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This chapter discusses how ‘hidden’ populations of women who use drugs (WWUD) in coastal Kenya became ‘visible’ through accessing health, harm reduction and rights services. This effort was facilitated by the Muslim Education and Welfare Association (MEWA) and their work with community leaders. Mapping undertaken by MEWA outreach workers identified women who use opioids and other substances in isolated drug use settings. MEWA introduced daily meals in identified sites, needle and syringe services and residential rehabilitation services for opioid withdrawal. The introduction of residential adherence services for HIV and tuberculosis and the provision of methadone enabled compliance with the 90-90-90 UN HIV cascade. These services achieved sustained HIV viral load suppression at 83% and a 100% cure rate for tuberculosis among WWUD. In addition, disclosure and partner risk tracing was established in the ‘drug dens’ for women who test positive for STIs. The introduction of women-only hours once per week at the drop-in centre contributed to a better understanding of drug dependency among outreach workers and clinicians. Policies on gender-based violence were also refined, leading to an increase in reported cases. Programmes targeting families were introduced to promote effective communication and improve parenting skills. Access barriers to social security programmes were tackled by a network of paralegal officers in partnership with Kenyan authorities. Finally, entrepreneurship training and mentorship programmes were implemented to build resilience among WWUD.

In recent years, there has been a growing dialogue around community-based and systems-based approaches to security risk management through the introduction of top-down and bottom-up knowledge acquisition. In essence, this relates to knowledge elicited from academic experts, or security subject-matter experts, practitioner experts, or field workers themselves and how much these disparate sources of knowledge may converge or diverge. In many ways, this represents a classic tension between organisational and procedural perspectives of knowledge management (i.e. top-down) versus more pragmatic and experience focussed perspectives (i.e. bottom-up).

This chapter considers these approaches and argues that a more consistent approach needs to address the conflict between procedures and experience, help convert field experience into knowledge, and ultimately provide effective training that is relevant to those heading out into demanding work situations. Ultimately, ethics and method are intricately bound together in whichever approach is taken and the security of both staff and at-risk populations depends upon correctly managing the balance between systems and communities.

There is more to primary care than solely medical and nursing services. Models of Child Health Appraised (MOCHA) explored the role of the professions of pharmacy, dental health and social care as examples of affiliate contributors to primary care in providing health advice and treatment to children and young people. Pharmacies are much used, but their value as a resource for children seems to be insufficiently recognised in most European Union (EU) and European Economic Area (EEA) countries. Advice from a pharmacist is invaluable, particularly because many medicines for children are only available off-label, or not available in the correct dose, access to a pharmacist for simple queries around certain health issues is often easier and quicker than access to a primary care physician or nursing service. Preventive dentistry is available throughout the EU and EEA, but there are few targeted incentives to ensure all children receive the service, and accessibility to dental treatment is variable, particularly for disabled children or those with specific health needs. Social care services are an essential part of health care for many extremely vulnerable children, for example those with complex care needs. Mapping social care services and the interaction with health services is challenging due to their fragmented provision and the variability of access across the EU and EEA. A lack of coherent structure of the health and social care interface requires parents or other family members to navigate complex systems with little assistance. The needs of pharmacy, dentistry and social care are varied and interwoven with needs from each other and from the healthcare system. Yet, because this inter-connectivity is not sufficiently recognised in the EU and EEA countries, there is a need for improvement of coordination and with the need for these services to focus more fully on children and young people.

Work-life flexibility policies (e.g., flextime, telework, part-time, right-to-disconnect, and leaves) are increasingly important to employers as productivity and well-being strategies. However, policies have not lived up to their potential. In this chapter, the authors argue for increased research attention to implementation and work-life intersectionality considerations influencing effectiveness. Drawing on a typology that conceptualizes flexibility policies as offering employees control across five dimensions of the work role boundary (temporal, spatial, size, permeability, and continuity), the authors develop a model identifying the multilevel moderators and mechanisms of boundary control shaping relationships between using flexibility and work and home performance. Next, the authors review this model with an intersectional lens. The authors direct scholars’ attention to growing workforce diversity and increased variation in flexibility policy experiences, particularly for individuals with higher work-life intersectionality, which is defined as having multiple intersecting identities (e.g., gender, caregiving, and race), that are stigmatized, and link to having less access to and/or benefits from societal resources to support managing the work-life interface in a social context. Such an intersectional focus would address the important need to shift work-life and flexibility research from variable to person-centered approaches. The authors identify six research considerations on work-life intersectionality in order to illuminate how traditionally assumed work-life relationships need to be revisited to address growing variation in: access, needs, and preferences for work-life flexibility; work and nonwork experiences; and benefits from using flexibility policies. The authors hope that this chapter will spur a conversation on how the work-life interface and flexibility policy processes and outcomes may increasingly differ for individuals with higher work-life intersectionality compared to those with lower work-life intersectionality in the context of organizational and social systems that may perpetuate growing work-life and job inequality.

