Non-governmental Research Articles

Mutual trust between German meat sector stakeholders, animal welfare and environmentalist non-governmental organizations against the backdrop of multi-stakeholder policies for sustainable meat

Excessive meat production and consumption (especially in high-income countries) are linked to global sustainability hazards, such as climate change. Yet, sustainable meat production constitutes a wicked problem (i.e., a problem resistant to final resolution with diverging interests by relevant stakeholders) and political intervention accordingly has remained limited. To tackle wickedness, scholars recommend policy formats that embrace diversity and complexity among stakeholders, so-called MSESs. Trust is said to facilitate stakeholder cooperation and ranks among the key ingredients to and outcomes of effective MSESs. Yet, trust remains under-conceptualized in the research that foregrounds MSESs vis-a-vis sustainable meat production. Thus, to test for stakeholders’ willingness to cooperate in MSESs aimed at sustainable meat production, our research applied a seminal trust concept to probe mutual trust between core stakeholders of the meat supply chain. Focusing on Germany, we investigated the relationship between those stakeholders assumed to share rather fragile bonds (i.e., representatives of meat production and of non-governmental organizations that advocate environmental and animal welfare causes). Using semi-structured interviews we interviewed both parties about their relationship, their opinion about MSESs and their willingness to cooperate with each other in them. Interview results were triangulated with secondary data. Our findings indicate limited trust by each party with the meat sector possibly being less trusting. They also reveal characteristics that may diminish trust in the eyes of each party. Our work further indicates acceptance of MSESs by both parties and suggests core characteristics that are relevant to the success of MSESs.

‘It’s fine in practice, but how about in theory?’ State-of-the-art minilateralism between expectations and reality

ABSTRACT This article examines the current state of minilateralism. The overall point is to evaluate the theoretical understanding of minilateralism in light of the empirical development of minilateral groupings, which have grown significantly over the last twenty years. In particular, the article focuses on questions of institutionalisation, the relationship of minilaterals to multilateralism, the growth of minilaterals from US-led alliances, and the type of goods (public or club) minilaterals tend to produce. Section I lays out the framework and context for the argument. Section II surveys the development of minilateralism, comparing and contrasting the emergence and characteristics of ‘legacy’ minilaterals from the mid-twentieth century to contemporary minilaterals. Section III details the empirical record of selected contemporary minilateral cases in order to deepen answers to some of the theoretical questions that have emerged as contemporary minilateralism has become a maturing phenomenon in international affairs. In section IV, the article addresses new issues in minilateral formations, such as inter-regional and non-US-led minilaterals, as well as involvement of the private sector and non-governmental organisations as nodes in minilateral networks. Finally, section V concludes with reflections on minilateralism’s future.

Mobile Medicine in Ukraine

Global Care Force, an international health nongovernmental organization, sent teams of physicians, physician assistants, nurses, and nurse practitioners every month to Ukraine to provide primary care for war-affected communities. I had the opportunity to partner with GCF in May 2024 during its monthly mission trip to this conflict-ravaged country. I described this medical outreach initiative in a first-person narrative in order to relay to a wider audience the realities of warfare for Ukrainian patients and health care workers. Our team treated chronic diseases in northern as well as southern Ukrainian villages near the front line near Kherson. We set up mobile medical clinics in these regions and delivered medications to patients suffering from blast injuries, hyperglycemia, hypertension, and posttraumatic stress disorder.

Effectiveness of government policy interventions towards enhancing access to pre-primary and primary education by street children in North Rift Kenya

