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This article traces the origin, sustenance and implications of a persistent rumour that is responsible for low measles mumps and rubella (MMR) vaccination uptake in the Somali diaspora in a number of countries across the globe. The rumour stipulates that the MMR vaccine – the silent shot – causes autism spectrum disorder (ASD). Although the association between MMR and ASD is non-causal, and various public health initiatives have promoted health information campaigns, the rumour continues to circulate in the Somali diaspora in many countries, including Sweden. This paper shows that there are valid reasons for this. The findings from this paper draw on a systematic scoping review and qualitative interview data from Sweden. The results show that the Somali community experiences higher than average rates of ASD compared to the general population. Moreover, ASD does not exist in the Somali language or their home country, is considered a Western disease that only affects Somali children in the diaspora, and is a highly stigmatised disease. Also, the Somali diaspora has had negative experiences with ASD diagnosis and care. The rumour has been sustained by the absence of an answer to their ASD fear and through active diaspora networks on social media. The network that surrounds the rumour has arguably further helped to create an epistemic community for a community whose concerns have been silenced. [ABSTRACT FROM AUTHOR]

The end of a pandemic is as much a political act as biological reality. It is over not simply when case counts or deaths are reduced to some objectively determined acceptable level but also when, and if, the public accepts the stories that politicians and health officials tell about it. This paper has three aims. First, to develop the concept of a pandemic illness narrative – a public narrative that makes the experience of an outbreak meaningful to a community of people and explains when it will be finished. Using the case of the United States, the paper then examines how American state organisations and public health officials tried to disseminate a version of the 'restitution illness narrative' to make sense out of the COVID-19 pandemic and explain how it would ultimately end. Lastly, the paper describes the factors that made this narrative ultimately implausible to the American public. As most Americans are now seemingly indifferent about the pandemic, it has ended in the United States without ever actually being narratively concluded. [ABSTRACT FROM AUTHOR]

Decades of 'feminist' sexual- and gender-based violence (SGBV) policies have produced limited change in southern African SGBV rates. Recent critiques highlight ongoing colonial legacies in such policymaking, arguing that these legacies limit the potential for liberatory change. Further, reflecting on such discourses can highlight reasons behind global public health intervention failure. To promote reflexivity among public health actors who create, reproduce, and implement SGBV policies, this paper presents a critical discourse analysis of how women's empowerment is constructed in foundational global and national health and development policies bearing on SGBV in Zambia. The analysis identifies neoliberal feminist discourses of empowerment: (i) the protection of women, which perpetuates a saviour complex; (ii) the promotion of equality to men, which excludes those deemed unworthy; (iii) the eradication of harmful cultural norms, which challenge the preservation of African values; and (iv) (neoliberal) empowerment through women's attained employment and capital, which empowers women within unequal economic relations rather than liberating women from those relations. The author critiques such neoliberal empowerment discourses for failing to structurally transform the conditions for women's liberation. This paper offers a first step to the dismantling of colonial structures in SGBV policies by unpacking and promoting reflexivity about such discourses. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has accelerated acceptance of learning from other countries, especially for high-income countries to learn from low- and middle-income countries, a practice known as global learning. COVID-19’s rapid disease transmission underscored how connected the globe is as well as revealed stark health inequities which facilitated looking outside of one’s borders for solutions. The Global Learning for Health Equity (GL4HE) Network, supported by Robert Wood Johnson Foundation, held a 3-part webinar series in December 2021 to understand the current state of global learning and explore how global learning can advance health equity in the post-COVID-19 era. This paper reflects on these cutting-edge discussions about the current state of global learning, drawing upon the highlights, perspectives, and conclusions that emerged from these webinars. The paper also comments on best practices for global learning, including adapting for context, addressing biases, funding considerations, ensuring bidirectional partnerships, community engagement, and adopting a multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Structural competency is a recent framework for understanding and addressing the structural drivers of disease. Latin American Social Medicine and Collective Health is a decades-long movement similarly concerned with the study and transformation of social structures to achieve health equity. In this paper, we put insights from Latin American Social Medicine and Collective Health into conversation with the developing structural competency framework. We focus specifically on insights from Jaime Breilh's new article summarising his theoretical work on medical ethics and rights in this special issue and his new book, Critical Epidemiology and the People's Health. This paper is comprised of three parts. Part 1 provides an introduction to the structural competency framework. Part 2 provides an overview of the Latin American Social Medicine and Collective Health movement, along with a summary of the social determination of health paradigm. Part 3 places insights from these works into conversation with structural competency and considers ways in which Latin American Social Medicine and Collective Health might inform the further development of structural competency, and potentially vice versa. The paper closes by calling for greater attention to Latin American Social Medicine and Collective Health among those committed to health equity within the anglophone world. [ABSTRACT FROM AUTHOR]

China has been contributing to new approaches to global governance. The Health Silk Road (HSR), a significant component of the Belt and Road Initiative (BRI), was proposed by China in 2016. This paper claims that HSR is a new institution introduced alongside the existing WHO-led multilateral health system, and its relationship with the existing system can be described as layering. Having explored the new development of HSR during COVID-19, this paper further argues that while HSR has its unique strength in making contributions to global health governance and economic recovery, it faces a prominent issue of securitisation in the context of China-U.S. strategic competition, suspicion of the quality of medical products and sectoral fragmentation. [ABSTRACT FROM AUTHOR]

While violence against health care workers is being progressively recognised as a serious problem in the healthcare industry, it remains an under-studied area of enquiry in global public health. Anthropologists have long observed that violence toward patients is tied to institutional care practises in multiple ways, including repression, misrecognition and silencing. But research on health care staff's experience of violence is still lacking. This article aims to address this literature gap by providing research on the daily experience of vulnerability to violence that health care providers face during their work. To do so, the paper ethnographically explores the effects and perception of violence against health care workers in an emergency department (ED) in northern Italy, a place with a dramatic escalation of violent incidents. The article illustrates how the ED staff attended to the experience of suffering of potentially violent patients. In so doing, ED professionals shifted the responsibility of violence against them from violent individuals to violent structures shaping health inequities. The paper thus argues that ED professionals display a structural competence perspective when dealing with violence. [ABSTRACT FROM AUTHOR]

