This analysis examines trends in health spending in Tajikistan from 2000 to 2022 and situates them within the country's key health financing reforms, with the aim of informing progress toward Universal Health Coverage (UHC) and identifying persistent gaps. By applying data from the WHO Global Health Expenditure Database (GHED), which is structured according to the System of Health Accounts (SHA 2011), and contextualizing results with national policy documents and relevant literature, the paper assesses both expenditure patterns and reform dynamics. While government health spending has increased in absolute terms, it remains modest as a share of GDP and general government expenditure. Out of pocket payments have declined slightly as a share of current health spending, yet they still account for nearly two-thirds, posing barriers to equitable access and financial protection. Recent reform initiatives, such as pooling and strategic purchasing pilots, show potential to improve equity and efficiency; however, their long-term impact will depend on sustained implementation and systematic tracking of expenditures. The findings underscore the importance of tracking expenditure in a systematic way to guide health reform. Institutionalizing the routine production of health accounts using SHA 2011 would improve transparency, strengthen allocative efficiency, and support more strategic resource allocation and informed policy dialogue. Ultimately, tracking health spending is not just a technical exercise, but a strategic tool to align financing with policy priorities and advance UHC.

There has been global concern about nursing shortages and nurse migration, as nurses move in search of better working conditions. Ireland is one of the countries facing nursing shortages. Ireland, like many other countries, has begun to rely heavily on migrant nurses. This study examines the recent trends in the nursing workforce and possible contributing factors to Ireland's dependence on international nurse recruitment, drawing insights from existing data and literature. This paper integrates and analyses secondary data obtained from the Nursing and Midwifery Board of Ireland (NMBI) 2003-2022 and data from the Faculty of Nursing and Midwifery, RCSI, registration register (2015-2022). The population data of Ireland was obtained from the Central Statistics Office (CSO). The data available indicates a heavy reliance on migrant nurses due to a shortage of Irish-trained nurses relative to increased demand for nurses in the period (2003-2022). More than 50% of the Nurses registered in that period were migrant nurses (EU and Non-EU). There is an urgent need for Ireland to increase the domestic training of nurses and midwives, as well as, a need to develop a robust nurse workforce planning system to improve retention and ensure nursing workforce self-sufficiency.

Private Health Insurance (PHI) in Gulf Cooperation Council (GCC) countries has experienced rapid growth over the past two decades, driven by demographic and economic changes. Although various analyses at the country level have been reported, no study has reviewed PHI systems in the GCC through a methodological approach. We provide a conceptual framework to review, describe and document the development of PHI in the GCC, based on literature from the scoping review. As of December 2023, all GCC countries have laws in place or have promulgated laws establishing mandatory PHI schemes. Most of these schemes are designed for expatriate populations residing in these countries, but there is a trend to extend them to nationals working in the private sector. The health system context plays a role in how PHI emerged and is designed in terms of role, eligibility, and coverage. PHI markets in the region are concentrated and dominated by local companies with performance levels that could be further improved. These markets are maturing and subject to more robust technical and prudential regulations as governments seek to enhance competition. Governments in the region must ensure the sustainable growth of these schemes and a more strategic alignment with health system objectives. Lessons learned from more mature markets are critical for future developments.

WHO Collaborating Centres (WHO CCs) are entities designated to provide scientific or technical support to the World Health Organization (WHO) in specific areas. They play a crucial role in global public health efforts; however, their leadership and sustainability present multiple complex challenges. The aim of this analysis is to identify the strategic and management challenges faced by WHO CCs and to provide expert recommendations to enhance their sustainability. This study focuses on leadership capabilities as a key driver of successful global health cooperation. The study employed a three-phase approach: (1) a conceptual framework for strategic management of WHO CCs, (2) empirical testing through qualitative interviews with WHO CCs directors worldwide, and (3) development of actionable recommendations. A flexible sampling strategy was used, including convenience, purposeful, and database-based sampling to ensure diversity across regions, institution types, and health topics. WHO CCs are manageable organizations but face unique strategic (mission alignment, core values, vision), and management challenges (project management, financial constraints, communication barriers).Long-lasting WHO CCs were led by directors whose leadership practices aligned with established models of effective leadership (e.g., self-awareness, strategic positioning, clear, and engaging vision). Key threats included a lack of resources, recognition, or project management skills, misaligned strategic vision, and communication gaps with WHO or the host institution. WHO CCs are vital to global health but require structured strategic management and leadership development. Their strategic management must take into account both the similarities and differences with other organizations. Expert recommendations include securing financial resources, improving WHO- WHO CCs communication, and fostering leadership skills to ensure sustainability and impact.

South Africa continues to experience the world's highest HIV burden despite major progress in antiretroviral therapy (ART) scale-up. Persistent disparities across gender, geography, and socioeconomic status reveal that structural and political inequities shape vulnerability, access, and outcomes. This paper examines inequalities in HIV outcomes and evaluates how social, economic, and political structures influence policy effectiveness despite expanded ART coverage. A document-based policy analysis was conducted using Walt and Gilson's Policy Triangle framework. National strategic plans, government policy documents, and peer-reviewed literature published between 2015 and 2025 were identified through targeted database and grey literature searches. Documents addressing HIV policy, health system reform, or structural determinants were thematically analysed across four domains: policy content, context, actors, and processes. Structural inequities in HIV incidence, access, and treatment outcomes remain despite expanded services. The 2023-2028 National Strategic Plan adopts a more equity-oriented and multisectoral approach, aligning with Universal Health Coverage and WHO behavioural insights. It includes differentiated service delivery, community-led monitoring, legal reform, and social protection integration. However, implementation is constrained by health system fragmentation, workforce shortages, donor dependency, and weak accountability. The suspension of PEPFAR funding disrupted community-based services, demonstrating the fragility of external financing. International experiences (eg, Thailand, Kenya) show that integrating HIV services within UHC and decentralising delivery can improve retention and equity when supported by domestic investment. Policy commitments increasingly recognise that equity requires structural transformation rather than solely biomedical solutions. Without stronger domestic investment, clearer implementation mechanisms, and alignment with broader reforms such as National Health Insurance, equity goals risk remaining aspirational. Embedding HIV services within a decentralised, accountable, and people-centred UHC framework offers a credible pathway to sustainability and health equity.

This study explores the impact of mental health policy reforms on geographic variations in inpatient psychiatric facility utilization and mental health outcomes in Virginia. Following the enactment of Senate Bill 260 (SB260), we observed significant changes in utilization patterns, particularly in regions with higher proportions of Medicaid-eligible populations. We identify nuanced factors influencing facility usage, including proximity to facilities and demographic characteristics, shedding light on the complex dynamics of mental health care access. Notably, our analysis indicates a notable increase in overall utilization of Virginia’s state-operated mental hospitals post-SB260, suggesting a greater fulfillment of unmet needs for inpatient care. Moreover, our research underscores the necessity to reconsider IMD exclusion laws, emphasizing the potential benefits of policy changes for underserved populations. This research contributes to mental health policy discussions by offering evidence-based considerations for future reforms aimed at improving access and equity in mental health care delivery in Virginia.