Social participation for Universal health coverage - evidence-informed NetWorks Advancing Inclusion (SUNWAI)

Research Question: In what contexts, through what mechanisms and at what costs, can sexual and gender minority populations (SGM) engage in social participation for Universal Health Coverage (UHC) reform, with what impact on health system process goals? Background: Social participation for health (SPH), where social actors group their collective potential to improve health, owes its legacy to the 1978 Alma Ata Declaration and the principle of ‘Greater Involvement of People Living with HIV/AIDS’ or GIPA. In Vietnam, Thailand and India, it has taken about four decades for sexual and gender minorities (SGM) to be recognised and granted entitlements, with potential for access to health under UHC reform. Yet we still have gaps on what the role of SGM can be in UHC reform, what the related contexts, mechanisms, costs and outcomes could be. Aim and objectives: The SUNWAI consortium aims to institutionalise and deepen cross-regional, co-produced research and action that advances the inclusion of SGM in social participation for UHC, and to understand its contexts, mechanisms, outcomes, and costs. Our objectives are to O1 - develop academic and civil society partnerships working on SGM participation for UHC in Vietnam, India, and Thailand; O2 - understand the contexts, mechanisms, outcomes, and costs of involving SGM in SPH initiatives; O3 - co-produce mechanisms to enhance SGM social participation for UHC; O4 - assess the relationship of these mechanisms to health system process goals; and O5 - catalyse expansion of SUNWAI Methods: We will conduct 6 studies in Thailand, Vietnam and India through 5 Work Packages (WP) over 5 years. WP 1: Engagement & Inclusion (O1, O2) entails peer, policy and public networking and dialogue in global and national forums, workshops consultations, conference panels, blogs, academic articles, video and photo documentation. WP 2: Retroduction & Development (O2) comprises a realist analysis of contexts and mechanisms of SPH initiatives in each country (study 1); alongside analysis of survey, program data, and prior studies to understand the situation of SGM health (study 2). An embedded realist economic evaluation costing analysis (study 3) will inform WP 3: Application & Impact (O3 and O4). This WP involves two costed Participatory Action Research cycles (study 4) across two locations per country. In WP 4: Learning & Evaluation (O1, O4, O5), we will create a SUNWAI learning system, use realist approach-based comparative case analysis across country settings (study 5), and evaluate SUNWAI’s impact on health systems processes (study 6). WP 5: Operations & Management will ensure high quality, timely and effective management of SUNWAI. Timelines: WP2 as well as WP4 will start in Y1, informing WP 3 which starts in Y2. WP 1 as well as WP 5 are in place anticipating the 2024 World Health Assembly resolution on SPH for UHC. Anticipated Impact and dissemination: Anticipated impacts are greater attention given in UHC policy to SPH, specifically of SGM; demonstrable change in country UHC service design to address needs of SGM persons; increase in funding for SPH involving SGM and for their UHC services; strengthened and sustained partnerships working on SGM health as well SPH for UHC and beyond 2030. Dissemination comprises meetings, consultations, digital content (i.e. infographics and short films), media outreach, and academic outputs (peer reviewed journal articles, blogs, conference presentations).