This study and report were commissioned by the Rockefeller Foundation to explore the feasibility of establishing a support mechanism for ministers and ministries of health especially in the poorest countries, as part of the Foundation’s Transforming Health Systems initiative. Based on data from minister and stakeholder interviews and supporting research and consultation activities, this report offers seven action items geared toward building a systematic and sustained program of support for health ministries. Recommendations and proposals provided address: capacity assessment tools; leveraging existing management development resources; mapping country networks of expertise; regional networks to support health systems stewardship and governance; knowledge networks to support ministers of health; executive leadership development; and advocacy for strengthening health ministries. Collective action on these proposals is needed to strengthen health ministries and enhance the leadership capabilities of ministers.
Governance and participation in health
In the HIV/AIDS pandemic, it is older people, particularly grandmothers, who are shouldering most of the emotional and financial burden as carers. Yet their vital role is going unrecognised. This report calls for a major shift in the response to HIV/AIDS. Some of the recommendations include: public recognition of the value, contribution and rights of older women carers to reduce stigma and discrimination against them more sophisticated analysis and understanding of the role of older women and men in caring for adults and children living with HIV, so that urgent; support can be targeted at these older carers; better support to access existing services home-based care policies and programmes that address the specific economic, health and psychosocial needs of older women carers and support them in their care giving roles.
Country-wide peaceful demonstrations against the regime in Sudan have involved women as organised activists. Women in marginalized areas of conflict such as Darfur, South Sudan, the Nuba Mountains and the Blue Nile have lost their children, family and livelihood to war and famine. In addition to their experience of socio-economic deprivation, many of those who fled to the capital Khartoum have been abandoned by their husbands who are unable to support their families. The women’s group No To Women’s Oppression provides legal aid, advocacy and awareness campaigns and monitors violations of human rights, a solid and active component of the resistance. Women activist in the Central Committee for Doctors and other organisations has, however, made them particularly prone to arrests and harassment. Women have also played a vital part in documenting the movement from the inside, especially in providing footage and proof of women's experiences of activism and of their conditions and the brutality they face.
Policy briefs are a relatively new approach to packaging research evidence for policymakers. Drawing on available systematic reviews makes the process of mobilising evidence feasible in a way that would not otherwise be possible if individual relevant studies had to be identified and synthesised for every feature of the issue under consideration. This article suggests questions that can be used to guide those preparing and using policy briefs to support evidence-informed policymaking: Does the policy brief address a high-priority issue and describe the relevant context of the issue being addressed? Does the policy brief describe the problem, costs and consequences of options to address the problem, and the key implementation considerations? Does the policy brief employ systematic and transparent methods to identify, select, and assess synthesised research evidence? Does the policy brief take quality, local applicability, and equity considerations into account when discussing the synthesised research evidence? Does the policy brief employ a graded-entry format? Was the policy brief reviewed for both scientific quality and system relevance?
Increasing interest in the use of policy dialogues has been fuelled by a number of factors, such as recognition that: there is a need for locally contextualised 'decision support' for policymakers and other stakeholders; research evidence is only one input into the decision-making processes of policymakers and other stakeholders; having many stakeholders can add significant value to these processes; and many stakeholders can take action to address high-priority issues, and not just policymakers. This article suggests questions to guide those organising and using policy dialogues to support evidence-informed policymaking: Does the dialogue address a high-priority issue? Does the dialogue provide opportunities to discuss the problem, options to address the problem, and key implementation considerations? Is the dialogue informed by a pre-circulated policy brief and by a discussion about the full range of factors that can influence the policymaking process? Does the dialogue ensure fair representation among those who will be involved in, or affected by, future decisions related to the issue? Are outputs produced and follow-up activities undertaken to support action?
