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The overall objective of this research was to elucidate the ecosystem of women’s health social enterprises (WHSEs) based in the United States. The Aim I was to conduct a secondary data analysis of a random national sample of non-profit WHSEs based in the United States regarding their characteristics and areas of intervention. Aim II was to conduct a qualitative assessment of a sample of WHSEs based in the United States regarding their perspectives on the ecosystem of WHSEs. Aim I utilized the GuideStar database and assessed enterprise size, geographic location, financial distress, health intervention area, and health activity category using descriptive statistics, statistical tests, and multivariable regression analysis via SPSS. Aim II utilized in-depth interviewing and grounded theory analysis via MAXQDA 2018 to identify novel themes and core categories while using an established framework for mapping social enterprise ecosystems as a scaffold.

Aim I findings suggest that WHSE activity is more predominant in the south region of the United States but not geographically concentrated around cities previously identified as social enterprise hubs. WHSEs take a comprehensive approach to women’s health, often simultaneously focusing on multiple areas of health interventions. Although most WHSEs demonstrate a risk for financial distress, very few exhibited severe risk. Risk for financial distress was not significantly associated with any of the measured enterprise characteristics. Aim II generated four core categories of findings that describe the ecosystem of WHSE: (1) comprehensive, community-based, and culturally adaptive care; (2) interdependent innovation in systems, finances, and communication; (3) interdisciplinary, cross-enterprise collaboration; and (4) women’s health as the foundation for family and population health. These findings are consistent with the three-failures theory for non-profit organizations, particularly that WHSEs address government failure by focusing on the unmet women’s health needs of the underserved populations (in contrast to the supply of services supported by the median voter) and address the market failure of over exclusion through strategies such as cross-subsidization and price discrimination. While WHSEs operate with levels of financial risk and are subject to the voluntary sector failure of philanthropic insufficiency, the data also show that they act to remediate other threats of voluntary failure.

Aim I findings highlight the importance of understanding financial performance of WHSEs. Also, lack of significant associations between our assessed enterprise characteristics and their financial risk suggests need for additional research to identify factors that influence financial performance of WHSE. Aim II findings show that WHSEs are currently engaged in complex care coordination and comprehensive biopsychosocial care for women and their families, suggesting that these enterprises may serve as a model for improving women’s health and health care. The community-oriented and interdisciplinary nature of WHSE as highlighted by our study may also serve as a unique approach for research and education purposes. Additional research on the ecosystem of WHSE is needed in order to better inform generalizability of our findings and to elucidate how WHSE interventions may be integrated into policies and practices to improve women’s health.

The purpose of this paper is to develop and evaluate the Standards of Healthcare Facility for Thai Female Inmates (SHF-TFI) through healthcare service improvement.

This research and quality improvement project was comprised of three phases. Surveying healthcare facilities and in-depth interviews with female inmates as well as prison nurses were employed in Phase I. Expert reviews and public hearing meetings were used for developing the SHF-TFI in Phase II. Satisfaction questionnaires, focus group interviews of the female inmates, and in-depth interviews with nurses and prison wardens were utilized to evaluate feasibility and effectiveness of SHF-TFI implementation in Phase III.

The SHF-TFI was elaborated in order to be more specific to the context of the correctional institutes and correspond with healthcare as to the needs of female inmates. It was divided into three main aspects: administrative standards, health service standards and outcome standards. After implementation, nurses reflected on the feasibility and benefits of the SHF-TFI on the organizations, inmates and nurses. The female inmates perceived remarkable improvement in the healthcare services including physical activity promotion and screening programs for non-communicable diseases, the physical environment and sufficiency of medical equipment. Moreover, the pregnant inmates and incarcerated mothers with children shared their views on better antenatal and child developmental care, as well as availability of baby supplies.

The findings support the feasibility and effectiveness of the SHF-TFI for quality care improvement and applicability of the Bangkok Rules in women’s correctional institutes.

This paper aims to examine links between women's access to micro‐finance and how they use maternal healthcare services in sub‐Saharan Africa (SSA).