Globally, there have been calls for an integrated zoonotic disease surveillance system. This study aimed to assess human and animal health surveillance systems to identify opportunities for One Health surveillance platform in Tanzania. A desk review of policies, acts and strategies addressing disease surveillance that support inter-sectoral collaboration was conducted. A semi-structured questionnaire was administered to key informants from the two sectors. Databases with potential relevance for surveillance were assessed. One Health-focused policies, acts, strategic plans and guidelines emphasising inter-sectoral collaboration strengthening were in place. Stable systems for collecting surveillance data with trained staff to implement surveillance activities at all levels in both sectors were available. While the human surveillance system was a mix of paper-based and web-based, the animal health system was mainly paper-based. The laboratory information system existed in both sectors, though not integrated with the epidemiological surveillance systems. Both the animal and human surveillance systems had low sensitivity to alert outbreaks. The findings indicate that individual, organisational, and infrastructure opportunities that support the integration of surveillance systems from multiple sectors exist. Challenges related to data sharing and quality need to be addressed for the effective implementation of the platform. [ABSTRACT FROM AUTHOR]

Interactions between International Organisations (IOs) within a regime complex often manifest themselves through competition and cooperation. Current research has examined the factors that promote inter-organisational competition and cooperation, yet the precise timing of when such competition or cooperation commences remains unclear. This paper focuses on two pivotal IOs in global health governance, the World Health Organization (WHO) and the World Bank, to explore the timing and onset of competition and cooperation within a regime complex, as well as the driving factors in the evolution of their inter-organisational relationships. By looking into the interactions between the WHO and the World Bank in norm-setting and resource mobilising, the paper sheds light on how their relationships have transitioned from competitors to cooperators. It systematically presents the mechanisms and processes of policy transformation in inter-organisational interactions. As a new agenda arises, IOs within a regime complex often compete for dominance, with ideational differences driving them to propose and implement distinct governance strategies. They will compete for resources and mainstream of their strategy. The negative spillover effects of competitive policies consequently undermine the effectiveness of IOs’ policy, thereby undercut their legitimacy. To surmount these challenges, the international community should promote inter-institutional coordination in global governance.

This paper investigates the demographic and socio-economic correlates of dietary patterns in South Africa, drawing on a sample of young adults experiencing internal migration and urbanisation. We use data from the 2018 baseline survey of the Migrant Health Follow-Up Study, an original longitudinal cohort study consisting of 3,087 internal migrants and rural residents aged 18–40 nested within the Agincourt Health and socio-Demographic Surveillance System in rural northeast South Africa. We employ principal components analysis to identify dietary patterns from food frequency questionnaires and ordinary least squares regression to assess whether migration and other socio-economic characteristics correlate with specific dietary patterns at baseline. We observe five distinct dietary patterns characterised by frequent consumption of processed foods, red meat, fruits and vegetables, diverse foods, and high sugar/fat foods. We find migration to be significantly associated with more frequent consumption of both processed foods and fruits and vegetables; we also find the association between migration status and dietary patterns to be heterogenous depending on migrants’ destinations. This paper extends current understanding of changing dietary patterns in the context of nutrition transitions with attention to dynamic migration processes rather than static rural-urban differences.

ABSTRACTThe COVID-19 pandemic has accelerated acceptance of learning from other countries, especially for high-income countries to learn from low- and middle-income countries, a practice known as global learning. COVID-19’s rapid disease transmission underscored how connected the globe is as well as revealed stark health inequities which facilitated looking outside of one’s borders for solutions. The Global Learning for Health Equity (GL4HE) Network, supported by Robert Wood Johnson Foundation, held a 3-part webinar series in December 2021 to understand the current state of global learning and explore how global learning can advance health equity in the post-COVID-19 era. This paper reflects on these cutting-edge discussions about the current state of global learning, drawing upon the highlights, perspectives, and conclusions that emerged from these webinars. The paper also comments on best practices for global learning, including adapting for context, addressing biases, funding considerations, ensuring bidirectional partnerships, community engagement, and adopting a multidisciplinary approach.

Foodborne illnesses result from inadequate food handling practices, but prevention is possible through implementing food safety principles by handlers and consumers. This paper presents an overview of food safety knowledge and practices among food handlers and consumers in the Gulf countries, identifies factors affecting knowledge and practice, and offers recommendations for promoting food safety among handlers and consumers. A literature search was conducted using an integrative review method. Various combinations of the following descriptors were used: (food safety, food hygiene), (knowledge, practice), and (Saudi Arabia, Qatar, UAE, Bahrain, Oman, and Kuwait). Out of 164 studies screened, 37 met the eligibility criteria. Food handler studies reported insufficient food safety knowledge, with poor translation of existing knowledge into practice. Consumer studies showed varying levels of food safety knowledge, and the translation of existing knowledge into practice was also found to be inconsistent. Training and educational level were the primary factors positively affecting food safety knowledge and practices. Overall, significant gaps in knowledge and practices were identified among food handlers and consumers in the Gulf. These gaps require urgent attention from the Gulf regulatory bodies to develop targeted food safety training and education programs to enhance awareness and implementation of food safety principles. [ABSTRACT FROM AUTHOR]

