New funding for research on advancing inclusion in healthcare systems across Asia

Researchers in Vietnam, Thailand, India and the UK have been awarded more than £4 million by the National Institute for Health and Care Research (NIHR) to identify and evaluate inclusive methods of healthcare provision.

Analysis of access to essential health services in these Asian countries, known as universal health coverage, is proposed in the SUNWAI project – Social participation for Universal health coverage: evidence-informed NetWorks Advancing Inclusion. This project is being jointly led by researchers from Northumbria University and India’s George Institute for Global Health with the aim of improving equity of access and outcomes for all, particularly sexual and gender minority groups.

Over the next five years, academics at Northumbria University and the George Institute for Global Health will collaborate with a consortium of partners, including community-based collectives and organisations, working side by side with researchers at the Mahidol University in Thailand, Hanoi Medical University in Vietnam and the University of Essex.

Dr Meghan Kumar, Principal Investigator and Associate Professor in the School of Healthcare and Nursing Sciences at Northumbria University, said: “For me this project is important because we’ll be looking at the differences and similarities in social participation for health across the Asian nations involved. By that, I mean analysis of how citizens are involved in the healthcare system outside of being patients. How do each of the systems ensure all citizens are receiving the treatment and support they need, and how do they hold the systems accountable for this? This includes looking at communities who may often be under-represented and looking at different approaches to improve inclusion and equity of access.”

The work will involve a focus on the LGBTQ+ community, including access to gender affirming services and treatment. This means looking at what is available to patients who feel their gender and physical sex do not match, and what happens when they seek medical and psychosocial support to bring those two things closer together.

Recent health policy and legal developments in Vietnam, Thailand, and India suggest varied pathways for these communities as members of society and as patients, which can provide important lessons on how social participation in health can impact on universal health coverage and availability.

Dr Devaki Nambiar, Principal Investigator and health and policy systems researcher at the George Institute for Global Health, added: “The SUNWAI consortium is a bold and ambitious effort to claim space for sexual and gender minority collectives and organisations to shape health systems and reform. For this to happen, our consortium will learn how to truly listen to each other – SUNWAI means being heard in a number of Asian languages – across disciplines, countries, health concerns and reform processes and see what ripples of listening and change we can create.”

Working with community organisations in each of the three countries and with funding for three doctoral students, researchers will gather and analyse data to understand prior and current structures that encourage social participation, accountability mechanisms, relevant legal and rights frameworks, and accessibility to gender-affirming care.

Qualitative research methods will include witness seminars from each country which will be shared through learning lab events to help the team understand and support the development of sustainable and inclusive health service delivery strategies for the future. The research will bring together realist and economic evaluation methods – this means establishing what works, for whom, and in which circumstances – whilst integrating better understanding of hidden costs and outcomes valued by each community.

SUNWAI consortium members travelled to Northumbria University on Monday 8 September for an inception meeting as the project begins its first year. The partners hosted a global health seminar – Social Participation for Health: Perspectives of Sexual and Gender Minority Groups in Asia – which was open to the public.

Northumbria University is dedicated to reducing health and social inequalities, contributing to the regional and national workforce and improving social, economic and health outcomes for the most marginalised in society. Through its new Centre for Health and Social Equity, known as CHASE, researchers will be delivering world-leading health and social equity research and creating innovative, evidence-based policies and data-driven solutions to bring impactful change across the North East of England, the UK and globally.