The Netherlands, because of the sustained and systematic attention it paid to migrant and minority health issues during the last quarter of the twentieth century, has been depicted as being ...progressive in its approach to healthcare for migrants and minorities. Recently, however, these progressive policies have changed, reflecting a trend towards problematising issues of integration in order to focus on the responsibilities that migrants and ethnic minorities bear in terms of their health. This article explores these shifts and specifically the development of particular categories of ethnicity, and examines the wider consequences that have arisen as a result.
The analysis presented here entailed a qualitative content analysis of health policies for migrants and ethnic minorities from 1970 to 2015, and examined various documents and materials produced by the institutions and organisations responsible for implementing these healthcare policies during the period from 1970 to 2015.
Four distinct periods of political discourse related to health policy for migrants and ethnic minorities were identified. These periods of political discourse were found to shape the manner in which ethnicity and various categories and representation of foreigners, later ethnic minorities, and at present non-Western allochtoons are constructed in health policy and the implantation practices that follow. At present, in the Netherlands the term allochtoon is used to describe people who are considered of foreign heritage, and its antonym autochtoon is used for those who are considered native to the Netherlands. We discuss the scientific reproduction and even geneticisation of these politically produced categories of autochtoon, Western allochtoon, and non-Western allochtoon-a phenomenon that occurs when politically produced categories are prescribed or taken up by other health sectors.
The categories of autochtoon, Western allochtoon, and non-Western allochtoon in the health sciences and the field of ethnicity and health in the Netherlands today have been co-produced by society and science. Policy formulated on the basis of specific political discourse informs the conceptualisations about groups and categories, issues, and solutions, and when these are institutionalised in subsequent health policy, databases, research, and care practices, these ethnic categorisations are replicated in a manner that renders them 'real' and enables them to be applied both socially and scientifically, culminating in pronouncements as to who is the same and who is different in Dutch society and science.
Background: HIV/AIDS has had a significant impact on maternal and child health in South Africa. It is thus of vital importance to implement interventions to prevent mother-to-child transmission of ...HIV (PMTCT) as early as possible during pregnancy. Negative interactions between patients and health care providers (HCPs) can be an important barrier to antenatal care, PMTCT use and PMTCT adherence. Research about respectful maternity care has focused more on the patient perspective. We therefore compared the patient and HCP perspectives and reflected on how interactions between HCPs and patients can be improved.
Objective: To obtain insights into the attitudes of HCPs in the context of HIV and PMTCT-related care, by studying patient and HCP perceptions of their interactions, in a peri-urban hospital setting in Gauteng province, South Africa.
Methods: A qualitative study was conducted in a public tertiary-level hospital. Fourteen semi-structured in-depth interviews were conducted with nurses and doctors in the antenatal clinic and postnatal ward. Thirty-one semi-structured in-depth interviews and two focus group discussions were conducted with HIV positive and negative women on the postnatal ward.
Results: HCPs experienced a difficult work environment due to a high workload. This was combined with frustrations when they felt that patients did not take responsibility for their own or their child's health. They were motivated by the need to help the child. Patients experienced judging comments by HCPs especially towards younger, older and foreign women. They expressed fear to ask questions and self-blame, which in some cases delayed health care seeking. No discrimination or isolation of HIV infected patients was reported by patients and HCPs.
Conclusion: We hypothesize that more humane working conditions for obstetric HCPs and a caring, personalised approach to patient management can improve patient-provider interactions and access to respectful care. These are critical to preventing mother-to-child transmission of HIV.
Racial discrimination is a global concern affecting education, including medical programs in the Netherlands. Covert racial discrimination in academia has been linked to adverse academic outcomes and ...unequal opportunities. This qualitative study explores the relationship between racism, well-being, and academic success among ethnic minority students in Dutch medical education. Conducted in 2021 at a southern Netherlands university, this research employed interviews to delve into the racial discrimination experiences of 11 diverse medical students. Utilising a phenomenological approach, the study conducted semi-structured interviews and applied thematic content analysis to understand how racial discrimination impacted the students’ well-being. The findings revealed the prevalence of both overt and covert racial discrimination in predominantly white educational environments. Ethnic minority students encountered discrimination that negatively affected their well-being and academic performance. Racism manifested in overt and covert ways, with students often normalising exclusionary and racist situations. Ethnic minority students reported experiencing more racial discrimination than their white European peers, resulting in feelings of exclusion and academic challenges. The study suggests that implementing student-centred inclusivity measures through structural and institutional changes, such as support structures, mentoring programs, and inclusive course content, can mitigate racial discrimination, enhance diversity and inclusion, and improve ethnic minority medical students’ mental well-being and academic performance. Addressing covert racism is crucial for fostering an equitable and inclusive educational environment. These findings underscore the importance of proactive action to combat racial discrimination in educational settings.
