Rachel Tolhurst
Dados Biográficos
| ID | 1445884 |
|---|---|
| NOME | Rachel Tolhurst |
| PRENOMES | Rachel |
| SOBRENOME | Tolhurst |
| ASSINATURA | TOLHURST R |
| AFILIAÇÕES | Liverpool School of Tropical Medicine |
| ORCID | 0000-0002-3005-6641 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 40 |
| TOTAL DE CITAÇÕES | 137 |
| TOTAL COMO AUTOR | 40 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 2001 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 5 |
Intersectional inequalities in healthcare utilisation in informal settlements in Freetown, Sierra Leone
Introduction Residents of informal settlements face significant intersectional inequalities, due to the overlapping and compounding effects of multiple social factors. This study aims to explore how these intersecting social factors, identified by community members, combine to shape household-level inequalities healthcare utilisation (HU) among residents of informal settlements in Freetown, Sierra Leone. Methods This study employed participatory …
“People here live in denial”
Epidemiological studies show a global increase in asthma, straining healthcare systems in low- and middle-income countries. There are multiple barriers to accessing diagnosis and treatment in Sub-Saharan African countries like Kenya and Sudan such as healthcare infrastructure, diagnostic tools, healthcare workers’ capacities, and cost. Asthma can be well controlled using safe and cost-effective treatments such as inhalers. Stigma related to asthm…
The Economic Burden of Healthcare Utilization
Seven core competencies and conditions for equitable partnerships and power sharing in community-based participatory research
Equitable health research requires actively engaging communities in producing new knowledge to advocate for their health needs. Community-based participatory research (CBPR) relies on the coproduction of contextual and grounded knowledge between researchers, programme implementers and community partners with the aim of catalysing action for change. Improving coproduction competencies can support research quality and validity. Yet, frameworks and …
Voices and challenges of marginalized and vulnerable groups in urban informal settlements in Nairobi, Kenya
Urbanization is rapidly increasing across Africa, including in Nairobi, Kenya. Many people, recent migrants and long-term residents, live within dense and dynamic urban informal settlements. These contexts are fluid and heterogeneous, and deepening the understanding of how vulnerabilities and marginalization are experienced is important to inform pointed action, service delivery and policy priorities. The aim of this paper is to explore vulnerabi…
Household antibiotic use in Malawi
Antimicrobial resistance (AMR) is a significant threat to public health. Use of antibiotics, particularly in contexts where weaker regulatory frameworks make informal access easier, has been identified as an important driver of AMR. However, knowledge is limited about the ways antibiotics are used in communities in Malawi and sub-Saharan Africa. Between April and July 2021, we undertook a cross-sectional survey of community antibiotic use practic…
‘Why would they spend all this money and give us these items for free?’
We carried out a qualitative study to gain a deeper understanding of the social context of the Cooking and Pneumonia Study (CAPS) and implications for implementation of clean cooking and similar interventions. Such initiatives are recognised as complex, power-laden processes, which has consequences for outcomes and uptake. However, understanding of how precarious livelihoods and unequal power differentials impact on trials of technology is limite…
Honestly, this problem has affected me a lot”
Chronic respiratory diseases have substantial social and economic impacts among people with CRD and their families in Sudan and Tanzania. Stigma is particularly strong and appears to be driven partly by association of chronic cough with infectiousness. Context-appropriate measures to address economic impacts and chronic cough stigma are urgently needed as part of interventions for chronic respiratory diseases in these sub-Saharan African contexts
Power and poverty
People in informal urban settlements in Kenya face multiple inequalities, yet researchers investigate issues such as HIV or intimate partner violence (IPV) in isolation, targeting single populations and focusing on individual behaviour, without involving informal settlement dwellers. We formed a study team of researchers (n = 4) and lay investigators (n = 11) from an informal settlement in Nairobi, Kenya to understand the power dynamics in the in…
Implications of Covid-19 for safeguarding in international development research
COVID-19 brings uncertainties and new precarities for communities and researchers, altering and amplifying relational vulnerabilities (vulnerabilities which emerge from relationships of unequal power and place those less powerful at risk of abuse and violence). Research approaches have changed too, with increasing use of remote data collection methods. These multiple changes necessitate new or adapted safeguarding responses. This practice piece s…
A syndemic born of war
The intersections between NTDs, disability, and mental ill-health are increasingly recognised globally. Chronic morbidity resultant from many NTDs, particularly those affecting the skin—including lymphatic filariasis (LF), leprosy, Buruli ulcer (BU) and onchocerciasis—is well known and largely documented from a medicalised perspective. However less is known about the complex biosocial interaction shaping interconnected morbidities. We apply synde…
