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Publications

Filtering by Category: Health systems research

Health policy and systems research: the future of the field

Future Health Systems

Peters D (2018) Health policy and systems research: the future of the field, Health Research Policy and Systems, 16:84, DOI: 10.1186/s12961-018-0359-0

Health policy and systems research (HPSR) has changed considerably over the last 20 years, but its main purpose remains to inform and influence health policies and systems. Whereas goals that underpin health systems have endured – such as a focus on health equity – contexts and priorities change, research methods progress, and health organisations continue to learn and adapt, in part by using HPSR. For HPSR to remain relevant, its practitioners need to re-think how health systems are conceptualised, to keep up with rapid changes in how we diagnose and manage disease and use information, and consider factors affecting people’s health that go well beyond healthcare systems. The Sustainable Development Goals (SDGs) represent a shifting paradigm in human development by seeking convergence across sectors. They also offer an opportunity for HPSR to play a larger role, given its pioneering work on applying systems thinking to health, its focus on health equity, and the strength of its multi-disciplinary approaches that make it a good fit for the SDG era.

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Doctoral level research and training capacity in the social determinants of health at universities and higher education institutions in India, China, Oman and Vietnam: a survey of needs

Future Health Systems

Ali F, Shet A, Yan W, Al-Maniri A, Atkins and Lucas H (2017) Doctoral level research and training capacity in the social determinants of health at universities and higher education institutions in India, China, Oman and Vietnam: a survey of needs, Health Research Policy and Systems, 15:76, DOI: 10.1186/s12961-017-0225-5

Research capacity is scarce in low- and middle-income country (LMIC) settings. Social determinants of health research (SDH) is an area in which research capacity is lacking, particularly in Asian countries. SDH research can support health decision-makers, inform policy and thereby improve the overall health and wellbeing of the population. In order to continue building this capacity, we need to know to what extent training exists and how challenges could be addressed from the perspective of students and staff. This paper aims to describe the challenges involved in training scholars to undertake research on the SDH in four Asian countries – China, India, Oman and Vietnam.

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Recognition matters: only one in ten awards given to women

Future Health Systems

Morgan R, Dhatt R, Muraya K, Buse K, and George AS (2017) Recognition Matters: Only One in Ten Awards given to Women, The Lancet, 389(10088):2469, DOI: 10.1016/S0140-6736(17)31592-1

Receiving an award is an accolade. Awards validate and bring visibility, help attract funding, hasten career advancement, and can consolidate career accomplishments. Yet, in the fields of public health and medicine, few women receive them. Between seven public health and medicine awards from diverse countries, the chances of a woman receiving a prize was nine out of 100 since their inception.

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Fair Resource Allocation to Health Research: Priority Topics for Bioethics Scholarship

Future Health Systems

Pratt B and Hyder AA (2017) Fair Resource Allocation to Health Research: Priority Topics for Bioethics Scholarship, Bioethics,31(6):454-466, DOI: 10.1111/bioe.12350

This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between health problems experienced domestically versus other health problems typically experienced by disadvantaged populations outside the funder's country, and how domestic and non-domestic health research funding should be further apportioned to different areas, e.g. types of research and recipients.

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Learning by doing in practice: a roundtable discussion about stakeholder engagement in implementation research

Future Health Systems

Arwal SH, AulakhBK, Bumba A and Siddula A (2017) Learning by doing in practice: a roundtable discussion about stakeholder engagement in implementation research, Health Research Policy and Systems, 15(Suppl 2):105, DOI: 10.1186/s12961-017-0275-8

Researchers and policy-makers alike increasingly recognise the importance of engaging diverse perspectives in implementation research. This roundtable discussion presents the experiences and perspectives of three decision-makers regarding the benefits and challenges of their engagement in implementation research.

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Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda

Future Health Systems

Kananura RM, Ekirapa-Kiracho E, Paina L, Bumba A, Mulekwa G, Nakiganda-Busiku D, Oo HNL, Kiwanuka SN, George A and Peters DH (2017) Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda, Health Research Policy and Systems, 15(Suppl 2):107, DOI: 10.1186/s12961-017-0274-9

The use of participatory monitoring and evaluation (M&E) approaches is important for guiding local decision-making, promoting the implementation of effective interventions and addressing emerging issues in the course of implementation. In this article, we explore how participatory M&E approaches helped to identify key design and implementation issues and how they influenced stakeholders’ decision-making in eastern Uganda.

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A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda

Future Health Systems

Tetui M, Coe A-B, Hurtig A-H, Bennett S, Kiwanuka SN, George A and Ekirapa Kiracho E (2017) A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda, Health Research Policy and Systems, 15(Suppl 2):110, DOI: 10.1186/s12961-017-0273-x

Many approaches to improving health managers’ capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers’ capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers’ capacity in Eastern Uganda.

