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Sverige har länge varit en drivande kraft för barns rättigheter, något som ytterligare förstärktes genom lagstiftningsreformer, däribland integreringen av FN:s barnkonvention i svensk lag år 2020. Landet har tagit aktiva steg för att förverkliga konventionens principer, bland annat genom olika initiativ som främjar barns delaktighet i beslutsprocesser, såsom skol- och ungdomsråd. Sverige har även infört politik som syftar till att minska barnfattigdom och ojämlikhet genom ett välutvecklat socialt välfärdssystem. Att analysera barns erfarenheter under covid-19-pandemin ger värdefulla insikter för att kunna skydda deras rättigheter i framtida krissituationer.

Detta projekt är baserat på data från kvalitativa gruppintervjuer med 44 barn (10 till 17 år gamla) i Umeå under 2024 som belyste hur covid-19-pandemin påverkade deras livssituation och utbildning. Dialogen i resultatet är en rekonstruktion av barnens berättelser.

Introduction: Accountability is crucial for improved functionality of health systems and can be ensured through community participation in health governance. To engage the community in the governance of the local health system, health facility governing committees (HFGCs) have been implemented in several low-income and middle-income countries including Tanzania. However, the effect of HFGCs on health system performance is not well studied. The aim of this study was to investigate the relationship between the functionality of the HFGCs and health system performance in 180 districts of mainland Tanzania, and to assess whether this relationship varies between dispensaries, health centres and hospitals.

Methods: We conducted an ecological study in which the studied outcome was health system performance. The main independent variable was functionality of HFGCs, that is, to what extent these committees reflect the concerns of and connect back to the community. Other explanatory variables included staff availability, location of the facility, gender of the manager of the facility and ownership of the facility. Data on all of the variables were retrieved from the Star Rating Assessment of 2017/2018, measured as mean proportions of all facilities in the districts. The analyses included linear regression for all facility levels combined, as well as for the levels of facility separated (dispensaries, health centres and hospitals).

Results: We found a positive relationship between the functionality of the HFGCs and health system performance (β=0.53; 95% CI=0.47 to 0.60). The relationship was stronger for dispensaries (β=0.56; 95% CI=0.50 to 0.63) compared to health centres (β=0.39; 95% CI=0.33 to 0.44) and hospitals (β=0.23; 95% CI=0.15 to 0.31).

Conclusions: Districts that have functional HFGCs tend to have better health system performance than others. This relationship is stronger in dispensaries compared to health centres and hospitals. Therefore, we believe the district authorities should allocate resources to strengthen the HFGCs.

Background: The COVID-19 pandemic disrupted children’s lives globally, yet limited research centres their voices in evaluating crisis responses. Sweden’s unique strategy, emphasizing voluntary guidelines rather than strict lockdowns, provides a critical context to explore how the pandemic policies reshaped children’s daily lives and affected systemic inequities between them; and to highlight children’s perspectives on how societal actors could better uphold children’s rights in future crises.

Methods: This qualitative study engaged 44 Swedish-speaking children (aged 10–17) from diverse neighborhoods in Umeå, Sweden, through ten focus group discussions conducted between February 2023 and January 2024. Child-friendly adaptations of the United Nations Convention on the Rights of the Child (UNCRC) articles guided discussions on pandemic experiences. Data included transcripts, participant drawings, and field notes, analysed via reflexive thematic analysis.

Results: The findings consolidate into four central themes. First, “Keep distance! COVID forming a new way of life” captures how Sweden’s voluntary measures reshaped daily norms, while prolonged isolation from quarantines, canceled activities, and restricted social interactions deepened confinement. Second, “Erosion of well-being and need for information and support” highlights the decline in physical health and mental well-being, compounded by inadequate mental health resources and schools’ dual role as social refuges and infection risks. Third, “Paradox of ‘Normalcy’: halted education and systemic inequities” reveals how Sweden’s open-school strategy masked halted learning, digital divides, and housing disparities shaping quarantine experiences. Finally, “Hear me out! Engaging children in decision-making” underscores children’s critiques of exclusion from policymaking, despite their resilience and proposals for participatory solutions.

