STI testing, diagnoses and online chlamydia self-sampling among young people during the first year of the COVID-19 pandemic in England.

PURPOSE: COVID-19 control measures reduced face-to-face appointments at sexual health services (SHSs). Remote access to SHSs through online self-sampling was increased. This analysis assesses how these changes affected service use and STI testing among 15-24 year olds ('young people') in England. METHODS: Data on all chlamydia, gonorrhoea and syphilis tests from 2019-2020, among English-resident young people were obtained from national STI surveillance datasets. We calculated proportional differences in tests and diagnoses for each STI, by demographic characteristics, including socioeconomic deprivation, between 2019-2020. Binary logistic regression was used to determine crude and adjusted odds ratios (OR) between demographic characteristics and being tested for chlamydia by an online service. RESULTS: Compared to 2019, there were declines in testing (chlamydia-30%; gonorrhoea-26%; syphilis-36%) and diagnoses (chlamydia-31%; gonorrhoea-25%; syphilis-23%) among young people in 2020. Reductions were greater amongst 15-19 year-olds vs. 20-24 year-olds. Amongst people tested for chlamydia, those living in the least deprived areas were more likely to be tested using an online self-sampling kit (males; OR = 1.24 [1.22-1.26], females; OR = 1.28 [1.27-1.30]). CONCLUSION: The first year of the COVID-19 pandemic in England saw declines in STI testing and diagnoses in young people and disparities in the use of online chlamydia self-sampling which risk widening existing health inequalities.

Exploring preferences of older adults for dental services: A pilot multi-national discrete choice experiment.

OBJECTIVES: To pilot an exploration of older adults' future preferences using discrete choice experiments to understand who should provide dental examinations and treatment, where these services should be provided, and participants' willingness to pay and willingness to travel. BACKGROUND: The proportion of older adults in the general population is increasing and is recognised as a pressing public health challenge. MATERIALS AND METHODS: Older people aged 65 years and over were recruited into this study from the UK, Switzerland and Greece. Drawing on earlier stakeholder engagement, a set of choice experiments are developed to explore the future preferences of older people for dental examinations and dental treatment, as they anticipated losing their independence. These were presented to the participants using a range of platforms, because of the COVID pandemic. Data were analysed in STATA using a random-effects logit model. RESULTS: Two hundred and forty-six participants (median age 70 years) completed the pilot study. There was a strong preference across all countries for a dentist to undertake a dental examination (Greece: ß = 0.944, Switzerland: ß = 0.260, UK ß = 0.791), rather than a medical doctor (Greece: ß = -0.556, Switzerland: ß = -0.4690, UK: ß = -0.468). Participants in Switzerland and the UK preferred these examinations to be undertaken in a dental practice (Switzerland: ß = 0.220, UK: ß = 0.580) while participants in Greece preferred the dental examination to be undertaken in their homes (ß = 1.172). Greek participants preferred dental treatment to be undertaken by a specialist (ß = 0.365) in their home (ß = 0.862), while participants from the UK and Switzerland preferred to avoid any dental treatment at home (Switzerland: ß = -0.387; UK: ß = -0.444). Willingness to pay analyses highlighted that participants in Switzerland and the UK were willing to pay more to ensure the continuity of future service provision at a family dental practice (Switzerland: ß = 0.454, UK: ß = 0.695). CONCLUSION: Discrete choice experiments are valuable for exploring older people's preferences for dental service provision in different countries. Future larger studies should be conducted to further explore the potential of this approach, given the pressing need to design services that are fit for purpose for older people. Continuity of dental service provision is considered as important by most older people, as they anticipate losing their dependence.

E-nursing homes: transforming access to nurses in nursing homes in response to the staffing crisis.

The UK is facing a nationwide staffing crisis within adult social care, due to difficulties in recruiting and retaining registered nurses. Current interpretation of legislation means nursing homes must always have the physical presence of a registered nurse on duty within the home. With the shortage of registered nurses increasing, reliance on agency workers is commonplace, a practice impacting service cost and continuity of care. Lack of innovation to tackle this issue means the question of how to transform service delivery to combat staffing shortages is open for debate. The potential for technology to augment the provision of care was highlighted during the COVID-19 pandemic. In this article the authors present one possible solution focused on the provision of digital nursing care within nursing homes. Anticipated benefits include enhanced accessibility of nursing roles, reduced risk of viral spread and opportunities for upskilling staff. However, challenges include the current interpretation of legislation.

