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Carson, D. B., Johansson, A. B., Schaumberg, M. & Hurtig, A.-K. (2024). Addressing the workforce crisis in (rural) social care: a scoping review. International Journal of Health Planning and Management, 39(3), 806-823
Open this publication in new window or tab >>Addressing the workforce crisis in (rural) social care: a scoping review
2024 (English)In: International Journal of Health Planning and Management, ISSN 0749-6753, E-ISSN 1099-1751, Vol. 39, no 3, p. 806-823Article, review/survey (Refereed) Published
Abstract [en]

Background: This scoping review identifies strategies potentially addressing the ‘workforce crisis’ in rural social care. The increasing global demand for social care has been coupled with widely recognised challenges in recruiting and retaining sufficient staff to provide this care. While the social care workforce crisis is a global phenomenon, it is particularly acute in rural areas.

Methods: The review identified 75 papers which (i) had been published since 2017, (ii) were peer reviewed, (iii) concerned social care, (iv) were relevant to rural settings, (v) referenced workforce shortages, and (vi) made recommendations for ways to address those shortages. Thematic synthesis was used to derive three analytical themes with a combined 17 sub-themes applying to recommended strategies and evidence supporting those strategies.

Results: The most common strategies for addressing social care workforce shortages were to improve recruitment and retention (‘recruit and retain’) processes without materially changing the workforce composition or service models. Further strategies involved ‘revitalising’ the social care workforce through redeploying existing staff or identifying new sources of labour. A small number of strategies involved ‘re-thinking’ social care service models more fundamentally. Very few papers specifically considered how these strategies might apply to rural contexts, and evidence for the effectiveness of strategies was sparse.

Conclusion: The review identifies a significant gap in the literature in relation to workforce innovation and placed-based studies in rural social care systems. It is unlikely that the social care workforce crisis can be addressed through continuing attempts to recruit and retain workers within existing service models.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
recruitment and retention, rural social care, social care workforce
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-221017 (URN)10.1002/hpm.3774 (DOI)001153680000001 ()38297468 (PubMedID)2-s2.0-85184158850 (Scopus ID)
Funder
Swedish Research Council Formas, 2016‐00352
Available from: 2024-03-06 Created: 2024-03-06 Last updated: 2024-07-02Bibliographically approved
Mulubwa, C., Zulu, J. M., Hurtig, A.-K. & Goicolea, I. (2024). Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents’ sexual and reproductive health needs in rural Zambia. BMC Public Health, 24(1), Article ID 1228.
Open this publication in new window or tab >>Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents’ sexual and reproductive health needs in rural Zambia
2024 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, no 1, article id 1228Article in journal (Refereed) Published
Abstract [en]

Introduction: Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents’ access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents’ SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents’ SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents.

Methods: Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz’s grounded theory approach was used for the analysis.

Results: We present the core category “being both a grandmother and a CBHW”, which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents’ SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges.

Conclusion: Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people’s sexual and reproductive health.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Adolescents, Community-based, Health workers, Sexual and reproductive health and rights, Zambia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-224244 (URN)10.1186/s12889-024-18685-6 (DOI)001214187100010 ()38702694 (PubMedID)2-s2.0-85192098118 (Scopus ID)
Funder
Swedish Research Council, 2019–04448Swedish Research Council, 2016–05830
Available from: 2024-05-15 Created: 2024-05-15 Last updated: 2024-05-15Bibliographically approved
Richter Sundberg, L., Gotfredsen, A., Christianson, M., Wiklund, M., Hurtig, A.-K. & Goicolea, I. (2024). Exploring cross-boundary collaborationfor youth mental health in Sweden: a qualitative study using the integrativeframework for collaborative governance. BMC Health Services Research, 24, Article ID 322.
Open this publication in new window or tab >>Exploring cross-boundary collaborationfor youth mental health in Sweden: a qualitative study using the integrativeframework for collaborative governance
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2024 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, article id 322Article in journal (Refereed) Published
Abstract [en]

Background: Youth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system.