An estimated 150 million children live on the streets globally, with many not enrolled in school. This growing issue requires urgent attention. UN Sustainable Development Goal 4, Target 5, aims to eliminate educational disparities for marginalized groups like street children, emphasizing the need to address prejudice in education access.The Kenyan government has developed measures to improve all children's access to education, particularly at the pre-primary and primary levels, in light of its signature on the United Nations convention. Government funding for the creation and execution of policy initiatives targeted at improving the access to education for these socially marginalised populations has been consistently large. Many street children still do not go to school though. In this regard a study was conducted to assess the effectiveness of government policy interventions towards enhancing access to pre-primary and primary education by street children. The study used mixed method research and pragmatic paradigm. By using both purposeful and random sampling, a sample size of 322 was selected. The respondents comprised of Street children, county directors of education, quality assurance officers, officers in the Department of Children Welfare, urban primary school teachers, non-governmental organisations, and community-based organisations that assist street children. Data was collected using observation guides, in-depth interviews, and questionnaires. Descriptive and inferential statistics as well as theme analysis were used to analyse the data, respectively. The results showed a statistically significant relationship between government policy interventions and street children's access to pre-primary and primary education in North Rift Kenya; specifically, the national pre-primary education policy had a Pearson correlation coefficient of 0.711, while the inclusive education policy had a coefficient of 1.0. The research additionally demonstrated the necessity of reinforcing the involvement of other relevant parties in improving street children's access to pre-primary and primary education.

Strategic Imperatives of Muslim Leadership in Post-War Sri Lanka: Citizenship, Rights and Reconciliation

This study examines how a few selected mainstream Sri Lankan Muslim civil organisations have been responding to the Sinhala Buddhist ideological paradigm in post-war Sri Lanka. The ideology perceives that Sinhala Buddhists are true citizens of Sri Lanka while minorities are “others” or “guests”. Hence, the ideology plays a structural role in generating anti-Muslim sentiments in post-war Sri Lanka. Contrary to prevailing wisdom which argues that minorities attempt to deconstruct the majoritarian ideological foundation in their struggle for equality, dominant and mainstream Muslim civil society organisations in Sri Lanka have chosen to reconcile with it while resisting only its practical implications upon the community. Even though this strategy brings self-contradictory elements into play on theoretical grounds, Muslim civil society organisations think that it is a practically reasonable strategy given the developing socio-political context of the state. Based on primary and secondary data and the thematic qualitative analysis, this study builds an argument by analysing discourses of the selected mainstream Muslim organisations that minorities pick strategies for their struggle against majoritarian state and ideology taking their political and other demographical realities into account. Hence, their choices are not static but rather dynamic.

9.C. Round table: The Global Oral Health Action Plan – Integrating Oral Health into the global health agenda

Abstract Oral diseases (OD) are a global public health problem affecting 3.5 billion people, with a global prevalence of 45%, higher than the prevalence of any other non-communicable disease (NCD). Recognizing the global public health importance, the 76th World Health Assembly (WHA) (May 2023) adopted the WHO’s Global Oral Health Action Plan (GOHAP) 2023-2030; a crucial step to bring momentum and mobilise all actors to address the burden of OD and common risk factors for all NCDs, while integrating oral health (OH) as part of general health and promoting cross-sectoral cooperation on good OH worldwide to reach UHC. Drawing insights from other successful global health action plans, this roundtable (RT) will explore key lessons learned in implementing effective strategies to improve OH outcomes at European and global levels, ensuring access to quality care for all. The objectives of the RT are: 1.To present the GOHAP 2023-2030, incl. challenges and opportunities; 2. To draw insights from other global health action plans; 3. To present good examples of civil society organization (CSO) actions supporting the GOHAP’s implementation - The Manifesto of the Platform for Better Oral Health, calling for policy actions by EU policymakers; 4. To present findings from the EU DELIVER (DELiberative ImproVEment of oRal care quality) and PRUDENT projects, funded by the European Commission, aiming to provide and implement a blueprint model for ensuring access to quality OH care for all; 5. To inform follow-up actions and collaboration across EUPHA sections, its strategy, as well as that of European Member States (MS), CSOs and other institutional partners, and to raise awareness across the European public and global health communities. The structure of the RT will include brief interactive presentations with real-time polling to maximize participant engagement and to consolidate key messages to present at the end of the session, incl. to inform follow-up actions across EUPHA. The first brief presentation on GOHAP will highlight the aims and evidence-informed actions, followed by: 1. Insights from other global health action plans, exploring lessons learned in implementing effective strategies, examining the approaches, opportunities, challenges and outcomes; 2. Good examples of actions taken by CSOs; 3. Preliminary findings from the EU DELIVER and EU PRUDENT will be presented, incl. key co-creation tools of deliberative dialogues and the development of a set of quality indicators for applicability on the practice, community and policy levels. Guided discussion will focus on opportunities and challenges in GOHAP implementation, with the targeted questions to panellists on: What can countries learn from other global health action plans? What should be the priorities of EU MS? What is the role the public health community can play? What are key steps needed to eliminate common NCD risk factors to drastically reduce the prevalence and burden of ODs? Key messages • There is an urgent need in the global and public health communities to better understand the processes involved in implementing the GOHAP, incl. challenges and opportunities. • Interdisciplinary and cross-sectoral collaboration is key to address the common risk factors of NCDs, to inform concerted action and evidence-informed policymaking to improve oral health care. Speakers/Panelists Pauline Vassallo European Association of Dental Public Health, Valletta, Malta Benoit Varenne Dental Officer, Prevention of Non Communicable Disease Department, WHO, Geneva, Switzerland Dympna Kavanagh Chief Dental Officer, Platform for Better Oral Health in Europe, Dublin, Ireland Neville Calleja Department of Health Information and Research, G’Mangia, Malta

