Service Delivery System Research Articles

Comprehensive Review of Healthcare Systems and Their Evolving Structures

Physical assessment of healthcare organizations shows they are experiencing changes in response to the dynamic global healthcare needs, technologies, and political, economic, and social systems. This extensive literature review explores the various dimensions of the HC system, including governance and financing, the health workforce, and models of the service delivery systems. It seeks to look at the various issues confronting healthcare delivery systems across the developed and developing worlds with special reference to policies, technology, and human resources. The current paper offers insight into how healthcare systems are evolving to enhance healthcare access, quality, and efficiency from the case studies and additional literature. The review also outlines some emerging trends, such as value-based care, personalized medicine, and digital tools in health. The implications of the knowledge support the effectiveness of the overall system transformation to establish firm and fair healthcare for the actual people's needs.

Hybrid governance in selected African countries:

Governance is still a contested concept in both theory and practice. A proliferation of the concept has sprung up in literature. One comes across variations where reference is made to co-production, public governance, good governance, hybridity governance, hybrid governance, to name but a few. The aim of this paper is to provide a conceptual overview of the evolution of the concept governance in general and hybrid governance particulary focused on selected African countries. It is important to clarify what hybrid governance involves, and its implications for state capacity and service delivery. Furthermore, it is imperative to discern whether hybrid governance could be a useful conceptual tool for facilitating more organised systems of service delivery in parts of Africa and South Africa, or whether it is just “new developmental jargon”. The paper employed a qualitative research approach where secondary sources of information, constituting document analysis, premised around forms of hybrid governance in selected African countries were explored. The paper makes a conceptual contribution to the collaborative international governance discourse.

The Future of Public Money: From Fiscal Fantasy to Reality

With relentless pressures on the public purse and urgent demand to improve policy outcomes, it is time to reshape the management of public money. Governments around the world are in a fiscal fix. Debt is high, growth remains stubbornly low, and taxpayers are dissatisfied as they pay more for outcomes that are stagnating or getting worse. Given aging populations, creaking infrastructure, heightened defense, security risks, and the green transition, demand for public spending will not ease up. In today’s volatile world, the next shock—which would be costly for governments to manage—could be just around the corner. Some commentators say their governments are living in a “fiscal fantasyland”; that the trade-offs required to place public finances on a sustainable footing remain unconfronted and leave difficult decisions delayed. It is not hard to feel pessimistic about the situation and the prospects for the future. However, the authors of this report do not share this pessimism. That is because the ideas and technology are in place to get us out of this fiscal fix. Our working hypothesis is that the answer lies in focusing not just on the money—the facts of revenue, expenditure, and debt—but in engaging much more deeply with the productivity of the money that is spent; how it contributes to the actual outcomes achieved. To test this hypothesis and draw up a route map to guide governments out of “fiscal fantasyland,” representatives of the EY organization have been working with OMFIF’s Economic and Monetary Policy Institute. We joined an OMFIF-convened group of leading public finance thinkers from international finance institutions, public sector bodies, and the investor community to review how public finances are managed today and explore how public money could be better allocated in the future—through more effective rules and institutions, and better use of data and technology. Our discussions led to a consensus. Although many countries have good public finance institutional frameworks and practices in place, fundamental implementation issues in the various service delivery systems are impeding their effectiveness. For instance, long-term goals and horizon targets are undermined by short-term political cycles and priorities; insufficient accounting for future risks disincentivizes investment in resilience; and the lack of information on the impact achieved by expenditure hampers effective decisions on how to allocate money. The heartening news is that there are clear ways in which structure, rules, and decision-making can be overhauled, to improve dramatically the management of public finances. These ideas and approaches are set out in this report and the authors hope you find them to be a valuable contribution to this debate. How well governments manage public money to improve outcomes matters greatly to citizens and communities all around the world. This is a vitally important debate and it is one we are delighted to help convene and advance.

