Curatio International Foundation

India’s healthcare landscape is characterized by a multitude of public and private healthcare providers, yet its health systems remain weak in many areas. Informal healthcare providers (IHPs) bridge this gap, particularly in rural India, and are deeply embedded within local communities. While their importance is widely recognized, there is a knowledge gap regarding the specifics of their social networks with actors in health systems. The aim of this study was to map the social networks of IHPs to elucidate the type and nature of their relationships, in order to explore opportunities for intersectoral collaboration to achieve universal health coverage (UHC). We have adopted the social network analysis (SNA) approach using qualitative ego-network methodology to evaluate the types and strengths of ties in the Indian Sundarbans. A total of 34 IHPs participated in the study. Qualitative data were analysed using NVivo10 and Kumu.io was used to visualize the social networks. Results show that the 34 IHPs had a total of 1362 ties with diverse actors, spanning the government, private sector and community. The majority of the ties were strong, with various motivating factors underpinning the relationships. Most of these ties were active and have continued for over a decade. The robust presence of IHPs in the Indian Sundarbans is attributable to the numerous, strong and often mutually beneficial ties. The findings suggest a need to reconsider the engagement of IHPs within formal health systems. Rather than isolation, a nuanced approach is required based on intersectoral collaboration capitalizing on these social ties with other actors to achieve UHC in impoverished and underserved regions globally.

Enhancing digital health governance is critical to healthcare systems in low-income and middle-income countries. However, implementing governance-enhancing reforms in these countries is often challenging due to the multiplicity of external players and insufficient operational guidance that is accessible. Using data from desktop research, in-depth interviews, focus group discussions and three stakeholder workshops, this paper aims to provide insights into Georgia’s experience in advancing digital health governance reforms. It reveals how Georgia has progressed on this path by unpacking the general term ‘governance’ into operational domains, where stakeholders and involved institutions could easily relate their institutional and personal roles and responsibilities with the specific function needed for digital health. Based on this work, the country delineated institutional responsibilities and passed the necessary regulations to establish better governance arrangements for digital health. The Georgia experience provides practical insights into the challenges faced and solutions found for advancing digital health governance in a middle-income country setting. The paper highlights the usefulness of operational definitions for the digital health governance domains that helped (a) increase awareness among stakeholders about the identified domains and their meaning, (b) discuss possible governance and institutional arrangements relevant to a country context, and (c) design the digital health governance architecture that the government decreed. Finally, the paper offers a broad description of domains in which the governance arrangements could be considered and used for other settings where relevant. The paper points to the need for a comprehensive taxonomy for governance domains to better guide digital health governance enhancements in low-middle-income country settings.

Health management information systems (HMISs) are essential in programme planning, budgeting, monitoring and evidence-informed decision-making. This paper focuses on donor transitions in two upper-middle-income countries, China and Georgia, and explores how national HMIS adaptations were made and what facilitated or limited successful and sustainable transitions. This comparative analytical case study uses a policy triangle framework and a mixed-methods approach to explore how and why adaptations in the HMIS occurred under the Gavi Alliance and the Global Fund–supported programmes in China and Georgia. A review of published and grey literature, key informant interviews and administrative data analysis informed the study findings. Contextual factors such as the global and country context, and health system and programme needs drove HMIS developments. Other factors included accountability on a national and international level; improvements in HMIS governance by establishing national regulations for clear mandates of data collection and reporting rules and creating institutional spaces for data use; investing in hardware, software and human resources to ensure regular and reliable data generation; and capacitating national players to use data in evidence-based decision-making for programme and transition planning, budgeting and outcome monitoring. Not all the HMIS initiatives supported by donors were sustained and transitioned. For the successful adaptation and sustainable transition, five interlinked and closely coordinated support areas need to be considered: (1) coupling programme design with a good understanding of the country context while considering domestic and external demands for information, (2) regulating appropriate governance and management arrangements enhancing country ownership, (3) avoiding silo HMIS solutions and taking integrative approach, (4) ensuring the transition of funding onto domestic budget and enforcing fulfilment of the government’s financial commitments and finally (5) investing in technologies and skilled human resources for the HMIS throughout all levels of the health system. Neglecting any of these elements risks not delivering sustainable outcomes.

