Corruption risks in health procurement during the COVID-19 pandemic and anti-corruption, transparency and accountability (ACTA) mechanisms to reduce these risks: a rapid review.

BACKGROUND: Health systems are often susceptible to corruption risks. Corruption within health systems has been found to negatively affect the efficacy, safety, and, significantly, equitable distribution of health products. Enforcing effective anti-corruption mechanisms is important to reduce the risks of corruption but requires first an understanding of the ways in which corruption manifests. When there are public health crises, such as the COVID-19 pandemic, corruption risks can increase due to the need for accelerated rates of resource deployment that may result in the bypassing of standard operating procedures. MAIN BODY: A rapid review was conducted to examine factors that increased corruption risks during the COVID-19 pandemic as well as potential anti-corruption, transparency and accountability (ACTA) mechanisms to reduce these risks. A search was conducted including terms related to corruption, COVID-19, and health systems from January 2020 until January 2022. In addition, relevant grey literature websites were hand searched for items. A single reviewer screened the search results removing those that did not meet the inclusion criteria. This reviewer then extracted data relevant to the research objectives from the included articles. 20 academic articles and 17 grey literature pieces were included in this review. Majority of the included articles described cases of substandard and falsified products. Several papers attributed shortages of these products as a major factor for the emergence of falsified versions. Majority of described corruption instances occurred in low- and middle-income countries. The main affected products identified were chloroquine tablets, personal protective equipment, COVID-19 vaccine, and diagnostic tests. Half of the articles were able to offer potential anti-corruption strategies. CONCLUSION: Shortages of health products during the COVID-19 pandemic seemed to be associated with increased corruption risks. We found that low- and middle-income countries are particularly vulnerable to corruption during global emergencies. Lastly, there is a need for additional research on effective anti-corruption mechanisms.

PrEP policy implementation gaps and opportunities in Latin America and the Caribbean: a scoping review.

Background: Pre-exposure prophylaxis (PrEP) is an important tool for HIV prevention in Latin America and the Caribbean (LAC). Yet, little is known about the PrEP policies landscape in the region. Addressing this gap, this scoping review assessed current PrEP policies throughout LAC to better understand existing PrEP implementation gaps and identify opportunities to improve access. Methods: We conducted a scoping review, using a modified PRISMA extension, through 28 July 2022, to identify country-level PrEP policies. Data were collected in English, Spanish, French, and Portuguese utilizing online platforms for screening and data extraction (Google Forms, Zotero, and Excel). Extracted data were divided by data source, including country-level government policies, gray literature, and peer-reviewed literature, with at least one full-text reviewer and data extractor per publication. An iterative summative content analysis was performed to compare and interpret themes across phases and data sources. Results: Of the 33 countries in LAC, 22 (67%) had policies approving daily oral PrEP for HIV prevention, which outlined specific key populations, including men who have sex with men, transgender women, sex workers, and serodiscordant couples. Generic tenofovir disoproxil fumarate/emtricitabine has been approved in 15 of the 33 countries, and 13 of the 33 countries have incorporated PrEP into their public health system. No countries were found to have approved cabotegravir. Costing data were reported by only one country, Ecuador, in its national health ministry guidelines. Findings also document a lag between the media/gray-literature announcement of PrEP and implementation of policies. Conclusion: Findings underscore significant advances in PrEP policies in the region and signal opportunities for greater PrEP implementation. Since 2017, an increasing number of countries have begun to provide PrEP to communities at heightened need, although significant gaps remain. Policy approval is a key step to further increasing access to PrEP in LAC, necessary to reduce the burden of HIV in LAC, specifically among marginalized populations.

Indigenous Cultural Safety Trainings for Healthcare Professionals Working in Ontario, Canada: Context and Considerations for Healthcare Institutions.

Background: Racism and discrimination are realities faced by Indigenous peoples navigating the healthcare system in Canada. Countless experiences of injustice, prejudice, and maltreatment calls for systemic action to redress professional practices of health care professionals and staff alike. Research points to Indigenous cultural safety training in healthcare systems to educate, train, and provide non-Indigenous trainees the necessary skills and knowledge to work with and alongside Indigenous peoples using cultural safe practices grounded in respect and empathy. Objective: We aim to inform the development and delivery of Indigenous cultural safety training within and across healthcare settings in the Canadian context, through repository of Indigenous cultural safety training examples, toolkits, and evaluations. Methods: An environmental scan of both gray (government and organization-issued) and academic literature is employed, following protocols developed by Shahid and Turin (2018). Synthesis: Indigenous cultural safety training and toolkits are collected and described according to similar and distinct characteristics and highlighting promising Indigenous cultural safety training practices for adoption by healthcare institutions and personnel. Gaps of the analysis are described, providing direction for future research. Final recommendations based on overall findings including key areas for consideration in Indigenous cultural safety training development and delivery. Conclusion: The findings uncover the potential of Indigenous cultural safety training to improve healthcare experiences of all Indigenous Peoples. With the information, healthcare institutions, professionals, researchers, and volunteers will be well equipped to support and promote their Indigenous cultural safety training development and delivery.

