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Publications

Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda

Future Health Systems

Tetui M, Coe A-B, Hurtig A-K, Ekirapa-Kiracho E and Kiwanuka SN (2017) Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda, Global Health Action, 10:sup4, 1346038, DOI: 10.1080/16549716.2017.1346038

To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical. A participatory action research approach is applauded for building local capacity such as health management. Thereby increasing the chances of sustaining health interventions. This study explored stakeholder experiences of using PAR to implement an intervention meant to strengthen the local district capacity.

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‘Nurture the sprouting bud; do not uproot it’. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda

Future Health Systems

Ekirapa-Kiracho E, Paina L, Kananura RM, Mutebi A, Jane P, Tumuhairwe J, Tetui M and Kiwanuka SN (2017) ‘Nurture the sprouting bud; do not uproot it’. Using saving groups to save for maternal and newborn health: lessons from rural Eastern Uganda, Global Health Action, 10:sup4, 1347311, DOI: 10.1080/16549716.2017.1347311

Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups.

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Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services

Future Health Systems

Mutebi A, Kananura RM, Ekirapa-Kiracho E, Bua J, Kiwanuka SN, Nammazi G, Paina L and Tetui M (2017) Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services, Global Health Action, 10:sup4, 1347363, DOI: 10.1080/16549716.2017.1347363

Rural populations in Uganda have limited access to formal financial Institutions, but a growing majority belong to saving groups. These saving groups could have the potential to improve household income and access to health services. This article aimed to understand organizational characteristics, benefits and challenges, of savings groups in rural Uganda.

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Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda

Future Health Systems

Namazzi G, Okuga M, Tetui M, Kananura RM, Kakaire A, Namutamba S, Mutebi A,  Kiwanuka SN, Ekirapa-Kiracho E and Waiswa P (2017) Working with community health workers to improve maternal and newborn health outcomes: implementation and scale-up lessons from eastern Uganda, Global Health Action, 10:sup4, 1345495, DOI: 10.1080/16549716.2017.1345495

Preventable maternal and newborn deaths can be averted through simple evidence-based interventions, such as the use of community health workers (CHWs), also known in Uganda as village health teams. However, the CHW strategy faces implementation challenges regarding training packages, supervision, and motivation. This paper explores knowledge levels of CHWs, describes the coverage of home visits, and shares lessons learnt from setting up and implementing the CHW strategy.

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Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda

Future Health Systems

Kiwanuka SN, Akulume M, Tetui M, Kananura RM, Bua J and Ekirapa-Kiracho E (2017) Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda, Global Health Action, 10:sup4, 1345494, DOI: 10.1080/16549716.2017.1345494

Health worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered. This paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda.

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Effect of support supervision on maternal and newborn health services and practices in Rural Eastern Uganda

Future Health Systems

Kisakye AN, Kananura RM, Ekirapa-Kiracho E, Bua J, Akulume M, Namazzi G and  Kiwanuka SN (2017) Effect of support supervision on maternal and newborn health services and practices in Rural Eastern Uganda, Global Health Action, 10:sup4, 1345496, DOI: 10.1080/16549716.2017.1345496

Support supervision is one of the strategies used to check the quality of services provided at health facilities. From 2013 to 2015, Makerere University School of Public Health strengthened support supervision in the district of Kibuku, Kamuli and Pallisa in Eastern Uganda to improve the quality of maternal and newborn services. This article assesses quality improvements in maternal and newborn care services and practices during this period.

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A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

Future Health Systems

Ajeani J, Ayiasi RM, Tetui M, Ekirapa-Kiracho E, Namazzi G, Kananura RM,  Kiwanuka SN and Beyeza-Kashesya J (2017) A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons, Global Health Action, 10:sup4, 1345497

There is increasing demand for trainers to shift from traditional didactic training to innovative approaches that are more results-oriented. Mentorship is one such approach that could bridge the clinical knowledge gap among health workers. This paper describes the experiences of an attempt to improve health-worker performance in maternal and newborn health in three rural districts through a mentoring process using the cascade model. The paper further highlights achievements and lessons learnt during implementation of the cascade model.

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Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda...

Future Health Systems

Kananura RM, Tetui M, Bua J, Ekirapa-Kiracho E, Mutebi A, Namazzi G, Kiwanuka SN and Waiswa P (2017) Effect of a participatory multisectoral maternal and newborn intervention on birth preparedness and knowledge of maternal and newborn danger signs among women in Eastern Uganda: a quasi-experiment study, Global Health Action, 10:sup4, 1362826, DOI: 10.1080/16549716.2017.1362826

Knowledge of obstetric danger signs and adequate birth preparedness (BP) are critical for improving maternal services utilization. This study assessed the effect of a participatory multi-sectoral maternal and newborn intervention on BP and knowledge of obstetric danger signs among women in Eastern Uganda.

