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Publications

Filtering by Category: Community

Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services

Future Health Systems

Mutebi A, Kananura RM, Ekirapa-Kiracho E, Bua J, Kiwanuka SN, Nammazi G, Paina L and Tetui M (2017) Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services, Global Health Action, 10:sup4, 1347363, DOI: 10.1080/16549716.2017.1347363

Rural populations in Uganda have limited access to formal financial Institutions, but a growing majority belong to saving groups. These saving groups could have the potential to improve household income and access to health services. This article aimed to understand organizational characteristics, benefits and challenges, of savings groups in rural Uganda.

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Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda

Future Health Systems

Namazzi G, Okuga M, Tetui M, Kananura RM, Kakaire A, Namutamba S, Mutebi A,  Kiwanuka SN, Ekirapa-Kiracho E and Waiswa P (2017) Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda, Global Health Action, 10:sup4, 1345495, DOI: 10.1080/16549716.2017.1345495

Preventable maternal and newborn deaths can be averted through simple evidence-based interventions, such as the use of community health workers (CHWs), also known in Uganda as village health teams. However, the CHW strategy faces implementation challenges regarding training packages, supervision, and motivation. This paper explores knowledge levels of CHWs, describes the coverage of home visits, and shares lessons learnt from setting up and implementing the CHW strategy.

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How can health systems research reach the worst-off? A conceptual exploration

Future Health Systems

Pratt B and Hyder AA (2016) How can health systems research reach the worst-off? A conceptual exploration, BMC Health Services Research 16:1868, DOI: 10.1186/s12913-016-1868-6

Health systems research is increasingly being conducted in low and middle-income countries (LMICs). Such research should aim to reduce health disparities between and within countries as a matter of global justice. For such research to do so, ethical guidance that is consistent with egalitarian theories of social justice proposes it ought to (amongst other things) focus on worst-off countries and research populations. Yet who constitutes the worst-off is not well-defined.

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Expressing collective voices on children’s health: photovoice exploration with mothers of young children from the Indian Sundarbans

Future Health Systems

Ghosh U, Bose S, Bramhachari R and Mandal S (2016) Expressing collective voices on children’s health: photovoice exploration with mothers of young children from the Indian Sundarbans, BMC Health Services Research, 16:1866, DOI: 10.1186/s12913-016-1866-8

The Indian Sundarbans is marked by inhospitable terrain and frequent climatic shocks which jointly hinder access to health care. Community members, and women in particular, have few means to communicate their concerns to local decision makers. Photovoice is one way in which communities can raise their local health challenges with decision makers. This study unlocks mothers’ voices on the determinants of their children’s health to inform local level decision-making on child health issues in the Indian Sundarbans.

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Unlocking community capability through promotion of self-help for health: experience from Chakaria, Bangladesh

Future Health Systems

Bhuiya A, Hanifi SMA and Hoque S (2016) Unlocking community capability through promotion of self-help for health: experience from Chakaria, Bangladesh, BMC Health Services Research, 16:1865, DOI: 10.1186/s12913-016-1865-9

People’s participation in health, enshrined in the 1978 Alma Ata declaration, seeks to tap into community capability for better health and empowerment. One mechanism to promote participation in health is through participatory action research (PAR) methods. Beginning in 1994, the Bangladeshi research organization ICDDR,B implemented a project “self-help for health,” to work with existing rural self-help organizations (SHOs). SHOs are organizations formed by villagers for their well-being through their own initiatives without external material help. This paper describes the project’s implementation, impact, and reflective learnings.

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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

Future Health Systems

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.

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Identifying community healthcare supports for the elderly and the factors affecting their aging care model preference: evidence from three districts of Beijing

Future Health Systems

Liu T, Hao X and Zhang Z (2016) Identifying community healthcare supports for the elderly and the factors affecting their aging care model preference: evidence from three districts of Beijing, BMC Health Services Research, 16:1863, DOI: 10.1186/s12913-016-1863-y

The Chinese tradition of filial piety, which prioritized family-based care for the elderly, is transitioning and elders can no longer necessarily rely on their children. The purpose of this study was to identify community support for the elderly, and analyze the factors that affect which model of old-age care elderly people dwelling in communities prefer.

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How is perceived community cohesion and membership in community groups associated with children’s dietary adequacy in disadvantaged communities? A case of the Indian Sundarbans

Future Health Systems

Barman D and Vadrevu L (2016) How is perceived community cohesion and membership in community groups associated with children’s dietary adequacy in disadvantaged communities? A case of the Indian Sundarbans, BMC Health Services Research, 16:1862, DOI: 10.1186/s12913-016-1862-z

Membership in community groups and a sense of community cohesion may facilitate collective action in mobilizing resources towards better health outcomes. This paper explores the relationship of these factors, along with individual level socio-economic variables, to dietary adequacy among children below 6 years of age, a proximate determinant of child malnutrition.