Climate change and health in informal settlements
In this paper, we present a narrative review of primary research on the health impacts of extreme weather events in urban informal settlements published between 1990 and June 2021. We include 54 studies and examine the health impacts of extreme weather events and how these were determined. We find that these events impact health directly by causing mortality, injury and disease and through indirect pathways by impacting livelihoods, access to hea…
Intersecting Systems of Power Shaping Health and Wellbeing of Urban Waste Workers in the Context of Covid-19 in Vijayawada and Guntur, Andhra Pradesh, India
Background: Waste work in India is an undervalued role relegated to historically marginalised communities. The informal nature of their work coupled with lack of state regulation keeps waste workers trapped in poverty. This study aims to understand how intersecting systems and relations of power impact the agency of waste workers to shape their health and wellbeing. Methods: We used in-depth interviews, key informant interviews, and focus group d…
Leaving No One Behind
Children heading households (CHH) in urban informal settlements face specific vulnerabilities shaped by limitations on their opportunities and capabilities within the context of urban inequities, which affect their wellbeing. We implemented photovoice research with CHHs to explore the intersections between their vulnerabilities and the social and environmental context of Nairobi's informal settlements. We enrolled and trained four CHHs living in …
‘Pneumonia has gone’
INTRODUCTION: Air pollution through cooking on open fires or inefficient cookstoves using biomass fuels has been linked with impaired lung health and with over 4 million premature deaths per annum. However, use of cleaner cookstoves is often sporadic and there are indications that longer-term health benefits are not prioritised by users. There is also limited information about how recipients of cookstoves perceive the health benefits of clean coo…
‘Cooking is for everyone?’
BACKGROUND: Household air pollution (HAP) resulting from cooking on open fires has been linked to considerable ill-health in women and girls, including chronic respiratory diseases, and has been identified as a contributor to climate change. It has been suggested that cleaner burning cookstoves can mitigate these risks, and that time saved through speedier cooking can lead to the economic empowerment of women. Despite these and other potential ad…
Building Forward Better
For the large population living in Nairobi’s informal settlements, the long-term effects of Covid-19 pose a threat to livelihoods, health, and wellbeing. For those working in the informal sector, who are the lifeblood of the city, livelihoods have been severely supressed by Covid-19 restrictions such as curfews, pushing many into further poverty. This article draws on community data, meetings, and authors’ observations as community organisers, to…
Psychological resilience, fragility and the health workforce
COVID-19 presents a time to redefine vulnerability; however, in discussions of vulnerability, the health workforce, particularly in \nregard to their psychosocial well-being, is often forgotten. Healthcare workers (HCWs) in fragile settings are constantly exposed to health system shocks, including; conflict, disease outbreaks and natural disasters, which compound the everyday challenges of working in an under-resourced health system. Based on a c…
How to prevent and address safeguarding concerns in global health research programmes
Safeguarding is rapidly rising up the international development agenda, yet literature on safeguarding in related research is limited. This paper shares processes and practice relating to safeguarding within an international research consortium (the ARISE hub, known as ARISE). ARISE aims to enhance accountability and improve the health and well-being of marginalised people living and working in informal urban spaces in low-income and middle-incom…
“I wanted evidence that my status had changed, so that is why I tested”
HIV testing among female sex workers (FSWs) is an established global health priority. HIV self-testing (HIVST) seems to have the potential to address issues of confidentiality, privacy and convenience among this key population. HIVST, however, may result in unintended consequences as its implementation unfolds in a complex sex work context characterised by unequal power relations, stigma and high HIV prevalence. We aimed to explore the experience…
Local response in health emergencies
This paper highlights the major challenges and considerations for addressing COVID-19 in informal settlements. It discusses what is known about vulnerabilities and how to support local protective action. There is heightened concern about informal urban settlements because of the combination of population density and inadequate access to water and sanitation, which makes standard advice about social distancing and washing hands implausible. There …
Applying an intersectionality lens to examine health for vulnerable individuals following devolution in Kenya
If key actors in devolved decision-making structures are to ensure progress towards universal health coverage, there is need for intersectoral policy action to address social determinants, promote equity and identify ways to challenge and shift power imbalances in priority-setting processes
How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework
