Kiracho, E.E., Namuhani, N., Apolot, R.R. et al. (2020) Influence of community scorecards on maternal and newborn health service delivery and utilization, Int J Equity Health 19, 145, https://doi.org/10.1186/s12939-020-01184-6
The community score card (CSC) is a participatory monitoring and evaluation tool that has been employed to strengthen the mutual accountability of health system and community actors. In this paper we describe the influence of the CSC on selected maternal and newborn service delivery and utilization indicators.
Alonge O, Sonkarlay S, Gwaikolo W, Fahim C, Cooper JL and Peters DH (2019) Understanding the role of community resilience in addressing the Ebola virus disease epidemic in Liberia: a qualitative study (community resilience in Liberia), Global Health Action, 12:1, DOI: 10.1080/16549716.2019.1662682
There is an increasing recognition that community resilience plays a significant role in addressing health shocks like the Ebola virus disease (EVD) epidemic. However, the factors that constitute community resilience, and how these operate dynamically with other health system factors are less understood. This paper seeks to understand key factors that constitute community resilience and their role in responding to the EVD outbreak in Liberia.
The Afghanistan experience of nearly 15 years of contracting for health services has demonstrated both how results-based financing (RBF) can serve to increase utilisation of health services and the equity in use, as well as the limitations and failings of RBF approaches to work consistently.
Future Health Systems (FHS) findings, generated through robust experimental and quasi-experimental studies in a rapidly changing context, suggests that attention to scheme design (especially to address demand side concerns, supply side capabilities, and the size and mechanisms of payments) and implementation (timeliness and communication about payments) are critical.
Peters D (2018) Health policy and systems research: the future of the field, Health Research Policy and Systems, 16:84, DOI: 10.1186/s12961-018-0359-0
Health policy and systems research (HPSR) has changed considerably over the last 20 years, but its main purpose remains to inform and influence health policies and systems. Whereas goals that underpin health systems have endured – such as a focus on health equity – contexts and priorities change, research methods progress, and health organisations continue to learn and adapt, in part by using HPSR. For HPSR to remain relevant, its practitioners need to re-think how health systems are conceptualised, to keep up with rapid changes in how we diagnose and manage disease and use information, and consider factors affecting people’s health that go well beyond healthcare systems. The Sustainable Development Goals (SDGs) represent a shifting paradigm in human development by seeking convergence across sectors. They also offer an opportunity for HPSR to play a larger role, given its pioneering work on applying systems thinking to health, its focus on health equity, and the strength of its multi-disciplinary approaches that make it a good fit for the SDG era.
Kananura RM, Ekirapa-Kiracho E, Paina L, Bumba A, Mulekwa G, Nakiganda-Busiku D, Oo HNL, Kiwanuka SN, George A and Peters DH (2017) Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda, Health Research Policy and Systems, 15(Suppl 2):107, DOI: 10.1186/s12961-017-0274-9
The use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders’ decision-making in eastern Uganda.
Peters DH, Bhuiya A and Ghaffar A (2017) Engaging stakeholders in implementation research: lessons from the Future Health Systems Research Programme experience, Health Research Policy and Systems, 15(Suppl 2):104, DOI: 10.1186/s12961-017-0269-6
Implementation research and the engagement of stakeholders in such research have become increasingly prominent in finding ways to design, conduct, expand and sustain effective and equitable health policies, programmes and related interventions. How to bring together key sets of health systems stakeholders, including affected communities, health workers, health system managers, health policy-makers and researchers, as well as non-state and non-health sector actors, is a critical challenge. Stakeholder engagement plays important roles across intersecting research, policy and management processes, from selecting and defining the most relevant research questions to address policy and management concerns, to designing and conducting research, learning from and applying evidence, making changes to policy and programmes, and holding each other accountable. The articles in this supplement examine some of the tools and approaches used to facilitate stakeholder engagement in implementation research, and describe learning from the experience of the Future Health Systems (FHS) Research Programme Consortium.
In public health research, the focus has traditionally been on descriptive and analytic epidemiological research (“what”, “why”, “where,” and “who”). Less attention has been given, particularly in low-income countries, to “how” interventions do or do not work in the “real world”, given the involvement of different actors, the context in which implementation occurs, and the factors that influence implementation. Future Health Systems (FHS) has been at the forefront in the exploration, application and growth of implementation research (IR).
