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Publications

Maternal newborn health community scorecards in Uganda: a story of change

Future Health Systems

Between June 2017 and December 2018, Makerere University School of Public Health (MakSPH), in collaboration with Future Health Systems, implemented a Community Scorecard project focusing on maternal and newborn health service delivery and utilization in six sub-counties in Kibuku district in Eastern Uganda. This short film highlights some successes from this pilot.

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Challenges and solutions to implementing MNH community scorecards

Future Health Systems

Between 2017 and 2018, the Makerere University School of Public Health (MakSPH), in collaboration with the Future Health Systems Research Consortium, implemented a CSC project focusing on maternal and newborn health service delivery and utilization in six sub-counties in Kibuku District, in Eastern Uganda. The implementation was led by stakeholders in the district and comprised of sub county chiefs, Local council chair persons, Health Unit Management Committee chairpersons, Village health team members, community development officers, sub county level councilors and volunteers. This short film is based on the challenges of implementing the project and also explains how these challenges were handled.

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How to do a maternal & newborn community scorecard

Future Health Systems

FHS partner Makerere University School of Public Health undertook a Community Score Cards study, which contributed to research on how leaders can work with the community and health workers to improve maternal and newborn health in Kibuku District. The use of the Community Score Card tool – a two-way and ongoing participatory tool for assessment, planning, monitoring and evaluation - aims to improve the performance of facilities and accountability by the different stakeholders who are responsible for improving the performance of facilities. This film provides an overview of how to undertake a maternal and newborn community scorecard.

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Vision 2030: Our journey with you

Future Health Systems

The Future Health Systems (FHS) research project consortium was funded by UK Department for International Development (DFID). FHS is a partnership of leading research institutes from across the globe working in a variety of contexts to build resilient health systems for the future in Bangladesh, Uganda, China, India, Sierra Leone, Liberia and Ethiopia. It generated evidence on health systems to benefit the poor.

The FHS India journey started in 2005 with a guiding principle of 'putting the poor first'. This document is a summary of the decade-long work of FHS India. It attempts to share our learnings and challenges and how we have contributed to the SDGs.

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Accountability in Health Service Delivery: a Community Scorecard Exploration in Rural Bangladesh

Future Health Systems

Community clinics (CCs) were established by the Government of Bangladesh with an aim to extend primary health services to the grassroots population in rural areas. Currently there are 13,500 CCs throughout the country and each covers 6,000 population under its jurisdiction and are meant to provide maternal, child health, family planning and other primary health care services. However, challenges still remain in ensuring accountability, quality and equity in healthcare service at the local level. Voice and accountability mechanism are almost non-existent. There are gaps in logistics, quality assurance procedures and the facilities suffer from high staff absenteeism, unskilled staff and inefficient use of supplies. Stakeholders are not fully aware of clinics' purposes and there is weak communication and lack of involvement of local government institutions.

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Children of an Uncertain Climate

Future Health Systems

The FHS-India team has been engaged in research on the human health status in the Indian Sundarbans since 2009 and came up with a comprehensive report in 2010. A more in-depth report on the health of children of the Indian Sundarbans was published in 2013 in the name of Sundarbans Health Watch. In this present endeavor we have reflected on the pathways of climate change impacts on the health of the Sundarbans’ children. This report is based on a mixed method study conducted in Sagar, one of the six most vulnerable blocks out of the nineteen administrative blocks of the Sundarbans. This study has made an attempt to find out the present condition of different aspects of child health under climate crisis, to identify the gaps in service delivery and possible ways out on the basis of scientific evidence.

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Key Message Brief 6: Lessons from results-based financing to improve health services in Afghanistan

Future Health Systems

The Afghanistan experience of nearly 15 years of contracting for health services has demonstrated both how results-based financing (RBF) can serve to increase utilisation of health services and the equity in use, as well as the limitations and failings of RBF approaches to work consistently.

Future Health Systems (FHS) findings, generated through robust experimental and quasi-experimental studies in a rapidly changing context, suggests that attention to scheme design (especially to address demand side concerns, supply side capabilities, and the size and mechanisms of payments) and implementation (timeliness and communication about payments) are critical.