Close-to-community (CTC) providers have been identified as a key cadre to progress universal health coverage and address inequities in health service provision due to their embedded position within communities. CTC providers both work within, and are subject to, the gender norms at community level but may also have the potential to alter them. This paper synthesises current evidence on gender and CTC providers and the services they deliver. This …
‘You’re disabled, why did you have sex in the first place?’ An intersectional analysis of experiences of disabled women with regard to their sexual and reproductive health and rights in Gujarat State,…
BACKGROUND: Globally, disabled people have significant unmet needs in relation to sexual and reproductive health (SRH). Disabled women in India face multiple discrimination: social exclusion, lack of autonomy with regard to their SRH, vulnerability to violence, and lack of access to SRH care. While they may face shared challenges, an intersectional perspective suggests that considering disabled women as a uniform and 'vulnerable' group is likely …
Perceptions of the mental health impact of intimate partner violence and health service responses in Malawi
BACKGROUND AND OBJECTIVES: This study explores the perceptions of a wide range of stakeholders in Malawi towards the mental health impact of intimate partner violence (IPV) and the capacity of health services for addressing these. DESIGN: In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in three areas of Blantyre district, and in two additional districts. A total of 10 FGDs, 1 small group, and 14 IDIs with health care …
Local response in health emergencies
This paper highlights the major challenges and considerations for addressing COVID-19 in informal settlements. It discusses what is known about vulnerabilities and how to support local protective action. There is heightened concern about informal urban settlements because of the combination of population density and inadequate access to water and sanitation, which makes standard advice about social distancing and washing hands implausible. There …
Going beyond the surface
Intersectionality and gender mainstreaming in international health
Critiques of gender mainstreaming (GM) as the officially agreed strategy to promote gender equity in health internationally have reached a critical mass. There has been a notable lack of dialogue between gender advocates in the global north and south, from policy and practice, governments and non-governmental organisations (NGOs). This paper contributes to the debate on the shape of future action for gender equity in health, by uniquely bringing …
He will ask why the child gets sick so often
Engendering the bureaucracy? Challenges and opportunities for mainstreaming gender in Ministries of Health under sector-wide approaches
The increasing ascendancy of 'gender mainstreaming' as the central approach to improving gender equity has largely determined strategies to integrate a gender focus in sector-wide approaches (SWAps). This paper explores the impetus for and process of gender mainstreaming in SWAps in the Ministries of Health in Uganda, Ghana, Malawi and Mozambique, and outlines some achievements and challenges. The shifting and contested relationships between the …
Sexual violence legislation in sub-Saharan Africa
Six sub-Saharan African countries currently have laws on sexual violence, including Kenya, and eight others have provisions on sexual violence in other legislation. Effective legislation requires functioning medico-legal linkages to enable both justice to be done in cases of sexual violence and the provision of health services for survivors of sexual violence. The health sector also needs to provide post-rape care services and collect and deliver…
Leaving No One Behind
Children heading households (CHH) in urban informal settlements face specific vulnerabilities shaped by limitations on their opportunities and capabilities within the context of urban inequities, which affect their wellbeing. We implemented photovoice research with CHHs to explore the intersections between their vulnerabilities and the social and environmental context of Nairobi's informal settlements. We enrolled and trained four CHHs living in …
Building Forward Better
For the large population living in Nairobi’s informal settlements, the long-term effects of Covid-19 pose a threat to livelihoods, health, and wellbeing. For those working in the informal sector, who are the lifeblood of the city, livelihoods have been severely supressed by Covid-19 restrictions such as curfews, pushing many into further poverty. This article draws on community data, meetings, and authors’ observations as community organisers, to…
Bypassing districts? Implications of sector-wide approaches and decentralization for integrating gender equity in Uganda and Kenya
While the concept of gender mainstreaming has gained acceptance among many national and international development organizations, many obstacles are faced in translating the concept into tangible improvements in the health and well-being of women and men. This paper presents two qualitative case studies, one from Kenya and one from Uganda, of experiences of mainstreaming gender at district level; experiences which are set against the context of de…
Engendering the bureaucracy? Challenges and opportunities for mainstreaming gender in Ministries of Health under sector-wide approaches
Health Policy and Planning volume 20, number 3, May 2005, pp. 141–9 The fourth author was erroneously printed as Helen Standing. It should in fact be Hilary Standing as it is printed above. The editors apologize to Dr Standing for this error.