Background Demand for rapid evidence-based syntheses to inform health policy and systems decision-making has increased worldwide, including in low- and middle-income countries (LMICs). To promote use of rapid syntheses in LMICs, the WHO’s Alliance for Health Policy and Systems Research (AHPSR) created the Embedding Rapid Reviews in Health Systems Decision-Making (ERA) Initiative. Following a call for proposals, four LMICs were selected (Georgia, India, Malaysia and Zimbabwe) and supported for 1 year to embed rapid response platforms within a public institution with a health policy or systems decision-making mandate. Methods While the selected platforms had experience in health policy and systems research and evidence syntheses, platforms were less confident conducting rapid evidence syntheses. A technical assistance centre (TAC) was created from the outset to develop and lead a capacity-strengthening program for rapid syntheses, tailored to the platforms based on their original proposals and needs as assessed in a baseline questionnaire. The program included training in rapid synthesis methods, as well as generating synthesis demand, engaging knowledge users and ensuring knowledge uptake. Modalities included live training webinars, in-country workshops and support through phone, email and an online platform. LMICs provided regular updates on policy-makers’ requests and the rapid products provided, as well as barriers, facilitators and impacts. Post-initiative, platforms were surveyed. Results Platforms provided rapid syntheses across a range of AHPSR themes, and successfully engaged national- and state-level policy-makers. Examples of substantial policy impact were observed, including for COVID-19. Although the post-initiative survey response rate was low, three quarters of those responding felt confident in their ability to conduct a rapid evidence synthesis. Lessons learned coalesced around three themes – the importance of context-specific expertise in conducting reviews, facilitating cross-platform learning, and planning for platform sustainability. Conclusions The ERA initiative successfully established rapid response platforms in four LMICs. The short timeframe limited the number of rapid products produced, but there were examples of substantial impact and growing demand. We emphasize that LMICs can and should be involved not only in identifying and articulating needs but as co-designers in their own capacity-strengthening programs. More time is required to assess whether these platforms will be sustained for the long-term.

While scientific research supporting mitigation of further global temperature rise remains a major priority, CoP26 and CoP27 saw increased recognition of the importance of research that informs adaptation to irreversible changes in climate and the increasing threats of extreme weather events. Such work is inevitably and appropriately contextual, but efforts to generalise principles that inform local strategies for adaptation and resilience are likely crucial. Systems approaches are particularly promising in this regard. This study adopted a system dynamics framing to consider linkages between climate change and population health across four low- and middle-income country settings with a view to identifying priority inter-sectoral adaptation measures in each. On the basis of a focused literature review in each setting, we developed preliminary causal loop diagrams (CLD) addressing dynamics operating in Mozambique, Lebanon, Costa Rica, and Georgia. Participatory workshops in each setting convened technical experts from different disciplines to review and refine this causal loop analysis, and identify key drivers and leverage points for adaptation strategy. While analyses reflected the unique dynamics of each setting, common leverage points were identified across sites. These comprised: i) early warning/preparedness regarding extreme events (thus mitigating risk exposure); ii) adapted agricultural practices (to sustain food security and community livelihoods in changing environmental conditions); iii) urban planning (to strengthen the quality of housing and infrastructure and thus reduce population exposure to risks); iv) health systems resilience (to maintain access to quality healthcare for treatment of disease associated with increased risk exposure and other conditions for which access may be disrupted by extreme events); and v) social security (supporting the livelihoods of vulnerable communities and enabling their access to public services, including healthcare). System dynamics modelling methods can provide a valuable mechanism for convening actors across multiple sectors to consider the development of adaptation strategies.

Background: The university years are associated with a variety of stressors, and recently, COVID-19 has presented an additional burden on students’ mental well-being. As mental health manifestations of stressors may differ between countries, this study compared students from Switzerland and the Republic of Georgia regarding the burden of stressors and the role of potentially culture-dependent risk and protective factors of mental health (i.e., help-seeking, cross-cultural coping, fatalism, sense of coherence). Method: We assessed two samples of university students in Georgia ( N = 425) and German-speaking Switzerland ( N = 298), using a cross-sectional design. Quantitative data were collected with online questionnaires during the third wave of the pandemic. Mental health screenings included measures of depression, anxiety, and adjustment disorder. Results: General life- and COVID-19-related stress levels were higher in Georgia than in Switzerland. Georgian students experienced more adjustment disorder symptoms but lower levels of depression and anxiety. While Swiss students reported more protective factors (formal and informal help-seeking, sense of coherence), Georgian students experienced more risk factors (fatalism and avoidance coping). Despite significant correlations between potentially culture-dependent risk and protective factors and mental health, few associations remained significant above and beyond the impact of general life stress. Conclusions: The high prevalence of stressors and adjustment disorder symptoms and risk factors for mental health among Georgian students illustrates a potential need for psychosocial support with stress management. The cross-cultural applicability of Western models of student mental health services should be evaluated.

