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Article ; Online: Health policy and systems research

David H. Peters

Health Research Policy and Systems, Vol 16, Iss 1, Pp 1-

the future of the field

2018 Volume 4

Abstract: Abstract Health policy and systems research (HPSR) has changed considerably over the last 20 years, but its main purpose remains to inform and influence health policies and systems. Whereas goals that underpin health systems have endured – such as a ... ...

Abstract	Abstract Health policy and systems research (HPSR) has changed considerably over the last 20 years, but its main purpose remains to inform and influence health policies and systems. Whereas goals that underpin health systems have endured – such as a focus on health equity – contexts and priorities change, research methods progress, and health organisations continue to learn and adapt, in part by using HPSR. For HPSR to remain relevant, its practitioners need to re-think how health systems are conceptualised, to keep up with rapid changes in how we diagnose and manage disease and use information, and consider factors affecting people’s health that go well beyond healthcare systems. The Sustainable Development Goals (SDGs) represent a shifting paradigm in human development by seeking convergence across sectors. They also offer an opportunity for HPSR to play a larger role, given its pioneering work on applying systems thinking to health, its focus on health equity, and the strength of its multi-disciplinary approaches that make it a good fit for the SDG era. Globally, population health is being challenged in different ways, from climate change and growing air pollution and toxic environmental exposure to food insecurity, massive population migration and refugee crises, to emerging and re-emerging diseases. Each of these trends reinforce each other and concentrate their harms on the most vulnerable populations. Multi-level governance, together with novel regulatory strategies and socially oriented investments, are key to successful action against many of the new challenges, with HPSR guiding their design and evolution. The HPSR community cannot be complacent about its successful, yet short, history. Tensions remain about how different stakeholders use HPSR such as the contrast between embedding research within government institutions versus independently evaluating and holding decision-makers accountable. Such tensions are inevitable in the boundary-spanning field that HPSR has become. We should strive to enhance ...
Keywords	Health policy ; Health systems ; Health systems research ; Sustainable Development Goals ; Public aspects of medicine ; RA1-1270
Subject code	360 ; 300
Language	English
Publishing date	2018-08-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: An Empirical Examination of the Inequality of Forgone Care in India

Bryan Patenaude / Krishna D. Rao / David H. Peters

Health Systems & Reform, Vol 7, Iss

2021 Volume 2

Abstract: Understanding how well a health system is meeting the needs of the population is critical to achieving the policy aspirations of universal health coverage. This study focuses on assessing the inequity of forgone care for priority maternal and child ... ...

Abstract	Understanding how well a health system is meeting the needs of the population is critical to achieving the policy aspirations of universal health coverage. This study focuses on assessing the inequity of forgone care for priority maternal and child health services across India. We utilize data from the 4th round of the Indian National Family Health Survey (NFHS-4) to examine inequality of forgone care. Our outcomes include forgone institutional delivery, antenatal care, medical care for a child with fever or cough, and medical care for a child with diarrhea. Wagstaff’s standardized concentration indices (CIs) are computed at the national level, over urban and rural sub-populations, and by state. Regression decomposition is performed to determine the influence of specific drivers on overall inequality. There was significant variation in the national-level prevalence and CIs for forgone antenatal care (17.8%, CI: −0.423), forgone medical care for a child with fever or cough (32.4%, CI: −0.199), forgone medical care for a child with diarrhea (33.8%, CI: −0.172), and forgone institutional delivery (24.5%, CI: −0.436). For all outcomes, forgone care is disproportionately concentrated among the poor, particularly in rural areas. There is also significant heterogeneity in state-level inequalities. Decomposition analyses show that socioeconomic status, maternal education, rural status, and state-level per capita health spending are the leading drivers of observed inequalities in forgone care. Results suggest attending to both the operation and financing of India’s health care system as well as the social determinants that make poor women more likely to forgo maternal health care.
Keywords	forgone care ; india ; inequity ; maternal child health ; access ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	Taylor & Francis Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A Special Issue Honoring the Legacy of Adam Wagstaff

