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.Read More
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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.Read More
The FHS India team have produced a new film titled Children of an Uncertain Climate, based on an FHS study titled ‘Decoding Child Health Impact under Climate Crisis.’ This short film identifies the pathways by which Climate Change is impacting the child health in Indian Sundarbans – a climatically vulnerable setting.Read More
Integrating Actions to Tackle Antimicrobial Resistance into Strategies to Achieve Universal Health Coverage
It is critical that ensuring people’s access to effective treatment for common infections is aligned with efforts to reduce the risk of emerging antimicrobial resistance. The Institute of Development Studies, a Future Health Systems partner, is influencing policy agendas to give greater focus on the need for the just and sustainable use of antimicrobials.
Engaging stakeholders in implementation research: lessons from the Future Health Systems Research Programme experience
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.Read More
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’.Read More
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.
Governance of global health research consortia: Sharing sovereignty and resources within 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.Read More
Unlocking community capabilities across health systems in low- and middle-income countries: lessons learned from research and reflective practice
George AS, Scott K, Sarriot E, Kanjilal B and Peters DH (2016) Unlocking community capabilities across health systems in low- and middle-income countries: lessons learned from research and reflective practice, BMC Health Services Research, 16:1859, DOI: 10.1186/s12913-016-1859-7
The right and responsibility of communities to participate in health service delivery was enshrined in the 1978 Alma Ata declaration and continues to feature centrally in health systems debates today. Communities are a vital part of people-centred health systems and their engagement is critical to realizing the diverse health targets prioritised by the Sustainable Development Goals and the commitments made to Universal Health Coverage. Community members’ intimate knowledge of local needs and adaptive capacities are essential in constructively harnessing global transformations related to epidemiological and demographic transitions, urbanization, migration, technological innovation and climate change. Effective community partnerships and governance processes that underpin community capability also strengthen local resilience, enabling communities to better manage shocks, sustain gains, and advocate for their needs through linkages to authorities and services. This is particularly important given how power relations mark broader contexts of resource scarcity and concentration, struggles related to social liberties and other types of ongoing conflicts.Read More
Systems thinking represents a unique theoretical and practical contribution. It facilitates ways to cross disciplines, and brings previously unused tools and approaches to tackle global health implementation differently. Future Health Systems (FHS) has played a major role in applying and advocating for the approach as a means to holistically understand health systems in low- and middle-income countries, as well as adaptation and scale-up of the project’s interventions.
Poor quality of maternal and newborn health services in Uganda have resulted in low maternal health service utilisation and high newborn mortality rates, both at home and at health facilities. The support Future Health Systems (FHS) provided to health workers to improve maternal health service delivery illustrates how a package of interventions that equips health workers with the necessary knowledge, skills and equipment, supplies and other non-financial incentives can improve the quality of maternal and newborn health service delivery.
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)
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.Read More
The Human Capital of Knowledge Brokers: An analysis of attributes, capacities and skills of academic teaching and research faculty at Kenyan schools of public health
Jessani N, Kennedy C and Bennett S (2016) The Human Capital of Knowledge Brokers: An analysis of attributes, capacities and skills of academic teaching and research faculty at Kenyan schools of public health, Health Research Policy and Systems, 14:58, doi:10.1186/s12961-016-0133-0
Academic faculty involved in public health teaching and research serve as the link and catalyst for knowledge synthesis and exchange, enabling the flow of information resources, and nurturing relations between ‘two distinct communities’ – researchers and policymakers – who would not otherwise have the opportunity to interact. Their role and their characteristics are of particular interest, therefore, in the health research, policy and practice arena, particularly in low- and middle-income countries. We investigated the individual attributes, capacities and skills of academic faculty identified as knowledge brokers (KBs) in schools of public health (SPH) in Kenya with a view to informing organisational policies around the recruitment, retention and development of faculty KBs.Read More
FHS Key Message Brief 3: Unlocking community capability: key to more responsive, resilient and equitable 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.Read More
Measuring spatial equity and access to maternal health services using enhanced two step floating catchment area method (E2SFCA) – a case study of the Indian Sundarbans
Vadrevu L and Kanjilal B (2016) Measuring spatial equity and access to maternal health services using enhanced two step floating catchment area method (E2SFCA) – a case study of the Indian Sundarbans, International Journal for Equity in Health, 15:87, DOI: 10.1186/s12939-016-0376-y
Inaccessibility due to terrain and lack of transport leaves mothers travelling for long hours before reaching a facility to deliver a child. This article analyzes the issue of spatial inaccessibility and inequity of maternal health services in the Indian Sundarbans where complex topography and repeated climatic adversities make access to health services very difficult.Read More
MANIFEST Research Brief: Improving maternal and newborn health outcomes in Kamuli, Kibuku and Pallisa Districts in Eastern Uganda
This MANIFEST Research brief presents some of the key results from the end line survey of the 4-year study which aimed at contributing to the reduction of maternal and neonatal deaths through the use of a participatory action research approach.Read More
The effectiveness of antibiotics in treating bacterial infections is decreasing in China because of the widespread development of resistant organisms. Although China has enacted a number of regulations to address this problem, but the impact is very limited. This paper investigates the implementation of these regulations through the lens of complex adaptive systems (CAS).Read More
In this short video, FHS CEO, Sara Bennett highlights some of the headlines from FHS activities during its second phase.Read More
FHS Key Message Brief 2: How can Research Programme Consortia contribute to capacity development in Low and Middle Income Countries?
This brief reflects upon the experience of FHS, a DFID funded RPC, with research capacity development. While FHS espoused a strong commitment to capacity development and put together a package of related strategies to support research capacity development among its partner organizations, these strategies met with varying degrees of success. We consider which types of capacity development strategies may work best for RPCs and under what circumstances.Read More
FHS Key Message Brief 1: How learning-by-doing can help cut through complexity in health service delivery
Throughout the duration of the Future Health Systems project (FHS), country teams have committed to undertaking systematic learning though implementation research and by bringing together key actors involved in service delivery. In this Key Message Brief, we share some examples of how FHS teams have embodied a “learning-by-doing” approach, and what the consequences of this approach have been.Read More