BACKGROUND There are currently large gaps in unit cost data for TB, and substantial variation in the quality and methods of unit cost estimates. Uncertainties remain about sample size, range and comprehensiveness of cost data collection for different purposes. We present the methods and results of a project implemented in Kenya, Ethiopia, India, The Philippines and Georgia to estimate unit costs of TB services, focusing on findings most relevant to these remaining methodological challenges. METHODS We estimated financial and economic unit costs, in close collaboration with national TB programmes. Gold standard methods included both top-down and bottom-up approaches to resource use measurement. Costs are presented in 2018 USD and local currency unit. RESULTS Cost drivers of outputs varied by service and across countries, as did levels of capacity inefficiency. There was substantial variation in unit cost estimates for some interventions and high overhead costs were observed. Estimates were subject to sampling uncertainty, and some data gaps remain. CONCLUSION This paper describes detailed methods for the largest TB costing effort to date, to inform prioritisation and planning for TB services. This study provides a strong baseline and some cost estimates may be extrapolated from this data; however, regular further studies of similar quality are needed to add estimates for remaining gaps, or to add new or changing services and interventions. Further research is needed on the best approach to extrapolation of cost data. Costing studies are best implemented as partnerships with policy makers to generate a community of mutual learning and capacity development.

Mitochondrial dysfunction, characterized by the electron transport chain (ETC) leakage and reduced adenosine triphosphate synthesis, occurs primarily due to free radicals -induced mutations in either the mitochondrial deoxyribonucleic acid (mtDNA) or nuclear (n) DNA caused by pathogenic infections, toxicant exposures, adverse drug-effects, or other environmental exposures, leading to secondary dysfunction affecting ischemic, diabetic, cancerous, and degenerative diseases. In these concerns, mitochondria-targeted remedies may include a significant role in the protection and treatment of mitochondrial function to enhance its activity. Coenzyme Q10 pyridinol and pyrimidinol antioxidant analogues and other potent drug-compounds for their multifunctional radical quencher and other anti-toxic activities may take a significant therapeutic effectivity for ameliorating mitochondrial dysfunction. Moreover, the encapsulation of these bioactive ligands attached potent compounds in vesicular system may enable them a superb biological effective for the treatment of mitochondria-targeted dysfunction-related diseases with least side effects. This review depicts mainly on mitochondrial enzymatic dysfunction and their amelioration by potent drugs with the usages of nanoparticulated delivery system against mitochondria-affected diseases.

Objectives In the post–COVID-19 world, when the adequacy of public health workforce education is being critically re-evaluated, this study undertakes a historical analysis of how the educational and scientific field of public health developed during and after the fall of the Soviet Union in 1991. The study intends to historically contextualize public health education and science development in former Soviet Republics. It attempts to document achievements after gaining independence and identify remaining challenges that need to be addressed for advancing public health science and education in Former Soviet Union countries to better prepare them for future pandemics and address current health challenges of the nations. Methods The study used a mixed-methods review approach combining both a literature review, information collection from the school's websites, and secondary analysis of the quantitative data available about scientific outputs—peer-reviewed articles. Results During communist rule and after the fall of the Soviet Union, the main historical events seem to have shaped the public health field of former Soviet countries, which also determined its eventual evolution. The international efforts post-1991 were instrumental in shifting medically oriented conceptualization of public health toward Western approaches, albeit with variable progress. Also, while scientific output has been growing from 1996 to 2019, sub-regional differences remain prominent. Conclusion The region seems to have matured enough that it might be time to start and facilitate regional cooperation of public health schools to advance the field of public health and research. Regional and country variabilities feature prominently in the volume and quality of scientific output and call for the immediate attention of national governments and international partners.

