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Publications

Filtering by Category: 2013

Health progress and research culture in Bangladesh

Future Health Systems

The emergence of a research culture in Bangladesh promoting rigorous research, developing interventions, and translating evidence into policies made a substantial contribution to the improvement of health outcomes in Bangladesh. Notably, the reduction of mortality from diarrhoea and vaccine preventable diseases and control of fertility have made the most significant contributions to recent health gains.
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Innovation for universal health coverage in Bangladesh: a call to action

Future Health Systems

A post-Millennium Development Goals agenda for health in Bangladesh should be defined to encourage a second generation of health-system innovations under the clarion call of universal health coverage. This agenda should draw on the experience of the first generation of innovations that underlie the country's impressive health achievements and creatively address future health challenges.
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Community-based approaches and partnerships: innovations in health-service delivery in Bangladesh

Future Health Systems

This article explores strategies in health-service delivery that have maximised reach and improved health outcomes. We identify three distinctive features that have enabled Bangladesh to improve health-service coverage and health outcomes: (1) experimentation with, and widespread application of, large-scale community-based approaches, especially investment in community health workers using a doorstep delivery approach; (2) experimentation with informal and contractual partnership arrangements that capitalise on the ability of non-governmental organisations to generate community trust, reach the most deprived populations, and address service gaps; and (3) rapid adoption of context-specific innovative technologies and policies that identify country-specific systems and mechanisms.
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Harnessing pluralism for better health in Bangladesh

Future Health Systems

How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defined by the participation of a multiplicity of different stakeholders and agents and by ad hoc, diffused forms of management has contributed to these outcomes by creating conditions for rapid change.
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The Bangladesh paradox: exceptional health achievement despite economic poverty

Future Health Systems

Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households.
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FHS India Research Brief 5: How healthy are the children of the Indian Sundarbans?

Future Health Systems

The health situation of children in the Indian Sundarbans couldn’t be more precarious. Facing chronic malnutrition as well as a high prevalence of easily preventable but highly communicable diseases, access for children to health services in the region is complicated by the rough terrain and the winding tidal rivers of the deltaic region.The key question is, what can be done to improve the health situation of children in the Sundarbans? This briefing answers that question by outlining the several methodologies employed in the study. It then considers both the demand and supply sides for child-centred health services in the block. It concludes with recommendations for beginning to repair the fractured health system there.
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FHS Bangladesh Research Brief 5: Use of mHealth to improve the quality of services of the village doctors

Future Health Systems

Village doctors are the dominant health care providers in rural areas of Bangladesh. icddr,b has previously tested interventions to improve the quality of their services – especially training on acceptable practice and the creation of a franchise called ShasthyaSena (health soldier). But training alone met with limited success. To improve the quality of these services, icddr,b has been testing an mHealth intervention that linked ShasthyaSenas to qualified physicians through a call centre. This brief documents the successes and challenges faced during the first year of implementation of the mHealth intervention.
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Aid alignment: a longer term lens on trends in development assistance for health in Uganda

Future Health Systems

Over the past decade, development assistance for health (DAH) in Uganda has increased dramatically, surpassing the government’s own expenditures on health. Yet primary health care and other priorities identified in Uganda’s health sector strategic plan remain underfunded. Using data available from the Creditor Reporting System (CRS), National Health Accounts (NHA), and government financial reports, the article examines trends in how donors channel DAH and the extent to which DAH is aligned with sector priorities.
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Public trust and vaccine acceptance-international perspectives

Future Health Systems

Trust in vaccines and in the health system is an important element of public health programs that aim to deliver life-saving vaccines. Indeed, understanding the contributors and threats to trust is essential to explaining vaccine acceptance, particularly as they vary across epidemiologic conditions, specific vaccines and cultural and sociopolitical settings. Greater efforts to communicate the benefits and risks of vaccines and address issues with evidence-based information will help improve and sustain public trust in vaccines and health systems worldwide. Measuring and monitoring trust levels and focusing on deliberate efforts to build trust in vaccines are important steps to reducing vaccine confidence gaps when they occur.
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How do you measure trust in the health system? A systematic review of the literature

Future Health Systems

People's trust in the health system plays a role in explaining one's access to and utilization of medical care, adherence to medications, continuity of care, and even self-reported health status. Yet it is not easy to find trust measures and understand what they are measuring. A systematic review of scales and indices identified 45 measures of trust within the health system with an average of 12 questions each, which quantified levels of trust among various relationships across the health system.
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Unlocking community capabilities to improve health service delivery

