policy triangle framework demonstrated that the main factors affecting the policy on reducing CHE in Iran were “conflicts of interest,” “contextual factors,” “monitoring and evaluation,” and “intersectoral relationship” factors.ConclusionThe present study reflected the multifaceted nature of the barriers to reducing CHE in Iran. The implementation of the policy on reducing CHE requires the political will to improve intersectoral collaboration, strengthen the stewardship role of the Ministry of Health, design monitoring and evaluation mechanisms, and prevent personal and organizational conflicts of interest.

Introduction The level of salt intake among the Iranian population remains considerably above the recommended limits. This exploratory, qualitative, and applied study adopts a prospective policy analysis framework to develop an evidence-based policy package to reduce salt consumption. Methods Employing a multi-method research design within a policy analysis framework, this study is carried out in four phases. Initially, a thorough literature review is conducted to gather and evaluate policies, programs, and interventions from various countries targeting population-level salt reduction. Subsequently, qualitative analyses examine the obstacles, challenges, and enabling factors associated with existing and ongoing salt reduction efforts in Iran. This involves assessing the policy content, context, and formulation processes, alongside examining stakeholders’ roles within the policy triangle framework. Following this, a draft set of policy options is generated. An expert panel consisting of specialists, policymakers, and officials is then assembled to review and classify these options. The policy options are prioritized using the Delphi method, combined with the Centers for Disease Control and Prevention (CDC) framework, to ensure an accurate assessment of feasibility specific to Iran. Ultimately, the highest-ranked options will be refined and compiled into a comprehensive policy package ready for practical implementation. Conclusions The prospective policy analysis approach enables the identification and selection of potentially viable and effective policies to reduce salt intake. The findings of this research will be disseminated in formats such as policy briefs, technical reports, and scholarly articles to inform and guide policymakers.

BackgroundUganda has been confronted with a sustained influx of refugees for decades. This prompted the government to explore opportunities to integrate refugees into local service structures including its national health system. This paper chronicles the history of policies and strategies that have influenced the integration of refugees into the national health system in Uganda and investigates factors that impacted policy evolution and progression.MethodsWe used a case study approach that drew on a document review and key informant interviews with 28 respondents at national and subnational levels. Interviews were analyzed using thematic qualitative analysis and findings were organized using Walt and Gilson’s Policy Triangle Framework. Data from the literature review, media review, and key informant interviews were triangulated.ResultsUganda’s experience with the integration of refugee’s dates to 1999 when the country first implemented the Self-reliance strategy. Since then, policy learning and evolution have taken place, with policies around integration evolving and improving over time, moving the country towards more effective implementation of integrated health services. A conducive policy environment was key as a set of legislations at national and district-levels and sector-specific plans and budgets that included refugees have provided the foundation for implementation. The integration received support and buy-in from the highest levels of government including the President and the Office of The Prime Minister. This was coupled with deliberate efforts by the government to mainstream refugee response in local plans and budgets, allowing implementation at district and sub-district levels. These factors were pivotal to the implementation of the integration agenda.ConclusionOur study highlights the complex, dynamic, evolving, and multifaceted nature of the multisectoral health policy process in the integration of health services in refugee settings. The findings shed light on the importance of collaboration between stakeholders, mobilization of legal and political frameworks to shape the integration of refugee health services into the national health system, and the importance of ensuring that high-level commitments translate to action and development plans at local levels.

The aim of this qualitative study was to describe the problems that parents or caregivers of children with mental health disabilities and disorders in Namibia experience when accessing healthcare resources for their children. Data was collected through focus group discussions with the participants and individual interviews with the key informants. Overall, a total of 41 people provided information for this study. Thematic data analysis was used to assess the data. The main barriers experienced by the parents were poor service provision, transport and money, whilst access to education services facilitated access to healthcare services. The challenges go beyond commonly-reported problems such as sub-optimal service provision and include the basic challenge of lack of transportation to reach healthcare services. Many of the barriers identified in this study have been related to general problems with the healthcare system in Namibia. Therefore there is a need to address general concerns about healthcare provision as well as improve specific services for children with mental health disabilities and disorders in Namibia.

Early cancer detection remains a major challenge in low- and middle-income countries (LMICs), where late diagnoses and unequal healthcare access are widespread. While digital innovations such as telemedicine and artificial intelligence (AI) offer significant promise, their successful adoption depends on enabling policy environments. This study investigates how health policy reforms influence the integration of telemedicine and AI tools for early cancer detection in four South Asian LMICs: India, Pakistan, Bangladesh, and Nepal. Employing a qualitative comparative case study design and guided by Walt and Gilson's Policy Triangle Framework, the research analyzes national health strategies, policy documents, and global development reports from 2010 to 2023. The analysis focuses on five thematic domains: policy integration, technological readiness, institutional capacity, regulatory frameworks, and health equity. India demonstrates the most comprehensive digital health alignment through centralized governance and public-sector AI pilots, while Pakistan shows moderate progress via public-private initiatives. Bangladesh and Nepal lag behind due to fragmented systems and infrastructural deficits. Common barriers include poor regulation, limited digital literacy, and socio economic disparities. The findings underscore the need for inclusive, equity-driven reforms and regional cooperation to scale digital health innovations sustainably across LMICs and strengthen cancer detection frameworks.