What is successful integration in primary health care: qualitative insights from the Chinese public

ABSTRACT Background China is transforming its hospital-centric service delivery system into a people-centered integrated care model, with service delivery organized around the health needs and expectations of people. Objective To guide reforms and align with public expectations, this study profiles successful integration in primary health care from the public perspective. Methods Guided by the rainbow model of integrated care, semi-structured interviews were conducted in six provinces in China. A total of 58 interviewees completed the interviews. Tape-based analysis was used to produce narrative summaries. Researchers listened to the recordings and summarized by 30-s segments. Thematic analysis was performed on summaries to identify thematic families. Results Five themes and 16 sub-themes were generated. Respondents’ expectations were primarily on three themes: clinical integration (such as interaction between professional and client, continuity, and empowering and engaging individuals), functional integration (such as resources management, quality improvement, and reforming payment systems), and system integration (such as institutional distribution and supervision). Yet a few interviewees mentioned professional integration (multi-disciplinary collaboration) and organizational integration (inter-organizational strategy). Conclusions Qualitative data were used to reveal public perceptions of successful primary health care integration. Service processes, institutional distribution, regulation, resource management, and quality improvement are more visible to the public and will be priorities for future efforts. Whereas inter-organizational strategies and multi-disciplinary collaboration have been shown to facilitate service improvements. Future efforts could consider how policy efforts can be grounded in visible service delivery through management practices.

The Antecedents of Courier Continuance Participation Intention: A Dyadic Analysis of Courier–Customer Interactions in Crowdsourcing Delivery

Crowdsourcing delivery has emerged as an innovative solution for last-mile delivery in the sharing economy era. However, enhancing courier continuance participation intention is an increasing challenge for crowdsourcing delivery platforms due to the independence of crowdsourced couriers. Given that couriers and customers are subject to interdependencies and may influence each other in delivery service systems, this paper utilizes a dyadic analysis to examine how courier–customer interactions may influence the continuance participation intention of couriers. Specifically, we investigate the influence mechanism of customer satisfaction and courier job satisfaction, as well as the mediating role of courier pay satisfaction, drawing upon the balance theory and distributive justice theory. The empirical results of 261 courier–customer dyads indicate that the customer side impacts the courier side in both direct and indirect ways. There is a direct satisfaction transmission in courier–customer delivery service interactions. Meanwhile, satisfied customers indirectly enhance courier job satisfaction via the mediator of courier pay satisfaction, which in turn strengthens courier continuance participation intention. Our study offers novel insights for administrators on the influence of courier–customer interactions and pay satisfaction on courier continuance participation intention, contributing to decreasing couriers’ turnover in the fluid crowdsourcing labor market.

Commentary: Bridging and Reducing the Gaps Between Research and Practice: Pathways to Outcomes and the Interactive Systems Framework for Dissemination and Implementation 2.0.

There are many ways proposed to achieve better societal outcomes (e.g., in health, education, and well-being) including: (1) bridging research and practice, (2) building the motivation and capacity of service delivery organizations (e.g., schools, hospitals, clinics, and community-based organizations) to innovate, and (c) providing service delivery systems with high-quality support via training and technical assistance. The Interactive Systems Framework for Dissemination and Implementation (ISF) was developed to describe how relevant systems, organizations, and processes can interact and work toward these goals. Stimulated by the 13 articles contained in the two special issues of Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers, we describe several enhancements to the ISF including: how service delivery systems can operate better, how motivation and capacity can be built, and how training and technical assistance centers can provide more evidence-informed technical assistance and other promising innovations. ISF 2.0 incorporates these and other enhancements with the goal of achieving better outcomes. We conclude that the actions and accountability of funders and of organizations and systems to funders would accelerate progress in the systems to achieve outcomes-and result in improving the science and practice of implementation support.

Adoption and Use of Electronic Human Resources Management Systems for Service Delivery in Tanzania: A Case to Tanzania Airports Authority

This articles explores the adoption and utilization of Electronic Human Resources Management Systems (e-HRMS) for service delivery at the Tanzania Airports Authority (TAA). General objective was to assess the adoption and use of electronic human resource management systems for HR service delivery at Tanzania Airports Authority. The specific objectives of the study were to examine the practice of eHRMS adopted to support service delivery in the Tanzania Airports Authority, to examine the effort made by the government to enhance the usage and adoption eHRMS in service delivery at Tanzania Airports Authority and to identify the challenges in using e-HRMS in service delivery in Tanzania. The study utilized the Technology Acceptance Model (TAM) to understand user acceptance behaviour and the Diffusion of Innovations Theory to explore how e-HRMS spreads within the organization. Research adopted an explanatory research design and population of study was 60 staff. Data was collected through questionnaires from a purposively selected sample of 52 staff with qualitative data from interviews conducted with HR and IT officers. Quantitative data was analysed using descriptive analysis, while thematic analysis was applied to qualitative data. Findings reveal that TAA has implemented various e-HRMS practices, including digital storage of employee data, automated payroll systems, and streamlined recruitment and onboarding processes. Government support has been instrumental in these efforts through policy implementation, financial support and infrastructure development. However, several challenges hinder the full potential of e-HRMS at TAA, such as limited access to technology, unreliable power supply, skills gaps, resistance to change, and cost considerations. The study concludes that e-HRMS has significantly improved HR service delivery at TAA. Nonetheless, continuous efforts are necessary to address existing challenges. Enhancing technological infrastructure, providing comprehensive training, and implementing effective change management strategies are crucial for optimizing the benefits of e-HRMS. The articles recommends that TAA invest in reliable internet connectivity and IT hardware, provide ongoing training for employees, and develop robust change management plans.

