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Publications

Filtering by Author: Future Health Systems

Use of photovoice to explore the potential role of youth in contributing to maternal health in rural Wakiso district, Uganda

Future Health Systems

Musoke D, Ndejjo R, Biyinzika Lubega G and Ekirapa-Kiracho E (2020) Use of photovoice to explore the potential role of youth in contributing to maternal health in rural Wakiso district, Uganda, Sexual and Reproductive Health Matters, 28:1, 1854152, DOI: 10.1080/26410397.2020.1854152

Despite youth constituting a large portion of the population in Uganda, their involvement in improving maternal health in their communities has been minimal. This paper explores the potential role of youth in contributing to maternal health in rural communities in Wakiso district, Uganda using photovoice. Photovoice was used as a community-based participatory research method among 10 youth (5 males and 5 females) over a period of 5 months. The photos taken by the youth were discussed in monthly meetings, and emerging data was analysed using thematic content analysis. Four themes emerged regarding how youth can contribute to improving maternal health in their communities. These themes were: community health education; advocacy for health improvement; community voluntary work; and being exemplary. The fifth and final theme provides the avenues, including drama and sports, that the youth suggested they could use for conveying messages to the community concerning maternal and general health. Health education on topics such as the importance of delivering at health facilities was emphasised. Regarding advocacy, the youth said they can be involved in reaching out to various stakeholders to raise concerns affecting maternal health. Voluntary work such as construction of energy stoves for pregnant women emerged. The youth also highlighted that they could be exemplary for instance by males accompanying their spouses during antenatal visits. With the need to continuously engage community actors in health initiatives, youth should be considered and supported as important stakeholders so they may engage in activities to improve health within their communities.

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Influence of community scorecards on maternal and newborn health service delivery and utilization

Future Health Systems

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.

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Do community scorecards improve utilisation of health services in community clinics: experience from a rural area of Bangladesh

Future Health Systems

Hanifi, S.M.A., Hossain, A., Chowdhury, A.H. et al. (2020) Do community scorecards improve utilisation of health services in community clinics: experience from a rural area of Bangladesh, Int J Equity Health 19, 149, https://doi.org/10.1186/s12939-020-01266-5

The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh.

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Feasibility, Acceptability and Initial Outcome Of Implementing Community Scorecard To Monitor Community Level Public Health Facilities: Experience From Rural Bangladesh

Future Health Systems

Mahmood, S.S., Rasheed, S., Chowdhury, A.H. et al. (2020) Feasibility, acceptability and initial outcome of implementing community scorecard to monitor community level public health facilities: experience from rural Bangladesh, Int J Equity Health 19, 155, https://doi.org/10.1186/s12939-020-01265-6

Engaging communities in health facility management and monitoring is an effective strategy to increase health system responsiveness. Many developing countries have used community scorecard (CSC) to encourage community participation in health. However, the use of CSC in health in Bangladesh has been limited. In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. The current study presents learnings around feasibility, acceptability, initial outcome and challenges of implementing CSC at community clinics.

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Maternal Health challenges experienced by adolescents; could community score cards address them? A case study of Kibuku District– Uganda

Future Health Systems

Apolot, R.R., Tetui, M., Nyachwo, E.B. et al. (2020) Maternal health challenges experienced by adolescents; could community score cards address them? A case study of Kibuku District– Uganda, Int J Equity Health 19, 191, https://doi.org/10.1186/s12939-020-01267-4

Approximately 34.8% of the Ugandan population is adolescents. The national teenage pregnancy rate is 25% and in Kibuku district, 17.6% of adolescents aged 12–19 years have begun child bearing. Adolescents mothers are vulnerable to many maternal health challenges including; stigma, unfriendly services and early marriages. The community score card (CSC) is a social accountability tool that can be used to point out challenges faced by the community in service delivery and utilization and ultimately address them. In this paper we aimed to document the challenges faced by adolescents during pregnancy, delivery and postnatal period and the extent to which the community score card could address these challenges.

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Universal health coverage: an opportunity to address antimicrobial resistance?