Mobility, access to transport and healthcare play a crucial part in healthy ageing. However, these often posechallenges for older adults in the global South. This study applies the three concepts of 'motility' (access, competence and appropriation), to explore transport inequalities and barriers to access healthcare services for older adults in Bengaluru, India. The paper draws on interviews with sixty adults, aged 50 years and over, residing in urban Bengaluru. A semi-structured in-depth interview guide was employed to explore the transport inequalities. Applying thematic analysis, we present the mobility and transport barriers to access healthcare. Restricted access to healthcare services due to unavailable and unaffordable transportation resulted in missed appointments, delayed care and deterioration of health conditions. To cope with the barriers, older adults often visited less specialised clinics for regular check-ups and those with financial constraints resorted to self-medication. These actions further deteriorated health and led to adverse health outcomes. Our findings suggest that integrated health and transport policies must be designed to ensure equitable access to transportation services. Enabling older adults to have more independent lives and improve access to preventive healthcare is essential for better health outcomes. [ABSTRACT FROM AUTHOR]

When the COVID-19 pandemic struck and China reported the first case to the World Health Organization in December 2019, there was no evidence-based treatment to combat it. With the catastrophic situation that followed, materialised by a considerable number of deaths, researchers, doctors, traditional healers, and governments of all nations committed themselves to find therapeutic solutions, including preventive and curative. There are effective treatments offered both by modern medicine and traditional medicine for COVID-19 today. However, other therapeutic proposals have not been approved due to the lack of effectiveness and scientific rigour during their development process. Proponents of modern medicine prefer biomedical therapies while in some countries, traditional treatments are used regularly because of their availability, affordability and satisfaction they bring to the population. In this paper, we propose a transactional medicine approach where the interaction between traditional and modern medicine produces a change. With this approach, the promoters of traditional medicine and those of modern medicine will be able to acquire knowledge through the experience produced by their encounters. Transactional medicine aims to be a model for decolonising medicine and recognising the value of both traditional and modern medicine in the fight against COVID-19 and other global emerging pathogens. [ABSTRACT FROM AUTHOR]

The health burden due to mental health has historically been underestimated with focus on communicable diseases and deaths and little consideration of disability and comorbidity effects of poor mental health. Recent data show increasing trends of mental health disorders as a share of global health burdens and vulnerability of adolescents. This paper aims to explore social determinants of mental health as experienced by adolescent girls, drawing attention to gendered risks during the COVID-19 pandemic. Semi-structured interviews with twenty-two adolescent girls in urban informal settlements in Kenya and Nigeria reveal unique environmental, socio-cultural, economic and educational factors that threatened their mental wellbeing. The pandemic exacerbated these determinants. An equitable recovery will require a consideration of not only disproportional mental health outcomes, but also social determinants that contribute to these outcomes. As more than half of the urban population in sub-Saharan Africa reside in informal settlements, this study has implications for youth-focused mental health interventions in these and similar settings. [ABSTRACT FROM AUTHOR]

Climate change is an important driver of migration, but little research exists on whether migrant communities in the U.S. identify climate change-related factors as reasons for migrating. In 2021, we conducted a multidisciplinary, collaborative project to better understand the nexus of climate change and immigrant health in the Atlanta area. This paper presents one arm of this collaboration that explored both the role of climate change in decisions to immigrate to Georgia and the ways that climate change intersects with other possible drivers of migration. First generation migrants from Latin America were recruited primarily through CPACS Cosmo Health Center and were invited to participate in an intake survey and an in-depth interview. Results were analyzed using descriptive statistics and thematic analysis. Findings suggest that while participants may not have explicitly identified climate change as a primary reason for migration, in both surveys and in-depth interviews, participants reported multiple and intersecting social, economic, political, and environmental factors that are directly or indirectly influenced by climate change and that are involved in their decisions to migrate. The narratives that emerged from in-depth interviews further contextualised survey data and elucidated the complex nexus of climate change, migration, and health. [ABSTRACT FROM AUTHOR]

There has been a push for understanding gendered violence in WASH in recent times. Attention is therefore shifting to how these issues are conceptualised, considering their embeddedness in context. One step primarily is to understand how existing policies in WASH acknowledge the needs of women and girls in WASH. In doing this, we conducted a summative content analysis of selected policy documents on WASH: five at the international level and five each from Ghana, Uganda and Kenya. Findings suggest that existing policies inadequately acknowledge WASH related gender-based violence and pay little attention to the complex ways gender and WASH relations are intimately connected. Generally, a holistic policy approach for addressing gender-based violence in WASH is needed. The paper recommends a system policy approach to address the unique needs of women and girls in WASH in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

In 2020, the New Zealand (NZ) Parliament voted to decriminalise abortion. Although NZ's abortion law formally opposes sex selective abortions, there is considerable complexity in the gender politics of 'choice' and 'agency' in multi-ethnic societies, and interpretations of reproductive rights for ethnic minority women and for the girl child, respectively. This paper explores these complexities through the perspectives of reproductive and maternity care practitioners who are situated at the interface of legal systems, health service provision, and delivery of culturally sensitive care. Thirteen practitioners were interviewed as part of this study. The analysis highlights strains in framings of 'reproductive choice' (underpinned by western liberal notions of rights) and 'gender equality' (abortion rights that acknowledge the complexity of cultural son-preference) for ethnic minority women. These tensions are played out in three aspects of the post-reform landscape: (a) everyday practice and accountability; (b) consumerism and choice; (c) custodianship and gender rights. The findings point to the limitations in operationalising choices for ethnic women in health systems wherein trust deficit prevails, and cultural dynamics render complex responses to abortion. They also highlight reconfigurations of client-expert relationships that may have implications for practitioners' abilities to advocate for ethnic women's rights against cultural influences. [ABSTRACT FROM AUTHOR]