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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

Future Health Systems

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.

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Unlocking community capabilities across health systems in low- and middle-income countries: lessons learned from research and reflective practice

Future Health Systems

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.

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Saving money, saving lives: community saving groups lead to improvements in maternal and newborn health care in Uganda

Future Health Systems

Future Health Systems (FHS) work on maternal and newborn health in the poorest districts of eastern Uganda has contributed to a story of community empowerment where people have learnt to prioritise, prepare and save money for childbirth. This increases the likelihood of delivery in a health facility, and therefore the chances of a healthy pregnancy and safe childbirth under skilled care.

Through the lens: empowering women in vulnerable communities to voice their concerns

Future Health Systems

Participatory Action Research (PAR) methodologies can help empower marginalised groups to capture and articulate their experiences and concerns to decision-makers. Future Health Systems (FHS) has worked with women in the Sundarbans of West Bengal to use Photovoice – a PAR method using photographs and narrative – to raise awareness of the challenges the women face to access health care. The initiative has led local policymakers and health workers to prioritise, and take steps to address, the issues.

Enhancing social accountability for health care in Afghanistan

Future Health Systems

In the United States and parts of Africa and Asia, community scorecards (CSCs) have improved accountability and responsiveness of services. Work supported by Future Health Systems (FHS) sought to evaluate CSC feasibility in a fragile context (Afghanistan) through joint engagement of service providers and community members in the design of patient-centred services, to assess impact on service delivery and perceived quality of care.

FHS India Research Brief 9 - Voices from the ground: Photovoice research on children’s health in the Indian Sundarbans

Future Health Systems

The objective of this brief is to introduce the Photovoice method, highlight how it helped capture the voices of mothers in the Sundarbans, and demonstrate how the method can bridge the gap between communities and local decision-makers. 

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FHS Key Message Brief 3: Unlocking community capability: key to more responsive, resilient and equitable health systems

Future Health Systems

In Future Health Systems, we focused on communities as active service delivery participants across a wide variety of contexts. In this brief, we reflect on the process of unlocking community capabilities, the key actors involved, and the productive tensions within community partnerships forged to build more responsive, resilient and equitable health systems.

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Supporting youth and community capacity through photovoice: Reflections on participatory research on maternal health in Wakiso district, Uganda

Future Health Systems

Musoke, D; Ndejjo, R; Ekirapa-Kiracho, E and George, AS (2016) Supporting youth and community capacity through photovoice: Reflections on participatory research on maternal health in Wakiso district, Uganda, Global Public Health, DOI:10.1080/17441692.2016.1168864

This paper reflects on the experiences of using photovoice to examine maternal health in Wakiso district, Uganda. The project involved 10 youth aged 18–29 years old, who were diverse in education, occupation, and marital status and identified by community leaders with researchers. By taking photos and sharing images and experiences in monthly meetings over five months, youth reported becoming more knowledgeable. They realised that they had common experiences but also reflected on and reinterpreted their circumstances.

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Community Participation in Health Systems Research: A Systematic Review

Future Health Systems

George AS, Mehra V, Scott K, Sriram V (2015) Community Participation in Health Systems Research: A Systematic Review Assessing the State of Research, the Nature of Interventions Involved and the Features of Engagement with Communities. PLoS ONE 10(10): e0141091. doi:10.1371/journal.pone.0141091

Community participation is a major principle of people centered health systems, with considerable research highlighting its intrinsic value and strategic importance. Existing reviews largely focus on the effectiveness of community participation with less attention to how community participation is supported in health systems intervention research.

This systematic review explores the extent, nature and quality of community participation in health systems intervention research in low- and middle-income countries.

It concludes that despite positive examples, community participation in health systems interventions was variable, with few being truly community directed. Future research should more thoroughly engage with community participation theory, recognize the power relations inherent in community participation, and be more realistic as to how much communities can participate and cognisant of who decides that.

Using photovoice to examine community level barriers affecting maternal health in rural Wakiso district, Uganda

Future Health Systems

Musoke D., Ekirapa-Kiracho E., Ndejjo R. and George A. (2015) Using photovoice to examine community level barriers affecting maternal health in rural Wakiso district, Uganda, Reproductive Health Matters, 23(45):136-47, doi: 10.1016/j.rhm.2015.06.011

Uganda continues to have poor maternal health indicators including a high maternal mortality ratio. This paper explores community level barriers affecting maternal health in rural Wakiso district, Uganda. Using photovoice, a community-based participatory research approach, over a five-month period, ten young community members aged 18-29 years took photographs and analysed them, developing an understanding of the emerging issues and engaging in community dialogue on them. Photovoice's strength is in generating evidence by community members in ways that articulate their perspectives, support local action and allow direct communication with stakeholders.

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