Introduction: Sexism and misogyny remains an ongoing threat to optimal health and medical services. An important factor in health and medical services is the education and training pipeline into these careers. A substantial body of literature demonstrates the impacts of sexism in third-level education and training institutions developing future health service staff. Athena SWAN accreditation is a benchmark designed to counter such institutional and individual sexist practices in education settings to foster equality. In recent years the Athena SWAN process has expanded to include professional and administrative staff, as well as academics. This process has also evolved to move beyond a narrow focus on gender, to also include other crucial issues such as race, sexuality and gender identity. Methods: This examination is based on the author’s role as a participant observer and critiques the Athena SWAN process in an Institute of Technology in Ireland. Results: This examination identifies a substantial number of deficits in the Athena SWAN process, as well as also identifying institutional resistance strategies to such gender equality work. Conclusion: The current Athena SWAN process in Ireland is critically flawed. Suggested strategies for those engaged in such work into the future are outlined. Conflict of interest: None declared.

Aim: An assessment of the training needs and interests of health managers working in the health care facilities of the Kyrgyz Republic was conducted, aiming to tailor and shape future training interventions. Methods: A rapid assessment was organized among directors of health care services in the Kyrgyz Republic, using a web-based questionnaire. Due to the pandemic situation (COVID-19), it was impossible to involve all healthcare facilities as initially planned. Therefore, a convenient sample of 75 directors was drawn with a response rate of 77.3%, or 58 filled-in questionnaires. Results: Among respondents, 60.3% were female and 39.7% male managers, with an average age of 53.5 years. Most of the respondents (89.7%) came to a managerial position by direct appointment, while only 10.3% were appointed through competitive process. More than half of health managers (63.8%) do not have any managerial category, and only 25.7% indicated that they have membership in the Association of Health Administrators of Kyrgyzstan[1]. All respondents reported the need to develop computer skills. Discussion: There is a high demand in all aspects of the management of health organizations. The respondents are deciding about involvement in management training based on (a) the full range of training' topics, (b) the quality of the training content, and (c) the focus on developing practical skills. The most cited training needs are digital health (E-Health), financing management, planning, and quality control; the interest in distance learning courses is excellent. Almost two-thirds of managers reported that the Ministry of Health and Social Development (MOHSD KR) did not evaluate their work. Conclusion: The main implications derived from this assessment are related to the culture of lifelong learning among the population of Kyrgyz health managers. Authors’ contributions: All authors contributed equally. Conflict of interest: None declared. Source of funding: The project is financed by the Government of Switzerland. The opinions expressed in this publication are the views of the authors and do not necessarily reflect the opinion of the Government of Switzerland.

Aim: The objective of this study was to assess the current status regarding Infection Prevention and Control (IPC) in selected healthcare facilities in Albania in light of the ongoing COVID-19 pandemic which continues unabated. Methods: A cross-sectional study was conducted in April 2021 including a nationwide representative sample of 505 health professionals working mostly in primary health care centres in Albania (84 men and 421 women;response rate: 95%). A structured questionnaire developed by the World Health Organization was administered online to all participants inquiring about a wide range of measures and practices employed at health facility level for an effective IPC approach. Fisher’s exact test was used to assess potential urban-rural differences in the distribution of characteristics regarding IPC aspects reported by survey participants. Results: About 47% of health facilities did not have a designated focal point for IPC issues;the lack of one patient per bed standard was evident in more than one-third of health facilities (37%);and the lack of an adequate distance between patient beds was reported in a quarter of health facilities (which was twice as high among health facilities in urban areas compared to rural areas). Furthermore, water services were always available only in about two-thirds of health facilities (63%), whereas an adequate number of toilets (at least two) was evident in slightly more than half of the health facilities surveyed (53%). Also, one out of four of the health facilities did not have functional hand hygiene stations and/or sufficient energy/power supply. A completely adequate ventilation was evidenced in slightly more than half of the health facilities (51%). Four out of five health facilities had always available materials for cleaning and about half (49%) had always available personal protective equipment. Functional waste collection containers were available in nine out of ten health facilities, of which, four out of five were correctly labelled. Conclusion: This study informs about the existing structures, capacities and available resources regarding IPC situation in different health facilities in Albania. Policymakers and decision-makers in Albania and in other countries should prioritize investments regarding IPC aspects in order to meet the basic requirements and adequate standards in health facilities at all levels of care. © 2021, Jacobs Verlag. All rights reserved.

