Background: The pandemic situation due to COVID-19 highlighted the importance of global health security preparedness and response. Since the revision of the International Health Regulations (IHR) in 2005, Joint External Evaluation (JEE) and States Parties Self-Assessment Annual Reporting (SPAR) have been adopted to track the IHR implementation stage in each country. While national IHR core capacities support the concept of Universal Health Coverage (UHC), there have been limited studies verifying the relationship between the two concepts. This study aimed to investigate empirically the association between IHR core capacity scores and the UHC service coverage index. Method: JEE score, SPAR score and UHC service coverage index data from 96 countries were collected and analyzed using an ecological study design. The independent variable was IHR core capacity scores, measured by JEE 2016-2019 and SPAR 2019 from the World Health Organization (WHO) and the dependent variable, UHC service coverage index, was extracted from the 2019 UHC monitoring report. For examining the association between IHR core capacities and the UHC service coverage index, Spearman’s correlation analysis was used. The correlation between IHR core capacities and UHC index was demonstrated using a scatter plot between JEE score and UHC service coverage index, and the SPAR score and UHC service coverage index were also presented. Result: While the correlation value between JEE and SPAR was 0.92 (p < 0.001), the countries’ external evaluation scores were lower than their self-evaluation scores. Some areas such as available human resources and points of entry were mismatched between JEE and SPAR. JEE was associated with the UHC score (r = 0.85, p < 0.001) and SPAR was also associated with the UHC service coverage index (r = 0.81, p < 0.001). The JEE and SPAR scores showed a significant positive correlation with the UHC service coverage index after adjusting for several confounding variables. Conclusion: The study result supports the premise that strengthening national health security capacities would in turn contribute to the achievement of UHC. With the help of the empirical result, it would further guide each country for better implementation of IHR.

A resilient health system is inevitable in attaining the health-related Sustainable Development Goals (SDGs). One way of strengthening health systems is improving the coverage of public health laws for better health governance. The aim of this study is to describe the public health law situation in the Western Pacific Region and analyse the association of public health law coverage with health-related SDGs statistics. A total of 33 Western Pacific countries were selected and analysed using a multi-group ecological study design. Public health law coverage was measured from April 2013 to October 2016 based on the public health law coverage module in the ‘Tool to Assess Health Law’ developed by the WHO Western Pacific Regional Office and Asian Institute for Bioethics and Health Law of Yonsei University. The health-related SDGs status were examined using health statistics data from World Health Statistics 2017 and 2018 by WHO and SDGs index scores of previous research. Countries with high public health law coverage were Vietnam, Republic of Korea, Hong Kong, and Singapore. Low coverage countries were mainly Pacific Island countries. High public health law coverage issues were health care organisation, communicable diseases, and substance abuse, whereas those of low coverage were human reproduction, family health, and oral health. Public health law coverage was associated with health-related SDGs statistics such as life expectancy at birth (r = 0.47, p = 0.03), health life expectancy at birth (r = 0.47, p = 0.04), health-related SDGs index (r = 0.43, p = 0.05). Among the SDG 3 indicators, maternal mortality ratio (r = − 0.53, p = 0.01), neonatal mortality rate (r = − 0.44, p = 0.02), new HIV infections (r = 0.78, p = 0.04), total alcohol consumption (r = 0.45, p = 0.02), adolescent birth rate (r = − 0.40, p = 0.04), UHC service coverage index (r = 0.50, p = 0.02), and IHR average core capacity score (r = 0.54, p = 0.004) were statistically meaningful. However, there was no association of public health law coverage with health statistics in other SDGs. This study proved the importance of public health law in supporting the attainment of health-related SDGs. These results should be used as the basis for review and action at country level in improving public health law for better health systems, consequently achieving health-related SDGs.

Community-based health insurance schemes help households to afford healthcare services. This paper describes healthcare facilities and community factors that are associated with the Improved Community Health Fund (iCHF) scheme in the Ubungo district of Tanzania. A cross-sectional descriptive study was conducted using online questionnaires that were completed by healthcare providers and community members in public-owned healthcare facilities in the Ubungo Municipal Council district of Dar es Salaam, Tanzania, between October and November 2021. The data were analyzed using descriptive statistics and the chi-squared test of association. We found a statistically significant relationship between income level and satisfaction with the iCHF scheme. For community-related factors, income level was statistically significant in the level of involvement in iCHF implementation among local leaders. Further, income level was statistically significant in relation to community behavior/culture toward the iCHF. Occupation was statistically significant in iCHF implementation, iCHF premiums, and iCHF membership size. A statistically significant relationship was also found between income, iCHF membership size, and iCHF premiums. Moreover, people would be willing to pay the required premiums if the quality of the healthcare services under the iCHF scheme improves. Therefore, the government should allocate resources to reduce the challenges that are facing iCHF implementation, such as the preference for a user fee scheme over the iCHF, the issues that are faced by enrollment officers, and inadequate iCHF premiums and membership size.

Background: Public health laws—whether focusing on taxation, bans, mandates, or licensing—are powerful tools for reducing risk behaviors and improving population health. However, identical legal interventions often produce starkly different outcomes across jurisdictions. Political and social contexts are increasingly recognized as key determinants of such variability.Objective: This study aimed to examine how and why public health legal interventions succeed or fail under different political circumstances, drawing on a Realist Review approach. We synthesized the interplay between legal epidemiology and political determinants of health to develop a deeper understanding of the mechanisms driving health policy outcomes.Methods: We followed RAMESES guidelines to identify and analyze 20 empirical studies, policy analyses, and global reports published from 2000 to 2023. We included sources that explicitly addressed both public health law or policy interventions and the political environment (e.g., trust in government, partisanship, lobbying, global donor influence). Using a Context–Mechanism–Outcome (CMO) framework, we coded and synthesized patterns to refine our initial program theory on how legal measures interact with political factors to shape health-related results.Results: Six recurring CMO patterns emerged. Laws are most effective when stable political leadership and public trust enable robust enforcement and funding. Conversely, fragmented governance or ideological polarization undermines or reverses legal interventions, especially those perceived as infringing personal freedoms (e.g., vaccine mandates, obesity restrictions). Industry lobbying frequently dilutes legislation, while external donor–driven policies can falter without sustained domestic support. Evolving moral and cultural attitudes likewise propel or hinder laws over time. We integrate these findings in a conceptual model demonstrating how political determinants modulate legal mechanisms, ultimately affecting population health outcomes.Conclusion: This Realist Review underscores that legal interventions alone cannot guarantee public health improvements. Rather, their success relies on supportive political contexts, coherent enforcement strategies, and alignment with evolving social values. Policymakers and advocates should anticipate and address political barriers—from partisanship to lobbying to donor dependency—to design and implement resilient, evidence-based public health laws. Future research should refine these insights using mixed-methods case studies and longitudinal evaluations, ensuring policy adaptations that optimize health equity and policy sustainability.