Agency at Play for Collective Impact in Human Services Systems

Responses to urban human services issues such as housing and unemployment often overlook lived experiences through these systems and are formulated from a top-down (systems, services, or policy-level) perspective. This study integrates systems thinking and design justice principles for centering the voices of those experiencing these issues towards exploring ‘agency'—the capacity to act—from the bottom-up and top-down in responding to these issues. An agency typology encompassing various bottom-up and top-down agencies is developed through an analysis of Digital Games for Change (DG4C) for the various agencies they can initiate. The agency typology's contributions are threefold—in research (as a method and analytical tool), in practice (as design principles) and in education (for teaching collective action, impact). The agency typology can drive ‘concerted agency' or collective action, where top-down and bottom-up agencies work together, enabling multipronged targeted approaches to complex social issues and maximizing social justice efforts through collective impact.

Contemporary Urban Missions and Reflecting Reality in Deprivation of Civil Areas in Indian Cantonments – A Pragmatic View

The contemporary urban schemes were launched around five years ago by the National Government to create more inclusive cities and offer a decent quality of life to urban residents. But in reality, the civilian areas of Cantonments are grossly overlooked from the benefits of such welfare schemes. There are 52 notified civil areas in Indian Cantonments with a population of 2.08 million, according to the 2011 census. The Cantonment Act, 2006 (by repealing the Cantonment Act, 1924) empowered Cantonment Boards to act as ‘deemed to be a municipality ’to receive grants and implement government welfare schemes, including the provision of 24 types of infrastructure and services to its residents. The present research reviews the provisions and coverage of contemporary urban missions, including Smart Cities, and highlights civilian areas of the cantonments as deprived urban areas. Besides the non-implementation of contemporary urban welfare schemes, issues like the age-old colonial infrastructure, revenue crunch through taxes and non-taxes, absence of development plan, lack of inter-jurisdictional coordination etc., need to be addressed. The present research will act as an input for policymakers to understand the problems of civilian areas, nature, and extent of welfare scheme implementation, and also suggest the necessary changes required at the policy level.

Oral Health for Older Adults: Policy Barriers and Opportunities

Tooth decay and gum disease are two of the most common chronic health conditions in the United States, are reversible and preventable, and impact approximately 68% of older adults nationwide (CDC, 2021; World Health Organization, 2020). While the Affordable Care Act added provisions to health prevention services, oral health prevention coverage was only included for children, leaving many adults and older adults without coverage (Nasseh & Vujicic, 2017). The research team used a rapid review process using 17 key search term combinations to identify literature in three medical databases (PubMed, CINAHL, and Consumer Health Complete) to identify system and policy level barriers and opportunities to address oral health equity issues for older adults in the United States. 40 articles met inclusion criteria for thematic analysis. Findings revealed three barrier categories: 1) poor oral health literacy of patients and health care providers, 2) reimbursement variability contributing to access and utilization barriers, 3) workforce and scope of practice variability. In addition, four opportunity categories were identified: 1) community-based oral health programming for older adults, 2) new reimbursement models, 3) medical-dental collaborations, and 4) policy and practice act updates. The COVID-19 public health crisis has impacted the implementation of some system and policy level opportunities. However, new health care initiatives specific to Medicare in discussion at the national level provide an opportunity to make some headway on the policy updates needed to address the oral health of older Americans. Findings and implications will be shared with the audience.

Barriers and facilitators of HIV and hepatitis C care among people who inject drugs in Nairobi, Kenya: a qualitative study with peer educators

Background In Kenya, people who inject drugs (PWID) are disproportionately affected by HIV and hepatitis C (HCV) epidemics, including HIV-HCV coinfections; however, few have assessed factors affecting their access to and engagement in care through the lens of community-embedded, peer educators. This qualitative study leverages the personal and professional experiences of peer educators to help identify HIV and HCV barriers and facilitators to care among PWID in Nairobi, including resource recommendations to improve service uptake. Methods We recruited peer educators from two harm reduction facilities in Nairobi, Kenya, using random and purposive sampling techniques. Semi-structured interviews explored circumstances surrounding HIV and HCV service access, prevention education and resource recommendations. A thematic analysis was conducted using the Modified Social Ecological Model (MSEM) as an underlying framework, with illustrative quotes highlighting emergent themes. Results Twenty peer educators participated, including six women, with 2-months to 6-years of harm reduction service. Barriers to HIV and HCV care were organized by (a) individual-level themes including the competing needs of addiction and misinterpreted symptoms; (b) social network-level themes including social isolation and drug dealer interactions; (c) community-level themes including transportation, mental and rural healthcare services, and limited HCV resources; and (d) policy-level themes including nonintegrated health services, clinical administration, and law enforcement. Stigma, an overarching barrier, was highlighted throughout the MSEM. Facilitators to HIV and HCV care were comprised of (a) individual-level themes including concurrent care, personal reflections, and religious beliefs; (b) social network-level themes including community recommendations, navigation services, family commitment, and employer support; (c) community-level themes including quality services, peer support, and outreach; and (d) policy-level themes including integrated health services and medicalized approaches within law enforcement. Participant resource recommendations include (i) additional medical, social and ancillary support services, (ii) national strategies to address stigma and violence and (iii) HCV prevention education. Conclusions Peer educators provided intimate knowledge of PWID barriers and facilitators to HIV and HCV care, described at each level of the MSEM, and should be given careful consideration when developing future initiatives. Recommendations emphasized policy and community-level interventions including educational campaigns and program suggestions to supplement existing HIV and HCV services.

