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Publications

Filtering by Category: Briefing

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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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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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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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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FHS Key Message Brief 5: Working with the media in pursuit of Health for All

Future Health Systems

This key message brief shares learning from Future Health Systems partners’ experiences of working with traditional, primarily mainstream, media outlets publishing in print and online, as well as some television and radio organisations over 12 years. We hope it offers some helpful reflections for those who are currently or considering working with the media.

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Climate change: a threat to child food security in the Indian Sundarbans

Future Health Systems

The Sundarbans, the mangrove forest delta shared both by India and Bangladesh, is among the worst hit regions of climate change in the world. Even though food insecurities due to climate change are felt across the region, the distribution of vulnerabilities is largely uneven depending upon existing climatic and social intersections.

Within the context of socio-cultural and political dynamics, and rapid globalization, efforts to respond to, mitigate, or adapt to climate change needs to address issues of equity and social justice, posing both challenges and opportunities.

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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 to do gender analysis in health systems research: A guide

Future Health Systems

This guidance brief provides an overview of how you can incorporate gender analysis into your health systems research, including: (1) disaggregating your data by sex; (2) organizing your thinking using frameworks; and (3) using gender analysis questions. It also discusses how you can incorporate gender into the overall research process.

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FHS Key Message Brief 4: Galvanising gender analysis and practice in health systems: Reflections from Research in Gender and Ethics: Building Stronger Health Systems (RinGs)

Future Health Systems

This brief outlines some of the challenges of incorporating gender analysis into existing research programmes, along with ways in which Research in Gender and Ethics (RinGs): Building Stronger Health Systems has responded to them. RinGs is a cross research programme consortium (RPC) bringing together three health systems RPCs – Future Health Systems, ReBUILD, and RESYST – to better understand gendered dynamics in health systems and to galvanise gender analysis in HSR. 

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FHS India Research Brief 9 - Voices from the ground: Photovoice research on children’s health in the Indian Sundarbans

Future Health Systems

The objective of this brief is to introduce the Photovoice method, highlight how it helped capture the voices of mothers in the Sundarbans, and demonstrate how the method can bridge the gap between communities and local decision-makers. 

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FHS Key Message Brief 3: Unlocking community capability: key to more responsive, resilient and equitable health systems

Future Health Systems

In Future Health Systems, we focused on communities as active service delivery participants across a wide variety of contexts. In this brief, we reflect on the process of unlocking community capabilities, the key actors involved, and the productive tensions within community partnerships forged to build more responsive, resilient and equitable health systems.

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MANIFEST Issue Brief 9: What a highly effective VHT for maternal and newborn health looks like

Future Health Systems

Makerere University School of Public health in collaboration with Ministry of Health and the three districts of Kamuli, Pallisa and Kibuku designed and implemented a four year (2012-2015) maternal and newborn study (MANIFEST) that aimed at improving access to institutionalized deliveries. One of the study components was community mobilization through use of Village Health Teams (VHTs), essentially community health workers. The VHTs were trained for five days and supervised by district level health workers and district health team (DHT) members with support from external trainers following a training of trainers (TOT). The VHTs effectively sensitized communities and improved awareness on birth preparedness, knowledge of danger signs and health facility service utilization. This brief therefore highlights the key characteristics of a good performing VHT based on observations of VHT performances over three years of implementation.

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