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Bakgrund: Sveriges regering har nyligen antagit en nationell strategi för psykisk hälsa och suicidprevention, där samiska perspektiv för första gången inkluderats. I rapporter om ungas psykiska hälsa, och samisk folkhälsa, saknas dock unga samers perspektiv. Den här rapporten fyller den kunskapsluckan, genom att undersöka och belysa unga samers hälsa och välbefinnande i Sverige,med särskilt fokus på psykisk hälsa.

Metoder: Rapporten har tagits fram i nära samverkan med den samiska ungdomsorganisationen Sáminuorra och bygger på kvalitativa data insamlade 2024 och kvantitativa data insamlade 2021. Totalt deltog 15 unga samer i intervjuer(15–30 år), 16 i webbenkäter (15–30 år), och 364i en befolkningsbaserad folkhälsoenkät (18–29 år). Kvalitativa data har analyserats med tematisk analys. Kvantitativa data har analyserats med deskriptiv statistik och skillnader mellan grupper har undersökts genom bivariat regressionsanalys.

Kvalitativa resultat: Genom analysen identifierades ett huvudtema och fyra underteman. Huvudtemat ”Det är hemskt och magiskt samtidigt” handlar om hur den samiska identiteten innebär både positiva och negativa sidor i de ungas liv. Detta återkommer i alla underteman. Undertemat ”Livsbalans” belyser hur unga samer (liksom andra unga) upplever stress och försöker få goda levnadsvanor och relationer att fungera för bättre välmående. Deltagarna beskriver stolthet i undertemat ”Samisk identitet”, men också utmaningar kopplade till att ta den samiska kampen – att försvara och förklara sin kultur för andra. Detta återkommer i ”Samhällets spelregler”, som också speglar hur bristande stöd och förståelse från majoritetssamhället försvårar livssituationen, samt hur rasism, diskrimineringoch kränkningar underminerar välmående. Slutligen visar analysen i ”Vårdens villkor” att deltagarna upplever att den svenska hälso- och sjukvården behöver stärka sin kunskap och tillgänglighet för att unga samer ska kunna få likvärdig vård och stöd.

Kvantitativa resultat: Analysen av kvantitativa data redovisas beskrivande som andelar (procent) av unga samer och jämnåriga i Sverige, fördelat på kön och totalt samt om skillnader mellan grupper var statistiskt säkerställda. En kort sammanställning visar att:

• Ungefär tre av fyra unga samer rapporterade gott psykiskt välbefinnande (76,7 procent) och bra allmän hälsa (74,4 procent). De totala andelarna skilde sig inte mellan unga samer och andra unga i Sverige.
• Unga samiska kvinnor rapporterade mindre ofta bra allmän hälsa (68,6 procent respektive76,6 procent), mer ofta att de fått en depressionsdiagnos av läkare (29,9 procent respektive22,4 procent) samt hade mer ofta försökt ta sina liv (18,4 procent respektive 9,9 procent), jämfört med andra unga kvinnor i Sverige.
• Unga samer var mindre ofta stillasittande merän 10 timmar dagligen (24,6 procent respektive 35,2 procent) jämfört med andra unga i Sverige, men hade annars mindre sunda levnadsvanor (åt mindre ofta grönsaker/rotfrukter och snusade mer) samt var mer ofta överviktiga.
• De allra flesta unga samer har någon att anförtro sig åt (84,4 procent) eller be om hjälp från om de behöver detta (95,8 procent). Dessa andelar skiljer sig inte från andra unga i Sverige.
• Unga samer har oftare än andra unga i Sverige svårigheter att klara sina löpande utgifter(23,7 procent respektive 17,8 procent).
• Sex av tio unga samer har upplevt diskriminering eller rasism för att de är samer och var fjärde har upplevt detta under det senaste året. Det är mycket vanligare att unga samer än andra unga i Sverige upplevt att de blivit behandlade på ett sådant sätt att de känt sig kränkta på grund av den egna etniciteten under de tre senaste månaderna(25,7 procent respektive 3,4 procent).
• Endast 11 procent av de unga samerna upplevde att vårdpersonalen vid deras senaste besök hade tillräcklig kunskap om samisk kultur och livsvillkor för att kunna ge bra vård, och var tionde ung same har avstått från att berätta om sin samiska identitet i ett vårdmöte, trots att de själva upplevt att det haft betydelse för att bedömningen ska bli rätt.

