Friday, 21 December 2012

FHS Outputs – Top 12 in 2012

As the FHS consortium wraps up yet another busy year, we wanted to say thanks to all of our funders, followers and fans. We couldn’t have done it without you!

2012 has been a remarkable year of progress for FHS. We entered the implementation phase of our current round of research, and after clearing a number of ethical reviews, things are starting to really take off.
One strand of work bears mentioning in particular – our work on health markets. With recent moves to encourage moves toward Universal Health Coverage, recognising the role that health markets play in delivering health services is critical. Highlights on health markets include a comment in Nature, two new books on the topic, and a recent meeting in Bellagio with key funders. In the new year, we look forward to continuing the discussion, especially as part of the Private Sector in Health Symposium happening in Sydney before the next iHEA World Congress. Which is as good of an opportunity as any to remind everyone that abstract submissions to participate in the symposium are due on 22 January 2013!

Beyond that, we’ve had a large number of outputs published in 2012. In case you missed them, here are the Top 12 FHS outputs of 2012, based on web views only (an imperfect measure, or course, but it’s a place start!) and limited only to items published this year (some of the top views are from previous years – talk about a long tail!).

Top 12 FHS outputs of 2012

12. Better Guidance Is Welcome, But Without Blinders: This comment in PLoS Med by David Peters and Sara Bennett cautioned HSR practitioners against the adoption of rigid approaches to the application of evidence to policy. It's the only journal article to make the list -- but given the number of articles in the pipeline for next year, we don't expect it will be in 2013.

11. Complex Adaptive Systems In Health: This presentation from David Bishai was presented to other FHS members at our partners meeting, but the modelling approach to complex systems has garnered a lot of interest from much further afield.

10. China’s Health Care Reform: Towards “Health Care For All”: This article, by FHS China partners at CNHDRC Yu Dezhi, Gu Xuefei and Wang Yunping, was originally published by our friends at the Institute for Tropical Medicine in Antwerp, but it’s timeliness in the run-up to the Beijing Symposium and the push to Universal Health Coverage has put it in our top 12 this year too.

9. Are Informal Providers A Dangerous Detour On The Road To Universal Health Coverage? This series of videos, produced in collaboration with the Center for Health Market Innovations, succeeded in marrying two key issues this year, health markets and UHC. Add your voice to the conversation!

8. The 2nd Symposium On HSR: As Daunting As Kabul? This short blog from Kojo Osei-Bonsu, who project manages the FHS Afghanistan research, added a different perspective to the proceedings in Beijing.

7. Transforming Health Markets In Asia And Africa: Improving Quality And Access For The Poor: The FHS book, edited by Gerry Bloom, David Bishai and Barun Kanjilal has been a massive effort from across the consortium. We’ve even had two successful launches for the book in Washington, D.C. in collaboration with the DC HSB and in Kolkata, India.

6. Doctoring The Village Doctors: Giving Attention Where It Is Due: This book from FHS Bangladesh gives a candid look at their first phase of FHS research and the challenges associated with trying to create a franchise of informal health providers.

5. Understanding The Policy Process: Reflections From The International Conference On Evidence-Informed Policy Making: In this blog, Kakaire Ayub Kirunda of FHS Uganda feeds back from his experience at a conference hosted by INASP on evidence-informed policymaking.

4. An Interview With Dr Kirsty Newman: Understanding Evidence-Informed Policy: And apparently, it was a really popular topic – Kakaire Ayub Kirunda also comes in at number 4 with another blog from the same conference, this time for an interview with Kirsty Newman, who is now a Research Uptake Manager at DFID.

3. Tackling Unregulated Health Markets: This news item helped us pull together our work on health markets. A version of the article appeared on the IDS webpage and was pulled through to ReliefWeb.

2. Forgetting John Snow At The Beijing HSR Symposium: Perhaps unsurprisingly, some of the most viewed content on the FHS website comes from our blogs during the Beijing HSR Symposium. This one, from Professor David Bishai of JHSPH, doesn’t pull any punches as it encouraged those at the symposium to remember the spirit of John Snow.

