To further understand the reactions of medical institutions in light of national healthcare reform and to explore corresponding influences of payment system reform on medical behaviors of the medical staff, China FHS conducted a full-scope site investigation in the pilot area of Hanbin District, Shannxi province from 9th-11th April, 2014. This blog by the China PIRU team provides further details on the process and outcomes of the investigation.
On 27 April 2015, the Indian Institute of Health Management Research (IIHMR) University (FHS partner) and Welthungerhilfe, with technical inputs from UNICEF, co-hosted a consultation meeting in Kolkata to address the challenges and barriers to the adoption of a sustainable multi-sectoral approach to combat child undernutrition in the Indian state of West Bengal. This blog outlines the key messages, outcomes and actions from the meeting.
Debjani Barman is a recipient of a RinGs’ small research grant. Within this blog post she discusses how she became interested in gender, care seeking, and health service delivery, and what led her to develop this project.
It is increasingly important to understand the role of medical institutions in health care reform and the influences of payment system reform on the medical behaviors of clinicians. In order to do so, Deputy Director Yu Lihua, from the payment system and medical classification team of the China National Health Development Research Centre (CNHDRC), led seven junior researchers from the health security team and the payment system team to conduct the second round field survey in Yubei District, Chongqin City, from 25 to 26 September 2014.
The FHS Young Researcher programme brought together three grantees for a workshop in Baltimore during January: Tianyang Liu from the China National Health Development Research Center, Francis Nzakimuena from the University of Kinshasa School of Public Health in the Democratic Republic of Congo, and Md. Shahnawaz from Institute of Health Management Research in India. All three are working on projects that incorporate aspects of mHealth. The fourth grantee is Jackline Sitienei from Moi University in Kenya.
By Shibaji Bose, FHS India Policy Influence and Research Uptake Officer
The media is famously called the fourth estate, after the executive, judiciary, and legislature.
My comprehension from the [ResUp meet] was that many who attended considered the media just one of the many channels that would take forward / upward / downward to the proletariat their ‘silver bullet’ research findings. However, from an Indian / South Asian context, there would have been no structural movements or user voices reclaiming their lost territory if they had not piggybacked on the media storm.
The week in Nairobi has been enjoyable. A valuable four days of learning and sharing with new and familiar colleagues tackling similar knowledge mobilisation challenges in different contexts. Tom Barker shares his reflections from the ResUp Symposium and Training Exchange.
Future Health Systems and Africa Hub partners will be participating at the ResUp MeetUp Symposium and Training Exchange in Nairobi from 9 to 12 February 2015, which will bring together members of the ResUp MeetUp community to share learning and best practice, and build capacity for research uptake
At the recent Third Global Symposium for Health Systems Research, Jeff Knezovich and I asked participants to complete an online network survey. Our aim was to map the networks (social, collaboration, information seeking) of conference participants. The idea of mapping the network seemed to resonate, but in total we had only 71 responses (give or take – cleaning the data outputted from the app was more grueling than a hike up Table Mountain!). Nevertheless, let’s see what these data look like...
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New to the wonderful world of health systems? Then this post is for you! Whether you’re a wonk that needs to brush up, a student, a health care practitioner or just an interested and engaged citizen – this primer is full of everything you've ever needed to know about health systems and how they function around the world.
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Every day, health service leaders face challenges like working with limited resources while delivering results, managing change, and keeping staff motivated. Decentralisation adds to these challenges, as many health workers have both clinical and managerial responsibilities.
However, little attention is paid to leadership and management skills during their health training.
In partnership with the districts, who select the candidates, the Makerere University School of Public Health is training health workers in three areas: planning and management of health services, improving management of logistics and improving management of labor and newborn care.
A six-month distance health services management certificate course, targeting district and health facility managers, caters for the first two thematic areas, the focus for this article. In the first phase, 30 health service delivery personnel were drawn from the three study districts (10 from each), and another 30 are attending the second phase of training. The results have been tremendous, with beneficiaries already registering significant improvements back at their work places.
Households and individual community members are being educated and encouraged to join or start financial social networks, like saving groups, which offer financial protection. In addition to the business funds, the networks are advised to have a separate fund to cater for maternal and newborn health needs. Members can access these funds to cater for emergency transport to and from the health facility for pregnant women, mothers and newborns. The fund is also meant to provide funds to cater for birth items. Saving groups are similarly encouraged to enter into partnership with transporters.
Deciding to seek care from a skilled health worker by a woman at the time of delivery is highly encouraged in order to improve health outcomes for both mother and baby. When a woman delivers under skilled care, it is easier to detect and attend to any emergences that arise.
Under the community mobilisation and sensitisation component of the study, around 1,691 community health workers (CHWs, also known as village health teams or VHTs), were trained across the three study districts of Kamuli, Pallisa and Kibuku. The training focused on early detection of emergencies, birth preparedness and care for mothers who just delivered and their newborns. During the visits, CHWs provide households with information needed to ensure mothers have a safe delivery and remain healthy with their babies. Two home visits happen during pregnancy and two after delivery.
