Institute of Development Studies (IDS)
IDS is an international centre of excellence in multi-disciplinary analysis, teaching, and practice of development based at the University of Sussex in Brighton, UK. Its areas of expertise include poverty dynamics, social policy analysis, processes for involving stakeholders, strategies for making health services more accountable to their community; and research methods that combine quantitative and qualitative evaluation of performance of health systems. The organisation has experience working on health and social protection in China, Uganda, and other Asian and African countries, innovative strategies to improve provider performance in China and Bangladesh, and developing analytic frameworks to bring together development and public health approaches to understanding health systems.
Who we work with at IDS
- Dr Gerry Bloom (FHS publications, Profile at IDS, Google Scholar profile)
- Tom Barker, FHS Policy Influence and Research Uptake Manager (FHS publications, Profile at IDS)
- Dr Henry Lucas (FHS publications, Profile at IDS)
- Dr Hilary Standing (FHS publications, Profile at IDS)
- Dr Hayley MacGregor (FHS publications, Profile at IDS)
- Dr Linda Waldman (FHS publications, Profile at IDS)
Recent FHS publications involving IDS
This article poses questions, challenges, and dilemmas for health system researchers striving to better understand how gender shapes accountability mechanisms, by critically examining the relationship between accountability and gender in health systems. It raises three key considerations, namely that: (1) power and inequities are centre stage: power relations are critical to both gender and accountability, and accountability mechanisms can transform health systems to be more gender-equitable; (2) intersectionality analyses are necessary: gender is only one dimension of marginalisation and intersects with other social stratifiers to create different experiences of vulnerability; we need to take account of how these stratifiers collectively shape accountability; and (3) empowerment processes that address gender inequities are a prerequisite for bringing about accountability. We suggest that holistic approaches to understanding health systems inequities and accountability mechanisms are needed to transform gendered power inequities, impact on the gendered dimensions of ill health, and enhance health system functioning.
In July 2017, IDS hosted a workshop on ‘Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity’, with the aim of generating dialogue and mutual learning among activists, researchers, policymakers, and funders working towards more equitable health systems and a commitment to Universal Health Coverage (UHC). This issue of the IDS Bulletin is based around three principal themes that emerged from the workshop as needing particular attention. First, the nature of accountability politics ‘in time’ and the cyclical aspects of efforts towards accountability for health equity. Second, the contested politics of ‘naming’ and measuring accountability, and the intersecting dimensions of marginalisation and exclusion that are missing from current debates. Third, the shifting nature of power in global health and new configurations of health actors, social contracts, and the role of technology.For the first time in IDS Bulletin history, themes are explored not only in text but also through a selection of online multimedia content, including a workshop video, a photo story and a documentary. This expansion into other forms of communication is explicitly aimed at galvanising larger numbers of people in a movement towards UHC and the linked agenda of accountability for health equity.The articles and multimedia in this IDS Bulletin reflect the fact that while the desired outcome might be the same – better health for all – accountability strategies are as diverse as the contexts in which they have developed.
Waldman L, Ahmed T, Scott N, Akter S, Standing H and Rasheed S (2018) ‘We have the internet in our hands’: Bangladeshi college students’ use of ICTs for health information, Globalization and Health, 14:31, DOI: 10.1186/s12992-018-0349-6
Information and Communications Technologies (ICTs) which enable people to access, use and promote health information through digital technology, promise important health systems innovations which can challenge gatekeepers’ control of information, through processes of disintermediation. College students, in pursuit of sexual and reproductive health (SRH) information, are particularly affected by gatekeeping as strong social and cultural norms restrict their access to information and services. This paper examines mobile phone usage for obtaining health information in Mirzapur, Bangladesh. It contrasts college students’ usage with that of the general population, asks whether students are using digital technologies for health information in innovative ways, and examines how gender affects this.