1. Would You Pee On Your Tomatoes? Where The HSR Approach To Knowledge Translation Is Falling Short: And the most read blog from this year comes from FHS Policy Influence and Research Uptake Manager, Jeff Knezovich. Maybe it’s the provocative title (it came out on the same day as the US election and one day before the Chinese 18th Party Congress, so he was looking for something that stood out a bit). Or maybe it was the content. Or maybe it was that it was linked to from the Beijing HSR site. Whatever the reason, Jeff assures us that there will be a follow up in the new year looking on the flip side of the coin – in other words, what the HSR approach to knowledge translation is getting right!

Wednesday, 19 December 2012

Shaping the future of health markets

Ideological debates about private and public sectors in health have gotten in the way of understanding how health markets work. This is despite the fact that most countries recognize that they have “mixed health systems”, with a variety of public and private providers and mechanisms for financing health goods and services. This was the starting point for a weeklong meeting convened by Future Health Systems with support from the Rockefeller Foundation at their centre in Bellagio, Italy last week.

The meeting brought together a small group of policy-makers, entrepreneurs, academics and funders to discuss the changing face of health markets, and in particular to consider future trends in such markets. The meeting report is now available.

The group that met at Bellagio were careful to explain that they take an agnostic view about health markets. They do not advocate for privatization or the expansion of private market share as a public health goal, but they do recognize the pervasiveness of market relationships in health systems, and the need to employ market analyses in order to develop a clearer understanding of market functioning, and how interventions can shape health markets for public policy goals.

At the meeting, participants reviewed the evolution of health markets, identified key drivers of and gaps resulting from their rapid development, and highlighted critical issues that must be tackled to ensure the poorest have access to safe, affordable, effective and equitable health services.

“Engaging with health markets is going to be critical for governments in the future, especially given the recent UN resolution,” noted FHS CEO Sara Bennett, referring to last week’s UN resolution urging countries to work towards affordable Universal Health Coverage. Many country governments will need to purchase services from both public and private providers to achieve universal health coverage, and this may present a real opportunity to shape health markets of the future. At the same time governments need to guard against arrangements that may enable powerful stakeholders to consolidate their position in a health system that provides ineffective services at an unnecessarily high cost.

The group highlighted several issues regarding health markets:
  • Incomplete information: Spotty data is available for government regulators in most low- and middle-income countries. The group therefore proposed that governments identify data that market actors should be required to provide on a routine basis, through, for example, routine reporting by private providers.
  • Regulatory experimentation: The group identified a wide variety of market shaping strategies to improve the delivery of a comprehensive range of health services and products. But they argued mainly for regulatory approaches packaged into “bundles”, which they felt were more likely to succeed despite being more complex to implement and to evaluate.
  • Building capacity among potential regulators:  As markets continue to expand and evolve, governments are playing “catch-up” in fulfilling their stewardship roles. To act as effective stewards, governments need to have organizational capabilities and staff that are skilled in understanding key market players, their interests and functioning, and have the ability to create rules and guidelines that can actually be used by market players.
  • Sustaining investments in health markets: Donors have subsidized the development of market mechanisms, such as social franchising and social marketing schemes, with the dual aims of making quality services more accessible to the poor and establishing effective mechanisms for shaping health markets. Public financing will need to play an important role in ensuring the maintenance of such quality services for the poor in the future.
  • Health worker markets: During the past decade much attention has been given to the global health worker crisis and in particular the imbalance of health workers between countries (rich and poor), rural and urban areas, and different cadres of health workers. Unfortunately the connections between health markets and the health workforce are rarely fully acknowledged, but are critical in many respects. For example, without sustained government funding newly trained cadres of community health workers will likely become the informal care providers of tomorrow.
  • Business models and entrepreneurs: A growing number and variety of business models and entrepreneurs in the health sector have emerged in recent years. It remains to be seen whether currently low-income markets will experience a transition from small, independent and often informal practices, drug shops and laboratories to larger chains and group practices (as seems to be occurring in many middle-income markets), whether transnational and vertically integrated models will develop, and what the consequences of such changes will be for equity and efficiency.
  • Networks and quality of care: Networks are important intermediaries between government and a disorganized private sector. Networks can help address information asymmetries, which may result in consumers having difficulty in judging the quality of care, by setting and enforcing quality standards. Networks can also facilitate the distribution of subsidies for the provision of preventive and public health services.
  • Toward a health market research agenda: Areas where research and evaluation could lead to rich returns include: the effectiveness of new regulatory approaches, the impact of informational interventions upon consumer behavior, and the effectiveness of alternative mobile and informational technologies. A more coordinated approach to identifying health market research priorities would be helpful.
In conclusion, the group recommended that: (i) work be done with a small group of countries to establish systems to collect basic data on health markets, and to develop ways to institutionalize such systems into locally relevant policy and management processes; (ii)  proposals be solicited to support research on building theory and empiric information on health market systems; and (iii) a challenge fund be created to encourage the development of effective regulatory approaches, bringing together different key market actors within countries to develop bundles of regulatory interventions, the information systems to monitor and evaluate their application, and support for rapid learning cycles that enable the application of emerging knowledge. The group intends to pursue some of these discussions with HANSHEP, a group of development agencies and countries that seeks to improve performance of the non-state sector in delivering health care for the poor.