Abdo S. Yazbeck / David H. Peters / Magnus Lindelow / Caryn Bredenkamp

Health Systems & Reform, Vol 7, Iss

2021 Volume 2

Keywords	Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Language	English
Publishing date	2021-07-01T00:00:00Z
Publisher	Taylor & Francis Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Strategies to promote evidence use for health programme improvement

N. Ilona Varallyay / Caitlin Kennedy / Sara C. Bennett / David H. Peters

Health Research Policy and Systems, Vol 20, Iss 1, Pp 1-

learning from the experiences of embedded implementation research teams in Latin America and the Caribbean

2022 Volume 14

Abstract: Abstract Background To achieve global health targets, innovative approaches are needed to strengthen the implementation of efficacious interventions. New approaches in implementation research that bring together health system decision-makers alongside ... ...

Abstract	Abstract Background To achieve global health targets, innovative approaches are needed to strengthen the implementation of efficacious interventions. New approaches in implementation research that bring together health system decision-makers alongside researchers to collaboratively design, produce and apply research evidence are gaining traction. Embedded implementation research (EIR) approaches led by decision-maker principal investigators (DM PIs) appear promising in this regard. Our aim is to describe the strategies study teams employ in the post-research phase of EIR to promote evidence-informed programme or policy improvement. Methods We conducted a prospective, comparative case study of an EIR initiative in Bolivia, Colombia and Dominican Republic. Guided by a conceptual framework on EIR, we used semi-structured key informant interviews (n = 51) and document reviews (n = 20) to examine three decision-maker-led study teams (“cases”). Focusing on three processes (communication/dissemination, stakeholder engagement with evidence, integrating evidence in decision-making) and the main outcome (enacting improvements), we used thematic analysis to identify associated strategies and enabling or hindering factors. Results Across cases, we observed diverse strategies, shaped substantially by whether the DM PI was positioned to lead the response to study findings within their sphere of work. We found two primary change pathways: (1) DM PIs implement remedial measures directly, and (2) DM PIs seek to influence other stakeholders to respond to study findings. Throughout the post-research phase, EIR teams adapted research use strategies based on the evolving context. Conclusions EIR led by well-positioned DM PIs can facilitate impactful research translation efforts. We draw lessons around the importance of (1) understanding DM PI positionality, (2) ongoing assessment of the evolving context and stakeholders and (3) iterative adaptation to dynamic, uncertain circumstances. Findings may guide EIR practitioners in planning ...
Keywords	Implementation research ; Embedded research ; Evidence coproduction ; Evidence-informed decision-making ; Knowledge translation ; Health policy and systems research ; Public aspects of medicine ; RA1-1270
Subject code	306
Language	English
Publishing date	2022-04-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Documenting the development, adoption and pre-ebola implementation of Liberia’s integrated disease surveillance and response (IDSR) strategy

Tolbert G. Nyenswah / Laura Skrip / Mardia Stone / Jessica L. Schue / David H. Peters / William R. Brieger

BMC Public Health, Vol 23, Iss 1, Pp 1-

2023 Volume 12

Abstract: Abstract Background In the immediate aftermath of a 14-year civil conflict that disrupted the health system, Liberia adopted the internationally recommended integrated disease surveillance and response (IDSR) strategy in 2004. Despite this, Liberia was ... ...