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Service delivery transformation for UHC in Asia and the Pacific

Future Health Systems

Bloom G (2018) Service Delivery Transformation for UHC in Asia and the Pacific, Health Systems & Reform, Volume 5, Issue 1, DOI: 10.1080/23288604.2018.1541498

This article was drafted as part of a review of strategies for making progress toward universal health coverage in the countries of Asia and the Pacific. It focuses on strengthening the delivery of services, in the context of population aging. It argues that it is important to take into account big differences in development contexts and also the rapid, interconnected changes that many countries are experiencing. The article focuses especially on countries with relatively undeveloped institutions and pluralistic and highly segmented health sectors. It argues that attempts by these countries to import institutional arrangements from outside are likely to be complicated. It argues that government needs to focus on both short-term measures to meet immediate needs and the longer-term aim of establishing effective institutional arrangements. This means that they need to take into account the political factors that influence the direction of health system change. The article emphasizes the need to strengthen the capacity of the health system to address the growing challenge of chronic noncommunicable diseases to avoid heavy political pressure to expand hospital services. It then explores the opportunities and challenges associated with the rapid expansion of digital health services. It concludes with a discussion of government stewardship and management of health system transformation to address the major challenges associated with population aging.

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Health impacts of the living conditions of people residing in informal settlements in Freetown: Report on the Future Health Systems (FHS) research in Freetown

Future Health Systems

The rapid pace of urbanisation in most countries in Africa makes urban environments a major determinant of population health. In Freetown, urban growth is associated with the proliferation of informal settlements/slums owing largely to the prevalent poverty, overcrowded and filthy living conditions. Therefore, health outcomes are generally worse with intermittent disease outbreaks which can sometimes spread beyond a single neighbourhood to overwhelm the entire city. But, while a number of studies have documented evidences on the urban health situation in Freetown, such studies have not sufficiently explained the specific and community-wide health risks that people in each informal settlement are faced with. The study describes the living conditions in informal settlements, and explore how these relate to the health of people living there, as told and understood by the residents themselves and as reported in routine statistics.

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Scoping study on the urban health situation in Sierra Leone: A study funded by Future Health Systems (FHS)

Future Health Systems

There is growing concern in recent times about the health burdens faced by urban populations, particularly by those living in informal settlements in Sierra Leone. Many informal settlement dwellers face a variety of health risks which are exacerbated by the rapid urbanization of cities and the subsequent overcrowded living condition of settlements. Though rapid urbanization has negative effects for all in Freetown, those in low-income and disadvantaged groups are disproportionately affected.

Unfortunately, official health statistics and surveys often do not capture sufficient detail on the range of health problems faced by the urban poor who live in slum-like informal settlements. Many health surveys collect data on an aggregate level and are not specifically designed with the urban settings in mind. The lack of disaggregated data on the different informal communities and their residents suggests that appropriate policies which clearly reflect the different demography and health situations may not be in place. Given the dearth of information on how slum living conditions are likely to impact health systems and exacerbate care-seeking barriers, this study was undertaken to provide insights on the current state of knowledge on urban health situation in Sierra Leone.

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Living conditions and health links in Freetown’s informal settlements

Future Health Systems

Living conditions of people living in urban informal settlements are characterized by inhumane conditions, underpinned by lack of essential services like water and sanitation services including toilets and waste disposal dumps, housing and health services. The current state of service provision in Freetown’s informal settlements is in part a product of growing informality, in response to gaps in the provision of public services, notably in sanitation and health care. This policy brief provides an insight into the current state of living conditions in informal settlements of Freetown and how these link to health.

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The state of healthcare access in Freetown’s informal settlements

Future Health Systems

Unequal access to healthcare exacerbates poor health due to their living conditions of those living in informal settlements across Freetown, Sierra Leone. This issue brief provides an insight into the current state of healthcare provision in Freetown’s informal settlements.

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Waste management challenges in Freetown’s informal settlements

Future Health Systems

Waste management has been a challenge in the Freetown municipality of Sierra Leone for a long time, underpinned by the limited capacity of institutions responsible for waste collection and depositing. These challenges come with a huge cost to human health. The situation is even worse for people living in informal settlements within and on the fringes on the city. The lack of a well-planned and regulated waste management system in the informal settlements is a key driver of indiscriminate waste dumping. Waste dumping by communities, mostly in waterways, drainages and under footbridges, are invariably linked to health challenges for informal communities and built-up settlements located alongside those communities. This issue brief therefore provides an insight into the current state of waste management challenges in informal settlements.

