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Publications

Building a competent health manager at district level: a grounded theory study from Eastern Uganda

Future Health Systems

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.

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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

Future Health Systems

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.

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A Practical Guide to Implementation Research on Health Systems

Future Health Systems

Lucas H and Zwarenstein M (2016) A Practical Guide to Implementation Research on Health Systems, Brighton: Institute of Development Studies

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. 

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Distance- and blended-learning in global health research: potentials and challenges

Future Health Systems

Lucas H and Kinsman J (2016) Distance- and blended-learning in global health research: potentials and challenges, Global Health Action, 9:1, DOI:10.3402/gha.v9.33429

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.

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Health Systems Research in a Complex and Rapidly Changing Context: Ethical Implications of Major Health Systems Change at Scale

Future Health Systems

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.

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Promoting equity through health systems research in low- and middle-income countries: Practices of researchers

Future Health Systems

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.

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Community readiness for adopting mHealth in rural Bangladesh: A qualitative exploration

Future Health Systems

Khatun F, Heywood AE, Ray PK, Bhuiya A, Liaw S-T (2016) Community readiness for adopting mHealth in rural Bangladesh: A qualitative exploration, International Journal of Medical Informatics, Volume 93, pp 49–56, DOI: 10.1016/j.ijmedinf.2016.05.010

There are increasing numbers of mHealth initiatives in middle and low income countries aimed at improving health outcomes. Bangladesh is no exception with more than 20 mobile health (mHealth) initiatives in place. A recent study in Bangladesh examined community readiness for mHealth using a framework based on quantitative data. Given the importance of a framework and the complementary role of qualitative exploration, this paper presents data from a qualitative study which complements findings from the quantitative study.

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Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems

Future Health Systems

Pratt B and Hyder AA (2017) Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems, Social Science and Medicine, Volume 174, Pages 113–121, DOI: 10.1016/j.socscimed.2016.11.039

Global health research partnerships are increasingly taking the form of consortia that conduct programs of research in low and middle-income countries (LMICs). An ethical framework has been developed that describes how the governance of consortia comprised of institutions from high-income countries and LMICs should be structured to promote health equity. It encompasses initial guidance for sharing sovereignty in consortia decision-making and sharing consortia resources. This paper describes a first effort to examine whether and how consortia can uphold that guidance. Case study research was undertaken with the Future Health Systems consortium, performs research to improve health service delivery for the poor in Bangladesh, China, India, and Uganda.

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Designing research funding schemes to promote global health equity: An exploration of current practice in health systems research

Future Health Systems

Pratt B and Hyder AA (2016) Designing research funding schemes to promote global health equity: An exploration of current practice in health systems research, Developing World Bioethics, DOI: 10.1111/dewb.12136

International research is an essential means of reducing health disparities between and within countries and should do so as a matter of global justice. Research funders from high-income countries have an obligation of justice to support health research in low and middle-income countries (LMICs) that furthers such objectives. This paper investigates how their current funding schemes are designed to incentivise health systems research in LMICs that promotes health equity.

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What does the end of Africa's boom mean for Universal Health Coverage?

Future Health Systems

Achieving universal health coverage by 2030, as stated in UN Global Goal 3, will require substantial increases in health spending and the proportion funded through taxation or social insurance to make health care affordable for all. Not only will institutions need to be established to ensure sustainable arrangements for social finance, it will also be vital to ensure that health financing is resilient to economic and other shocks if Global Goal 3 is to be realised. This presents a major challenge in Africa, where an economic downturn is projected in a number of resource-dependent countries, such as Mozambique and Guinea Bissau and where countries such as Sierra Leone have weakened health systems. The response to these challenges by governments and development partners, will have important effects on how well people, and the health services on which they rely, cope in the short term and longer-term evolution of health coverage.

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How can health systems research reach the worst-off? A conceptual exploration

Future Health Systems

Pratt B and Hyder AA (2016) How can health systems research reach the worst-off? A conceptual exploration, BMC Health Services Research 16:1868, DOI: 10.1186/s12913-016-1868-6

Health systems research is increasingly being conducted in low and middle-income countries (LMICs). Such research should aim to reduce health disparities between and within countries as a matter of global justice. For such research to do so, ethical guidance that is consistent with egalitarian theories of social justice proposes it ought to (amongst other things) focus on worst-off countries and research populations. Yet who constitutes the worst-off is not well-defined.

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Exploring pathways for building trust in vaccination and strengthening health system resilience

Future Health Systems

Ozawa S, Paina L and Qiu M (2016) Exploring pathways for building trust in vaccination and strengthening health system resilience, BMC Health Services Research, 16:1867, DOI: 10.1186/s12913-016-1867-7

Trust is critical to generate and maintain demand for vaccines in low and middle income countries. However, there is little documentation on how health system insufficiencies affect trust in vaccination and the process of re-building trust once it has been compromised. We reflect on how disruptions to immunizations systems can affect trust in vaccination and can compromise vaccine utilization. We then explore key pathways for overcoming system vulnerabilities in order to restore trust, to strengthen the resilience of health systems and communities, and to promote vaccine utilization.