Conclusion: This study emphasizes the need to incorporate children’s voices in policymaking, particularly during crises, to ensure their rights and well-being are upheld. It calls for a shift in crisis response beyond just physical safety to include mental and emotional health, highlighting the importance of school-based mental health services and tailored support for marginalized groups in Sweden. To truly implement UNCRC Article 12, the country should establish formal systems that actively engage children and consider their feedback in decision-making processes.

Background: Male partners’ involvement in family planning can be crucial for women’s contraceptive choices. Limited research exists on migrant men’s experiences and perceptions of family planning and associated decisions. The study aims to investigate experiences and perceptions of family planning use and decision-making among Arabic-speaking men living in Sweden.

Methods: This qualitative study utilized reflexive thematic analysis of eighteen in-depth interviews. The participants aged 22–43 years, had relocated to Sweden within the past decade, and represented various countries of origin (e.g., Syria, Iraq, Palestine) with most participants having 13 or more years of education.

Results: We identified an overarching theme, “Navigating the complex family planning decision-making in a new setting” supported by four sub-theme; 1) “The new living conditions influencing family planning decision-making” described how financial (in)stability, childcare responsibilities, personal development goals, and the impact of changing circumstances shaped family planning choices; 2) “Social norms affecting family planning decision-making” emphasized the diversity of gender roles and norms within Arabic-speaking communities, with an emphasis on joint decisions and shared responsibility. Instances of controlling behaviour and the role of beliefs and extended family members were also noted; 3) “Challenges in accessing contraceptive services free of discrimination” underscored the need for and importance of access to comprehensive information and culturally sensitive services in shaping family planning decisions; 4) “Conflicting considerations when deciding on contraceptive method” addressed factors such as familiarity with the methods, perceived effectiveness and safety, fear of side-effects, and taboos associated with the methods.

Conclusions: The findings highlight the diverse factors influencing family planning decisions. The study underscores men’s willingness to be active partners for family planning and highlights the need for improved information provision and services to empower informed decision-making.

This viewpoint advocates for the inclusion of art in global health discourse and practice. We explore four areas in which art can be leveraged to improve global health: (1) to amplify disenfranchised voices, (2) to advance social justice activism, (3) to strengthen communities and individuals, and (4) to improve global health communication. Drawing on community-driven art initiatives, we argue for an inclusive approach that respects diverse cultural perspectives and uplifts marginalized voices. Emphasizing interdisciplinary collaboration and ethical engagement, our framework invites global health discourse and practice to integrate art in order to foster empathy, challenge systemic inequities, and envision sustainable futures. By centering art, we seek to enrich the global health discipline with insights and transformative potential grounded in human experiences, cultural diversity, and shared humanity.

Introduction: Evidence suggests that migrants are at a higher risk of poor sexual health compared to non-migrants. However, this vulnerability may vary depending on their socio-demographic backgrounds and experiences. This study aimed to describe the prevalence of poor self-rated sexual health, its distribution, and associated risk factors among migrants in Sweden.

Methods: This study is a secondary analysis of the 2018 Migrants’ Sexual and Reproductive Health and Rights (MSRHR-2018) survey, which included a total of 1,118 migrants enrolled in language programmes. Data were analysed with descriptive, bivariate, and multivariable regression analyses.

Results: About 19% of participants reported poor self-rated sexual health. The latter was associated with older (>44 years) age (PR:1.83; 95% CI:1.08, 3.10), low educational attainment (PR: 1.80; 95% CI: 1.04, 3.11), repeated difficulty in making ends meet (PR: 1.51; 95% CI:1.01, 2.26), being not at all or not particularly open about one’s sexual orientation (PR: 1.62; 95% CI: 1.06, 2.49), lifetime experience of discrimination (PR: 1.61; 95% CI: 1.09, 2.39), and refraining from seeking sexual and reproductive health (SRH) services despite felt needs (PR: 1.87; 95% CI: 1.22, 2.85) remained associated with poor self-rated sexual health.

Conclusion: This study highlights the prevalence of poor self-rated sexual health among migrants, while revealing significant disparities across specific subgroups that warrant targeted attention. These findings can inform policy makers, programme managers, and civil society actors in designing targeted policies and interventions for migrant subgroups at an increased risk of poor sexual health, such as middle-aged and elderly migrants, the least educated, and those who do not fully conform to social expectations on gender identity/sexual orientation. To improve sexual and reproductive health outcomes, it is essential to identify and address the barriers that hinder migrants’ access to relevant health services.

