Migrant healthcare workers during COVID-19: bringing an intersectional health system-related approach into pandemic protection. A German case study (preprint)

Introduction: Migrant healthcare workers played an important role during the COVID-19 pandemic, but data are lacking especially for high-resourced European healthcare systems. This study aims to research migrant healthcare workers through an intersectional health system-related approach, using Germany as a case study. Methods. An intersectional research framework was created and a rapid scoping study performed. Secondary analysis of selected items taken from two COVID-19 surveys was undertaken to compare perceptions of national and foreign-born healthcare workers, using descriptive statistics. Results. Available research is focused on worst-case pandemic scenarios of Brazil and the United Kingdom, highlighting racialised discrimination and higher risks of migrant healthcare workers. The German data did not reveal significant differences between national-born and foreign-born healthcare workers for items related to health status including SARS-CoV-2 infection and vaccination, and perception of infection risk, protective workplace measures, and government measures, but items related to social participation and work conditions with higher infection risk indicate a higher burden of migrant healthcare workers. Conclusions. COVID-19 pandemic policy must include migrant healthcare workers, but simply adding the migration status is not enough. We introduce an intersectional health systems-related approach to understand how pandemic policies create social inequalities and how the protection of migrant healthcare workers may be improved.

Comparative health policy goes qualitative: refocusing research after COVID-19 (preprint)

The COVID-19 pandemic has pushed health policy frontstage and exposed the stark differences in government capacities to respond to the crisis. This has created new demands for comparative heath policy to support knowledge creation on a large scale. However, comparative health policy has been ill prepared; studies have focused on health systems and used typologies together with descriptive, quantitative methods. This clouds the view for the multi-level nature of health policy, the diverse actors involved and the many societal facets of governance performance. We argue for health policy as a bottom-up process with diverse interests and suggest researching these processes comparatively to support policy learning. This calls for expanding the methodology of comparative health policy to include approaches that make greater use of explorative, qualitative research. We introduce possible developmental pathways to illustrate what this may look like. Firstly, the Pan-European Commission points to novel transnational and cross-sectoral collaborations, and a coordinated policy response to global challenges like the pandemic. Secondly, feminist networks show how to shift the focus towards social inequalities and the health needs of women and vulnerable populations. Thirdly, researchers demonstrate the value of new knowledge emerging from small-scale bottom-up comparisons based on structured assessment frameworks. Together, these developmental pathways demonstrate the potential to refocus comparative health policy towards greater responsiveness to the societal performance of governments, such as social inequalities created by the COVID-19 pandemic. This also opens opportunities for strengthening the global outlook of comparative health policy.

SDG5 Gender Equality and the COVID-19 pandemic: a rapid assessment of health system responses in selected upper-middle and high-income countries (preprint)

The COVID-19 pandemic disrupted healthcare and societies, exacerbating existing inequalities for women and girls across every sphere. Our study explores health system responses to gender equality goals during the COVID-19 pandemic and inclusion in future policies. We apply a qualitative comparative approach, drawing on secondary sources and expert information; material was collected from March-July 2022. Australia, Brazil, Germany, the United Kingdom and USA were selected, reflecting upper-middle and high-income countries with established public health and gender policies but different types of healthcare systems and epidemiological and geo-political conditions. Three sub-goals of SDG5 were analysed: maternity care and reproductive health, gender-based violence, and gender equality and womens leadership. We found similar trends across countries. Pandemic policies strongly cut into womens health, constrained prevention and support services and weakened reproductive rights, while essential maternity care services were kept open. Intersecting gender inequalities were reinforced, sexual violence increased and womens leadership was weak. All healthcare systems failed to protect womens health and essential public health targets. Yet there were relevant differences in the responses to increased violence and reproductive rights, ranging from some support measures in Australia to an abortion ban in the US. Our study highlights a need for revising pandemic policies through a feminist lens.

Healthcare workers perceptions and medically approved COVID-19 infection risk: understanding the mental health dimension of the pandemic. A German hospital case study (preprint)

Introduction. This study analyses how healthcare workers (HCWs) perceived risks, protection and preventive measures during the COVID-19 pandemic in relation to medically approved risks and organisational measures. The aim is to explore blind spots of pandemic protection and make mental health needs of HCWs visible. Methods. We have chosen an optimal-case scenario of a high-income country with a well-resourced hospital sector and low HCW infection rate at the organisational level to explore governance gaps in HCW protection. A German multi-method hospital study at Hannover Medical School served as empirical case; document analysis, expert information and survey data (n=1163) were collected as part of a clinical study into SARS-CoV-2 serology testing during the second wave of the pandemic (November 2020-February 2021). Selected survey items included perceptions of risks, protection and preventive measures. Descriptive statistical analysis and regression were undertaken for gender, profession and COVID-19 patient care. Results. The results reveal a low risk of 1% medically approved infections among participants, but a much higher mean personal risk estimate of 15%. The majority (68.4%) expressed some to very strong fear of acquiring infection at the workplace. Individual protective behaviour and compliance with protective workplace measures were estimated as very high. Yet only about half of the respondents felt strongly protected by the employer; 12% even perceived no or little protection. Gender and contact with COVID-19 patients had no significant effect on the estimations of infection risks and protective workplace behaviour, but nursing was correlated with higher levels of personal risk estimations and fear of infection. Conclusions. A strong mismatch between low medically approved risk and personal risk perceptions of HCWs brings stressors and threats into view, that may be preventable through better information and risk communication and through investment in mental health and inclusion in pandemic preparedness plans.