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Publications

Filtering by Category: Innovation

Innovations for Universal Health Coverage: A South-South Collaboration to Transform Health Systems in Africa and India

Future Health Systems

The Public Health Foundation of India (PHFI), Amref Health Africa and the Institute of Development Studies (IDS) have agreed to collaborate in an effort to explore ways that technological innovations can contribute to government strategies for making progress towards universal health coverage (UHC). This means substantially increasing access by those whose basic health care needs are not being met. This report presents the outcome of a meeting held in Bengaluru, India. At this meeting, people with direct experience of different aspects of the development, piloting and taking to scale of technological innovations in India and a number of African countries explored the factors that influence this process.

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Evaluation and learning in complex, rapidly changing health systems: China’s management of health sector reform

Future Health Systems

Xiao, Y, Husain, L and Bloom, G (2018) Evaluation and learning in complex, rapidly changing health systems, Globalization and Health, 14:112, DOI: 10.1186/s12992-018-0429-7

Healthcare systems are increasingly recognised as complex, in which a range of non-linear and emergent behaviours occur. China’s healthcare system is no exception. The hugeness of China, and the variation in conditions in different jurisdictions present very substantial challenges to reformers, and militate against adopting one-size-fits-all policy solutions. As a consequence, approaches to change management in China have frequently emphasised the importance of sub-national experimentation, innovation, and learning. Multiple mechanisms exist within the government structure to allow and encourage flexible implementation of policies, and tailoring of reforms to context. These limit the risk of large-scale policy failures and play a role in exploring new reform directions and potentially systemically-useful practices. They have helped in managing the huge transition that China has undergone from the 1970s onwards. China has historically made use of a number of mechanisms to encourage learning from innovative and emergent policy practices. Policy evaluation is increasingly becoming a tool used to probe emergent practices and inform iterative policy making/refining. This paper examines the case of a central policy research institute whose mandate includes evaluating reforms and providing feedback to the health ministry. Evaluation approaches being used are evolving as Chinese research agencies become increasingly professionalised, and in response to the increasing complexity of reforms. The paper argues that learning from widespread innovation and experimentation is challenging, but necessary for stewardship of large, and rapidly-changing systems.

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How can mobile phones be used to improve nutrition service delivery in rural Bangladesh?

Future Health Systems

Khan NU, Rasheed S, Sharmin T, Siddique AK, Dibley M and Alam A (2018) How can mobile phones be used to improve nutrition service delivery in rural Bangladesh?, BMC Health Services Research, 18(1):530, DOI: 10.1186/s12913-018-3351-z

Nutrition has been integrated within the health services in Bangladesh as it is an important issue for health and development. High penetration of mobile phones in the community and favourable policy and political commitment of the Government of Bangladesh has created possibilities of using Information Communication Technology such as mobile phones for nutrition programs. In this paper the implementation of nutrition services with a specific focus on infant and young child feeding was explored and the potential for using mobile phones to improve the quality and coverage of nutrition services was assessed.

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‘We have the internet in our hands’: Bangladeshi college students’ use of ICTs for health information

Future Health Systems

Waldman L, Ahmed T, Scott N, Akter S, Standing H and Rasheed S (2018) ‘We have the internet in our hands’: Bangladeshi college students’ use of ICTs for health information, Globalization and Health, 14:31, DOI: 10.1186/s12992-018-0349-6

Information and Communications Technologies (ICTs) which enable people to access, use and promote health information through digital technology, promise important health systems innovations which can challenge gatekeepers’ control of information, through processes of disintermediation. College students, in pursuit of sexual and reproductive health (SRH) information, are particularly affected by gatekeeping as strong social and cultural norms restrict their access to information and services. This paper examines mobile phone usage for obtaining health information in Mirzapur, Bangladesh. It contrasts college students’ usage with that of the general population, asks whether students are using digital technologies for health information in innovative ways, and examines how gender affects this.

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Health system innovations: adapting to rapid change

Future Health Systems

Bloom G, Wilkinson A and Bhuiya A  (2018) Health system innovations: adapting to rapid change, Globalization and Health, 14:29, DOI: 10.1186/s12992-018-0347-8

A fundamental challenge for health systems is the need to adapt to changes in the patterns of health service need, scientific and technological developments, and the economic and institutional contexts within which providers of health services are embedded. This is especially true of many low and middle-income countries, where the pace of multiple and interconnected changes is breath-taking. This paper introduces the Thematic Issue on Innovation in Health Systems in Low- and Middle-Income Countries. 

