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Publications

Filtering by Category: Informal providers

In from the cold: Shifting the discourse on informal providers in Bangladesh and India

Future Health Systems

In Bangladesh and India, informal healthcare providers (IHPs) have long been part of the countries’ health systems. However, formal recognition of their existence is sensitive, partly due to resistance and concern from professional health bodies. Research by Future Health Systems (FHS) partners ICDDR,B and IIHMR has been instrumental in bringing the issues to discussion tables. Consequently, stakeholders have begun to recognize and work with IHPs – something previously unheard of.

Antimicrobial resistance and Universal Health Coverage

Future Health Systems

Bloom G, Wilkinson A and Buckland Merritt G (2017) Antimicrobial resistance and Universal Health Coverage, In Antimicrobial resistance in the Asia Pacific region: a development agenda (pp. 9-21). Manila, Philippines. World Health Organization Regional Office for the Western Pacific. Licence: CC BY-NC-SA 3.0 IGO.

Chapter two highlights priorities for an integrated approach for addressing AMR by strengthening universal health coverage (UHC). It focuses on the use of drugs in outpatient settings. The chapter gives particular consideration to low- and middle-income countries with pluralistic health systems, where government provision and health markets combine and where people seek treatment for a large proportion of common infections in weakly regulated markets.

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Towards the just and sustainable use of antibiotics

Future Health Systems

Buckland Merrett GL, Bloom G, Wilkinson A and MacGregor H (2016) Towards the just and sustainable use of antibiotics, Journal of Pharmaceutical Policy and Practice, 9:31, DOI: 10.1186/s40545-016-0083-5

The emergence and spread of antibiotic resistant pathogens poses a big challenge to policy-makers, who need to oversee the transformation of health systems that evolved to provide easy access to these drugs into ones that encourage appropriate use of antimicrobials, whilst reducing the risk of resistance. This is a particular challenge for low and middle-income countries with pluralistic health systems where antibiotics are available in a number of different markets. This review paper considers access and use of antibiotics in these countries from a complex adaptive system perspective. It highlights the main areas of intervention that could provide the key to addressing the sustainable long term use and availability of antibiotics.

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Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh

Future Health Systems

Khan NUZ, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, Hanifi SMA, Hoque S, Iqbal M and Bhuiya A (2015) Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh, BMC Medical Informatics and Decision Making, 15:62, doi:10.1186/s12911-015-0188-9

Bangladesh is facing serious shortage of trained health professionals. In the pluralistic healthcare system of Bangladesh, formal health care providers constitute only 5 % of the total workforce; the rest are informal health care providers. Information Communication Technologies (ICTs) are increasingly seen as a powerful tool for linking the community with formal healthcare providers. This study assesses an intervention that linked village doctors (a cadre of informal health care providers practising modern medicine) to formal doctors through call centres from the perspective of the village doctors who participated in the intervention.

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Symposium on the Private Sector in Health: Sydney 2013

Future Health Systems

There is a growing appreciation and recognition of the role of the private sector in the development of better health systems and the improvement of healthcare worldwide.

This Health Policy and Planning supplement reflects contributions to a Symposium of the Health Systems Global Private Sector in Health Thematic Working Group during the 9th World Congress on Health Economics, held in Sydney in July 2013. Members of the PSIH TWG that convened the Symposium included FHS members David Bishai (JHBSPH) and Gerry Bloom (IDS), and was generously supported by Rockefeller, Gates, USAID, AusAid (DFAT), and DFID.

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What Do They Do? Interactions Between Village Doctors and Medical Representatives in Chakaria, Bangladesh

Future Health Systems

Hafizur Rahman, M, Agarwal, S, Tuddenham, S, Iqbal, M, Bhuiya, A, and Peters, DH (2014) What do they do? Interactions between village doctors and medical representatives in Chakaria, Bangladesh International Health doi:10.1093/inthealth/ihu077

Informally trained village doctors supply the majority of health care services to the rural poor in many developing countries. This study describes the demographic and socioeconomic differences between medical representatives, hired by pharmaceutical companies to provide their products to health providers, and village doctors in rural Bangladesh, and explores the nature of their interactions. The research team used focus group discussions, in-depth interviews, and a quantitative survey to understand practice perceptions. They found that medical representatives have a higher average per capita monthly expenditure compared to village doctors, and that the former are better educated with 98% having bachelor's degrees whereas 84% of village doctors have twelfth grade education or less. Medical representatives are the principal information source about new medications for the village doctors. Furthermore, incentives offered by medical representatives and credit availability might influence the prescription practices of village doctors. Findings suggests that improvements in the quality of health care delivered to the rural poor in informal provider-based health markets require stricter regulations and educational initiatives for providers and medical representatives.

Informal rural healthcare providers in North and South India

Future Health Systems

Rural households in India rely extensively on informal biomedical providers, who lack valid medical qualifications. Their numbers far exceed those of formal providers. Our study reports on the education, knowledge, practices and relationships of informal providers (IPs) in two very different districts: Tehri Garhwal in Uttarakhand (north) and Guntur in Andhra Pradesh (south).