Glandon D, Paina L, Alonge O, Peters DH and Bennett S (2017) 10 Best resources for community engagement in implementation research, Health Policy and Planning, Volume 32, Issue 10, 1457–1465, doi: 10.1093/heapol/czx123
Implementation research (IR) focuses on understanding how and why interventions produce their effects in a given context. This often requires engaging a broad array of stakeholders at multiple levels of the health system. Whereas a variety of tools and approaches exist to facilitate stakeholder engagement at the national or institutional level, there is a substantial gap in the IR literature about how best to do this at the local or community level. Similarly, although there is extensive guidance on community engagement within the context of clinical trials—for HIV/AIDS in particular—the same cannot be said for IR. We identified a total of 59 resources by using a combination of online searches of the peer-reviewed and grey literature, as well as crowd-sourcing through the Health Systems Global platform. The authors then completed two rounds of rating the resources to identify the ‘10 best’.
Ekirapa-Kiracho E, Namazzi G, Tetui M, Mutebi A, Waiswa P, Oo H, Peters DH and George AS (2016) Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda, BMC Health Services Research, 16:1864, DOI: 10.1186/s12913-016-1864-x
Community capacities and resources must be harnessed to complement supply side initiatives addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda.
Paina L, Vadrevu L, Hanifi SMMA, Akuze J, Rieder R, Chan KS and Peters DH (2016) What is the role of community capabilities for maternal health? An exploration of community capabilities as determinants to institutional deliveries in Bangladesh, India, and Uganda, BMC Health Services Research, 16:1861, DOI: 10.1186/s12913-016-1861-0
While community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access to maternal health services has been underexplored. In this paper, we summarize the development of a community capability score based on the Future Health System (FHS) project’s experience in Bangladesh, India, and Uganda, and, examine the role of community capabilities as determinants of institutional delivery in these three contexts.
George AS, Scott K, Sarriot E, Kanjilal B and Peters DH (2016) Unlocking community capabilities across health systems in low- and middle-income countries: lessons learned from research and reflective practice, BMC Health Services Research, 16:1859, DOI: 10.1186/s12913-016-1859-7
The right and responsibility of communities to participate in health service delivery was enshrined in the 1978 Alma Ata declaration and continues to feature centrally in health systems debates today. Communities are a vital part of people-centred health systems and their engagement is critical to realizing the diverse health targets prioritised by the Sustainable Development Goals and the commitments made to Universal Health Coverage. Community members’ intimate knowledge of local needs and adaptive capacities are essential in constructively harnessing global transformations related to epidemiological and demographic transitions, urbanization, migration, technological innovation and climate change. Effective community partnerships and governance processes that underpin community capability also strengthen local resilience, enabling communities to better manage shocks, sustain gains, and advocate for their needs through linkages to authorities and services. This is particularly important given how power relations mark broader contexts of resource scarcity and concentration, struggles related to social liberties and other types of ongoing conflicts.
Nyenswah T, Engineer CY & Peters DH (2016) Leadership in Times of Crisis: The Example of Ebola Virus Disease in Liberia, Health Systems & Reform, 2:3, 194-207, DOI: 10.1080/23288604.2016.1222793
The Ebola epidemic of 2014–2015 was one of the most significant public health threats of the 21st century, a crisis that challenged leadership in West Africa and around the world. Using the experience of Liberia's epidemic control efforts, we highlight the critical role that leadership played during four phases of the epidemic response: (1) crisis recognition and early mobilization; (2) the emergency phase; (3) the declining epidemic; and (4) the long tail. We examine how the decisions and actions taken in each phase of the epidemic address key crisis leadership tasks, including sense-making, decision making, meaning-making, crisis termination, and learning, and assess how leadership approaches evolved during the different epidemic phases to accomplish these tasks.
Mirelman AJ, Rose S, Khan JAM, Ahmed S, Peters DH, Niessen LW, Trujillo AJ (2016) The relationship between non-communicable disease occurrence and poverty—evidence from demographic surveillance in Matlab, Bangladesh, Health Policy and Planning. 2016, 1-8, doi: 10.1093/heapol/czv134
In low-income countries, a growing proportion of the disease burden is attributable to non- communicable diseases (NCDs). There is little knowledge, however, of their impact on wealth, human capital, economic growth or household poverty. This article estimates the risk of being poor after an NCD death in the rural, low-income area of Matlab, Bangladesh.
Engineer C, Dale E, Agarwal A, Agarwal A, Alonge O, Edward A, Gupta S, Schuh H, Burnham G, Peters DH (2016) Effectiveness of a pay for performance intervention to improve maternal and child health services in Afghanistan: A cluster-randomized trial, International Journal of Epidemiology, doi: 10.1093/ije/dyv362
A cluster randomized trial of a pay-for-performance (P4P) scheme was implemented in Afghanistan to test whether P4P could improve maternal and child (MCH) services. The authors found that the intervention had minimal effect, possibly due to difficulties communicating with health workers and inattention to demand-side factors. P4P interventions need to consider management and community demand issues.
