Anuj Kapilashrami | University of Essex (original) (raw)
Papers by Anuj Kapilashrami
International journal for equity in health, May 23, 2024
International journal for equity in health, May 23, 2024
BMJ Global Health
Acknowledgements Kerry Scott was involved in early discussions regarding this manuscript, and kin... more Acknowledgements Kerry Scott was involved in early discussions regarding this manuscript, and kindly provided comments on early versions. Contributors MS and RK conceived the manuscript. MS led the drafting of the paper. AK, AG, AA, SD, VB, GS, LR, PN and RK all drafted some text, and read and commented on several versions of the paper. All authors read and approved the final manuscript.
IMISCOE research series, 2023
In 2020, COVID-19 disrupted all forms of human mobility through the closing of national borders a... more In 2020, COVID-19 disrupted all forms of human mobility through the closing of national borders and halting of travel worldwide. However, the impact of the pandemic and policy responses to it wasn't equal across populations and regions-in resource-poor contexts in South Asia, the ban on movement within countries and across national borders and suspension of transport at short notice left millions of migrants stranded. For instance, the closure of the Nepal-India border left hundreds of workers returning to Nepal stuck in crowded temporary shelters at the border (Down to Earth, 2020b). Covid-19 also disrupted migration patterns, increasing the risk of concentrated outbreaks in areas of return, a majority of which were illequipped to offer even general care (Kapilashrami et al., 2020). Nearly 117,145 undocumented Afghans returned from Iran and Pakistan in the first 2 weeks of March 2020 alone (IOM, 2021). When the pandemic struck, sectors such as tourism, construction, and service sectors, which employ millions of migrant workers, closed overnight. By early May 2020, 30% of families in Sri Lanka and Bangladesh engaged in these sectors had lost all their income (UNICEF, 2021). In India, closure of work sites and eviction forced 10.4 million domestic migrant workers to return to their home states (Down To Earth, 2020a); many undertook weeks-long journeys on foot, with no provision for their food, shelter and health. As reports emerged on their state of hunger and assaults, it became clear that the physical and mental health impacts of the lockdown would be "potentially worse than the threat of the virus itself."
The International Journal of Health Planning and Management
Human resource for health (HRH) is considered critical for achieving Universal Health Coverage, a... more Human resource for health (HRH) is considered critical for achieving Universal Health Coverage, and the crisis surrounding HRH is now established as a global emergency. Their vital role has been central in the pandemic response. Yet, the discussions and deliberations on the recent pandemic treaty circumscribe HRH discussions to their capacities and protection, and address discrimination mainly in relation to gender. While this paper endorses the case for prioritisation of HRH in global pandemic preparedness planning, it re‐frames the HRH crisis in relation to the institutional and structural factors driving HRH shortage, maldistribution and skills‐needs misalignment. We critique the supply‐and‐demand framing of HRH crisis as one that obliviates the systematic inequalities within health systems that underpin health workforce motivations, distribution, satisfaction and performance. We propose an intersectional equity lens to redefine the HRH challenges, understand their underlying dri...
IMISCOE Research Series
This paper examines how self-designation among Afghan refugees and migrants is evolving. While te... more This paper examines how self-designation among Afghan refugees and migrants is evolving. While terms such as muhājir, “refugee,” with a religious connotation, panāhenda, “refugee,” and mosāfer, “traveller,” were used by Afghans in the 1980s and 1990s, they no longer have the favour of younger people who might have grown up in Iran or Pakistan and often aspire to try their chance in the West. New generations tend to describe their situation with words such as āwāra, sargardān, dar-ba-dar, which generally convey the idea of “wandering,” “vagrancy,” “homelessness,” “lack of purpose.” This evolving terminology suggest that exile has lost the religious and political significance it might have had during the anti-Soviet jihad, on the one hand. It also can be interpreted as a quest for meaning in life, an assertion of agency in an effort to define their place in this world, on the other hand. Social media and blogs run by Afghans evoke an ontology of displacement and mobility, which ultima...