The authors use theoretical and empirical literature to propose a framework to sustain and improve women's access to maternal healthcare services through micro‐financing.

It is found that improved access to micro‐finance by women, combined with education may enhance maternal health service uptake.

The paper does not consider empirical data in the analysis. The authors advocate empirically testing the framework proposed in other SSA countries.

It is important to empower women by facilitating their access to education and micro‐finance. This has implications for improving maternal healthcare utilization in SSA.

The paper moves beyond poor access to maternal health services in SSA and proposes a framework for providing sustainable solutions.

The purpose of this paper is to provide an overview of post-Soviet and demographic challenges faced by the government in Moldova that have posed as challenges to reform of the healthcare system. Since independence from the Soviet Union in 1991, Moldova has undergone significant challenges and reforms throughout the society. Healthcare has been no exception. Changes in family structures due to migration, a decreased birthrate, and an aging population have placed strain on the healthcare system which is working to both modernize and provide specialized care. Legislation has helped to streamline and reform the healthcare system but systemic challenges are still faced by at-risk populations including the elderly, women, and rural populations.

Information presented in this paper is based on a review of independent research, United Nations and government reports.

Findings show that progress has been made through legislative reform, new government programming, and most recently volunteer/nonprofit involvement in healthcare reform. Currently, the government is working to establish holistic patient centered care and to bridge the healthcare divide between rural and urban populations. Healthcare reforms include basic universal health care services and family support programming. Additionally, there has been a renewed emphasis on how environmental factors, like housing and nutrition, interact with health quality.

Moldova faces an increasing challenge of caring for elderly populations at the family and societal level due to the increased number of elderly, shifts in family structures, and international migration for employment. A discussion of the developing role of nonprofit and nongovernment organizations is included.

The purpose of this paper is to show the link between the comparative effectiveness research (CER) and the interest in developing drugs for rare disease by the pharmaceutical industry. Total healthcare spending is on the rise without having a corresponding better health outcome. As such, with the growing role of government in healthcare, measuring and demonstrating value is beginning to expand beyond the private sector to metrics applied in the public sector. A modern approach to comparative effective research began its rapid rise in the USA when the American Recovery and Reinvestment Act of 2009 allocated $1.1 billion for CER. This paper analyzes the implication and impact on the pharmaceutical industry.

The paper reviews the basic definitions of CER and its areas of strength and weakness. It used real examples of drugs to show the impact of the Reinvestment Act of 2009 on the rise of orphan drugs.

The study shows that the act encouraged the development of orphan drugs, mainly because of the low budget impact due to a smaller patient base. Provisions of the Affordable Care Act provide incentives for such rare disease indications, as no one can be denied coverage with pre-existing conditions.

The study is limited by the number of available rare drugs and the ongoing process of implementation of the Affordable Care Act.

The study shows the cost-effective method of treating medical conditions.

Development of orphan drugs opens up access to care for many patients at a cost-effective price.

This paper shows the link between the CER and the interest in developing drugs for rare disease by the pharmaceutical industry. It also brings out the possible implication of the Affordable Care Act on the pharmaceutical industry with respect to its strategies for drug development and drug portfolio.

The issues of women empowerment and gender equality have gained the increased attention of scholars and policymakers in Western societies. Gender diversity and the professional participation of women are increasingly acknowledged as transversal drivers for economic development. However, in less developed countries, research and evidence are still accumulating. Thus, this study aims to explore actors and factors empowering female talent to work and achieve managerial positions and run their businesses in two countries with patriarchal social and cultural norms, Saudi Arabia and Kazakhstan. Based on the qualitative interview data collected from 15 female managers and entrepreneurs working in the healthcare sector, we explore the conditions under which women can start their businesses and get promoted to managerial positions in the organizations. Our findings indicate that individual agencies and structural factors in female talent capacity building and empowering women to achieve higher hierarchical positions in organizations form together important dynamics that foster more inclusive practices and internalized schemes. Furthermore, the findings also demonstrate the importance of female talent empowerment in achieving gender diversity in managerial positions in healthcare organizations. Hence, by stating that increased female talent participation in the upper-echelons of the organization and entrepreneurship contributes to the decent employment of women in countries with male-dominated social and cultural norms and promotes the more inclusive and sustainable economic growth of these countries, our research contributes to United Nations (UN) Sustainable Development Goals (SDG) #5.5, #8.5 and #10.2.

