Strengthening health systems and peacebuilding through women's leadership: a qualitative study.

BACKGROUND: Active and protracted conflict settings demonstrate the need to prioritise the peace through health agenda. This can be achieved by reorienting attention toward gender diverse leadership and more effective governance within health systems. This approach may enable women to have a greater voice in the decision-making of health and social interventions, thereby enabling the community led and context specific knowledge required to address the root causes of persistent inequalities and inequities in systems and societies. METHODS: We conducted a qualitative study, which included semi-structured interviews with 25 key informants, two focus group discussions and one workshop with humanitarian workers in local and international non-governmental organisations (NGOs), United Nations (UN) agencies, health practitioners, and academics, from Sub-Saharan Africa, Middle East and North Africa (MENA), and Latin America. Findings were then applied to the peacebuilding pyramid designed by John Paul Lederach which provides a practical framework for mediation and conflict resolution in several conflict-affected settings. The purpose of the framework was to propose an adapted conceptualisation of leadership to include women's leadership in the health system and be more applicable in protracted conflict settings. RESULTS: Five interrelated themes emerged. First, perceptions of terms such as gender equality, equity, mainstreaming, and leadership varied across participants and contexts. Second, armed conflict is both a barrier and an enabler for advancing women's leadership in health systems. Third, health systems themselves are critical in advancing the nexus between women's leadership, health systems and peacebuilding. Fourth, across all contexts we found strong evidence of an instrumental relationship between women's leadership in health systems in conflict-affected settings and peacebuilding. Lastly, the role of donors emerged as a critical obstacle to advance women's leadership. CONCLUSION: Continuing to empower women against social, cultural, and institutional barriers is crucial, as the emerging correlation between women's leadership, health systems, and peacebuilding is essential for long-term stability, the right to health, and health system responsiveness

A narrative review of health research capacity strengthening in low and middle-income countries: lessons for conflict-affected areas

Abstract Conducting health research in conflict-affected areas and other complex environments is difficult, yet vital. However, the capacity to undertake such research is often limited and with little translation into practice, particularly in poorer countries. There is therefore a need to strengthen health research capacity in conflict-affected countries and regions. In this narrative review, we draw together evidence from low and middle-income countries to highlight challenges to research capacity strengthening in conflict, as well as examples of good practice. We find that authorship trends in health research indicate global imbalances in research capacity, with implications for the type and priorities of research produced, equity within epistemic communities and the development of sustainable research capacity in low and middle-income countries. Yet, there is little evidence on what constitutes effective health research capacity strengthening in conflict-affected areas. There is more evidence on health research capacity strengthening in general, from which several key enablers emerge: adequate and sustained financing; effective stewardship and equitable research partnerships; mentorship of researchers of all levels; and effective linkages of research to policy and practice. Strengthening health research capacity in conflict-affected areas needs to occur at multiple levels to ensure sustainability and equity. Capacity strengthening interventions need to take into consideration the dynamics of conflict, power dynamics within research collaborations, the potential impact of technology, and the wider political environment in which they take place

Réactions photochimiques et photoredox en réacteurs microfluidiques : applications aux cycloadditions, à la polymérisation contrôlée et la chimie radicalaire

Ce travail consiste à étudier différentes réactions photochimiques en dispositifs microfluidiques en utilisant la lumière UV/visible, par le biais de catalyseurs recyclables métalliques et non-métalliques, pour la synthèse organique aux applications pharmaceutiques et industrielles. En outre, l’utilisation des systèmes microfluidiques dans des chemins optiques miniaturisés de 500 µm résultant en une amélioration d’illumination. Les mesures d’actinométrie chimique confirment que ≈ 98% de la lumière émise atteint le mélange de réaction dans un réacteur fluidique Mikroglas® Dwell Device largement utilisé dans la littérature. Différentes réactions de cycloaddition [2 + 2] utilisées en synthèse totale ont été testées en utilisant un sensibilisateur sous UV. La réaction est quantitative après 2 h contre 47% après 10 h en batch. La polymérisation radicalaire contrôlée (ATRP) a été étudiée en utilisant le catalyseur photorédox éosine Y sous illumination à base de LED vertes. Six heures d'irradiations sont suffisantes pour fournir des polymères mono dispersés aux applications variables (plastiques, latex ...). Ces catalyseurs non-métalliques sont d'une importance capitale car ils sont plus respectueux de l'environnement. Former de nouvelles liaisons C-C et C-O est le cœur de la synthèse organique. L’utilisation de sources LEDs UV et d’un catalyseur photorédox nous a permis de former des produits d'addition (> 99%), à partir d’une part de sels de trifluoroborates et de TEMPO ou d’accepteurs de Michaël, d’autre part, après 2,5 min d'irradiation contre 8-24 h en batch.Ce travail montre clairement l’apport des systèmes microfluidiques pour l’accélération de réactions photochimiques.In order to mimic nature’s highly energy efficient photosynthesis reaction, this work focuses on photochemical reactions using UV/visible light, metal based recyclable catalysts and metal free catalysts in flow to synthesize organic material that have pharmaceutical and industrial applications. The utilized microfluidic systems have small path lengths (500 μm) resulting in improved illumination. Using chemical actinometry, it was shown that ≈ 98% of the light supplied reached the reaction mixture inside the widely used Mikroglas® Dwell device. [2+2] cycloaddition, used in total synthesis, was tested in flow using a sensitizer under UV. The optimized reaction was quantitative after 2 h vs. 47% after 10 h in literature’s batch system. Metal free ATRP was assessed using the commercial Eosin Y in flow with green LEDs. Only 6 h of irradiation were enough to give narrow dispersed polymers that have wide applications (plastics, latex…). Metal free catalysts are of critical importance as they are more ecofriendly. Forming new C-C and C-O bonds is the heart of organic synthesis. Using UV LEDs and a photoredox catalyst, adducts of trifluoroborate salts with TEMPO and with Michaël acceptors were obtained (>99%) after only 2.5 min of irradiation in flow compared to 8-24 h in batch. Our results highlight the impact of miniaturization on accelerating photochemical reactions. Less time and energy usage, improved yields and strictly linear kinetic graphs are main features of flow technology. In addition, miniaturization requires less safety precautions rendering it favorable for large scale industry. This work supports considering the microfluidic technology for greener industrial systems