Methods: We conducted 42 interviews (November 2020 to March 2022) with health and social care professionalsand managers in the youth mental health system in Sweden. Interviews explored participants’ experience andunderstanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergentstudy design using reflexive thematic analysis.

Results: The analysis produced three themes. The first shows that collaboration is considered as essential andimportant, and that it serves diverse purposes and holds multiple meanings in relation to professionals’ roles andresponsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, andtarget levels, and the third captures the challenges and criticisms in collaborating across the youth mental healthlandscape, but also in growing possibilities for future development.

Conclusion: We conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
Keywords
Youth mental health, Youth mental health services, Mental health system, Collaboratio, Governance
National Category
Medical and Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Public health; Public health
Identifiers
urn:nbn:se:umu:diva-221945 (URN)10.1186/s12913-024-10757-y (DOI)38468279 (PubMedID)2-s2.0-85187412932 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00364
Available from: 2024-03-11 Created: 2024-03-11 Last updated: 2024-04-22Bibliographically approved
Nkulu Kalengayi, F. K., Baroudi, M. & Hurtig, A.-K. (2024). Prevalence of perceived discrimination, determinants and associations with self-rated general and sexual health, healthcare utilization and self-perceived integration: a cross-sectional survey of migrants in Sweden. BMC Public Health, 24, Article ID 699.
Open this publication in new window or tab >>Prevalence of perceived discrimination, determinants and associations with self-rated general and sexual health, healthcare utilization and self-perceived integration: a cross-sectional survey of migrants in Sweden
2024 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 24, article id 699Article in journal (Refereed) Published
Abstract [en]

Background: Sweden has welcomed migrants, but attitudes have shifted, becoming hostile due to populism and the growing number of migrants. This has left migrants feeling unwelcome and marginalized. Few studies have examined the extent to which migrants perceive discrimination, who, why, where and its relationships with different outcomes. This study has two aims: to assess the prevalence, reasons, and determinants of perceived discrimination among migrants (1) and its associations with self-rated health, sexual health, healthcare use, and integration (2).

Methods: We analysed data from a 2018 survey on migrants' sexual and reproductive health and rights. The survey included 1740 migrants aged 16 or older. We used descriptive and log-binomial regression analyses to estimate prevalence, crude and adjusted prevalence ratios (APR) with 95% confidence interval (CI).

Results: About 36% of participants perceived discrimination in Sweden, with ethnic origin (62%) and religion (35%) as main reasons. Perceived discrimination occurred in public spaces (47%), schools (33%), internet (20%), work (19%), public services (18%), residential areas (16%), and healthcare settings (10%). Migrant men (APR: 1.26, CI:1.07–1.49), born in Middle East and North Africa (APR: 1.57, CI:1.26–1.95) and South Asia (APR: 1.61, CI:1.27–2.04) regions, with more than 12 years of education (APR: 1.33, CI:1.10–1.60), a non-heterosexual orientation (APR: 1.21, CI: 1.02–1.43), a non-Christian religion (APR: 1.41, CI: 1.10–1.80), economic stress (APR:1.67, CI: 1.44–1.93) or Swedish language skills (APR: 1.24, CI:1.07–1.43) perceived discrimination more than their counterparts. In contrast, the oldest participants (46 years or more) perceived less discrimination (APR:0.55, CI: 0.37–0.80) than the youngest ones (16–25 years). Moreover, perceived discrimination was associated with poor self-rated general (APR:1.72, CI: 1.45–2.04) and sexual health (APR:1.40, CI:1.2–1.64), integration (APR:1.25, CI:1.14–1.37), and healthcare access (APR: 1.48, 1.16–1.89).

