Policy-makers, entrepreneurs, academics and funders convened at the Rockefeller Foundation Bellagio Center from 10th-14th December 2012 to discuss the changing face of health markets, and in particular to consider future trends in such markets. Their aim was to promote a greater shared understanding and analysis of health market systems, and to consider how markets can better serve the needs of the poor in low- and middle-income countries (LMICs). This report is an attempt to capture the rich discussions held during the meeting, which reviewed the evolution of health markets, identified key drivers of and gaps resulting from their rapid development, and highlighted critical issues that must be tackled to ensure the poorest have access to safe, affordable, effective and equitable health services. The report concludes with recommendations for shaping future health markets as agreed during the meeting.
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Sector-wide approaches (SWAps) in health were developed in the early 1990s in response to widespread dissatisfaction with fragmented donor-sponsored projects and prescriptive adjustment lending. SWAps were intended to provide a more coherent way to articulate and manage government-led sectoral policies and expenditure frameworks and build local institutional capacity as well as offer a means to more effective relationships between governments and donor agencies. The global health landscape has changed dramatically since then. Although many countries have undertaken SWAps, the experience deviated considerably from the early vision, and many of the problems in national health systems persist. The future of SWAps will depend on stronger government oversight and innovative institutional arrangements to support health strategies that address the need for both targeted initiatives and stronger health systems to provide a wide range of public health and clinical services. For development assistance to be more effective, it will also depend on better discipline by donors to support national governments through transparent negotiation.
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这四页的文档介绍了未来卫生体系(FHS)。FHS是顶尖科研机构协力开展的一个伙伴项目，项目地点包括低收入（孟加拉国、乌干达）、中等收入（中国、印度）和脆弱国家（阿富汗），旨在加强卫生体系的适应力。章节包括：我们核心研究主题, 我们开展工作的地区, 我们开展工作的方式, 谁参与项目, 新的跨领域主题, 学习平台, 近期主要出版物.
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This four-page document outlines the research activities of the Future Health Systems research consortium. It outlines the core research themes, where we work, how we work, who is inolved, emerging cross-cutting themes, and highlights some key publications.
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Childhood chronic under-nutrition and common childhood illness are highly prevalent in the delta region of the Sundarbans of West Bengal, India. The present work tested the hypothesis—frequent climatic shock is likely to predispose chronic and transient health shocks through behavioural responses of households in the presence of inaccessibility, inadequacy and acceptability barriers which act in the economy as long wave shocks. The work is based on a household and facility survey; primary data was collected in 19 blocks of the Sundarbans. The results highlight that transient climatic shock make child health worse through the pathway of chronic poverty, low resilience, physical and social barriers to health-seeking as well as ineffective service delivery systems. Further in-depth research is required to understand multiple vulnerabilities, related to coping of households and ways to improve the service delivery mechanism to have healthy children in the Sundarbans in the near future.
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Although health interventions start with good intentions to develop services for disadvantaged populations, they often distort the health market, making the delivery or financing of services difficult once the intervention is over: a condition called the ‘Develop-Distort Dilemma’ (DDD). In this paper, we describe how to examine whether a proposed intervention may develop or distort the health market. Our goal is to produce a tool that facilitates meaningful and systematic dialogue for practitioners and researchers to ensure that well-intentioned health interventions lead to productive health systems while reducing the undesirable distortions of such efforts.
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This is a film about the Safe Deliveries study project of the Makerere University School of Public Health which was conducted in the eastern Uganda districts of Kamuli, Buyende, Pallisa and Kibuku. The project sought to increase skilled deliveries through an intervention that comprised both demand (vouchers for transport and maternal services) and supply side initiatives (training health workers and provision of essential equipment, drugs and supplies). Although final analysis of data is still ongoing initial outcomes of the study which wound up at the end of 2011 showed increased community awareness about benefits of delivering in health facilities, and phenomenal increases in facility births, with an average of 1336 deliveries per month in the intervention area compared to an average of 461 deliveries per month in the control area (June 2010 -- June 2011, Facility records).