Colombia has been one of the main cocaine producing countries. The state’s response has been a repressive approach against the primary levels of the coca economy, such as cultivators and consumers. Although recent literature has documented the gendered impacts of drug policy, that is not the case for women who grow illicit crops. This chapter examines the ways drug policy has impacted women coca growers, cocaleras, in Putumayo, Colombia. Cocalero or cocalera is the term referred to rural workers dedicated to the cultivation and harvest of coca leaf. The term is a vindication from these communities, dignifying the rural activities they perform. In this chapter, we will use the term cocalera to refer to women coca growers.

From an intersectional gender perspective, the chapter explores the implications of rural life, gender, armed conflict and illegality over the trajectories of cocaleras in Putumayo, southern Colombia, a region where non-state armed actors, poverty and a precarious state presence converge. In this context, cultivating coca has become the main livelihood for rural families. It has transformed women’s roles within their communities, providing them with economic autonomy they previously did not have, but also located them in vulnerable positions. This chapter – which is an adaption from some chapters of the book ‘Voices from the coca fields: Women Building Rural Communities’ (Dejusticia, 2018 ) – is the outcome of research undertaken through in-depth interviews and social mapping exercises.

Improvements in neonatal and paediatric care mean that many children with complex care needs (CCNs) now survive into adulthood. This cohort of children places great challenges on health and social care delivery in the community: they require dynamic and responsive health and social care over a long period of time; they require organisational and delivery coordination functions; and health issues such as minor illnesses, normally presented to primary care, must be addressed in the context of the complex health issues. Their clinical presentation may challenge local care management. The project explored the interface between primary care and specialised health services and found that it is not easily navigated by children with CCNs and their families across the European Union and the European Economic Area countries. We described the referral-discharge interface, the management of a child with CCNs at the acute–community interface, social care, nursing preparedness for practice and the experiences of the child and family in all Models of Child Health Appraised countries. We investigated data integration and the presence of validated standards of care, including governance and co-creation of care. A separate enquiry was conducted into how care is accessed for children with enduring mental health disorders. This included the level of parental involvement and the presence of multidisciplinary teams in their care. For all children with CCNs, we found wide variation in access to, and governance of, care. Effective communication between the child, family and health services remains challenging, often with fragmentation of care delivery across the health and social care sector and limited service availability.

Parallel with trends in the wider East Africa region, there has been an increase in the number of women involved in drug use, trafficking and drug-related crime in Kenya (Beckerleg, Telfer, & Hundt, 2005 ). Vulnerable populations, such as domestic labourers, ethnic minorities, those living in slums, bar attendants, sex workers and refugees, are recruited into criminal organisations and assigned roles that expose them to negative health outcomes, human rights violations and incarceration (NACADA, 2016 ). In cases where women do not directly participate in drug use or the drug trade, they often are responsible for mitigating the risks arising from drug use by family members and the community. This reflects their triple burden of care and support when family and social life deteriorates (Mburu, Limmer, & Holland 2019).

The Kenya Narcotic Drugs and Psychotropic Substances Control Act of 1994, criminalises possession and trafficking of illicit drugs. The enforcement of this legislation has led to an increase in the number of women incarcerated in Kenya for drug, but also (and mainly) alcohol offences. This goes against the recommendation of the UN Commission on Narcotic Drugs in 2005 that States should adopt innovative measures and policies that prioritise treatment and rehabilitation as opposed to incarceration. In Kenya, prisons have adopted the Mandela and Bangkok Rules, enabling a paradigm shift in the provision of correctional services for women offenders, including remote parenting, family open days and linkages to aftercare services. However, these policies need to be anchored in the legal framework, with adequate resources to hasten the realisation of goals for the care and treatment of female drug and criminal offenders.