Teaching about gender, health, and communicable disease
This article looks at the challenges and opportunities we have encountered while teaching a short course on gender, health, and communicable disease. The course is aimed at health policy-makers, planners, and managers from national ministries, international and national health organisations, and non-governmental organisations (NGOs). It ran for the first time in April 2000, with participants from Asia, Africa, and Europe. In this article, we expl…
Gender, health and development I
This is the first paper of a series of three that focus on key topical areas in gender health and development. Using the health sector as a case study this progress report will synthesize discourse action and progress to date on gender mainstreaming within sector wide approaches. Subsequent reports will consider gender equity and access to HIV and AIDS health services and research approaches in gender health and development. Building a health sys…
Mainstreaming HIV/Aids in development sectors
Drawing on an international literature review, two international workshops and primary qualitative research in Uganda this paper reviews experiences of mainstreaming HIV/AIDS in development sectors (such as education, health and agriculture) in developing countries. The extent to which HIV/AIDS mainstreaming strategies and associated challenges are similar to or different from those of mainstreaming gender in the health sector is also explored. T…
Engendering the bureaucracy? Challenges and opportunities for mainstreaming gender in Ministries of Health under sector-wide approaches
The increasing ascendancy of 'gender mainstreaming' as the central approach to improving gender equity has largely determined strategies to integrate a gender focus in sector-wide approaches (SWAps). This paper explores the impetus for and process of gender mainstreaming in SWAps in the Ministries of Health in Uganda, Ghana, Malawi and Mozambique, and outlines some achievements and challenges. The shifting and contested relationships between the …
Bypassing districts? Implications of sector-wide approaches and decentralization for integrating gender equity in Uganda and Kenya
While the concept of gender mainstreaming has gained acceptance among many national and international development organizations, many obstacles are faced in translating the concept into tangible improvements in the health and well-being of women and men. This paper presents two qualitative case studies, one from Kenya and one from Uganda, of experiences of mainstreaming gender at district level; experiences which are set against the context of de…
Engendering the bureaucracy? Challenges and opportunities for mainstreaming gender in Ministries of Health under sector-wide approaches
Health Policy and Planning volume 20, number 3, May 2005, pp. 141–9 The fourth author was erroneously printed as Helen Standing. It should in fact be Hilary Standing as it is printed above. The editors apologize to Dr Standing for this error.
Potential for abuse in the VCT counselling room
The rapid scale-up of HIV counselling and testing programmes in Kenya has led to quality concerns, including the potential for abuse within the private, confidential setting of client-initiated voluntary counselling and testing (VCT). A qualitative study was conducted in three provinces of Kenya, involving 26 VCT service providers and 13 key informants. First and second hand accounts of emotional, physical and sexual abuse emerged in all three st…
He will ask why the child gets sick so often
Evaluating the financial protection of patients with chronic disease by health insurance in rural China
A significant proportion of patients with chronic diseases face catastrophic healthcare costs and these are especially heavy for the poor. The NCMS offers only a limited degree of financial protection. The heavy financial burden of healthcare for chronic disease poses an urgent challenge to the NCMS. There is an urgent need for a clear policy on how to offer financial protection to those with chronic disease
Sexual violence legislation in sub-Saharan Africa
Six sub-Saharan African countries currently have laws on sexual violence, including Kenya, and eight others have provisions on sexual violence in other legislation. Effective legislation requires functioning medico-legal linkages to enable both justice to be done in cases of sexual violence and the provision of health services for survivors of sexual violence. The health sector also needs to provide post-rape care services and collect and deliver…
Promoting vulnerability or resilience to HIV? A qualitative study on polygamy in Maiduguri, Nigeria
Literature on the links between polygamy and HIV and AIDS is limited and the findings inconclusive. Literature to date in Sub-Saharan Africa has relied mainly on case-control studies and surveys. This qualitative study aimed to explore different community members' perceptions of the links between the practice of polygamy and vulnerability or resilience to HIV and AIDS in Maiduguri, north-eastern Nigeria. The study used focus group discussions and…
Changes and Equity in Use of Maternal Health Care in China
Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam
China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insura…
Intersectionality and gender mainstreaming in international health
Critiques of gender mainstreaming (GM) as the officially agreed strategy to promote gender equity in health internationally have reached a critical mass. There has been a notable lack of dialogue between gender advocates in the global north and south, from policy and practice, governments and non-governmental organisations (NGOs). This paper contributes to the debate on the shape of future action for gender equity in health, by uniquely bringing …
