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Leaving no one behind: how women seize control of wheat-maize technologies in Bangladesh.

ABSTRACT: Bangladesh is strongly committed to the "leave no one behind" principle of the UN's Sustainable Development Goals. However, social norms and institutional biases in agricultural organisations can prevent indigenous peoples and women from participating in wheat-maize innovation processes, as they rarely meet the requisite criteria: sufficient land, social capital or formal education. The GENNOVATE (Enabling Gender Equality in Agricultural and Environmental Innovation) research initiative in Bangladesh shows that indigenous Santal women are obtaining access to and benefiting from wheat-maize innovations, enabling low-income Muslim women to benefit as well.

SUBMITTER: Farnworth CR

PROVIDER: S-EPMC7077353 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Leaving no one behind: how women seize control of wheat-maize technologies in Bangladesh.

Farnworth Cathy Rozel CR Jafry Tahseen T Rahman Siddiqur S Badstue Lone B LB

Revue canadienne d'etudes du developpement = Canadian journal of development studies 20190829 1

Bangladesh is strongly committed to the "leave no one behind" principle of the UN's Sustainable Development Goals. However, social norms and institutional biases in agricultural organisations can prevent indigenous peoples and women from participating in wheat-maize innovation processes, as they rarely meet the requisite criteria: sufficient land, social capital or formal education. The GENNOVATE (Enabling Gender Equality in Agricultural and Environmental Innovation) research initiative in Bangl ...[more]

PMID: 32257594

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Project description:BackgroundOne way to achieve universal health coverage (UHC) in low- and middle-income countries (LMIC) is the implementation of health insurance schemes. A robust and up to date overview of empirical evidence assessing and substantiating health equity impact of health insurance schemes among specific vulnerable populations in LMICs beyond the more common parameters, such as income level, is lacking. We fill this gap by conducting a systematic review of how social inclusion affects access to equitable health financing arrangements in LMIC.MethodsWe searched 11 databases to identify peer-reviewed studies published in English between January 1995 and January 2018 that addressed the enrolment and impact of health insurance in LMIC for the following vulnerable groups: female-headed households, children with special needs, older adults, youth, ethnic minorities, migrants, and those with a disability or chronic illness. We assessed health insurance enrolment patterns of these population groups and its impact on health care utilization, financial protection, health outcomes and quality of care.ResultsThe comprehensive database search resulted in 44 studies, in which chronically ill were mostly reported (67%), followed by older adults (33%). Scarce and inconsistent evidence is available for individuals with disabilities, female-headed households, ethnic minorities and displaced populations, and no studies were yielded reporting on youth or children with special needs. Enrolment rates seemed higher among chronically ill and mixed or insufficient results are observed for the other groups. Most studies reporting on health care utilization found an increase in health care utilization for insured individuals with a disability or chronic illness and older adults. In general, health insurance schemes seemed to prevent catastrophic health expenditures to a certain extent. However, reimbursements rates were very low and vulnerable individuals had increased out of pocket payments.ConclusionDespite a sizeable literature published on health insurance, there is a dearth of good quality evidence, especially on equity and the inclusion of specific vulnerable groups in LMIC. Evidence should be strengthened within health care reform to achieve UHC, by redefining and assessing vulnerability as a multidimensional process and the investigation of mechanisms that are more context specific.

Project description:Patient navigation interventions, which are designed to enable patients excluded from health systems to overcome the barriers they face in accessing care, have multiplied in high-income countries since the 1990s. However, in low-income countries (LICs), indigents are generally excluded from health policies despite the international paradigm of universal health coverage (UHC). Fee exemption interventions have demonstrated their limits and it is now necessary to act on other dimensions of access to healthcare. However, there is a lack of knowledge about the interventions implemented in LICs to support the indigents throughout their care pathway. The aim of this paper is to synthesize what is known about patient navigation interventions to facilitate access to modern health systems for vulnerable populations in LICs. We therefore conducted a scoping review to identify all patient navigation interventions in LICs. We found 60 articles employing a total of 48 interventions. Most of these interventions targeted traditional beneficiaries such as people living with HIV, pregnant women and children. We utilized the framework developed by Levesque et al. (Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health 2013;12:18) to analyse the interventions. All acted on the ability to perceive, 34 interventions on the ability to reach, 30 on the ability to engage, 8 on the ability to pay and 6 on the ability to seek. Evaluations of these interventions were encouraging, as they often appeared to lead to improved health indicators and service utilization rates and reduced attrition in care. However, no intervention specifically targeted indigents and very few evaluations differentiated the impact of the intervention on the poorest populations. It is therefore necessary to test navigation interventions to enable those who are worst off to overcome the barriers they face. It is a major ethical issue that health policies leave no one behind and that UHC does not benefit everyone except the poorest.

Dataset Information

Leaving no one behind: how women seize control of wheat-maize technologies in Bangladesh.

Publications

Leaving no one behind: how women seize control of wheat-maize technologies in Bangladesh.

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