Universal Health Coverage and the Pacific Islands: An Overview of Senior Leaders' Discussions, Challenges, Priorities and Solutions, 2015-2020.

In 1995, Pacific Health Ministers articulated their vision of a healthy Pacific as 'a place where children are nurtured in body and mind; environments invite learning and leisure; people work and age with dignity; where ecological balance is a source of pride; and where the ocean is protected.' Central to this vision is the achievement of universal health coverage (UHC). To provide an indication of the UHC-related priorities of Pacific health authorities and promote alignment of domestic and international investments in health sector development, we thematically analyzed the discussion, resolutions, and recommendations from 5 years (2015-2020) of senior-level Pacific health meetings. Five main themes emerged: (i) the Healthy Islands vision has (and continues to have) a unifying influence on action for UHC; (ii) adoption of appropriate service delivery models that support integrated primary health care at the community level are needed; (iii) human resources for health are critical if efforts to achieve UHC are to be successful; (iv) access to reliable health information is core to health sector improvement; and (v) while not a panacea for all challenges, digital health offers many opportunities. Small and isolated populations, chronic workforce limitations, weak governance arrangements, ageing and inadequate health facilities, and supply chain and logistics difficulties (among other issues) interact to challenge primary health care delivery across the Pacific Islands. We found evidence that the Healthy Islands vision is a tool that garners support for UHC; however, to realize the vision, a realistic understanding of needed political, human resource, and economic investments is required. The significant disruptive effect of COVID-19 and the uncertainty it brings for implementation of the medium- to long-term health development agenda raises concern that progress may stagnate or retreat.

"The real pandemic's been there forever": qualitative perspectives of domestic and family violence workforce in Australia during COVID-19.

BACKGROUND: In 2020, Australia, like most countries, introduced restrictions related to the global pandemic of coronavirus disease 2019 (COVID-19). Frontline services in the domestic and family violence (DFV) sector had to adapt and innovate to continue supporting clients who were experiencing and/or at risk of DFV. There is a need to understand from the perspective of those on the frontline how DFV service responses in different contexts impacted their working conditions and subsequent wellbeing, and what they want to see continued in 'the new normal' to inform future effective practices. We address this by reporting on findings from in-depth interviews conducted with practitioners and managers from the DFV sector in Australia. METHODS: Between July and September 2020 semi-structured interviews were conducted with 51 DFV practitioners and managers from a range of services and specialisations across legal, housing, health and social care services. The data was analysed using iterative thematic analysis. RESULTS: The most common service adaptations reported were shifting to outreach models of care, introducing infection control procedures and adopting telehealth/digital service delivery. Adjacent to these changes, participants described how these adaptations created implementation challenges including increased workload, maintaining quality and safety, and rising costs. Impacts on practitioners were largely attributed to the shift towards remote working with a collision in their work and home life and increased risk of vicarious trauma. Despite these challenges, most expressed a sense of achievement in how their service was responding to COVID-19, with several adaptations that practitioners and managers wanted to see continued in 'the new normal', including flexible working and wellbeing initiatives. CONCLUSIONS: The pandemic has amplified existing challenges for those experiencing DFV as well as those working on the frontline of DFV. Our findings point to the diversity in workforce experiences and has elucidated valuable lessons to shape future service delivery. Given the continuing impacts of the pandemic on DFV, this study provides timely insight and impetus to strengthen the implementation of remote working and telehealth/digital support across the DFV sector and to inform better supports for DFV workforce wellbeing in Australia and other contexts. TRIAL REGISTRATION: Not a clinical intervention.

Intimate partner violence during the COVID-19 pandemic in Western and Southern European countries.

BACKGROUND: Intimate partner violence (IPV) is a significant problem with several negative health outcomes. Disasters are linked to increased IPV, but little is known about reporting of and strategies to address IPV during the COVID-19 pandemic. This review maps the IPV reporting during the pandemic and interventions to prevent and respond to IPV in 11 Western and Southern European countries. METHODS: Government websites, news articles and pre-prints were searched using the terms 'domestic violence' or 'violence' in combination with 'Covid' or 'Corona'. Embase, PubMed, Scopus and Google Scholar were searched using the terms 'domestic violence' and 'partner violence' and 'interventions'. RESULTS: Six countries showed an increase in domestic violence reports (Austria, Belgium, France, Ireland, Spain and UK), two countries a drop (Italy and Portugal), two countries showed no change (The Netherlands and Switzerland) and one country did not provide comparative data (Germany). Common measures to address IPV were starting a campaign (nine countries), creating online support (seven), more funding for alternative accommodation (seven) and support (eight) and use of a code word (four). CONCLUSIONS: IPV reports or helpline calls in Western and Southern European countries in the first weeks of COVID-19 measures increased in six countries, remained the same in two countries and showed a decrease in two countries. While this review cannot ascertain the impact of the measures taken by the countries during the pandemic and beyond, this mapping provides a foundation for future research, and an opportunity to trace the efficacy of these strategies.