Leadership by health professionals is key in any health system, but health leadership training programmes are varied in their conceptualisation, learning objectives, and design. This paper describes an undergraduate leadership and management module for health students at the University of Sierra Leone and provides lessons from the design process. Our methods included an initial scoping review and qualitative study, followed by a co-design process of 10 workshops and 17 consultation meetings. The result was a curriculum with learning outcomes emphasising leadership identity, proactiveness, management of people and of change, and the formation of peer relationships. Learning methods included group teaching, team quality improvement projects, mentoring, and reflective practice. Lessons from the design process included the importance of support from university leadership and extensive consultation. Virtual workshops enabled broader participation but limited relationship building. Integrating doctoral research into the process facilitated inclusion of evidence and theory but risked reducing ownership by faculty. The importance of interprofessionalism and management skills in leadership training emerged during the process, illustrating the effectiveness of a co-design approach. Our programme is broadly aligned with other health leadership frameworks and is distinctive due to its undergraduate focus, offering insights for leadership training design in other settings. [ABSTRACT FROM AUTHOR]

Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes. [ABSTRACT FROM AUTHOR]

The International Convention on the Suppression and Punishment of the Crime of Apartheid (1974) and Article 7 of the Rome Statute of the International Criminal Court (1998) recognise apartheid as a crime against humanity, characterised by a practice of systematic oppression and violations of human rights with the intent of one racial group to maintain domination over another. The term 'medical apartheid', although without a formal definition in international human rights law, has been used similarly to refer to situations of pervasive segregation and discrimination in health care, based upon race, and characterised by stark inequality in health care accessibility, availability, acceptability, and quality. This paper, using a combination of literature review; data on attacks on Palestinian health facilities, workers, and transport; and information from Palestinian and Israeli government authorities on referrals to specialised health care services, examines the ways in which Israeli policies and practices can be understood to constitute a form of 'medical apartheid' that deprives Arab residents of the Palestinian territories the full realisation of their right to health. [ABSTRACT FROM AUTHOR]

Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower – and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18–75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict. [ABSTRACT FROM AUTHOR]

This paper evaluates global health responses to the COVID-19 pandemic through the 'two regimes of global health' framework. This framework juxtaposes global health security, which contains the threat of emerging diseases to wealthy states, with humanitarian biomedicine, which emphasises neglected diseases and equitable access to treatments. To what extent did the security/access divide characterise the response to COVID-19? Did global health frames evolve during the pandemic? Analysis focused on public statements from the World Health Organization (WHO), the humanitarian nonprofit Médecins Sans Frontières (MSF), and the American Centers for Disease Control and Prevention (CDC). Following a content analysis of 486 documents released in the first two years of the pandemic, the research yielded three findings. First, the CDC and MSF affirmed the framework; they exemplified the security/access divide, with the CDC containing threats to Americans and MSF addressing the plight of vulnerable populations. Second, surprisingly, despite its reputation as a central actor in global health security, the WHO articulated both regime priorities and, third, after the initial outbreak, it began to favour humanitarianism. For the WHO, security remained, but was reconfigured: instead of traditional security, global human health security was emphasised – collective wellbeing was rooted in access and equity. [ABSTRACT FROM AUTHOR]

Financial technology tools have been utilised to create readily available mobile loan platforms for urban-based, daily-wage earners in Kenya. From a financial lending perspective, this development signals greater inclusion and equality in formal bank financing systems. In this paper, however, we examine mobile loans and their repayment from the perspective of women who sell sex in Nairobi, drawing upon the qualitative findings of two community-based studies conducted in close collaboration with sex worker-led organisations serving the sexual health needs of their peers. Our findings suggest that mobile loans may undermine the financial security strategies and economic independence of sex workers, leaving these women in more precarious economic circumstances, which have been shown in other instances to have effects on sexual risk taking and vulnerability to HIV infection. [ABSTRACT FROM AUTHOR]

Global health practitioners and policymakers have become increasingly vocal about the complex challenges of identifying and quantifying the causes of death of the world's poorest people. To address this cause-of-death uncertainty and to minimise longstanding sensitivities about full autopsies, the Bill and Melinda Gates Foundation have been one of the foremost advocates of minimally invasive autopsy technology (MIA). MIA involves using biopsy needles to collect samples from key organs and body fluids; as such, it is touted as potentially more acceptable and less invasive than a complete autopsy, which requires opening the cadaver. In addition, MIA is considered a good means of collecting accurate bodily samples and can provide the crucial information needed to address cause-of-death uncertainty. In this paper, we employ qualitative data to demonstrate that while MIA technology has been introduced as a solution to the enduring cause-of-death uncertainty, the development and deployment of technologies such as these always constitute interventions in complex social and moral worlds; in this respect, they are both the solutions to and the causes of new kinds of uncertainties. We deconstruct the ways in which those new dimensions of uncertainty operate at different levels in the global health context. [ABSTRACT FROM AUTHOR]

Early motherhood can negatively impact health, educational, and socio-economic outcomes for adolescent mothers and their children. Supporting adolescent mothers' educational attainment, and timely return to school, may be key to interrupting intergenerational cycles of adversity. Yet, there remains a paucity of evidence on the factors that are associated with mothers' postpartum return to school and the mediators of this process, particularly across sub-Saharan Africa where adolescent pregnancy rates remain high. This paper is based on interviews with 1,046 adolescent mothers from South Africa. Mothers who had returned to school after birth showed lower poverty, fewer repeated grades preceding the pregnancy, continued schooling during pregnancy, higher daycare/crèche use, more family childcare support, and lower engagement in exclusive breastfeeding within six months postpartum. Mediation analyses showed that lower poverty was directly associated with school return and via two indirect pathways: continued schooling during pregnancy and using daycare/crèche services. This study demonstrates that lacking childcare constitutes a major hurdle to mothers' school return which needs to be addressed in addition to socioeconomic and individual-level barriers. Policy makers and practitioners should consider supporting young mothers with combination interventions which include services supporting school retention during pregnancy and access to, and financial supplements for, daycare. [ABSTRACT FROM AUTHOR]