An Analysis of Factors Influencing the Intention to Use "Untact” Services by Service Type

Since COVID-19, social distancing has become common, and the demand for untact services has increased rapidly, resulting in an economic phenomenon centered on untact worldwide. Due to social distancing, the untact service area is expanding not only to shopping but also to online learning, home training, and telemedicine, and untact services are expected to expand to more diverse areas in the future. This study investigates four types of untact services: online lectures, online meetings related to work and study, online seminars, and online performances, and the effects of concerns about untact services on the intention of use have been examined using a path analysis model. As a result of the analysis, the perceived usefulness had a positive effect on the user's continuous intention to use untact services. However, depending on the type of untact service, it can be confirmed that the factors that affect the intention to continue using the service differ from each other. Practitioners can use the results of this study when designing untact services in the future. © 2023 by the authors.

Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement.

Background: Despite evidence-based national guidelines for ADHD in the United Kingdom (UK), ADHD is under-identified, under-diagnosed, and under-treated. Many seeking help for ADHD face prejudice, long waiting lists, and patchy or unavailable services, and are turning to service-user support groups and/or private healthcare for help. Methods: A group of UK experts representing clinical and healthcare providers from public and private healthcare, academia, ADHD patient groups, educational, and occupational specialists, met to discuss shortfalls in ADHD service provision in the UK. Discussions explored causes of under-diagnosis, examined biases operating across referral, diagnosis and treatment, together with recommendations for resolving these matters. Results: Cultural and structural barriers operate at all levels of the healthcare system, resulting in a de-prioritization of ADHD. Services for ADHD are insufficient in many regions, and problems with service provision have intensified as a result of the response to the COVID-19 pandemic. Research has established a range of adverse outcomes of untreated ADHD, and associated long-term personal, social, health and economic costs are high. The consensus group called for training of professionals who come into contact with people with ADHD, increased funding, commissioning and monitoring to improve service provision, and streamlined communication between health services to support better outcomes for people with ADHD. Conclusions: Evidence-based national clinical guidelines for ADHD are not being met. People with ADHD should have access to healthcare free from discrimination, and in line with their legal rights. UK Governments and clinical and regulatory bodies must act urgently on this important public health issue.

Retailer service strategy on livestreaming platforms considering free riding behavior.

Livestreaming e-commerce is a significant and effective digital tool for retailers to boost sales during the COVID-19 outbreak. Services on livestreaming platforms may be provided by either the manufacturer or the retailer. As service free riding across products becomes increasingly prevalent, the key issues retailers face include selecting which product should be promoted and who should provide service on the livestreaming channel. Using a game-theoretic framework, we investigate a retailer's optimal livestreaming service strategy that considers free riding between the retailer's store brand and a manufacturer's national brand. Our main findings are as follows. When service resources on the livestreaming channel are limited, (1) the retailer should not promote products with extremely low base demand, and (2) given that the national brand is promoted, if the two brands exhibit either very similar or significantly different features, the retailer should provide service for the national brand personally; otherwise, the retailer should delegate the service to the manufacturer. When livestreaming resources are unlimited, it may be unnecessary for the retailer to promote both brands if the store brand has a large base demand.

Why are there so many hospital beds in Germany?

The place of hospitals in health systems is undergoing rapid change worldwide due to the high cost of hospital care and the changing health needs of the population. The Covid-19 pandemic has recently drawn public attention towards hospital capacity and has added new urgency to discussions on the future role of hospitals. In this context, recent experience in Germany provides valuable information for health systems seeking to manage hospital capacity. Despite reform efforts to reduce hospital capacity, Germany has the highest rates of intensive care beds among high-income countries and the highest overall hospital capacity in Europe. The capacity of the German hospital system can be explained in large part by the high number of elderly in-patients. This, in turn, is driven by (1) a fragmented ambulatory care system; (2) physicians admitting and maintaining elderly patients in hospital at a high rate; (3) a hospital market adding incentives to admit patients; and (4) a political commitment to egalitarian access and universal care. Additionally, recent policies to reduce hospital capacity have had limited impact because hospitals have not responded to financial incentives in the expected manner. Countries looking to learn from Germany's hospital capacity must therefore consider systemic features, political commitments, and unintended policy consequences.

The Role of Trust in Older Adult Service Provision at the Onset of the COVID-19 Pandemic.