International Journal of Health Policy and Management
Journal of Transport & Health
Journal of Global Health
Background Community and stakeholder involvement in decision-making to determine publicly-funded ... more Background Community and stakeholder involvement in decision-making to determine publicly-funded health services and interventions is advocated to fulfil citizens' rights and improve health outcomes. The inclusion of public actors, particularly disadvantaged populations, in priority setting for universal health coverage (UHC) is also enshrined in guidance from the World Health Organization (WHO). However, challenges remain in operationalising this policy aim and ensuring that these approaches are effective and equitable. This study aimed to synthesise published evidence on the role of community and stakeholder participation in determining health service coverage. Methods A systematic review was conducted, searching the Web of Science, Ovid Global Health, and PubMed Central databases from 2000 onwards, including all study types. A framework synthesis approach was used for charting and synthesising data on mechanisms, effectiveness (equity, depth, and stage), and barriers and facilitators for engagement. Results Twenty-seven relevant studies were identified that involve community actors and other stakeholders in priority setting and decision-making processes for defining health benefit packages and UHC, health technology assessment, and pharmaceutical coverage. Mechanisms of engagement include a wide variety of consultation approaches; participation in decision-making committees, advisory councils, and local planning meetings; and appeals mechanisms. Participation occurs primarily at Data and Dialogue stages of decision-making processes, and we found limited depth of engagement among identified cases. Limited consideration of equity was observed in planning and reporting on community involvement in priority setting. A number of challenges are identified in the literature, which we typologise as institutional, procedural, technical, and structural / normative barriers to meaningful participation. Conclusions This systematic review identifies key gaps and opportunities in the literature and practice related to effective and equitable community and stakeholder participation in determining health service coverage. It offers essential considerations for planning and executing inclusive approaches to priority setting for publicly-funded health services and interventions and defining health benefit packages for UHC.
Journal of Migration and Health
India Migration Report 2021, 2022
Global health initiatives (GHIs) have gained prominence as innovative and effective policy mechan... more Global health initiatives (GHIs) have gained prominence as innovative and effective policy mechanisms to tackle global health priorities. More recent literature reveals governance-related challenges and their unintended health system effects. Much less attention is received by the relationship between these mechanisms, the ideas that underpin them and the country-level practices they generate. The Global Fund has leveraged significant funding and taken a lead in harmonizing disparate efforts to control HIV/AIDS. Its growing influence in recipient countries makes it a useful case to examine this relationship and evaluate the extent to which the dominant public discourse on Global Fund departs from the hidden resistances and conflicts in its operation. Drawing on insights from ethnographic fieldwork and 70 interviews with multiple stakeholders, this article aims to better understand and reveal the public and the hidden transcript of the Global Fund and its activities in India. We argue that while its public transcript abdicates its role in country-level operations, a critical ethnographic examination of the organization and governance of the Fund in India reveals a contrasting scenario. Its organizing principles prompt diverse actors with conflicting agendas to come together in response to the availability of funds. Multiple and discrete projects emerge, each leveraging control and resources and acting as conduits of power. We examine how management of HIV is punctuated with conflicts of power and interests in a competitive environment set off by the Fund protocol and discuss its system-wide effects. The findings also underscore the need for similar ethnographic research on the financing and policy-making architecture of GHIs.
Bulletin of the World Health Organization, 2021
Critical Public Health, 2021
ABSTRACT This paper examines determinants of ethnic disparities in workplace risks of COVID-19 am... more ABSTRACT This paper examines determinants of ethnic disparities in workplace risks of COVID-19 among health and social care workers (HCWs) in the UK. This was undertaken to inform public health policy in the management of COVID-19 relating to health and social care provision. A cross-sectional survey was administered in July–August 2020 (n = 456) to elicit HCWs’ experiences of COVID-19 management in the workplace and their perceptions of exposure, personal protection against infection, involvement in local clinical management, and other workplace hazards. Findings suggest minority ethnic HCWs were twice as likely as White HCWs to be in a patient-facing role (OR = 2.14, 95% CI:1.21; 3.78, P < 0.01) and twice as likely (63% vs 39%) to be caring for COVID-19 positive patients (OR = 2.68, 95% CI: 1.77; 4.06, P < 0.01). Those in nursing, were three times as likely to be redeployed to a COVID-19 care setting (OR = 3.33, 95%CI: 1.23; 9.02, P= 0.02). Minority ethnic HCWs within lower- and mid-level roles carried a higher burden of frontline clinical management of COVID-19 positive patients than their White counterparts. This study found evidence of ethnic disparities across several workplace hazards, with increased exposure to and less protection against infection, more responsibility for the clinical management of infection, and evidence of systemic racial bias in the disproportionate redeployment of minority ethnic nursing staff to COVID-19 areas. An NHS-wide review is required to assess procedural fairness, ensure safe practices now, and to avert future crises.