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Expressing collective voices on children’s health: photovoice exploration with mothers of young children from the Indian Sundarbans

Future Health Systems

Ghosh U, Bose S, Bramhachari R and Mandal S (2016) Expressing collective voices on children’s health: photovoice exploration with mothers of young children from the Indian Sundarbans, BMC Health Services Research, 16:1866, DOI: 10.1186/s12913-016-1866-8

The Indian Sundarbans is marked by inhospitable terrain and frequent climatic shocks which jointly hinder access to health care. Community members, and women in particular, have few means to communicate their concerns to local decision makers. Photovoice is one way in which communities can raise their local health challenges with decision makers. This study unlocks mothers’ voices on the determinants of their children’s health to inform local level decision-making on child health issues in the Indian Sundarbans.

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Unlocking community capability through promotion of self-help for health: experience from Chakaria, Bangladesh

Future Health Systems

Bhuiya A, Hanifi SMA and Hoque S (2016) Unlocking community capability through promotion of self-help for health: experience from Chakaria, Bangladesh, BMC Health Services Research, 16:1865, DOI: 10.1186/s12913-016-1865-9

People’s participation in health, enshrined in the 1978 Alma Ata declaration, seeks to tap into community capability for better health and empowerment. One mechanism to promote participation in health is through participatory action research (PAR) methods. Beginning in 1994, the Bangladeshi research organization ICDDR,B implemented a project “self-help for health,” to work with existing rural self-help organizations (SHOs). SHOs are organizations formed by villagers for their well-being through their own initiatives without external material help. This paper describes the project’s implementation, impact, and reflective learnings.

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Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda

Future Health Systems

Ekirapa-Kiracho E, Namazzi G, Tetui M, Mutebi A, Waiswa P, Oo H, Peters DH and  George AS (2016) Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda, BMC Health Services Research, 16:1864, DOI: 10.1186/s12913-016-1864-x

Community capacities and resources must be harnessed to complement supply side initiatives addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda.

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Identifying community healthcare supports for the elderly and the factors affecting their aging care model preference: evidence from three districts of Beijing

Future Health Systems

Liu T, Hao X and Zhang Z (2016) Identifying community healthcare supports for the elderly and the factors affecting their aging care model preference: evidence from three districts of Beijing, BMC Health Services Research, 16:1863, DOI: 10.1186/s12913-016-1863-y

The Chinese tradition of filial piety, which prioritized family-based care for the elderly, is transitioning and elders can no longer necessarily rely on their children. The purpose of this study was to identify community support for the elderly, and analyze the factors that affect which model of old-age care elderly people dwelling in communities prefer.

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How is perceived community cohesion and membership in community groups associated with children’s dietary adequacy in disadvantaged communities? A case of the Indian Sundarbans

Future Health Systems

Barman D and Vadrevu L (2016) How is perceived community cohesion and membership in community groups associated with children’s dietary adequacy in disadvantaged communities? A case of the Indian Sundarbans, BMC Health Services Research, 16:1862, DOI: 10.1186/s12913-016-1862-z

Membership in community groups and a sense of community cohesion may facilitate collective action in mobilizing resources towards better health outcomes. This paper explores the relationship of these factors, along with individual level socio-economic variables, to dietary adequacy among children below 6 years of age, a proximate determinant of child malnutrition.

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What is the role of community capabilities for maternal health? An exploration of community capabilities as determinants to institutional deliveries in Bangladesh, India, and Uganda

Future Health Systems

Paina L, Vadrevu L, Hanifi SMMA, Akuze J, Rieder R, Chan KS and Peters DH (2016) What is the role of community capabilities for maternal health? An exploration of community capabilities as determinants to institutional deliveries in Bangladesh, India, and Uganda, BMC Health Services Research, 16:1861, DOI: 10.1186/s12913-016-1861-0

While community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access to maternal health services has been underexplored. In this paper, we summarize the development of a community capability score based on the Future Health System (FHS) project’s experience in Bangladesh, India, and Uganda, and, examine the role of community capabilities as determinants of institutional delivery in these three contexts.

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Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review

Future Health Systems

George AS, Scott K, Mehra V and Sriram V (2016) Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review, BMC Health Services Research, 16:1860, DOI: 10.1186/s12913-016-1860-1

Community capability is the combined influence of a community’s social systems and collective resources that can address community problems and broaden community opportunities. We frame it as consisting of three domains that together support community empowerment: what communities have; how communities act; and for whom communities act. We sought to further understand these domains through a secondary analysis of a previous systematic review on community participation in health systems interventions in low and middle income countries (LMICs).

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