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Using Theories of Change to inform implementation of health systems research and innovation: experiences of Future Health Systems consortium partners in Bangladesh, India and Uganda

Future Health Systems

Paina L, Wilkinson A, Tetui M, Ekirapa-Kiracho E, Barman D, Ahmed T, Mahmood SS, Bloom G, Knezovich J, George A and Bennett S (2017) Using Theories of Change to inform implementation of health systems research and innovation: experiences of Future Health Systems consortium partners in Bangladesh, India and Uganda, Health Research Policy and Systems, 15(Suppl 2):109, DOI: 10.1186/s12961-017-0272-y

The Theory of Change (ToC) is a management and evaluation tool supporting critical thinking in the design, implementation and evaluation of development programmes. We document the experience of Future Health Systems (FHS) Consortium research teams in Bangladesh, India and Uganda with using ToC. We seek to understand how and why ToCs were applied and to clarify how they facilitate the implementation of iterative intervention designs and stakeholder engagement in health systems research and strengthening.

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Engaging stakeholders: lessons from the use of participatory tools for improving maternal and child care health services

Future Health Systems

Ekirapa-Kiracho E, Ghaosh U, Brahmachari R and Paina L (2017) Engaging stakeholders: lessons from the use of participatory tools for improving maternal and child care health services, Health Research Policy and Systems, 15(Suppl 2):106, DOI: 10.1186/s12961-017-0271-z


Effective stakeholder engagement in research and implementation is important for improving the development and implementation of policies and programmes. A varied number of tools have been employed for stakeholder engagement. In this paper, we discuss two participatory methods for engaging with stakeholders – participatory social network analysis (PSNA) and participatory impact pathways analysis (PIPA). Based on our experience, we derive lessons about when and how to apply these tools.

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Strengthening scaling up through learning from implementation: comparing experiences from Afghanistan, Bangladesh and Uganda

Future Health Systems

Bennett S, Mahmood SS, Edward A, Tetui M and Ekirapa-Kiracho E (2017) Strengthening scaling up through learning from implementation: comparing experiences from Afghanistan, Bangladesh and Uganda, Health Research Policy and Systems, 15(Suppl 2):108, DOI: 10.1186/s12961-017-0270-0

Many effective innovations and interventions are never effectively scaled up. Implementation research (IR) has the promise of supporting scale-up through enabling rapid learning about the intervention and its fit with the context in which it is implemented. We integrate conceptual frameworks addressing different dimensions of scaling up (specifically, the attributes of the service or innovation being scaled, the actors involved, the context, and the scale-up strategy) and questions commonly addressed by IR (concerning acceptability, appropriateness, adoption, feasibility, fidelity to original design, implementation costs, coverage and sustainability) to explore how IR can support scale-up.

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Engaging stakeholders in implementation research: lessons from the Future Health Systems Research Programme experience

Future Health Systems

Peters DH, Bhuiya A and Ghaffar A (2017) Engaging stakeholders in implementation research: lessons from the Future Health Systems Research Programme experience, Health Research Policy and Systems, 15(Suppl 2):104, DOI: 10.1186/s12961-017-0269-6

Implementation research and the engagement of stakeholders in such research have become increasingly prominent in finding ways to design, conduct, expand and sustain effective and equitable health policies, programmes and related interventions. How to bring together key sets of health systems stakeholders, including affected communities, health workers, health system managers, health policy-makers and researchers, as well as non-state and non-health sector actors, is a critical challenge. Stakeholder engagement plays important roles across intersecting research, policy and management processes, from selecting and defining the most relevant research questions to address policy and management concerns, to designing and conducting research, learning from and applying evidence, making changes to policy and programmes, and holding each other accountable. The articles in this supplement examine some of the tools and approaches used to facilitate stakeholder engagement in implementation research, and describe learning from the experience of the Future Health Systems (FHS) Research Programme Consortium. 

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Implementation research and delivery science

Future Health Systems

In public health research, the focus has traditionally been on descriptive and analytic epidemiological research (“what”, “why”, “where,” and “who”). Less attention has been given, particularly in low-income countries, to “how” interventions do or do not work in the “real world”, given the involvement of different actors, the context in which implementation occurs, and the factors that influence implementation. Future Health Systems (FHS) has been at the forefront in the exploration, application and growth of implementation research (IR).

10 Best resources for community engagement in implementation research

Future Health Systems

Glandon D, Paina L, Alonge O, Peters DH and Bennett S (2017) 10 Best resources for community engagement in implementation research, Health Policy and Planning, Volume 32, Issue 10, 1457–1465, doi: 10.1093/heapol/czx123

Implementation research (IR) focuses on understanding how and why interventions produce their effects in a given context. This often requires engaging a broad array of stakeholders at multiple levels of the health system. Whereas a variety of tools and approaches exist to facilitate stakeholder engagement at the national or institutional level, there is a substantial gap in the IR literature about how best to do this at the local or community level. Similarly, although there is extensive guidance on community engagement within the context of clinical trials—for HIV/AIDS in particular—the same cannot be said for IR. We identified a total of 59 resources by using a combination of online searches of the peer-reviewed and grey literature, as well as crowd-sourcing through the Health Systems Global platform. The authors then completed two rounds of rating the resources to identify the ‘10 best’.

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Building the field: ethics in health systems research

Future Health Systems

Members of the Future Health Systems (FHS) consortium have spearheaded important and previously unexplored work on the ethics of health systems research (HSR). FHS has contributed empirical knowledge on understanding how researchers are dealing with the ethics of HSR on the ground, as well as conceptual thinking, including exploring issues of justice, health capabilities, and responsiveness. The work has engaged new actors, built a movement of parties interested in the issues, and influenced the agendas of global institutions such as the World Health Organization.

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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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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