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Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts

Future Health Systems

Ekirapa-Kiracho E, Kananura RM, Tetui M, Namazzi G, Mutebi A, George A, Paina L, Waiswa P, Bumba A, Mulekwa G, Nakiganda-Busiku D, Lyagoba M, Naiga H, Putan M, Kulwenza A, Ajeani J, Kakaire-Kirunda A, Makumbi F, Atuyambe L, Okui O and  Kiwanuka SN (2017) Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts, Global Health Action, 10:sup4, 1363506, DOI: 10.1080/16549716.2017.1363506

The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices.

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Maternal and neonatal implementation for equitable systems: A study design paper

Future Health Systems

Ekirapa-Kiracho E, Tetui M, Bua J, Kananura RM, Waiswa P, Makumbi F, Atuyambe L, Ajeani J, George A, Mutebi A, Kakaire A, Namazzi G, Paina L and Kiwanuka SN (2017) Maternal and neonatal implementation for equitable systems: A study design paper, Global Health Action, 10:sup4, 1359924, DOI: 10.1080/16549716.2017.1346925

Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach.

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Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda

Future Health Systems

George A, Tetui M, Pariyo GW and Peterson SS (2017) Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda, Global Health Action,  10:sup4, 1359924, DOI: 10.1080/16549716.2017.1359924

This editorial provides an overview of the Global Health Action MANIFEST special issue. The special issue covers 10 papers whose main purpose is to share findings from a maternal and neonatal health intervention in Uganda. The MANIFEST intervention used a participatory action research approach to engage different actors to improve maternal and neonatal health outcomes in the districts of
Pallisa, Kibuku and Kamuli, in eastern Uganda.

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Beyond pilotitis: taking digital health interventions to the national level in China and Uganda

Future Health Systems

Huang F, Blaschke S and Lucas H (2017) Beyond pilotitis: taking digital health interventions to the national level in China and Uganda, Globalization and Health, 13:49, doi: 10.1186/s12992-017-0275-z

Innovation theory has focused on the adoption of new products or services by individuals and their market-driven diffusion to the population at large. However, major health sector innovations typically emerge from negotiations between diverse stakeholders who compete to impose or at least prioritise their preferred version of that innovation. Thus, while many digital health interventions have succeeded in terms of adoption by a substantial number of providers and patients, they have generally failed to gain the level of acceptance required for their integration into national health systems that would promote sustainability and population-wide application. The area of innovation considered here relates to a growing number of success stories that have created considerable enthusiasm among donors, international agencies, and governments for the potential role of ICTs in transforming weak national health information systems in middle and low income countries. This article uses a case study approach to consider the assumptions, institutional as well as technical, underlying this enthusiasm and explores possible ways in which outcomes might be improved.

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ICTs and the challenge of health system transition in low and middle-income countries

Future Health Systems

Bloom G, Berdou E, Standing H, Guo Z and Labrique A (2017) ICTs and the challenge of health system transition in low and middle-income countries, Globalization and Health, 13:56, doi: 10.1186/s12992-017-0276-y

The aim of this paper is to contribute to debates about how governments and other stakeholders can influence the application of ICTs to increase access to safe, effective and affordable treatment of common illnesses, especially by the poor. First, it argues that the health sector is best conceptualized as a ‘knowledge economy’. This supports a broadened view of health service provision that includes formal and informal arrangements for the provision of medical advice and drugs. This is particularly important in countries with a pluralistic health system, with relatively underdeveloped institutional arrangements. It then argues that reframing the health sector as a knowledge economy allows us to circumvent the blind spots associated with donor-driven ICT-interventions and consider more broadly the forces that are driving e-health innovations. It draws on small case studies in Bangladesh and China to illustrate new types of organization and new kinds of relationship between organizations that are emerging. It argues that several factors have impeded the rapid diffusion of ICT innovations at scale including: the limited capacity of innovations to meet health service needs, the time it takes to build new kinds of partnership between public and private actors and participants in the health and communications sectors and the lack of a supportive regulatory environment. It emphasises the need to understand the political economy of the digital health knowledge economy and the new regulatory challenges likely to emerge. It concludes that governments will need to play a more active role to facilitate the diffusion of beneficial ICT innovations at scale and ensure that the overall pattern of health system development meets the needs of the population, including the poor.

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Policy experimentation and innovation as a response to complexity in China’s management of health reforms

Future Health Systems

Husain L (2017) Policy experimentation and innovation as a response to complexity in China’s management of health reforms, Globalization and Health, 13:54, doi: 10.1186/s12992-017-0277-x

There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the late 1970s, Chinese government has managed complex, rapid and intersecting reforms across many policy areas. As with reforms in other policy areas, reform of the health system has been through a process of trial and error. There is increasing understanding of the importance of policy experimentation and innovation in many of China’s reforms; this article argues that these processes have been important in rebuilding China’s health system. 

