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Publications

Filtering by Category: Research methods

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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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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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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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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Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda

Future Health Systems

Tetui M, Coe A-B, Hurtig A-K, Ekirapa-Kiracho E and Kiwanuka SN (2017) Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda, Global Health Action, 10:sup4, 1346038, DOI: 10.1080/16549716.2017.1346038

To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical. A participatory action research approach is applauded for building local capacity such as health management. Thereby increasing the chances of sustaining health interventions. This study explored stakeholder experiences of using PAR to implement an intervention meant to strengthen the local district capacity.

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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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Expressing collective voices on children’s health: photovoice exploration with mothers of young children from the Indian Sundarbans

Future Health Systems

Ghosh U, Bose S, Bramhachari R and Mandal S (2016) Expressing collective voices on children’s health: photovoice exploration with mothers of young children from the Indian Sundarbans, BMC Health Services Research, 16:1866, DOI: 10.1186/s12913-016-1866-8

The Indian Sundarbans is marked by inhospitable terrain and frequent climatic shocks which jointly hinder access to health care. Community members, and women in particular, have few means to communicate their concerns to local decision makers. Photovoice is one way in which communities can raise their local health challenges with decision makers. This study unlocks mothers’ voices on the determinants of their children’s health to inform local level decision-making on child health issues in the Indian Sundarbans.

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Through the lens: empowering women in vulnerable communities to voice their concerns

Future Health Systems

Participatory Action Research (PAR) methodologies can help empower marginalised groups to capture and articulate their experiences and concerns to decision-makers. Future Health Systems (FHS) has worked with women in the Sundarbans of West Bengal to use Photovoice – a PAR method using photographs and narrative – to raise awareness of the challenges the women face to access health care. The initiative has led local policymakers and health workers to prioritise, and take steps to address, the issues.

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 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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Do academic knowledge brokers exist? Using social network analysis to explore academic research-to-policy networks from six schools of public health in Kenya

Future Health Systems

The potential for academic research institutions to facilitate knowledge exchange and influence evidence-informed decision-making has been gaining ground. Schools of public health (SPHs) may play a key knowledge brokering role—serving as agencies of and for development. Understanding academic-policymaker networks can facilitate the enhancement of links between policymakers and academic faculty at SPHs, as well as assist in identifying academic knowledge brokers (KBs). Using a census approach, the authors administered a sociometric survey to academic faculty across six SPHs in Kenya to construct academic-policymaker networks.

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