A Nation Changed? provides the first detailed and wide-ranging analysis of the SNP in office. It ... more A Nation Changed? provides the first detailed and wide-ranging analysis of the SNP in office. It looks at how Scotland has changed and not changed during that time, and the challenges that lie ahead. The book examines the SNP's record, its role as a government and as a party, detailed policy issues such as education and health, the Brexit conundrum and independence. Offering insights and suggestions for further action and reform, A Nation Changed? brings together an unparalleled range of knowledgeable and expert voices all of whom care deeply about Scotland, public policy, the state of democracy, and the future of our nation. Irrespective of your political views or allegiance, this groundbreaking study offers fresh thinking, food for thought and ideas for debate concerning the changing terrain of Scottish politics
It is fundamentally unjust that systematic inequalities in Scotland today mean that some people l... more It is fundamentally unjust that systematic inequalities in Scotland today mean that some people live healthier, longer lives than many others. This is not just a concern for those most unfairly impacted: while declining deaths from alcohol, heart disease, most cancers and respiratory disease are encouraging, Scotland’s population as a whole remains, in European terms, comparatively sick. This can only change if there is a fundamental transformation in how we view health and how we understand its underlying causes. It is not about individual lifestyle choices; it is about structural change. We need our government in Scotland to commit to establishing a right to health for all. As a first step we need to foster a debate about exactly what a ‘right to health’ entails and then work together to address underlying social, economic, political and commercial determinants of health to address real change in the nation’s health. A peoples’ movement with a committed government can do just that. And it can make Scotland healthier
European Journal of Public Health, 2018
International Journal of Transgender Health
International Journal of Health Policy and Management
Lassa et al.’s study is a strong commentary on the biomedical hegemony and professional monopoly ... more Lassa et al.’s study is a strong commentary on the biomedical hegemony and professional monopoly of medical doctors in the policy landscape of the Global Fund in Nigeria. Situating this critical dimension of professional power within wider scholarship of power and governance of global health initiatives (such as the Global Fund), in this comment, I put forth two core arguments. I call for a relational perspective of power in a dynamic policy space that the Fund characterises. I argue that a systems-view analysis of power requires a thorough examination of subsystems, how they interact, and the diverse forms of power– individual agentic, ideational, and structural – and the mechanisms through which power is wielded. The lens of governmentality allows linking individual (expertise and practices) with institutional regimes and social practices these enable; and in examining the interface of local/ sub-national, national and global within which policy formulation and implementation occurs.
International journal for equity in health, May 23, 2024
International journal for equity in health, May 23, 2024
BMJ Global Health
Acknowledgements Kerry Scott was involved in early discussions regarding this manuscript, and kin... more Acknowledgements Kerry Scott was involved in early discussions regarding this manuscript, and kindly provided comments on early versions. Contributors MS and RK conceived the manuscript. MS led the drafting of the paper. AK, AG, AA, SD, VB, GS, LR, PN and RK all drafted some text, and read and commented on several versions of the paper. All authors read and approved the final manuscript.
IMISCOE research series, 2023
In 2020, COVID-19 disrupted all forms of human mobility through the closing of national borders a... more In 2020, COVID-19 disrupted all forms of human mobility through the closing of national borders and halting of travel worldwide. However, the impact of the pandemic and policy responses to it wasn't equal across populations and regions-in resource-poor contexts in South Asia, the ban on movement within countries and across national borders and suspension of transport at short notice left millions of migrants stranded. For instance, the closure of the Nepal-India border left hundreds of workers returning to Nepal stuck in crowded temporary shelters at the border (Down to Earth, 2020b). Covid-19 also disrupted migration patterns, increasing the risk of concentrated outbreaks in areas of return, a majority of which were illequipped to offer even general care (Kapilashrami et al., 2020). Nearly 117,145 undocumented Afghans returned from Iran and Pakistan in the first 2 weeks of March 2020 alone (IOM, 2021). When the pandemic struck, sectors such as tourism, construction, and service sectors, which employ millions of migrant workers, closed overnight. By early May 2020, 30% of families in Sri Lanka and Bangladesh engaged in these sectors had lost all their income (UNICEF, 2021). In India, closure of work sites and eviction forced 10.4 million domestic migrant workers to return to their home states (Down To Earth, 2020a); many undertook weeks-long journeys on foot, with no provision for their food, shelter and health. As reports emerged on their state of hunger and assaults, it became clear that the physical and mental health impacts of the lockdown would be "potentially worse than the threat of the virus itself."
