Developing political capabilities with Community-Based Monitoring for health accountability: The case of the Mahila Swasthya Adhikar Manch

Community-Based Monitoring (CBM) is a participatory process in which citizens gather evidence on services to hold governments accountable to their commitments. Research on CBM for health in developing countries has mostly measured its impact on service performance. Overall, these studies have produced mixed evidence of CBM’s effectiveness. This has led some authors to question the role of civic engagement, especially in communities where expectations from public services and power to demand for change are low. This conclusion, we argue, overlooks the role of the CBM process in fostering both participation and social change. Drawing from qualitative research with the Indian grassroots women’s organisation Mahila Swasthya Adhikar Manch, we argue that CBM can foster political capabilities through mediating communities’ relationships with the state as well as relationships within communities. The engagement of women and their power to demand for change in the health sector and beyond emerges at the intersection of these two spheres. This suggests that measuring the impact of CBM on health services is not sufficient. Expanding the focus of research on CBM to its process is necessary to fully understand the role of civic engagement and to restore its political relevance

Towards a Feminist Global Health Policy: Power, intersectionality, and transformation

Eger H, Chacko S, El-Gamal S, et al. Towards a Feminist Global Health Policy: Power, intersectionality, and transformation. PLOS Global Public Health. 2024;4(3): e0002959.In the realm of global health policy, the intricacies of power dynamics and intersectionality have become increasingly evident. Structurally embedded power hierarchies constitute a significant concern in achieving health for all and demand transformational change. Adopting intersectional feminist approaches potentially mitigates health inequities through more inclusive and responsive health policies. While feminist approaches to foreign and development policies are receiving increasing attention, they are not accorded the importance they deserve in global health policy. This article presents a framework for a Feminist Global Health Policy (FGHP), outlines the objectives and underlying principles and identifies the actors responsible for its meaningful implementation. Recognising that power hierarchies and societal contexts inherently shape research, the proposed framework was developed via a participatory research approach that aligns with feminist principles. Three independent online focus groups were conducted between August and September 2022 with 11 participants affiliated to the global-academic or local-activist level and covering all WHO regions. The qualitative content analysis revealed that a FGHP must be centred on considerations of intersectionality, power and knowledge paradigms to present meaningful alternatives to the current structures. By balancing guiding principles with sensitivity for context-specific adaptations, the framework is designed to be applicable locally and globally, whilst its adoption is intended to advance health equity and reproductive justice, with communities and policymakers identified as the main actors. This study underscores the importance of dismantling power structures by fostering intersectional and participatory approaches for a more equitable global health landscape. The FGHP framework is intended to initiate debate among global health practitioners, policymakers, researchers and communities. Whilst an undeniably intricate and time-consuming process, continuous and collaborative work towards health equity is imperative to translate this vision into practice

Investigating the Mental Health Impacts of Climate Change in Youth: Design and Implementation of the International Changing Worlds Study

As climate change continues unabated, research is increasingly focused on capturing and quantifying the lesser-known psychological responses and mental health implications of this humanitarian and environmental crisis. There has been a particular interest in the experiences of young people, who are more vulnerable for a range of reasons, including their developmental stage, the high rates of mental health conditions among this population, and their relative lack of agency to address climate threats. The different geographic and sociocultural settings in which people are coming of age afford certain opportunities and present distinct challenges and exposures to climate hazards. Understanding the diversity of lived experiences is vitally important for informing evidence-based, locally led psychosocial support and social and climate policies. In this Project Report we describe the design and implementation of the “Changing Worlds” study, focusing on our experiences and personal reflections as a transdisciplinary collaboration representing the UK, India, Trinidad and Tobago, Guyana, Barbados, the Philippines, and the USA. The project was conceived within the planetary health paradigm, aimed at characterizing and quantifying the impacts of human-mediated environmental systems changes on youth mental health and wellbeing. With input from local youth representatives, we designed and delivered a series of locally adapted surveys asking young people about their mental health and wellbeing, as well as their thoughts, emotions, and perceived agency in relation to the climate crisis and the global COVID-19 pandemic. This project report outlines the principles that guided the study design and describes the conceptual and practical hurdles we navigated as a distributed and interdisciplinary research collaboration working in different institutional, social, and research governance settings. Finally, we highlight lessons learned, specify our recommendations for other collaborative research projects in this space, and touch upon the next steps for our work. This project explicitly balances context sensitivity and the need for quantitative, globally comparable data on how youth are responding to and coping with environmental change, inspiring a new vision for a global community of practice on mental health in climate change