Conclusions: This study shows that migrants in Sweden face widespread perceived discrimination based on ethnicity and religion. This can affect their health, healthcare use, and social integration. The study calls for policies and interventions that tackle systemic perceived discrimination, foster inclusion, and guarantee equal opportunities in accessing healthcare and resources for migrants. It also urges support for vulnerable groups who perceive more discrimination, such as migrants from certain regions or under economic stress.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-221889 (URN)10.1186/s12889-024-18160-2 (DOI)38443834 (PubMedID)2-s2.0-85186878462 (Scopus ID)
Funder
Public Health Agency of Sweden
Available from: 2024-03-07 Created: 2024-03-07 Last updated: 2024-07-02Bibliographically approved
Brunet Johansson, A., Hurtig, A.-K. & Nkulu Kalengayi, F. (2024). Sexual and reproductive health and rights for young migrants in Sweden: an ideal-type analysis exploring regional variations of accessible documents. International Journal of Public Health, 69, Article ID 1606568.
Open this publication in new window or tab >>Sexual and reproductive health and rights for young migrants in Sweden: an ideal-type analysis exploring regional variations of accessible documents
2024 (English)In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 69, article id 1606568Article in journal (Refereed) Published
Abstract [en]

Objectives: This study aims to map sexual and reproductive health and rights (SRHR) policies, strategies, and interventions targeting young migrants and describe the patterns of organisation, resources, and services across Sweden’s 21 regions.

Methods: We conducted a document analysis of accessible online documents on SRHR policies, strategies, and interventions targeting young migrants in Sweden’s 21 regions. We used ideal-type analysis of the documents to create a typology, which formed the basis of a ratings system illustrating variations in organisation, resources, and services across regions.

Results: Findings suggest that efforts aimed at addressing young migrants’ SRHR are fragmented and unequal across regions. While SRHR policies and strategies are commonplace, they routinely lack specificity. Available resources vary depending on region and resource type. Additionally, information and interventions, although common, do not consistently meet the specific needs of migrant youths.

Conclusion: This study suggests that fragmented efforts are fuelling geographic inequalities in fulfilling SRHR among young migrants. There is an urgent need to improve national coordination and collaboration between national and local actors in SRHR efforts targeting young migrants to ensure equity.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2024
Keywords
document analysis, migrant health, sexual and reproductive health, sexual and reproductive rights, young adults
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-224256 (URN)10.3389/ijph.2024.1606568 (DOI)001211095100001 ()38698911 (PubMedID)2-s2.0-85191964775 (Scopus ID)
Available from: 2024-05-14 Created: 2024-05-14 Last updated: 2024-07-02Bibliographically approved
Aweesha, H., Hurtig, A.-K., Pulkki-Brännström, A.-M. & San Sebastian, M. (2024). Sudan's health sector partnership: from confined progression to openness and hope to uncertain demise. Development Policy Review, 42(2), Article ID e12757.
Open this publication in new window or tab >>Sudan's health sector partnership: from confined progression to openness and hope to uncertain demise
2024 (English)In: Development Policy Review, ISSN 0950-6764, E-ISSN 1467-7679, Vol. 42, no 2, article id e12757Article in journal (Refereed) Published
Abstract [en]

Motivation: Despite signature of the 2005 Paris Declaration on Aid Effectiveness and subsequent adoption of the effective development cooperation (EDC) principles for better health cooperation, there is a gap in documenting the challenges to implement these commitments at country level. Sudan represents an interesting case study: the country adopted a local health compact in 2014, but for much of the time since the regime was under sanction. Sudan witnessed a revolution in 2018, followed by a counter-coup in 2021.

Purpose: We aim to explore the evolution of Sudan health sector partners’ relationships, perspectives, and adherence to EDC principles of ownership, alignment, and harmonization, while accounting for underlying processes and context changes between 2015 and 2022.

Methods and approach: We collected data through two rounds of interviews, in 2015 (16) and 2022 (8), with stakeholders within the Sudan Health Sector Partnership. We used the framework method for data analysis where responses are coded then sorted into themes.

Findings: Prior to the 2019 revolution cooperation was progressive but restricted, with civil society marginalized and a dominating government. The principles, especially ownership, were misused and misaligned with national priorities driven by donors’ interests and conditions.

