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Blog

Is the health system response out of sync with the demands of the islanders in the Indian Sundarbans?

Future Health Systems

Five years ago, a mid-summer nightmare named Aila crashed on the Sundarbans with murderous fury and wreaked destruction beyond repair. On May 25, 2009 the tropical cyclone hit the Sundarbans in India and Bangladesh with a wind speed of 110 km/hr. Over 8,000 people went missing and more than a million were rendered homeless in the two countries. In India about 300 people were killed in Sagar Island alone in the Indian Sundarbans. Figures can scarcely do justice to record the number of homes destroyed, lives lost and livelihoods decimated.

There was a localised health system collapse in the immediate aftermath of Aila – a fact attested by the islanders loudly and by the state health policy makers privately.

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From ‘Basket Case’ to ‘One of the Great Mysteries of Global Health’: How did Bangladesh become such a success story?

Future Health Systems

Last week I was lucky enough to attend the UK launch of the Lancet Special Issue on Bangladesh, Innovation for Universal Health Coverage. In addition to this blog, there is also a complete Storify of the event.

Bangladesh is a fascinating case study for this type of review because, in terms of many health and social status indicators, they outperform many of their neighbouring countries despite having a lower GDP. This is particularly surprising as their health system is weak in many respects and is pluralistic, characterised by a range of health service providers from the for-profit and not-for-profit private sectors. Per capita expenditure on health care is $27 and two thirds of payments for health care are out of pocket – meaning that government investment in the health sector is very low. There are only 0.3 doctors/nurses per 1000 population. Despite this Bangladesh is one of six countries which is on-track to achieve Millennium Development Goals 4 and 5 on child and maternal health.

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Storify of FHS event - Why development matters for health systems: Lessons from Bangladesh

Future Health Systems

Last Friday, FHS co-hosted an event with the Institute of Development Studies and the Brighton and Sussex Medical School to help launch a recent special series from The Lancet on Bangladesh. We were pleased to welcome both FHS Research Co-Director Abbas Bhuiya, Deputy Director of icddr,b, and Mushtaque Chowdhury, Vice Chair and Interim Executive Director of BRAC.

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The 4Cs of the Health Systems in Asia Conference

Future Health Systems

During the Health Systems in Asia conference last weekend in Singapore, I was able to identify a clear trend. No, not pluralism in Asian health systems, we already knew that one. But rather, on two of the four days the closing thoughts from different speakers involved 4Cs. In keeping with this important new trend, I’ve decided to frame my blog similarly. And so I present to you my four takeaways from the conference using the same ‘4C framework’: Confucius, context, communication, and coverage.

 

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    Two hops from FHS: What can our Facebook page tell us about our network?

    Future Health Systems

    The other week I had the good fortune of participating in an excellent meeting in Prague hosted by the Open Society Foundations: Policy Research, Technology and Advocacy Event @ the Hub. The event was designed to bring experts together from across Central and Eastern European think tanks to share ideas and learn from each other on innovative approaches to evidence-based advocacy and communications.

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    The ethics of emergent knowledge intermediaries

    Future Health Systems

    The use of new knowledge intermediaries in the public health sphere gives rise to a host of ethical issues. These include questions about fairness of access; the quality of the technology used and information generated; who has access to and control of such information; the impact of commercial interests within a healthcare setting; and regulation across borders. How do we address all of these from within our current frameworks of ethical thinking in medicine? In fact, can we?

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    Innovations on the ground: Implications for ICTs in patient self-management

    Future Health Systems

    This series of interviews with participants in a recent workshop on patient self-management hosted by IDS at the Brocher Foundation explores how information and communication technologies are being used to help people cope with chronic diseases in Cambodia, Bangladesh and Uganda. From Cambodia, we hear from Maurits van Pelt of MoPoTsyo, a patient peer group for diabetes sufferers in Cambodia. Dr Mohammed Iqbal from icddr,b talks about chronic disease clubs in Chakaria, Bangladesh. And William Roy Mayega discusses advances in Uganda on treating chronic diseases.

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    The ethical implications of new diagnostic technologies: how personal should we get?

    Future Health Systems

    Diagnostic categories will always be a site of contestation, often linked as much to contemporary standards of morality and normality as to medicine’s capacity to detect disease. But with the global diagnostic industry expanding to be worth $49.2 billion in 2012, and with emerging NCD markets in the BRIC countries behind much of that growth, it is timely to ask if there are developments in diagnostics that are bringing new social, moral or legal concerns to the fore. And how might these play out in the emerging markets?

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    New technologies: Causing and solving the healthcare funding crisis?

    Future Health Systems

    While health economists and actuaries may devise sophisticated models to estimate the costs and benefits of healthcare, it is not only the rich, but the majority of individuals who will insist that no price is too high to pay to delay death or reduce the disability or suffering of themselves or loved ones. However, while the rich can take care of themselves, the rest of us rely on collective risk-sharing arrangements, through various forms of insurance or social welfare schemes. Unfortunately, as advances in medical technology provide new possibilities for extending life by managing serious illness – at an ever increasing cost – the sustainability of such schemes is often called into question.