Indigenous Cultural Safety Training for Applied Health, Social Work, and Education Professionals: A PRISMA Scoping Review.

Anti-Indigenous racism is a widespread social problem in health and education systems in English-speaking colonized countries. Cultural safety training (CST) is often promoted as a key strategy to address this problem, yet little evidence exists on how CST is operationalized and evaluated in health and education systems. This scoping review sought to broadly synthesize the academic literature on how CST programs are developed, implemented, and evaluated in the applied health, social work and education fields in Canada, United States, Australia, and New Zealand. MEDLINE, EMBASE, CINAHL, ERIC, and ASSIA were searched for articles published between 1996 and 2020. The Joanna Briggs Institute's three-step search strategy and PRISMA extension for scoping reviews were adopted, with 134 articles included. CST programs have grown significantly in the health, social work, and education fields in the last three decades, and they vary significantly in their objectives, modalities, timelines, and how they are evaluated. The involvement of Indigenous peoples in CST programs is common, but their roles are rarely specified. Indigenous groups must be intentionally and meaningfully engaged throughout the entire duration of research and practice. Cultural safety and various related concepts should be careful considered and applied for the relevant context.

Anti-corruption in global health systems: using key informant interviews to explore anti-corruption, accountability and transparency in international health organisations.

OBJECTIVES: Corruption undermines the quality of healthcare and leads to inequitable access to essential health products. WHO, Global Fund, United Nations Development Programme (UNDP) and World Bank are engaged in anti-corruption in health sectors globally. Throughout the COVID-19 pandemic, weakened health systems and overlooked regulatory processes have increased corruption risks. The objective of this study is thus to explore the strengths and weaknesses of these organisations' anti-corruption mechanisms and their trajectories since the pandemic began. DESIGN, SETTING AND PARTICIPANTS: 25 semistructured key informant interviews with a total of 27 participants were conducted via Zoom between April and July 2021 with informants from WHO, World Bank, Global Fund and UNDP, other non-governmental organisations involved in anti-corruption and academic institutions. Key informant selection was guided by purposive and snowball sampling. Detailed interview notes were qualitatively coded by three researchers. Data analysis followed an inductive-deductive hybrid thematic analysis framework. RESULTS: The findings demonstrate that WHO, World Bank, Global Fund and UNDP have shifted from criminalisation/punitive approaches to anti-corruption to preventative ones and that anti-corruption initiatives are strong when they are well funded, explicitly address corruption and are complemented by strong monitoring and evaluation mechanisms. Weaknesses in the organisations' approaches to anti-corruption include one-size-fits-all approaches, lack of political will to address corruption and zero-tolerance policies for corruption. The COVID-19 pandemic has highlighted the necessity of improving anti-corruption by promoting strong accountability and transparency in health systems. CONCLUSIONS: Results from this study highlight the strengths, weaknesses and recent trajectories of anti-corruption in the Global Fund, World Bank, UNDP and WHO. This study underscores the importance of implementing strong and robust anti-corruption mechanisms specifically geared towards corruption prevention that remain resilient even in times of emergency.

An exploration of anti-corruption and health in international organizations.

Corruption is a global wicked problem that threatens the achievement of health, social and economic development goals, including Sustainable Development Goal # 3: Ensuring healthy lives and promoting well-being for all. The COVID-19 pandemic and its resulting strain on health systems has heightened risks of corruption both generally and specifically within health systems. Over the past years, international organizations, including those instrumental to the global COVID-19 response, have increased efforts to address corruption within their operations and related programs. However, as attention to anti-corruption efforts is relatively recent within international organizations, there is a lack of literature examining how these organizations address corruption and the impact of their anti-corruption efforts. This study addresses this gap by examining how accountability, transparency, and anti-corruption are taken up by international organizations within their own operations and the reported outcomes of such efforts. The following international organizations were selected as the focus of this document analysis: the World Health Organization, the Global Fund, the United Nations Development Programme, and the World Bank Group. Documents were identified through a targeted search of each organization's website. Documents were then analyzed combining elements of content analysis and thematic analysis. The findings demonstrate that accountability and transparency mechanisms have been employed by each of the four international organizations to address corruption. Further, these organizations commonly employed oversight mechanisms, including risk assessments, investigations, and audits to monitor their internal and external operations for fraud and corruption. All organizations used sanction strategies meant to reprimand identified transgressors and deter future corruption. Findings also demonstrate a marked increase in anti-corruption efforts by these international organizations in recent years. Though this is promising, there remains a distinct absence of evidence demonstrating the impact of such efforts on the prevalence and severity of corruption in international organizations.

