The overarching aim of this paper is to address the issue of building resilient health systems in the context of the Ebola outbreak in West Africa which has brought renewed attention to this challenge. The paper highlights insight gained from two decades work creating resilient health systems in Nigeria—in Northern Nigeria in particular. In highlighting how the “simple” basics of outbreak control tie into larger, complex adaptive systems, this paper summarises key learning from the Nigerian experience as a basis for suggesting both how such outbreaks can be averted in the future and how sustainable development goals around eliminating excess mortality and improving health equity can be realised in practice.
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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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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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Dr Gerry Bloom from the Institute of Development studies presents to the M4P (Markets for the Poor) Conference in Brighton, UK, on 8 November 2011.
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Dr Gerry Bloom from the Institute of Development studies presents to the M4P (Markets for the Poor) Conference in Brighton, UK, on 8 November 2011.
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Oladimeji Oladepo from the University of Ibadan in Nigeria discusses findings from recent FHS research on the role of patent medicine vendors in the informal market for anti-malarials in Nigeria.
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There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria.
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A recent study in Nigeria by the Future Heath Systems (FHS) consortium identified patent medicine vendors (PMV) associations as having potential important roles to play in providing information, influencing PMV behaviour and procuring drugs, but the government knows very little about PMVs or their associations. As a way of bridging this gap, a team from the University of Ibadan undertook an exploratory study among the officers of Patent Medicine Vendors Association (PMVA) in Oyo State, Nigeria at the state, zonal and local government area (LGA) levels to explore the organizational and regulatory practices of the association in relation to the management of malaria, using an exploratory research design.
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A team from Ibadan University undertook a scoping study in 12 local government areas (LGAs) in three states to explore the malaria treatment market and the role of PMVs, and to look at ways to improve malaria treatment.
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Future Health Systems: Innovations for Equity (FHS) is working in six partner countries in Asia and Africa, focusing on strengthening the research–policy interface in relation to specific health system research projects. These projects present an opportunity to study the influence of stakeholders on research and policy processes.
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Three key activities were undertaken by FHS during the initial phase of this five-year project. First, key considerations in strengthening evidence-policy linkages in health system research were developed by FHS researchers through workshops and electronic communications. Four key considerations in strengthening evidence-policy linkages are postulated: development context; research characteristics; decision-making processes; and stakeholder engagement. Second, these four considerations were applied to research proposals in each of the six countries to highlight features in the research plans that potentially strengthen the research-policy interface and opportunities for improvement. Finally, the utility of the approach for setting research priorities in health policy and systems research was reflected upon.
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This study seeks to better understand the role played by PMVs in the provision of AMDs in Nigeria, and to explore ways to improve the regulation and delivery of AMDs.
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If health services are to benefit the poor, it is essential to gain a detailed understanding of such markets that can both inform attitudes towards them and guide innovations that attempt to engage with them to improve health outcomes.
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