Search

Background: Uganda has been confronted with a sustained influx of refugees for decades. This prompted the government to explore opportunities to integrate refugees into local service structures including its national health system. This paper chronicles the history of policies and strategies that have influenced the integration of refugees into the national health system in Uganda and investigates factors that impacted policy evolution and progression. Methods: We used a case study approach that drew on a document review and key informant interviews with 28 respondents at national and subnational levels. Interviews were analyzed using thematic qualitative analysis and findings were organized using Walt and Gilson's Policy Triangle Framework. Data from the literature review, media review, and key informant interviews were triangulated. Results: Uganda's experience with the integration of refugee's dates to 1999 when the country first implemented the Self-reliance strategy. Since then, policy learning and evolution have taken place, with policies around integration evolving and improving over time, moving the country towards more effective implementation of integrated health services. A conducive policy environment was key as a set of legislations at national and district-levels and sector-specific plans and budgets that included refugees have provided the foundation for implementation. The integration received support and buy-in from the highest levels of government including the President and the Office of The Prime Minister. This was coupled with deliberate efforts by the government to mainstream refugee response in local plans and budgets, allowing implementation at district and sub-district levels. These factors were pivotal to the implementation of the integration agenda. Conclusion: Our study highlights the complex, dynamic, evolving, and multifaceted nature of the multisectoral health policy process in the integration of health services in refugee settings. The findings shed light on the importance of collaboration between stakeholders, mobilization of legal and political frameworks to shape the integration of refugee health services into the national health system, and the importance of ensuring that high-level commitments translate to action and development plans at local levels. [ABSTRACT FROM AUTHOR]

Abstract\nPlain language summaryMore than 650 million women alive today were married as children. Relative to efforts to prevent child marriage, efforts to support child brides have received much less attention. This review set out to map and describe interventions that support child brides. We performed a scoping review using seven electronic databases coupled with a grey literature search in January 2022. Data were extracted using a piloted extraction tool and findings were reported in narrative synthesis. A total of 34 projects were included in our review. Most projects focused on improving sexual and reproductive health (SRH) knowledge and behaviours among child brides, which was often achieved through a combination of SRH education, counselling and information provision, along with linkages to SRH services. Some interventions were health facility-based and aimed at improving responsiveness of health service providers to the needs of child brides. Very few described economic interventions as one component of a broader health intervention, and only three interventions focused on improving girls’ educational outcomes. We also note the paucity of media-based interventions, despite their popularity among adolescents. Over time, interventions addressing the needs of child brides have increased, but the preponderance of evidence has focused on SRH interventions, with interventions that couple education with adolescent-friendly health services demonstrating promise. Interventions addressing other areas of health and social wellbeing of this group, such as mental health, sexual health, and economic independence, have been overlooked in comparison. The review highlights the need for additional empirical evidence on what works to support child brides.Women and girls who are married under age 18 have specific vulnerabilities and unique needs for interventions and services. While child marriage prevention has received substantial attention over the past decade, as evidenced by several systematic reviews investigating what works to prevent child marriage, very few reviews have been done to assess the effectiveness of interventions that address the needs of child brides. This review takes stock of programmes and interventions that have a specific focus on meeting the health and social needs of child brides. Our review finds that most published interventions focus on improving sexual and reproductive health outcomes in this population, and few interventions target the mental health needs and social wellbeing of this group, despite evidence that child brides have worse mental health outcomes and are more likely to experience adverse social outcomes like intimate partner violence. Programming to enhance women and girls’ economic wellbeing and education are also underrepresented in this body of literature. With a critical mass of studies investigating sexual and reproductive health outcomes in this group, we can conclude that programmes which empower child brides with knowledge and SRH information when coupled with referral and accompaniment to adolescent and women friendly health services show serious potential for improving outcomes. [ABSTRACT FROM AUTHOR]