Future Health Systems

Tayler E, Gregory R, Bloom G, Salma P, and Balkhy H (2019) Universal health coverage: an opportunity to address antimicrobial resistance?, The Lacent Global Health, Published Online September 20, 2019, DOI: 10.1016/S2214-109X(19)30362-6

On Sept 23, 2019, global leaders will gather at the UN for a high-level meeting on universal health coverage and discuss commitments and action to extend essential health services to over half of the world's population that have no access to them. 3 years ago, leaders met similarly at the UN General Assembly to consider antimicrobial resistance, perhaps the greatest threat to public health of our time. These two major global health priorities are much more closely linked than they might appear at first. If antimicrobial resistance is not controlled, health care will become more difficult, less effective, and more expensive. Conversely, action towards universal health coverage — and a positive response by countries at the meeting to the key asks proposed by the universal health coverage movement — can help expand coverage of measures to prevent and manage infection, including appropriate use of antibiotics. Countries have a great opportunity to both accelerate universal health coverage progress and tackle antimicrobial resistance, with substantial and sustainable gains.

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Photo voice as a participatory approach to influence climate related health policy in the Sundarbans

Future Health Systems

Ghosh U, Sen B, and Bose S (2019) Photo voice as a participatory approach to influence climate related health policy in the Sundarbans, The Lancet Planetary Health, Volume 3, Special Issue, S22, DOI: 10.1016/S2542-5196(19)30165-2

The IPCC Fifth Assessment Report highlights community-based strategies to drive effective and ecologically sustainable local adaptation strategies. A climate change hot spot, Sundarbans, India, needs collective action between communities and for local level health and non-health decision makers to find sustainable solutions to combat the impacts of climate change on child health.

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Understanding the role of community resilience in addressing the Ebola virus disease epidemic in Liberia: a qualitative study (community resilience in Liberia)

Future Health Systems

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.

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Maternal newborn health community scorecards in Uganda: a story of change

Future Health Systems

Between June 2017 and December 2018, Makerere University School of Public Health (MakSPH), in collaboration with Future Health Systems, implemented a Community Scorecard project focusing on maternal and newborn health service delivery and utilization in six sub-counties in Kibuku district in Eastern Uganda. This short film highlights some successes from this pilot.

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Challenges and solutions to implementing MNH community scorecards

Future Health Systems

Between 2017 and 2018, the Makerere University School of Public Health (MakSPH), in collaboration with the Future Health Systems Research Consortium, implemented a CSC project focusing on maternal and newborn health service delivery and utilization in six sub-counties in Kibuku District, in Eastern Uganda. The implementation was led by stakeholders in the district and comprised of sub county chiefs, Local council chair persons, Health Unit Management Committee chairpersons, Village health team members, community development officers, sub county level councilors and volunteers. This short film is based on the challenges of implementing the project and also explains how these challenges were handled.

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How to do a maternal & newborn community scorecard

Future Health Systems

FHS partner Makerere University School of Public Health undertook a Community Score Cards study, which contributed to research on how leaders can work with the community and health workers to improve maternal and newborn health in Kibuku District. The use of the Community Score Card tool – a two-way and ongoing participatory tool for assessment, planning, monitoring and evaluation - aims to improve the performance of facilities and accountability by the different stakeholders who are responsible for improving the performance of facilities. This film provides an overview of how to undertake a maternal and newborn community scorecard.

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Vision 2030: Our journey with you

Future Health Systems

The Future Health Systems (FHS) research project consortium was funded by UK Department for International Development (DFID). FHS is a partnership of leading research institutes from across the globe working in a variety of contexts to build resilient health systems for the future in Bangladesh, Uganda, China, India, Sierra Leone, Liberia and Ethiopia. It generated evidence on health systems to benefit the poor.

The FHS India journey started in 2005 with a guiding principle of 'putting the poor first'. This document is a summary of the decade-long work of FHS India. It attempts to share our learnings and challenges and how we have contributed to the SDGs.

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Accountability in Health Service Delivery: a Community Scorecard Exploration in Rural Bangladesh

Future Health Systems

Community clinics (CCs) were established by the Government of Bangladesh with an aim to extend primary health services to the grassroots population in rural areas. Currently there are 13,500 CCs throughout the country and each covers 6,000 population under its jurisdiction and are meant to provide maternal, child health, family planning and other primary health care services. However, challenges still remain in ensuring accountability, quality and equity in healthcare service at the local level. Voice and accountability mechanism are almost non-existent. There are gaps in logistics, quality assurance procedures and the facilities suffer from high staff absenteeism, unskilled staff and inefficient use of supplies. Stakeholders are not fully aware of clinics' purposes and there is weak communication and lack of involvement of local government institutions.