India’s experience with the National Rural Health Mission (NRHM) is notable on account of nationally formalising – at scale – community action in service delivery,monitoring, and planning of health services. A study was undertaken to document and create a historical record of NRHM’s ‘communitization’ processes. The oral history method of the Witness Seminar was adopted and two virtual seminars with five and nine participants, respectively, were conducted, and supplemented with 4 in depth interviews. Analysis of transcripts was done using ATLAS.ti 22 with the broad themes of emergence, evolution, and evaluation and impact of ‘communitization’ under NRHM. This paper engages with the theme of ‘emergence’ and adopts the Multiple Streams Framework (MSF) conceptualised by John Kingdon for analysis. Key findings include the pioneering role of boundary spanning decision makers and the Jan Swasthya Abhiyan (JSA) in advocacy and design of ‘communitization’ structures, and the legacy of rights based social mobilizations and state-civil society partnerships in health during the 1990s influencing the ethos underlying ‘communitization’. Democracy, leadership from the civil society in policy design and implementation, and state-civil society partnerships are linked to the positive results witnessed as part of ‘communitization’ in NRHM. [ABSTRACT FROM AUTHOR]

Young mothers often encounter stigma and discrimination, affecting their lives and that of their children. This paper explores stigma management strategies and their effectiveness for young mothers in rural Nigeria. Ten key informants and 24 young mothers were recruited from Ife-East in South-Western Nigeria. Data from semi-structured interviews showed that societal disapproval of pregnant teenagers and young mothers were common experiences. Women used a range of strategies to actively cope with stigma including: belief in predestination, avoidance, concealment, and cohabitation. These strategies could be seen as tools to mitigate negative stereotypes and discrimination. However, they also had the unintended consequences of compounding many young women’s difficult circumstances and exposing them to adverse outcomes, including gender-based violence, repeat pregnancies, poor mental health, and low uptake of services. The results show the need for policy frameworks to actively combat stigma by addressing the negative framing of early pregnancy and motherhood and promoting supportive environments for young mothers. Health professionals need to be trained to offer de-stigmatising services to encourage young mothers to seek help and reduce pre-existing inequities in access to services, and policies need to include measures that address the rights of young mothers and protect them from violence and abuse. [ABSTRACT FROM AUTHOR]

One in five child deaths under age 5 are a result of severe wasting. Malnutrition at early ages is linked to lifelong consequences, such as reduced cognitive skills, reduced earnings in adulthood and chronic health conditions. Countries worldwide have committed to addressing child undernutrition, and ending hunger is foundational to the Millennium Development Goals. In this paper, we study the intergenerational effect of providing free tuition in secondary school on future children’s nutrition. We combined a novel longitudinal dataset that captures educational policies for 40 African countries from 1990 to 2019 with the Demographic and Health Survey (DHS). We identified three countries that introduced free secondary education several years after implementing free primary education. Exploiting this variation in timing we estimate the additional impact of providing free secondary education over free primary education. Using a difference-in-difference approach, we find that introducing free secondary education significantly reduced wasting. Cohorts exposed to free secondary had an 18% relative decrease in wasting. The impact on cohorts exposed only to free primary was smaller and not statistically significant. Expanding free secondary education has long-term, intergenerational benefits and is an effective path to reducing malnutrition. Results are robust to different specifications. [ABSTRACT FROM AUTHOR]

The government of India introduced the Accredited Social Health Activist (ASHA) programme in 2006 to connect marginalised communities to the health system. ASHAs are mandated to increase the uptake of modern contraception through the doorstep provision of services. There is currently no evidence on the impact of ASHAs on the uptake of contraception at the national level. This paper examines the impact of ASHAs on the uptake of modern contraception using nationally representative National and Family Health Survey data collected in 2019– 21 in India. A multilevel logistic regression analysis was performed to determine the effect of contact with ASHAs on the uptake of modern contraception, controlling for regional variability and socio-demographic variables. The data provide strong evidence that ASHAs have succeeded in increasing modern contraceptive use. Women exposed to ASHAs had twice the odds of being current users of modern contraception compared to those with no contact, even after controlling for household and individual characteristics. However, only 28.1% of women nationally reported recent contact with ASHA workers. The ASHA programme should remain central to the strategy of the government of India and should be strengthened to achieve universal access to modern contraception and meet sustainable development goals by 2030. [ABSTRACT FROM AUTHOR]

Scientific evidence on the safety and efficacy of pharmaceutical drugs, substances and herbal medicines is important in medical advertising and promotion. Following guidelines for conducting a scoping review, we systematically searched PubMed, SCOPUS and Web of Science to identify in peer reviewed articles medications that were promoted and used widely in Africa during the COVID-19 pandemic. We also searched for information about how safety concerns about untested/or not properly tested drugs were communicated to the public during the pandemic. Of the 2043 articles identified, 41 papers were eligible for inclusion. Most studies were clinical trials (n = 11), systematic reviews (n = 9), quantitative studies (n = 9) the rest were qualitative studies, reviews and reports. We found that following global trends, several drugs, traditional and herbal treatments were used and repurposed for the treatment of respiratory symptoms of COVID-19 in Africa. The results highlighted the value of some herbal medicines for treatment during the COVID-19 pandemic, as well as the risks posed by the unregulated sharing of advice and recommendations on treatments in Africa, and globally. [ABSTRACT FROM AUTHOR]

The world is facing a tremendous problem in the form of food insecurity that is posing a great challenge to achieving sustainable development goal 2 of creating a hunger-free world. Refugees and displaced populations are particularly vulnerable to food insecurity and malnutrition, who lack any productive assets and depend on aid. Rohingya refugees, displaced from Myanmar and took refuge in Cox’s Bazar, Bangladesh, live in a crowded unhealthy environment and are severely vulnerable to food insecurity and malnutrition. In our recent study, we found that only 21.6% of the households in Rohingya refugee camps had acceptable food security status. Interestingly, this study further revealed that acceptable food security status was significantly higher among the households that had some additional income aside from aid, compared to those relying on aid alone. This shows the importance of promoting livelihood opportunities to improve food security status among the camp dwellers. In this paper, we presented our views on promoting livelihood opportunities to address the overwhelming food insecurity crisis among the Rohingya refugees in Bangladesh. [ABSTRACT FROM AUTHOR]