Risk communication with asylum-seekers: Insights from the COVID-19 Pandemic experience in Munich

Abstract Background The COVID-19 pandemic has created a ‘double crisis’ for asylum-seekers, whose lives were already in crisis. Many reports indicated the syndemic consequences on asylum seekers’ health, underscoring the need for their inclusion in risk communication (RC) and community engagement (CE) and infodemic management (IM) actions. This study aims to describe RCCE experience with asylum seekers in Munich during the COVID-19 pandemic from an expert perspective and thus gain a thorough understanding of the requirements for inclusive RCCE. Methods Our qualitative study involved people who conducted COVID-19-related RCCE for asylum-seekers. Volunteers/workers of civil society organizations and health professionals were interviewed using purposeful sampling. After reviewing international guidelines, an interview form was created. The content analysis resulted in themes and categories. Results Four of the interviewees were health managers, while 8 were working in civil society organizations. The first category of the results describes the context in which RCCE occurs; syndemic factors (uncertainty; social exclusion and stigma; precarious housing; limited access to healthcare and unmet mental health needs) and pandemic management. The second category includes determinants of RCCE from both the asylum-seeker (trust; risk perception; health literacy; language; culture and gender) and RCCE member (competences; overburden; continuity) standpoint. The third category focuses on various RCCE-IM measures, including their effectiveness and consequences. Conclusions Syndemic factors hampered the effective implementation of RCCE for asylum seekers in Munich. RCCE determinants show that pre-crisis actions are necessary for an effective response and individual interactions should accompany community-level activities, particularly for female and marginalised migrants. This study’s scope will be expanded by incorporating the IM component.

4.K. Scientific session: The realm of the information ecosystem and its public health impact

Abstract Workshop background As a field of science, study, practice, and policy, infodemic management has emerged during the Covid-19 pandemic but has since been emancipated and can be translated to any topic where information ecosystems play a vital role. In particular relevant to public health, infodemic managers have grown in the ranks of institutes of public health, academic institutions, UN agencies and civil society organizations, tackling outbreaks and public health issues as wide as mpox, Marburg, teen mental health, chronic diseases, seasonal influenza, Ebola and routine immunization. Aiming at improving public health strategies, they are responsible for exploring and investigating personal and organizational (health) information ecosystem, generating evidence, identifying patterns of communication and information flow, tackling the onset and distribution of circulating mis- and disinformation, better understanding information voids, and respond to citizen needs concerning information demands around emergencies. In this workshop, we will focus on several common challenges associated with implementing whole-of-society interventions and strategies for resilience to health misinformation. Solving these challenges, which often are too big just for the health system to solve, will sometimes require creativity, out-of-the-box thinking as well as cross-disciplinary perspectives and new partnerships. Infodemics are also a global challenge that can easily cross borders, which is why country-to-country discussions of experiences by participants is encouraged-while no previous infodemic management experience is required. Workshop objectives The workshop will be organized as a research symposium with five speakers from infodemic management, health information, and health literacy. They will provide a solid introduction to infodemic management from different perspectives and angles. (i) The first presentation will introduce a study on health information seeking and health literacy in midwife-led care and the modern information environment. (ii) The second presentation will discuss how fact-checking organizations can partner within public health for a healthier internet. (iii) The third presentation will focus on unravelling misinformation by investigating the associations between health literacy and resilience. (iv) The fourth presentation will present a novel web-platform for credible health information and tackling misinformation. (v) The fifth presentation focuses on the impact of misinformation on social media in the context of natural disasters. The format of this workshop will be 5x8-minute presentations, including Q&A with the audiences, followed by a 20-minute panel discussion, reflecting the relevance of the results to public health research, practice and policy. Key messages • Infodemic management seeks to quickly understand the public’s information and health needs improve future public health responses, especially during emergencies. • Whole-of-society approaches are needed to address and mitigate harms caused by infodemics by developing closer partnerships and understanding between health systems and the public.