This article addresses strategies to inform and engage the public in policy development and implementation. The importance of engaging the public (both patients and citizens) at all levels of health systems is widely recognised. They are the ultimate recipients of the desirable and undesirable impacts of public policies, and many governments and organisations have acknowledged the value of engaging them in evidence-informed policy development. The potential benefits of doing this include the establishment of policies that include their ideas and address their concerns, the improved implementation of policies, improved health services, and better health. Public engagement can also be viewed as a goal in itself by encouraging participative democracy, public accountability and transparency. The article suggests three questions that can be considered with regard to public participation strategies: What strategies can be used when working with the mass media to inform the public about policy development and implementation? What strategies can be used when working with civil society groups to inform and engage them in policy development and implementation? What methods can be used to involve consumers in policy development and implementation?
Community capability is the combined influence of a community’s social systems and collective resources that can address community problems and broaden community opportunities. The authors frame it as consisting of three domains that together support community empowerment: what communities have; how communities act; and for whom communities act. The authors sought to further understand these domains through a secondary analysis of a previous systematic review on community participation in health systems interventions in low and middle income countries (LMICs). The authors searched for journal articles published between 2000 and 2012 related to the concepts of “community”, “capability/participation”, “health systems research” and “LMIC.” They identified 64 with rich accounts of community participation involving service delivery and governance in health systems research for thematic analysis following the three domains framing community capability. When considering what communities have, articles reported external linkages as the most frequently gained resource, especially when partnerships resulted in more community power over the intervention. In contrast, financial assets were the least mentioned, despite their importance for sustainability. With how communities act, articles discussed challenges of ensuring inclusive participation and detailed strategies to improve inclusiveness. Very little was reported about strengthening community cohesiveness and collective efficacy despite their importance in community initiatives. When reviewing for whom communities act, the importance of strong local leadership was mentioned frequently, while conflict resolution strategies and skills were rarely discussed. Synergies were found across these elements of community capability, with tangible success in one area leading to positive changes in another. Access to information and opportunities to develop skills were crucial to community participation, critical thinking, problem solving and ownership. Although there are many quantitative scales measuring community capability, health systems research engaged with community participation has rarely made use of these tools or the concepts informing them. Overall, the amount of information related to elements of community capability reported by these articles was low and often of poor quality.
This report synthesises the results of the first evaluation of the early implementation of the Paris Declaration, from March 2005 to late 2007. It comprises extensive assessments in eight countries, together with ‘lighter’ studies on eleven development partner agencies, focusing at the headquarters level. It found that the principle of ownership has gained much greater prominence since 2005, although the evaluations show that the practical meaning and boundaries of country ownership and leadership often remain difficult to define. The evaluations do not suggest any backsliding on harmonisation, but neither do they indicate any overall trend toward progress. All the evaluations convey a sense that the joint processes for tracking progress and resolving problems fall short in terms of mutual accountability. Development agency and partner country evaluations reveal that, despite clear commitments to alignment, implementation of the various components of alignment set out in the Paris Declaration has been highly uneven.
Since the World Health Organisation declared Zika a global public health emergency in February of this year, much attention has been brought to bear on applying lessons learned during the Ebola crisis of 2014-15. This blog draws on the lessons for the health communication sector explored through a new practice briefing from BBC Media Action, Using media and communication to respond to public health emergencies - lessons learned from Ebola, and the unique role media and communications can play in effectively tackling Zika. BBC Media Action has responded to 28 humanitarian emergencies since 1994 – including Ebola. One recurring lesson has been that interventions are most effective if the formats and technologies used to communicate give affected communities a chance to participate and have a voice. This ensures that content reflects local realities, needs and concerns. People need to be told more than just what they should or should not do. They need to be engaged in a discussion around the ‘how’ and the ‘why’.
This paper argues that stronger and values-based public sector management and leadership is essential in building health systems that better address health inequities. By considering evidence on existing weaknesses in health system action to redress inequity, it identifies a complex and inter-locking set of problems involving individuals, organisational culture and the ways in which wider political, economic and socio-cultural forces influence public sector organisations. It then examines the particular features of organisational culture in organisations judged to be better performing, and considers how change in organisational culture can be brought about. It also identifies the particular competencies of public sector managers and reviews evidence on how these competencies can be developed.