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Mapping Networks from #HSR2014

Future Health Systems

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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Training health workers in management skills bears fruit

Future Health Systems

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.

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Minimising delays for maternal health seeking in Uganda through saving schemes

Future Health Systems

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.

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Community health workers encourage women in Uganda to seek skilled care early in pregnancy

Future Health Systems

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.

 

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Tackling negative social cultural norms in Uganda through community dialogues and radio

Future Health Systems

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.

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10 Pictures That Explain The Challenges Of Motherhood In Uganda

Future Health Systems

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).

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Research methods for people-centred health systems: Photovoice

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!

A Fork in the Road in Implementation Research: Swerving towards people centeredness

Future Health Systems

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.

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Research methods for people-centred health systems: Social network analysis

Future Health Systems

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.

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The conversion of a complex adaptive systems modeling sceptic

Future Health Systems

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.

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Communicating complexity

Future Health Systems

Alexander Galloway (2011) in his article ‘Are some things unrepresentable?’ cites a causal loop diagram as an example of a critical tension in communication where the more information that is represented the less information is actually conveyed. He dubs it ‘McChrystal’s Law’, and then proceeds to suggest that such visualisations contribute to a political violence committed against the viewer, in part because the aesthetics of the diagram overstate its ability to represent. Yikes!

Unfortunately, McChrystal’s Law is just the tip of the iceberg when it comes to communicating complexity. At a three-day workshop jointly convened by Future Health Systems and the STEPS Centre examining complex adaptive systems (CAS), we had an interesting discussion about some of those challenges.

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Complexity in practice: Experiences from research to improve maternal health in Uganda

Future Health Systems

Many will already be familiar with the term ‘complex adaptive systems’ (CAS). It’s certainly something we’ve talked about a lot within the Future Health Systems consortium. But it’s a term, and concept and a practice that has taken me some time to fully comprehend and to utilize in my own work. We are implementing a number of implementation research projects in Eastern Uganda, and most of my attention has been focused on the day-to-day operations of these large projects. However, I’ve found CAS tools to help me step back and get a broader picture of our research intervention. Here’s why.

 

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How participatory is participatory modelling for complex adaptive systems?

Future Health Systems

At a recent workshop on methods for understanding complex adaptive systems (CAS) in the context of health systems strengthening, we looked at a number of modelling techniques, like agent-based modeling and causal loop diagrams, some purporting to be participatory in nature. But is the idea of participatory approaches to complex systems thinking inherently contradictory? Inherently confusing? Or are they revolutionary, altering how we see the world and empowering us to transform health systems radically?

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Capturing the legacy of and learning from long-term programmes using innovation histories

Future Health Systems

At the recent workshop on methods for complex adaptive systems (CAS) research in Baltimore, jointly organised by the STEPS Centre and Future Health Systems, thoughts turned to the legacy of such long-term programmes. Though they had different funders, both STEPS and FHS started in 2006. So now, as both programmes start thinking about their 10th anniversaries, how can we begin to summarise all that research and the influence that it has had?

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Ten things to know about causal loop diagrams (CLDs)

Future Health Systems

As discussed at a methods workshop held in Baltimore in June 2014, systems mapping and conceptualization – a key part of the puzzle of intervening in complex systems – is a process of developing diagrams to illustrate system boundaries and the connections between variables.

CLDs are one type of system map, but they are by no means the only one. What makes CLDs particularly useful is that, in addition to mapping a system structure, they help build understanding of connections between a range of variables.

The increased momentum around complexity and tools such as the CLDs begin to raise issues that question the very core of the paradigms in which we generally operate in public health. That creates demand for understanding what CLDs are and when to develop and use them. It also creates an opportunity to drop some of the communication barriers that exist between disciplines and to push the boundaries of our understanding of complex systems.

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New methods needed: How can complexity science help us to understand pluralistic health systems?

Future Health Systems

Until recently, the dominant view of a health system was as a combination of building blocks -- such as human resources, finance and so forth -- capable of delivering a package of services. The construction of this kind of health system was seen as relatively straight forward.

However, a number of studies have challenged this view by demonstrating the important influence of context on health system performance. This has stimulated an interest among health system analysts in the application of concepts associated with complex adaptive systems to the challenge of managing health system development and change.

This was the theme of a workshop jointly organised by Future Health Systems and the STEPS Centre in Baltimore in June 2014. The workshop provided an opportunity for an exchange of ideas between people whose focus has been on the analysis of health systems, those involved in systems thinking and the role of modelling and those who bring a social science perspective to the analysis of complex and dynamic contexts.

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7 Things Everyone Should Know About DFID’s Approach To Health Systems Strengthening

Future Health Systems

At the end of June, the UK Parliament’s International Development Committee heard oral evidence about the UK Department for International Development’s (DFID’s) efforts to improve health systems in low- and middle-income countries (LMICs). But why do health systems matter? And what is health systems strengthening anyway? Here are the top things you need to know. Click through to original post on Buzzfeed.

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