IntroductionMental health literacy is essential for the recognition, management, and prevention of mental disorders among school-aged children. However, few studies have examined the implementation status of school-based mental health literacy in Asian countries. This study aims to compare the approaches taken by the Philippines, Indonesia, and Japan in managing school-based mental health literacy through curriculum-related policies.MethodsThe collected documents of this study analyzed both policies (formulated from 2000 to 2023) and curricula (from grade 1 to grade 12) that were adapted to the deductive content analysis methods. Policies were analyzed using the policy triangle framework (Walt and Gilson in Health Policy Plan 9:353–370, 1994) and mapped using the review points (Margaretha et al. in Front Psychiatry 14:1126767, 2023). Curricula were analyzed using the definition of mental health literacy (Jorm in Am Psychol 67:231–243, 2012). This study focused on mental health laws and policies in the Philippines, Indonesia, and Japan, highlighting their success in addressing the needs of adults and school-aged children. By considering each country’s unique socio-cultural contexts and basic educational approaches, this study identified diverse strategies and methodologies in addressing mental health challenges. Using a common analytic framework, this study collected and analyzed policies and curricula on mental health literacy from the three countries (Philippines, 22; Indonesia, 9; and Japan, 6). The basic education curricula developed by their respective Ministries of Education were used.ResultsThis study highlights two key findings on school-based mental health literacy. First, mental health literacy is incorporated into health and physical education in Japan, health, values education and homeroom guidance in the Philippines, and religious education in Indonesia. Second, while the Philippines and Indonesia implement mental health education based on established policies, Japan lacks a core mental health literacy policy but has developed and implemented related curricula through its course of study guidelines. The curriculum analysis identified a specific challenge: a lack of “first aid skills to support others who are developing a mental disorder or are in a mental health crisis”.ConclusionsThis study revealed the partial implementation of mental health literacy education in the Philippines, Indonesia, and Japan. The Philippines offers a nearly comprehensive curriculum on mental health literacy (grades 1–12), Japan incorporates it into health education (grades 5–10), and Indonesia integrates it into religious education (grades 1–12). While the Philippines and Indonesia align with mental health policies, Japan relies on its national curriculum without a core policy. A key challenge was indicated involving teachers, guidance counselors, or school health personnel as key actors to support students with mental disorders or those potentially at risk, as well as to handle emergency cases of mental disorders in schools. Recommendations include systematic monitoring of the implementation of school-based mental health policies, collaboration with UN agencies to align with international standards while incorporating culturally tailored strategies for each country.

BACKGROUND:One of the main issues related to the inefficiency of the health system is the lack of sufficient communication between researchers and health policymakers regarding the exchange of the latest findings and the use of inappropriate evidence to manage cases. The knowledge translation removes this disconnect.MATERIALS AND METHODS:In this comparative study, to obtain appropriate data on the status of knowledge translation, refer to the databases of reputable centers and governments and the knowledge translation models were reviewed in the title of main articles, abstracts, guidelines, and reports of reputable international organizations between 2005 and 2020. The origin of the models was determined, then the countries with the largest number of models were selected and analyzed using Walt and Gilson's “Policy Triangle framework in four dimensions: context, content, process, and actors.”RESULTS:All the three countries have politically, socially, and economically made knowledge translation one of their policy priorities. Iran's centralized health system is a major obstacle. The USA and Canada have clear strategies and coherent and practical infrastructures that implement the knowledge translation in the form of operational plans. In contrast, in Iran, it has been enough to establish the knowledge translation centers at the level of universities and knowledge translation websites. In Iran, the Ministry of Health and universities of medical sciences play a direct role, but in Canada, they also use knowledge broker to apply knowledge.CONCLUSION:Iran is building capacity in the field of knowledge translation. That the implementation of interventions with the cooperation of macro policymakers can strengthen it.