In tandem with the current drive to achieve the SDG 2030 goals, the Universal Health Coverage (UHC) is been projected as a strong propelling strategy with key indicators, all aimed at achieving universal access to health services without having to endure financial difficulties in individual countries. Currently, Africa is lagging in meeting the targets of the UHC with between 5% -25% coverage across countries. Adoption of new innovations are critical for the actualization of Universal Health Coverage in Africa. Digital health technology offers one of such novel approaches to providing quality healthcare services and can help countries achieve the Universal Health Coverage targets. It has been suggested that digital health provides an opportunity to overcome the longstanding problems of inefficiency of health information gathering, sharing, and access. In addition, literature is already replete with various factors that can aid countries to achieve UHC and one of such factors is the urgency of generating valid and quality evidence to inform decision-making. Although the Primary Health Care remains at the core of the achievement of Universal Health Coverage, the utilization of digital health technologies remains very poor at the grassroots in Africa and this poses a huge barrier to effectiveness and quality of healthcare delivery. Given the foregoing, it is obvious that there is an urgent need to understand the landscapes, issues and barriers to utilization of digital health at the Primary Health Care levels. However, there remains a paucity of data to support evidence-based decision making about full implementation of digital health services across the continent while also taking into cognisance the peculiarities of individual countries. Hence, there is a critical need to determine the current levels of knowledge, skills, attitude, practice and readiness to adopt digital health in service delivery by healthcare workers at the Primary Health Care levels across the continent. The generation of such data from major stakeholders such as health workers and health managers, providers among others will provide important evidence needed for attaining optimal utilization of digital health in the context of health for all. Summarily, a clear understanding of the contextual and implementation bottlenecks highlighted from such assessment(s), especially as it relates to individual African countries, will go a long way to guide decisions to address the low utilization of digital health technologies in health services delivery in Africa. Source of funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Acknowledgement The authors acknowledge the support of the Department of Environmental Health Sciences, University of Ibadan and contributions of Prof. G.R.E. E Ana, Prof. M.K.C. Sridhar, Dr. E.C. Uwalaka, Dr. O.T. Okareh and Dr. O.M. Morakinyo, in the writing of this paper CO is supported by Consortium for Advanced Research Training in Africa (CARTA) which is funded by the Carnegie Corporation of New York (Grant No--B 8606.R02), Sida (Grant No:54100029), the DELTAS Africa Initiative (Grant No: 107768/Z/15/Z). Conflict of interest statement The authors declare that they have no known competing financial interests or personal relationships that could have influenced the writing of this paper. Author contributions CO: Conceptualization; CO, PO and OF: Writing- Original draft preparation, CO, PO and OF: Writing- Reviewing and Editing.

Context: An inclusive and diverse public health workforce maximizes health outcomes. However, little is known about the current diversity and inclusiveness profile of professionals, leaders and students of public health. To obtain a diverse and inclusive (D&I) public health workforce in the future, D&I leadership in Public Health Schools is necessary to encourage a D&I student body. Policy Options: A variety of policy responses can be utilized to diversify schools of public health (SPH). Response types include (i) exploratory policies that instigate D&I research with the aim to increase knowledge and build hypotheses, (ii) regulatory (and financial) policies that change the environment by placing rules, restrictions, or expectations on the institution to increase and promote D&I and (iii) soft options, which are non-binding actions that aim to change the institutional culture surrounding D&I. However, policies are often not specifically tailored to their school and are therefore unsuccessful. Recommendations: To understand the composition and identify gaps within the current diversity and inclusion (D&I) profile of leadership in European Schools of Public Health (SPH) an exploratory needs assessment is advised. A baseline assessment will be the much needed first step of this paper’s proposed project: The Diverse and Inclusive Public Health Schools (DIPHS) Project. A needs assessment should be seen as a baseline evaluation of the current D&I profile among leaders in European Schools of Public Health (SPH). This information should then build the basis to encourage institution-tailored policy interventions for SPH to actively promote a diverse and inclusive public health workforce. Acknowledgments: We thank Valia Kalaitzi, our senior advisor, and Kasia Czabanowska for their thoughtful feedback. Authors’ contributions: All authors contributed equally to this work. Source of funding: None declared