To achieve Sustainable Development Goal 5 for gender equality by 2030, it is crucial for health and development professionals and governmental officials to understand how legal systems empower or oppress populations on the basis of gender worldwide, including opportunities and challenges of statutory provisions created by legal pluralism. Using Ethiopia as a case study, this paper examines how local laws applied in Sharia and Customary Dispute Resolution courts impact gender equality and the health of women and girls inspite of the inculcation of human rights statutes into national legislation, including the Constitution. We identify several key issues with the substantive law and its enforcement. First, laws which have been instituted at the national level to improve gender equally have been poorly enforced at the local level. Second, there is a sustained enforcement of laws that oppress women and that protect male perpetrators of gender-based violations. Third, local courts limit female representation and uphold patriarchy. To improve the health of women and girls, stakeholders must take into consideration the ways in which legal systems uphold harmful gender norms and obstruct and/or advance progress towards equal representation, opportunities, and constitutionally-mandated protections for all. [ABSTRACT FROM AUTHOR]

Pharmaceutical sector corruption undermines patient access to medicines by diverting public funds for private gain and exacerbating health inequities. This paper presents an analysis of UN Convention Against Corruption (UNCAC) compliance in seven countries and examines how full UNCAC adoption may reduce corruption risks within four key pharmaceutical decision-making points: product approval, formulary selection, procurement, and dispensing. Countries were selected based on their participation in the Medicines Transparency Alliance and the WHO Good Governance for Medicines Programme. Each country’s domestic anti-corruption laws and policies were catalogued and analysed to evaluate their implementation of select UNCAC Articles relevant to the pharmaceutical sector. Countries displayed high compliance with UNCAC provisions on procurement and the recognition of most public sector corruption offences. However, several countries do not penalise private sector bribery or provide statutory protection to whistleblowers or witnesses in corruption proceedings, suggesting that private sector pharmaceutical dispensing may be a decision-making point particularly vulnerable to corruption. Fully implementing the UNCAC is a meaningful first step that countries can take reduce pharmaceutical sector corruption. However, without broader commitment to cultures of transparency and institutional integrity, corruption legislation alone is likely insufficient to ensure long-term, sustainable pharmaceutical sector good governance. [ABSTRACT FROM AUTHOR]

Young people in Colombia present high rates of mental health problems, to which the country’s history of armed internal conflict contributes in complex ways. Mental health services in Colombia are fragmented, inadequate, and difficult to access for many. Young people’s help)seeking is often hindered by mental health stigma and/or poor experiences with services. This paper presents a thematic analysis of qualitative data from a mixed-methods study aimed at developing and testing a mental health intervention for Colombian youths. We draw upon theoretical lenses from scholarly work on stigma and Sen’s ‘capabilities approach’ to inform our analysis of interviews and group discussions with staff and young people involved in the state-funded human capital building programme ‘Jovenes en Acción’ (JeA). By illustrating how study participants talked about stigma, vulnerability, mental health services organisation, and the challenges of discussing mental health topics in a learning environment, we illuminate aspects of mental health support and anti-stigma interventions that might need enhancing. In particular, we suggest that more emphasis on ‘community competencies’ as complementary to and interrelated with individual competencies would strengthen young people’s individual and collective resources for mental wellbeing while being in line with the sociocritical principles of existing human capital-enhancing programmes. [ABSTRACT FROM AUTHOR]

The UN’s Zero Tolerance Policy, which bans all relationships between UN staff and locals, portrays all relationships as exploitative, fails to account for nuances in these relationships and does not acknowledge the agency of local women or communities. This study uses community-based qualitative data from eastern DRC that shares narratives on a wide variety of consensual relationships between peacekeepers and local women. Our paper uses a data-driven approach, including a post-colonial feminist lens, and ideas of structural agency to provide an expanded definition of agency that invites readers to re-examine their views of women in conflict settings. Finally, we provide clear recommendations for the UN and other international non-governmental agencies on policies related to sexual exploitation and abuse. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between child labour and educational attainment and explores the distinction between harmful and non-harmful agricultural cocoa work. We conduct a secondary analysis of data on 3,338 children who reported attending school in 2018 across cocoa growing regions of Ghana and Côte d’Ivoire. To address differences between harmful and non-harmful child labour, we differentiated work completed by a child by hazardous activity engagement. These groups of child labour were then modelled against educational attainment, defined by a whether or not the child needed to repeat a class. We then conducted mediation analysis to assess whether injury mediates this relationship. Our results show that hazardous child labour increases the odds of repeating a class and work-related injury compared to non-hazardous labour. The effect of hazardous child labour on academic attainment was also found to be mediated by work-related injuries by 14%. Educational attainment is associated with hazardous labour activities and the odds of injury and not the act of participation in agricultural labour alone. Programmes based on strong measures of harmful work will foster better protection for children who are most at risk and may inform global debates around the benefits versus the risks of child labour. [ABSTRACT FROM AUTHOR]