Slutsatser: Rapporten visar att de flesta unga samer har god hälsa och ofta tillgång till särskilda resurser som stärker deras hälsa – det vill säga den ”magiska” sidan av unga samers liv. Detta är till exempel den stolthet, trygghet och det sociala nätverk som har sin grund i den samiska identiteten. Samtidigt visar rapporten också på ”hemska” sidor såsom unga samers större ekonomiska sårbarhet, samt stora utsatthet för rasism, diskriminering och kränkningar mot dem för att de är just samer. Det finns också en del hälsoområden där unga samer har sämre hälsa än andra, och mest allvarligt är att de unga samiska kvinnorna oftare saknar bra allmän hälsa, oftare rapporterar att de fått depressionsdiagnoser och oftare gjort självmordsförsök, jämfört med andra unga kvinnor i Sverige. Detta är områden där samhället måste göra mer för att förverkliga unga samers lika rätt till god hälsa och välbefinnande.

Rapporten fyller kunskapsluckor och skapar bättre förutsättningar för att det samiska och svenska samhället ska kunna stötta och stärka unga samers hälsa och välbefinnande, samt prioritera insatserna där de behövs bäst. Deltagarna har själva lämnat många goda förslag som kan förväntas stärka unga samers hälsa, inklusive genom att skapa fler trygga samiska mötesplatser och öka möjligheterna att få lära sig och tala samiska. Det omgivande samhället bör också öka sin kunskap om det samiska och motverka rasism mot samer, så unga samer slipper utsättas och försvara sig. Unga samer behöver också en lättillgänglig hälso- och sjukvård där personalen har den kompetens som krävs för att de ska bli förstådda på lika villkor som andra.

Background: The Swedish government has recently adopted a national strategy for mental health and suicide prevention, which for the first time includes Sámi perspectives. However, reports on young people's mental health and Sámi public health lack the perspectives of young Sámi. This report fills that knowledge gap by examining and highlighting the health and well-being of young Sámi in Sweden, with a particular focus on mental health.

Methods: The report was developed in close collaboration with the Sámi youth organisation Sáminuorra and is based on qualitative data collected in 2024 and quantitative data collected in 2021. A total of 15 youang Sámi participated in interviews (ages 15–30), 16 in online surveys (ages 15–30), and 364 in a population-based public health survey (ages 18–29). Qualitative data were analysed using thematic analysis. Quantitative data were analysed using descriptive statistics, and differences between groups were examined using bivariate regression analysis.

Qualitative results: The analysis identified one main theme and four sub-themes. The main theme, "It is terrible and magical at the same time," describes how Sámi identity involves both positive and negative aspects in young people's lives. This is reflected in all sub-themes. The sub-theme "Life balance" highlights how young Sámi (like other young people) experience stress and strive to maintain good living habits and relationships for better well-being. Participants expressed pride in the sub-theme "Sámi identity," but also challenges related to defending and explaining their culture to others. This is echoed in "Society's rules," which also reflects how lack of support and understanding from the majority society complicates life situations, and how racism, discrimination, and harassment undermine well-being. Finally, the analysis in "Conditions of care" shows that participants feel that the Swedish healthcare system needs to strengthen its knowledge and accessibility to provide equitable care and support for young Sámi.

Quantitative results: The analysis of quantitative data is presented descriptively as proportions (percentages) of young Sámi and peers in Sweden, divided by gender and total, and whether differences between groups were statistically significant. A brief summary shows that:

• About three out of four young Sámi reported good mental well-being (76.7%) and good general health (74.4%). The total proportions did not differ between young Sámi and other young people in Sweden.
• Young Sámi women reported good general health less often (68.6% vs. 76.6%), that they had received a depression diagnosis from a doctor more often (29.9% vs. 22.4%), and more often had attempted suicide (18.4% vs. 9.9%) compared to other young women in Sweden.
• Young Sámi were less often sedentary for more than 10 hours daily (24.6% vs. 35.2%) compared to other young people in Sweden, but otherwise had less healthy living habits (ate vegetables/root vegetables less often and used ‘snus’ more), and were more often overweight.
• Most young Sámi have someone to confide in (84.4%) or ask for help if needed (95.8%). These proportions do not differ from other young people in Sweden.Young Sámi more often than other young people in Sweden have difficulty managing their ongoing expenses (23.7% vs. 17.8%).
• Six out of ten young Sámi have experienced discrimination or racism because they are Sámi, and one in four has experienced this in the past year. It is much more common for young Sámi than other young people in Sweden to have felt insulted because of their ethnicity in the past three months (25.7% vs. 3.4%).
• Only 11% of young Sámi felt that the healthcare staff at their last visit had sufficient knowledge of Sámi culture and living conditions to provide good care, and one in ten young Sámi has refrained from disclosing their Sámi identity in a healthcare encounter, despite feeling that it was relevant for an accurate assessment.

