The poor health of those living in informal settlements across Freetown is a direct consequence of their living conditions, but often in locally specific ways. This is further exacerbated by unequal access to healthcare, meaning such communities face a double burden on their health due to the environmental conditions in which they live. This blog post highlights some of the findings of a research study, led by SLURC in collaboration with Future Health Systems, seeking to explore relationships between living conditions in informal settlements and common health problems, and to explore whether the socioeconomic backgrounds of people living in informal settlements affect their access to health care services.
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Worldwide, 830 women die daily from preventable causes related to pregnancy and childbirth, and unfortunately one fifth of these women reside in India (UNICEF). Maternal death accounts for highest share of Disability-Adjusted Life Year (DALY) and is more prevalent in rural areas as compared to urban ones. This is demonstrated in areas such as the Sundarbans, where geographically inaccessible terrain makes maternal health service delivery challenging. In the near absence of formal delivery care at the grassroots level, Community Delivery Centers (CDCs) bring basic obstetric care to the doorsteps of hard-to-reach regions of Indian Sundarbans.
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At the upcoming Global Symposium on Health Systems Research, we will be running a participatory session that builds on research from Uganda, Bangladesh and Nepal, entitled Amplifying Marginalised Voices: Towards Meaningful Inclusion in Social Accountability Mechanisms for Health. This session applies an intersectional lens to accountability mechanisms, asking about the inclusion of specific, marginalised categories within communities in mainstream accountability initiatives.
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Projections about urbanization are staggering: 55% of the world’s population already live in urban areas, and by 2050 this is predicted to rise to 68% with almost 90% of the growth happening in Asia and Africa. The implications for health are huge, as is the learning agenda for health systems research.
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If you watch soccer, you will agree with me that just like a football team working together to set up the perfect shot at goal, every team member has a specific role to play in accomplishing tasks on an initiative that requires joint effort. While it may look like one player scored the goal, that score was made possible by on and off pitch team members’ planning, coordination, and cooperation to get that scorer the ball.
That is what we have observed with the different stakeholders as we implement a study that is testing a community and facility score card for maternal and newborn health service delivery in Kibuku District in Eastern Uganda.
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Sehwah Sonkarlay, LiCORMH, Liberia, and Future Health Systems, writes about reflections by key actors on Liberia’s experience in identifying and building resilience at the community level in the context of the recent Ebola epidemic, combined with its post-war and unique sociopolitical history.
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Moses Tetui, FHS Researcher, writes for New Vision about the FHS Community Score Card Project being undertaken in eastern Uganda by Makerere University School of Public Health to improve maternal health.
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For World Health Day 2018, Elizabeth Ekirapa-Kiracho, Makerere University School of Public Health, Uganda, calls on Africans to hold their politicians accountable for meeting the health care needs of their people, and delivering on the commitments they made in the Abuja Declaration 17 years ago.
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Stefan Peterson, Chief of Health, UNICEF, highlights the contribution of a maternal and newborn health implementation project in Uganda led by Future Health Systems partner, the Makerere School of Public Health, to improvements in early antenatel care attendance, facility deliveries, newborn care practices, birth preparedness, and awareness of obstetric danger signs.
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In 1895, poet Joseph Malins described an ill-starred town shadowed by a cliff. Citizens would regularly tumble off the cliff, so the town mercifully pays for a public ambulance. The poet berates the town for not building a fence at the rim of the cliff. As the G20 come together this July in Hamburg, they should take heed and learn the lessons from this fenceless town. Addressing global health security challenges like pandemics and resistance to antibiotics requires not just an ambulance, but a fence too.
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“Scaling up” is considered as a pertinent and scientific pathway recognized by academia and policy makers to reduce inequalities, to achieve the Sustainable Development Goals (SDGs), and for universal health coverage. To build upon and learn from the longstanding partnership between Bangladesh Rural Advancement Committee (BRAC), International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B), and the Institute of Development Studies (IDS), a two day conference was held on 7 -8 February in Dhaka, Bangladesh to share diverse perspectives, pathways and learnings from contextual settings to achieve successful scaling up of interventions and collaborations. The conference, in addition to throwing light on the pathways of scaling up of programs through our learnings, also acted as a potential accelerator for collaboration. This blog post shares five critical reflections from the conference mentioned below.
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How sustainable is your intervention? If someone wanted to replicate it, how easy would it be? What happens when the study ends? Will the communities be able to continue with this initiative after the implementers have gone? Ayub Kakaire, FHS PIRU Officer for Uganda, blogs about what working on the Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study has taught him about how to ensure an intervention is sustainable.
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Health system and policy researchers and practitioners, civil society, academia and policy makers from around the world will gather in Vancouver, Canada for the Fourth Global Symposium on Health Systems Research (#HSR2016). The build-up to this biennial conference shows that there is considerable excitement and debate on this year’s symposium theme – Resilient and Responsive Health Systems for a changing world. Can we think of a resilient health system without it being people-centred? The answer is most certainly no.
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In April 2016, FHS IIHMR presented their research on ‘Climate, Society and Health - Research to policy’ at a workshop in Bangalore, India examining complexities, at both the macro and micro level, of ensuring that climate health research informs polity. The workshop - which was attended by academics, post graduate students and civil society members with thematic expertise in agriculture, climate, food security and child rights - was being conducted to mark the silver jubilee celebrations of SOCHARA - an NGO committed to a community health approach to addressing public health problems.
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In this blog, Annie Wilkinson, of IDS and Future Health Systems, shares her reflections from the MAGic 2015 conference, where contributions highlighted game-changing local efforts and innovations which have been central to turning the Ebola epidemic around.
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Deciding to seek care from a skilled health worker by a woman at the time of delivery is highly encouraged in order to improve health outcomes for both mother and baby. When a woman delivers under skilled care, it is easier to detect and attend to any emergences that arise.
Under the community mobilisation and sensitisation component of the study, around 1,691 community health workers (CHWs, also known as village health teams or VHTs), were trained across the three study districts of Kamuli, Pallisa and Kibuku. The training focused on early detection of emergencies, birth preparedness and care for mothers who just delivered and their newborns. During the visits, CHWs provide households with information needed to ensure mothers have a safe delivery and remain healthy with their babies. Two home visits happen during pregnancy and two after delivery.
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Having knowledge of obstetric danger signs and embracing good birth preparedness practices could enhance maternal and newborn health outcomes. Through the use of communications and media advocacy, the intervention study is tackling social and cultural issues that affect maternal and newborn health negatively. We are using village-level dialogues (once every three months) and radio talk shows (monthly) as well as spot messages (daily).
During the dialogues, women and men shared sad memories of maternal and newborn illness and death, underlining the grim reality of the situation. They also discussed good and bad practices and made commitments to abandon negative practices and therefore improve maternal and newborn health. “I resolve to stop putting cow dung and other dangerous things on the cord of newborns. After today’s talk I realise why my baby’s cord took that long to heal. I urge fellow women to join a new me,” said Ms Nabirye at a dialogue in Kamuli to thunderous applause from fellow women. Monitoring data shows that, while only 17 per cent of sampled women who had just given birth treated cords with nothing but the appropriate saline water in mid-2013, that percentage had shot to 56% in mid-2014.
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