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Blog

Future Health Systems in Time

Future Health Systems

September 1978. October 2018. July 2004? My guess is that the first two dates will ring a bell for those with a passing knowledge of ‘global health’ and the third will make you scratch your heads. This year we celebrated the 40th anniversary of the the Alma-Ata Declaration of 1978, which established primary health care and community involvement as core to the achievement of ‘health for all’. Whether the goals of Alma Ata are ‘still relevant’ was a hotly debated topic at the biennial gathering of the Health Systems Global community in Liverpool. Just weeks later in Astana, yet another global gathering of health folks marked the anniversary with a reaffirmation of ‘the fundamental right of every human being to the enjoyment of the highest attainable standard of health without distinction of any kind’. In ten years time we will mark it again, using the moment to consider what progress has been made (or not) towards this grand goal of a universal human right to health. Why this third date? Why July 2004?

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Future Health Systems - Research Validation Workshop

Future Health Systems

The poor health of those living in informal settlements across Freetown is a direct consequence of their living conditions, but often in locally specific ways. This is further exacerbated by unequal access to healthcare, meaning such communities face a double burden on their health due to the environmental conditions in which they live. This blog post highlights some of the findings of a research study, led by SLURC in collaboration with Future Health Systems, seeking to explore relationships between living conditions in informal settlements and common health problems, and to explore whether the socioeconomic backgrounds of people living in informal settlements affect their access to health care services.

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Thinking of Health Insurance beyond OOPs

Future Health Systems

Out-of-pocket payments (OOPs) dominate the discourse on health insurance. The success of health insurance schemes is typically measured by whether such expenses decrease for the insured. Financial hardships can indeed significantly hinder access to health care. But other barriers exist within households and across social groups that can also restrict access to health care. Health insurance schemes can improve such situations and enhance access to health care. While they are well recognised for their potential to offer financial risk protection, their ability to promote equity in other ways is not as well understood. This blog draws from a recent presentation at the Fifth Global Symposium on Health Systems Research (HSR2018) to highlight how inter- and intra-household equity can be promoted through health insurance schemes for the poor. Empirical evidence from the Rashtriya Swasthya Bima Yojana (RSBY) - a state funded health insurance scheme for the poor in India – is cited to make the case.

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We shall experiment, but how shall we learn?: Next steps for research on innovation in China’s health and social policy

Future Health Systems

Some years ago, Tony Saich likened doing research on local government in China to the story of the blind men and the elephant – the complexity of China, and the differences between places, mean that different people experience different things, and describe different realities. China has always provided avenues for interesting research. Many of the debates that Tony Saich was reflecting on were around China’s rapid industrialisation, development of markets, and the ways in which local governments steered reforms. Fifteen years on, while the debates have progressed and the amount of research and analysis on China has increased dramatically, some of the fundamental questions remain.

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Engaging with Journalists in Liberia to report more accurately

Future Health Systems

On September 7, 2018, Liberia Center for Outcomes Research in Mental Health (LiCORMH) hosted a one-day workshop entitled ‘Preparing Journalists for Accurately Reporting Research Finding’ in the business conurbation of Monrovia called Sinkor. We are pleased to have had journalists from various media outlets attend the workshop to hear our concerns and requests.

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Enhancing the capacity of national and local governments to drive quality improvements

Future Health Systems

Improving the effectiveness with which health services are delivered has continued to be a major concern especially in low- and middle-income countries. The ills from poor quality services have now exceeded those from non-utilization of services, with about five million deaths attributed to poor quality services. FHS Uganda Country Coordinator Elizabeth Ekirapa-Kiracho, blogs about the session that she attended at the Fifth Global Symposium on Health Systems Research in Liverpool, which focused on improving quality to promote equity and effectiveness in the SDG era.

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Community Delivery Center: the answer for safe delivery for women of the Indian Sundarbans?

Future Health Systems

Worldwide, 830 women die daily from preventable causes related to pregnancy and childbirth, and unfortunately one fifth of these women reside in India (UNICEF). Maternal death accounts for highest share of Disability-Adjusted Life Year (DALY) and is more prevalent in rural areas as compared to urban ones. This is demonstrated in areas such as the Sundarbans, where geographically inaccessible terrain makes maternal health service delivery challenging. In the near absence of formal delivery care at the grassroots level, Community Delivery Centers (CDCs) bring basic obstetric care to the doorsteps of hard-to-reach regions of Indian Sundarbans.