We report on a comparative situational analysis of comprehensive abortion care (CAC) in Botswana, Eswatini, Lesotho and Namibia. We conducted systematic literature searches and country consultations and used a reparative health justice approach (with four dimensions) for the analysis. The following findings pertain to all four countries, except where indicated. Individual material dimension: pervasive gender-based violence (GBV); unmet need for contraception (15−17%); high HIV prevalence; poor abortion access for rape survivors; fees for sexual and reproductive health (SRH) services (Eswatini). Collective material dimension: no clear national budgeting for SRH; over-reliance on donor funding (Eswatini; Lesotho); no national CAC guidelines or guidance on legal abortion access; poor data collection and management systems; shortage and inequitable distribution of staff; few facilities providing abortion care. Individual symbolic dimension: gender norms justify GBV; stigma attached to both abortion and unwed or early pregnancies. Collective symbolic dimension: policy commitments to reducing unsafe abortion and to post-abortion care, but not to increasing access to legal abortion; inadequate research; contradictions in abortion legislation (Botswana); inadequate staff training in CAC. Political will to ensure CAC within the country's legislation is required. Reparative health justice comparisons provide a powerful tool for foregrounding necessary policy and practice change. [ABSTRACT FROM AUTHOR]

ABSTRACTIt is estimated that more than 200,000 women were sterilised without giving free, prior and informed consent in Peru between 1996 and 2000 during the Fujimori regime. This paper places forced sterilisation within the frameworks of precarity and reproductive justice to understand policies that legitimised the violation of women's rights irrespective of the type of political regime: forced sterilisations during a dictatorial regime and denial of access to sexual and reproductive rights during a period of democracy. Through document analysis, this paper examines narratives around sterilisation and reproduction produced by policymakers, political and religious leaders and health care practitioners during these two political periods. This paper shows the continuity of the struggle that marginalised populations face in exercising their reproductive rights in the context of symbolic and structural inequalities.

ABSTRACTDecades of ‘feminist’ sexual- and gender-based violence (SGBV) policies have produced limited change in southern African SGBV rates. Recent critiques highlight ongoing colonial legacies in such policymaking, arguing that these legacies limit the potential for liberatory change. Further, reflecting on such discourses can highlight reasons behind global public health intervention failure. To promote reflexivity among public health actors who create, reproduce, and implement SGBV policies, this paper presents a critical discourse analysis of how women’s empowerment is constructed in foundational global and national health and development policies bearing on SGBV in Zambia. The analysis identifies neoliberal feminist discourses of empowerment: (i) the protection of women, which perpetuates a saviour complex; (ii) the promotion of equality to men, which excludes those deemed unworthy; (iii) the eradication of harmful cultural norms, which challenge the preservation of African values; and (iv) (neoliberal) empowerment through women’s attained employment and capital, which empowers women within unequal economic relations rather than liberating women from those relations. The author critiques such neoliberal empowerment discourses for failing to structurally transform the conditions for women’s liberation. This paper offers a first step to the dismantling of colonial structures in SGBV policies by unpacking and promoting reflexivity about such discourses.

ABSTRACTGlobally, there have been calls for an integrated zoonotic disease surveillance system. This study aimed to assess human and animal health surveillance systems to identify opportunities for One Health surveillance platform in Tanzania. A desk review of policies, acts and strategies addressing disease surveillance that support inter-sectoral collaboration was conducted. A semi-structured questionnaire was administered to key informants from the two sectors. Databases with potential relevance for surveillance were assessed. One Health-focused policies, acts, strategic plans and guidelines emphasising inter-sectoral collaboration strengthening were in place. Stable systems for collecting surveillance data with trained staff to implement surveillance activities at all levels in both sectors were available. While the human surveillance system was a mix of paper-based and web-based, the animal health system was mainly paper-based. The laboratory information system existed in both sectors, though not integrated with the epidemiological surveillance systems. Both the animal and human surveillance systems had low sensitivity to alert outbreaks. The findings indicate that individual, organisational, and infrastructure opportunities that support the integration of surveillance systems from multiple sectors exist. Challenges related to data sharing and quality need to be addressed for the effective implementation of the platform.

Structural competency is a recent framework for understanding and addressing the structural drivers of disease. Latin American Social Medicine and Collective Health is a decades-long movement similarly concerned with the study and transformation of social structures to achieve health equity. In this paper, we put insights from Latin American Social Medicine and Collective Health into conversation with the developing structural competency framework. We focus specifically on insights from Jaime Breilh’s new article summarising his theoretical work on medical ethics and rights in this special issue and his new book, Critical Epidemiology and the People’s Health. This paper is comprised of three parts. Part 1 provides an introduction to the structural competency framework. Part 2 provides an overview of the Latin American Social Medicine and Collective Health movement, along with a summary of the social determination of health paradigm. Part 3 places insights from these works into conversation with structural competency and considers ways in which Latin American Social Medicine and Collective Health might inform the further development of structural competency, and potentially vice versa. The paper closes by calling for greater attention to Latin American Social Medicine and Collective Health among those committed to health equity within the anglophone world.

The end of a pandemic is as much a political act as biological reality. It is over not simply when case counts or deaths are reduced to some objectively determined acceptable level but also when, and if, the public accepts the stories that politicians and health officials tell about it. This paper has three aims. First, to develop the concept of a pandemic illness narrative – a public narrative that makes the experience of an outbreak meaningful to a community of people and explains when it will be finished. Using the case of the United States, the paper then examines how American state organisations and public health officials tried to disseminate a version of the ‘restitution illness narrative’ to make sense out of the COVID-19 pandemic and explain how it would ultimately end. Lastly, the paper describes the factors that made this narrative ultimately implausible to the American public. As most Americans are now seemingly indifferent about the pandemic, it has ended in the United States without ever actually being narratively concluded.

While violence against health care workers is being progressively recognised as a serious problem in the healthcare industry, it remains an under-studied area of enquiry in global public health. Anthropologists have long observed that violence toward patients is tied to institutional care practises in multiple ways, including repression, misrecognition and silencing. But research on health care staff’s experience of violence is still lacking. This article aims to address this literature gap by providing research on the daily experience of vulnerability to violence that health care providers face during their work. To do so, the paper ethnographically explores the effects and perception of violence against health care workers in an emergency department (ED) in northern Italy, a place with a dramatic escalation of violent incidents. The article illustrates how the ED staff attended to the experience of suffering of potentially violent patients. In so doing, ED professionals shifted the responsibility of violence against them from violent individuals to violent structures shaping health inequities. The paper thus argues that ED professionals display a structural competence perspective when dealing with violence.