Tuesday, 18 December 2012

FHS India presents initial findings from the forthcoming Sundarbans Health Watch

To drum up support for the forthcoming Sundarbans Health Watch and to share findings with the stakeholders who inform Union Planning Commission directions on livelihood and health policies, FHS India presented their initial findings from a 2012 scoping study at a seminar at the end of November. The FHS panel session in the national seminar “Challenges of Livelihood and Inclusive Rural Development in the Era of Globalization”, organized by the A.K. Dasgupta Centre for Planning and Development, Department of Economics & Politics at the Visva-Bharati University, discussed the supply and demand axis in the study area with particular emphasis on role of rural medical practitioners (RMPs) and policy influence and research uptake (PIRU) issues.

Chair professor P.K. Chattopadhya delivered the welcome address, explaining the necessity and timeliness of having a proactive discussion on livelihood with emphasis on health as an inclusive subject in the backdrop of globalization.

Prof. A.K. Banerjee, Director, IDSK (ex-Vice-Chancellor, University of Calcutta) – in his keynote address – highlighted the absolute necessity of including basic rural health within inclusive rural development and explained the poor condition of India in public health indicators among her south-east Asian counterparts.
The FHS India session was chaired by Prof. Aparajita Mukherjee, a noted expert on health and livelihood issues. The one-and-a-half hour session included presentations on four papers based on findings of recently completed scoping study in the Patharpratima block of the Sundarbans along with a presentation on PIRU. The four papers covered the demand side as well as the supply side of the child health care market in the context of the Sundarbans.

The paper on health care markets sought to provide a differential picture about the rural health care market covering all the providers and the complex interplay among them in the backdrop of climatic shock. The paper on the issues of access by Debjani Burman examined the four dimensions of access – geographical accessibility, availability, affordability and acceptability. The use of a geographic information system (GIS) mapping to indicate the location of providers and the gaps therein drew the audience's attention.
The paper on rural medical practitioners by Nilanjan Patra drew the most questions and interest as well, while the paper on determinants of parent’s choice was acclaimed for its methodology which used an ethnographic approach to address the issue.

The presentation on PIRU honed upon the objectives of introducing to the stakeholders about the nascent concept of PIRU and a demand generation for a proactive value addition to the process. The discussion session saw a good discussion on the potential magnitude of impact a policy-oriented research uptake can actually have. Demand generation for the forthcoming FHS Sundarbans Health Watch Report and our future course of action resulted in a considerable interest and spirited response. Academics remained interested in a judicious and balanced mix of various research methods to inform them of the rural health care market and its allied dimensions for the Sundarbans in the context of its geo-climatic adversities.

The center is going to organize a global meet with policy makers and academicians in which FHS plans to have a panel discussion on its findings.

Monday, 17 December 2012

The challenges of Research Uptake: Systemic, institutional and individual barriers

By Jeff Knezovich, Policy Influence and Research Uptake Manager, IDS
[Editor's note: This blog was originally written for and published on the DRUSSA (Development Research Uptake in Sub-saharan Africa) website as a four part series. It was based on a short presentation to the RIMI4AC conference in London, UK. It has been shortened and reproduced with permission.]