Education in uncertainty: Academic life as Indigenous health scholars during COVID-19.

As the COVID-19 crisis continues to develop, communities around the world find themselves living in new and uncertain times. School and university closures are significantly disrupting the lives of students, educators and researchers alike. With the sudden shift to online learning platforms, the limitations on research projects and the lack of standardised policies and procedures, many concerns arise surrounding the unequal impacts of this crisis. This article brings together diverse perspectives on the effects of COVID-19 on post-secondary life for students and scholars engaged in the field of Indigenous health research. The authors reflect on how this time has impacted them as a graduating student, incoming PhD student, junior faculty member and mid-career faculty member respectively. Their experiences of teaching and learning at a large, research-intensive university in Toronto, Canada have been profoundly transformed, and will continue to change the way they work, research and interact at the graduate level. Working with Indigenous communities and organisations requires relationship building, collaboration and ceremony. In these unprecedented times, scholars cannot simply continue "business as usual". They must adapt everything, including how they teach, learn and work with Indigenous peoples, who are particularly vulnerable to this pandemic. Reflecting on the impacts that have already occurred and those that are still likely to come, the authors discuss what changes may need to be made in academia to support diverse actors within their scholarly community. They suggest changes to their scholarship with Indigenous communities in Canada to help them continue to work in a respectful, reciprocal and culturally appropriate way.

L'éducation dans des temps incertains : la vie universitaire pour les chercheurs dans le domaine de la santé des autochtones à l'heure de la COVID-19 ­ La crise de la COVID-19, qui continue de prendre de l'ampleur, plonge des communautés du monde entier dans des périodes inédites et incertaines. Les fermetures d'écoles et d'universités perturbent considérablement la vie des étudiants au même titre que celle des éducateurs et des chercheurs. Le brusque passage aux plateformes d'apprentissage en ligne, les restrictions imposées aux projets de recherche et l'absence de politiques et de procédés standardisés ont fait apparaître des préoccupations concernant l'impact hétérogène de la crise en cours. Cet article réunit différents points de vue sur les effets qu'a la COVID-19 sur la vie des étudiants de troisième cycle et des chercheurs dans le domaine de la recherche sur la santé des autochtones. Les auteures se penchent sur la façon dont cette période a impacté leur existence respectivement en tant qu'étudiante en fin de deuxième cycle, future doctorante et membres du corps professoral en début et en milieu de carrière ; une période qui a profondément marqué leur expérience de l'enseignement et de l'apprentissage dans une université centrée sur la recherche dans la ville canadienne de Toronto, et qui continuera à transformer leur façon de travailler, de faire de la recherche et d'interagir au niveau de l'enseignement supérieur. Travailler avec des communautés et organisations autochtones exige de construire des relations et de collaborer avec elles, et de respecter leurs usages. En cette période sans précédent, les universitaires ne peuvent pas faire comme si de rien n'était. Ils doivent tout adapter, y compris leur façon d'enseigner, d'apprendre et de travailler avec les peuples autochtones, particulièrement vulnérables face à cette pandémie. Dans une réflexion sur les conséquences qui se sont déjà fait sentir et sur celles probablement à venir, les auteures se penchent sur les changements susceptibles de devenir indispensables dans la sphère universitaire pour soutenir différents acteurs de leur communauté scientifique. Elles proposent des changements à leur travail avec les communautés autochtones au Canada pour les aider à continuer à opérer dans le respect et la réciprocité, et de façon adaptée sur le plan culturel.

Many lenses for planetary health: seeding citizen engagement for sustainable futures visioning with new ways of seeing.

