An Investment Case for Addressing Social Drivers of Structural Stigma and Discrimination Against Refugees in Resource-Poor Urban Areas

Investment in addressing structural stigma and discrimination against refugees in resource-poor urban areas is both needed, and possible. The large population of refugees residing in resource-poor urban areas is likely to grow, and tensions in a number of settings are now documented. Without interventions to adequately address such tensions, both the protection needs of refugee populations and the stability of hosting countries could be affected. Through qualitative analysis of an urban refugee dataset in Uganda, this dissertation identified community-level drivers of structural stigma and discrimination as safeguarding one’s body and property, defending status, and perpetuating exploitation. The designs of potentially successful programs to address these drivers were then identified though systematic review, and included one or more of the following: 1) the utilization of multiple intervention components; 2) direct information provision (e.g., lecture, role-play, other active engagement) or direct contact with stigmatized groups; 3) cooperative work between community members and stigmatized groups to better livelihoods; 4) popular opinion leaders who have authority to make change, and 5) traditional ceremonies valued by the communities for cleansing and healing. One such design involving an agricultural livelihood program in a resource-poor urban area of the Northeast United States was costed, utilizing a primarily bottom-up approach and a societal perspective in the collection of both financial and economic costs. The unit cost per participating family was significantly lower than government services that provide comparable nutritional support, but did not include components of working with the community to reduce stigma and discrimination. Thus, the studied program provided more services for a lower cost. In addition, it empowered stigmatized refugees to advocate for and support themselves, and engendered goodwill in the community by involving community members to work alongside refugee participants, improving upon a neglected piece of land, and providing fresh produce. Further research is needed to better measure the social and financial dividends of programs to address structural stigma and discrimination, particularly against urban refugees. Such research can only come in tandem with further investment, the imperative and potential of which are compellingly clear

Guidelines for costing of social and behavior change health interventions

These Guidelines for Costing of Social and Behavior Change Health Interventions (SBC Costing Guidelines) provide a framework for estimating the cost of interventions for social and behavior change, which seek to change health behaviors by addressing factors such as knowledge, attitudes, and social norms

The business case for investing in social and behavior change for family planning

Although the development field generally considers social and behavior change interventions essential parts of quality health programs, lack of synthesized information on costs and effectiveness means that decision-makers under-appreciate and under-fund social and behavior change efforts. This business case uses evidence to answer questions about the effectiveness, cost, cost-effectiveness, and return on investment from social and behavior change efforts. To develop this family planning social and behavior change business case, nearly 200 studies were evaluated. All USAID strategic priorities for global health—preventing child and maternal deaths, controlling the HIV/AIDS epidemic, and combating infectious diseases—employ social and behavior change approaches to varying degrees. This is the first in a planned series of complementary, health area-specific business cases

Correction to: A Systematic Review of Methodological Variation in Healthcare Provider Perspective Tuberculosis Costing Papers Conducted in Low- and Middle-Income Settings, Using An Intervention-Standardised Unit Cost Typology.

In the original version of this article, Fig. 3 was published in an incorrect format. The correct figure is published with this correction

Developing the Global Health Cost Consortium Unit Cost Study Repository for HIV and TB: methodology and lessons learned.

Consistently defined, accurate, and easily accessible cost data are a valuable resource to inform efficiency analyses, budget preparation, and sustainability planning in global health. The Global Health Cost Consortium (GHCC) designed the Unit Cost Study Repository (UCSR) to be a resource for standardised HIV and TB intervention cost data displayed by key characteristics such as intervention type, country, and target population. To develop the UCSR, the GHCC defined a typology of interventions for each disease; aligned interventions according to the standardised principles, methods, and cost and activity categories from the GHCC Reference Case for Estimating the Costs of Global Health Services and Interventions; completed a systematic literature review; conducted extensive data extraction; performed quality assurance; grappled with complex methodological issues such as the proper approach to the inflation and conversion of costs; developed and implemented a study quality rating system; and designed a web-based user interface that flexibly displays large amounts of data in a user-friendly way. Key lessons learned from the extraction process include the importance of assessing the multiple uses of extracted data; the critical role of standardising definitions (particularly units of measurement); using appropriate classifications of interventions and components of costs; the efficiency derived from programming data checks; and the necessity of extraction quality monitoring by senior analysts. For the web interface, lessons were: understanding the target audiences, including consulting them regarding critical characteristics; designing the display of data in "levels"; and incorporating alert and unique trait descriptions to further clarify differences in the data

Reference case for estimating the costs of global health services and Interventions

Estimates of the costs of implementing health interventions are required for informing a wide range of decisions in global health. Costs are used in economic evaluations, such as benefit-cost or cost-effectiveness analysis, and other economic analyses to inform priority setting. Cost interventions are also needed for financial planning and management, and the formulation of resource requirements and budgets. In addition, cost estimates can provide additional detail on how interventions are implemented, which can be useful for assessing the efficiency of service delivery. Costs are typically estimated using a range of approaches and assumptions, often combining data obtained as part of research studies with data collected as part of routine program implementation. While numerous textbooks and guideline documents exist, analysts apply and interpret such guidance based on their prior training, professional experience, and context. However, there is no widely agreed-upon common guidance on principles, methods, and reporting standards specifically aimed at cost estimation across global health. The variation in applying the methods and reporting of costs for global health interventions has long been recognized. This variation can have an impact on estimates of cost-effectiveness, which should be comparable across interventions. A review of economic evaluations in the Tufts Medical Center Cost-Effectiveness Analysis (CEA) Registry found a high level of variation in costing methods, although the review noted an improvement in consistency over time. Differences in data collection methods and in the application of analytic methods, a general lack of comprehensiveness, and inconsistent compliance to existing guidance were all observed. As a result, reviews of global health costs conclude that methodological heterogeneity and lack of transparency make it impossible to compare studies over setting and time, and several papers point to the need to develop standardized methods for cost estimation in global health

'He always thinks he is nothing': The psychosocial impact of discrimination on adolescent refugees in urban Uganda

Armed conflict causes massive displacement, erodes the social fabric of communities, and threatens the healthy development of a nation's future e its youth. Although more than half of the world's registered refugees under the age of eighteen currently reside in urban areas, research on the unique needs of and realities experienced by this population remain limited. In Uganda, as in many refugee-receiving countries, most regulated refugee protections and entitlements fail to extend beyond the confines of official settlements or camps. This dearth of support, in combination with few material resources, uncertain local connections, and little knowledge of the language, leaves refugee families vulnerable to the added burden of an unwelcome reception in cities. Drawing on qualitative data from a study conducted in March and April 2013 with Congolese and Somali adolescents, caregivers, and service providers in refugee settlements in Kampala, this manuscript explores the pervasive nature of discrimination against urban refugees and its effects upon adolescent well-being. Findings suggest that discrimination not only negatively impacts acculturation as youth pursue social recognition in the classroom and among neighborhood peers, but it also impedes help-seeking behavior by caregivers and restricts their ability to ameliorate protection concerns, thereby lowering adolescents' psychosocial well-being. Youth reported low self-worth, withdrawal from school, and an adverse turn toward street connections. Targeted and innovative strategies along with reformed policies that address the unique challenges facing urban refugees are paramount to ensuring that young people in this population experience greater protection, well-being, and future success.sch_iih146pub4295pu