Driving policy changes: RISE-Vac lessons learnt and recommendations

Abstract The RISE-Vac project consortium applied evidence-based public health methods to collate, assess, and analyze all the evidence generated through project activities, including literature review and prospective data collection on quantitative and qualitative aspects of vaccine services implementation in prison settings. A multi-sectorial and inter-disciplinary group of experts was set-up including health professionals, statisticians, social scientists and people with lived experience from civil society organisations, health services, prison administrations, academia and international agencies. A set of recommendations, advice, and policy options on how to increase vaccine uptake, targeted to people in prison and using a citizen-centred approach, were developed and tailored to specific needs profiles of different prison population subgroups. Vaccinations to be considered in prison settings were grouped according to target population and/or public health objective into: Seasonal vaccinations and vaccination during outbreak; Childhood life-course vaccinations (booster doses); Vaccinations for cancer prevention; Vaccination for older population groups and people with chronic conditions. In consideration of the diversity of the countries participating in the project, their epidemiological context and available resources and infrastructures, a multi-tiered approach for the development and implementation of models for vaccination services implementation in prison settings was devised, encompassing core vaccinations, such as HBV, Flu, COVID-19 and tetanus, as well as expanded vaccination offer to respond to enhanced health needs and to promote equity of health outcomes, including e.g. HPV vaccination.

Study on access to social protection policies by homeless people during the COVID-19 pandemic

Abstract The study analyzed the access of homeless people (HP) to health and social protection policies, including emergency measures, during the COVID-19 pandemic in Belo Horizonte (BH), capital of the state of Minas Gerais, Brazil. Its main objective was to provide data on the profile of HP in the municipality, in addition to evaluating existing public policies focused on HP, based on the time frame of the health emergency. Study with mixed methods design with triangulation of quantitative and qualitative data. It used official databases in parallel with document analysis, interviews and focus groups. As a result, the cartography showed that in the first months of the pandemic the municipality had difficulty reorganizing the health system, which underwent constant protocol updates, consolidating, however, over the months. Important emergency interventions in the municipality of BH involved activities that facilitated HP’s access to the provision of services, including intersectorality between health services, social assistance and the third sector. The temporary offer of various intersectoral services, simultaneously with the offer of daytime shelters by organized civil society, was considered a key factor for the expansion and intensification of care networks for HP during the emergency phase. Itinerant services were among those with the greatest positive evidence of service to HP, with emphasis on the ‘Consultório na Rua’. The study concluded that understanding the profile of homeless people in BH and the intersectoral variables that impact HP contributes to better directing investments in interventions for these individuals and increasing the effectiveness of health and social protection systems, in line with with the work carried out by the third sector. Key messages • Understanding the inter-sector variables that impact Homeless People contributes to better targeting of investments in interventions in protection social. • Knowing the profile of the homeless population makes it possible to organize more effective health care and social assistance.