The transitional (post-revolution) period witnessed partners’ openness and influx, but unstable leadership and subsequent changes in priorities led to wasted opportunities.

Following the coup, donors adopted a no-contact policy towards the de facto government. Instead, the expectation was that civil society organizations would replace the government as the main implementers. Overall, limited coordination capacity and no sustainability measures were present throughout.

Policy implications: Much of what was observed was down to the often complicated and difficult context of the governance of Sudan. That said, general issues arose including the government's ability to coordinate policy and implementation; the need for stable, legitimate arrangements; and the need to define the role of civil society and to empower civil society organizations. Within a complex and volatile context, revisiting partners’ commitments through joint compact reviews and transparent EDC progress monitoring is crucial.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
alignment, coordination, effective development cooperation, framework analysis, harmonization, health sector, ownership, partnership, Sudan
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-216479 (URN)10.1111/dpr.12757 (DOI)001155272200001 ()2-s2.0-85184249903 (Scopus ID)
Funder
Familjen Erling-Perssons Stiftelse
Available from: 2023-11-13 Created: 2023-11-13 Last updated: 2024-07-02Bibliographically approved
Nkulu Kalengayi, F., Hurtig, A.-K. & Linander, I. (2023). "Discrimination is harder to live with than the disease": an interview study of the perceptions and experiences of sexual and reproductive health and rights among women living with HIV in Sweden. Sexual and Reproductive Health Matters, 31(1), Article ID 2245197.
Open this publication in new window or tab >>"Discrimination is harder to live with than the disease": an interview study of the perceptions and experiences of sexual and reproductive health and rights among women living with HIV in Sweden
2023 (English)In: Sexual and Reproductive Health Matters, E-ISSN 2641-0397, Vol. 31, no 1, article id 2245197Article in journal, News item (Refereed) Published
Abstract [en]

Around 40% of people living with human immunodeficiency virus (HIV) in Sweden are women. However, little is known about their experiences, particularly those related to sexual and reproductive health and rights (SRHR). This study aims to explore perceptions and experiences of SRHR among women living with HIV (LWH). Twelve interviews were conducted with women LWH from September to October 2019 and analysed using thematic analysis. The central theme describing participants’ experiences of social relationships, intimate encounters and reproductive life, “Discrimination is harder to live with than the disease itself”, is based on three themes that contain subthemes. Theme 1 describes how participants reconsider and reorient their sexual and reproductive life after diagnosis. Theme 2 highlights how (mis)perceptions of HIV affect sexual and reproductive life and lead to abusive treatment and internalisation. Theme 3 describes a paradoxical shift of responsibilities where participants experience being compelled to take greater responsibility in some situations and stripped of the right to decide in others. This study suggests that despite notable progress in HIV treatment, stigma and discrimination stemming from outdated beliefs and (mis)conceptions, ambiguous policies and guidelines, and unequal access to information affect SRHR experiences of women LWH more than the virus itself. The results emphasise the need to: update knowledge within healthcare settings and among the public; clarify ambiguous legislations and guidelines; ensure equal access to information to enable all women LWH to take informed decisions, make fully informed choices and realise their SRHR; and consider the diversity of women LWH and enable shared decision-making.

Abstract [fr]

