Mathieu Seppey

Background: Sexual orientations, gender identities and expressions, and sexual characteristics (SOGIESC) concepts are not mentioned in human rights treaties but are increasingly present in the activity of UN treaty bodies, resulting for instance in decisions, general comments and recommendations, concluding observations. Scholars have developed an increasing interest for this inclusion of SOGIESC in international law, more specifically human rights. However, the literature and case work of treaty bodies are not uniform but consist of a diversity of issues and cases under different conventions. A clearer understanding of the legal context could improve human rights advocates’ engagement and facilitate the inclusion of SOGIESC concepts in international human rights law. Methods: This scoping review aims to better understand how treaty bodies address diverse SOGIESC issues, while illustrating information gaps and contemporary debates through academic literature. A search of two UN treaty bodies’ databases resulted in the inclusion of 58 documents related to treaty bodies’ activity and a search of six academic literature databases resulted in the inclusion of 57 documents that were thematically analysed. Following these key emerging themes, gaps are identified through a “Gender and Sexual Diversity Health and Wellbeing Critical Analysis”. Results: While SOGIESC diversity is not mentioned within any treaty, it is nonetheless present through an evolutive interpretation of human rights treaties by treaty bodies. This evolutive interpretation can be represented by a chronology of legal events and key emerging and maturing themes such as privacy, freedom of expression and peaceful assembly, family life, health, education, sexism and stereotypes, non-refoulement and torture, bodily integrity and the best interest of the child. Discussion: Various disparities based on SOGIESC are now recognised through these key issues. However cis-heteronormativity is seldomly mentioned as a root cause, leaving these disparities “unexplained” and unchanged. SOGIESC concepts are also understood separately from other intersectionalities. Key UN treaty bodies still have not made the connection with SOGIESC, including for example the Committee on the Elimination of Racial Discrimination and the Committee on the Rights of Persons with Disabilities. An important gap appears in academic literature around the mobilisation and applicability of human rights treaties by/for diverse SOGIESC individuals and communities. Treaty bodies can be further mobilised through their general comments or recommendations, concluding observations, and decisions to provide further authoritative norms protecting SOGIESC rights. Specific attention should address substantiating claims properly, with improved investigating and charging practices and with stronger partnerships with SOGIESC diverse communities.

By developing its first Feminist International Assistance policy, Canada has positioned itself as an international feminist and diverse SOGIESC rights leader. However, the scarcity of references to sexual orientations, gender identities and expressions, and sex characteristics (SOGIESC) has raised questions on how these concepts were included in such a policy. This case study's objective is to better understand how Canadian policies play a role in including and normalizing diverse SOGIESC at the global level. We used documentary research, observations, and interviews to respond to that question. An abductive analysis was conducted, integrating a socio-ecological approach with emerging themes from the data. All socio-ecological levels were mobilized by Canadian actions toward SOGIESC normalization. Public policies were informed by a human rights-based approach and inclusive language. Canadian norms toward SOGIESC rights were conveyed within international communities by building bridges, positioning Canada as a political broker, while organizational resources remained limited. Individuals and their interpersonal skills were central in creating allyship through firsthand experiences. The importance of transpartisanship and stronger coordination of soft power emerged as new and practical strategies responding to inclusion and normalization challenges. These strategies could represent important interactive spaces and leaders, in a context of rising conservative right-wing coalitions.

Diverse SOGIESC issues (sexual orientations, gender identities and expressions, and sex characteristics) are seldom discussed in humanitarian work but are emerging as an important gap to fill in both knowledge and practice. This review’s objective is to provide a clearer picture of how SOGIESC issues are included in humanitarian practices. A socio-ecological approach is used to identify the different settings in which these issues are present and should be addressed by the humanitarian sector. The review is based on a search of three databases covering peer-reviewed articles and grey literature that link SOGIESC issues and populations with humanitarian work. The fifty-one documents included in this review provide insights into its three main results. (1) SOGIESC concepts must be clarified in the humanitarian sector, which has been partially aware of these concepts and related issues. Two good governance principles should be prioritised and reviewed. (2) The inclusion of SOGIESC issues lacks clear ‘Direction’ (strategic planning) for the reduction of SOGIESC-based discrimination beyond short-term disaster management. (3) Diverse SOGIESC communities lack ‘legitimacy and voice’ to address their needs and participate in emergency responses. Transformative practices are identified to palliate those gaps but, most importantly, to connect humanitarian work to diverse SOGIESC peoples.