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Water and sanitation challenges and impact on health in informal settlements

Future Health Systems

Access to water is one of the major challenges faced by residents of Freetown, Sierra Leone, and informal settlements are no exception to this problem. Communities’ sources and access to water vary by location. The rapid urbanisation and over population is part of the reasons for the water crisis in the city as the estimated beneficiaries far outweigh the capacity of the national Guma valley water company that is responsible for water supply in the city. The topography of the lands occupied by informal settlements makes their situations even worse to get access to safe drinking water. This issue brief provides an insight into the current state of water and sanitation challenges in informal settlements.

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Innovations for Universal Health Coverage: A South-South Collaboration to Transform Health Systems in Africa and India

Future Health Systems

The Public Health Foundation of India (PHFI), Amref Health Africa and the Institute of Development Studies (IDS) have agreed to collaborate in an effort to explore ways that technological innovations can contribute to government strategies for making progress towards universal health coverage (UHC). This means substantially increasing access by those whose basic health care needs are not being met. This report presents the outcome of a meeting held in Bengaluru, India. At this meeting, people with direct experience of different aspects of the development, piloting and taking to scale of technological innovations in India and a number of African countries explored the factors that influence this process.

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The Ebola Virus Disease in Liberia: improving community awareness for disease surveillance

Future Health Systems

At the time of the 2014–2015 Ebola Virus Disease (EVD) outbreak, Liberia was still recovering from years of civil war and unrest. The country’s infrastructure was very poor, especially in rural regions, where people could not easily travel because of the lack of adequate roads. Liberia’s health system was also weakened by the civil war, leaving health facilities struggling to respond to the EVD outbreak effectively.

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Community scorecards: Engaging community and bringing in positive changes to health service delivery at community clinics in rural Bangladesh

Future Health Systems

Community clinics, a flagship programme of the Government of Bangladesh, are health facilities set up to deliver primary health care, family planning and nutrition services to rural people at the grassroots level. Currently there are 13,500 community clinics (CC) in Bangladesh, aimed to cover every 6000 rural population. Despite the widespread establishment of the community clinics, challenges such as shortage of supply, provider absenteeism, lack of properly defined roles and responsibilities of human resources, poor behaviour towards patients, weak accountability and governance, and absence of active participation from community in healthcare delivery restrict efficient use of these facilities and available resources.

To complement the monitoring mechanism of community clinics, the Future Health Systems (FHS) Bangladesh team at icddr,b aimed to implement a community scorecard (CSC) to ensure community participation and provider accountability in the local health system. This FHS Research Brief presents the learnings from the three cycles of community scorecard implementation in the intervention community clinics.

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How to improve child health service utilisation in Ethiopia

Future Health Systems

Ethiopia successfully achieved Millennium Development Goal 4 of reducing under five mortality by more than two-thirds between 1990 and 2015. Adoption of the health extension programme, and implementation of the integrated management of neonatal and childhood illnesses (IMNCI) and the integrated community case management (iCCM) models of care, contributed to this achievement. However, child mortality remains high at 67 per 1,000 live births.

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How to improve maternal health service utilisation in Ethiopia

Future Health Systems

Guided by global health initiatives and with support from the international community, Ethiopia is implementing the primary health care model to improve access to basic maternal health services. However, utilisation of maternal health services along the full cascade of maternity care (family planning, safe abortion, antenatal care, institutional delivery, and postnatal care) is low due to socio-economic, cultural, and structural barriers. This Issue Brief presents key facilitators and barriers to maternal health service utilization in primary care in Ethiopia.

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Which contextual factors facilitate successful implementation of Community Score Cards in Uganda?

Future Health Systems

This issue brief describes the factors that facilitate the CSC implementation process, based on the lessons learnt from a CSC project on maternal and newborn health service delivery and utilization in six sub-counties of Kibuku district in Uganda. District and sub-county stakeholders led the implementation of the CSC, with support from Makerere University School of Public Health (MakSPH). Four rounds of scoring were undertaken between November 2017 and September 2018.

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