The COVID-19 pandemic caused near immediate service delivery adaptation among social service and healthcare sectors. Findings from in-depth interviews with 45 senior leaders of social services and healthcare organizations serving older adults in Washington State elucidate the role of trust in service provision at the onset of the pandemic. First, a history of trust facilitated service adaptation. Intentional outreach, programs, and culturally responsive services sustained trust with service recipients. Providing services and information in an older adult's preferred language built trust. Community networks facilitated and reflected trust between organizations and older adults. Finally, mistrust was prevalent for clients who perceived a high risk of experiencing negative consequences from accessing services. Our findings support the need for culturally and linguistically diverse services. To improve trust, the aging network should strengthen and expand partnerships with community-based organizations who have established trust through history, intentionality, and relevance to their service populations..

A co-production approach to exploring an integrated service model in UK local authorities

PurposeIntegrated service models aim to simplify access, enable effective delivery, remove duplication and provide a holistic and person-centred approach. This project explored the development of integrated well-being services in two local authorities in North-East England. The purpose of this paper is to address this issue.Design/methodology/approachUnderpinned by public health and co-production approaches, the project utilised a mixed-methods approach. Data were collected via online surveys (n = 95), virtual interviews with members of the local population (n = 8) and practitioners and commissioners (n = 8) to explore needs for a new service. Thematic analysis was used to identify key themes and issues.FindingsSeveral benefits of an integrated service were highlighted by both staff and service users, with a central anticipated benefit being the provision of holistic care. Improvement in information sharing was also seen to increase the efficiency of services and communication barriers between services. Beneficial aspects and barriers related to the COVID-19 pandemic on current service provision were reported that have informed our future recommendations.Originality/valueThe authors' findings provide a much deeper insight into function, care, social inclusion and ongoing support needs, from both the perspectives of staff and service users. Service users and staff saw value in an integrated model for themselves, as well as the wider community. The authors' findings indicate that the integrated service model is a promising one for the development of services within local authorities.

Religious Influences on the Experience of Family Carers of People with Dementia in a British Pakistani Muslim Community.

This paper reports on a study that begins to address the paucity of research around the religious motivations of Muslim carers of family members with dementia. Seven carers were recruited for interviews from the British Pakistani Muslim community concentrated in the Midlands and North of England. Interview transcripts were analysed thematically using an iterative collaborative methodology. The findings suggested that the Muslim faith plays a pivotal role as a support mechanism for individual carers and their families, but the wider faith community and its leaders did not typically offer support and could impede access to external care. This was a result of cultural pressure and lack of awareness both among religious leaders and the community as a whole. The study concluded that the inequality in access to dementia services may be constructively addressed if service providers engage with these faith concerns in the community and religious leaders to meet the needs of Muslims of British Pakistani origin.

Evaluation of service providers’ experiences and views on the mental health and wellbeing services for Syrian refugees in Warwickshire

Refugees have specific mental health and wellbeing needs as a result of multiple traumas experienced in their countries of origin, during their journey to the UK and the ongoing stressors following resettlement (Liebling et al., 2014). The main objective of this project was to explore service providers’ (SPs) experiences and views on the current mental health and wellbeing services provided for Syrian refugees in Warwickshire. Twenty-one SPs participated in a structured interview or questionnaire. SPs’ data was collated per area of interest and then coded. The areas of interest included nature of SPs’ work, source of funding, mental health needs of the Syrian refugee population and any additional mental health needs as a result of the Covid-19 pandemic, how SPs are addressing the mental health needs, gaps in mental health provision and suggestions for addressing the gaps. The findings identify a range of mental health needs and specific challenges and gaps in current service provision. Recommendations for improvements, in addition to clinical implications are included in this report. © 2022, British Psychological Society. All rights reserved.

Where now for infection services in the NHS? How lessons from the pandemic should drive long-overdue integration of microbiology and infectious diseases.