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.

Denna studie undersöker barns upplevelser och perspektiv på sina rättigheter under COVID-19-pandemin. Genom kvalitativa metoder visade data från 22 barn i Umeå hur pandemin påverkade barnens liv och skolgång. Barnen uppskattade Sveriges hantering av pandemin men tyckte samtidigt att deras fysiska och mentala hälsa påverkades negativt.

Distansundervisningen medförde flera utmaningar, inklusive tekniska ojämlikheter och bristande stöd från lärare. Barnen betonade behovet av bättre kommunikation och informationsdelning, samt föreslog fler kanaler för att kommunicera med beslutsfattare. De framhöll också vikten av investeringar i skolhälsa och åtgärder mot ojämlikhet och diskriminering. Resultaten understryker betydelsen av att integrera barnens perspektiv i beslutsfattande och krisberedskap för att säkerställa att deras rättigheter skyddas och främjas. Denna studie belyser vikten av barnens röster för att skapa en mer rättvis och inkluderande framtid.

Background: Evidence amounted early that migrants, who are often side-lined in pandemic response or preparedness plans, are disproportionately affected by the COVID-19 pandemic and its consequences. However, synthesised evidence that quantifies the magnitude of inequalities in infection risk, disease outcomes, consequences of pandemic measures or that explains the underlying mechanisms is lacking.

Methods: We conducted a systematic review searching 25 databases and grey literature (12/2019 to 09/2023) and considered empirical articles covering migrants, refugees, asylum-seekers, and internally displaced persons reporting COVID-19 cases, hospitalisation, ICU admission, mortality, COVID-19 vaccination rates or health consequences of pandemic measures. Random-effects meta-analysis of observational studies and qualitative analysis were performed for evidence synthesis. A protocol was registered with PROSPERO (CRD42021296952).

Findings: Out of 17,088 records, we included 370 reports in the review. For the quantitative studies (n = 65; mainly from high income countries), meta-analysis with over 53 million participants studied showed that, compared to non-migrants, migrants have an elevated risk of infection (RR = 1.84; 95%-CI: 1.44–2.35) but similar risk for hospitalisation (RR = 1.10; 0.91–1.33), while the probability of ICU admission was higher (RR = 1.23; 0.99–1.52). Among those hospitalised, migrants had a lower risk of mortality (RR = 0.56; 0.42–0.76), while their population-based mortality tended to be higher (RR = 1.46; 0.95–2.26). The qualitative synthesis (n = 75) highlighted the complex interplay of social and COVID-19-related factors at different levels. This involved increased exposure, risk, and impact of pandemic measures that compromised the health of migrants.

Interpretation: Even in the advanced stages of the pandemic, migrants faced higher infection risks and disproportionately suffered from the consequences of COVID-19 disease, including deaths. Population-level interventions in future health emergencies must better consider socio-economic, structural and community-level exposures to mitigate risks among migrants. Enhancing health information systems is crucial, as the lack of migration variables makes it difficult to close coverage gaps, leaving migrants largely ‘invisible’ in official data.

Methods: Youth clinics in Sweden are not reaching young men to the same extent as young women. We conducted a qualitative study to explore healthcare providers’ (HCPs) perspectives on the barriers to young men’s access to sexual and reproductive health (SRH) services and how youth clinics can better accommodate the needs of young men. We used thematic analysis to analyze eight interviews with nine HCPs (three men and six women).

Results: We developed three themes: 1) It’s about the youth clinics and those working in them—the clinics suffered from low organizational support, which affected their ability to accommodate young men’s needs and were perceived as “girls’ clinics”. Midwifery, which is the main profession of HCPs working with SRH in the clinics, was perceived as a women’s profession for women’s SRH; 2) It’s not all about the youth clinics—young men were perceived as lacking essential knowledge about SRH and gender norms were preventing young men from visiting youth clinics; 3) Organizational strategies for improving access—the participants discussed strategies to attract young men, including separate reception for young men, hiring more male staff, having higher age limits for young men, and digital solutions to address privacy concerns.

Conclusion: There is a need for societal efforts to increase young men’s knowledge about SRH and improve their access to SRH services. Several strategies can be adapted by youth clinics to attract more young men but there is need for further research to design and evaluate such interventions.