Background: Concept mapping (CM) is a method used to create consensus around a concept within a group of actors, which enables an empowering process for the participants through dialogues and shared information. We performed a CM, aiming to improve the operationalisation of a health policy, the RAMED, to promote healthcare access to the indigent population in Mali. Methods: The CM followed five steps leading to the conceptual map development: 1) brainstorming, 2) statements’ scoring, 3) clustering, 4) statistical (hierarchical clustering and multi-dimensional scaling) and qualitative analysis, and 5) validating the map. Twenty-seven participants took place in the CM, representing eighteen organisations linked to the implementation of the policy. Results: We identified seven clusters of activities towards finding the concrete and collective solutions to improve healthcare access: “funding strengthening,” “integral management and care of indigents,” “expertise creation,” “promotion and communication,” “indigents’ identification processes,” “monitoring and evaluation,” and “integration and coordination of actors.” According to scalability and priority scores, “identification processes” was the most scalable and important cluster (3.03 [±0.51] and 3.26 [±0.47]/4 respectively), while “funding strengthening” was the least scalable and important (2.59 [±0.47] and 2.76 [±0.42]/4 respectively). Conclusions: Although this method is primarily exploratory and a great starting point for further collaborative research, it managed to highlight the two fundamental issues in action-research: the difficulty related to the knowledge transfer to vulnerable populations and their lack of participation in the research process. It is particularly an issue in West Africa, due to lack of empirical studies and high poverty levels. Results of this study demonstrate that CM offers an important starting point for improvements, which should focus on knowledge transfer and inclusion of vulnerable populations’ points of view.

Purpose: A performance-based financing (PBF) pilot project was implemented in 2011 in Burkina Faso. After more than five years of implementation (data collection in 2016), the project's sustainability was not guaranteed. This study's objective is to assess this project's sustainability in 2016 by identifying the presence/absence of different determinants of sustainability according to the conceptual framework of Seppey et al. (2017).Design/methodology/approach: It uses a case study approach using in-depth interviews with various actors at the local, district/regional and national levels. Participants (n = 37) included health practitioners, management team members, implementers and senior members of health directions. A thematic analysis based on the conceptual framework was conducted, as well as an inductive analysis.Findings: Results show the project's sustainability level was weak according to an unequal presence of sustainability's determinants; some activities are being maintained but not fully routinised. Discrepancies between the project and the context's values appeared to be important barriers towards sustainability. Project's ownership by key stakeholders also seemed superficial despite the implementers' leadership towards its success. The project's objective towards greater autonomy for health centres was also directly confronting the Burkinabe's hierarchical health system.Originality/value: This study reveals many fits and misfits between a PBF project and its context affecting its ability to sustain activities through time. It also underlines the importance of using a conceptual framework in implementing and evaluating interventions. These results could be interesting for decision-makers and implementers in further assessing PBF projects elsewhere.

Background Numerous countries have undertaken performance-based financing (PBF) reforms to improve quality and quantity of healthcare services. However, only few reforms have successfully managed to achieve the different scale-up phases. In Burkina Faso, a pilot project was implemented, but was put on hold before being scaled. During the writing of this article, discussions to scale-up were still ongoing on a national strategic purchasing strategy within a government led user fee exemption policy. Methods This study’s objective is to identify facilitators and barriers to scaling-up for that pilot, based on the World Health Organization’s (WHO’s) theoretical framework. Interviews were conducted in three health centres and in Ouagadougou to discuss the scale-up with different actors. The software QDA Miner© was used to help in the framework analysis. Results The low involvement of some key stakeholders (mainly decision-makers) and the unstable context hindered ownership of the project, thus its priority on the political agenda. PBF reform therefore lost its momentum to the benefit of a user fee exemption policy. This latter program was seen to be more beneficial since it addressed access to healthcare services, in comparison to service quality, which was the PBF’s relative advantage. A scale-up of some PBF elements (eg, strategic purchasing tools) is however still in discussion in 2019, but would be integrated within the user fee exemption program. Increased costs during the PBF’s implementation gave the impression that the project was too costly and not scalable. The involvement of an important funding agency (World Bank, WB) also fed the impression of high costs, which demotivated the actors, especially decision-makers. Conclusion Contextual factors remain central to the implementation of PBF, while their evaluation and mitigation have remained unclear. The participation of key actors in scaling-up operations and the use of social science as tools to better understand the context is therefore primordial.

Le financement basé sur les résultats (FBR) est un type de réforme du financement du système de santé très populaire en Afrique. Plusieurs projets pilotes sont mis en œuvre dans le but d’offrir plus de soins de santé ainsi que d’en améliorer la qualité. Cependant, la pérennisation de ce type d’intervention en Afrique a encore été trop peu étudiée. Ce chapitre explique donc comment la pérennité de cette intervention a été évaluée au moyen d’une méthodologie qualitative. En lisant ce chapitre, on pourra mieux comprendre le processus de recherche qui a été mis en œuvre grâce à sa présentation exhaustive, de la première étape (ex. : la réalisation d’une revue de la littérature) jusqu’à la dernière (ex. : l’attribution du niveau de pérennité de l’intervention). Une section plus réflexive permet aussi aux lecteurs et lectrices de s’immiscer davantage dans l’expérience des chercheurs en ayant une meilleure compréhension des défis rencontrés (tant méthodologiques que professionnels) et des leçons apprises.

The aims of this article are to describe the development of a self-administered questionnaire assessing the core values in the field of public health ( rad