Background: The decade between the ages of 14 and 25 is a particularly vulnerable period for the development of mental health problems, especially of common mental disorders. Mental health and psychosocial prevention and support services for young people in the Republic of Georgia have been extremely limited, leaving a wide treatment and care gap. Club Synergy was designed as an innovative, pragmatic solution that is responsive to the needs of young people and incorporates all necessary levels of care required (prevention, early identification & intervention, and treatment) into a single, trauma-informed service that uses a transdiagnostic approach. This paper presents preliminary findings from the pilot phase of establishing and running the service. Aim: To examine the characteristics of young people presenting to Club Synergy and the effectiveness of contact with the service. Methods: Quantitative evaluation of a consecutive series of young people seen by Club Synergy between November 2019 and July 2020. Demographic information was analysed using descriptive statistics. Pre-post outcomes for anxiety (GAD-7), depression (PHQ-9) and health-related quality of life (EQ-5D-5L) were analysed using the Wilcoxon signed-rank test. Results: Hundred and seventy-four young people were included. The majority (68.9%) self-referred, with referral from The Ministry of Justice due to conflict with law (23%) accounting for most of the other young people seen. Emotional disturbance (73.6%), anxiety (60.3%), problems in interpersonal relationships (57.5%) and low mood (49.4%) were the commonest presenting symptoms. Seventy-three per cent reported 4 or more adverse childhood experiences. After engaging in transdiagnostic modules, median baseline scores for depression and anxiety reduced by 40% and 45%, respectively, and self-rated health improved by 14%. Conclusions: Preliminary analysis indicates that Club Synergy's trauma-informed model of care, based on a transdiagnostic approach, has the potential to provide an effective service to young people in Georgia at risk of developing and with mental health problems. Highlights: This pragmatic study of a newly established mental health service for young people in Georgia suggests that a trauma-informed approach, using transdiagnostic modules, has the potential to effectively prevent and treat common mental health presentations.

In an effort to improve the poor quality of maternal, newborn, and child health services, the Zimbabwe Ministry of Health and Child Care implemented a Continuous Quality Improvement (CQI) pilot in 2016. Health workers and district managers were trained and supported to implement cycles of quality target setting, developing and implementing action plans, and tracking outcomes. The pilot was implemented in district hospitals and primary health centers in five districts as an arm of the performance-based health financing (PBF) program. This study uses mixed methods to estimate the effect of the CQI model on quality of care for various services and to identify factors that enabled or impeded quality improvements. We assessed changes in quality of care for seven services over a two-year implementation period and compared these changes against other PBF districts. We also conducted focus group discussions and in-depth interviews with district and facility-level health workers and managers after implementation to explore enabling and impeding factors affecting program performance. Among the seven services assessed, CQI was associated with quality improvement in primary health centers for two: postnatal care and maternal delivery care. Enabling factors included strengthened leadership, teamwork and joint decision-making at facilities; and supportive supervision. Impeding factors included fragmentation of quality assurance policies; staff shortages and turnover; and gaps in the CQI training. Improvements were limited when considering the full breadth of potential outcomes but arise in certain areas of core focus of the CQI program. In order to see large scale improvement in the quality of healthcare in Zimbabwe, CQI should be seen as one potential tool in a broader health systems quality improvement strategy.

BACKGROUND Patient-centred care along with optimal financing of inpatient and outpatient services are the main priorities of the Georgia National TB Programme (NTP). This paper presents TB diagnostics and treatment unit cost, their comparison with NTP tariffs and how the study findings informed TB financing policy. METHODS Top-down (TD) and bottom-up (BU) mean unit costs for TB interventions by episode of care were calculated. TD costs were compared with NTP tariffs, and variations in these and the unit costs cost composition between public and private facilities was assessed. RESULTS Outpatient interventions costs exceeded NTP tariffs. Unit costs in private facilities were higher compared with public providers. There was very little difference between per-day costs for drug-susceptible treatment and NTP tariffs in case of inpatient services. Treatment day financing exceeded actual costs in the capital (public facility) for drug-resistant TB, and this was lower in the regions. CONCLUSION Use of reliable unit costs for TB services at policy discussions led to a shift from per-day payment to a diagnosis-related group model in TB inpatient financing in 2020. A next step will be informing policy decisions on outpatient TB care financing to reduce the existing gap between funding and costs.