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In recent years, there have been several calls for rigorous health policy and systems research to inform efforts to strengthen health systems (HS) in low- and middle-income countries (LMICs), including the use of systems thinking concepts in designing and evaluating HS strengthening interventions. The objectives of this paper are to assess recentevaluations of HS strengthening interventions to examine the extent to which they ask a broader set of questions, and provide an appropriately comprehensive assessment of the effects of these interventions across the health system.
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There has been a dramatic spread of health markets in much of Asia and Africa over the past couple of decades. This has substantially increased the availability of health-related goods and services in all but the most remote localities, but it has created problems with safety, efficiency and cost. The effort to bring order to these chaotic markets is almost certain to become one of the greatest challenges in global health. This book documents the problems associated with unregulated health markets and presents innovative approaches that have emerged to address them. It outlines a framework that researchers, policy makers and social entrepreneurs can use to analyse health market systems and assess the likely outcome of alternative interventions. The book presents a new way of understanding highly marketised health systems, applies this understanding to an analysis of health markets in countries across Asia and Africa and identifies some of the major new developments for making these markets perform better in meeting the needs of the poor. It argues that it is time to move beyond ideological debates about the roles of public and private sectors in an ideal health system and focus more on understanding the operation of these markets and developing practical strategies for improving their performance. This book is ideal reading for researchers and students in public health, development studies, public policy and administration, health economics, medical anthropology, and science and technology studies. It is also a valuable resource for policy makers, social entrepreneurs, and planners and managers in public and private sector health systems, including pharmaceutical companies, aid agencies, NGOs and international organisations.
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Over the past few decades, there has been increasing attention focused on the ethics of health research, particularly in low- and middle-income countries. Despite the increasing focus on the literature addressing human protection, community engagement, appropriate consent procedures and ways to mitigate concerns around exploitation, there has been little discussion about how the duration of the research engagement may affect the ethical design and implementation of studies. In other words, what are the unique ethical challenges when researchers engage with host communities for longer periods (10 years or more), and what special considerations does this time commitment generate when applying ethical principles to these kinds of studies? This article begins to outline key areas of ethical concern that arise during long-term, sustained research activities with communities in low-resource settings. Through a review of the literature and consultations with experts in health systems, we identified the following key themes: fair benefits and long-term beneficence; community autonomy, consultation and consent; impacts on local health systems; economic impacts of research participation; ethical review processes; and institutional processes and oversight within research organizations. We hope that this preliminary exploration will stimulate further dialogue and help inform ethical guidance around long-term research engagements in the developing world.
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Dr David Bishai gives an introduction complex adaptive systems and their application to health systems modelling and strengthening.
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In this commentary in Nature, the authors argue that the rapid expansion of health markets in Asia and Africa has made medicines, information and primary-care services available in all but the most remote areas. But it also creates problems with drug safety and efficiency, equity of treatment and the cost of care. Poorly trained practitioners often prescribe unnecessary pills or injections, with patients bearing the expense and the costs to their health. Counterfeit drugs are rife and drug resistance is growing. Bringing order to unruly health markets is a major challenge.
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Previous work from ICDDR,B established village doctors as an important player Bangladesh’s healthcare system, as they are often the first port of call for the rural poor. Considering this importance and the huge shortfall of formally trained health workforce in the country, there is a clear need to improve the quality of the services offered by these semi-trained village doctors.
In response, a team of ICDDR,B researchers tested a package of interventions, which included training of the village doctors, establishing a community watch for improved accountability and establishing branded franchise of better trained village doctors.
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The three-paper series on guidance for evidence-informed decisions about health systems, published in PLoS Medicine, and produced by members of the World Health Organization (WHO) Task Force on Developing Health Systems Guidance, offers important contributions to improving the quality of evidence-informed decision-making in health systems [1]–[3]. We recognize the importance of engendering greater structure and systematization in processes that collate and evaluate evidence, and bring it to bear on policy. However, there are significant challenges in doing this for policies related to health systems, and we caution against the adoption of rigid approaches to the development of guidance and to the application of evidence to policy.
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In this short video, Jeff Knezovich, the Policy Influence and Research Uptake (PIRU) Manager for FHS, talks about getting development research into use and the importance of understanding the policy landscape around your research area. He outlines a simple approach that PIRU officers in each of the FHS countries undertook to develop our engagement strategies.
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