As highlighted in a recent DFID-run event for research uptake practitioners entitled: Beyond communications, research uptake is a concept that has been evolving rapidly over the last several decades. As such, a variety of challenges face research uptake practitioners and those wanting to strengthen capacity to get research into use. These operate at three levels: systemic barriers, institutional barriers and individual barriers.

Systemic barriers
The first challenge is probably that the concept of 'research uptake' is little understood.  In brief, it is focused mainly on the demand side of research, working to stimulate an enabling environment among end users of research to commission and find appropriate information to support their own policy processes. This assumes working closely with key stakeholders, but also probably assumes some sort of capacity strengthening for them to understand and demand high-quality research.

But more at a systemic level, the barriers to research uptake are numerous—and have been well articulated by others. In particular, the RAPID programme at ODI notes six lessons for getting research into use. They highlight different time horizons and different notions of evidence between the research and policy spheres. A researcher needs as long as research takes and findings are often wrapped in a variety of qualifications and caveats, but policymakers often need clear findings at key points during the policymaking process. As a former policymaker turned researcher from Brazil so wonderfully put it: “In Brazil we don’t talk about pilots. I can’t go to an official and say ‘give me two years and I’ll give you the answer’. Why? Because we have elections. If a policymaker waited two years to take action he’d be shot.”

We also know that the research-policy-practice interface is a complex and dynamic one. Not only do those trying to get research into policy need to have some knowledge about where in a particular policy cycle the research topic is, they must also understand who is working to influence that process, what their drivers are and how they’re doing it. And unfortunately, one of the corollary barriers is that change doesn’t happen the same way twice, which means a lot of experimentation, expertise and critical thinking are required to link research, policy and practice. This latter point also helps explain why research uptake is focusing so heavily on strengthening the demand-side—if a policymaker is requesting research findings, half the battle is already fought.

This brings in another systemic barrier—research funders distort demand. While research funders aren’t necessarily the end users of research, they are the ones that set the priorities through what they are willing to fund. Often some sort of demonstration that there is a gap in existing knowledge and some demand for the research results is part of the grading criteria when selecting proposals, but the distortionary effect of the donor cannot be overlooked.

There are also perverse incentives on both the supply and demand side that act as a significant barrier to research uptake. On the research side, promotion is most often dependent on publishing as many papers as possible in peer-reviewed journals with high impact factors, not in communicating that research. There are also time pressures—a student knocking on the office door is more likely to capture a researcher’s attention than a distant policymaker in a capital city far away. And funding is a chronic problem—with researchers perpetually chasing the next grant, who has time to do “extra” work communicating research findings? On the policy side, incentives tend to focus on maintaining political legitimacy. That might include carrying through on promises made during electoral processes, adhering to a particular ideological standpoint (and let’s be clear, evidence-informed policy is a clear ideological position too), or just not looking idiotic in the public eye.

Finally, at a systemic level, research uptake requires a diverse skills set to deliver. In addition to strong research skills, Simon Maxwell likes to argue that policy entrepreneurs require four key skills: story telling, policy engineering, networking and political fixing. But these skills are underpinned by a huge area of oft-overlooked technical skills, including:
  • Editing and language skills
  • Digital engagement skills
  • Graphic design and desktop publishing
  • Media planning and engagement
  • Event planning and management
  • Database management
  • Data analysis
  • Information literacy
  • Knowledge management
  • Budgeting and programme management
  • Marketing and public relations
  • IT skills
Institutional barriers
Focusing now mainly on the supply side of research at an organisational level, given all the systemic challenges, one of the biggest barriers to research uptake is figuring out where to start and how to institutionalise appropriate systems and processes that support research uptake activities. Does a research institute need a central communications/ marketing/ dissemination/ media relations/ knowledge management team? If so, where should it sit? In a grant management office? By itself? As part of the IT department? In the library?

On top of that, where are the capacities for research uptake best placed? Certain skills probably need to remain with individual researchers, but some are probably better supported by an outside team.