Objectives: We examine how health policy and systems research (HPSR) is produced and funded in 14 post-Soviet states to inform possible strategies to improve the supply and quality of research and advance evidence-based health policy making in these states. Study type: Mixed methods. Methods: Using mixed methods - secondary data analysis, desk review and in-depth interviews - this qualitative study is exploratory and explanatory.The secondary data analysis involved a comparative analysis of available data from: a) the 'fiscal space' (national economic resources) - using gross domestic expenditure on research and development for the years 2013-2018; and b) capacity for HPSR - using the number of published papers and average citation per paper (as a quality proxy) in the years 2015-2019. To explain the secondary data analysis findings, we used the approach proposed by Hallerberg et al., highlighting the importance of institutional context, actors, and their incentives and influence in budget allocation decisions. The desk review of available documents and 32 in-depth interviews were conducted remotely to obtain insights on the context and actors. The interview transcripts were analysed using Nvivo 12 software with an inductive approach. Results: In all studied countries, except the Baltic states, funding levels for HPSR remain inadequate. Most research and development funding is allocated to fundamental sciences and biomedical research - fields with more influential long-standing institutional legacies. The low volume and poor quality of published HPSR research appears to be adversely affecting the credibility of researchers in this field in the eyes of critical beneficiaries - policy makers, who do not prioritise and advocate for funding of HPSR. Conclusions: HPSR funding in most post-Soviet countries is caught in a vicious cycle of inadequate funding and poor quality. International collaborative projects focused on post-Soviet states and involving science funders, academic institutions and researchers from those countries may help strengthen HPSR capacity, improve research quality and help boost priority funding and the credibility of researchers in this field.

Background Numbers of psychiatric beds (general, forensic, and residential) and prison populations have been considered to be indicators of institutionalisation of people with mental illnesses. The present study aimed to assess changes of those indicators across Central Eastern Europe and Central Asia (CEECA) over the last three decades to capture how care has developed during that historical period. Methods We retrospectively obtained data on numbers of psychiatric beds and prison populations from 30 countries in CEECA between 1990 and 2019. We calculated the median of the percent changes between the first and last available data points for all CEECA and for groups of countries based on former political alliances and income levels. Findings Primary national data were retrieved from 25 out of 30 countries. Data from international registries were used for the remaining five countries. For all of CEECA, the median decrease of the general psychiatric bed rates was 33•8% between 1990 and 2019. Median increases were observed for forensic psychiatric beds (24•7%), residential facility beds (12•0%), and for prison populations (36•0%). Greater reductions of rates of psychiatric beds were observed in countries with lower per capita income as well as in countries that were formerly part of the Soviet Union. Seventeen out of 30 countries showed inverse trends for general psychiatric beds and prison populations over time, indicating a possible shift of institutionalisation towards correctional settings. Interpretation Most countries had decreased rates of general psychiatric beds, while there was an increase of forensic capacities. There was an increase in incarceration rates in a majority of countries. The large variation of changes underlines the need for policies that are informed by data and by comparisons across countries. Funding Agencia Nacional de Investigación y Desarrollo in Chile, grant scheme FONDECYT Regular, grant number 1190613.

Objectives This paper presents the iterative process of participatory multistakeholder engagement that informed the development of a new national tuberculosis (TB) policy in Georgia, and the lessons learnt. Methods Guided by realist evaluation methods, a multistakeholder dialogue was organised to elicit stakeholders’ assumptions on challenges and possible solutions for better TB control. Two participatory workshops were conducted with key actors, interspersed by reflection meetings within the research team and discussions with policymakers. Using concept mapping and causal mapping techniques, and drawing causal loop diagrams, we visualised how actors understood TB service provision challenges and the potential means by which a results-based financing (RBF) policy could address these. Setting The study was conducted in Tbilisi, Georgia. Participants A total of 64 key actors from the Ministry of Labour, Health and Social Affairs, staff of the Global Fund to Fight AIDS, TB and Malaria Georgia Project, the National Centre for Disease Control and Public Health, the National TB programme, TB service providers and members of the research team were involved in the workshops. Results Findings showed that beyond provider incentives, additional policy components were necessary. These included broadening the incentive package to include institutional and organisational incentives, retraining service providers, clear redistribution of roles to support an integrated care model, and refinement of monitoring tools. Health system elements, such as effective referral systems and health information systems were highlighted as necessary for service improvement. Conclusions Developing policies that address complex issues requires methods that facilitate linkages between multiple stakeholders and between theory and practice. Such participatory approaches can be informed by realist evaluation principles and visually facilitated by causal loop diagrams. This approach allowed us leverage stakeholders’ knowledge and expertise on TB service delivery and RBF to codesign a new policy