Protocol for process evaluation of ARTEMIS cluster randomised controlled trial: an intervention for management of depression and suicide among adolescents living in slums in India

Introduction There are around 250 million adolescents (10–19 years) in India. The prevalence of mental health-related morbidity among adolescents in India is approximately 7.3%. Vulnerable subpopulations among adolescents such as those living in slum communities are particularly at risk due to poor living conditions, financial difficulty and limited access to support services. Adolescents’ Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) is a cluster randomised controlled trial of an intervention that intends to improve the mental health of adolescents living in slum communities in India. The aim of this paper is to describe the process evaluation protocol for ARTEMIS trial. The process evaluation will help to explain the intervention outcomes and understand how and why the intervention worked or did not work. It will identify contextual factors, intervention barriers and facilitators and the adaptations required for optimising implementation.Methods Case study method will be used and the data will include a mix of quantitative metrics and qualitative data. The UK Medical Research Council’s guidance on evaluating complex interventions, the Reach, Efficacy, Adoption, Implementation and Maintenance Framework and the Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Safety/Side Effects and, Equity criteria will be used to develop a conceptual framework and a priori codes for qualitative data analysis. Quantitative data will be analysed using descriptive statistics. Implementation fidelity will also be measured.Discussion The process evaluation will provide an understanding of outcomes and causal mechanisms that influenced any change in trial outcomes.Ethics and dissemination Ethics Committee of the George Institute for Global Health India (project number 17/2020) and the Research Governance and Integrity Team, Imperial College, London (ICREC reference number: 22IC7718) have provided ethics approval. The Health Ministry’s Screening Committee has approved to the study (ID 2020-9770).Trial registration number CTRI/2022/02/040307

An intervention to reduce stigma and improve management of depression, risk of suicide/self-harm and other significant emotional or medically unexplained complaints among adolescents living in urban slums:protocol for the ARTEMIS project

BACKGROUND: There are around 250 million adolescents in India. Adolescents are vulnerable to common mental disorders with depression and self-harm accounting for a major share of the burden of death and disability in this age group. Around 20% of children and adolescents are diagnosed with/ or live with a disabling mental illness. A national survey has found that suicide is the third leading cause of death among adolescents in India. The authors hypothesise that an intervention involving an anti-stigma campaign co-created by adolescents themselves, and a mobile technology-based electronic decision support system will help reduce stigma, depression, and suicide risk and improve mental health for high-risk adolescents living in urban slums in India. METHODS: The intervention will be implemented as a cluster randomised control trial in 30 slum clusters in each of the cities of Vijayawada and New Delhi in India. Adolescents aged 10 to 19 years will be screened for depression and suicide ideation using the Patient Health Questionnaire (PHQ-9). Two evaluation cohorts will be derived—a high-risk cohort with an elevated PHQ-9 score ≥ 10 and/or a positive response (score ≥ 2) to the suicide risk question on the PHQ-9, and a non-high-risk cohort comprising an equal number of adolescents not at elevated risk based on these scores. DISCUSSION: The key elements that ARTEMIS will focus on are increasing awareness among adolescents and the slum community on these mental health conditions as well as strengthening the skills of existing primary healthcare workers and promoting task sharing. The findings from this study will provide evidence to governments about strategies with potential for addressing the gaps in providing care for adolescents living in urban slums and experiencing depression, other significant emotional or medically unexplained complaints or increased suicide risk/self-harm and should have relevance not only for India but also for other low- and middle-income countries. TRIAL STATUS: Protocol version – V7, 20 Dec 2021 Recruitment start date: tentatively after 15th July 2022 Recruitment end date: tentatively 14th July 2023 (1 year after the trial start date) TRIAL REGISTRATION: The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries (https://www.who.int/clinical-trials-registry-platform/network/primary-registries) Reference No. CTRI/2022/02/040307. Registered on 18 February 2022. The tentative start date of participant recruitment for the trial will begin after 15th July 2022. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13063-022-06539-8