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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.

Background: Tanzania has been promoting community participation in health, either directly or through health facility governing committees (HFGCs), as part of its wider, ongoing health system reforms since the 1990s. Although some studies have assessed the functioning of the HFGCs, little is known about community knowledge and involvement in their activities.

Methods: A cross-sectional survey assessing community awareness and participation in HFGCs was conducted between July and October 2022, involving two rural districts of Tanzania, which were selected based on their performance: Handeni, showing low performance and Mbarali, high performance. A total of 1,184 household heads living in the catchment areas of diverse facilities were involved. Frequencies and percentages were calculated overall and by district. The Chi-squared test was applied to assess statistically significant differences in knowledge, awareness, and participation between the districts.

Results: The results revealed that 85.3% of the participants were unaware of the presence of the HFGCs and 91.7% did not know their roles. Additionally, 87% had neither heard nor seen any announcement about the selection of committee members. Only 14.5% considered that HFGCs were accountable to the community. While 96.7% of the respondents said they had never received any feedback from the HFGCs, only 8.1% reported that HFGCs were collecting views from the community. Regarding participation, 79.9% believed that the community had not been supporting their activities; however, 44.7% believed that the committees were important in improving health service delivery. Feedback and support were more common in Handeni.

Conclusion: The level of community awareness of and participation in HFGCs was very low in both districts. The Ministry of Health and the President’s Office of Regional Administration and Local Government should implement an action plan to raise community awareness of the role of the HFGCs and their significance in promoting social accountability within the Tanzanian health system.

BACKGROUND: Previous research has highlighted inequalities in access to Swedish youth clinics (YCs). These inequalities exist not only between non-migrant and young migrant populations but also within various migrant groups. OBJECTIVES: To assess awareness and utilization of Swedish YCs among migrants enrolled in Swedish language programmes and explore associated factors.

METHODS: This cross-sectional study involved 1,112 migrants aged 15-65. The analytical sample included 642 (57%) participants who answered the main outcome question about awareness of YCs. Descriptive statistics, bivariate, and multivariate log-binomial regression analyses using a Bayesian approach were applied to summarize the data and identify factors associated with awareness and utilization of YCs among migrants.

RESULTS: The results revealed that 30% of all participants and 40% of the participants aged 15-25 years had heard of YCs. Additionally, 23% of the target group (15-25 years) had ever visited one. During descriptive and bivariate analyses, socio-demographic variations were evident in YCs' awareness and utilization. However, in multivariate analyses, only the associations between awareness and year of arrival, and YCs' utilization and year of arrival and type of residence permit, remained statistically significant.

CONCLUSION: This study highlights the level of awareness of YCs among migrants attending Swedish language programmes and their utilization by those aged 15-25 years, potentially impacting their access to crucial services and resources. Targeted interventions and sustainable strategies beyond one-time interventions are essential to address the specific needs of different socio-demographic groups and ensure equitable access to YCs' information and services.

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.

Introduction: Social accountability initiatives are considered a way to address inefficiencies and improve overall health system performance. Tanzania has introduced Health Facility Governing Committees (HFGCs) to improve social accountability of the health system. However, information on how communities perceive these committees is lacking. This study aimed to assess the prevalence and social determinants of the HFGCs accountability from the community perspective in Tanzania.

Methods: The research employed a cross-sectional survey design in two Tanzanian districts (Handeni and Mbarali) selected for their contrasting health performance. Data collection took place from July to October 2022, involving 1184 households in 31 villages/mitaa. The study measured social accountability through a set of six questions, focusing on community support, sensitization, feedback, trust, engagement, and overall accountability of HFGCs. Socio-demographic data such as sex, age, education, occupation, type of health facility and district were also collected and analyzed using linear regression to identify factors influencing perceptions of accountability.

Results: The findings revealed a low prevalence of social accountability as measured by the variables of community awareness and engagement with the HFGCs. Only a small percentage of respondents felt adequately informed or involved in the activities of these committees. Social determinants such as higher education levels and certain occupations, such as business and retirement and those living in Handeni district, correlated positively with a better perception of social accountability.

Conclusion: The study highlights significant challenges in the operational effectiveness of HFGCs in Tanzania, with a notable disconnect between these bodies and the communities they serve. Despite the theoretical framework for social accountability, actual community engagement remains low, impacting the overall efficacy of health governance at the local level. Future research should focus on improving community awareness and participation in these committees to improve their functionality and accountability, thereby aligning with national health objectives and local needs.

Introducción: Las iniciativas de responsabilidad social son una estrategia para abordar las ineficiencias y mejorar el desempeño del sistema de salud. Tanzania ha implementado los Comités de Gobierno de los Centros Sanitarios (CGCS) para reforzar esta responsabilidad social. No obstante, falta información sobre la percepción comunitaria de estos Comités. Este estudio buscó evaluar la prevalencia y los factores sociales que influyen en la responsabilidad de los CGCS desde la perspectiva comunitaria en Tanzania.

Métodos: La investigación utilizó una encuesta transversal en dos distritos tanzanos (Handeni y Mbarali) seleccionados por sus diferencias de rendimiento. La recopilación de datos se llevó a cabo entre julio y octubre de 2022, abarcando 1,184 hogares de 31 aldeas/vecindarios. El estudio midió la responsabilidad social a través de seis preguntas que abordan el apoyo comunitario, la sensibilización, la retroalimentación, la confianza, el compromiso y la responsabilidad general de los CGCS. Además, se recogieron datos sociodemográficos (sexo, edad, educación, ocupación, tipo de centro de salud y distrito) que se analizaron mediante regresión lineal para identificar los factores que influyen en la percepción de responsabilidad.

