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Phase 2 Research

FHS has adopted an action-research model, where each of the country teams has identified an intervention strategy to improve the delivery of health services in their country. In the case of India and one of the two Uganda projects, the teams identified processes (as opposed to interventions) that will enable communities and other key stakeholders to develop an intervention strategy.

In keeping with our understanding of CAS, the teams are planning for the strategies to evolve over time as implementers, users, and other key stakeholders interact in the health system, and as other events influence how the health system operates.

The main research questions, intervention strategies, and health services outcomes are identified in the table below.


Main Research Question

Intervention Strategy

Primary Health Services Outcomes

Afghanistan: Enhancing Community Capacity for Health Service Delivery in Afghanistan

In a post-conflict society, how can trust be built in public institutions that provide health care through the use of community scorecards on health services?

Facilitation of community development, including the use of scorecards on health service delivery by local providers

Scorecard measures of quality and utilization of primary health care services (currently 25 facility-based indicators at provincial and national level)

Bangladesh: Does an integrated system of health services, linking informal and formal healthcare providers by information technology and mobile phones, strengthen health services in rural Bangladesh?

Can an innovative and locally relevant network of providers supported by technology systems be supported to improve quality, utilization, and equity of health services?

Application of mobile technology and computer-assisted guidance with network of informal and public health providers

Population and facility-based measures of utilization and quality of health care (e.g. outpatient utilization rates; percent of patients of village doctors receiving an antibiotic; percent of patients having one of 20 common conditions whose treatment follows standard guidelines)

China: Effective Drug Delivery at Rural Grass-Root Health Facilities

Can the Chinese health reforms be implemented in a way that improves the quality of and access to health services delivery at an affordable cost?

Multiple levels of intervention including mandated case-based financing reforms and the introduction of an essential drugs systems to promote rationale use of drugs, with scope for wide variation in financing, organization, and oversight at the county level

Facility-based and population based measures:

Quality of care (e.g. Proportion of prescriptions with: (i) antibiotic; (ii) intravenous injection; (iii) vitamin)

Utilization of care (Outpatient visits per capita)

Cost of care (total cost to government and out-of-pocket payments)

Patient satisfaction (index to be developed)

India Phase 1: Decoding Healthcare Access under Climate Crisis: A Case Study of Sundarbans


Can the health and livelihoods of a climatically fragile population be understood in a way to feasibly design a new model of care that takes advantage of local resources and is resilient to environmental shocks?

New model of health care to be developed from phase 1 research and interactions with DOHFW, community members, and other stakeholders

Descriptive measures on health, health services, livelihoods, risks, coping strategies, functioning of health-related markets

India Phase 2: Healthcare Access under Climate Crisis: A Case Study of Sundarbans

Can a new model of service delivery provide effective health services for children in an environmentally fragile setting?

New model of health care delivery based on phase 1 work that links formal and informal providers and holds key stakeholders accountable for effective service delivery

Increase in coverage and quality of child health care for nutrition-related and common diseases such as diarrhea and ARI in six vulnerable blocks of Sundarbans

Uganda 1: Innovations for increasing access to integrated safe delivery, PMTCT and newborn care in rural Uganda

Can an integrated system for maternal-newborn care be implemented in a way to increase utilization, quality, and impact of maternal-newborn health care?

Community mobilization through CHWs, supply and demand vouchers, integration and quality improvements of clinical services for maternal and newborn care

Population and facility-based: Rates of ANC, Institutional delivery, PNC, and Neonatal mortality (projected by LiST)

Uganda 2: Mobilizing Community Resources for Maternal Health

Can existing community resources be mobilized to support a successful voucher scheme that has increased access to institutional deliveries and post-natal care?

Community mobilization to develop financing scheme to maintain system to finance maternal and newborn care

Development of tools for community capacity and demonstration of community capacity through sustainability of voucher scheme