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New Digital Ways of Delivering Sex Education: A Practice Perspective

Future Health Systems

Waldman L and Amazon-Brown I (2017) New Digital Ways of Delivering Sex Education: A Practice Perspective, IDS Bulletin, Institute of Development Studies, DOI: 10.19088/1968-2017.104

This article explores new, under-researched genres of sex education for adolescents in sub-Saharan Africa resulting from access to the internet through mobile phones. It examines the history of developing online health information platforms tailored for youth through the experiences of digital developers and the reflections of users.

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Antimicrobial resistance and Universal Health Coverage

Future Health Systems

Bloom G, Wilkinson A and Buckland Merritt G (2017) Antimicrobial resistance and Universal Health Coverage, In Antimicrobial resistance in the Asia Pacific region: a development agenda (pp. 9-21). Manila, Philippines. World Health Organization Regional Office for the Western Pacific. Licence: CC BY-NC-SA 3.0 IGO.

Chapter two highlights priorities for an integrated approach for addressing AMR by strengthening universal health coverage (UHC). It focuses on the use of drugs in outpatient settings. The chapter gives particular consideration to low- and middle-income countries with pluralistic health systems, where government provision and health markets combine and where people seek treatment for a large proportion of common infections in weakly regulated markets.

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Opportunities for strengthening infant and young child feeding policies in South Asia: Insights from the SAIFRN policy analysis project

Future Health Systems

Thow AM, Karn S, Devkota MD, Rasheed S, Roy SK, Suleman Y, Hazir T, Patel A, Gaidhane A, Puri S, Godakandage S, Senarath U and Dibley MJ (2017) Opportunities for strengthening infant and young child feeding policies in South Asia: Insights from the SAIFRN policy analysis project, BMC Public Health, 17(Suppl 2):404 DOI: 10.1186/s12889-017-4336-2

South Asian countries experience some of the highest levels of child undernutrition in the world, strongly linked to poor infant and young child feeding (IYCF) practices. Strong and responsive policy support is essential for effective interventions to improve IYCF. This study aimed to identify opportunities for strengthening the policy environment in the region to better support appropriate infant and young child feeding.

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Analysis of stakeholders networks of infant and young child nutrition programmes in Sri Lanka, India, Nepal, Bangladesh and Pakistan

Future Health Systems

Uddin S, Mahmood H, Senarath U, Zahiruddin Q, Karn S, Rasheed S and Dibley M (2017) Analysis of stakeholders networks of infant and young child nutrition programmes in Sri Lanka, India, Nepal, Bangladesh and Pakistan, BMC Public Health, 17(Suppl 2):405, DOI: 10.1186/s12889-017-4337-1


Effective public policies are needed to support appropriate infant and young child feeding (IYCF) to ensure adequate child growth and development, especially in low and middle income countries. The aim of this study was to: (i) capture stakeholder networks in relation to funding and technical support for IYCF policy across five countries in South Asia (i.e. Sri Lanka, India, Nepal, Bangladesh and Pakistan); and (ii) understand how stakeholder networks differed between countries, and identify common actors and their patterns in network engagement across the region.

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Policy content and stakeholder network analysis for infant and young child feeding in Bangladesh

Future Health Systems

Rasheed S, Roy SK, Das S, Chowdhury SN, Iqbal M, Akter SM, Jahan K, Uddin S and Thow AM (2017) Policy content and stakeholder network analysis for infant and young child feeding in Bangladesh, BMC Public Health, 17(Suppl 2):402, DOI: 10.1186/s12889-017-4338-0

Appropriate infant and young child feeding (IYCF) practices are essential for nutrition of infants and young children. Bangladesh has one of the highest levels of malnutrition globally along with sub-optimal IYCF practices. A supportive policy environment is essential to ensure that effective IYCF interventions are scaled up.

The objectives of our study were to assess the support for IYCF in the national policy environment through policy analysis and stakeholder analysis and in so doing identify opportunities to strengthen the policy environment.

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Impact of fortified biscuits on micronutrient deficiencies among primary school children in Bangladesh

Future Health Systems

Adams AM, Ahmed R, Mahbub Latif AHM, Rasheed S, Das SM, Hasib E, Farzana FD, Ferdous F, Ahmed S, Faruque ASG (2017) Impact of fortified biscuits on micronutrient deficiencies among primary school children in Bangladesh, PLOS One, 12(4): e0174673, DOI: 10.1371/journal.pone.0174673

Micronutrient deficiencies can compromise the development potential of school-aged children, and their later health and productivity as adults. School feeding and school-based fortification approaches have been utilized globally to redress nutritional deficiencies in this age group. The authors explored the acceptability and micronutrient impact of a Bangladesh Government supported school-based micronutrient fortification program for children attending rural primary schools in 10 disadvantaged sub-districts.

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