Cultivating resilience and hope: A qualitative study of a pilot program using patient navigators to assist men who have sex with men with retention in the HIV care continuum in Uganda

Exploring the role of the JEEViKA swasthya mitra helpdesk in improving healthcare access: a qualitative study in tertiary healthcare facilities in Bihar, India

BACKGROUND

Rural populations in Bihar, India, face significant healthcare access challenges due to geographical, infrastructural, and financial barriers. The Swasthya Mitra program, initiated by the Bihar Rural Livelihood Promotion Society in collaboration with local and international partners, aims to mitigate these challenges by employing trained community members to navigate patients through the healthcare system.

METHODS

This qualitative study employed in-depth interview and thematic analysis to evaluate the Swasthya Mitra program in the Bhagalpur and Jamui districts in Bihar, India. The participants included Swasthya Mitras, healthcare professionals, and beneficiaries. This study focused on understanding the role of Swasthya Mitras in facilitating healthcare services.

FINDINGS

The program improved healthcare access for rural populations, with beneficiaries reporting reduced navigational confusion, decreased out-of-pocket expenditures, and enhanced patient care. Swasthya Mitras bridged the gap between the community and healthcare facilities. The program also empowered women, both Swasthya Mitras and beneficiaries, by improving their access to healthcare and increasing their involvement in health-related decision-making.

INTERPRETATION

The Swasthya Mitra program may offer a viable model for improving healthcare access in rural settings, demonstrating the importance of community involvement in healthcare delivery. The findings suggested that such programs can be instrumental in overcoming barriers to healthcare access and reducing financial burdens on vulnerable populations.

FUNDING

The study was supported by the Bihar Rural Livelihood Promotion Society supported by the World Bank and Project Concern Internation India.

Human trafficking risk factors, health impacts, and opportunities for intervention in Uganda: a qualitative analysis

BACKGROUND

Human trafficking is a global public health issue that is associated with serious short- and long-term morbidity. To address and prevent human trafficking, vulnerabilities to human trafficking and forces sustaining it need to be better understood among specific subpopulations. We aimed to explore risk and protective factors for human trafficking, the health impact of exploitation, and barriers and facilitators of seeking help throughout the human trafficking trajectory among forced labor and sex trafficking victims in Kampala, Uganda.

METHODS

Between March and November 2020, in-depth, semi-structured qualitative interviews were conducted with 108 victims of forced labor and sex trafficking who had completed a human trafficking survey conducted by the Uganda Youth Development Link (UYDEL). Participants who experienced various forms of exploitation were purposively invited for qualitative interviews and a convenience sample was interviewed. Interviews explored personal history, trafficking recruitment, experiences of exploitation and abuse, and experiences seeking help. Interviews were analyzed using a combination of deductive and inductive thematic analysis. Themes and subthemes were organized using an adapted conceptual framework of human trafficking.

RESULTS

Poverty and an abusive home life, frequently triggered by the death of a caretaker, underpinned vulnerability to human trafficking recruitment. Limited education, lack of social support, and survival needs pushed victims into exploitative situations. Victims of human trafficking were systematically exploited and exposed to dangerous working conditions. Victims suffered from sexually transmitted diseases, incontinence, traumatic fistulae, musculoskeletal injuries, and mental health symptoms. Lack of awareness of resources, fear of negative consequences, restrictions on movement, and dependence on the trafficker and exploitation income prevented victims from seeking help. The police and healthcare workers were the few professionals that they interacted with, but these interactions were oftentimes negative experiences.

CONCLUSIONS

To address and prevent human trafficking, localized interventions are needed at all stages of the human trafficking trajectory. Health impacts of human trafficking are severe. As some of the few professionals trafficking victims interact with, police and healthcare workers are important targets for anti-trafficking training. Improved understanding of human trafficking drivers and barriers and facilitators to seeking help can inform the design of necessary interventions.