Resultados: Los resultados mostraron una baja prevalencia de responsabilidad social, particularmente en las variables de concienciación y compromiso de la comunidad hacia los CGCS. Solo un pequeño porcentaje de los encuestados se sentía adecuadamente informado o involucrado en las actividades de estos Comités. Factores como un mayor nivel educativo, determinadas ocupaciones (tener un negocio o estar jubilado) y vivir en el distrito de Handeni se correlacionaron positivamente con una percepción más favorable de la responsabilidad social.

Conclusiones: El estudio resalta importantes desafíos en la eficacia operativa de los CGCS en Tanzania, mostrando una desconexión entre estos comités y las comunidades que atienden. A pesar del marco teórico de responsabilidad social, la participación comunitaria sigue siendo limitada, lo que afecta la eficacia de la gobernanza sanitaria a nivel local. Futuros estudios deberían enfocarse en fortalecer la sensibilización y participación comunitaria en estos comités, alineándose con los objetivos de salud nacionales y necesidades locales.

Introduction: Social accountability initiatives are considered a way to address inefficiencies and improve overall health system performance. Tanzania has introduced Health Facility Governing Committees (HFGCs) to improve social accountability of the health system. However, information on how communities perceive these committees is lacking.  This study aimed to assess the prevalence and social determinants of the HFGCs accountability from the community perspective in Tanzania.

Methods: The research employed a cross-sectional survey design in two Tanzanian districts (Handeni and Mbarali) selected for their contrasting health performance. Data collection took place from July to October 2022, involving 1184 households in 31 villages/mitaa. The study measured social accountability through a set of six questions, focusing on community support, sensitization, feedback, trust, engagement, and overall accountability of HFGCs. Socio-demographic data such as sex, age, education, occupation, type of health facility and district were also collected and analyzed using linear regression to identify factors influencing perceptions of accountability.

Results: The findings revealed a low prevalence of social accountability as measured by the variables of community awareness and engagement with the HFGCs. Only a small percentage of respondents felt adequately informed or involved in the activities of these committees. Social determinants such as higher education levels and certain occupations, such as business and retirement and those living in Handeni district, correlated positively with a better perception of social accountability.

Conclusion: The study highlights significant challenges in the operational effectiveness of HFGCs in Tanzania, with a notable disconnect between these bodies and the communities they serve. Despite the theoretical framework for social accountability, actual community engagement remains low, impacting the overall efficacy of health governance at the local level. Future research should focus on improving community awareness and participation in these committees to improve their functionality and accountability, thereby aligning with national health objectives and local needs.

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.

Background: Since the 1990s, Tanzania has actively encouraged stakeholder participation in health services through Health Facility Governing Committees (HFGCs) to promote social accountability within its broader health system reforms. While previous studies have explored the functionality of the HFGCs, this study aimed to understand whether stakeholder participation in the HFGCs contributes to promoting social accountability in the health system.

Methods: Between July and October 2022, a qualitative study in two districts of Tanzania was carried out. Selected participants, knowledgeable about HFGCs, included facility managers, HFGC members representing diverse stakeholders in the committees, local government leaders, district health secretaries, and religious leaders. Twenty in-depth interviews were conducted and analysed thematically.

Results: Findings revealed low stakeholder participation in the committees´ activities, partly due to the committees´ inability to effectively sensitize and mobilize them. Inadequate support from local government leaders and the dominance of the facility managers in the committees´ activities, also affected the committees´ role as promoters of social accountability.

Conclusion: The HFGCs in Tanzania have faced challenges in promoting social accountability due to weak stakeholder participation. Key issues include limited awareness of HFGCs, inadequate mobilization, and insufficient training, supervision, and guidelines from district councils. Additionally, flawed election processes, leadership interference, lack of political support, and limited financial resources undermined the committees’ effectiveness. To improve engagement, district councils should enhance stakeholder sensitization, build HFGC capacity, ensure that facilities allocate 5% of their budgets for committee activities, monitor performance, and encourage local government support for HFGCs.

Introduction: Many adolescents in low- and middle-income countries face challenges related to sexual and reproductive health and rights, which are exacerbated by gender inequalities. One approach to address these issues is the integration of Comprehensive Sexuality Education (CSE) in schools. However, the process of effectively implementing CSE in these settings is often suboptimal. There is a significant lack of research exploring the specific conditions and methods that effectively lead to enhanced knowledge and improved decision-making in sexuality and gender equality among adolescents through CSE. This realist evaluation protocol will address this gap by exploring how the nature and pattern through which CSE is provided has a) changed adolescents’ knowledge regarding sexuality and gender relations and b) shaped adolescents’ capacity to make positive decisions.

Methods: This study uses a multiple-case design, combining realist evaluation with participatory action research methods to explore Comprehensive Sexuality Education (CSE) integration across multiple levels in Eastern province—from provincial to community levels. Data collection will occur in phases, utilizing interviews, photovoice, drawings, reviews, and observations. The study involves several key steps: 1) identifying challenges to CSE integration, 2) creating an initial theory or action plan that explains how CSE promotes positive decisions among adolescents about sexuality, 3) testing this theory through case studies, and 4) refining the theory and formulating recommendations to improve future CSE integration. Additionally, the study will document informal, contextual, and horizontal factors (ICAMO configurations) that influence the integration of CSE at the school level and affect adolescents' understanding and decision-making regarding sexuality and gender relations.

Discussion: This study will contribute to the development of strategies for effectively facilitating the integration process of similar programmes within the school system. The study will further contribute to methodological development in participatory research driven realist evaluation.