The Institute for Global Health and Development
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Item Social Sciences in Emerging Infectious Disease: The Ebola Disease Response(Springer International Publishing, 2023-01-01) James, Peter Bai; Lane, Rashon; Bah, Abdulai JawoEmerging infectious disease outbreaks are increasingly prevalent, and the need to develop or strengthen existing health systems to effectively respond to a global health threat has become more apparent. Moreover, it has become clear the critical role social science research plays in exploring human behavior, cultural, social, and political economic forces that are equally important to inform emerging infectious disease response and recovery. This chapter discusses the role of social science research in infectious disease outbreaks, looking at benefits and current barriers. It further considers Ebola as a e study to illustrate how social science research approaches are used to explain the cultural, social, and political economic forces that explain community response and inform public health response to recent Ebola outbreaks in Western and Eastern Africa. Specifically, it discusses issues surrounding the origin of the Ebola virus, community beliefs and understanding of Ebola virus disease, surveillance, burial practices, the influence of politics and conflict on Ebola response efforts, vaccine hesitancy and Ebola survivorship relating to community stigma, as well as discrimination and health-seeking behavior. © Springer Nature Switzerland AG 2023.Item How to attract and retain health workers in rural areas of a fragile state: Findings from a labour market survey in Guinea(PLOS, 2021-12-16) Witter, Sophie; Herbst, Christopher H.; Smitz, Marc; Balde, Mamadou Dioulde; Magazi, Ibrahim; Zaman, Rashid U.; Mayne, Elizabeth S.Most countries face challenges attracting and retaining health staff in remote areas but this is especially acute in fragile and shock-prone contexts, like Guinea, where imbalances in staffing are high and financial and governance arrangements to address rural shortfalls are weak. The objective of this study was to understand how health staff could be better motivated to work and remain in rural, under-served areas in Guinea. In order to inform the policy dialogue on strengthening human resources for health, we conducted three nationally representative cross-sectional surveys, adapted from tools used in other fragile contexts. This article focuses on the health worker survey. We found that the locational job preferences of health workers in Guinea are particularly influenced by opportunities for training, working conditions, and housing. Most staff are satisfied with their work and with supervision, however, financial aspects and working conditions are considered least satisfactory, and worrying findings include the high proportion of staff favouring emigration, their high tolerance of informal user payments, as well as their limited exposure to rural areas during training. Based on our findings, we highlight measures which could improve rural recruitment and retention in Guinea and similar settings. These include offering upgrading and specialization in return for rural service; providing greater exposure to rural areas during training; increasing recruitment from rural areas; experimenting with fixed term contracts in rural areas; and improving working conditions in rural posts. The development of incentive packages should be accompanied by action to tackle wider issues, such as reforms to training and staff management.Item Young Refugees and Forced Displacement: Navigating Everyday Life in Beirut(Routledge, 2020-12-30) Riga, Liliana; Holmes, Mary; Dakessian, Arek; Langer, Johannes; Anderson, DavidYoung Refugees and Forced Displacement is about young Syrian and Iraqi refugees navigating the complex realities of forced displacement in Beirut. It is based on a British Academy funded two-year project with 51 displaced youths aged 8 to 17 and under the care of three local humanitarian organisations. Focus groups, interviews and innovative arts-based methods were used to learn about their everyday lives. At the end of the project, we coproduced with them a public mural, allowing unexpected epistemological and methodological reflections on researching refugees and the "right to opacity." Families and friendships, humanitarian caregiving, racism, discrimination and everyday decencies and civilities make up the stuff of their ordinary, everyday encounters within refugeedom, defining both its sharper edges and its more inadvertent and quietly political ones. Thus, refugeedom, as we conceive it, includes "the humanitarian condition" but goes a little beyond it, to become also a human condition of political alterity. In navigating refugeedom, the young Syrians and Iraqis become sophisticated political and moral actors, using emotional reflexivity as they engage layered subjectivities to define the terms of their own forced displacement. This book will be of interest to policymakers, humanitarian organisations, social science scholars and students working on refugees, displacement, humanitarianism, intimacies and emotions, racism and discrimination. It may also be of interest to displaced youth.Item "Treatment is of primary importance, and social assistance is secondary": A qualitative study on the organisation of tuberculosis (TB) care and patients' experience of starting and staying on TB treatment in Riga, Latvia(Public Library of Science, 2018-10-17) Kielmann, Karina; Vidal, Nicole L.; Riekstina, Vija; Krutikov, Maria; van der Werf, Marieke J.; Biraua, Evita; Duric, Predrag; Moore, David A. J.Background Vulnerable individuals with tuberculosis (TB) struggle to access and stay on treatment. While patient-related and social barriers to TB treatment adherence are well documented, less is known about how the organisation and delivery of TB care influences adherence behaviour. Aim To examine the influence of TB service organisation and culture on patients’ experience of starting and staying on treatment in Riga, Latvia. Methods An intervention package to support adherence to TB treatment amongst vulnerable patients in Riga, Latvia was piloted between August 2016 and March 2017. Qualitative observations (5), interviews with staff (20) and with TB patients (10) were conducted mid-way and at the end of the intervention to understand perceptions, processes, and experiences of TB care. Results The organisation of TB services is strongly influenced by a divide between medical and social aspects of TB care. Communication and care practices are geared towards addressing individual risk factors for non-adherence rather than the structural vulnerabilities that patients experience in accessing care. Support for vulnerable patients is limited because of standardised programmatic approaches, resource constraints and restricted job descriptions for non-medical staff. Conclusion Providing support for vulnerable patients is challenged in this setting by the strict division between medical and social aspects of TB care, and the organisational focus on patient-related rather than systems-related barriers to access and adherence. Potential systems interventions include the introduction of multi-disciplinary approaches and teams in TB care, strengthening patient literacy at the point of treatment initiation, as well as stronger linkages with social care organisations.Item Context matters (but how and why?) A hypothesis-led literature review of performance based financing in fragile and conflict-affected health systems(PLoS, 2018-04-03) Bertone, Maria Paola; Falisse, J-B; Russo, Giuliano; Witter, Sophie; ** Funder: Department for International Development; Grant num: ReBUILD; funder-id: http://dx.doi.org/10.13039/501100000278Performance-based financing (PBF) schemes have been expanding rapidly across low and middle income countries in the past decade, with considerable external financing from multilateral, bilateral and global health initiatives. Many of these countries have been fragile and conflict-affected (FCAS), but while the influence of context is acknowledged to be important to the operation of PBF, there has been little examination of how it affects adoption and implementation of PBF. This article lays out initial hypotheses about how FCAS contexts may influence the adoption, adaption, implementation and health system effects of PBF. These are then interrogated through a review of available grey and published literature (140 documents in total, covering 23 PBF schemes). We find that PBF has been more common in FCAS contexts, which were also more commonly early adopters. Very little explanation of the rationale for its adoption, in particular in relation with the contextual features, is given in programme documents. However, there are a number of factors which could explain this, including the greater role of external actors and donors, a greater openness to institutional reform, and lower levels of trust within the public system and between government and donors, all of which favour more contractual approaches. These suggest that rather than emerging despite fragility, conditions of fragility may favour the rapid emergence of PBF. We also document few emerging adaptations of PBF to humanitarian settings and limited evidence of health system effects which may be contextually driven, but these require more in-depth analysis. Another area meriting more study is the political economy of PBF and its diffusion across contexts.