The International Journal of Health Planning and Management
Human resource for health (HRH) is considered critical for achieving Universal Health Coverage, a... more Human resource for health (HRH) is considered critical for achieving Universal Health Coverage, and the crisis surrounding HRH is now established as a global emergency. Their vital role has been central in the pandemic response. Yet, the discussions and deliberations on the recent pandemic treaty circumscribe HRH discussions to their capacities and protection, and address discrimination mainly in relation to gender. While this paper endorses the case for prioritisation of HRH in global pandemic preparedness planning, it re‐frames the HRH crisis in relation to the institutional and structural factors driving HRH shortage, maldistribution and skills‐needs misalignment. We critique the supply‐and‐demand framing of HRH crisis as one that obliviates the systematic inequalities within health systems that underpin health workforce motivations, distribution, satisfaction and performance. We propose an intersectional equity lens to redefine the HRH challenges, understand their underlying dri...
IMISCOE Research Series
This paper examines how self-designation among Afghan refugees and migrants is evolving. While te... more This paper examines how self-designation among Afghan refugees and migrants is evolving. While terms such as muhājir, “refugee,” with a religious connotation, panāhenda, “refugee,” and mosāfer, “traveller,” were used by Afghans in the 1980s and 1990s, they no longer have the favour of younger people who might have grown up in Iran or Pakistan and often aspire to try their chance in the West. New generations tend to describe their situation with words such as āwāra, sargardān, dar-ba-dar, which generally convey the idea of “wandering,” “vagrancy,” “homelessness,” “lack of purpose.” This evolving terminology suggest that exile has lost the religious and political significance it might have had during the anti-Soviet jihad, on the one hand. It also can be interpreted as a quest for meaning in life, an assertion of agency in an effort to define their place in this world, on the other hand. Social media and blogs run by Afghans evoke an ontology of displacement and mobility, which ultima...
International Journal of Health Policy and Management
Journal of Transport & Health
Journal of Global Health
Background Community and stakeholder involvement in decision-making to determine publicly-funded ... more Background Community and stakeholder involvement in decision-making to determine publicly-funded health services and interventions is advocated to fulfil citizens' rights and improve health outcomes. The inclusion of public actors, particularly disadvantaged populations, in priority setting for universal health coverage (UHC) is also enshrined in guidance from the World Health Organization (WHO). However, challenges remain in operationalising this policy aim and ensuring that these approaches are effective and equitable. This study aimed to synthesise published evidence on the role of community and stakeholder participation in determining health service coverage. Methods A systematic review was conducted, searching the Web of Science, Ovid Global Health, and PubMed Central databases from 2000 onwards, including all study types. A framework synthesis approach was used for charting and synthesising data on mechanisms, effectiveness (equity, depth, and stage), and barriers and facilitators for engagement. Results Twenty-seven relevant studies were identified that involve community actors and other stakeholders in priority setting and decision-making processes for defining health benefit packages and UHC, health technology assessment, and pharmaceutical coverage. Mechanisms of engagement include a wide variety of consultation approaches; participation in decision-making committees, advisory councils, and local planning meetings; and appeals mechanisms. Participation occurs primarily at Data and Dialogue stages of decision-making processes, and we found limited depth of engagement among identified cases. Limited consideration of equity was observed in planning and reporting on community involvement in priority setting. A number of challenges are identified in the literature, which we typologise as institutional, procedural, technical, and structural / normative barriers to meaningful participation. Conclusions This systematic review identifies key gaps and opportunities in the literature and practice related to effective and equitable community and stakeholder participation in determining health service coverage. It offers essential considerations for planning and executing inclusive approaches to priority setting for publicly-funded health services and interventions and defining health benefit packages for UHC.
Journal of Migration and Health
India Migration Report 2021, 2022
Global health initiatives (GHIs) have gained prominence as innovative and effective policy mechan... more Global health initiatives (GHIs) have gained prominence as innovative and effective policy mechanisms to tackle global health priorities. More recent literature reveals governance-related challenges and their unintended health system effects. Much less attention is received by the relationship between these mechanisms, the ideas that underpin them and the country-level practices they generate. The Global Fund has leveraged significant funding and taken a lead in harmonizing disparate efforts to control HIV/AIDS. Its growing influence in recipient countries makes it a useful case to examine this relationship and evaluate the extent to which the dominant public discourse on Global Fund departs from the hidden resistances and conflicts in its operation. Drawing on insights from ethnographic fieldwork and 70 interviews with multiple stakeholders, this article aims to better understand and reveal the public and the hidden transcript of the Global Fund and its activities in India. We argue that while its public transcript abdicates its role in country-level operations, a critical ethnographic examination of the organization and governance of the Fund in India reveals a contrasting scenario. Its organizing principles prompt diverse actors with conflicting agendas to come together in response to the availability of funds. Multiple and discrete projects emerge, each leveraging control and resources and acting as conduits of power. We examine how management of HIV is punctuated with conflicts of power and interests in a competitive environment set off by the Fund protocol and discuss its system-wide effects. The findings also underscore the need for similar ethnographic research on the financing and policy-making architecture of GHIs.