A missing piece in the Health for Peace agenda:gender diverse leadership and governance

The purpose of this paper is to explore how gender diverse leadership and governance of health systems may contribute to the Health for Peace Agenda. Despite recent momentum, the evidence base to support, implement and evaluate ‘Health for Peace’ programmes remains limited and policy-makers in conflict settings do not consider peace when developing and implementing interventions and health policies. Through this analysis, we found that gender diverse leadership in health systems during active conflict offers greater prospects for sustainable peace and more equitable social economic recovery in the post-conflict period. Therefore, focusing on gender diversity of leadership and governance in health systems strengthening offers a novel way of linking peace and health, particularly in active conflict settings. While components of health systems are beginning to incorporate a gender lens, there remains significant room for improvement particularly in complex and protracted conflicts. Two case studies are explored, north-west Syria and Afghanistan, to highlight that an all-encompassing health systems focus may provide an opportunity for further understanding the link between gender, peace and health in active conflict and advocate for long-term investment in systems impacted by conflict. This approach may enable women and gender minorities to have a voice in the decision-making of health programmes and interventions that supports systems, and enables the community-led and context-specific knowledge and action required to address the root causes of inequalities and inequities in systems and societies

Health research capacity building of health workers in fragile and conflict-affected settings: a scoping review of challenges, strengths, and recommendations

Background Fragile and conflict-affected settings (FCAS) have a strong need to improve the capacity of local health workers to conduct health research in order to improve health policy and health outcomes. Health research capacity building (HRCB) programmes are ideal to equip health workers with the needed skills and knowledge to design and lead health-related research initiatives. The study aimed to review the characteristics of HRCB studies in FCASs in order to identify their strengths and weaknesses, and to recommend future directions for the field. Methods We conducted a scoping review and searched four databases for peer-reviewed articles that reported an HRCB initiative targeting health workers in a FCAS and published after 2010. Commentaries and editorials, cross-sectional studies, presentations, and interventions that did not have a capacity building component were excluded. Data on bibliographies of the studies and HRCB interventions and their outcomes were extracted. A descriptive approach was used to report the data, and a thematic approach was used to analyse the qualitative data. Results Out of 8822 articles, a total of 20 were included based on the eligibility criteria. Most of the initiatives centred around topics of health research methodology (70%), targeted an individual-level capacity building angle (95%), and were delivered in university or hospital settings (75%). Ten themes were identified and grouped into three categories. Significant challenges revolved around the lack of local research culture, shortages in logistic capability, interpersonal difficulties, and limited assessment and evaluation of HRCB programmes. Strengths of HRCB interventions included being locally driven, incorporating interactive pedagogies, and promoting multidisciplinary and holistic training. Common recommendations covered by the studies included opportunities to improve the content, logistics, and overarching structural components of HRCB initiatives. Conclusion Our findings have important implications on health research policy and related capacity building efforts. Importantly, FCASs should prioritize (1) funding HRCB efforts, (2) strengthening equitable international, regional, and national partnerships, (3) delivering locally led HRCB programmes, (4) ensuring long-term evaluations and implementing programmes at multiple levels of the healthcare system, and (5) adopting engaging and interactive approaches

Sensitized [2 + 2] intramolecular photocycloaddition of unsaturated enones using UV LEDs in a continuous flow reactor: kinetic and preparative aspects

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