Conclusions: The report shows that most young Sámi have good health and often access to specific resources that strengthen their health – the "magical" side of young Sámi's lives. This includes the pride, security, and social network rooted in Sámi identity. At the same time, the report also highlights "terrible" aspects such as young Sámi's greater economic vulnerability and significant exposure to racism, discrimination, and harassment because they are Sámi. There are also some health topics where young Sámi have poorer health than others, and most seriously, young Sámi women more often lack good general health, more often report receiving depression diagnoses, and more often have attempted suicide compared to other young women in Sweden. These are areas where society must do more to realise young Sámi's equal right to good health and well-being.

The report fills knowledge gaps and creates better conditions for the Sámi and Swedish societies to support and strengthen young Sámi's health and well-being and prioritise interventions where they are most needed. Participants themselves have provided many good suggestions that can be expected to strengthen young Sámi's health, including creating safer Sámi meeting places and increasing opportunities to learn and speak Sámi. The surrounding society should also increase its knowledge of the Sámi and counteract racism against Sámi so that young Sámi do not have to be exposed and defend themselves. Young Sámi also need accessible healthcare where staff have the competence required to understand them on equal terms as others.

Background: Mental health problems are the leading cause of disease burden among young people in India. While evidence shows that youth mental health and resilience can be improved with group interventions in school settings, such an intervention has not been robustly evaluated in informal urban settings.

Objective: This study aimed to evaluate whether the Nae Disha 3 group intervention could improve youth resilience, mental health and gender equal attitudes among disadvantaged young people from low-income urban communities in India.

Methods: This cluster randomised controlled trial used an analytic sample of 476 adolescents and young adults aged 11–25 years from randomised clusters in urban Dehradun, India. The 251 intervention group participants were 112 boys and 139 girls, and the 225 young people in the wait-control group were 101 boys and 124 girls. Five validated tools measuring resilience gender equity and mental health were filled by participants at three different points in time.

Results: Difference in difference (DiD) analysis at T2 showed that scores improved among girls in intervention group, for adjusted model, resilience (DiD = 4.12; 95% CI: 2.14, 6.09) and among boys, for resilience (DiD = 5.82; 95% CI: 1.57, 9.74).

Conclusions: The Nae Disha 3 intervention among disadvantaged urban youth moderately improved resilience for both young men and women, though it did not significantly impact mental health, self-efficacy, or gender-equal attitudes. We establish potential merit for this approach to youth mental health but recommend further research to examine active ingredients and the ideal duration of such group interventions.

Background: Decentralization has been a prominent strategy to enhance health systems’ efficiency, service quality, autonomy and accountability in low- and middle-income countries (LMICs) like Tanzania since the 1990s. Previous studies have mainly focused on assessing how much power for decision-making on different health system functional areas is granted to local-level authorities from the central government and the interconnections between decision space, organizational capacity, and accountability mechanisms. Empirical evidence on its impact on performance remains limited. This study investigates conditions for good performance in a decentralised health system of Tanzania.

Methods: We used fuzzy set qualitative comparative analysis to analyse the necessary and sufficient conditions for good health system performance. Eighteen purposively districts were chosen to capture variations in performance and geography in a multiple case study approach.

Results: Functional Health Facility Governing Committees (HFGCs) emerged as a necessary condition for good performance. To achieve good performance, however, there is a need for functional decision space among managers or high accountability among managers or high capacity of staff/ okay level of staffing.

Conclusion: The study underscores the importance of the interplay between decision space, organizational capacity, and accountability in improving health system performance. While decentralization aims to provide greater autonomy, effective implementation depends on the development of local capacities and oversight through accountability. Decentralization alone is not sufficient to enhance healthcare delivery; HFGCs and their local context that promote (social) accountability are essential. Further research is warranted to identify interventions supporting HFGCs in fulfilling their mandates and enhancing health service delivery.

