Mental health and COVID-19: is the virus racist?

COVID-19 has changed our lives and it appears to be especially harmful for some groups more than others. Black and Asian ethnic minorities are at particular risk and have reported greater mortality and intensive care needs. Mental illnesses are more common among Black and ethnic minorities, as are crisis care pathways including compulsory admission. This editorial sets out what might underlie these two phenomena, explaining how societal structures and disadvantage generate and can escalate inequalities in crises

Barriers to uptake of reproductive information and contraceptives in rural Tanzania: An intersectionality informed qualitative enquiry

Objectives: Access to reproductive information and contraception continues to be a critical unmet need in Tanzania and impedes the realization of reproductive health rights. This study examined key sources of reproductive information and contraception (RIC) and the factors influencing their uptake by women in Mbeya region of Tanzania. Setting: This qualitative study was undertaken in a rural ward in a district in the south of the Mbeya Region Participants: In-depth interviews were undertaken with 48 women users and two nurses working in public health facility, and focus group discussions with 16 home-based care workers in the district. Participants were recruited through a local NGO in the region, and via snowball sampling. All interactions were recorded, translated and transcribed and sought to identify the available resources and barriers in utilising them. Results: Participants reported six main sources of reproductive information and contraceptives: public health facilities, non-governmental organization (NGO) mobile clinics, other women, Mganga wa Asili (witchdoctors/traditional doctors), and Duka la Dawa (Pharmacy). Women users and healthcare workers identified a range of individual (age, marital status, geography) and health system-wide factors shaping women’s reproductive choices and preventing uptake of contraceptives. The study also revealed structural factors such as gender, ethnicity, indigeneity as key determinants of access and health seeking, placing women from Sukuma and Maasai communities is most disadvantageous position. Historical social disadvantage, patriarchal social controls and the pressure to preserve socio-cultural traditions that women experience in the Maasai and Sukuma tribes underpin their disconnect from mainstream services. Conclusion: Women’s reproductive choices and their uptake of contraceptives are shaped by the interaction of a range of individual, household, institutional and structural factors. An intersectional lens enables examination of the ways in which these factors interact and mutually constitute disadvantage and privilege

Situating Biomedical and Professional Monopoly at the Intersections of Structural, Ideational and Agentic Power Comment on "Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process".

Lassa and colleagues' study is a strong commentary on the biomedical hegemony and professional monopoly of medical doctors in the policy landscape of the Global Fund in Nigeria. Situating this critical dimension of professional power within wider scholarship of power and governance of global health initiatives (such as the Global Fund), in this comment, I put forth two core arguments. I call for a relational perspective of power in a dynamic policy space that the Fund characterises. I argue that a systems-view analysis of power requires a thorough examination of subsystems, how they interact, and the diverse forms of power-individual agentic, ideational, and structural-and the mechanisms through which power is wielded. The lens of governmentality allows linking individual (expertise and practices) with institutional regimes and social practices these enable; and in examining the interface of local/ sub-national, national, and global within which policy formulation and implementation occurs

Sick Scotland: SNP plans to deal with health inequality are lukewarm at best

First paragraph: Scotland has long beenthe “sick man of Europe”. Scots' physical and mental health compares poorly to that other western countries and neighbours within the UK. Glasgow, the largest city, is notably unhealthier than most other parts, and the most affluent 10% live far longer than the most deprived.  Access this article on The Conversation website: https://theconversation.com/sick-scotland-snp-plans-to-deal-with-health-inequality-are-lukewarm-at-best-5929

Pandemic preparedness with 20/20 vision: Applying an intersectional equity lens to health workforce planning.

Human resource for health (HRH) is considered critical for achieving Universal Health Coverage, and the crisis surrounding HRH is now established as a global emergency. Their vital role has been central in the pandemic response. Yet, the discussions and deliberations on the recent pandemic treaty circumscribe HRH discussions to their capacities and protection, and address discrimination mainly in relation to gender. While this paper endorses the case for prioritisation of HRH in global pandemic preparedness planning, it re-frames the HRH crisis in relation to the institutional and structural factors driving HRH shortage, maldistribution and skills-needs misalignment. We critique the supply-and-demand framing of HRH crisis as one that obliviates the systematic inequalities within health systems that underpin health workforce motivations, distribution, satisfaction and performance. We propose an intersectional equity lens to redefine the HRH challenges, understand their underlying drivers and accordingly integrate in the global pandemic preparedness plans

The Right to Health in Times of Pandemic: What Can We Learn from the UK’s Response to the COVID-19 Outbreak?

