Accessing needed sexual health services during the COVID-19 pandemic in British Columbia, Canada: a survey of sexual health service clients

ObjectivesWe assessed COVID-19 pandemic impacts on accessing needed sexual health services, and acceptability of alternative service delivery models, among sexual health service clients in British Columbia (BC), Canada.MethodsWe administered an online survey on 21 July–4 August 2020 to clients using a provincial STI clinic or internet-based testing service, GetCheckedOnline, in the year prior to March 2020. We used logistic regression to identify factors associated with having unmet sexual health needs (ie, not accessing needed services) during March–July 2020 and the likelihood of using various alternative service models, if available.ResultsOf 1198 survey respondents, 706 (59%) reported needing any sexual health service since March 2020; of these 706, 365 (52%) did not access needed services and 458 (66%) had avoided or delayed accessing services. GetCheckedOnline users (univariate OR (uOR)=0.62; 95% CI 0.43 to 0.88) or clients with more urgent needs (eg, treatment for new STI, uOR 0.40 (95% CI 0.21 to 0.7)) had lower odds of unmet sexual health needs. The most common factors reported for avoiding or delaying access were public messaging against seeking non-urgent healthcare (234/662, 35%), concern about getting COVID-19 while at (214/662, 32%) or travelling to (147/662, 22%) a clinic or lab and closure of usual place of accessing services (178/662, 27%). All factors were positively associated with having unmet sexual health needs, with public messaging showing the strongest effect (adjusted OR=4.27 (95% CI 2.88 to 6.42)). Likelihood of using alternative sexual health service models was high overall, with the most appealing options being home self-collection kits (634/706, 90%), receiving test kits or antibiotics at home (592/700, 85%) and express testing (565/706, 80%).ConclusionsOf BC sexual health service clients needing services during March–July 2020, many had unmet needs. Offering alternative service delivery methods may help to improve access during and beyond the COVID-19 pandemic.

Enhancing accountability in public–private partnerships in South Africa

South Africa, like other developing countries, has joined other nations around the world in resorting to public–private partnerships (PPPs) as an integral strategy to improve its deeply rooted socio-economic, political, fiscal and societal problems and to meet the pressure of attaining the goals of national and international developmental projects. In spite of the reasons advanced for the importance of PPPs as an alternative service-delivery option, several doubts about the efficacy of accountability and suggestions that it may undermine public control have been expressed. Given the importance of accountability, this paper seeks to determine some approaches to enhance accountability in public–private partnerships in South Africa. It identifies some of the accountability challenges and suggests ways of overcoming them.

Perceptions, Realities, and Euphemisms: Community Choices of In-House Service Provision or Alternative Service Delivery

Increased expectations for municipalities to provide services, a push for updating and maintaining the services already provided, and simultaneous dealing with strained budgets and less federal funding opportunities have led some communities to adopt alternative service for delivery of public works systems. This research project creates a new data set of localities and investigates what characteristics increase the likelihood a political subdivision will choose an alternative service delivery system for what was a traditionally in-house public service. Testing three hypotheses, findings indicate need for expertise does not play a role in service delivery choices.

Risks and Projects Phases

This chapter provides the rational for the importance of developing an effective and efficient replica for risks in PPP arrangement in order to optimize measures to handle them. Various attempts have been made to dig up all the risks in the project phases as an alternative service delivery improvement but to date there has been a lack of proper analogies of risks in the PPP project phases. This is also a lack of clear codification for risk of the project phases in the literature to provide useful benchmark mechanisms to improve a particular phase and to share risk optimally. The aim of this chapter is to develop a conceptual replica to comprehend risks in the project phases, and to determine means to advance risk-free PPP project phase. The different case studies will be examined in an effort to simplify the tasks of creating a risk-free PPP projects. In unearthing the melodrama in handling risks in PPP project phases, it is concluded that there is a lack of proper risk sharing formula that make most PPP projects to fail and a lack of emphasis in designing a less risk prone PPP projects.

Influence of Citizens and Form of Government on Alternative Service Delivery Choices in Local Governments

<p>Citizens are an essential part of democratic setup and especially as recipients of public services play a crucial role in decisions regarding provision of these services. Citizen engagement not only provides feedback on the activities undertaken by government but may also influence how governments plans for future allocation of resources and means for providing various services. Citizen engagement emerges from the initiatives taken by the governments to improve the quality of government planning, processes, and decisions as well as it is a source of legitimacy to such decisions as part of democratic process. However, there are tremendous pressures from various actors such as government officials for cutting costs due to budgetary constraints, public managers for managing costs and quality, vendors for bargaining and deciding cost versus service quality measures, technical and line staff for administrating negotiations and producing services, and citizens for receiving services in exchange of price they pay in the form of taxes. This study examines the effects of citizens and forms of government on the service decisions regarding health and human services. Findings fail to support citizen’s role but indicate a significant role of form of government, partisanship orientation, and taxes in making alternative service delivery choices.</p>

Alternative Service Delivery in Africa: The Case for International Regional Organisations

Alternative service delivery (ASD) is generally confined to the provision opublic services within the boundaries of a single nation state. This paper extends thisconceptualization and practice beyond a single nation state by focusing on services provided by international regional organizations (IROs), which encompass more than a single country. Recognizing that the regional approach may not be suitable under all circumstances, the papertakes a contingency approach and discusses with illustrations the conditions under which the regional or continental approaches may provide superior public services to the wider population. Three examples from the East African Community (EAC), Africa’s riparian river basins, and cross-border illicit trade of conflict minerals in the Great Lakes region are given as illustrative cases. Noting that Africa’s growing aspirations for inclusive development and rapid transformation call for better governance and quality public services, the paper ends by calling for more scholarly work and field experiments on ASD and other models applicable at local, national, regional and continental levels.