En Suède, les femmes représentent près de 40% des personnes vivant avec le virus de l’immunodéficience humaine (VIH). Pourtant, on sait peu de choses sur leurs expériences, en particulier celles qui se rapportent à la santé et aux droits sexuels et reproductifs. Cette étude souhaite explorer les perceptions et les expériences de la santé et des droits sexuels et reproductifs chez les femmes vivant avec le VIH. Douze entretiens ont été menés avec des femmes séropositives entre septembre et octobre de 2019, et ont fait l’objet d’une analyse thématique. « La discrimination est plus difficile à vivre que la maladie elle-même » est le thème central qui décrit les expérience des participantes en matière de relations sociales, de rencontres intimes et de vie reproductive. L’analyse est fondée sur trois thèmes qui contiennent des sous-thèmes. Le thème 1 décrit comment les participantes revoient et réorientent leur vie sexuelle et reproductive après le diagnostic. Le thème 2 met en lumière comment les idées (erronées) sur le VIH influent sur la vie sexuelle et reproductive et conduisent à des traitements abusifs et à l’intériorisation. Le thème 3 décrit un déplacement paradoxal des responsabilités où les participantes sont contraintes d’assumer une plus grande responsabilité dans certaines situations et sont privées du droit de décider dans d’autres. Cette étude suggère qu’en dépit des progrès notables accomplis dans le traitement du VIH, la stigmatisation et la discrimination découlant de croyances obsolètes et d’idées erronées, de politiques et de directives ambiguës, et d’un accès inégal à l’information influent davantage sur les expériences des femmes vivant avec le VIH en matière de santé et droits sexuels et reproductifs que le virus lui-même. Les résultats mettent en évidence la nécessité: de mettre à jour les connaissances dans les établissements des soins de santé et parmi le grand public; de clarifier les législations et les directives ambiguës; de garantir l’accès sur un pied d’égalité à l’information afin de permettre à toutes les femmes vivant avec le VIH de prendre des décisions éclairées, de faire des choix pleinement informés et de réaliser leurs droits à la santé sexuelles et reproductive; de tenir compte de la diversité des femmes vivant avec le VIH et de permettre une prise de décision partagée.

Abstract [es]

Aproximadamente el 40% de las personas que viven con el virus de inmunodeficiencia humana (VIH) en Suecia son mujeres. Sin embargo, no se sabe mucho sobre sus experiencias, en particular aquellas relacionadas con la salud y los derechos sexuales y reproductivos (SDSR). Este estudio pretende explorar las percepciones y experiencias de SDSR entre mujeres que viven con VIH (MVVIH). Se realizaron 12 entrevistas con MVVIH de septiembre a octubre de 2019, las cuales se analizaron con análisis temático. “Es más difícil vivir con discriminación que con la enfermedad” es el tema central que describe las experiencias de las participantes con relaciones sociales, encuentros íntimos y su vida reproductiva. Se basa en tres temas que contienen subtemas. El tema 1 describe cómo las participantes reconsideran y reorientan su vida sexual y reproductiva después del diagnóstico. El tema 2 destaca cómo las percepciones (erróneas) del VIH afectan la vida sexual y reproductiva y propician un trato abusivo e internalización. El tema 3 describe un cambio paradójico de responsabilidades mediante el cual las participantes se sienten obligadas a asumir mayor responsabilidad en algunas situaciones y despojadas de su derecho a decidir en otras. Este estudio indica que, a pesar de notables avances en el tratamiento del VIH, el estigma y la discriminación derivados de creencias y conceptos (erróneos) obsoletos, políticas y directrices ambiguas, y acceso no equitativo a la información afectan las experiencias de SDSR de las MVVIH más que el virus. Los Resultados Ponen de Relieve la Necesidad de: Actualizar los Conocimientos en los Establecimientos de Salud y en el Público; aclarar legislaciones y directrices ambiguas; garantizar acceso equitativo a la información para que todas las MVVIH puedan tomar decisiones informadas, hacer elecciones completamente informadas y realizar su SDSR; y considerar la diversidad de MVVIH y permitir la toma de decisiones compartida.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2023
Keywords
HIV infection, Women, Sexual health, Reproductive health, Reproductive rights, Disclosure, Stigma, Discrimination, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-214242 (URN)10.1080/26410397.2023.2245197 (DOI)37671828 (PubMedID)2-s2.0-85169766019 (Scopus ID)
Funder
Public Health Agency of Sweden
Available from: 2023-09-09 Created: 2023-09-09 Last updated: 2024-07-02Bibliographically approved
Amani, P. J., San Sebastian, M., Hurtig, A.-K., Kiwara, A. D. & Goicolea, I. (2023). Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania: an explorative qualitative study. BMC Public Health, 23(1), Article ID 459.
Open this publication in new window or tab >>Healthcare workers´ experiences and perceptions of the provision of health insurance benefits to the elderly in rural Tanzania: an explorative qualitative study
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2023 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 23, no 1, article id 459Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Healthcare workers play an important part in the delivery of health insurance benefits, and their role in ensuring service quality and availability, access, and good management practice for insured clients is crucial. Tanzania started a government-based health insurance scheme in the 1990s. However, no studies have specifically looked at the experience of healthcare professionals in the delivery of health insurance services in the country. This study aimed to explore healthcare workers' experiences and perceptions of the provision of health insurance benefits for the elderly in rural Tanzania.