An intersectional approach on menstrual inequity as lived by women in circumstances of socioeconomic vulnerability in an urban and rural setting in Spain: a qualitative study

Since menstrual health and menstrual inequity are determined by social power structures, this study proposes to analyse, from an intersectional perspective, the experiences of menstrual inequity of women and people who menstruate (PWM) (≥18 years) under circumstances of socioeconomic vulnerability in an urban and rural setting in Catalonia (Spain), focusing on menstrual poverty, menstrual management and access to health care for menstrual health. An exploratory and interpretative qualitative study was conducted. Venue-based convenience sampling was carried out, recruiting women from a non-governmental organisation and a primary health care centre. Eighteen individual semi-structured interviews were conducted between October 2022 and February 2023. Data were analysed through reflexive thematic analysis. Analysis revealed that menstrual care was generally a distant preoccupation that revolved around circumstances of socioeconomic vulnerability, housing, and productive/reproductive work. Menstrual poverty, menstrual management and menstrual self-care challenges, barriers to accessing health care for menstrual health, and menstrual taboo, stigma and discrimination were commonplace and deepened by socioeconomic vulnerability. In this way, women’s menstrual experiences were rooted in intersecting axes of inequity, based on gender, race and class. Intersectional and critical participatory research, policy and practice are imperative to develop counter mechanisms that confront systems of privilege-oppression to modulate menstrual experience, health and equity.

Survival in STEMI in resource limited settings - obstacles and potential solutions. Critical lesson learnt thorough a prospective observational study

Abstract Background Early revascularization in ST segment elevation myocardial infarction(STEMI) by Primary Percutaneous coronary Intervention (PPCI) or fibrinolysis, reduces mortality. In the absence of a well-functioning STEMI care system, patients may not get guideline directed revascularisation (GDR). Objective We sought to determine the prevalent mode of revascularisation for STEMI in the community, to discern the factors contributing to lack of GDR during their initial medical encounter, and to investigate the consequences of not getting GDR. Methods Consecutive patients within 24 hours of STEMI from October 2021 to December 2021 in a public hospital from a developing nation, were enrolled. In addition to baseline data, the details of the first medical contact (FMC) and second medical contacts (SMC) before reaching the study site were collected. The hospitals where patients sought care earlier, could be lysis capable hospitals (LCH), PCI/lysis capable hospitals (PLCH) and non-lysis-capable hospitals (NLCH). Medical records related to these visits were scrutinised and in-depth interviews were conducted with patients and their care givers. Details of GDR offered / received during FMC/SMC and the reasons for not receiving GDR were collected. Results 300 patients were enrolled during the study period. 19 reported directly to the study site, while others had visited 1-3 hospitals en route(Figure-1). The 159 who received fibrinolysis in at least one of their medical contacts, had a significantly lower incidence of cardiogenic shock and in-hospital mortality, compared to the rest(Figure-2). 162(54%) patients had had FMC in NLCH and had to be referred to SMC for GDR. Of the 157 visits by a patient with STEMI in a LCH / PLCH within 6 hours’ time window (6HTW), GDR was provided only 44 visits(28%) (Figure-1). The common reason for not receiving GDR was financial. This revascularisation solutions offered were not affordable. These include, PPCI only or pharmaco-invasive package only in PLCH and high cost bolus lytic only in LCH. Of the 132 patients, who had FMC ≤ 12 hours in LCH, only 33 had lysis. Patients who did not receive revascularisation, despite reaching within 6HTW, had adverse in-hospital outcome. (Figure-2) Conclusion The public awareness of the need for early revascularisation in STEMI and the revascularisation solutions available in the neighbourhood hospitals is low. Most patients with STEMI do not receive GDR despite reaching revascularisation capable hospitals within 6HTW. The common reasons for this include, non-availability of low cost fibrinolytics and lack of financial resources. Hospitals should offer fibrinolysis when patients cannot afford PPCI, and low-cost infusion lytics, when patients cannot afford high cost bolus lytics. Provision of GDR in STEMI at the first medical contact, is a social responsibility. Governmental and non-governmental organisations should work in tandem, to ensure 100% GDR at first medical contact.