Having knowledge of obstetric danger signs and embracing good birth preparedness practices could enhance maternal and newborn health outcomes. Through the use of communications and media advocacy, the intervention study is tackling social and cultural issues that affect maternal and newborn health negatively. We are using village-level dialogues (once every three months) and radio talk shows (monthly) as well as spot messages (daily).
During the dialogues, women and men shared sad memories of maternal and newborn illness and death, underlining the grim reality of the situation. They also discussed good and bad practices and made commitments to abandon negative practices and therefore improve maternal and newborn health. “I resolve to stop putting cow dung and other dangerous things on the cord of newborns. After today’s talk I realise why my baby’s cord took that long to heal. I urge fellow women to join a new me,” said Ms Nabirye at a dialogue in Kamuli to thunderous applause from fellow women. Monitoring data shows that, while only 17 per cent of sampled women who had just given birth treated cords with nothing but the appropriate saline water in mid-2013, that percentage had shot to 56% in mid-2014.
In recognition of the UN’s International Day of Rural Women today — 15 October — we share stories of motherhood in rural Uganda.
Compared to other countries, Uganda’s maternal mortality rate is high. In 2010, it was estimated that 345 women died for every 100,000 births in the country (in the UK, that number is closer to 8.2!).
In rural areas, that figure is even higher
Here are a few pictures that help to explain why (courtesy of a Photovoice research project undertaken by David Musoke at the Makerere University School of Public Health as part of Future Health Systems).
By Jeff Knezovich, FHS Policy Influence and Research Uptake Manager, Institute of Development Studies
In our previous blog post introducing how FHS approached the Third Global Symposium on Health Systems Research, we highlighted the thematic focus of the symposium is 'people-centred health systems'.
FHS has been working for some years to put people first when it comes to health systems, whether it be through understanding how people actually use new technologies, such as in our project on health information seeking behaviour in Bangladesh, or working with communities in Afghanistan to rate and improve their health services through community scorecards.
But putting people at the centre of health systems also means finding different research approaches to studying health systems strengthening. We're profiling a few methods during the symposium. And today's focus is on photovoice.
A bit about photovoice
Photovoice is a visual research methodology through which people can represent, and enhance their community by photographing their daily lives and the lives of those around them. It is a qualitative and participatory research method that aims to capture what occurs when researchers are not necessarily present.
Following a range of trainings – on how to use digital cameras, how to approach a picture subject, and getting people’s consent – study participants use the cameras provided to them to capture photographs and moments that are relevant to the research study. These photos are then discussed, often in a group, to highlight particular photos and to explain their particular relevance to the topic at hand. In many cases, these photographs then also serve as a key part of the communication strategy of the research project.
How FHS has employed photovoice
Although this is a relatively new approach for us, The Future Health Systems consortium has already used the photovoice technique in two of our focus countries: Uganda and India.
In Uganda, as part of the FHS young researcher grant, David Musoke worked with select youth in a community in rural Uganda to document issues related to maternal and childhood health in the community. Study participants used the cameras provided to them to capture aspects and situations in their community where youth can contribute to improving maternal health for a period of five months. Monthly meetings were held between the youth and research team to discuss the photos and to identify collectively emerging themes and areas for action. See the Uganda photovoice slideshow below, or download the booklet, to see some of the results.
In India, researchers worked with women's groups in the Indian Sundarbans of West Bengal to document the interplay between climate, health and resilience there. The focus remained mainly on maternal and newborn health. The participants mainly sought to capture images that explain how a changing climate affects their daily livelihoods, barriers that exist to accessing health services, and ways that locals are adapting to these challenges. The results are available for download in our FHS India photovoice booklet and for viewing in the slideshow below.
Giving photovoice a try at HSR2014
On Thursday, 2 October 2014, FHS invited participants at the Symposium to take pictures with Instagram and Twitter and to tag them with #HSG2014PV, #HSR2014PV or #HSR2014. These were collected via Evenstagram to form our own snapshot of the Symposium for the day.
You can review the photos below or online. Let us know which ones are your favourite and why!
Health systems researchers face a fork in the road. One path leads to implementation research as big science which can anoint a priestly caste of implementation experts pursuing universal truths and codifying best practices in mistake correction. The experts’ business model is to sell expertise to clients and research foundations. Another path leads to implementation research as small science — a cottage industry practiced by every district health officer, clinic manager, and MoH official.
As the first two plenary sessions have already highlighted, the focus of the Third Global Symposium on Health Systems Research here in Cape Town, South Africa, is on people-centred health systems. For FHS, which has unlocking community capabilities as a core theme, this is a welcome focus.
But if we're focusing on people-centred health systems, what are the implications for research? We've been exploring a number of methodologies during our research that we will be highlighting throughout the symposium.
For today, the focus is on social network analysis, or SNA.
This post was written by Upasona Ghosh, Senior Research Officer at the Indian Institute of Health Management Research and originally appeared on Eldis. It is one of two case studies published on Eldis to mark the World Health Organization conference on health and climate, which tookplace in Geneva from 27-29 August.
During the past few years complex adaptive systems theory has suddenly become very popular in the health systems research field. However, I have to admit that, until recently, I was something of a complex systems modeling sceptic. A couple of recent events, notably the FHS workshop and an NIH conference, have changed my perspective. Here's what has driven my change in thinking.