METHODS: An exploratory qualitative study was conducted in the rural districts of Igunga and Nzega, western-central Tanzania. Eight interviews were carried out with healthcare workers who had at least three years of working experience and were involved in the provision of healthcare services to the elderly or had a certain responsibility with the administration of health insurance. The interviews were guided by a set of questions related to their experiences and perceptions of health insurance and its usefulness, benefit packages, payment mechanisms, utilisation, and availability of services. Qualitative content analysis was used to analyse the data.

RESULTS: Three categories were developed that describe healthcare workers´ experiences and perceptions of delivering the benefits of health insurance for the elderly living in rural Tanzania. Healthcare workers perceived health insurance as an important mechanism to increase healthcare access for elderly people. However, alongside the provision of insurance benefits, several challenges coexisted, such as a shortage of human resources and medical supplies as well as operational issues related to delays in funding reimbursement.

CONCLUSION: While health insurance was considered an important mechanism to facilitate access to care among rural elderly, several challenges that impede its purpose were mentioned by the participants. Based on these, an increase in the healthcare workforce and availability of medical supplies at the health-centre level together with expansion of services coverage of the Community Health Fund and improvement of reimbursement procedures are recommended to achieve a well-functioning health insurance scheme.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Elderly, Health insurance, Healthcare workers, Qualitative, Rural, Tanzania
National Category
Public Health, Global Health, Social Medicine and Epidemiology Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-205785 (URN)10.1186/s12889-023-15297-4 (DOI)000946288900009 ()36890474 (PubMedID)2-s2.0-85149684611 (Scopus ID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2023-03-28 Created: 2023-03-28 Last updated: 2023-09-05Bibliographically approved
Jonsson, F., Blåhed, H. & Hurtig, A.-K. (2023). More than meets the eye: a critical discourse analysis of a Swedish health system reform. BMC Health Services Research, 23(1), Article ID 1226.
Open this publication in new window or tab >>More than meets the eye: a critical discourse analysis of a Swedish health system reform
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1226Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In line with international trends acknowledging the importance of Primary Health Care (PHC) for improving population health and reducing health inequalities, the Swedish health system is undergoing a restructuring towards the coordinated development of a modern, equitable, accessible, and effective system, with PHC principles and functions at its core. Since discursive analyses of documents underpinning PHC reforms are scarce in Sweden and beyond, the aim of this study was to explore how the reorientation towards good quality and local health care has been represented in official government reports.

METHODS: Based on a policy-as-discourse analysis, four Swedish Government Official Reports underpinning the good quality and local health care reform were interrogated following four questions of Bacchi's "What's the Problem Represented to be?" (WPR) approach. By applying the first WPR question, concrete proposals guiding the reorientation were identified, analyzed and thematized into candidate problem representations. These problem representations were then analyzed in relation to previous empirical and conceptual research considering WPR questions two and three, which resulted in the development of three problem representations. Potential silences that the problem representations might produce were then identified by applying WPR question four.

RESULTS: The three problem representations connected the Swedish health system "problem" to a narrow mission, a siloed structure, and a front-line service disconnected, especially from the needs and preferences of individual patients. By representing the problem along these lines, the analysis also illustrated how the policy reorientation towards good quality and local health care risk silencing important PHC aspects such as health promotion, equitable access, and human resources.