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Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh

Future Health Systems

Khatun F, Heywood AE, Hanifi SM, Rahman MS, Ray PK, Liaw ST and Bhuiya A (2017) Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh, BMC health services research, 17:573, DOI: 10.1186/s12913-017-2523-6

Traditional gender roles result in women lagging behind men in the use of modern technologies, especially in developing countries. Although there is rapid uptake of mobile phone use in Bangladesh, investigation of gender differences in the ownership, access and use of mobile phones in general and mHealth in particular has been limited. This paper presents gender differentials in the ownership of mobile phones and knowledge of available mHealth services in a rural area of Bangladesh.

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Community readiness for adopting mHealth in rural Bangladesh: A qualitative exploration

Future Health Systems

Khatun F, Heywood AE, Ray PK, Bhuiya A, Liaw S-T (2016) Community readiness for adopting mHealth in rural Bangladesh: A qualitative exploration, International Journal of Medical Informatics, Volume 93, pp 49–56, DOI: 10.1016/j.ijmedinf.2016.05.010

There are increasing numbers of mHealth initiatives in middle and low income countries aimed at improving health outcomes. Bangladesh is no exception with more than 20 mobile health (mHealth) initiatives in place. A recent study in Bangladesh examined community readiness for mHealth using a framework based on quantitative data. Given the importance of a framework and the complementary role of qualitative exploration, this paper presents data from a qualitative study which complements findings from the quantitative study.

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Strengthening capacity to enhance delivery: implementation of payment reform in China

Future Health Systems

In 2002, China launched a voluntary health insurance scheme to provide financial protection to people affected by disease-related illness. Future Health Systems (FHS) work in Hanbin County, western China, has drawn on innovative methods from implementation and participatory research to train and support local policymakers, managers and health professionals in the evidence-based implementation of the scheme.

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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Looking for ‘New Ideas That Work’: county innovation in China’s health system reforms—the case of the New Cooperative Medical Scheme

Future Health Systems

Husain, L (2016) Looking for ‘New Ideas That Work’: county innovation in China’s health system reforms—the case of the New Cooperative Medical Scheme, Journal of Contemporary China, Volume 25, Issue 99, pages 438-452, DOI: 10.1080/10670564.2015.1104911

The article presents a case study of a low tech and ‘second best’ reimbursement mechanism developed sub-nationally under the New Cooperative Medical Scheme, China’s rural health insurance framework, and its spread and incorporation into national policy. It argues for the importance of local government development of ‘appropriate’ policy mechanisms (jizhi) as underpinning central reforms and system adaptation.

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Logics of government innovation and reform management in China

Future Health Systems

Since the beginning of reforms in the late 1970s, China has developed rapidly, transforming itself into a middle-income country, raising hundreds of millions out of poverty and, latterly, developing broad-based social protection systems. The country’s approach to reform has been unorthodox, leading many to talk of a specific Chinese model of development. This paper analyses the role of innovation (chuangxin) and experimentation in the Chinese government repertoire and their contribution to management of change during the rapid, complex and interconnected reforms that China is undergoing. 

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Sexual and reproductive health and rights and mHealth in policy and practice in South Africa

Future Health Systems

Waldman, L. and Stevens, M. (2015) Sexual and reproductive health and rights and mHealth in policy and practice in South Africa, Reproductive Health Matters, Vol 23, Issue 45, PP 93 - 102, doi:10.1016/j.rhm.2015.06.009

Information and Communications Technology (ICT) offers enormous opportunity and innovation to improve public health and health systems.This paper explores the intersections between mHealth and sexual and reproductive health and rights in both policy and practice. It is a qualitative study, informed by policy review and key informant interviews. Three case studies provide evidence of what is happening on the ground in relation to ICTs and reproductive health and rights.