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Including marginalised people in ‘people centred health systems’

Future Health Systems

At the upcoming Global Symposium on Health Systems Research, we will be running a participatory session that builds on research from Uganda, Bangladesh and Nepal, entitled Amplifying Marginalised Voices: Towards Meaningful Inclusion in Social Accountability Mechanisms for Health. This session applies an intersectional lens to accountability mechanisms, asking about the inclusion of specific, marginalised categories within communities in mainstream accountability initiatives.

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Urbanization and the learning agenda for health systems research: insights from Future Health Systems

Future Health Systems

Projections about urbanization are staggering: 55% of the world’s population already live in urban areas, and by 2050 this is predicted to rise to 68% with almost 90% of the growth happening in Asia and Africa. The implications for health are huge, as is the learning agenda for health systems research.

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The 3rd Delay: Prominent and fatal in maternal delivery services, pleas from the frontline

Future Health Systems

Currently, thanks to the sustained campaign by the Ugandan government and development partners, more women deliver in facilities than ever before. However, without concerted efforts to ensure that facilities are well equipped to handle these increased numbers, more women will continue dying to give life.

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Tackling antimicrobial resistance (AMR) in pluralistic health systems

Future Health Systems

There is growing scientific evidence that infections that are resistant to antibiotics are a serious global health challenge. This has stimulated wide agreement on a Global Action Plan for Addressing AMR and many countries have produced National Action Plans. It is important that these action plans take into account the local context. This is especially important in countries with a pluralistic health system in which people seek health care from a wide variety of public and private providers of drugs and medical care. One lesson from the work of the Future Health Systems Consortium is the need to take a systems approach for tackling health challenges in these countries. This blog highlights some priority issues that this kind of approach needs to take into account.

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Team work key in implementation of Community Score Cards

Future Health Systems

If you watch soccer, you will agree with me that just like a football team working together to set up the perfect shot at goal, every team member has a specific role to play in accomplishing tasks on an initiative that requires joint effort. While it may look like one player scored the goal, that score was made possible by on and off pitch team members’ planning, coordination, and cooperation to get that scorer the ball.

That is what we have observed with the different stakeholders as we implement a study that is testing a community and facility score card for maternal and newborn health service delivery in Kibuku District in Eastern Uganda.

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Community Resilience in the context of the Ebola Virus Disease epidemic in Liberia

Future Health Systems

Sehwah Sonkarlay, LiCORMH, Liberia, and Future Health Systems, writes about reflections by key actors on Liberia’s experience in identifying and building resilience at the community level in the context of the recent Ebola epidemic, combined with its post-war and unique sociopolitical history.

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Not business as usual: make Ugandan health facilities friendly for women with walking disabilities

Future Health Systems

World Health Day has come and gone this year, but nevertheless, it is very important for us to continue to remember our commitments towards health care delivery, such as equitable health systems. Most efforts to improve Maternal and Newborn Health (MNH) outcomes in Uganda have focused on access and quality of care for women in general, paying no attention to special populations such as women with walking disabilities who have a high likelihood of poor MNH outcomes. 

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Accountability for health equity and the struggle to meet the most basic health needs

Future Health Systems

There are rare moments in the global health calendar when those with an eye on the past are given space to speak in the present. Over the last decade working in this field, I have mostly kept my historical leanings secret and worn my anthropologist ‘hat’ instead. Who wants to think about the detritus of the past when there is so much pressure to move as quickly as possible towards the ‘next big thing’? This year, however, the past is inescapable. We are on the eve of marking the anniversary of the Alma Ata “Health for All by 2000” declaration. We are in a period defined by a renewed global commitment to achieve Universal Health Coverage by 2030 and at IDS we have just launched the new IDS Bulletin Accountability for Health Equity: Galvanising a Movement for Universal Health Coverage. Given that inequities in health have stagnated, and in some cases worsened, over these last forty years, we need to think more critically about what UHC2030 means in light of past efforts and the nature of change over time.

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Propelling decision-makers to action! The (he)art of an issue brief

Future Health Systems

FHS partners from Ethiopia, Uganda, India and Liberia attended the recent FHS “Issue Briefs: A Knowledge translation tool for evidence-informed decision-making” workshop held at IIFPHC-E from March 26-29, 2018.

FHS partners alongside other researchers from Ethiopian research institutes and universities, and practitioners from the Federal Ministry of Health in Ethiopia gathered to take a deep dive into the art and science of writing an Issue Brief.

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