The health system of Bangladesh is haunted by challenges of accessibility and affordability. Despite impressive gains in many health indicators, recent evidence has raised concerns regarding the utilization, quality and equity of healthcare. In the context of new and unfamiliar public health challenges including high population density and rapid urbanization, eHealth and mHealth are being promoted as a route to cost-effective, equitable and quality healthcare in Bangladesh. The aim of this paper is to highlight such initiatives and understand their true potential.
Read More
Local health systems research (HSR) provides policymakers and practitioners with contextual, evidence-based solutions to health problems. However, producers and users of HSR rarely understand the complexities of the context within which each operates, leading to the "know-do" gap. Universities are well placed to conduct knowledge translation (KT) integrating research production with uptake. The HEALTH Alliance Africa Hub, a consortium of seven schools of public health (SPHs) in East and Central Africa, was formed to build capacity in HSR. This paper presents information on the capacity of the various SPHs to conduct KT activities.
Read More
Despite significant investments in health systems research (HSR) capacity development, there is a dearth of information regarding how to assess HSR capacity. An alliance of schools of public health (SPHs) in East and Central Africa developed a tool for the self-assessment of HSR capacity with the aim of producing institutional capacity development plans.
Read More
The role of health systems research (HSR) in informing and guiding national programs and policies has been increasingly recognized. Yet, many universities in sub-Saharan African countries have relatively limited capacity to teach HSR. Seven schools of public health (SPHs) in East and Central Africa undertook an HSR institutional capacity assessment, which included a review of current HSR teaching programs. This study determines the extent to which SPHs are engaged in teaching HSR-relevant courses and assessing their capacities to effectively design and implement HSR curricula whose graduates are equipped to address HSR needs while helping to strengthen public health policy.
Read More
Despite its importance in providing evidence for health-related policy and decision-making, an insufficient amount of health systems research (HSR) is conducted in low-income countries (LICs). Schools of public health (SPHs) are key stakeholders in HSR. This paper, one in a series of four, examines human and financial resources capacities, policies and organizational support for HSR in seven Africa Hub SPHs in East and Central Africa.
Read More
Many low and middle-income countries have pluralistic health systems with a variety of providers of health-related goods and services in terms of their level of training, their ownership (public or private) and their relationship with the regulatory system. The development of institutional arrangements to influence their performance has lagged behind the spread of these markets. This paper presents a framework for analysing a pluralistic health system.
Read More
Health policy and systems research (HPSR) is a transdisciplinary field of global importance, with its own emerging standards for creating, evaluating, and utilizing knowledge, and distinguished by a particular orientation towards influencing policy and wider action to strengthen health systems. In this commentary, we argue that the ability of the HPSR field to influence real world change hinges on its becoming more people-centred. We see people-centredness as recognizing the field of enquiry as one of social construction, requiring those conducting HPSR to locate their own position in the system, and conduct and publish research in a manner that foregrounds human agency attributes and values, and is acutely attentive to policy context.
Read More
There is growing enthusiasm amongst analysts of global health for the possibilities opened up by the rapid spread of mobile phone coverage. This includes substantially increasing access to health-related information and advice and to expert medical consultations.This report presents a snapshot of how information and communication technologies (ICTs) are influencing health system development in Bangladesh.
Read More
The goal of Future Health Systems (FHS) is to improve access, affordability and quality of health services for the poor. In order to build resilient health systems for the future, we generate high quality scientific knowledge about how health systems can better deliver basic health services to the world’s poor. FHS supports its country research teams to identify and respond to health system challenges identified by local stakeholders. This annual report from the period 2012-13 captures our ongoing research, research uptake, and capacity building activities.