Tappis H, Koblinsky M, Doocy S, Warren N, Peters DH (2016) Bypassing primary care facilities for childbirth: findings from a multilevel analysis of skilled birth attendance determinants in Afghanistan, Journal of Midwifery and Women’s Health, Volume 61, Issue 2, pages 185–195, DOI: 10.1111/jmwh.12359
The objective of this study was to assess the association between health facility characteristics and other individual/household factors with a woman's likelihood of skilled birth attendance in north-central Afghanistan. The study finds that assumptions that women who give birth with a skilled attendant do so at the closest health facility may mask the importance of supply-side determinants of skilled birth attendance. More research based on actual utilization patterns, not assumed catchment areas, is needed to truly understand the factors influencing care-seeking decisions in both emergency and nonemergency situations and to adapt strategies to reduce preventable mortality and morbidity in Afghanistan.
Khan JAM, Trujillo AJ, Ahmed S, Siddiquee AT, Alam N, Mirelman AJ, Koehlmoos TP, Niessen LW and Peters DH (2015) Distribution of chronic disease mortality and deterioration in household socioeconomic status in rural Bangladesh - an analysis over a 24 year period, International Journal of Epidemiology, 44 (6), 1917-1926, doi: 10.1093/ije/dyv197
Little is known about long-term changes linking chronic diseases and poverty in low-income countries such as Bangladesh. This study examines how chronic disease mortality rates change across socioeconomic groups over time in Bangladesh, and whether such mortality is associated with households falling into poverty.
Alonge O, Peters DH, (2015) Utility and limitations of measures of health inequities: a theoretical perspective, Global Health Action, 8: 27591 - http://dx.doi.org/10.3402/gha.v8.27591
This paper examines common approaches for quantifying health inequities and assesses the extent to which they incorporate key theories necessary for explicating the definition of health inequity. The first theoretical analysis examined the distinction between inter-individual and inter-group health inequalities as measures of health inequities. The second analysis considered the notion of fairness in health inequalities from different philosophical perspectives.
Alonge O, Gupta S, Engineer C, Salehi AS, Peters DH, (2015) Assessing the pro-poor effect of different contracting schemes for health services on health facilities in rural Afghanistan, Health Policy & Plannning, 30 (10): 1229-1242, doi: 10.1093/heapol/czu127
Despite progress in improving health outcomes in Afghanistan by contracting public health services through non-governmental organizations (NGOs), inequity in access persists between the poor and non-poor. This study examined the distributive effect of different contracting types on primary health services provision between the poor and non-poor in rural Afghanistan.
Bennett S and Peters D, (2015) Assessing National Health Systems: Why and How, Health Systems & Reform 1(1):9-17, DOI:10.1080/23288604.2014.997107
In reviewing national health systems assessments (HSAs), the authors identify four primary rationales for doing HSAs: (i) to motivate health systems reform, (ii) to promote harmonization and alignment across actors in the health system, (iii) to help translate health systems reforms into meaningful ways to track performance, and (iv) to facilitate learning through cross-country comparisons. The authors propose a set of principles to guide HSAs.
Hafizur Rahman, M, Agarwal, S, Tuddenham, S, Iqbal, M, Bhuiya, A, and Peters, DH (2014) What do they do? Interactions between village doctors and medical representatives in Chakaria, Bangladesh International Health doi:10.1093/inthealth/ihu077
Informally trained village doctors supply the majority of health care services to the rural poor in many developing countries. This study describes the demographic and socioeconomic differences between medical representatives, hired by pharmaceutical companies to provide their products to health providers, and village doctors in rural Bangladesh, and explores the nature of their interactions. The research team used focus group discussions, in-depth interviews, and a quantitative survey to understand practice perceptions. They found that medical representatives have a higher average per capita monthly expenditure compared to village doctors, and that the former are better educated with 98% having bachelor's degrees whereas 84% of village doctors have twelfth grade education or less. Medical representatives are the principal information source about new medications for the village doctors. Furthermore, incentives offered by medical representatives and credit availability might influence the prescription practices of village doctors. Findings suggests that improvements in the quality of health care delivered to the rural poor in informal provider-based health markets require stricter regulations and educational initiatives for providers and medical representatives.