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.Read More
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.Read More
Policy experimentation and innovation as a response to complexity in China’s management of health reforms
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.Read More
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.Read More
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.Read More
Opportunities for strengthening infant and young child feeding policies in South Asia: Insights from the SAIFRN policy analysis project
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.Read More
Analysis of stakeholders networks of infant and young child nutrition programmes in Sri Lanka, India, Nepal, Bangladesh and Pakistan
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.
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.Read More
Impact of fortified biscuits on micronutrient deficiencies among primary school children in Bangladesh
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.
Socioeconomic and programmatic determinants of renewal of membership in a voluntary micro health insurance scheme: evidence from Chakaria, Bangladesh
Iqbal M, Chowdhury AH, Mahmood SS, Mia MN, Hanifi SMA and Bhuiya A (2017) Socioeconomic and programmatic determinants of renewal of membership in a voluntary micro health insurance scheme: evidence from Chakaria, Bangladesh, Global Health Action, Vol 10, Issue 1, DOI: 10.1080/16549716.2017.1287398
Out-of-pocket (OOP) healthcare expenditure is a major obstacle for achieving universal health coverage in low-income countries including Bangladesh. Sixty-three percent of the USD 27 annual per-capita healthcare expenditure in Bangladesh comes from individuals’ pockets. Although health insurance is a financial tool for reducing OOP, use of such tools in Bangladesh has been limited to some small-scale voluntary micro health insurance (MHI) schemes run by non-governmental organizations (NGO). The MHI, however, can orient people on health insurance concept and provide learning for product development, implementation, barriers to enrolment, membership renewal, and other operational challenges and solutions. Keeping this in mind, icddr,b in 2012 initiated a pilot MHI, Amader Shasthya, in Chakaria, Bangladesh. This paper explores the determinants of membership renewal in this scheme, which is a perpetual challenge for MHI.Read More
Prevalence, pattern and sociodemographic differentials in smokeless tobacco consumption in Bangladesh: evidence from a population-based cross-sectional study in Chakaria
Mia MN, Hanifi SMA, Rahman MS, et al (2017) Prevalence, pattern and sociodemographic differentials in smokeless tobacco consumption in Bangladesh: evidence from a population-based cross-sectional study in Chakaria, BMJ Open 2017;7, DOI: 10.1136/bmjopen-2016-012765
The health hazards associated with the use of smokeless tobacco (SLT) are similar to those of smoking. However, unlike smoking, limited initiatives have been taken to control the use of SLT, despite its widespread use in South and Southeast Asian countries including Bangladesh. It is therefore important to examine the prevalence of SLT use and its social determinants for designing appropriate strategies and programmes to control its use.Read More
Health literacy in a community with low levels of education: findings from Chakaria, a rural area of Bangladesh
Das S, Mia MN, Hanifi SMA, Hoque S and Bhuiya A (2017) Health literacy in a community with low levels of education: findings from Chakaria, a rural area of Bangladesh, BMC Public Health, 17:203, DOI: 10.1186/s12889-017-4097-y
Health literacy (HL) helps individuals to make effective use of available health services. In low-income countries such as Bangladesh, the less than optimum use of services could be due to low levels of HL. Bangladesh’s health service delivery is pluralistic with a mix of public, private and informally trained healthcare providers. Emphasis on HL has been inadequate. Thus, it is important to assess the levels of HL and service utilization patterns. The findings from this study aim to bridge the knowledge gap.
Lessons Learned From Implementing E-Learning for the Education of Health Professionals in Resource-Constrained Countries
Gupta M et al (2017) Lessons Learned From Implementing E-Learning for the Education of Health Professionals in Resource-Constrained Countries, The Electronic Journal of e-Learning, Volume 15 Issue 2 2017, (pp144-155)
The growing global demand for tertiary education has led to the increased use of e-learning approaches around the world. Demand has increased most rapidly in low and middle income countries (LMICs), which account for half of the students currently enrolled in higher educational institutions (HEIs). But the implementation of e-learning programmes in resource-constrained settings faces many obstacles. This paper explores some of the key issues involved in implementation of e-learning in HEIs involved in the education of health professionals, given the resource constraints within which many institutions have to function. We present case studies of three such LMIC institutions of varying size and primary purpose. The paper suggests use of appropriate ICT infrastructure, both in terms of hardware and software, combined with effective access and bandwidth management policies is crucial to the successful implementation of e-learning courses on health within HEIs based in LMICs.