Incarcerated transgender women often require healthcare to meet their physical-, mental-, and gender transition-related health needs; however, their healthcare experiences in prisons and jails and interactions with correctional healthcare providers are understudied. The paper aims to discuss these issues.

In 2015, 20 transgender women who had been incarcerated in the USA within the past five years participated in semi-structured interviews about their healthcare experiences while incarcerated.

Participants described an institutional culture in which their feminine identity was not recognized and the ways in which institutional policies acted as a form of structural stigma that created and reinforced the gender binary and restricted access to healthcare. While some participants attributed healthcare barriers to providers’ transgender bias, others attributed barriers to providers’ limited knowledge or inexperience caring for transgender patients. Whether due to institutional (e.g. sex-segregated prisons, biased culture) or interpersonal factors (e.g. biased or inexperienced providers), insufficient access to physical-, mental-, and gender transition-related healthcare negatively impacted participants’ health while incarcerated.

Findings highlight the need for interventions that target multi-level barriers to care in order to improve incarcerated transgender women’s access to quality, gender-affirmative healthcare.

This study provides first-hand accounts of how multi-level forces serve to reinforce the gender binary and negatively impact the health of incarcerated transgender women. Findings also describe incarcerated transgender women’s acts of resistance against institutional and interpersonal efforts to maintain the gender binary and present participant-derived recommendations to improve access to gender affirmative healthcare for incarcerated transgender women.

In this article visible minority immigrant women's encounters and perceptions in accessing healthcare in Canada are explored. The aim is to understand the role play of the vulnerability statuses, gender, visibility, immigration and their intersectionality as factors contributing to (in)equitiesin healthcare accessibility.

Qualitative data were collected from a sample of 32 adult immigrant women, living in Halifax, Nova Scotia, Canada, using five focus group meetings. The participants have migrated from five regions of the world; South‐Eastern Asia, Middle‐Eastern Asia, the African continent, Latin/South America and non‐English speaking countries in Eastern Europe. Data were analysed using an inductive coding using the cultural health capital framework.

The findings reveal that audio and visual personal attributes such as skin colour, accent and excess body weight that are beyond Canadian norms lead to unfavourable interpersonal dynamics. Fundamental causes of diseases and clinical discourses are embedded in ethno‐cultural realties of gender, ethno‐racial identity, English communication styles and immigration related economic downturns.

Individual level recommendations include self efficacy and empowerment. Policies and program level recommendations include enhancement of multicultural realms of healthcare to promote equity in healthcare accessibility.

Utilization of cultural health capital framework to illustrate inequities in healthcare accessibility, for visible and audible minority immigrant women, living in a country with universal healthcare coverage, brings a novel conceptual approach. New policy implications stemmed from the original research findings. Canadian cultural health capital framework that was developed in this article can be applied to illustrate other minorities' healthcare accessibility.

This research explores the subjective health experiences of women incarcerated in a provincial detention center in Ottawa, Canada.

Narrative interviews conducted with 16 previously incarcerated women were analyzed to explore how health issues shaped their experiences in detention.

Women identified a set of practices and conditions that negatively impacted health, including the denial of medication, medical treatment, and healthcare, limited prenatal healthcare, and damaged health caused by poor living conditions.

Findings suggest that structural health problems emerge in penal environments where healthcare is provided by the same agency responsible for incarceration. The incompatibility between the mandates of incarceration and healthcare suggests that responsibility for institutional healthcare should be transferred to provincial healthcare bodies.

This research responds to the lack of research on carceral health experiences within both penal scholarship and medical sociology, particularly in relation to women and those confined in jails.