CONCLUSION: The results from this study indicate that as discursively framed within concrete proposals, government official reports in Sweden represent the health system problem in particular ways and with these problem representations overlooking several aspects that are central to a health system characterized by PHC principles and functions. In the continued reorientation towards good quality and local health care, these silences might need to be acknowledged.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Discourse, Policy analysis, Primary health care, Reform, Sweden, WPR
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-216605 (URN)10.1186/s12913-023-10212-4 (DOI)37946232 (PubMedID)2-s2.0-85176104373 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2017-00183
Available from: 2023-11-13 Created: 2023-11-13 Last updated: 2023-11-16Bibliographically approved
San Sebastian, M., Maluka, S., Kamuzora, P., Kapologwe, N. A., Kigume, R., Masawe, C. & Hurtig, A.-K. (2023). Role of health facility governing committees in strengthening social accountability to improve the health system in Tanzania: protocol for a participatory action research study. BMJ Open, 13(6), Article ID e067953.
Open this publication in new window or tab >>Role of health facility governing committees in strengthening social accountability to improve the health system in Tanzania: protocol for a participatory action research study
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2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 6, article id e067953Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Social accountability is important for improving the delivery of health services and empowering citizens. The government of Tanzania has transferred authority to plan, budget and manage financial resources to the lower health facilities since 2017. Health facility governing committees (HFGCs) therefore play a pivotal role in ensuring social accountability. While HFGCs serve as bridges between health facilities and their communities, efforts need to be made to reinforce their capacity. This project therefore aims to understand whether, how and under what conditions informed and competent HFGCs improve social accountability.

METHODS AND ANALYSIS: This study adopts a participatory approach to realist evaluation, engaging members of the HFGCs, health managers and providers and community leaders to: (1) map the challenges and opportunities of the current reform, (2) develop an initial programme theory that proposes a plan to strengthen the role of the HFGCs, (3) test the programme theory by developing a plan of action, (4) refine the programme theory through multiple cycles of participatory learning and (5) propose a set of recommendations to guide processes to strengthen social accountability in the Tanzanian health system. This project is part of an ongoing strong collaboration between the University of Dar es Saalam (Tanzania), and Umeå University (Sweden), providing opportunities for action learning and close interactions between researchers, decision-makers and practitioners.

ETHICS AND DISSEMINATION: Ethical approval to conduct the study was obtained from the National Ethical Review Committee in Tanzania- National Institute for Medical Research (NIMR/HQ/R.8a/Vol.IX/3928). Permissions to conduct the study in the health facilities were given by the President's Office Regional Administration and Local Government and relevant regional and district authorities. The results will be published in open-access, peer-reviewed journals and presented at scientific conferences.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
Health policy, Public health, Quality in health care
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-209553 (URN)10.1136/bmjopen-2022-067953 (DOI)37263689 (PubMedID)2-s2.0-85160967355 (Scopus ID)
Funder
Swedish Research Council, 2021-04218
Available from: 2023-06-12 Created: 2023-06-12 Last updated: 2023-08-28Bibliographically approved
Projects
Community-based interventions for strengthening adolescent sexual reproductive health and rights: how can they be integrated and sustained? A multiple case study from Zambia [2016-05830_VR]; Umeå UniversityStrengthening community-based health systems through e-health innovations? a realist evaluation of Virtual Health Rooms in northern Sweden [2017-00183_Forte]; Umeå University; Publications
Jonsson, F., Carson, D. B., Goicolea, I. & Hurtig, A.-K. (2022). Strengthening Community Health Systems Through Novel eHealth Initiatives? Commencing a Realist Study of the Virtual Health Rooms in Rural Northern Sweden. International Journal of Health Policy and Management, 11(1), 39-48
How does Integration of sexuality education in schools shape sexuality decisions among adolescents? A community based participatory research driven realist evaluation in Zambia [2019-04448_VR]; Umeå University
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7087-1467

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