Bulletin of the World Health Organization, 2021
Critical Public Health, 2021
ABSTRACT This paper examines determinants of ethnic disparities in workplace risks of COVID-19 am... more ABSTRACT This paper examines determinants of ethnic disparities in workplace risks of COVID-19 among health and social care workers (HCWs) in the UK. This was undertaken to inform public health policy in the management of COVID-19 relating to health and social care provision. A cross-sectional survey was administered in July–August 2020 (n = 456) to elicit HCWs’ experiences of COVID-19 management in the workplace and their perceptions of exposure, personal protection against infection, involvement in local clinical management, and other workplace hazards. Findings suggest minority ethnic HCWs were twice as likely as White HCWs to be in a patient-facing role (OR = 2.14, 95% CI:1.21; 3.78, P < 0.01) and twice as likely (63% vs 39%) to be caring for COVID-19 positive patients (OR = 2.68, 95% CI: 1.77; 4.06, P < 0.01). Those in nursing, were three times as likely to be redeployed to a COVID-19 care setting (OR = 3.33, 95%CI: 1.23; 9.02, P= 0.02). Minority ethnic HCWs within lower- and mid-level roles carried a higher burden of frontline clinical management of COVID-19 positive patients than their White counterparts. This study found evidence of ethnic disparities across several workplace hazards, with increased exposure to and less protection against infection, more responsibility for the clinical management of infection, and evidence of systemic racial bias in the disproportionate redeployment of minority ethnic nursing staff to COVID-19 areas. An NHS-wide review is required to assess procedural fairness, ensure safe practices now, and to avert future crises.
A Nation Changed? provides the first detailed and wide-ranging analysis of the SNP in office. It ... more A Nation Changed? provides the first detailed and wide-ranging analysis of the SNP in office. It looks at how Scotland has changed and not changed during that time, and the challenges that lie ahead. The book examines the SNP's record, its role as a government and as a party, detailed policy issues such as education and health, the Brexit conundrum and independence. Offering insights and suggestions for further action and reform, A Nation Changed? brings together an unparalleled range of knowledgeable and expert voices all of whom care deeply about Scotland, public policy, the state of democracy, and the future of our nation. Irrespective of your political views or allegiance, this groundbreaking study offers fresh thinking, food for thought and ideas for debate concerning the changing terrain of Scottish politics
It is fundamentally unjust that systematic inequalities in Scotland today mean that some people l... more It is fundamentally unjust that systematic inequalities in Scotland today mean that some people live healthier, longer lives than many others. This is not just a concern for those most unfairly impacted: while declining deaths from alcohol, heart disease, most cancers and respiratory disease are encouraging, Scotland’s population as a whole remains, in European terms, comparatively sick. This can only change if there is a fundamental transformation in how we view health and how we understand its underlying causes. It is not about individual lifestyle choices; it is about structural change. We need our government in Scotland to commit to establishing a right to health for all. As a first step we need to foster a debate about exactly what a ‘right to health’ entails and then work together to address underlying social, economic, political and commercial determinants of health to address real change in the nation’s health. A peoples’ movement with a committed government can do just that. And it can make Scotland healthier
European Journal of Public Health, 2018
International Journal of Transgender Health
International Journal of Health Policy and Management
Lassa et al.’s study is a strong commentary on the biomedical hegemony and professional monopoly ... more Lassa et al.’s study is a strong commentary on the biomedical hegemony and professional monopoly of medical doctors in the policy landscape of the Global Fund in Nigeria. Situating this critical dimension of professional power within wider scholarship of power and governance of global health initiatives (such as the Global Fund), in this comment, I put forth two core arguments. I call for a relational perspective of power in a dynamic policy space that the Fund characterises. I argue that a systems-view analysis of power requires a thorough examination of subsystems, how they interact, and the diverse forms of power– individual agentic, ideational, and structural – and the mechanisms through which power is wielded. The lens of governmentality allows linking individual (expertise and practices) with institutional regimes and social practices these enable; and in examining the interface of local/ sub-national, national and global within which policy formulation and implementation occurs.