IntroductionPatient rights are “those rights that are attributed to a person seeking healthcare”. Patient rights have implications for quality of healthcare and acts as a key accountability tool. It ...can galvanise structural improvements in the health system and reinforces ethical healthcare. States are duty bound to respect, protect and promote patient rights. The rhetoric on patient rights is burgeoning across the globe. With changing modes of governance arrangements, a number of state and non-state actors and institutions at various levels play a role in the design and implementation of (patient rights) policies. However, there is limited understanding on the multilevel institutional mechanisms for patient rights implementation in health facilities. We attempt to fill this gap by analysing the available scholarship on patient rights through a critical interpretive synthesis approach in a systematic scoping review.MethodsThe review question is ‘how do the multilevel actors, institutional structures, processes interact and influence the patient rights implementation in healthcare facilities? How do they work at what level and in which contexts?” Three databases PubMed, LexisNexis and Web of Science will be systematically searched until 30th April 2020, for empirical and non-empirical literature in English from both lower middle-income countries and high-income countries. Targeted search will be performed in grey literature and through citation and reference tracking of key records. Using the critical interpretive synthesis approach, a multilevel governance framework on the implementation of patient rights in health facilities which is grounded in the data will be developed.Ethics and disseminationThe review uses published literature hence ethics approval is not required. The findings of the review will be published in a peer-reviewed journal.Registration numberPROSPERO 2020 CRD42020176939
PurposeThe pledge of the 2030 Agenda for Sustainable Development is “to leave no one behind.” However, there are significant groups of people who are at risk of being left behind. The health and ...social issues facing prisoners are well known, but past initiatives to address them through international development initiatives have failed to gain widespread support. The purpose of this paper is to advocate for inclusion of prison health care in current international development frameworks such as Universal Health Coverage and the 2030 Sustainable Development Goals.Design/methodology/approachThis is a commentary paper.FindingsThe governments of most countries have accepted both the 2030 Agenda for Sustainable Development and Universal Health Coverage as frameworks for future national development planning. Including prison health care in these frameworks will provide a powerful platform for those advocating for better prison health services and will allow governments wary of offending public opinion to make significant changes to the way prisons are managed. Providing better prison health care services will not only lead to better long-term population health outcomes overall but will also contribute to achieving the 2030 Agenda aspiration to “leave no-one behind.”Originality/valueThis paper provides a discussion of current international development guidance and identifies that prison health care is not sufficiently recognized as an essential contributor to achieving the sustainable development goals.
Background: Primary Health Centres (PHC) in India have evolved over the last seven decades to meet the healthcare needs of communities aligned to the epidemiological transitions the country has ...undergone. It is a well understood fact that the performance of PHCs is vital for overall improvement in the general health of the population of any nation. The relationship between the performance of PHCs, patients' perspectives of PHC performance and provider perspective of well-being is not well understood. This research aimed to test a new tool for patients' assessment of PHC performance and to explore the relationships between the centre's performance and the provider's well -being across centres with different workloads.
Methodology: PHC workload was assessed based on the number of babies delivered to the population covered by the facility. Three PHCs with high, medium and low workloads were selected for the study in Bengaluru (Bangalore), Karnataka, India. The centres were assessed based on the Indian Public Health Standards. A new tool 'Questionnaire for Patient's Perspective on Performance of Primary Health Centres' (Q4PHC) was developed and tested for reliability. A total of 298 patients assessed the performance of these PHCs using Q4PHC by an 'exit survey'. 36 Provider's perspective on one's well -being were studied using the Quality of Life (WHO QoL Bref) tool and the work engagement tool (The Utrecht Work Engagement Survey - UWES). The data were analysed across the three centres using the ANOVA test.
Results: Q4PHC was found to be reliable with have high internal consistency. Patients assessed the 'low' workload PHC as the best-performing among the three centres (p<0.000). Provider's well being was found better in 'medium' workload PHC but was not statistically significant.
CONCLUSION: Q4PHC is found to be a useful instrument to assess PHC performance from patients' perspective in the Indian context. The study results suggest that there is a trade-off between the provider's perspective on well -being and maximum PHC performance.
Background: Depending on a country's diagnostic infrastructure, patients and providers play different roles in ensuring that correct and timely diagnosis is made. However, little is known about the ...work done by patients in accessing diagnostic services and completing the 'test and treat' loop.