Governing the Slovenian National Cancer Control Programme - Key Lessons Learnt

Abstract Issue Strategic documents addressing major public health concerns should extend beyond health sector. Cancer control is commonly perceived only as a health issue, thus involving diverse stakeholders is challenging. Description of the problem The inclusion of stakeholders within and beyond the health sector is crucial in the preparation, and through implementation of National Cancer Control Programmes (NCCP). Lessons learned on how to involve and maintain fruitful collaboration with diverse stakeholders in Slovenian NCCP are presented. Results Over the past 14 years Slovenia’s NCCP has built a reliable and reputable partnership with diverse stakeholders, a collaboration that continues to evolve. Efforts extend across multiple sectors, encompassing health, education, employment, research, environment, technology, and non-governmental organizations. NCCP has set up multistakeholder governance structures: an advisory board, board of experts, specialised expert groups, and a group of representatives of cancer hospitals. These groups engage a diverse range of experts and institutions nationwide. Whenever feasible, representatives of patient organizations are included. All these structures hold regular meetings, complemented by an annual event that convenes all stakeholders and also provides an invaluable platform for informal networking. To ensure seamless coordination of all activities, a dedicated team is essential. Our approach has evolved to embrace a dual leadership, comprising both a public health specialist and a clinical expert. Additionally, we benefit from the expertise of communication experts, who offer valuable insights into effectively reaching diverse audiences. Lessons Governing Slovenia’s NCCP by involving diverse stakeholders in planning and implementation activities has demonstrated its effectiveness. Furthermore, we are witnessing an increasing number of new stakeholders actively seeking out to participate in the NCCP. Key messages • Slovenia’s NCCP is recognized for its credibility and strategic approach. • Involving diverse stakeholders in cancer control endeavours has proven effective, fostering trust and partnerships.

Innovating Community Engagement: The Role of Micro-Influencers in Promoting Sustainable Behaviors among Malaysian Millennials

Social Influencers as environmental leaders utilize social media platforms to enhance community engagement in advocating sustainability. This study explores the underexplored role of micro-influencers in fostering pro-environmental behaviors among Malaysian youths and innovating community engagement by employing a qualitative approach in conducting semi-structured interviews with five micro-influencers. Our findings indicate the critical role of micro-influencers in raising awareness and actively engaging communities in adopting sustainable practices. The findings reveal three key themes: leadership qualities, pro-environmental behaviors, and persuasive narrative strategies. Through the innovative use of social media, these influencers overcome linguistic and geographical barriers, fostering enhanced community engagement in the pursuit of environmental stewardship. However, the sample size of five micro-influencers may limit the generalizability of the findings, as it may only partially represent the diverse range of micro-influencers. The result of this research can be used as recommendations for organizations, non-governmental organizations and governmental bodies that can leverage the insights from this study to strategically engage micro-influencers in environmental campaigns, recognizing their unique ability to reach and resonate with specific communities, particularly Malaysian youths. This study offers a novel perspective on digital environmental leadership by uncovering the unique role of micro-influencers in fostering community engagement and cultivating a culture of sustainability. It provides original insights into how these emerging leaders not only inspire but also empower communities to take meaningful action toward environmental preservation. The study highlights the underexamined potential of micro-influencers in exceeding traditional barriers to community engagement, offering valuable implications for future strategies in environmental advocacy.

Capacity mapping of comprehensive sexuality education in Gabon: A qualitative analysis

Abstract Background Access to comprehensive sexuality education (CSE) is crucial for adolescent health and well-being. Following UNESCO’s recommendations, Gabon revised its sex education policy in 2017 to better address adolescents’ sexual health needs. This study aims to map the capacities of the public health and education sector to implement Gabon’s CSE policy. Methods Semi-structured interviews were held with 15 professionals from ministries, NGOs, and development partners. Thematic analysis guided by Aluttis et al’s public health capacity model allowed to assess the existing capacities and gaps in leadership, organizational structures, partnerships, resources, and knowledge development for CSE. Results The implementation of CSE in Gabon is hindered by sociocultural and political factors, including the taboo on adolescent sexuality influencing perceptions of CSE content, natalist policies, and socio-economic disparities. Governmental involvement in CSE is limited to key ministries. Organizational structures for CSE lack cohesion due to changes in governance regimes and a lack of support for civil society organizations. Human resources are unevenly distributed, and financial constraints impede government initiatives, causing a strong reliance on external funding. An important role in supporting CSE is played by development partners and partnerships between stakeholders. While knowledge development for CSE is underway, monitoring and evaluation procedures are insufficient, and evidence mobilization by key professionals is insufficient. Conclusions Enhancing stakeholder collaboration, addressing structural constraints, and mobilizing human and financial resources are critical for effective CSE implementation in Gabon. Addressing these barriers requires coordinated efforts among stakeholders and addressing systemic challenges. This study provides insights for policymakers and practitioners to strengthen CSE programs and promote adolescent sexual health in Gabon. Key messages • CSE implementation is hindered by taboos on adolescent sexuality, natalist policies, and socio-economic gaps. • Evaluation and evidence mobilization deficits limit effectiveness.

