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Publications

Filtering by Tag: Shehrin Shaila Mahmood

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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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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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.

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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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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Socioeconomic and programmatic determinants of renewal of membership in a voluntary micro health insurance scheme: evidence from Chakaria, Bangladesh

Future Health Systems

Iqbal M, Chowdhury AH, Mahmood SS, Mia MN, Hanifi SMA and Bhuiya A (2017) Socioeconomic and programmatic determinants of renewal of membership in a voluntary micro health insurance scheme: evidence from Chakaria, Bangladesh, Global Health Action, Vol 10, Issue 1, DOI: 10.1080/16549716.2017.1287398

Out-of-pocket (OOP) healthcare expenditure is a major obstacle for achieving universal health coverage in low-income countries including Bangladesh. Sixty-three percent of the USD 27 annual per-capita healthcare expenditure in Bangladesh comes from individuals’ pockets. Although health insurance is a financial tool for reducing OOP, use of such tools in Bangladesh has been limited to some small-scale voluntary micro health insurance (MHI) schemes run by non-governmental organizations (NGO). The MHI, however, can orient people on health insurance concept and provide learning for product development, implementation, barriers to enrolment, membership renewal, and other operational challenges and solutions. Keeping this in mind, icddr,b in 2012 initiated a pilot MHI, Amader Shasthya, in Chakaria, Bangladesh. This paper explores the determinants of membership renewal in this scheme, which is a perpetual challenge for MHI.

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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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Stakeholder analysis for health research: Case studies from low- and middle-income countries

Future Health Systems

Future Health Systems: Innovations for Equity (FHS) is working in six partner countries in Asia and Africa, focusing on strengthening the research–policy interface in relation to specific health system research projects. These projects present an opportunity to study the influence of stakeholders on research and policy processes.
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Chakaria Health and Demographic Surveillance System

Future Health Systems

This report contains findings from a population census carried out in 8 of the 19 unions of Chakaria, a remote rural upazila in the south-eastern coastal area of Bangladesh. ICDDR,B has been engaged in health activities in 6 of these 8 unions since 1994 through a community-initiated primary healthcare project. Two of the unions where ICDDR,B has no activities were designated as comparison areas to assess the impact of ICDDR,B activities on health and health-related behaviours.
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