Gender-responsive monitoring and evaluation (M&E) for health and health systems interventions and programs is vital to improve health, health systems, and gender equality outcomes. It can be used to identify and address gender disparities in program participation, outcomes and benefits, as well as ensure that programs are designed and implemented in a way that is inclusive and accessible for all. While gender-responsive M&E is most effective when interventions and programs intentionally integrate a gender lens, it is relevant for all health systems programs and interventions. Within the literature, gender-responsive M&E is defined in different and diverse ways, making it difficult to operationalize. This is compounded by the complexity and multi-faceted nature of gender. Within this methodological musing, we present our evolving approach to gender-responsive M&E which we are operationalizing within the Monitoring for Gender and Equity project. We define gender-responsive M&E as intentionally integrating the needs, rights, preferences of, and power relations among, women and girls, men and boys, and gender minority individuals, as well as across social, political, economic, and health systems in M&E processes. This is done through the integration of different types of gender data and indicators, including: sex- or gender-specific, sex- or gender-disaggregated, sex- or gender-specific/disaggregated which incorporate needs, rights and preferences, and gender power relations and systems indicators. Examples of each of these are included within the paper. Active approaches can also enhance the gender-responsiveness of any M&E activities, including incorporating an intersectional lens and tailoring the types of data and indicators included and processes used to the specific context. Incorporating gender into the programmatic cycle, including M&E, can lead to more fit-for-purpose, effective and equitable programs and interventions. The framework presented in this paper provides an outline of how to do this, enabling the uptake of gender-responsive M&E. [ABSTRACT FROM AUTHOR]

Background: Understanding people's interest in using modern contraception is critical to ensuring programs align with people's preferences and needs. Current measures of demand for contraception are misinterpreted. More direct measures of intention to use (ITU) contraception do exist but remain underexplored. This systematic review examines the relationship between intention to use and actual use of contraception., Methods: We searched PubMed, PsycInfo, Web of Science, and the Cochrane Collaboration to identify studies published from 1975-2020 that: (1) examined contraceptive behaviour, (2) included measures of ITU and future contraceptive use, and (3) included at least one quantitative measure of association between ITU and actual use. The inclusion criteria were: 1) examined contraceptive behaviour (excluding condom use only), (2) included disaggregated integral measures of ITU contraceptives and later contraceptive use, (3) included at least one quantitative measure of the association between ITU contraceptives and actual contraceptive use, (4) study population was women of reproductive age, (5) were peer-reviewed, and (6) written in English., Results: 10 prospective cohort studies met the inclusion criteria; these provided 28,749 person-years of data (N=10,925). Although we could pool the data for unadjusted odds ratios, a metanalysis was not possible. We calculated that 6 of the 10 studies indicated significant, increased, unadjusted odds of subsequent contraceptive use after reporting ITU. Of those, 3 study analyses reported significant, positive adjusted odds ratios for the relationship between intention to use and later contraceptive use across varying covariates. The range of confounding factors, particularly around sub-populations, points to the need for more research so that a meta-analysis can be done in the future., Conclusions: People's self-reported ITU contraception has the potential to be a strong predictor of subsequent contraceptive use. Few studies directly examined the relationship between ITU and contraceptive uptake and recruitment was primarily pregnant or postpartum samples., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Boydell V et al.)

Objective: To examine incidence of child marriage among displaced and host populations in humanitarian settings., Design: Cross-sectional surveys., Setting: Data were collected in Djibouti, Yemen, Lebanon and Iraq in the Middle East and in Bangladesh and Nepal in South Asia., Participants: Adolescent girls aged 10-19 in the six settings and age cohort comparators., Outcome Measures: Cumulative incidence of marriage by age 18., Results: In Bangladesh and Iraq, the hazard of child marriage did not differ between internally displaced populations (IDPs) and hosts (p value=0.25 and 0.081, respectively). In Yemen, IDPs had a higher hazard of child marriage compared with hosts (p value<0.001). In Djibouti, refugees had a lower hazard of child marriage compared with hosts (p value<0.001). In pooled data, the average hazard of child marriage was significantly higher among displaced compared with host populations (adjusted HR (aHR) 1.3; 95% CI 1.04 to 1.61).In age cohort comparisons, there was no significant difference between child marriage hazard across age cohorts in Bangladesh (p value=0.446), while in Lebanon and Nepal, younger cohorts were less likely to transition to child marriage compared with older comparators (p value<0.001). Only in Yemen were younger cohorts more likely to transition to child marriage, indicating an increase in child marriage rates after conflict (p value=0.034). Pooled data showed a downward trend, where younger age cohorts had, on average, a lower hazard of child marriage compared with older cohorts (aHR 0.36; 95% CI 0.29 to 0.4)., Conclusions: We did not find conclusive evidence that humanitarian crises are associated with universal increases in child marriage rates. Our findings indicate that decision-making about investments in child marriage prevention and response must be attuned to the local context and grounded in data on past and current trends in child marriage among communities impacted by crisis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)