Background: A healthy active child is a promise for healthy and productive future generation. But sometimes a baby is born with apparent defects or develop disturbances in intellectual, motor and social functioning in early childhood. This may be due to due to impaired development of the nervous system. It is estimated that in India 2.21% of the population is affected with disabilities out of which a major portion is contributed by disabilities of childhood origin. Developmental disabilities include limitations in function resulting from disorders of the developing nervous system. These limitations manifest during infancy or childhood as delays in reaching developmental milestones or lack of function in one or multiple domains including cognition, motor performance, vision, hearing and behavior. Early identification of the disabilities combined with initiation of appropriate medical, educational, social and psychological interventions can maximize the health outcome and minimize the impact of disability. This paper discusses the barriers identified in early intervention of developmental disabilities. Materials and methods: Qualitative Sample: Parents of children affected with developmental disabilities, Primary School Teachers, Special Educators, Nursing personnel working in the clinical setting. Sample subjects were selected from local schools, and hospital by purposive sampling. Method of data collection: Focus group discussion. Instruments used: Self developed questionnaire to conduct discussion. Results: The major themes evolved as the barriers in adoption of early intervention programmes were grouped under 7 categories namely intellectual, attitudinal, social, cultural, technological, political and economic barriers. Conclusion: The study findings suggest direction regarding possible steps to facilitate enhancement of early intervention services by an exploration of the role played by different barriers.

BackgroundSame-sex attracted men in Tanzania and globally carry a disproportionate burden of HIV. Drawing on qualitative research, this article explores healthcare providers’ ideas and recommendations regarding how to improve HIV prevention among same-sex attracted men.MethodsWe carried out a qualitative study among healthcare workers in the cities of Dar es Salaam and Tanga in Tanzania between August 2018 and October 2019. Data were collected using qualitative methods of data collection, specifically in-depth interviews, focus group discussions, and participant observation. Study participants were recruited through a purposive sampling strategy that aimed to ensure variation in age, education, and work experience. Forty-eight interviews with 24 healthcare workers, six focus group discussions, and participant observation were conducted. A total of 64 persons participated in the study.ResultsThis paper describes five different “ways of reasoning” that were identified among healthcare workers regarding how to strengthen HIV prevention among same-sex attracted men. One held that punitive measures should be taken to prevent HIV transmission, another that health services needed to become more friendly towards men who have sex with men, a third that healthcare workers should reach out to provide more education to this population, a fourth called for strengthened collaboration between healthcare providers and same-sex attracted men in healthcare delivery, and the fifth proposed that activistic efforts be taken to remove structural barriers for same-sex attracted men to access healthcare.ConclusionWhen reflecting on what is needed to strengthen HIV prevention among men who have sex with men, healthcare workers described six different ideas. One was that restrictive and punitive measures ought to be taken to prevent HIV transmission through same-sex sex. The remaining five promoted understanding of and support for same-sex attracted men. They prescribed more healthcare education, measures to improve attitudes among healthcare workers, healthcare delivery with user involvement, and political action to achieve law reform. Finally, some study participants raised concerns about the implementation of the national comprehensive package for key populations.

BackgroundKenya has prioritized the attainment of universal health coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fund (NHIF). In 2015, the NHIF introduced reforms in premium contribution rates, benefit packages, and provider payment methods. We examined the influence of these reforms on NHIF’s purchasing practices and their implications for strategic purchasing and health system goals of equity, efficiency and quality.MethodsWe conducted an embedded case study with the NHIF as the case and the reforms as embedded units of analysis. We collected data at the national level and in two purposively selected counties through 41 in-depth interviews with health financing stakeholders, facility managers and frontline providers; 4 focus group discussions with 51 NHIF members; and, document reviews. We analysed the data using a Framework approach.ResultsThe new NHIF reforms were characterized by weak purchasing actions. Firstly, the new premium contribution rates were inadequately communicated and unaffordable for certain citizen groups. Secondly, while the new benefit packages were reported to be based on service needs, preferences and values of the population, they were inadequately communicated and unequally distributed across different citizen groups. In addition, the presence of service delivery infrastructure gaps in public healthcare facilities and the pro-urban and pro-private distribution of contracted health facilities compromised delivery of, and access to, these new services. Lastly, the new provider payment methods and rates were considered inadequate, with delayed payments and weak links to financial accountability mechanisms which compromised their ability to incentivize equity, efficiency and quality of healthcare delivery.ConclusionWhile NHIF sought to expand population and service coverage and reduce out-of-pocket payments with the new reforms, weaknesses in the reforms’ design and implementation limited NHIF’s purchasing actions with negative implications for the health system goals of equity, efficiency and quality. For the reforms to accelerate the country’s progress towards UHC, policy makers at the NHIF and, national and county government should make deliberate efforts to align the design and implementation of such reforms with strategic purchasing actions that are aimed at improving health system goals.