Funding research activities is also usually a challenge. It depends on the funding models employed by an individual institute, but many (maybe even most, particularly in Sub-Saharan Africa) institutes lack core funding, and must raise money through projects or other sources. Striking a balance between support to projects versus strengthening and supporting institutional engagement is key, and is also hugely difficult. Does a central team get funded out of overheads? Do they try to support themselves through their own projects and research?

And from an institutional perspective, brain drain is always a worry. If organisations invest in building research uptake skills, there’s no guarantee staff will stick around and that they will continue to benefit from these skills. Researchers may end up in a relevant ministry, for example (though this could turn out to be a good thing for the institution). More centralised teams with specific transferable skills often find themselves poached by the private sector, and in developing countries, especially, by international agencies and non-governmental organisations.

Individual barriers
Last but not least, at an individual level, barriers to research uptake are multiple. One of the most frequent points of opposition to research uptake that I hear, and one that I’m hugely sympathetic to, is that researchers must, first and foremost, be good researchers and that if policymakers or practitioners want to use their work, it’s their prerogative. This is a notion we must counter, strongly and with a moral imperative. It is not just the responsibility of policymakers and practitioners to seek out research—it is also the researcher’s responsibility to make it accessible, especially when it can (and does!) save lives.

Another individual barrier is the ego—and I mean this in two ways. At one level, effective research uptake activities require strong brands from strong researchers. This means that researchers must at some level be sure of themselves and of their findings and be confident to take them out into the big wide world. On the flip side, researchers must be willing to accept help and advice and work with others. Just because a researcher, who has more often than not been focusing on a study for a significant period of time, understands the findings doesn’t mean everyone will—EVERYONE needs a good editor, always. Also, given the diverse skills required for research uptake, it’s highly unlikely that any one person knows best.

That may sound like a lot of barriers and I’d hate to leave people thinking it cannot be done. A number of examples of incredibly impactful research uptake activities exist—and they can and have improved and saved the lives of many. It just means there’s some work to do.

Wednesday, 12 December 2012

Time for a rethink? Getting smart about politics on climate change and agriculture

By Lars Otto Naess, FAC Climate Change theme convenor, and Peter Newell, Professor of International Relations at the University of Sussex.
Women and baby in field

One of the big debates at the 18th Conference of the Parties (COP18) to the United Nations Framework Convention on Climate Change, which came to a close last week, revolved around the role of agriculture and whether to establish a separate agricultural work programme. The decision to set up a work programme has now been deferred – again. This is an opportunity to rethink the broader issues around climate change and agriculture.
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Tuesday, 11 December 2012

Credibility across cultures: expertise, uncertainty and the global politics of scientific advice, 6-7 February 2013, UK

Speakers include: Professors Anne Glover, Sir Robert Watson, Lidia Brito, David Spiegelhalter, Chris Whitty, Roger Pielke, Duncan Green and more.

Tackling 21st century sustainability and development challenges requires the 'best available' scientific advice. But what is 'best advice' and how might this idea need to be re-thought?

Many questions persist about how to build and maintain robust, open and accountable processes of expert advice that can operate effectively across disciplines, sectors, social contexts and national boundaries.

Join us for the STEPS Centre Annual Symposium on 6-7 Feb 2013, to debate the critical task of maintaining credibility across cultures.

• Register Now:
(50% discount available for students)
• Programme: View the Symposium programme

This posting includes an audio/video/photo media file: Download Now

Saturday, 1 December 2012

Understanding the how, where and why of global land, water and green grabs

As policy makers gather in Doha over the next week for the United Nations Climate Change Conference (COP 18), discussions will inevitably turn to the creation of a green economy that responds to the world's ongoing climate and resource scarcity challenges. It is exactly within this context of scarcity and  security that fellows from the Institute of Development Studies (IDS) argued that land, water and green grabs need to be understood.
In their seminar, IDS fellows Ian Scoones, Melissa Leach and Lyla Mehta from the KNOTS Team provided a timely insight into the global land, water and green grab deals that are increasingly taking place. The seminar explored in more detail how, where and why these grabs were occurring and made reference to articles contributed recently to the Journal of Peasant Studies by all three fellows on the issues of land, water and green grabs. It also set out a number of recommendations relevant to those policy makers currently meeting at COP 18.
For more details and video of the seminar see the IDS website