Primary health care (PHC) systems are a crucial instrument for achieving equitable population health, but there is little evidence of how PHC reforms impact equities in population health. In 2010, Sweden implemented a reform that promoted marketization and privatization of PHC. The present study uses a novel integration of intersectionality-informed and evaluative epidemiological analytical frameworks to disentangle the impact of the 2010 Swedish PHC reform on intersectional inequities in avoidable hospitalizations. The study population comprised the total Swedish population aged 18–85 years across 2001–2017, in total 129 million annual observations, for whom register data on sociodemographics and hospitalizations due to ambulatory care sensitive conditions were retrieved. Multilevel Analysis of Individual Heterogeneity and Discriminatory Analyses (MAIHDA) were run for the pre-reform (2001–2009) and post-reform (2010–2017) periods to provide a mapping of inequities. In addition, random effects estimates reflecting the discriminatory accuracy of intersectional strata were extracted from a series MAIHDAs run per year 2001–2017. The estimates were re-analyzed by Interrupted Time Series Analysis (ITSA), in order to identify the impact of the reform on measures of intersectional inequity in avoidable hospitalizations. The results point to a complex reconfiguration of social inequities following the reform. While the post-reform period showed a reduction in overall rates of avoidable hospitalizations and in age disparities, socioeconomic inequities in avoidable hospitalizations, as well as the importance of interactions between complex social positions, both increased. Socioeconomically disadvantaged groups born in the Nordic countries seem to have benefited the least from the reform. The study supports a greater attention to the potentially complex consequences that health reforms can have on inequities in health and health care, which may not be immediate apparent in conventional evaluations of either population-average outcomes, or by simple evaluations of equity impacts. Methodological approaches for evaluation of complex inequity impacts need further development.

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.

Este estudio tiene como objetivo actualizar la información sobre la incidencia del cáncer en la región amazónica (provincias de Sucumbíos, Orellana, Napo y Pastaza) del Ecuador durante el periodo 1990-2019.

Dado que no existe un registro de tumores en la región amazónica, se obtuvieron los datos del Registro Nacional de Tumores de Quito, donde se registran todos casos que se diagnostican en establecimientos de salud de esa ciudad procedentes de las provincias de estudio.

Se calcularon el número total de casos de cáncer por sexo, provincia y periodo. Se establecieron seis periodos de estudio: 1990-1994, 1995-1999, 2000-2004, 2005-2009, 2010-2014 y 2015-2019. Se estimaron también las tasas estandarizadas por edad de todos los cánceres combinados por provincia y periodo.

En total se registraron 4.881 casos (36,8% en hombres) de cáncer durante el periodo 1990-2019 en las cuatro provincias. En hombres, los cánceres de próstata, sistema hematopoyético (sangre y médula ósea), estómago, otros de piel, y el no especificado de ganglios fueron los más frecuentes. En las mujeres, los de cuello de útero, mama, tiroides, otros de piel y sistema hematopoyético fueron los cinco cánceres más comunes.

El estudio muestra un incremento acelerado de cáncer en la región en total y para cada uno de los tipos de cáncer seleccionados en los últimos tres quinquenios (2005-2019). Este aumento es probablemente un indicador del continuo aumento de esta patología junto con un posible mayor acceso al diagnóstico en la ciudad de Quito. La situación geográfica (comunidades alejadas), diferentes estilos de vida, el crecimiento de la población, sobre todo por procesos migratorios, un envejecimiento de la misma y el limitado acceso a los servicios sanitarios son probablemente los determinantes más importantes en la evolución de las tasas de cáncer en esta región. 

Especialmente preocupantes son los incrementos en los cánceres de próstata en hombres, de mama y tiroides en mujeres y la estabilidad del resto de los tumores, sobre todo teniendo en cuenta la posibilidad de implementar programas de prevención para la mayoría de estos tumores. 

En conclusión, la tendencia ascendente de casos de cáncer en la Amazonía ecuatoriana exige la necesidad urgente de contar con un Plan Nacional de Control de Cáncer como hoja de ruta para el manejo de pacientes dentro del sistema de salud.

This study aims to update information on cancer incidence in the Amazon region (provinces of Sucumbíos, Orellana, Napo and Pastaza) of Ecuador during the period 1990-2019.