Self-efficacy is the ability to believe in one self in performing a given task. The main objective of this study was to explore the attributes of self-efficacy of learners with intellectual and developmental disabilities in selected special units in Kajiado County, Kenya. The study was informed by self-efficacy theory by Albert Bandura. A mixed method approach, Embedded design was used to collect and analyze the data. Simple random sampling was done to select the 10 special units in Kajiado county. Purposive sampling was done to select learners with IDD who have been in the special units for a period of 7 years and above and their parents/caregivers. The learners were 85 and their parents/caretakers 85. All the 26 teachers in the selected special units participated in the study. The target population was 343 while the sample size was 196 respondents. Tools for collecting data were questionnaires, focus group discussion guide and observation schedule. Teachers filled in questionnaires; parents/caretakers participated in the focus group discussion while the observation guide was used for the learners as they worked. Quantitative data was analyzed using descriptive statistics while qualitative data was analyzed through NVivo software version 12. The major findings of the attributes according to the teachers, parents/caregiver’s include skills mastery, verbal persuasion, appreciation, energy flow and exposure. Teachers too felt that incorporating modern technology in teaching and learning can in a big way enhance self-efficacy of learners with IDD.

This qualitative inquiry focused on the perceptions that Chinese families of children with developmental disabilities have pertaining to their needs. Data were collected through focus group discussions and in‐depth interviews; transcript analysis relied on the constant comparative method. We identified seven categories of needs, subsumed under the following three thematic areas: survival needs, sufficiency needs, and enhancement needs. Survival needs refer to maintaining basic family existence and include (1) financial needs and (2) physical health needs. Sufficiency needs refer to families' needs for social inclusion, educational support, and relationships with others, and include the categories of (3) higher quality education and therapy for the child; (4) home‐based education and information for parents; and (5) social inclusion for both parents and the child. Finally, the third theme relates to enhancement needs, defined as families' needs to realize family growth and development for a better family life; this includes the categories of (6) emotional health and (7) future planning. The authors found sufficiency needs were more child focused among respondents and that survival and enhancement needs for families in this study were directly linked to the whole family unit in promoting the family's overall functioning. The dynamic nature of needs suggests that more than one need may motivate families’ desires for enhanced family quality of life.

Individuals with disabilities have been less involved in school activities than their peers of the same age and this includes career preparation in science and math (Agran et al., 2019; Eriksson et al., 2007; Jackson et al., 2022). Students with disabilities often lack access to facilities, programs, and equipment, and acceptance by educators, employers, and co-workers (Burgstahler, 1994). The effects of a virtual reality (VR) human anatomy application as the means of teaching science vocabulary definitions and locations acquisition for three different human anatomy systems (digestive, respiratory, and integumentary) to college-age students with intellectual disability (ID) are reviewed. This single subject, multiple baseline study included two transition age youth with ID. The intervention package included both a guided and exploratory portion. Data were collected on the participants’ accuracy on the definitions and locations of ten vocabulary words for each of the three body systems on a paper assessment. Findings indicated that a functional relation existed between the implementation of the intervention package and an increase in the accuracy of scores in both definitions and locations for each of the three body systems for each participant.

Research shows that a local hygiene package washing, wound care, and exercise improves lymphedema (LE) patients’ quality of life by reducing ADLA, costs, stigma, and boosting work capacity. The ‘LEdoxy’ study, a 24-month, multicountry, double-blind, randomized controlled trial of doxycycline plus hygiene, investigated the efficacy of daily doxycycline versus a placebo for lymphatic filariasis in Mali, India, and Sri Lanka. All ‘LEdoxy’ participants consistently followed a standardized hygiene program. This study, embedded within the previous ‘LEdoxy’ study, assessed cost reductions in ADLA management and evaluated the social impact of the regular local care based on the HP among LE patients in Mali. We conducted a cross-sectional study embedded in “LEdoxy” study participants in the health districts of Kolondieba and Kolokani from September to December 2021. Questionnaire was used to collect retrospective data on pre-trial conditions and prospective data on post-trial conditions. Data were collected using a digital questionnaire and qualitative methods, including in-depth interviews and focus group discussions with interview guide, without recycling ‘LEDoxy’ data. These quantitative data were analysed using SPSS version 25.0. We performed a thematic analysis approach using Quirkos version 2. We investigated 196 LE patients with a median age of 56 years [range: 25-70 years]. We observed a reduction in the monthly frequency of acute ADLA from 90.8% (178/196) before the trial to 43.9%, (86/196) after the trial (p<0.05). Importantly, in term of economic evaluation the average ADLA attack management cost decreased significantly from US$20.01(± US $18.56) before the trial to US$5.7(± US $4.78), after the trial (p< 0.001). Patients reported that the hygiene program reduced social isolation and stigma and improved their ability to work. Using a basic care package improved LE patients’ quality of life by lowering ADLA costs. To sustain this, community-based programs that include income-generating activities are essential.