Context: In the Netherlands, the number of homeless people increased from 17.800 in 2009 to 39.300 in 2018. Due to the COVID-19 pandemic and its socioeconomic consequences, the needs of marginalized people have increased worldwide in terms of access to services and relevant information. In the Netherlands, along with the Red Cross, other humanitarian organizations such as the Salvation Army, the Rainbow Foundation, and the Foundation for the Homeless are already providing people in need with primary needs such as food and housing, but also with healthcare and legal support. Cooperation between services for the homeless is also gaining attention. However, collaboration between relevant stakeholders is still insufficient and urges to be expanded. Moreover, centralized monitoring is challenging as different services are provided (shelters, assisted housing) by different stakeholders and there is no central data collection system or pre-defined indicators. Recent, comprehensive data on homelessness figures are needed to understand the needs and how these may have changed, given the exacerbated consequences of COVID-19 pandemic on those in socioeconomic vulnerability, in order safeguard the health, safety and dignity of homeless people. Policy Options: To address the needs of homeless people, innovation is needed to overcome sectoral boundaries and to work collaboratively. At the level of service provision, as shown by some successful global experiences (e.g. Homeless Individuals and Families Information System (HIFIS), Housing First, Les Infirmieres de la Rue), new partnerships and collaborations are a central dimension of many effective innovative initiatives relating to homelessness. The target of collaboration is to improve health and social outcomes in the most appropriate and efficient manner. To improve case management at the local level, in Canada, the Homeless Individuals and Families Information System (HIFIS) provides a single platform for homogeneous data collection on clients among service providers that facilitates referrals between services. Recommendations: Approaches to improve cross-sectoral collaboration and communication at two levels should be identified. Firstly, establishing a coordinated and comprehensive cross-sectoral network among organizations in the field and secondly, improving data collection. Acknowledgments: The authors would like to express their sincere thanks to J. Neicun and K. Czabanowska for their support in preparing and revising the policy brief. Authors’ contributions: All authors contributed equally to this work. Conflicts of interest: None declared Funding: None declared

Context: Food-Based Dietary Guidelines (FBDGs) are science-based recommendations in the form of guidelines for healthy eating. They provide information and advice on foods and dietary patterns to consumers to promote the overall health and prevent chronic disease. As of now, these FBDGs lack information about the sustainability of food products. Consumer food choices have a large impact on human and planetary health and wellbeing, as the production and processing of diets make up between 20% and 30% of the total greenhouse gas emission of consumable goods in the European Union (EU). A plethora of different ecolabels exist to aid consumers in making sustainable choices when purchasing items, both food and non-food products. These ecolabels make it easier for consumers to choose eco-friendly product alternatives, with the aim of lowering the environmental impact of the products a consumer buys. While the growth of ecolabels may be interpreted as a sign of success, label overload and gaps in the understanding might result in confusion for consumers, resulting in the limit of use of these already existing ecolabels. Therefore, this policy brief proposes the development of a universal, understandable ecolabel for food products, to enable consumers to make better informed decisions. Policy Options: Three policy options are examined. Firstly, a hypothetical ‘do nothing’ scenario is considered, in which food ecolabels are not used. As a second alternative, the use of carbon footprint labelling is examined. Lastly, the implementation of a “traffic light” colour pattern label that uses the colours green, orange and red to demonstrate low, medium and high environmental impact, respectively, is examined. Recommendations: In order to determine the best policy option, the three proposed policy options are compared using five evaluation criteria (time of implementation, cost of implementation, ease of implementation, consumer friendliness and positive environmental impact). The traffic light ecolabel had the highest overall score, and it is thus recommended that this food ecolabel should be used. Lastly, it is recommended that the ecolabel is incorporated into the already existing EU ecolabel, in an effort to increase consumer knowledge and understanding of this novel ecolabel. Acknowledgments: This research was supported by Professor Suzanne M. Babich. Associate Dean of Global Health and Professor, Health Policy and Management, at the Indiana University Richard M. Fairbanks School of Public Health in Indianapolis, Indiana, USA, for North America. Authors’ contributions: All authors contributed equally to this work. Conflict of Interest: None declared. Source of Funding: None declared

Context: Access to education is a fundamental right that should be realised to the degree that every child can develop their talents to the fullest potential. Therefore, children with special education needs and disabilities (SEND) have the right to claim resources and aid to function in schools and should not be excluded from any level of mainstream education. However, the process towards executing this fundamental right is slowed down by existing ableist structures. Policy Options: This policy brief analyses inclusive education policies from the perspective of four different European Countries (Italy, the Netherlands, Poland, and the United Kingdom). The data was synthesised using four types of ableism that are addressed in this policy brief. The gaps within definitions and argumentation were identified and discussed to provide recommendations concerning education for people with SEND. Recommendations: The evaluation provided three significant recommendations towards inclusive education systems by addressing ableist structures. Firstly, it is crucial to reduce the linguistic gaps between national educational policies and the underlying national laws. Secondly, it is necessary to include the target group and raise awareness for SEND to reinforce societal and scientific perspectives, and influence policy decision-making. Lastly, it is important to address the discrepancies between the inclusive education policies and the structural capacity. The synergy between these two key factors is crucial for an effective implementation of inclusive education. Acknowledgments: We thank Robin van Kessel, our senior advisor, and Dr Katarzyna Czabanowska for the opportunity to explore this topic as part of the Leadership track in the Master Governance and Leadership in European Public Health. Authors’ contributions: All authors contributed equally to this work. Conflict of interest: None declared Source of funding: None declared