Engagement of non-governmental organisations in moving towards universal health coverage: a scoping review

Equity in HIV/AIDS services requires optimization of mainstreaming sectors in Ethiopia

BACKGROUND

Mainstreaming HIV and AIDS across sectors is crucial to close the disparities in service provision and coverage. However, evidence has shown that certain social groups are left behind in receiving HIV/AIDS services. The objective of this study was twofold: to understand the reasons behind the existing inequities and to explore challenges of equity in HIV/AIDS services in the Amhara region of Ethiopia.

METHODS

Twenty-two adults (aged 26-57 years) from eighteen sectors that are mainstreaming HIV and AIDS were purposefully selected until the point of saturation and participated in a semi-structured in-depth interview conducted between January 20 and February 17, 2023. Interviewees were asked to describe their mainstreaming experiences in equitable HIV/AIDS services, reflect on the challenges and barriers that impede equitable service provision, or explain the reasons behind the existence of inequity in HIV/AIDS services. The interviews were audio recorded, transcribed, translated, and iteratively analysed, with early analysis informing subsequent interviews. An inductive-reflexive thematic analysis was conducted, whereby themes and subthemes were identified, and the relationships between subthemes and patterns were critically reviewed.

RESULTS

The challenges to equitable HIV/AIDS service provision were grouped into eight thematic areas: (1) changing contexts that shifts public and government attention to emerging diseases, war and political instability, and poverty; (2) leadership-related, such as the lack of supervision and monitoring, not politicising HIV/AIDS (not providing political attention to HIV/AIDS) and weak intersectoral collaboration; (3) financial constraints due to a random budgeting and contract interruption with non-governmental organisations (NGOs); (4) lack of resources due to scarcity and unfair distribution; (5) inadequate skilled personnel due to inadequate numbers and lack of continuous professional and career development; (6) lack of equity-related evidence-based tools and guidelines; (7) inadequate understanding of equity due to lack of training and misunderstanding, and lack of access to equity-oriented tools and guidelines; and (8) cultural norms, values, and perceptions.

CONCLUSIONS

This study identified critical challenges faced in the equitable HIV/AIDS services provision. To achieve equity in HIV/AIDS services, mainstreaming sectors need to invest in mechanisms to sustain services in emergency situations; identify effective leaders to maintain collaboration, monitoring, and evaluation; institutionalise responsive budgeting and establish alternative funds to maintain non-governmental organisations initiatives; provide continuous up-to-date training and create a common evidence-sharing platform; implement proper recruitment, education, and professional development of HIV/AIDS focal persons; and promote and practice culturally safe care. It is, therefore, essential to optimise sectors that are mainstreaming HIV/AIDS and incorporate equity considerations in their strategic plans and working guidelines.

Perceived Well-Being among Adults with Diabetes and Hypertension: A National Study

Perceived health and distresses are associated with the practice of lifestyle modifications, which increases the risk of diabetes and hypertension-related complications. This study aimed to define the characteristics and distribution of perceived health and distresses across the states between people with diabetes and hypertension. Data were derived from a national survey of US adults aged ≥18 years who were interviewed via phone call. Perceived health and distresses were assessed through corresponding questions. An amount of 333,316 respondents (43,911 with diabetes and 130,960 with hypertension) were included in the analysis; 61.8% of people with diabetes and 74.5% of people with hypertension reported having good or better health, while residents in the Southwest region perceived poor health statuses and more distresses. Education level (diabetes: odds ratio [OR] = 0.47-0.79, hypertension: OR = 0.42-0.76), employment status level (diabetes: OR = 1.40-2.22, hypertension: OR = 1.56-2.49), and household income (diabetes: OR = 0.22-0.65, hypertension: OR = 0.15-0.78) were significant factors associated with poorly perceived health among people with diabetes and hypertension, and the use of technology and strategies for policymakers are suggested to improve the perceived health status in this regard.

Scaling a group intervention to promote caregiver mental health in Uttarakhand, India: A mixed-methods implementation study

Caregivers are integral to health and social care systems in South Asian countries yet are themselves at higher risk of mental illness. Interventions to support caregiver mental health developed in high-income contexts may be contextually inappropriate in the Global South. In this mixed-methods study, we evaluated the implementation and scaling of a locally developed mental health group intervention for caregivers and others in Uttarakhand, India. We describe factors influencing implementation using the updated Consolidated Framework for Implementation Research, and selected implementation outcomes. Key influencing factors we found in common with other programs included: an intervention that was relevant and adaptable; family support and stigma operating in the outer setting; training and support for lay health worker providers, shared goals, and relationships with the community and the process of engaging with organisational leaders and service users within the inner setting. We identified further factors including the group delivery format, competing responsibilities for caregivers and opportunities associated with the partnership delivery model as influencing outcomes. Implementation successfully reached target communities however attrition of 20% of participants highlights the potential for improving outcomes by harnessing enablers and addressing barriers. Findings will inform others implementing group mental health and caregiver interventions in South Asia.