The UK’s response to COVID-19 has been widely criticized by scientists and the public. According to EuroMOMO, a European mortality monitoring initiative, the excess mortality that may be attributable to COVID-19 in England is one of the highest in Europe, second only to Spain. While critiqued from a public health perspective, much less attention is given to the implications of the pandemic outbreak for the right to health as defined under international human rights law and ratified by member states. Using the UK as a case study, we examine critically the extent to which the government’s response to COVID-19 complied with the legal framework of the right to health. We review further key state obligations on the right to health and assess its suitability in times of pandemic. Finally, we offer some recommendations for an update of the right to health. This paper adds to the body of literature on the right to health and human rights based-approaches to health, which, to our knowledge, has not yet focused on pandemics

Global HIV/AIDS initiatives, recipient autonomy and country ownership: an analysis of the rise and decline of Global Fund and PEPFAR funding in Namibia

The Global Fund to Fight HIV/AIDS, Malaria and TB and U.S President’s Emergency Fund for AIDS Relief (PEPFAR) are global health initiatives (GHIs) that were established in the early 2000s with the mandates to increase global capacity to address HIV and AIDS rapidly. When the two GHIs were created, Namibia was one of the highest recipients of funding from both GHIs. A significant portion of their support to the country went to the Ministry of Health, which was the principal provider of treatment services in the country. Critics have argued, however, that the rise of financial support from the Global Fund and PEPFAR was associated with the creation of new administrative structures and procedures at the country level. This approach raises important questions about the degree to which Namibian health policymakers were able to exercise autonomy in the presence of GHI support. The aim of this thesis is to analyse the implications for institutional capacity and autonomy at the rise and fall of funding from the Global Fund and PEPFAR to the Ministry of Health concerning financial flows; human resources recruitment; and civil society engagement. With a focus on the changing relationship between the Ministry of Health and the two initiatives, the thesis examines the implications for country ownership and health systems capacity in the context of decreasing financial support from the Global Fund and PEPFAR. The field studies for this research was undertaken in 2011- 2012, when the two GHIs had indicated their intentions to scale-down the financial support made available to Namibia. This thesis uses multiple sources of data to qualitatively analyse the influences of Global Fund and PEPFAR support to Namibia from when the two initiatives were first established in 2002 and 2004, respectively, to 2012. A principal source of data was 43 semi-structured interviews conducted in Namibia during a placement with the Directorate of Special Programs in the Ministry of Health in early 2012. For financial flows, both the Global Fund and PEPFAR channelled and managed their funding through funder-specific structures and procedures that were developed and operated in parallel to existing Ministry of Health operations. Both for financial flows and human resources, initial structures and processes created difficulties for the Ministry of Health’s long-term objectives for HIV and AIDS. For civil society engagement, the thesis examined the Ministry of Health’s relationship with the Global Fund. At the rise of funding, the Global Fund required the establishment of a new multi-sector coordination structure for HIV and AIDS. This new structure operated at the same time as the existing national coordination structure and was perceived as having undermined the Ministry of Health’s role as the primary steward of Namibia's response. The Global Fund was also criticised for initially funding civil society organisations without making provisions for sustaining their capacity in the event of funding decline. The findings presented in this thesis indicate that at the rise of financing, the Ministry of Health’s engagement with the two HIV and AIDS GHIs initiatives was governed by the objectives of the two initiatives, rather than the long-term health systems goals of the Namibian Government. Their relationships with Namibia had an adverse impact on the Ministry of Health’s autonomy in making decisions on the national response to HIV and AIDS. The initial operations of the GHIs also had negative implications for Namibia's ability to sustain the health systems capacity they had helped to increase

Unmasking power as foundational to research on sexual and reproductive health and rights

Relations of power are intrinsic to the social determinants of sexual and reproductive health (SRH); they influence the content, quality and outcomes of SRH care; and they shape the negotiation and realisation of sexual and reproductive health and rights (SRHR) more broadly. Power dynamics pervade how SRHR is understood, studied and acted on, in ways that are distinct from other health issues.1 For example, the deeply held personal beliefs about women’s sexuality and childbearing, cultural mores regarding adolescent sexuality and state goals related to fertility all mark SRHR as a sphere with distinct and deeply contested power dynamics. Unmasking power as a central element in SRHR research is therefore crucial to developing a research agenda that can produce knowledge to transform hierarchies of power and advance SRHR.2 For example, key studies on violence against women and HIV that included explicit measures of power broke new ground by assessing how multilevel programmes impacted power relations and SRH outcomes, thus elucidating the importance of power relations, the factors that shape power relations and how these relations can be changed.3–5 In this Commentary, we summarise key ways power has been understood, defined and operationalised in SRHR research. We propose areas where further theoretical and empirical work and improved research processes could better interrogate power, yielding insights that can help transform policies, programmes and services