In its first 2 decades, the NHS witnessed the near eradication of life-threatening community-acquired infections. However, medical advances have created different challenges (such as antimicrobial resistance and healthcare-associated infections) against a background of an increasingly ageing population. The recent COVID-19 pandemic has highlighted a lack of parity with regards to provision of NHS 'infection services' (infectious diseases, microbiology and virology) across the UK, which urgently needs to be addressed. We recommend a fundamental review of NHS infection service provision: divided into four key areas. Firstly, there should be a consideration of a single multidisciplinary specialty of infection medicine removing barriers to training and service delivery. Secondly, streamline infection training via a single pathway through to certificate of completion of training, encompassing all aspects of infection service provision, for example, infection diagnostics, clinical care (including inpatient, outpatient and community based care), and infection prevention and control. There should be flexibility within the training curriculum to facilitate combined training with general internal medicine (GIM) as well as out of programme activities. Innovative ways of providing clinical experience should be considered, acknowledging the roles that medical microbiologists working closely with GIM colleagues in district general hospitals can play in managing patients with infections. Thirdly, formally commission a national network of specialised infectious diseases units with the creation of service standards. This can facilitate future pandemic resilience using a hub-and-spoke model utilising local infection expertise. Lastly, standardise the NHS framework to lead and coordinate development of integrated infection services at the local level.

Territories and COVID-19 in Ecuador: Functional regions in response to the health crisis

The spread of COVID-19 has altered the structure and functioning of spatial systems, giving rise to multiple dynamics. The spatial and temporal concentration of cases requiring medical care has led to the collapse of healthcare systems around the world, particularly in territories with already limited resilience potential and provision of medical services, as was the case of Ecuador. In this South American country, a reform of the healthcare system was launched as part of the 2008 Constitution that involved a strengthened investment in healthcare services;however © 2022 Instituto de Geografia. All rights reserved.

Gains and losses within the homeless service, supportive housing, and harm reduction sectors during the COVID-19 pandemic: A qualitative study of what matters to the workforce.

The COVID-19 pandemic has had deleterious effects on individuals experiencing homelessness; yet, less is known about how this global health crisis is impacting service providers that support the homeless population. This qualitative study examined the perceived impacts of the COVID-19 pandemic on the lives and work experiences of service providers in the homeless service, supportive housing, and harm reduction sectors in Canada. Further analyses were conducted to identify the occupational values that were represented in the work-related changes experienced by providers. A stratified purposive sample of 40 participants (30 direct service providers and 10 providers in leadership roles) were drawn from a pan-Canadian study of the mental health of service providers working with individuals experiencing homelessness. Reflexive thematic analysis was used to identify five themes of the work-related changes experienced by service providers during the pandemic: [1] "Everything was changing every day": Work role and responsibility instability; [2] "How on Earth do we do our job?": Challenges to working relationships with service users; [3] "It used to be a social environment": Transitions to impersonal and isolating workspaces; [4] "It all comes down the chute": Lack of organisational support and hierarchical conflict; and [5] "We've been supported as well as we could have": Positive organisational support and communication. The findings underscored how many of the occupational changes during the pandemic did not align with service providers' occupational values for collaboration, control, effective and safe service provision, and the importance of human relationships, among other values. As pre-existing sectoral problems were exacerbated by the pandemic, recovery efforts need to address these long-standing issues in ways that are aligned with service providers' values. Future research is warranted on how organisational approaches can promote supportive workplaces for service providers and improve outcomes for individuals experiencing homelessness.

Supporting Telephone Counsellors in the Context of the COVID-19 Pandemic

The COVID-19 pandemic has caused a necessary increase in the use of non-face-to-face modalities of human and social service delivery, including via the telephone. The ongoing nature of the COVID-19 pandemic and cost-efficiencies associated with welfare austerity measures make it likely that distance modalities will be used by social services well into the future. However, this transition may not be straightforward. Many services have needed to make this transition to disembodied forms of communication, requiring a rapid uptake of skills by staff whose previous work was based on face-to-face interactions with clients and other staff. The use of telephone and other electronic forms of communication (e.g. Zoom, chatrooms) has significantly changed the nature of the work, requiring practitioners to attend to different dimensions of the interactions. This article draws on interview data taken from two separate studies involving telephone counsellors: (1) a case study project involving 10 practitioners working in New Zealand and (2) a qualitative study about how practitioners engage in dynamic practice. Findings from both studies detail the influence of managerial policies on practitioners' capacity to respond to the complexity of their telephone work. It concludes with cautionary notes about the important institutional obligations that organisations have to both clients and workers obligations that cannot be sidestepped because they are deemed 'too expensive'.

A Qualitative Assessment of the Essential Health and Nutrition Service Delivery in the Context of COVID-19 in Bangladesh: The Perspective of Divisional Directors.