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    Exploring the implications of new technologies for the self-management of Illness

    Future Health Systems

    What are the potential effects of the development of technology — and specifically information communication technologies (ICTs) such as smartphones, the internet and diagnostic technologies — will have on our current healthcare systems and how this could transform the way we manage health at both an individual and public level? At the beginning of June, the Institute of Development Studies convened a three-day workshop titled ‘Exploring the social, ethical and legal implications of new information and diagnostic technologies for the self-management of Illness’ to tackle exactly that issue. The workshop focused on how people living with chronic communicable and non-communicable disease in low-income countries (LICs) were beginning to actively engage in health seeking behaviour and were using ICTS to manage their conditions. This is the first post in a six-week series that explores these issues.
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    The messy reality of health markets

    Future Health Systems

    During the wrap up session at the end of the Private Sector in Health Symposium 2013, an eminent health economist reflected on a number of the interventions presented at the symposium which revealed the messy reality of the health sector in many countries. He suggested that we really did not seem to know what we meant by the “private sector” – it seemed to cover everything from transnational companies, large and small NGOs, small private clinics, suppliers of health-related goods and services operating outside any legal framework.
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    This is not a love-fest

    Future Health Systems

    On July 6th, the Private Sector in Health Symposium will convene for the third time in six years before the International Health Economics Association (iHEA) World Congress, and builds upon a well-attendedwebinar series in the run-up to the symposium.. The symposium attracts a broad spectrum of scholars from multiple disciplines. It won’t just be economists, and it won’t be a love-fest for unleashing free market economics in health care systems. The private sector in health is problematic, but we are going to have to live with it for quite some time -- so it’s a good thing so many intrepid scholars have joined forces to find ways to get the private sector to effectively deliver high quality services, to reach the poor, and to reduce the financial jeopardy for patients who access it.

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    The challenges of Research Uptake: Systemic, institutional and individual barriers

    Future Health Systems

    Research uptake as a field of study, and more importantly as a field of practice, has been evolving rapidly over the last several decades. But a variety of challenges face research uptake practitioners and those wanting to strengthen capacity to get research into use. These operate at three levels: systemic barriers, institutional barriers and individual barriers.
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    Are informal providers a dangerous detour on the road to universal health coverage?

    Future Health Systems

    At the Second Global Symposium on Health Systems Research, the unifying theme was 'universal health coverage' (UHC). A commitment to achieving UHC was enshrined in the Beijing Statement, and much discussion at the symposium targeted the post-2015 agenda with one health goal. But the road to universal health coverage is long, and the devil is in the details. Human resources for health is critical in meeting the access element of universal health coverage, and working with informal providers to improve care is one way of bolstering the health workforce.
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    Participatory action research for health systems

    Future Health Systems

    There were many methodologically focused sessions during the 2nd Sympsoium on Health Systems Research, including several focusing on more qualitative methods. Future Health Systems participated in one on participatory action research, highlighting their research in Easter Uganda to help improve mothers’ access to safe deliveries. Below are some reflections from the two FHS participants.
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    Would you pee on your tomatoes? Where the HSR approach to knowledge translation is falling short

    Future Health Systems

    As the Policy Influence and Research Uptake Manager for the Future Health Systems research consortium, knowledge translation is central to what I do. I was very pleased to hear, then, that it was a key theme of the 2nd Global Symposium on Health Systems Research. During the symposium, I had the opportunity to participate in several related sessions, and while there were a few interesting insights, it seems to me the health systems research (HSR) approach to knowledge translation is still falling short. Here's why.
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    Where have all the taxis gone? Complex Adaptive Systems in Action in Beijing

    Future Health Systems

    I was cold, and I was wet – having waited for a taxi home for about an hour. And despite my interest in the subject, I somehow took little solace in the fact that getting soaked was the failure of a complex adaptive system. In order to keep Beijing taxi drivers in check, local government made the drivers themselves directly responsible for the costs associated with an accident. That may help keep speeding and reckless driving to a minimum when the skys are blue(ish -- it is Beijing after all), but when it comes to driving in more difficult road conditions, when demand is at its peak, in means that taxi drivers make something of a different economic calculation and stay off the roads. Talk about unintended consequences. But the local transport system was not the only complex adaptive system (CAS) on show here in Beijing. As a PhD student who is currently grappling with understanding Uganda’s complex health workforce dynamics for my dissertation research, I was unsure what to expect to hear about complex adaptive systems (CAS) at the 2nd Global Symposium on HSR. I was fortunate to have participated in the 1st Global Symposium on HSR in Montreux in 2010, which included a handful of discussions on this topic. In Montreux, the discourse was focused on conceptualizing CAS and systems thinking, asking what it they are and why should we apply them in health systems research.

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