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eHealth and mHealth initiatives in Bangladesh: A scoping study

Future Health Systems

The health system of Bangladesh is haunted by challenges of accessibility and affordability. Despite impressive gains in many health indicators, recent evidence has raised concerns regarding the utilization, quality and equity of healthcare. In the context of new and unfamiliar public health challenges including high population density and rapid urbanization, eHealth and mHealth are being promoted as a route to cost-effective, equitable and quality healthcare in Bangladesh. The aim of this paper is to highlight such initiatives and understand their true potential.

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E-health and M-health in Bangladesh: Opportunities and Challenges

Future Health Systems

There is growing enthusiasm amongst analysts of global health for the possibilities opened up by the rapid spread of mobile phone coverage. This includes substantially increasing access to health-related information and advice and to expert medical consultations.This report presents a snapshot of how information and communication technologies (ICTs) are influencing health system development in Bangladesh.

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FHS Bangladesh Research Brief 6: Knowledge of, Attitude towards, and Use of mHealth Services in Chakaria, Bangladesh

Future Health Systems

Bangladesh has a serious shortage of physicians, paramedics, nurses, and midwives. The available qualified care providers are centred in urban areas, resulting in an inequitable access of the rural and disadvantaged sections of the population to healthcare. Under these circumstances, the use of mHealth meaning provision of healthcare services through mobile devices provides a new opportunity to ensure access to quality healthcare services for the population in general, and for people from poorer sections and hard-to-reach areas in particular. There are currently around 20 mHealth service initiatives in the country which are mostly telephone hotlines for consulting physicians and/or obtaining healthcare information. Effectiveness of these services depends on the evidence-informed development of appropriate programmes designed around people’s perceptions of mHealth and user feedback. To that end, FHS Bangladesh partner, ICDDR,B recently conducted a survey on mHealth in Chakaria, a rural area in the southeast coastal area of Bangladesh. This brief presents the findings from this survey.

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Innovation for universal health coverage in Bangladesh: a call to action

Future Health Systems

A post-Millennium Development Goals agenda for health in Bangladesh should be defined to encourage a second generation of health-system innovations under the clarion call of universal health coverage. This agenda should draw on the experience of the first generation of innovations that underlie the country's impressive health achievements and creatively address future health challenges.
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FHS Bangladesh Research Brief 5: Use of mHealth to improve the quality of services of the village doctors

Future Health Systems

Village doctors are the dominant health care providers in rural areas of Bangladesh. icddr,b has previously tested interventions to improve the quality of their services – especially training on acceptable practice and the creation of a franchise called ShasthyaSena (health soldier). But training alone met with limited success. To improve the quality of these services, icddr,b has been testing an mHealth intervention that linked ShasthyaSenas to qualified physicians through a call centre. This brief documents the successes and challenges faced during the first year of implementation of the mHealth intervention.
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Real Time Monitoring for the Most Vulnerable: Concepts and Methods

Future Health Systems

In assessing the value of different approaches to real-time monitoring for the most vulnerable, an initial requirement is to set out a conceptual framework that provides at least some degree of clarity as to what precisely is meant by ‘real time’, ‘monitoring’ and ‘vulnerable’ – all terms that can be highly context-specific. That is the first task addressed here. The second is to consider potential sources of data that might be used to undertake real-time monitoring and assess their advantages and disadvantages for the present purpose. Four general approaches are considered – community-based participatory monitoring, sentinel sites, routine data systems and rapid surveys – and selected examples from the literature are given to illustrate the potential use and limitations of their applications.
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Real Time Monitoring and the New Information Technologies

Future Health Systems

Debates as to the potential role of new Information and Communication Technologies (ICTs) in monitoring the wellbeing of vulnerable groups is often bedevilled by the failure of two principal actors – social researchers and technical experts – to address the other’s concerns or even to use language that is comprehensible to the other side. The aim here is to unpick some of the technical language relevant in this context and provide a brief introductory guide to some aspects of the current, rapidly changing and highly diverse ICT environment.

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Introduction: Real Time Monitoring for the Most Vulnerable – Investing in Common Guidance for Equity and Quality

Future Health Systems

Growth in the use of real-time digital information for monitoring has been rapid in developing countries across all the social sectors, and in the health sector has been remarkable. Commonly these Real Time Monitoring (RTM) initiatives involve partnerships between the state, civil society, donors and the private sector. This article proposes the development of an effective learning and action agenda centred on the adoption of common guidance.
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