Bangladesh suffered disruptions in the utilization of essential health and nutrition services (EHNS) during the COVID-19 pandemic. The magnitude of the pandemic has been documented, but little is known from the perspectives of health administrators. A rapid qualitative assessment of division-level capacity identified successes and bottlenecks in providing EHNS- and COVID-19-related services during the first months of the pandemic in Bangladesh. Semi-structured interviews were held with the Health and Family Planning Divisional Directors of the Ministry of Health and Family Welfare. The Primary Health Care System Framework guided the content analysis, focusing on (i) service delivery, (ii) communication and community outreach, and (iii) surveillance and service monitoring. Our findings identified low care seeking due to fears of getting infected and unawareness that EHNS were still available. Adaptations to telemedicine were highly heterogeneous between divisions, but collaboration with NGOs were fruitful in reinstating outreach activities. Guidelines were centered on COVID-19 information and less so on EHNS. The inflexibility of spending capacities at divisional and clinic levels hindered service provision. Misinformation and information voids were difficult to handle all around the country. Community health workers were useful for outreach communication. EHNS must be guaranteed during sanitary emergencies, and Bangladesh presented with both significant efforts and areas of opportunity for improvement.

Collaborative public service provision archetypes in healthcare emergencies: a case of COVID-19 administration in Sri Lanka

Purpose>This paper examines how the properties and patterns of a collaborative “networked hierarchy” incident command system (ICS) archetype can provide incident command centres with extra capabilities to manage public service delivery during COVID-19.Design/methodology/approach>The paper illustrates the case of Sri Lanka's COVID-19 administration during its “first wave” (from 15 February to 1 September 2020). Primary data were collected through in-depth interviews with government officials who were directly involved in the administration of the COVID-19 outbreak. Secondary data sources were government publications and web sources. The data were analysed and interpreted by using narrative analysis and archetype theory respectively.Findings>The findings highlight how Sri Lanka's public sector responses to COVID-19 have followed a collaborative “networked hierarchy” ICS archetype. More specifically, the government changed its normative ICS “properties” by incorporating a diverse group of intergovernmental agencies such as the police, the military, the health service and administrative services by articulating new patterns of collaborative working, namely, organisational values, beliefs and ideas that fit with the Sri Lankan public service context.Originality/value>In responding to high magnitude healthcare emergencies, the flexibility of a collaborative networked ICS hierarchy enables different balances of organisational properties to be incorporated, such as hierarchy and horizontal networking and “patterns” in public service provision.

The impact of Covid-19 pandemic on services for children and adolescents with ADHD: results from a survey of paediatricians in the United Kingdom.

Background: The Covid-19 pandemic has led to huge disruptions and multi-domain healthcare crisis, with additional impact on children and young people (CYP) affected by Attention Deficit and Hyperactivity Disorder (ADHD). Methods: We conducted an online survey and obtained responses from 62 Paediatricians who provide ADHD services for CYP about their experience of Service disruption and adaptations during the first Covid-19 lockdown in the United Kingdom between March and June 2020. The responses were both quantitative and qualitative. Results: The Paediatricians reported huge service disruptions such that almost half ceased the assessment of new patients with ADHD, and only 5% were able to offer physical monitoring for most patients. However, all respondents had adopted telemedicine, which allowed them to maintain high levels of non-physical service provision for existing patients. The Paediatricians used risk stratification strategies to determine which patients were more likely to benefit from the limited available face to face appointments for physical monitoring. The Paediatricians demonstrated clinical pragmatism to meet the needs of their patients such as starting medication without physical exam especially if the patient's behaviour was so challenging that it was presenting a crisis at home, and setting aside monthly limits for stimulant medications. Some respondents reported helpful cross-service collaborations to support CYP with ADHD and their families. Conclusion: The Covid-19 pandemic has had adverse effect on many CYP with ADHD and caused huge disruption to the ADHD services that support them. As the pandemic continues to cause disruptions to ADHD services, the service adaptations emerging from the literature including some of those identified in this study could be useful to support more stable and sustainable ADHD services, both during and after the pandemic.

Politics, Pandemics, and Trauma: Understanding and Addressing Latino Health Needs Through a Culturally-Informed Lens.