OBJECTIVES: This pilot project sought to seed citizen engagement processes for sustainable futures visioning with ideas, perspectives, and processes informed by Indigenous ways of knowing. METHODS: Five circle dialogues were convened with students, faculty, and members of the public, in the spring of 2019, using Indigenous talking circle methodology and intentionally seeded with "disruptive" ideas to encourage reflexivity and open space for "out-of-the-box" thinking. These were complemented by a series of one-on-one dialogues with members of the pan-Canadian research team. Pre- and post-dialogue surveys, notes taken by participants, team members, and co-facilitators, as well as notes from one-on-one interviews, constituted the data drawn upon for this paper. RESULTS: Participants were overwhelmingly positive about their experience, noting they were able to go further and deeper in their thinking and listening, and that they valued the Indigenous talking circle methodology, even if they stopped short of claiming the experience had transformed their way of seeing the world. Key points raised in the dialogues included the need for a more relational worldview, the need to repair severed relations with the land and nature, the importance of Indigenous ways of knowing, the importance of community building, and the need to question the fundamental assumptions undergirding contemporary Western societies. CONCLUSIONS: While caution must be exercised in drawing conclusions and extrapolating from this modest pilot project, our experience underscores the value of processes that intentionally catalyze critical reflexivity and openness to other ways of seeing, informed by Indigenous ways of knowing and talking circle methodology.

RéSUMé: OBJECTIFS: Ce projet pilote visait à faire germer des idées, des opinions et des processus éclairés par les modes de savoir autochtones dans des processus de mobilisation citoyenne pour faire naître des scénarios d'avenir durables. MéTHODE: Cinq cercles de dialogue ont été organisés avec des étudiants, des professeurs et des personnes du public, au printemps 2019, en faisant appel à la méthode autochtone des cercles de la parole et en semant délibérément des idées « perturbatrices ¼ afin d'encourager la réflexivité et de sortir des sentiers battus. Les cercles ont été complétés par une série de dialogues individuels avec les membres de l'équipe de recherche pancanadienne. Les sondages pré- et post-dialogue, les notes prises par les participants, les membres de l'équipe et les coanimateurs, ainsi que les notes des entretiens individuels ont constitué la matière première du présent article. RéSULTATS: La très grande majorité des participants ont trouvé l'expérience positive : ils ont dit avoir pu aller plus loin et plus profond dans leur réflexion et leur écoute et avoir apprécié la méthode des cercles de la parole autochtones, sans toutefois aller jusqu'à dire que l'expérience avait transformé leur vision du monde. Les principaux points soulevés dans les dialogues ont été le besoin d'avoir une vision du monde plus relationnelle, le besoin de réparer les relations rompues avec la terre et la nature, l'importance des modes de savoir autochtones, l'importance de la solidarité sociale et le besoin de remettre en cause les hypothèses fondamentales qui soutiennent les sociétés occidentales contemporaines. CONCLUSIONS: S'il faut faire preuve de prudence avant d'extrapoler et de tirer des conclusions d'un simple projet pilote, notre expérience souligne la valeur des processus qui induisent intentionnellement une réflexivité critique et une ouverture à d'autres façons de voir, éclairés par les modes de savoir autochtones et par la méthode des cercles de la parole.

Exploring anti-corruption, transparency, and accountability in the World Health Organization, the United Nations Development Programme, the World Bank Group, and the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Corruption is recognized by the global community as a threat to development generally and to achieving health goals, such as the United Nations Sustainable Development Goal # 3: ensuring healthy lives and promoting well-being for all. As such, international organizations such as the World Health Organizations and the United Nations Development Program are creating an evidence base on how best to address corruption in health systems. At present, the risk of corruption is even more apparent, given the need for quick and nimble responses to the COVID-19 pandemic, which may include a relaxation of standards and the rapid mobilization of large funds. As international organizations and governments attempt to respond to the ever-changing demands of this pandemic, there is a need to acknowledge and address the increased opportunity for corruption.In order to explore how such risks of corruption are addressed in international organizations, this paper focuses on the question: How are international organizations implementing measures to promote accountability and transparency, and anti-corruption, in their own operations? The following international organizations were selected as the focus of this paper given their current involvement in anti-corruption, transparency, and accountability in the health sector: the World Health Organization, the United Nations Development Program, the World Bank Group, and the Global Fund to Fight Aids, Tuberculosis and Malaria. Our findings demonstrate that there has been a clear increase in the volume and scope of anti-corruption, accountability, and transparency measures implemented by these international organizations in recent years. However, the efficacy of these measures remains unclear. Further research is needed to determine how these measures are achieving their transparency, accountability, and anti-corruption goals.