A fundamental challenge for health systems is the need to adapt to changes in the patterns of health service need, scientific and technological developments, and the economic and institutional contexts within which providers of health services are embedded. This is especially true of many low and middle-income countries, where the pace of multiple and interconnected changes is breath-taking. This paper introduces the Thematic Issue on Innovation in Health Systems in Low- and Middle-Income Countries.
Information and communication technologies (ICTs) and mHealth innovations hold great potential to improve health systems and health outcomes while at the same time enhancing citizen engagement and accountability. Yet there has been little assessment of the impact of mHealth innovations on the ground.
This paper reviews the experiences of seven mHealth initiatives funded by the Making All Voices Count programme: OurHealth, eThekwini WACs and Thuthuzela Voices (all in South Africa), Mobile Mapping for Women’s Health (Tanzania), Text2Speak (Nigeria), SMS Gateway (Indonesia) and Citizen Journalism for Quality Governance of Universal Health Insurance Scheme (also Indonesia). It discusses the accountability model adopted by each project, and the challenges they faced.
This Working Paper explores the literature on accountability in health systems and on mHealth and to build theoretical and empirical bridges between them. In so doing, the authors lay out a clearer understanding of the role that mHealth can play in accountability for public health services in LMICs, as well as its limitations. At the centre of this role is technology-facilitated information which, for instance, can help governments enforce and improve existing health policy, and which can assist citizens and civil society to communicate with each other to learn more about their rights, and to engage in data collection, monitoring and advocacy. Ultimately however, information, facilitated as it may be by mHealth, does not automatically lead to improved accountability. Different forms of health care come with different accountability challenges to which mHealth is only variably up to task. Furthermore, health systems, embedded as they are in diverse political, social and economic contexts, are extremely complex, and accountability requires far more than information. Thus, mHealth can serve as a tool for accountability, but is likely only able to make a difference in institutional systems that support accountability in other ways (both formal and informal) and in which political actors and health service providers are willing and able to change their behaviour.
Recent FHS blogs from IDS
Quite a lot has changed in the last 40 years, right? And yet, four decades since the 1978 signing of the international Alma Ata declaration in Almaty, Kazakhstan, meeting the essential health needs of people through primary health care has once again been highlighted as the key to the attainment of Health for All by a ‘new’ global movement.
We had three days. That was it. We had three days: to gather, to share ideas and experiences, to make new connections, to strengthen existing ones, and to wrestle with the conceptual beast that is “accountability.” The aim? To bring sharp minds, creative problem-solvers and pragmatic innovators together under one roof so that we might get a few steps closer to our common goal of greater health equity. Did it work? Yes. With caveats. You can be the judge.
The term ‘BRICS’ was coined to reflect a changing world, in which a number of large, emerging economies were starting to play a greater role in world economic affairs. Terms such as this reflect changing global realities, but also have the potential to shape those realities. The jury is still out on how far China’s ‘Belt and Road Initiative’ (BRI) will reshape the way we see the world. The view of blog post authors Lewsi Husain and Gerry Bloom is that it will have a significant impact in many areas, one of which is advancing cooperation for global health. At a time of retrenchment and reorientation in developed economies’ assistance, how China, existing donors and health agencies learn to work together will have an important impact on global health outcomes and may provide learning on how to collaborate on other, more contentious, issues.
By Ligia Paina, FHS Researcher
What happens when you bring 80+ social activists, anthropologists, health systems researchers and policy makers together for a three day workshop and ask them to further the collective understanding of accountability and its role in health equity?
I am going to leave that question for the team from the Institute of Development Studies that hosted the workshop, but here I wanted to share some reflections on what was a fascinating event.
Last week, between 80-90 researchers, practitioners, advocates and policymakers gathered for a three-day workshop organised by the IDS Accountability for Health Equity programme. Entitled Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity, the event was hosted in collaboration with Unequal Voices, Future Health Systems, the Open Society Foundations, the Impact Initiative, and Health Systems Global. In this blog, Tom Barker and Karine Gatellier share their reflections from the event.