Innovations in abortion care in France, Germany and the UK following the COVID-19 pandemic

Abstract Background Through an international comparison of health systems and policies, we aim at assessing the contextual and circumstantial characteristics of abortion care innovation in three European countries following the upheaval of the COVID-19 pandemic. The three contrasting care models pre-pandemic constitute an interesting baseline for observing different systems’ reaction to health crises. Methods We conducted a review of the recent (2020 onward) peer-reviewed and grey literature, including national policy documents and guidelines. We then carried a comparative analysis of innovations implemented during the pandemic and their sustainability post-crisis. Results In France and the UK, where abortion care was more accessible before the pandemic than in Germany, a series of innovations were officially introduced to facilitate access during the pandemic. They included teleconsultations and the mailing of abortion medication. Most changes have been sustained since then, contributing to addressing historic and systemic health inequities in terms of access (e.g. due to geography and the existence of “medical deserts”). In Germany, innovations during the pandemic have been crafted by the civil society through NGOs offering for the first time teleabortion services (e.g. Balance Berlin and Doctors for Choice). The legitimation of those practices by professional bodies is still in the making, highlighting the limitations of the catalyst role of crises in the face of cultural barriers and resistance of health systems to innovation. Conclusions The COVID-19 pandemic provoked or accelerated innovation in terms of abortion care in France, Germany and the UK. Yet, its sustainability, as well as its scaling up, remains fragile, especially in Germany, where the disruptive approach of civil society organisations has not yet found its way into mainstream health care services. Key messages • International comparison of health systems’ reaction to the COVID-19 pandemic in terms of abortion care shows different paths to innovation. • The sustainability of innovation beyond the first pandemic years pertains to the wider debate on equity in access to abortion care.

4.A. Skills building seminar: Waves of community health engagement and governance: innovating through a design-as-policy approach

Abstract In this workshop we will engage our participants in a practice oriented exercise to experiment with a collaborative design-as-policy approach for a community health action plan. The exercise will be based on the lessons learned in two large evaluation projects: 1) an 8-year evaluation of the Dutch All about Health (AaH) platform of social health initiatives on the local, regional and national level; and 2) a comparative multiple case study, including Portugal, building a framework for sustainable citizen engagement, published in the WHO Handbook ‘Voice, Agency, Empowerment: The Handbook on Social Participation for UHC’. Both projects show striking similarities in findings, and developed guidance for devising collaborative action through (a) the use of community platforms, (b) concrete engagement mechanisms and (c) mediating civil society organizations. These will be brought together in a Guidance Tool that participants will work with in the exercise. The aim of the tool is to support initiatives to bring together both top-down participatory efforts and bottom-up grassroots movements in order to anchor community and minority voices into policy decision-making for a more level playing field for policy influence. The aim of the workshop is to let participants experiment with the Guidance Tool and develop collaborative design-as-policy skills. The outline of the skills building exercise: 1. Group introductions using Mentimeter and invitation to pick a particular complex health issue from participants’ own work or community setting (5 mins). 2. Three pitches on the projects, the Portugal case and the Guidance Tool (10 mins). 3. Exercise instructions (5 mins). 4. Exercise (35 mins) a. Upon room entrance participants receive a colored badge based on their professional background: public health professional/practitioner, community resident, researcher or policymaker; b. Form small sub groups of 6-8 participants with different backgrounds (2 mins); c. Introduce with key words on paper their respective complex community health issues and sub group jointly selects one issue for which most information and experience is present (6 mins); d. First round in duos within sub group: participants work through the guidance steps to an initial idea for the collaborative action approach consisting of a community platform, engagement mechanisms, and mediating civil society organizations, drawn out on paper (10 mins); e. Second round in duos within the sub group: duos review another duos initial design idea and conduct an intuitive SWOT analysis of feasibility, acceptability, and practicability (8 mins); f. Third round in sub group: compare the three proposals in SWOT perspective, select the most salient one, and improve with strong elements from other proposals (8 mins); g. Summarize in key words the final proposal and enter into Mentimeter. 5. Plenary wrap up using Mentimeter: select the winning proposal, and evaluate the exercise (5 mins). Key messages • Collaborative action is enhanced considerably through (a) the use of community platforms, (b) concrete engagement mechanisms and (c) mediating civil society organizations. • The Guidance Tool offers concrete steps for designing a reflexive and adaptive structure and process for community collaborative action and self-governance. Speakers/Panelists Marleen Bekker Wageningen University & Research, Wageningen, Netherlands Dheepa Rajan WHO, Brussels, Belgium Goncalo Figueiredo Augusto National Health Council, Lisbon, Portugal