RESPONDENT ANALYSIS IN CONTEXT TO IMPACT OF CLIMATE CHANGE ON THE REGULATING SERVICES OF MANGROVE VEGETATION

The mangrove ecosystem in the lower Gangetic delta is noted for providing several regulatory services. The major regulatory services include erosion, natural disaster, Phytoremediation, carbon sequestration, siltation, and sea-level rise. Here, we have attempted to develop a mechanism of assessing and ranking the magnitude of regulatory services offered by Sundarban mangroves based on stakeholder’s views on the subject. The respondents were categorized into five major classes namely policy level worker, researcher, fisherman, agriculturist, and local inhabitant. About 295 respondents belonging to these 5 categories were asked about the types of regulatory services and their respective magnitude by ranking the services between 1 and 6. Finally, based on data generated, three separate Combined Mangrove Regulating Service Scale (CMRSS) were assessed for three sectors (western, central, and eastern) of Indian Sundarbans. The basic root for such assessment is contrasting variations between these three sectors based on geographical features, salinity, and biodiversity. The present approach of analysis can be a road map to identify and empirically score the regulatory services of mangroves.

Non-Existent “Bi”omes : Attitudes and Binegativity against Bisexual People in India

3 years ago the same-sex law was decriminalized in India which has brought about an increase in the LGBTQIA+ community’s visibility. Today, around 9% of India’s population identifies as bisexual (Ipsos, 2021). Bisexuality is the sexuality of any person who identifies themselves to be sexually attracted to people of any gender including binary, non-binary and agender individuals. There has been some research to understand the lesbian/gay and transgender population in India, but there’s a dearth of literature studying the various factors influencing the lives of bisexual population of India. Thus, the purpose of this study is to examine the attitudes and binegativity against bisexual people by cisgender and heterosexual (cis-het) high school (9-12th grade) students from Delhi, Kolkata, Mumbai and Chennai. This study will follow a cross-sectional exploratory design using a multiple stage cluster sampling. The Attitudes Regarding Bisexuality Scale (Mohr & Rochlen, 1999) and the Gender Specific Binegativity Scale (Mullik & Wright, 2002) would be administered to the students using an online survey platform. The findings would provide a better understanding of the bisexual population in India and present implications at the policy level to prevent discrimination against the bisexual community.

A Basic Right Denied: The Interplay Between Various Factors Contributing to School Dropouts in Pakistan

Enshrined in different conventions nationally and internationally, education is a fundamental right of every child irrespective of identity and location worldwide. Despite the Universal Declaration of Human Rights (UDHR) 1948 and the United Nations (UN) Convention on the Rights of the Child 1989, education is not accessible and affordable for every child globally due to several entwined factors. Focusing on Pakistan’s Sindh Province, this article identifies the numerous factors that lead to school dropouts and illustrates their interconnectedness. Employing Sen’s Capabilities Approach, we show a relation between freedom and function, whereby a capability can only be a function if there is an opportunity. We conclude and suggest that since the basic right of education is denied in Pakistan owing to sociocultural, economic, and political factors, there is a need to make necessary efforts at the parental as well as national policy level to address it. We also ask for ethnographically rich studies that should comparatively and thoroughly bring this dropout problem to the center stage for generating a comprehensive understanding so that this basic right is given to every child of this country.

Perspectives of Service Providers on Aftercare Service Provision for Persons with Substance Use Disorders at a Rural District in South Africa.

Background: Provision of aftercare services for persons with substance use disorders (PWSUD) within a rural context is typically met with various intersecting challenges, including unclear policy implications and lack of resources. In the South African context, service providers are expected to provide aftercare services that should achieve successful reintegration of persons with PWSUD into society, the workforce, family and community life as mandated by Act No. 70 of 2008, despite population diversity. Little has been established on the provision of aftercare services in South Africa and specifically within a rural context. This article explores the perspectives of service providers in aftercare service provision for PWSUD in a rural district.Methods: A qualitative exploratory study design was conducted in a rural district in South Africa using semi-structured interviews and focus group discussions with forty-six service providers from governmental and non-governmental institutions, ranging from implementation to policy level of service provision. Data were analyzed thematically using a deductive approach. Codes were predetermined from the questions and the aims and objectives of the study used Beer’s Viable Systems Model as a theoretical framework. NVivo Pro 12 qualitative data analysis software guided the organization and further analysis of the data.Results: Four themes emanated from the data sets. Theme 1 on reflections of the interactional state of aftercare services and program content identified the successes and inadequacies of aftercare interventions including relevant recommendations for aftercare services. Themes 2, 3, and 4 demonstrate reflections of service provision from implementation to policy level, namely, identifying existing barriers to aftercare service provision, situating systemic enablers to aftercare service provision, and associated aftercare system recommendations. Conclusions: The intersecting systemic complexities of providing aftercare services in a rural context in South Africa was evident. There existed minimal enablers for service provision in this rural district. Service providers are confronted with numerous systemic barriers at all levels of service provision. To strengthen the aftercare system, policies with enforcement of aftercare services are required. Moreover, a model of aftercare that is integrated into the existing services, family centered, sensitive to the rural context and one that encourages the collaboration of stakeholders could also strengthen and sustain the aftercare system and service provision.