Read More
Bangladesh has a serious shortage of physicians, paramedics, nurses, and midwives. The available qualified care providers are centred in urban areas, resulting in an inequitable access of the rural and disadvantaged sections of the population to healthcare. Under these circumstances, the use of mHealth meaning provision of healthcare services through mobile devices provides a new opportunity to ensure access to quality healthcare services for the population in general, and for people from poorer sections and hard-to-reach areas in particular. There are currently around 20 mHealth service initiatives in the country which are mostly telephone hotlines for consulting physicians and/or obtaining healthcare information. Effectiveness of these services depends on the evidence-informed development of appropriate programmes designed around people’s perceptions of mHealth and user feedback. To that end, FHS Bangladesh partner, ICDDR,B recently conducted a survey on mHealth in Chakaria, a rural area in the southeast coastal area of Bangladesh. This brief presents the findings from this survey.
Read More
The emergence of a research culture in Bangladesh promoting rigorous research, developing interventions, and translating evidence into policies made a substantial contribution to the improvement of health outcomes in Bangladesh. Notably, the reduction of mortality from diarrhoea and vaccine preventable diseases and control of fertility have made the most significant contributions to recent health gains.
Read More
A post-Millennium Development Goals agenda for health in Bangladesh should be defined to encourage a second generation of health-system innovations under the clarion call of universal health coverage. This agenda should draw on the experience of the first generation of innovations that underlie the country's impressive health achievements and creatively address future health challenges.
Read More
This article explores strategies in health-service delivery that have maximised reach and improved health outcomes. We identify three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes: (1) experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach; (2) experimentation with informal and contractual partnership arrangements that capitalise on the ability of non-governmental organisations to generate community trust, reach the most deprived populations, and address service gaps; and (3) rapid adoption of context-specific innovative technologies and policies that identify country-specific systems and mechanisms.
Read More
How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defined by the participation of a multiplicity of different stakeholders and agents and by ad hoc, diffused forms of management has contributed to these outcomes by creating conditions for rapid change.
Read More
Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households.
Read More
The health situation of children in the Indian Sundarbans couldn’t be more precarious. Facing chronic malnutrition as well as a high prevalence of easily preventable but highly communicable diseases, access for children to health services in the region is complicated by the rough terrain and the winding tidal rivers of the deltaic region.The key question is, what can be done to improve the health situation of children in the Sundarbans? This briefing answers that question by outlining the several methodologies employed in the study. It then considers both the demand and supply sides for child-centred health services in the block. It concludes with recommendations for beginning to repair the fractured health system there.
Read More
Village doctors are the dominant health care providers in rural areas of Bangladesh. icddr,b has previously tested interventions to improve the quality of their services – especially training on acceptable practice and the creation of a franchise called ShasthyaSena (health soldier). But training alone met with limited success. To improve the quality of these services, icddr,b has been testing an mHealth intervention that linked ShasthyaSenas to qualified physicians through a call centre. This brief documents the successes and challenges faced during the first year of implementation of the mHealth intervention.
Read More
Over the past decade, development assistance for health (DAH) in Uganda has increased dramatically, surpassing the government’s own expenditures on health. Yet primary health care and other priorities identified in Uganda’s health sector strategic plan remain underfunded. Using data available from the Creditor Reporting System (CRS), National Health Accounts (NHA), and government financial reports, the article examines trends in how donors channel DAH and the extent to which DAH is aligned with sector priorities.
Read More
FHS's 'unlocking community capabilities' (UCC) theme systematically examines how communities can be active participants in the planning, delivery, monitoring and evaluation of their health system, by identifying and mobilising individual and collective capabilities in different social, political, and institutional environments. This brief explores current activities and initial findings from the theme.
Read More
The aim of this systematic review was to assess whether socioeconomic development can contribute to malaria control. Of 4696 studies reviewed, 20 met the criteria for inclusion in the qualitative analysis, and 15 of these reported the necessary data for inclusion in the meta-analysis. The odds of malaria infection were higher in the poorest children than in the least poor children (unadjusted odds ratio [OR] 1·66, 95% CI 1·35–2·05, p<0·001,I2=68%; adjusted OR 2·06, 1·42–2·97, p<0·001, I2=63%), an effect that was consistent across subgroups. Although we would not recommend discontinuation of existing malaria control efforts, we believe that increased investment in interventions to support socioeconomic development is warranted, since such interventions could prove highly effective and sustainable against malaria in the long term.
Read More