Why Is Hospice One of the Few Health Care Environments Structured for Peace?

Historically, Western medicine has recognized health care environments as vital to patient well-being and enhanced clinical outcomes. Yet most modern Western hospitals are primarily designed and regulated to promote safety and minimize risk rather than to enhance comfort or serve as therapeutic environments in and of themselves. Hospice stands out as one of the few places within the Western health care service delivery system in which the structures and spaces of caregiving are viewed as key to patient-centered practice. This commentary on a case suggests the importance of designing health care environments that center patient experiences of well-being throughout the lifespan, not just at the end of life.

Реабілітація: історія формування, сучасна стратегія розвитку

The history and defined stages of the formation and development of rehabilitation care from the 19th century have been studied. to modern times. The formation of the methodology for the organization of rehabilitation assistance in national health care systems is shown. The logistics of the WHO’s initiatives regarding the recognition of rehabilitation assistance as the main direction of the development of medical service delivery systems have been studied. What is connected with the provision of human rights in the field of health, the achievement of health for all. The role of national governments, the responsibility of communities and the importance of primary medical care in ensuring the availability of rehabilitation care are shown. The main provisions of the WHO documents on the problem of rehabilitation are presented.

장애학생 보호자 지원 전달 체계에 대한 연구

Purpose: Identify the needs for support for guardians of the disabled and diagnose the current system to establish the direction of support for guardians of the disabled. In addition, a support system for guardians of the disabled is established in terms of special education and lifelong education for the disabled. Method: In the analysis stage of prior research, related data such as laws, policies and systems related to supporting guardians of the disabled, and policy research reports published by government departments were reviewed and analyzed. For the analysis of practical prior research, data analysis was conducted based on the life cycle of the disabled at home and abroad and the policies and support cases for the disabled by disability type through cooperation with institutions related to supporting guardians of the disabled. Results: First, this study suggested three directions for supporting guardians of the disabled: direct support for guardians of the disabled, improvement of the quality of life for guardians of the disabled, and strengthening the capacity of families with disabilities. Second, this study proposed an integrated model for service delivery systems to support guardians of the disabled. Third, 'one-stop service', 'service specialization', 'continuity of support for guardians by life cycle', and 'periodic update of guardian information' were suggested as conditions for an integrated support platform that focuses on providing information for guardians of the disabled. Finally, it was emphasized that the guardians of the disabled should be provided with various education and information related to the protection of the disabled through the establishment of an education and information support center for the disabled. Conclusion: The support system for guardians of the disabled should focus on direct support for guardians, and in order to establish a support system for guardians of the disabled, a service delivery system for supporting guardians of the disabled must be established at the national level.

Analysis of Factors Affecting Inpatient Satisfaction at RSU Wulan Windy Medan Marelan

Patient satisfaction is a key indicator in assessing the quality of healthcare services provided by hospitals. It reflects the individual experiences of each patient and signifies the effectiveness of the service delivery system. High levels of satisfaction are associated with timely service delivery, environmental comfort, effective communication, and the expertise and friendliness of medical staff. This study analyzes factors influencing inpatient satisfaction at RSU Wulan Windy Medan Marelan. The research employs a quantitative approach through survey methodology with data collected from 355 respondents. Statistical analysis included bivariate chi-square tests and multivariate logistic regression. Results indicate significant impacts of timely service delivery, comfort, and staff competence on patient satisfaction, with p-values of <0.001 for each factor.