Background: Georgia has a high prevalence of hepatitis C, with 5·4% of adults chronically infected. On April 28, 2015, Georgia launched a national programme to eliminate hepatitis C by 2020 (90% reduction in prevalence) through scaled-up treatment and prevention interventions. We evaluated the interim effect of the programme and feasibility of achieving the elimination goal. Methods: We developed a transmission model to capture the hepatitis C epidemic in Georgia, calibrated to data from biobehavioural surveys of people who inject drugs (PWID; 1998-2015) and a national survey (2015). We projected the effect of the administration of direct-acting antiviral treatments until Feb 28, 2019, and the effect of continuing current treatment rates until the end of 2020. Effect was estimated in terms of the relative decrease in hepatitis C incidence, prevalence, and mortality relative to 2015 and of the deaths and infections averted compared with a counterfactual of no treatment over the study period. We also estimated treatment rates needed to reach Georgia's elimination target. Findings: From May 1, 2015, to Feb 28, 2019, 54 313 patients were treated, with approximately 1000 patients treated per month since mid 2017. Compared with 2015, our model projects that these treatments have reduced the prevalence of adult chronic hepatitis C by a median 37% (95% credible interval 30-44), the incidence of chronic hepatitis C by 37% (29-44), and chronic hepatitis C mortality by 14% (3-30) and have prevented 3516 (1842-6250) new infections and averted 252 (134-389) deaths related to chronic hepatitis C. Continuing treatment of 1000 patients per month is predicted to reduce prevalence by 51% (42-61) and incidence by 51% (40-62), by the end of 2020. To reach a 90% reduction by 2020, treatment rates must increase to 4144 (2963-5322) patients initiating treatment per month. Interpretation: Georgia's hepatitis C elimination programme has achieved substantial treatment scale-up, which has reduced the burden of chronic hepatitis C. However, the country is unlikely to meet its 2020 elimination target unless treatment scales up considerably. Funding: CDC Foundation, National Institute for Health Research, National Institutes of Health.

The public image of nursing is important because it can facilitate or create barriers to achieving an adequate supply of nursing human resources. This study sought to gain a better understanding of nursing’s professional image within the Republic of Georgia. The Nursing Human Resources Systems model was used to guide the study’s exploratory, qualitative approach. Data collection occurred over a 2‐week period in the Republic of Georgia, and thirty‐three participants formed the final study sample. Participants included healthcare professionals, key informants from nonprofit and research institutions, and patients. Data analysis occurred using directed content analysis techniques, and three themes emerged: (a) gender dimension; (b) the nursing service recipient experience; and (c) historical legacies. Themes revealed the complexities of nursing’s image in the country. Findings from this study serve as baseline data for understanding nursing’s image in the Republic of Georgia which could assist with improving pre‐entry nursing production issues.

The field of health policy and systems research (HPSR) has grown rapidly in the past decade. Examining recently aggregated data from the Global Symposia on Health Systems Research, a key global fora for HPSR convened by the largest international society-Health Systems Global (HSG)-provides opportunities to enhance existing research on HPSR capacity using novel analytical techniques. This addresses the demand not only to map the field but also to examine potential predictors of acceptance to, and participation at, these global conferences to inform future work and strategies in promoting HPSR. We examined data from the abstracts submitted for two Global Symposia on Health Systems Research in 2016 and 2018 by type of institution, countries, regional groupings and gender. After mapping hotspot areas for HPSR production, we then examined how the corresponding author's characteristics were associated with being accepted to present at the Global Symposia. Our findings showed that submissions for the Global Symposia increased by 12% from 2016 to 2018. Submissions increased across all participant groups, in particular, the for-profit organizations and research/consultancy firms showing the highest increases, at 58% for both. We also found reduced submissions from high-income countries, whereas submissions from low- and middle-income countries (LMICs), Sub-Saharan Africa and Latin America, increased substantially revealing the inclusivity values of Symposium organizers. Submissions increased to a larger extent among women than men. Being a woman, coming from a high-income country and having multiple abstracts submitted were found to be significant predictors for an abstract to be accepted and presented in the Symposia. Findings provide critical baseline information on the extent of interest and engagement in a global forum of various institutions and researchers in HPSR that can be useful for setting future directions of HSG and other similar organizations to support the advancement of HPSR worldwide.