Latino communities in the United States (U.S.) have long endured trauma due to multiple intersecting social and political forces. New restrictive immigration policies since 2016 and the COVID-19 pandemic have each created novel stressors for Latino communities, while escalating the risk of mental health disorders and highlighting the communities' vulnerabilities. The effects of these stressors have been particularly pronounced in southeastern states, such as Tennessee and Georgia, due to their state-level anti-immigrant legislation. Yet, we lack sufficient data to understand how these factors present among Latinos seeking services. To focus attention on the specific experiences of Latino communities living in the U.S. Southeast, the authors analyzed the perspectives of 44 service providers working with these communities in the region using qualitative data collected in an online survey administered during the COVID-19 pandemic and while President Trump's exclusionary immigration policies were in force. Four themes were identified: (1) Latino communities' strengths; (2) impact of the Trump administration on Latino communities; (3) impact of COVID-19's on Latino communities; and (4) strategies to enhance service delivery in Latino communities. Results provide meaningful data to inform micro- and macro-level service delivery in two exclusionary policy states and beyond. Findings suggest future research should include other new immigrant destinations and explore perceptions of Latino community members.

Looking at COVID-19 effects on intimate partner and sexual violence organizations in Canada through a feminist political economy lens: a qualitative study.

OBJECTIVES: Intimate partner violence and sexual violence organizations such as women's shelters play a crucial role in advancing gender equality in Canada. COVID-19 has challenged how such organizations operate. This study explored how intimate partner violence and sexual violence organizations in Canada have been affected by COVID-19 and the consequences on service delivery. METHODS: We interviewed 17 frontline and management staff from intimate partner violence and sexual violence organizations and programs across Canada, and analyzed the data using thematic analysis and applying a feminist political economy lens. RESULTS: We identified the following themes: (1) Adapting; (2) Struggling financially; (3) Resourcefulness; (4) Troubles connecting; (5) Narrowing scope of work; and (6) Burden of care. CONCLUSION: A feminist political economy framework considers the gendered impact of the pandemic and related measures on the workforce. Both the pandemic and measures to control it have affected intimate partner violence and sexual violence organizations in Canada, the staff working in these organizations, and the quality of relationships between staff and clients. Intimate partner and sexual violence organizations in Canada have been chronically underfunded and their predominantly female staff underpaid, affecting their ability to meet the needs of women. The onset of COVID-19 not only worsened these issues but converged with a shift in focus to more pandemic-related tasks, further limiting the scope and reach of organizations. Whether the adaptations, innovations, and perseverance demonstrated by such organizations and staff can tip the balance in favour of more equitable policy and outcomes remains to be seen.

RéSUMé: OBJECTIFS: Les organismes de lutte contre la violence conjugale et la violence sexuelle, comme les hébergements pour femmes, jouent un rôle crucial dans la promotion de l'égalité des genres au Canada. La COVID-19 a remis en question le mode de fonctionnement de ces organisations. Cette étude a examiné la manière dont les organismes de lutte contre la violence conjugale et sexuelle au Canada ont été affectés par la COVID-19 et les conséquences sur la prestation de services. MéTHODES: Nous avons mené des entrevues avec 17 intervenantes de première ligne et membres de la direction d'organismes et de programmes de lutte contre la violence conjugale et sexuelle à travers le Canada. Les données ont été analysées à l'aide d'une analyse thématique et en appliquant une optique d'économie politique féministe. RéSULTATS: Nous avons identifié les thèmes suivants : 1) adaptation; 2) difficultés financières; 3) ingéniosité; 4) difficultés à établir des liens; 5) réduction du champ d'action; et 6) charge de travail. CONCLUSION: Un cadre d'économie politique féministe permet d'examiner l'impact genré de la pandémie et des mesures connexes sur le personnel. La pandémie a eu des répercussions sur les organismes de lutte contre la violence conjugale et la violence sexuelle au Canada, sur le personnel qui y travaille et sur la qualité des relations entre le personnel et les clients. Les organisations de lutte contre la violence ont souffert d'un sous-financement chronique et leur personnel, majoritairement féminin, a été sous-payé, ce qui a nui à leur capacité de répondre aux besoins des femmes. L'apparition du COVID-19 a non seulement aggravé ces problèmes, mais a aussi entraîné un changement d'orientation vers des tâches plus liées à la pandémie, ce qui a limité encore davantage le champ d'action des organismes. Il reste à voir si les adaptations, les innovations et la persévérance dont font preuve ces organisations et leur personnel peuvent faire pencher la balance en faveur d'une politique et de résultats plus équitables.