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Publications

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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How can political leaders help ensure Community Score Cards in Uganda are sustainable?

Future Health Systems

Beginning in June 2017, the Makerere University School of Public Health (MakSPH), in collaboration with Future Health Systems, has been implementing a CSC project focusing on maternal and newborn health service delivery and utilization in six sub-counties in Kibuku district, Uganda. As one of its exit strategies, the project carried out a qualitative study that explored ways of involving political leaders in the CSC process to ensure its sustainability.

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Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation

Future Health Systems

MacGregor H, McKenzie A, Jacobs T and Ullauri A (2018) Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation, Globalization and Health, 14:40, DOI: 10.1186/s12992-018-0351-z

In 2011, a decision was made to scale up a pilot innovation involving ‘adherence clubs’ as a form of differentiated care for HIV positive people in the public sector antiretroviral therapy programme in the Western Cape Province of South Africa. In 2016 we were involved in the qualitative aspect of an evaluation of the adherence club model, the overall objective of which was to assess the health outcomes for patients accessing clubs through epidemiological analysis, and to conduct a health systems analysis to evaluate how the model of care performed at scale. In this paper we adopt a complex adaptive systems lens to analyse planned organisational change through intervention in a state health system. We explore the challenges associated with taking to scale a pilot that began as a relatively simple innovation by a non-governmental organisation.

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Reflecting strategic and conforming gendered experiences of community health workers (CHWs) using photovoice in rural Wakiso district, Uganda

Future Health Systems

Musoke D, Ssemugabo C, Ndejjo R, Ekirapa-Kiracho E and George AS (2018) Reflecting strategic and conforming gendered experiences of community health workers (CHWs) using photovoice in rural Wakiso district, Uganda, Human Resources for Health, 16:41, DOI: 10.1186/s12960-018-0306-8

Community health workers (CHWs) are an important human resource in Uganda as they are the first contact of the population with the health system. Understanding gendered roles of CHWs is important in establishing how they influence their performance and relationships in communities. This paper explores the differential roles of male and female CHWs in rural Wakiso district, Uganda, using photovoice, an innovative community-based participatory research approach.

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Gender dynamics in digital health: Overcoming blind spots and biases to seize opportunities and responsibilities for transformative health systems

Future Health Systems

George, A, Morgan, R, Larson, E and LeFevre, A (2018) Gender dynamics in digital health: Overcoming blind spots and biases to seize opportunities and responsibilities for transformative health systems, Journal of Public Health, fdy180, DOI: 10.1093/pubmed/fdy180

Much remains to ensure that digital health affirms rather than retrenches inequality, including for gender. Drawing from literature and from the SEARCH projects in this supplement, this commentary highlights key gender dynamics in digital health, including blind spots and biases, as well as transformative opportunities and responsibilities. Women face structural and social barriers that inhibit their participation in digital health, but are also frequently positioned as beneficiaries without opportunities to shape such projects to better fit their needs. Furthermore, overlooking gender relations and focussing on women in isolation can reinforce, rather than address, women’s exclusions in digital health, and worsen negative unanticipated consequences. While digital health provides opportunities to transform gender relations, gender is an intimate and deeply structural form of social inequality that rarely changes due to a single initiative or short-term project. Sustained support over time, across health system stakeholders and levels is required to ensure that transformative change with one set of actors is replicated and reinforced elsewhere in the health system. There is no one size prescriptive formula or checklist. Incremental learning and reflection is required to nurture ownership and respond to unanticipated reactions over time when transforming gender and its multiple intersections with inequality.

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Where girls are less likely to be fully vaccinated than boys: Evidence from a rural area in Bangladesh

Future Health Systems

Hanifi SM, Ravn H, Aaby P and Bhuiya A (2018) Where girls are less likely to be fully vaccinated than boys: Evidence from a rural area in Bangladesh, Vaccine, 36(23):3323-30, DOI: 10.1016/j.vaccine.2018.04.059

Immunization is one of the most successful and effective health intervention to reduce vaccine preventable diseases for children. Recently, Bangladesh has made huge progress in immunization coverage. In this study, we compared the recent immunization coverage between boys and girls in a rural area of Bangladesh.

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