Future Health Systems

FHS's 'unlocking community capabilities' (UCC) theme systematically examines how communities can be active participants in the planning, delivery, monitoring and evaluation of their health system, by identifying and mobilising individual and collective capabilities in different social, political, and institutional environments. This brief explores current activities and initial findings from the theme.
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Real Time Monitoring for the Most Vulnerable: Concepts and Methods

Future Health Systems

In assessing the value of different approaches to real-time monitoring for the most vulnerable, an initial requirement is to set out a conceptual framework that provides at least some degree of clarity as to what precisely is meant by ‘real time’, ‘monitoring’ and ‘vulnerable’ – all terms that can be highly context-specific. That is the first task addressed here. The second is to consider potential sources of data that might be used to undertake real-time monitoring and assess their advantages and disadvantages for the present purpose. Four general approaches are considered – community-based participatory monitoring, sentinel sites, routine data systems and rapid surveys – and selected examples from the literature are given to illustrate the potential use and limitations of their applications.
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Real Time Monitoring and the New Information Technologies

Future Health Systems

Debates as to the potential role of new Information and Communication Technologies (ICTs) in monitoring the wellbeing of vulnerable groups is often bedevilled by the failure of two principal actors – social researchers and technical experts – to address the other’s concerns or even to use language that is comprehensible to the other side. The aim here is to unpick some of the technical language relevant in this context and provide a brief introductory guide to some aspects of the current, rapidly changing and highly diverse ICT environment.

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Introduction: Real Time Monitoring for the Most Vulnerable – Investing in Common Guidance for Equity and Quality

Future Health Systems

Growth in the use of real-time digital information for monitoring has been rapid in developing countries across all the social sectors, and in the health sector has been remarkable. Commonly these Real Time Monitoring (RTM) initiatives involve partnerships between the state, civil society, donors and the private sector. This article proposes the development of an effective learning and action agenda centred on the adoption of common guidance.
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Socioeconomic development as an intervention against malaria: a systematic review and meta-analysis

Future Health Systems

The aim of this systematic review was to assess whether socioeconomic development can contribute to malaria control. Of 4696 studies reviewed, 20 met the criteria for inclusion in the qualitative analysis, and 15 of these reported the necessary data for inclusion in the meta-analysis. The odds of malaria infection were higher in the poorest children than in the least poor children (unadjusted odds ratio [OR] 1·66, 95% CI 1·35–2·05, p<0·001,I2=68%; adjusted OR 2·06, 1·42–2·97, p<0·001, I2=63%), an effect that was consistent across subgroups. Although we would not recommend discontinuation of existing malaria control efforts, we believe that increased investment in interventions to support socioeconomic development is warranted, since such interventions could prove highly effective and sustainable against malaria in the long term.
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Unfree markets: Socially embedded informal health providers in northern Karnataka, India

Future Health Systems

The dynamics of informal health markets in marginalised regions are relevant to policy discourse in India, but are poorly understood. The authors examine how informal health markets operate from the viewpoint of informal providers (those without any government-recognised medical degrees, otherwise known as RMPs) by drawing upon data from a household survey in 2002, a provider census in 2004 and ongoing field observations from a research site in Koppal district, Karnataka, India.
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Building institutions for health and health systems in contexts of rapid change

Future Health Systems

Many Asian countries are in the midst of multiple interconnected social, economic, demographic, technological, institutional and environmental transitions. These changes are having important impacts on health and well-being and on the capacity of health systems to respond to health-related problems. This paper focuses on the creation of institutions to overcome information asymmetry and encourage the provision of safe, effective and affordable health services in this context of complexity and rapid change.
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Infographic - How healthy are the children of the Indian Sundarbans?

Future Health Systems

How Healthy are the Children of the Indian Sundarbans?\n\nIn early 2012, Future Health Systems India set out to answer this question. It undertook a study in one representative block (geographically and socially) of the Sundarbans: Patharpratima.\n\nThe key statistics presented in the following charts relate to our sample block (FHS 2012) in comparison to West Bengal (District Level Household Survey [DLHS-3] 2007-08) and Rural India overall (DLHS-3).\n\nAll findings and data can be found in the Sundarbans Health Watch Report (August 2013).
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Sundarbans Health Watch - Series 1: How healthy are the children of the Sundarbans

Future Health Systems

The present report focuses on one of the more vulnerable blocks of the Sundarbans in West Bengal, India -- namely Patharpratima -- as a representative block of the Sundarbans. To understand the root of the problem, the study takes a child health right approach and attempts to understand whether and to what extent the rights are protected, especially in climatically challenged areas such as the Sundarbans. In a nutshell, this report generates research evidence on the barriers to service delivery and access of health care services for children and endeavours to find out ways to make the system more effective in the Sundarbans.
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