A structural equation analysis on the relationship between maternal health services utilization and newborn health outcomes: a cross-sectional study in Eastern Uganda
Kananura RM, Wamala R, Ekirapa-Kiracho E, Tetui M, Kiwanuka SN, Waiswa P and Atuhaire LK (2017) A structural equation analysis on the relationship between maternal health services utilization and newborn health, BMC Pregnancy and Childbirth, 17:98, DOI: 10.1186/s12884-017-1289-5
Neonatal and maternal health services have a bearing on neonatal mortality. Direct and indirect factors affecting neonatal health outcomes therefore require understanding to enable well-targeted interventions. This study, therefore, assessed the interrelationship between newborn health outcomes and maternal service utilization factors.
Tetui M, Hurtig A-K, Ekirpa-Kiracho E, Kiwanuka SN and Coe A-B (2016) Building a competent health manager at district level: a grounded theory study from Eastern Uganda, BMC Health Services Research, 16:665, DOI: 10.1186/s12913-016-1918-0
Health systems in low-income countries are often characterized by poor health outcomes. While many reasons have been advanced to explain the persistently poor outcomes, management of the system has been found to play a key role. According to a WHO framework, the management of health systems is central to its ability to deliver needed health services. In this study, we examined how district managers in a rural setting in Uganda perceived existing approaches to strengthening management so as to provide a pragmatic and synergistic model for improving management capacity building.Read More
Measuring spatial equity and access to maternal health services using enhanced two step floating catchment area method (E2SFCA) – a case study of the Indian Sundarbans
Vadrevu L and Kanjilal B (2016) Measuring spatial equity and access to maternal health services using enhanced two step floating catchment area method (E2SFCA) – a case study of the Indian Sundarbans, International Journal for Equity in Health, 15: 87, doi:10.1186/s12939-016-0376-y
Inaccessibility due to terrain and lack of transport leaves mothers travelling for long hours before reaching a facility to deliver a child. In the present article we analyzed the issue of spatial inaccessibility and inequity of maternal health services in the Indian Sundarbans where complex topography and repeated climatic adversities make access to health services very difficult.Read More
This is an open access resource targeted primarily at post-graduate students intending to undertake field research on health systems interventions in resource-poor environments.
The book consists of twelve chapters addressing theory, methodology, analysis, and influencing policy. Each consists of both original text and links to relevant, open access, web-based journal and multi-media materials, including selected case studies.Read More
It has been argued that in every country, ‘social, educational, technological, and economic development fundamentally depends on the advancement of science through research … and [it] benefits from having a … network of actors engaged in promoting and using scientific research’. This applies in particular to life sciences research in low- and middle-income countries (LMICs), given that many such countries face the heaviest burdens of disease. However, Langer et al. lamented in 2004, that ‘In the fields of medicine and public health … papers where researchers from developing countries are the sole authors represent a very low proportion of published manuscripts’. The reasons identified for this include: poor access to scientific literature, poor participation in publication-related decision-making processes, and the bias of journals. Much has changed since then, with a dramatic growth in the number of journals addressing public health concerns, many of which are based in LMICs or which include LMIC researchers on their editorial boards. There have been substantial initiatives, most notably Hinari, to provide LMIC researchers with access to the scientific literature. However, though the number of LMIC publications has increased substantially, a recent publication found no LMIC in the top forty countries in terms of publications per capita.Read More
Health Systems Research in a Complex and Rapidly Changing Context: Ethical Implications of Major Health Systems Change at Scale
MacGregor H and Bloom G (2016) Health Systems Research in a Complex and Rapidly Changing Context: Ethical Implications of Major Health Systems Change at Scale, Developing World Bioethics, 16(3): 158–167, doi:10.1111/dewb.12115
This paper discusses health policy and systems research in complex and rapidly changing contexts. It focuses on ethical issues at stake for researchers working with government policy makers to provide evidence to inform major health systems change at scale, particularly when the dynamic nature of the context and ongoing challenges to the health system can result in unpredictable outcomes.Read More
Promoting equity through health systems research in low- and middle-income countries: Practices of researchers
Pratt B, Allen KA and Hyder AA (2016) Promoting equity through health systems research in low- and middle-income countries: Practices of researchers, AJOB Empirical Bioethics, Volume 7, Issue 3, DOI:10.1080/23294515.2015.1122669
Health systems research is increasingly identified as an indispensable means to achieve the goal of health equity between and within countries. While conceptual work has explored what form of health systems research in low and middle-income countries (LMICs) is needed to promote health equity, there have been few attempts to investigate whether it is being performed in practice. This paper describes the results of a survey undertaken with health systems researchers worldwide to assess how equity-oriented current practice is in LMICs.Read More