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People-centred science: strengthening the practice of health policy and systems research

Future Health Systems

Health policy and systems research (HPSR) is a transdisciplinary field of global importance, with its own emerging standards for creating, evaluating, and utilizing knowledge, and distinguished by a particular orientation towards influencing policy and wider action to strengthen health systems. In this commentary, we argue that the ability of the HPSR field to influence real world change hinges on its becoming more people-centred. We see people-centredness as recognizing the field of enquiry as one of social construction, requiring those conducting HPSR to locate their own position in the system, and conduct and publish research in a manner that foregrounds human agency attributes and values, and is acutely attentive to policy context. 

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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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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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Challenges of Livelihood and Inclusive Rural Development in the Era of Globalization

Future Health Systems

Challenges of livelihood and inclusive rural development in the era of globalization deals with different challenges in rural development and recommended practical ideas for development. This book is an extremely timely publication when the prevailing situations are putting more and more emphasis on the sharing of knowledge and ideas in the development sector. The research papers highlighting strength of our programmes and focuses on the areas of intervention. Researchers and general readers will find this volume very informative and useful in the area of policy making.
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Future Health Markets: A meeting statement from Bellagio

Future Health Systems

Policy-makers, entrepreneurs, academics and funders convened at the Rockefeller Foundation Bellagio Center from 10th-14th December 2012 to discuss the changing face of health markets, and in particular to consider future trends in such markets. Their aim was to promote a greater shared understanding and analysis of health market systems, and to consider how markets can better serve the needs of the poor in low- and middle-income countries (LMICs). This report is an attempt to capture the rich discussions held during the meeting, which reviewed the evolution of health markets, identified key drivers of and gaps resulting from their rapid development, and highlighted critical issues that must be tackled to ensure the poorest have access to safe, affordable, effective and equitable health services. The report concludes with recommendations for shaping future health markets as agreed during the meeting.
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Transforming Health Markets in Asia and Africa: Improving quality and access for the poor

Future Health Systems

There has been a dramatic spread of health markets in much of Asia and Africa over the past couple of decades. This has substantially increased the availability of health-related goods and services in all but the most remote localities, but it has created problems with safety, efficiency and cost. The effort to bring order to these chaotic markets is almost certain to become one of the greatest challenges in global health. This book documents the problems associated with unregulated health markets and presents innovative approaches that have emerged to address them. It outlines a framework that researchers, policy makers and social entrepreneurs can use to analyse health market systems and assess the likely outcome of alternative interventions. The book presents a new way of understanding highly marketised health systems, applies this understanding to an analysis of health markets in countries across Asia and Africa and identifies some of the major new developments for making these markets perform better in meeting the needs of the poor. It argues that it is time to move beyond ideological debates about the roles of public and private sectors in an ideal health system and focus more on understanding the operation of these markets and developing practical strategies for improving their performance. This book is ideal reading for researchers and students in public health, development studies, public policy and administration, health economics, medical anthropology, and science and technology studies. It is also a valuable resource for policy makers, social entrepreneurs, and planners and managers in public and private sector health systems, including pharmaceutical companies, aid agencies, NGOs and international organisations.
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Bring order to unregulated health markets

Future Health Systems

In this commentary in Nature, the authors argue that the rapid expansion of health markets in Asia and Africa has made medicines, information and primary-care services available in all but the most remote areas. But it also creates problems with drug safety and efficiency, equity of treatment and the cost of care. Poorly trained practitioners often prescribe unnecessary pills or injections, with patients bearing the expense and the costs to their health. Counterfeit drugs are rife and drug resistance is growing. Bringing order to unruly health markets is a major challenge.
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Regulatory challenges associated with the rapid spread of health markets

Future Health Systems

Dr Barun Kanjilal of IIHMR gives an overview of the regulatory challenges associated with the rapid spread of health markets in India to the Health System Reform in Asia conference held in Hong Kong in early December 2011. He notes in particular the important role that informal providers have played in delivering health services in the wake of government reforms.
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Understanding informal markets: The roles and perspectives of RMPs in West Bengal and Karnataka, India

Future Health Systems

Dr Asha George of JHSPH presents work on the role of informal health care providers in India at the Health System Reform in Asia conference held in December 2011 in Hong Kong. She compares West Bengal and Karnataka -- two states with very different health profiles -- providing both qualitative and quantitative insights into how and why the poor use poorly trained rural medical practitioners as their first port of call when accessing health services.
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Making health markets work better for poor people: the case of informal providers

Future Health Systems

There has been a dramatic spread of market relationships in many low- and middle-income countries. This spread has been much faster than the development of the institutional arrangements to influence the performance of health service providers. This paper applies lessons from this experience to the issue of informal providers, drawing on the findings of studies in Bangladesh and Nigeria.
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