Feasibility of Developing Audiovisual Material for Training Needs in a Vietnam Orphanage: A Mixed-Method Design

Disabled children living in orphanages in low-income countries may not have access to the therapy they need. The COVID-19 pandemic has complicated the situation dramatically, making online training activities a possible innovative option to meet the real needs of local staff. This study aimed to detect the training needs of the local staff of an orphanage in Vietnam, as well as develop an audiovisual training material and measure its feasibility. Training needs were identified through a focus group carried out by the volunteers of Fisios Mundi, a nongovernmental organization. The audiovisual training material was developed to meet these specific needs. Lastly, its feasibility was evaluated, in terms of both content and format, through an ad hoc questionnaire. Nine volunteers participated in the project. Twenty-four videos were created and structured around five themes. This study expands the body of knowledge on how an international cooperation project can be developed in a pandemic situation. The audiovisual training material content and format created in this project was considered by the volunteers as very feasible and useful for training the staff of a Vietnamese orphanage.

Role of civil society in health care: Mechanisms for realizing universal health coverage in vulnerable communities of India

The role of civil society as a partner in the delivery of primary health care is well-established. The pandemic placed a great burden on the existing public health system and civil society stepped forward not only to help the vulnerable population to mitigate challenges that subsequently arose but also to fill the gaps the pandemic exposed in India's health care system. The objective of this paper is to provide mechanisms for realizing universal health coverage by strengthening primary health care from the perspective of civil society. The paper uses examples of efforts of SNEHA, a non-profit organization working on the health of women and children in informal settlements of Mumbai and other civil society organizations working with vulnerable or hard-to-reach populations. We use existing literature, field data, reports and published work over the years. We find that civil society helps the health system to connect with difficult-to-reach populations and achieve wider coverage. They can also build the capacity of frontline staff in the public systems in formal and informal ways. They can recommend ways to change the attitudes and motivations of these workers. Civil society organizations with their close connection with the community can play the part of a "gap-filler" and data messenger. Finally, they can refer people to appropriate health facilities minimizing out-of-pocket expenditure on health.

Nongovernmental organizations supporting the HIV service delivery response in Africa - an engine for innovation

PURPOSE OF REVIEW

Nongovernmental organizations (NGOs) are pivotal to the HIV response, supporting access to HIV services since the start of the epidemic. Against the backdrop of the impact of NGOs, is the recognition of the unique role that local NGOs bring to the HIV response, drawing from their deep understanding of the context and knowledge of local health problems.

RECENT FINDINGS

The Centre for Infectious Disease Research in Zambia (CIDRZ) is one such NGO. Through various implementation science research and programs, CIDRZ has supported the Zambian government's HIV response. As Zambia moves closer to epidemic control, understanding reasons for patient disengagement from care and patient preferences for HIV care demonstrated by CIDRZ have contributed to global and national HIV treatment and care guidelines.

SUMMARY

This paper offers a case study for how NGOs like CIDRZ can serve as health system-wide catalyst to identify, integrate, and scale up evidence-based practices for HIV prevention, care, and treatment. It draws from the public health literature, CIDRZ extensive program and research experience and implementation science theory, to illustrate key strategies that can be deployed by local NGOs to spark innovation, quality improvement, and support governments to achieve and sustain HIV epidemic control.

Role of non-governmental organizations in moving toward universal health coverage: A case study in Iran

Background

Delivering essential health services through non-governmental organizations (NGOs) could facilitate moving toward universal health coverage (UHC), especially in low- and middle-income countries. This study investigates the viewpoints of Iranian health system experts and executive stakeholders on the role of NGOs in moving toward UHC.

Method

We conducted 33 semi-structured interviews with health policymakers, NGO representatives at the national and provincial level, and other key informants and analyzed using content analyses methods, using MAXQDA 12. The inductive-deductive approach was used for qualitative data analyses.

Result

Based on the thematic analysis of interviews and document reviews, nine main themes and one hundred and five sub-themes were identified. Each theme was categorized based on NGO-, society-, and government-related factors.

Conclusion

Recognizing the critical role of NGOs and their contribution in moving toward UHC is essential, particularly in the local context. Collaboration between NGO stakeholders and the government could facilitate moving toward UHC.

Interventions to increase participation of NGOs in preventive care: A scoping review

Background and Aims

Nongovernmental organizations (NGOs) have enormous potential to effectively prevent and manage diseases; however, little research is available on interventions used to improve NGOs' participation in this area. A scoping review was conducted to identify options proposed or implemented to improve the participation of the NGOs in preventive care.

Methods

Pubmed, Web of Science, and ProQuest were extensively searched. Google Scholar was also searched to find potential studies related to the subject. Relevant keywords were used in the English language. The reference list of relevant studies was also scanned. Studies were screened with defined inclusion and exclusion criteria. Relevant data were then extracted. Two individuals independently screened and extracted studies. The interventions implemented or proposed to promote the participation of the NGOs in the implementation of preventive interventions were deductively identified and classified.

Results

Eighteen articles were included in our review. We identified 31 interventions and categorized them into 11 strategies, including (1) building strong collaboration among NGOs and with governments; (2) expanding networks and sustained relations among NGOs; (3) evaluating the NGOs' performance; (4) increasing intersectoral collaboration; (5) advocating for the role of NGOs; (6) supporting NGOs from the side of government; (7) empowering the abilities and capabilities of NGOs; (8) defining the precise roles and responsibilities of the parties; (9) strengthening the health system governance; (10) increasing the health literacy of the community; and (11) developing required regulations, rules, and policies. None of the interventions identified had evidence of its effectiveness.

Conclusion

The current evidence on effective interventions to strengthen NGOs' participation in implementing health care is scanty. It means there is an information gap in the effect of interventions to improve NGOs' participation in health.