The primary healthcare workforce crisis: a comparative assessment of the European region

Abstract Background The healthcare workforce crisis strongly affects the primary healthcare sector, worsening the work conditions of healthcare workers and hampering service delivery and health system resilience. This study introduces a health system and governance approach to identify transformative capacities in health system contexts. Methods A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England. Results Our findings reveal both convergence and pronounced diversity across the healthcare systems, with none fully aligning with the ideal attributes of primary healthcare suggested by WHO. However, across all categories, Denmark and the Netherlands, and to a lesser extent also Kazakhstan, depict closer alignment to this model than the other countries. Workforce composition and skill-mix vary strongly, while disparities persist in education and data availability, particularly within Social Health Insurance systems. Policy responses and interventions span governance, organisational, and professional realms, although with weaknesses in the implementation of policies and a systematic lack of data and evaluation. The WHO primary healthcare model only marginally informs policy decisions, but it may receive some more attention in Kazakhstan. Conclusions We conclude that aligning primary healthcare and workforce considerations within the broader health system context may help move the debate forward and build governance capacities to improve resilience in both areas. Speakers/Panelists Tiago Correia NOVA IHMT, Lisbon, Portugal Viola Burau Aarhus University, Aarhus C, Denmark Marius-Ionuț Ungureanu Babeș-Bolyai University, Cluj-Napoca, Romania Anna Sagan WHO European Centre for Primary Health Care, Almaty, Kazakhstan

Assessing the role of non-state actors in health service delivery and health system resilience in Myanmar

BackgroundDue to the weaknesses of the public health system and its low reach, especially in border areas, provision of health services by non-state actors (NSAs) has historically played an important role in Myanmar. NSAs include local and international NGOs and civil society organisations (CSOs), but also Ethnic Health Organisations (EHOs) in the border areas, as well as the private (for profit) sector. This study aims to understand the changing role of NSAs in the shifting political environment of Myanmar between 2010 and 2022, and to explore their contribution to health system resilience.MethodsOur study includes three main components: a documentary review (n = 22), key informant interviews (KIIs) at central level (n = 14) and two township-level case studies (13 KIIs, 4 FGDs). Mostly qualitative data were collected in 2022 and synthesized, using a health system resilience framework to structure the analysis.ResultsDuring the transition period (2010–2014) and the new political era (2015–2020), while the country gradually transitioned to a democratic system, the government increasingly recognized NSAs. Initially, engagement with NSAs remained focused on disease-specific activities and government oversight was limited, but later it expanded to health system strengthening, including the start of a “convergence” with ethnic health systems. Progress was relatively slow, but defined by a clear vision and plans. The military coup of February 2021 brought a halt to this progress. Collaboration between government and NSAs was interrupted, and NSAs restored previous practices and parallel systems. Initially, most health service provision stopped, but with time coping strategies emerged, which showed the capacity of NSAs to absorb the shocks (focusing on basic services; using informal communication channels; maintaining buffer stocks of supplies) and adapt (changing modes of delivery and supply chains, and adjusting HRH training).ConclusionsThe study highlights the role of NSAs during crises, and provides insights on how the resilience capacities built over time by NSAs to provide services in adverse circumstances have informed the response to the latest crisis. While strategies of absorption and adaptation are noted in the study, we did not identify any transformation strategy – which might indicate the difficulty of NSAs to introduce radical changes when subjected to multiple shocks and a hostile political environment.

Interdependent Effects of Agro-input Node Interventions on the Adoption of Cattle milk Production Technologies among Smallholder Farmers in Kericho County, Kenya

Agricultural extension service delivery system is a vital component in agricultural development initiatives of any nation. Several extension approaches are used to achieve these initiatives. Globally, many Governments and development partners in rural agricultural development initiatives have gradually transitioned away from total state control of rural community and agricultural extension service delivery into adopting and supporting a more multifaceted system built on holistic participatory approach commonly referred to as Agricultural Value Chain Extension Approach (AVCEA). This AVCEA is relatively new in developing countries, including Kenya, and specifically in Kericho County where exploration on its impact on farm-level technology adoption has yet to be undertaken. The purpose of this study was to investigate the interdependent effects of agro-input node interventions on the adoption of cattle milk production technologies among smallholder farmers in Kericho, Kenya. This study adopted an ex-post-facto research design and systematic random sampling technique to select a sample of 132 farmers who previously exposed to AVCEA. Interviews were conducted for eight (8) dairy production experts and 6 Dairy organization representatives as key informants. The primary data were collected using interview schedules, questionnaires and focus group discussion tools. The data were analyzed for descriptive statistics like frequencies, percentages and inferential statistics like Chi-square tests with the aid of SPSS version 26.0. The results of the study indicated that there was a significant interdependence between some agro-input value chain node interventions and the adoption of cattle milk production technologies. There was also Interdependence between ease of access to farmers ‘groups/cooperative societies and the adoption of cattle milk production technologies by the smallholder farmers. Based on findings of this study, Agricultural experts, stakeholders, and other concerned bodies should focus on developing strategies to strengthen interventions at the agro-input node, particularly by fostering cooperation among smallholder farmers to enhance collective actions.