Since there is no registry of tumours in the Amazon region, data were obtained from the National Cancer Registry in Quito, where all cases diagnosed in health facilities in that city from the provinces under study are registered.

The total number of cancer cases by sex, province and period was calculated. Six study periods were established: 1990-1994, 1995-1999, 2000-2004, 2005-2009, 2010-2014 and 2015-2019. Age-standardised rates for all cancers combined by province and period were also estimated.

In total, 4,881 cases (36.8% in men) of cancer were registered during the period 1990-2019 in the four provinces. In men, prostate, haematopoietic system (blood and bone marrow), stomach, other skin, and unspecified lymph node cancers were the most frequent cancers. In women, cervical, breast, thyroid, other skin and haematopoietic system were the five most common cancers.

The study shows an accelerated increase in cancer in the region in total and for each of the selected cancer types over the last three five-year periods (2005-2019). This increase is probably an indicator of the continued rise of this pathology together with a possible increased access to diagnosis in the city of Quito. Geographical location (remote communities), different lifestyles, population growth, especially due to migration, an ageing population and limited access to health services are probably the most important determinants in the evolution of cancer rates in this region. 

Of particular concern are the increases in prostate cancer in men, breast and thyroid cancer in women and the stability of the remaining tumours, especially considering the possibility of implementing prevention programmes for most of these tumours. 

In conclusion, the rising trend of cancer cases in the Ecuadorian Amazon requires the urgent need for a National Cancer Control Plan as a roadmap for patient management within the health system.

In Zambia, efforts to produce a tobacco control policy have stalled for over a decade, and the country is not yet close to developing one. Limited studies have explored the dynamics in this policy process and how they affect the attainment of policy goals and outcomes. This study explored how collaborative dynamics within tobacco control policy development shaped shared motivation among stakeholders in Zambia. The study used a qualitative case study design that adopted a collaborative governance lens, comprising an in-depth exploration of the tobacco control policy working group meetings and their internal collaborative dynamics. The integrative framework for collaborative governance, which identifies mutual trust, mutual understanding, internal legitimacy and shared commitment as key elements of shared motivation, was adapted for this study. Data were collected from 27 key informants and analysed using thematic analysis. Several collaborative dynamics thwarted mutual trust among tobacco control stakeholders, including concerns about associated loyalties, fear of a ban on tobacco production, silo-mentality and lack of comprehensive dialogue. All stakeholders agreed that the limited sharing of information on tobacco control and the lack of reliable local evidence on the tobacco burden hindered mutual understanding. Diverse factors hampered internal legitimacy, including sector representatives’ lack of authority and the perceived lack of contextualization of the proposed policy content. Acknowledgement of the need for multisectoral action, lack of political will from other sectors and limited local allocation of funds to the process were some of the factors that shaped shared commitment. To accelerate the development of tobacco control policies in Zambia and elsewhere, policymakers must adopt strategies founded on shared motivation that deliberately create opportunities for open discourse and respectful interactions, promote a cultural shift towards collaborative information sharing and address unequal power relations to enable shaping of appropriate tobacco control actions in respective sectors.

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: The COVID-19 pandemic prompted varied policy responses globally, with LatinAmerica facing unique challenges. A detailed examination of these policies’ impacts on healthsystems is crucial, particularly in Bolivia, where information about policy implementation andoutcomes is limited.

Objective: To describe the COVID-19 testing trends and evaluate the effects of quarantinemeasures on these trends in Cochabamba, Bolivia.

Methods: Utilizing COVID-19 testing data from the Cochabamba Department Health Servicefor the 2020–2022 period. Stratified testing rates in the health system sectors were firstestimated followed by an interrupted time series analysis using a quasi-Poisson regressionmodel for assessing the quarantine effects on the mitigation of cases during surge periods.

Results: The public sector reported the larger percentage of tests (65%), followed by theprivate sector (23%) with almost double as many tests as the public-social security sector(11%). In the time series analysis, a correlation between the implementation of quarantinepolicies and a decrease in the slope of positive rates of COVID-19 cases was observedcompared to periods without or with reduced quarantine policies.

Conclusion: This research underscores the local health system disparities and the effective-ness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabambaregion. The findings stress the importance of the measures’ intensity and duration, providingvaluable lessons for Bolivia and beyond. As the global community learns from the pandemic,these insights are critical for shaping resilient and effective health policy responses.