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Publications

Filtering by Category: JHSPH

Association between health workforce capacity and quality of care for children under five in Afghanistan

Future Health Systems

This presentation by Dr Anbrasi Edward at the 28th ISQua conference in Hong Kong was informed by a study to determine the association between health workforce capacity and quality of care in primary care facilities providing a basic package of health services (BPHS) in Afghanistan.
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Can community health workers increase coverage of reproductive health services?

Future Health Systems

Health services were severely affected during the many years of instability and conflict in Afghanistan. In recent years, substantial increases in the coverage of reproductive health services have been achieved, yet absolute levels of coverage remain very low, especially in rural areas. One strategy for increasing use of reproductive health services is deploying community health workers (CHWs) to promote the use of services within the community and at health facilities. Results show that presence of a female CHW in the community is associated with higher use of modern contraception, antenatal care services and skilled birth attendants but presence of a male CHW is not. Community-level random effects were also significant.
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Understanding pathways for scaling up health services through the lens of complex adaptive systems

Future Health Systems

Despite increased prominence and funding of global health initiatives, efforts to scale up health services in developing countries are falling short of the expectations of the Millennium Development Goals. Arguing that the dominant assumptions for scaling up are inadequate, we propose that interpreting change in health systems through the lens of complex adaptive systems (CAS) provides better models of pathways for scaling up.
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FHS Podcast 1: Complexity, complexity, complexity

Future Health Systems

In this first podcast from Future Health Systems, Jeff Knezovich finds out what complexity science is, and how a complex adaptive systems approach can help scale up health systems interventions. We find out from Ben Ramalingam about the history of complexity science, while Professor David Peters explains a few key concepts of complex adaptive systems.
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Villagers’ evaluation of a community-based health insurance scheme in Thmar Pouk, Cambodia

Future Health Systems

There is growing international evidence that the effectiveness of health services stems primarily from the extent to which the incentives facing providers and consumers are aligned with "better health" objectives. Efficiency in health service provision requires that providers and consumers have incentives to use healthcare resources in ways that generate the maximum health gains. Equity in at least one sense requires that consumers requiring the same care are treated equally, irrespective of their ability to pay. Efficiency in the use of health services requires that consumers are knowledgeable about the services on offer and which are most appropriate to their needs. Although these principles are enshrined in the design of every health system in the world, they have proven extremely difficult to apply in practice. Healthcare providers have financial obligations to their families as well as professional obligations to their patients. Health service consumers generally lack information about both their health and health services so that they under-consume or over-consume healthcare.
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Building the Field of Health Policy and Systems Research: An Agenda for Action

Future Health Systems

This is the third of a series of three papers addressing the current challenges and opportunities for the development of Health Policy and Systems Research (HPSR). HPSR is a multidisciplinary and interdisciplinary field identified by the topics and scope of questions asked rather than by methodology. The focus of discussion is HPSR in low- and middle-income countries. This article outlines an agenda for future action in HPSR.
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Building the Field of Health Policy and Systems Research: Social Science Matters

Future Health Systems

This is the second of a series of three papers addressing the current challenges and opportunities for the development of Health Policy and Systems Research (HPSR). HPSR is a multidisciplinary and interdisciplinary field identified by the topics and scope of questions asked rather than by methodology. The focus of discussion is HPSR in low- and middle-income countries. This article highlights the importance of social sciences for strengthening HPSR.
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Building the Field of Health Policy and Systems Research: Framing the Questions

Future Health Systems

This is the first of a series of three papers addressing the current challenges and opportunities for the development of Health Policy and Systems Research (HPSR) developed with a number of partners following the First Global Symposium on Health Systems Research in Montreux in November 2010. The article calls for greater attention to fundamental, exploratory, and explanatory types of HPSR; to the significance of the field for societal and national development, necessitating HPSR capacity building in low- and middle-income countries; and for greater literacy and application of a wide spectrum of methodologies.
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Configuring Balanced Scorecards for Measuring Health System Performance: Evidence from 5 Years' Evaluation in Afghanistan

Future Health Systems

n 2004, Afghanistan pioneered a balanced scorecard (BSC) performance system to manage the delivery of primary health care services. This study examines the trends of 29 key performance indicators over a 5-year period between 2004 and 2008.
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Research translation to inform national health policies: learning from multiple perspectives in Uganda

Future Health Systems

Research and evidence can have an impact on policy and practice, resulting in positive outcomes. However, research translation is a complex, dynamic and non-linear process. Although universities in Africa play a major role in generating research evidence, their strategic approaches to influence health policies and decision making are weak. This study was conducted with the aim of understanding the process of translating research into policy in order to guide the strategic direction of Makerere University College of Health Sciences (MakCHS) and similar institutions in their quest to influence health outcomes nationally and globally.
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Exploring new health markets: experiences from informal providers of transport for maternal health services in Eastern Uganda

Future Health Systems

Although a number of intermediate transport initiatives have been used in some developing countries, available evidence reveals a dearth of local knowledge on the effect of these rural informal transport mechanisms on access to maternal health care services, the cost of implementing such schemes and their scalability. This paper, attempts to provide insights into the functioning of the informal transport markets in facilitating access to maternal health care. It also demonstrates the role that higher institutions of learning can play in designing projects that can increase the utilization of maternal health services.
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Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

Future Health Systems

eographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders.
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Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?

Future Health Systems

Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing independent private sector providers; social franchises of private providers; non-government organization (NGO) providers; and government providers on these three factors.
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Medical Representatives in rural Bangladesh: Who are They and What Is Their Role in the Drug Market?

Future Health Systems

M Hafizur Rahman from Johns Hopkins Bloomberg School of Public Health looks at the role of medical representatives in Chakaria, Bangladesh. He focuses on their link with informal providers of health services in rural areas. The presentation was given on 11 July 2011 at the 8th World Congress on Health Economics (iHEA).
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Patient satisfaction with services in outpatient clinics at Mulago hospital, Uganda

Future Health Systems

This study highlights the important findings about outpatient services at Mulago hospital. The sub-optimal satisfaction scores for outpatient care strongly suggest that more could be done to assure that services provided are more patient centered. Significant factors including category of clinic visited, waiting time, costs incurred, accessibility of services and perceived providers' technical competence at this hospital should be explored by the Makerere University College of Health Sciences and Mulago hospital for potential improvements in quality of the health service delivered.
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Determinants of Skilled Birth Attendant Utilization in Afghanistan: A Cross-Sectional Study

Future Health Systems

This article seeks to identify characteristics associated with use of skilled birth attendants where health services exist in Afghanistan. It is based on a cross-sectional study in all 33 provinces in 2004.
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Determinants of primary care service quality in Afghanistan

Future Health Systems

This article identifies factors associated with service quality provided by agencies implementing a basic package of health services in Afghanistan and is based on a cross-sectional survey of outpatient health facilities, health workers, patients and caretakers.
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