BackgroundThe countries of Brazil, India and South Africa have mixed health systems wherein public and private providers operate side-by-side to deliver the same set of services. The health administrations in these countries are increasingly purchasing services from the private sector for delivering care. There is some evidence to suggest that the purchase arrangements could contribute to quick expansion of health access. But at the same time, community participation rooted in the human rights framework hitherto has largely been envisaged as part of the public health system for better responsiveness and accountabilities. But the changing scenario, of the governments actively engaging private providers (both private for-profit and private non-profit), is making health systems pluralistic. In such a pluralistic scenario does the conventional understanding of Community participation hold and whether community participation can still aim for better health system effectiveness?AimTo strengthen the participation an

Background Access to essential medicines is a critical building block of the health system, but many low-and middle-income countries (LMICs) continue to face major challenges in ensuring medicine accessibility, affordability and quality. The sale of medicines online (or e-pharmacy, we use the terms interchangeably)  represents a major disruption to pharmacy provision across the globe. Whilst e-pharmacy was initially the preserve of high-income countries (HICs), in the past decade it has been growing rapidly in LMICs, and this growth was further catalysed by widespread lockdowns during the COVID-19 pandemic. This rapid expansion of e-pharmacy has been largely uncontrolled and accompanied by significant public health concerns, the most commonly cited being the sale of prescription-only medicines (POMs) without a prescription, including opioids and antibiotics; the sale of substandard or falsified (counterfeit) medicines; inadequate provision of information to patients; and erosion of the doctor-pharm

Background Globally, tobacco use is one of the biggest public health threats and a leading cause of death and disease in India, affecting nearly 1.35 million people each year. India is also the world's second-largest producer and consumer of tobacco. The most smoked tobacco product in India is bidi. It is estimated that about 71.8 million adults smoke bidi in India. Bidis are small hand-rolled tobacco cigarettes wrapped in tendu or temburni leaf (Diospyros melanoxylon). Bidi smoke contains higher concentrations of nicotine, tar, and other toxic agents, in comparison to cigarette. The bidi industry employs approximately one million people, the vast majority of whom are women and children. Beedi workers are constantly exposed to tobacco dust, fumes, and other hazardous chemicals such as nitrosamines and nicotine, which can be easily absorbed by the body through the skin, respiratory epithelium, and mucous membranes. However, there is no evidence synthesis on the environmental risks and health hazards

Health and economic impacts of NCDs on women in Mexico

The MESSAGE (Medical Science Sex and Gender Equity) project is a policy initiative bringing together the UK research sector to improve integration of sex and gender in biomedical, health and care research.The project responds to our preliminary research which showed that in 2021, not a single UK research funder had a policy in place requiring researchers to consider the sex and/or gender of research participants, and to sex- and/or gender-disaggregate data when analysing and reporting findings. This is in contrast to the US, Canada and Europe, who have longstanding sex and gender policies for research, and has led to a dearth of evidence on critical sex and gender differences across all areas of medicine, leading to worse health outcomes and greater health inequity.Over a series of four Policy Labs held in 2023-24, the MESSAGE project has led co-design of a sex and gender policy framework for UK research funders. Stakeholders involved in the framework’s co-design include:Research funders, both government (N

BackgroundCOVID-19 caused by the SARS-CoV-2 virus is a highly transmissible disease that has affected millions worldwide. The majority of COVID-19 survivors have recovered, but many have reported lingering health issues or symptoms that suddenly appear even after months of the initial infection. The World Health Organization (WHO) recently provided a case definition for this post-COVID condition termed "Long COVID" or "post-acute COVID syndrome". Long COVID has been labelled as 'the next public health disaster' due to its significant health, economic, and societal burden. The debilitating symptoms of Long COVID are wide-ranging, multisystemic, and pre-dominantly fluctuating or relapsing. Despite a rapidly increasing population of recovered COVID-19 survivors, there is a lack of data on the extent of cardiovascular, respiratory, and psychiatric complications in recently infected individuals or whether these risks can be reduced. Exploring the therapeutic options available is necessary to prevent Long

Background Knee replacement improves the quality of life for those suffering from disabling knee osteoarthritis. Physiotherapy is an important component of the rehabilitation phase following surgery for restoring function and improving quality of life. However, poor adherence to physical therapy due to various socio-environmental and patient-related factors delays recovery. A lack of mechanism for the continuum of care following discharge to home leads to sub-optimal outcomes, chronic knee pain and patient dissatisfaction in some proportions of individuals. Evidence suggests that home-based physical rehabilitation with a monitoring mechanism is as good as and cost-effective compared to clinic-based rehabilitation. In India, unsupervised home-based rehabilitation is the usual care, leading to a considerable amount of out-of-pocket expenditure to seek physiotherapist support at home. Hence, keeping the local requirements and literacy level in mind, a customised and context-specific rehabilitation monitori

Background Older people with kidney disease often receive treatment called haemodialysis, which requires the patient to be connected to a machine that filters and cleans the blood. This connection is made by creating a vascular access with the patients’ bloodstream, typically an arteriovenous fistula (fistula) or central venous dialysis catheter (catheter). Fistulas are created during a surgical procedure in the forearm by joining a vein and artery under the skin and often take many months to ‘mature’ before they can be used. Catheters are inserted into a vein in the neck or chest via a simple non-surgical procedure and can be used immediately once inserted.  There are potential issues with both of these vascular access types:  Fistulas can make the forearm appear bumpy, and although they are associated with a lower risk of infection, additional procedures (including additional surgical procedures) to maintain the fistula may be required. Such additional procedures increase the amo

Background Snakebite is a public health problem in many low- and middle-income countries in leading to estimated 138,000 deaths and leaving four lakh people with permanent disabilities. Most of the snakebite burden is from South Asia. The WHO strategy on snakebite (2019) suggests ‘safe and effective treatment of snakebite’, as one of the key pillars to reduce snakebite burden globally.   In 2020, our research group conducted an overview of systematic reviews and identified the need for more clinical trials to inform clinical practice around snakebite management. The overview also found that the use of varied outcomes and their non-standardised measurement and reporting is an important gap which limits the ability of researchers, healthcare providers, decision makers, and patients to undertake meaningful comparisons and understand benefits or harms of different treatments. The current project aims to fill this gap by developing a ‘core outcome set’ (COS), for research on snakebite managem