Going beyond the surface
Perceptions of the mental health impact of intimate partner violence and health service responses in Malawi
BACKGROUND AND OBJECTIVES: This study explores the perceptions of a wide range of stakeholders in Malawi towards the mental health impact of intimate partner violence (IPV) and the capacity of health services for addressing these. DESIGN: In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted in three areas of Blantyre district, and in two additional districts. A total of 10 FGDs, 1 small group, and 14 IDIs with health care …
‘You’re disabled, why did you have sex in the first place?’ An intersectional analysis of experiences of disabled women with regard to their sexual and reproductive health and rights in Gujarat State,…
BACKGROUND: Globally, disabled people have significant unmet needs in relation to sexual and reproductive health (SRH). Disabled women in India face multiple discrimination: social exclusion, lack of autonomy with regard to their SRH, vulnerability to violence, and lack of access to SRH care. While they may face shared challenges, an intersectional perspective suggests that considering disabled women as a uniform and 'vulnerable' group is likely …
How do gender relations affect the working lives of close to community health service providers? Empirical research, a review and conceptual framework
Close-to-community (CTC) providers have been identified as a key cadre to progress universal health coverage and address inequities in health service provision due to their embedded position within communities. CTC providers both work within, and are subject to, the gender norms at community level but may also have the potential to alter them. This paper synthesises current evidence on gender and CTC providers and the services they deliver. This …
Applying an intersectionality lens to examine health for vulnerable individuals following devolution in Kenya
If key actors in devolved decision-making structures are to ensure progress towards universal health coverage, there is need for intersectoral policy action to address social determinants, promote equity and identify ways to challenge and shift power imbalances in priority-setting processes
Psychological resilience, fragility and the health workforce
COVID-19 presents a time to redefine vulnerability; however, in discussions of vulnerability, the health workforce, particularly in \nregard to their psychosocial well-being, is often forgotten. Healthcare workers (HCWs) in fragile settings are constantly exposed to health system shocks, including; conflict, disease outbreaks and natural disasters, which compound the everyday challenges of working in an under-resourced health system. Based on a c…
How to prevent and address safeguarding concerns in global health research programmes
Safeguarding is rapidly rising up the international development agenda, yet literature on safeguarding in related research is limited. This paper shares processes and practice relating to safeguarding within an international research consortium (the ARISE hub, known as ARISE). ARISE aims to enhance accountability and improve the health and well-being of marginalised people living and working in informal urban spaces in low-income and middle-incom…
“I wanted evidence that my status had changed, so that is why I tested”
HIV testing among female sex workers (FSWs) is an established global health priority. HIV self-testing (HIVST) seems to have the potential to address issues of confidentiality, privacy and convenience among this key population. HIVST, however, may result in unintended consequences as its implementation unfolds in a complex sex work context characterised by unequal power relations, stigma and high HIV prevalence. We aimed to explore the experience…
Local response in health emergencies
This paper highlights the major challenges and considerations for addressing COVID-19 in informal settlements. It discusses what is known about vulnerabilities and how to support local protective action. There is heightened concern about informal urban settlements because of the combination of population density and inadequate access to water and sanitation, which makes standard advice about social distancing and washing hands implausible. There …
‘Pneumonia has gone’
INTRODUCTION: Air pollution through cooking on open fires or inefficient cookstoves using biomass fuels has been linked with impaired lung health and with over 4 million premature deaths per annum. However, use of cleaner cookstoves is often sporadic and there are indications that longer-term health benefits are not prioritised by users. There is also limited information about how recipients of cookstoves perceive the health benefits of clean coo…
‘Cooking is for everyone?’
BACKGROUND: Household air pollution (HAP) resulting from cooking on open fires has been linked to considerable ill-health in women and girls, including chronic respiratory diseases, and has been identified as a contributor to climate change. It has been suggested that cleaner burning cookstoves can mitigate these risks, and that time saved through speedier cooking can lead to the economic empowerment of women. Despite these and other potential ad…
Sociology (26 obras) · Economic growth (25 obras) · Medicine (25 obras) · Political science (23 obras) · Economics (18 obras) · Geography (16 obras) · Environmental health (13 obras) · Health care (13 obras) · Psychology (13 obras) · Nursing (12 obras)