‘Social work transformed me’: narratives of fulfillment and lessons learned of retired social workers on their practice experience

ABSTRACT This study explores the retired Bicolano social workers’ practice experiences and wisdom, emphasising their significant contributions, fulfilment, and valuable lessons. Employing a qualitative approach, the researchers utilised in-depth interviews and thematic analysis to meet its objectives. The participants’ contributions to their practice include innovating systems for better service delivery, sustaining commitment and sense of service amidst complexities, and empowering co-workers through meaningful engagement and knowledge transfer. In terms of fulfilment, the participants experienced deepening self-awareness through service, preserving and demonstrating professional values and principles, and practicing self-care for sustained professional commitment. Additionally, the participants’ valuable lessons include capitalising on the ‘oragon’ spirit, embracing individual growth and transformations, and diversifying and strengthening social work competencies. The findings may serve as guiding principles for present and aspiring social workers, motivating them to approach their work with creativity, consciousness, and competence to make a lasting impact on individuals and society.

Lessons for Strengthening a Resilient Health System from the View of Health Facilities During the COVID-19 Pandemic: A Qualitative Study.

Coronavirus disease 2019 caused significant negative damage to the health status of populations and health systems globally. In Uganda, our previous study revealed that the strict Public Health and Social measures (PHSMs) and the closure of Entebbe Regional Referral Hospital (ERRH) led to missed healthcare access among the citizens in the Entebbe municipality. Limited studies, however, exist on the impact of the response measures on the local health systems. This study aims to explore the impacts of these measures on the local health service provision from the views of health facilities in Entebbe. We used a thematic framework method, grounded by the health systems resilience framework consisting of five components: (1) health service delivery; (2) medical products and technology; (3) health workforce; (4) public health functions; and (5) governance and financing. Key informant interviews with eight representatives from four private hospitals and four health centers were conducted from September to October 2022. Fifteen themes and 25 subthemes were identified. With the closure of the ERRH and the strict PHSMs, the citizens faced various difficulties in accessing the needed health services. The facilities received an overwhelming number of patients and faced various challenges, such as a lack of medicine, healthcare workers, facility capacity, and no means to transfer patients. Nevertheless, the facilities made efforts to maintain the required services. Moreover, mobilizing vertical and horizontal actors through a flexible network, from the district health office to community health volunteers, helped to coordinate the medicines, transportation for both patients and healthcare workers, conduct patient tracking, etc. Our study suggested the importance of an integrated system of public health and health service delivery systems, the formalization of a vertical cooperative mechanism, and the introduction of public health insurance for strengthening resilient health systems. These insights may benefit other sub-Saharan cities.

A National Strategy for Preventing Substance and Opioid Use Disorders Through Evidence-Based Prevention Programming That Fosters Healthy Outcomes in Our Youth.

The recently released National Drug Control Strategy (2022) from the White House Office of National Drug Control Policy (ONDCP) lays out a comprehensive plan to, not only enhance access to treatment and increase harm reduction strategies, but also increase implementation of evidence-based prevention programming at the community level. Furthermore, the Strategy provides a framework for enhancing our national data systems to inform policy and to evaluate all components of the plan. However, not only are there several missing components to the Strategy that would assure its success, but there is a lack of structure to support a national comprehensive service delivery system that is informed by epidemiological data, and trains and credentials those delivering evidence-based prevention, treatment, and harm reduction/public health interventions within community settings. This paper provides recommendations for the establishment of such a structure with an emphasis on prevention. Systematically addressing conditions known to increase liability for behavioral problems among vulnerable populations and building supportive environments are strategies consistently found to avert trajectories away from substance use in general and substance use disorders (SUD) in particular. Investments in this approach are expected to result in significantly lower rates of SUD in current and subsequent generations of youth and, therefore, will reduce the burden on our communities in terms of lowered social and health systems involvement, treatment needs, and productivity. A national strategy, based on strong scientific evidence, is presented to implement public health policies and prevention services. These strategies work by improving child development, supporting families, enhancing school experiences, and cultivating positive environmental conditions. Appeared originally in Clin Child Fam Psychol Rev 2023; 26:1-16.

Pre-exposure Prophylaxis (PrEP) implementation among latino MSM: a qualitative scoping review of implementation determinants and change methods.

