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Publications

Filtering by Category: Featured

FHS Key Message Brief 1: How learning-by-doing can help cut through complexity in health service delivery

Future Health Systems

Throughout the duration of the Future Health Systems project (FHS), country teams have committed to undertaking systematic learning though implementation research and by bringing together key actors involved in service delivery. In this Key Message Brief, we share some examples of how FHS teams have embodied a “learning-by-doing” approach, and what the consequences of this approach have been. 

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Toward universal coverage in Afghanistan: A multi-stakeholder assessment of capacity investments in the community health worker system

Future Health Systems

Edward, A., Branchini, C., Aitken, I., Roach, M., Osei-Bonsu, K., & Arwal, S. H. (2015) Toward universal coverage in Afghanistan: A multi-stakeholder assessment of capacity investments in the community health worker system, Social Science & Medicine, Vol 145, pp 173-183, doi:10.1016/j.socscimed.2015.06.011

Global efforts to scale-up the community health workforce have accelerated as a result of the growing evidence of their effectiveness to enhance coverage and health outcomes. Reconstruction efforts in Afghanistan integrated capacity investments for community based service delivery, including the deployment of over 28,000 community health workers (CHWs) to ensure access to basic preventive and curative services. The study aimed to conduct capacity assessments of the CHW system and determine stakeholder perspectives of CHW performance. 

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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.

Honouring the Value of People in Public Health

Future Health Systems

Complex and dynamic public health problems require a different approach: an emphasis on the value of people. People who own the problem can anticipate the most likely social obstacles to its resolution, and their participation is essential to maintain an evolving strategy that can institutionalize an approach to the problem.

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MANIFEST Progress Brief 3: Mentorship Contributes to Quality Improvement in Maternal and Newborn Care, Health Worker Motivation

Future Health Systems

The concept of clinical mentorship is increasingly becoming important in order to improve the delivery of quality healthcare services.  This MANIFEST Progress Brief is based on perspectives of mentors and mentees following a six month mentorship exercise in the districts of Kamuli, Kibuku and Pallisa in eastern Uganda. It outlines the issue, the approach taken, preliminary results, a summary of findings, improvements in clinical care, administrative improvements and challenges. 

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Addressing Resistance To Antibiotics In Pluralistic Health Systems

Future Health Systems

There is growing international concern about the threat to public health of the emergence and spread of bacteria resistant to existing antibiotics. An effective response must invest in both the development of new drugs and measures to slow the emergence of resistance. This paper addresses the former. It focuses on low and middle-income countries with pluralistic health systems, where people obtain much of their antibiotics in unorganised markets. 

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The application of systems thinking in health: why use systems thinking?

Future Health Systems

This paper explores the question of what systems thinking adds to the field of global health. Observing that elements of systems thinking are already common in public health research, the article discusses which of the large body of theories, methods, and tools associated with systems thinking are more useful. 

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SHOWCASE -- News and lessons from the MANIFEST study in Uganda | Autumn 2014

Future Health Systems

Welcome to the first edition of Showcase, which is débuting at the third Global Symposium on Health Systems Research in Cape Town, South Africa. Showcase is published by the Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) study to share news and lessons from the study

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The Bangladesh paradox: exceptional health achievement despite economic poverty

Future Health Systems

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.
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Sundarbans Health Watch - Series 1: How healthy are the children of the Sundarbans

Future Health Systems

The present report focuses on one of the more vulnerable blocks of the Sundarbans in West Bengal, India -- namely Patharpratima -- as a representative block of the Sundarbans. To understand the root of the problem, the study takes a child health right approach and attempts to understand whether and to what extent the rights are protected, especially in climatically challenged areas such as the Sundarbans. In a nutshell, this report generates research evidence on the barriers to service delivery and access of health care services for children and endeavours to find out ways to make the system more effective in the Sundarbans.
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Future Health Markets: A meeting statement from Bellagio

Future Health Systems

Policy-makers, entrepreneurs, academics and funders convened at the Rockefeller Foundation Bellagio Center from 10th-14th December 2012 to discuss the changing face of health markets, and in particular to consider future trends in such markets. Their aim was to promote a greater shared understanding and analysis of health market systems, and to consider how markets can better serve the needs of the poor in low- and middle-income countries (LMICs). This report is an attempt to capture the rich discussions held during the meeting, which reviewed the evolution of health markets, identified key drivers of and gaps resulting from their rapid development, and highlighted critical issues that must be tackled to ensure the poorest have access to safe, affordable, effective and equitable health services. The report concludes with recommendations for shaping future health markets as agreed during the meeting.
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Transforming Health Markets in Asia and Africa: Improving quality and access for the poor

Future Health Systems

There has been a dramatic spread of health markets in much of Asia and Africa over the past couple of decades. This has substantially increased the availability of health-related goods and services in all but the most remote localities, but it has created problems with safety, efficiency and cost. The effort to bring order to these chaotic markets is almost certain to become one of the greatest challenges in global health. This book documents the problems associated with unregulated health markets and presents innovative approaches that have emerged to address them. It outlines a framework that researchers, policy makers and social entrepreneurs can use to analyse health market systems and assess the likely outcome of alternative interventions. The book presents a new way of understanding highly marketised health systems, applies this understanding to an analysis of health markets in countries across Asia and Africa and identifies some of the major new developments for making these markets perform better in meeting the needs of the poor. It argues that it is time to move beyond ideological debates about the roles of public and private sectors in an ideal health system and focus more on understanding the operation of these markets and developing practical strategies for improving their performance. This book is ideal reading for researchers and students in public health, development studies, public policy and administration, health economics, medical anthropology, and science and technology studies. It is also a valuable resource for policy makers, social entrepreneurs, and planners and managers in public and private sector health systems, including pharmaceutical companies, aid agencies, NGOs and international organisations.
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Bring order to unregulated health markets

Future Health Systems

In this commentary in Nature, the authors argue that the rapid expansion of health markets in Asia and Africa has made medicines, information and primary-care services available in all but the most remote areas. But it also creates problems with drug safety and efficiency, equity of treatment and the cost of care. Poorly trained practitioners often prescribe unnecessary pills or injections, with patients bearing the expense and the costs to their health. Counterfeit drugs are rife and drug resistance is growing. Bringing order to unruly health markets is a major challenge.
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Removing user fees for basic health services: a pilot study and national roll-out in Afghanistan

Future Health Systems

User fees for primary care tend to suppress utilization, and many countries are experimenting with fee removal. Studies show that additional inputs are needed after removing fees, although well-documented experiences are lacking. This study presents data on the effects of fee removal on facility quality and utilization in Afghanistan, based on a pilot experiment and subsequent nationwide ban on fees.
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Exploring evidence-policy linkages in health research plans: A case study from six countries

Future Health Systems

Three key activities were undertaken by FHS during the initial phase of this five-year project. First, key considerations in strengthening evidence-policy linkages in health system research were developed by FHS researchers through workshops and electronic communications. Four key considerations in strengthening evidence-policy linkages are postulated: development context; research characteristics; decision-making processes; and stakeholder engagement. Second, these four considerations were applied to research proposals in each of the six countries to highlight features in the research plans that potentially strengthen the research-policy interface and opportunities for improvement. Finally, the utility of the approach for setting research priorities in health policy and systems research was reflected upon.
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