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Children of an Uncertain Climate

Future Health Systems

The FHS-India team has been engaged in research on the human health status in the Indian Sundarbans since 2009 and came up with a comprehensive report in 2010. A more in-depth report on the health of children of the Indian Sundarbans was published in 2013 in the name of Sundarbans Health Watch. In this present endeavor we have reflected on the pathways of climate change impacts on the health of the Sundarbans’ children. This report is based on a mixed method study conducted in Sagar, one of the six most vulnerable blocks out of the nineteen administrative blocks of the Sundarbans. This study has made an attempt to find out the present condition of different aspects of child health under climate crisis, to identify the gaps in service delivery and possible ways out on the basis of scientific evidence.

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Key Message Brief 6: Lessons from results-based financing to improve health services in Afghanistan

Future Health Systems

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.

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Service delivery transformation for UHC in Asia and the Pacific

Future Health Systems

Bloom G (2018) Service Delivery Transformation for UHC in Asia and the Pacific, Health Systems & Reform, Volume 5, Issue 1, DOI: 10.1080/23288604.2018.1541498

This article was drafted as part of a review of strategies for making progress toward universal health coverage in the countries of Asia and the Pacific. It focuses on strengthening the delivery of services, in the context of population aging. It argues that it is important to take into account big differences in development contexts and also the rapid, interconnected changes that many countries are experiencing. The article focuses especially on countries with relatively undeveloped institutions and pluralistic and highly segmented health sectors. It argues that attempts by these countries to import institutional arrangements from outside are likely to be complicated. It argues that government needs to focus on both short-term measures to meet immediate needs and the longer-term aim of establishing effective institutional arrangements. This means that they need to take into account the political factors that influence the direction of health system change. The article emphasizes the need to strengthen the capacity of the health system to address the growing challenge of chronic noncommunicable diseases to avoid heavy political pressure to expand hospital services. It then explores the opportunities and challenges associated with the rapid expansion of digital health services. It concludes with a discussion of government stewardship and management of health system transformation to address the major challenges associated with population aging.

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Health impacts of the living conditions of people residing in informal settlements in Freetown: Report on the Future Health Systems (FHS) research in Freetown

Future Health Systems

The rapid pace of urbanisation in most countries in Africa makes urban environments a major determinant of population health. In Freetown, urban growth is associated with the proliferation of informal settlements/slums owing largely to the prevalent poverty, overcrowded and filthy living conditions. Therefore, health outcomes are generally worse with intermittent disease outbreaks which can sometimes spread beyond a single neighbourhood to overwhelm the entire city. But, while a number of studies have documented evidences on the urban health situation in Freetown, such studies have not sufficiently explained the specific and community-wide health risks that people in each informal settlement are faced with. The study describes the living conditions in informal settlements, and explore how these relate to the health of people living there, as told and understood by the residents themselves and as reported in routine statistics.

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Scoping study on the urban health situation in Sierra Leone: A study funded by Future Health Systems (FHS)

Future Health Systems

There is growing concern in recent times about the health burdens faced by urban populations, particularly by those living in informal settlements in Sierra Leone. Many informal settlement dwellers face a variety of health risks which are exacerbated by the rapid urbanization of cities and the subsequent overcrowded living condition of settlements. Though rapid urbanization has negative effects for all in Freetown, those in low-income and disadvantaged groups are disproportionately affected.

Unfortunately, official health statistics and surveys often do not capture sufficient detail on the range of health problems faced by the urban poor who live in slum-like informal settlements. Many health surveys collect data on an aggregate level and are not specifically designed with the urban settings in mind. The lack of disaggregated data on the different informal communities and their residents suggests that appropriate policies which clearly reflect the different demography and health situations may not be in place. Given the dearth of information on how slum living conditions are likely to impact health systems and exacerbate care-seeking barriers, this study was undertaken to provide insights on the current state of knowledge on urban health situation in Sierra Leone.

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Living conditions and health links in Freetown’s informal settlements

Future Health Systems

Living conditions of people living in urban informal settlements are characterized by inhumane conditions, underpinned by lack of essential services like water and sanitation services including toilets and waste disposal dumps, housing and health services. The current state of service provision in Freetown’s informal settlements is in part a product of growing informality, in response to gaps in the provision of public services, notably in sanitation and health care. This policy brief provides an insight into the current state of living conditions in informal settlements of Freetown and how these link to health.

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The state of healthcare access in Freetown’s informal settlements

Future Health Systems

Unequal access to healthcare exacerbates poor health due to their living conditions of those living in informal settlements across Freetown, Sierra Leone. This issue brief provides an insight into the current state of healthcare provision in Freetown’s informal settlements.

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