The increasing rates of HIV among Latino men who have sex with men (MSM) necessitate innovative and rigorous studies to evaluate prevention and treatment strategies. Pre-exposure prophylaxis (PrEP) is a highly effective tool in preventing HIV acquisition and plays a crucial role in the Ending the HIV Epidemic in the U.S. initiative. However, there is a scarcity of PrEP research specifically focused on Latino MSM, and the factors influencing its implementation remain largely unknown. To address this gap, we conducted a comprehensive review exploring the determinants (barriers and facilitators) of PrEP implementation among Latino MSM, as well as the change methods (implementation strategies and adjunctive interventions) that have been evaluated to promote its adoption. Our review encompassed 43 peer-reviewed articles examining determinants and four articles assessing change methods. Determinants were coded using the updated Consolidated Framework for Implementation Research (CFIR 2.0) to understand the multilevel barriers and facilitators associated with implementation. The majority of research has focused on PrEP recipients (i.e., patients), primarily examining their awareness and willingness to use PrEP. Fewer studies have explored the factors influencing clinicians and service delivery systems. Additionally, the evaluation of change methods to enhance clinician adoption and adherence to PrEP and recipient adherence to PrEP has been limited. It is evident that there is a need for culturally adapted strategies tailored specifically for Latino MSM, as the current literature remains largely unexplored in this regard. By incorporating principles from implementation science, we can gain a clearer understanding of the knowledge, skills, and roles necessary for effective cultural adaptations. Future research should emphasize factors influencing implementation from a clinician standpoint and focus on innovative change methods to increase PrEP awareness, reach, adoption, and sustained adherence among Latino MSM.

Strategic analysis of Iran's climate resilient health system.

Climate change is a long-term systematic climate variability caused by human activities that alters the composition of the global atmosphere. Health systems should be adaptive and resilient to climate change. Hence, this research aimed to strategically analyze the resilience of Iran's health system to climate change. This study utilized a multiple methods approach. First, in-depth semi-structured interviews were conducted with 32 key climate change and health experts to identify the strengths, weaknesses, opportunities and threats of the Iranian health system's resilience to climate change. Purposeful and snowball sampling techniques were used to ensure maximum diversity among the participants. Then, a questionnaire was developed based on the findings of the first stage and was completed by 33 climate change and health experts. Finally, the strategic position of Iran's health system's resilience to climate change was determined using the internal - external factors matrix. A total of 84 internal factors and 101 external factors were identified that affect the resilience of Iran's health system against climate change. The internal factors were categorized into seven dimensions (i.e., governance and leadership; health financing; health workforce; facilities, equipment and medicines; health information system; health services delivery, and key results). The external factors were categorized into six dimensions (i.e., political, economic, social, technological, environmental, and legal factors). The average score of internal and external factors were 2.47 and 2.12, out of 4 respectively. Iran's health system was found to be in the strategic position of V in terms of resilience to climate change. Therefore, precautionary strategies such as strengthening the climate resilience of healthcare facilities, promoting healthcare facilities' adaptation to climate change, public-private partnership, strengthening the health service delivery system, quality management and cost management, should be implemented to strengthen the resilience of Iran's health system to climate change. Iran's health system is facing significant weaknesses and challenges that have hindered its resilience to climate change. Iran's health system can better prepare and respond to the health impacts of climate change, and safeguarding the health and well-being of its population by addressing these challenges and implementing adaptive and resilience strategies.

The Perniciousness and Promise of School-Based Mental Health Service Delivery for Youth.

Rates of child and adolescent mental disorder have risen sharply while access to community-based mental health care options continues to be elusive for many families. Substantial and persistent barriers to community-based mental health care have prompted multiple stakeholders to pursue an approach that emphasizes health promotion and intervention practices within the context of ecologically valid and more accessible environments. The most prominent of these environments has been schools that can serve as local and centralized access points to various services, including mental health care. The rapid expansion of school-based mental health service delivery systems, however, carries both risk of perniciousness as well as significant promise with respect to effective and equitable care. This article summarizes key concerns surrounding school-based mental health service delivery systems, including non-beneficence and harm, support disparities, unsustainable implementation, oppressive school climate, and linkage to punitive and discriminatory practices. Broad-based recommendations to help realize the promise of effective and equitable care for students with mental health and behavioral challenges are also presented vis-à-vis each of these concerns. At the same time, natural tensions between various mandates assigned to schools as well as between schools and their surrounding communities will need to be addressed to reach the full potential of school-based mental health service delivery systems.