China has been contributing to new approaches to global governance. The Health Silk Road (HSR), a significant component of the Belt and Road Initiative (BRI), was proposed by China in 2016. This paper claims that HSR is a new institution introduced alongside the existing WHO-led multilateral health system, and its relationship with the existing system can be described as layering. Having explored the new development of HSR during COVID-19, this paper further argues that while HSR has its unique strength in making contributions to global health governance and economic recovery, it faces a prominent issue of securitisation in the context of China-U.S. strategic competition, suspicion of the quality of medical products and sectoral fragmentation.

The intensified scramble for the digitalisation of healthcare across Africa, coupled with the general drive for digital economies, has ushered in digital health innovations that are reconfiguring national discourses on humanitarian and development contexts. Through these innovations, imaginaries of health have become entangled with aspirations for universal health coverage (UHC) and the actualisation of the health-related sustainable development goals (SDGs). Among these innovations, drones promise to leapfrog and transform conventional African healthcare systems, which have suffered from structural bottlenecks for years, offering citizens on the margins of care critical biomedical gazes. By using drones, African states hope to improve revenue collection, curb corruption, redress health insecurities and deliver life-saving medicines, vaccines and laboratory diagnostics through a last-mile distribution schedule. Ethnographic fieldwork from 2022 to 2023 in Ghana and Malawi on the use of drones found distortions to the health workforce, disruptions to health work, and a pervasive internal brain drain, all exacerbating health-worker shortages. This paper explores how drones are reconfiguring health work and its available labour force in practice amid persistent shortages of health-workers.

This paper contributes to the literature on the professionalisation of NGOs in the context of the rise of ‘business-minded’ approaches whereby donors establish a market environment in which NGOs compete for funding by demonstrating their achievement of targets and implementing globally recognised management models. Theoretically, we use the distinction between ‘economies of performance’ and ‘ecologies of practice’ to explore how NGOs simultaneously ‘perform’ themselves publicly as meeting expected professional standards while simultaneously producing themselves practically through ‘unprofessional’ means. Limited global health and development literature addresses professionalisation as an empirical practice and experience. We report on an ethnography of a Bill and Melinda Gates Foundation-funded, HIV-targeted intervention NGO in western India, drawing on six months of participant observation and 17 interviews with NGO workers. The organisation meets ‘business-minded’ success criteria but does so through informal, personal, hierarchical arrangements at odds with the professionalisation model. Frontline workers are demotivated by their professionalisation experience, are suspicious of the performance of success, and find ways of achieving their vocation despite a system which they feel does not recognise the value of human relationships. Showing that ‘business-minded’ approaches do not necessarily rule out informal, potentially ‘corrupt’ ways of working, we argue against the ‘professional-unprofessional’ binary.

Global health photography has historically been commissioned and, therefore, dominated by the gaze of Western photographers on assignments in the Global South. This is changing as part of international calls to decolonise global health and stimulate ‘empowerment’, spawning a growing initiative to hire local photographers. This article, based on interviews with global health photographers, reflects on this paradigm shift. It highlights how behind the laudable aim of ‘empowerment’ of local global health photography there is a simultaneous exploitation of precarious photographer labour and the emergence of ‘glocal’ photography elites. The paper argues that empowerment of local photographers can become a euphemism for reducing image production costs and maintaining control over the image content, while extending the scope of mainstream global health visual culture without challenging it. Finally, the article amplifies the growing concern that uncritical engagement with institutionalised empowerment becomes a warrant for the reproduction of local inequalities behind the fashionable façade of cooperation and care.

The self-collection of vaginal swabs and point-of-care testing and treatment of sexually transmitted infections (STIs) is reported from several low-and middle-income countries. However, the reporting on women’s experiences of self-collection and same-day testing and treatment of STIs is less well described. In this paper, we present the acceptability of self-collected vaginal swabs and point-of-care testing and treatment among pregnant women enrolled in a clinical trial (Women and Newborn Trial of Antenatal Intervention and Management – WANTAIM) in Papua New Guinea. Semi-structured interviews were conducted among 54 women enrolled into WANTAIM to identify the acceptability of the test and treat approach. Analysis of qualitative data used deductive and inductive thematic analysis applying Sekhon, Cartwright and Francis’ acceptability theoretical framework. Most women reported that they understood that the vaginal swab was to identify infections that may affect their unborn baby; however, some were unsure about the specific infections they were being tested for. Among women who tested positive for an STI, some were unsure what they had been treated for. Overall, the self-collection of vaginal swabs for STI testing during pregnancy was highly acceptable.

Urban inequalities are exacerbated due to rapid urbanisation. This is also evident within slums in low- and middle-income countries, where high levels of heterogeneity amongst the slum population lead to differential experiences in Water, Sanitation, and Hygiene (WASH) and housing access. This scoping review provides evidence of the interconnection of WASH and housing and presents barriers to access and the consequences thereof for slum dwellers. It does so while considering the social stratification amongst urban slum dwellers and their lived experiences. A systematic search of journal articles was conducted in November 2022 in PubMed, Scopus, and Web of Science. A total of 33 papers were identified which were full text reviewed and data extracted. Infrastructure, social and cultural, socio-economic, governance and policy and environmental barriers emerged as general themes. Barriers to WASH and housing were more frequently described concerning women and girls due to gender norms within WASH and the home. Barriers to WASH lead to compromised health, socio-economic burdens, and adverse social impacts, thus causing residents of slums to navigate their WASH mobility spatially and over time. Insights from this review underscore the need for an intersectional approach to understanding access inequalities to WASH and housing.