Exploring the Social Media Practices of Environmental Non-Governmental Organizations (ENGO): A Qualitative Approach

This study aims to enhance the understanding of how Environmental Non-Governmental Organizations (ENGOs) use social media to engage their audiences in the causes they advocate. By incorporating elements from the Uses and Gratification theory and other sources, the researchers conducted one-on-one interviews with 20 ENGOs. Data were analysed through textual analysis using NVIVO software. The results indicate that ENGOs leverage social media, particularly Facebook, to raise awareness about climate change and biodiversity, with positive impacts on fundraising and lobbying, depending on resource availability. However, limited budgets and corporate governance issues pose challenges to social media use. This study provides managerial recommendations for developing more engaging and effective communication strategies on social media, as well as further exploration of environmental communication trends.

Humanitarian Activism, Social Protection, and Emergent Citizenship in Myanmar

Through the confluent impacts of the Covid-19 pandemic and the 2021 military coup, Myanmar has become a failed state. Deliberate targeting of humanitarian actors by the military junta has severely constrained the activities of international non-governmental organisations and United Nations agencies. In the first three post-coup years, welfare provision to the distressed and displaced were mainly undertaken by local actors who adapted to new conditions of both insecurity and broader economic turmoil. This localised welfare is intertwined with emergent local governance mechanisms, using technology and data analysis to deliver transparent, accountable, and inclusive public service. In the absence of a coherent central state, the social contract of welfare develops at more local levels, generating smaller islands of citizenship from which to build future political communities.

A Qualitative Study Evaluating the Challenges of Orthopedists and Internists in the Earthquake Zone

Abstract Background The earthquake centered in Kahramanmaras province, Turkey, on February 6, 2023, with a magnitude of 7.7, resulted in the loss of 53,537 lives and the injury of 107,213 people. This study was conducted to evaluate the challenges and experiences of physicians who provided post-disaster medical care. Methods We conducted a qualitative study with orthopedists and internists who had worked in the earthquake zone using in-depth interviews. Participants were selected through snowball sampling. Interviews explored challenges in the disaster zone, obstacles related to healthcare services, and disaster management. Thematic analysis was used. Results A total of 13 physicians participated in the study. Data revealed four main themes: disaster management, organizational deficiencies, challenges faced, and logistical issues. Participants indicated that the Ministry of Health didn’t have a priori operational emergency action plan, which led to problems in healthcare service delivery. Some physicians complained that they had to serve just as emergency consultants and were not able to carry out tasks compatible with their expertise. Some indicated that they organized the services rather than providing medical care. Almost all encountered a variety of interesting cases and evaluated their experience as significant. Logistical needs were met mostly with the support of non-governmental organizations. Conclusions We need to have a priori operational emergency action plan to ensure the effective delivery of healthcare services in the aftermath of a disaster. The Ministry of Health needs to allocate and coordinate healthcare personnel in line with their areas of expertise and prevent service disruptions. Key messages • There is a need to make an operational emergency action plan beforehand to deliver healthcare services effectively following a disaster. • Physicians should be allocated in line with their specialty of expertise to efficiently address the healthcare needs.