Objective: To address this knowledge gap, we traced the diagnostic journeys of patients with tuberculosis, diabetes, hypertension and typhoid, and examined the work they had to do to arrive at a diagnosis.
Methods: This paper draws on a qualitative study, which included 78 semi-structured interviews and 13 focus group discussions with patients, public and private healthcare providers, community health workers, test manufacturers, laboratory technicians, program managers and policymakers. Data were collected between January and June 2013 in rural and urban Karnataka, South India, as part of a larger project on barriers to point-of-care testing. We reconstructed patient diagnostic processes retrospectively and analyzed emerging themes and patterns.
Results: The journey to access diagnostic services requires a high level of involvement and immense work from patients and/or their caretakers. This process entails overcoming cost and distance, negotiating social relations, continuously making sense of their illness and diagnosis, producing and transporting samples, dealing with the social consequences of diagnosis, and returning results to the treating provider. The quality and content of interactions with providers were crucial for completion of test and treat loops. If the tasks became overwhelming, patients opted out, delayed being tested, switched providers and/or reverted to self-testing or self-treatment practices.
Conclusion: Our study demonstrated how difficult it can be for patients to complete diagnostic journeys and how the health system works as far as diagnostics are concerned. If new point-of-care tests are to be implemented successfully, policymakers, program officers and test developers need to find ways to ease patient navigation through diagnostic services.
Armed conflict in Colombia has a history of 50 years that continues to this day. According to the Victims Record of Colombia, from 1985 to 2013 2.683.335 women have been victims of the armed ...conflict. Women have been described as the main victims of the armed conflict, especially in the Colombian cultural context that in some regions is still considered to be a 'machista' and patriarchal one. In contrast, some authors have explicitly stressed Colombian women's agency instead of positioning them only as victims. Some of them are described as 'survivors' of the war, emphasizing their impressive resistance to the outcomes of war and forced displacement. In contrast to the background of these scholarly discussions, our study focused on how displaced women living in Bogotá themselves articulate their experiences of agency and victimization. This paper will therefore explore how women, in reconstructing their life stories, expressed the tussles between victimization and agency.
We used qualitative methods conducted within an ethnographic approach. Based on ten years of experience in the neighborhood and one year of fieldwork, we collected the life stories of twenty internally displaced mothers, and ran eight workshops with them. We analyzed the narratives with a specific focus on how women expressed victimization and agency in four important periods in their life that related to the process of displacement: when they left home, when they became pregnant, when they were forced to leave their towns, and when they arrived in Bogotá.
Participants' life stories showed how they struggled with agency during their lives. They were victims of abuse and violence during childhood and finally decided to leave their homes. They decided to have their babies despite the fact that they were abandoned by their partners and families, and after doubts about and attempts to have an abortion. Throughout the process of displacement the participants had been engaged in ambiguous relationships with armed groups. Finally they arrived in Bogotá and faced adverse circumstances but were looking for better opportunities for them and their children.
The analysis of how internally displaced women narrated their life stories showed us that the concepts that dominate scholarly debates about agency, victimization and survivorship do not do justice to the life stories of the participants in our study. These stories show that changes with a major impact were loaded with ambiguity and were characterized by helplessness, lack of control and agency simultaneously. The reconstruction of these life stories goes beyond the stereotype of displaced women as only 'victims', but points also to their agency and courageous decisions they made in contexts that were not controlled by them and where support was often lacking. Instead of label them, it is important to understand the complexity of the life experiences of IDW, in order to build policies that offer them aids as victims, but also build policies and intervention programs that empower them as agents in order to support them during resettlement.
The fourth Global Forum on Human Resources (HRH) for Health was held in Ireland November 2017. Its Dublin declaration mentions that strategic investments in the health workforce could contribute to ...sustainable and inclusive growth and are an imperative to shared prosperity. What is remarkable about the investment frame for health workforce development is that there is little debate about the type of economic development to be pursued. This article provides three cautionary considerations and argues that, in the longer term, a perspective beyond the dominant economic frame is required to further equitable development of the global health workforce. The first argument includes the notion that the growth that is triggered may not be as inclusive as proponents say it is. Secondly, there are considerable questions on the possibility of expanding fiscal space in low-income countries for public goods such as health services and the sustainability of the resulting economic growth. Thirdly, there is a growing consideration that economic growth solely expressed as increasing gross domestic product (GDP) might have intrinsic problems in advancing sustainable development outcomes. Economic development goals are a useful approach to guiding health workforce policies and health employment but this depends very much on the context. Alternative development models and policy options, such as a Job Guarantee scheme, need to be assessed, deliberated and tested. This would meet considerable political challenges but a narrow single story and frame of economic development is to be rejected.
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