Abstract	Abstract Background In the immediate aftermath of a 14-year civil conflict that disrupted the health system, Liberia adopted the internationally recommended integrated disease surveillance and response (IDSR) strategy in 2004. Despite this, Liberia was among the three West African countries ravaged by the worst Ebola epidemic in history from 2014 to 2016. This paper describes successes, failures, strengths, and weaknesses in the development, adoption, and implementation of IDSR following the civil war and up until the outbreak of Ebola, from 2004 to early 2014. Methods We reviewed 112 official Government documents and peer-reviewed articles and conducted 29 in-depth interviews with key informants from December 2021 to March 2022 to gain perspectives on IDSR in the post-conflict and pre-Ebola era in Liberia. We assessed the core and supportive functions of IDSR, such as notification of priority diseases, confirmation, reporting, analysis, investigation, response, feedback, monitoring, staff training, supervision, communication, and financial resources. Data were triangulated and presented via emerging themes and in-depth accounts to describe the context of IDSR introduction and implementation, and the barriers surrounding it. Results Despite the adoption of the IDSR framework, Liberia failed to secure the resources—human, logistical, and financial—to support effective implementation over the 10-year period. Documents and interview reports demonstrate numerous challenges prior to Ebola: the surveillance system lacked key components of IDSR including laboratory testing capacity, disease reporting, risk communication, community engagement, and staff supervision systems. Insufficient financial support and an abundance of vertical programs further impeded progress. In-depth accounts by donors and key governmental informants demonstrate that although the system had a role in detecting Ebola in Liberia, it could not respond effectively to control the disease. Conclusion Our findings suggest that post-war, Liberia’s ...
Keywords	Ebola Virus Disease ; Health Management Information System ; Integrated Disease Surveillance and Response ; Public Health Emergency ; Liberia ; West Africa ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2023-10-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The effectiveness of training strategies to improve healthcare provider practices in low-income and middle-income countries

David H Peters / Alexander K Rowe / Samantha Y Rowe / Kathleen A Holloway

BMJ Global Health, Vol 6, Iss

2021 Volume 1

Abstract: Introduction In low/middle-income countries (LMICs), training is often used to improve healthcare provider (HCP) performance. However, important questions remain about how well training works and the best ways to design training strategies. The objective ...

Abstract	Introduction In low/middle-income countries (LMICs), training is often used to improve healthcare provider (HCP) performance. However, important questions remain about how well training works and the best ways to design training strategies. The objective of this study is to characterise the effectiveness of training strategies to improve HCP practices in LMICs and identify attributes associated with training effectiveness.Methods We performed a secondary analysis of data from a systematic review on improving HCP performance. The review included controlled trials and interrupted time series, and outcomes measuring HCP practices (eg, percentage of patients correctly treated). Distributions of effect sizes (defined as percentage-point (%-point) changes) were described for each training strategy. To identify effective training attributes, we examined studies that directly compared training approaches and performed random-effects linear regression modelling.Results We analysed data from 199 studies from 51 countries. For outcomes expressed as percentages, educational outreach visits (median effect size when compared with controls: 9.9 %-points; IQR: 4.3–20.6) tended to be somewhat more effective than in-service training (median: 7.3 %-points; IQR: 3.6–17.4), which seemed more effective than peer-to-peer training (4.0 %-points) and self-study (by 2.0–9.3 %-points). Mean effectiveness was greater (by 6.0–10.4 %-points) for training that incorporated clinical practice and training at HCPs’ work site. Attributes with little or no effect were: training with computers, interactive methods or over multiple sessions; training duration; number of educational methods; distance training; trainers with pedagogical training and topic complexity. For lay HCPs, in-service training had no measurable effect. Evidence quality for all findings was low.Conclusions Although additional research is needed, by characterising the effectiveness of training strategies and identifying attributes of effective training, decision-makers in LMICs can improve how these strategies are selected and implemented.
Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Subject code	331
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Decomposing the rural–urban gap in factors associated with childhood immunisation in sub-Saharan Africa

David H Peters / Alexander K Rowe / Samantha Y Rowe / Kathleen A Holloway

BMJ Global Health, Vol 6, Iss

evidence from surveys in 23 countries

2021 Volume 1

Abstract: Background About 31 million children in sub-Saharan Africa (SSA) suffer from immunisation preventable diseases yearly and more than half a million children die because of lack of access to immunisation. Immunisation coverage has stagnated at 72% in SSA ... ...

Abstract	Background About 31 million children in sub-Saharan Africa (SSA) suffer from immunisation preventable diseases yearly and more than half a million children die because of lack of access to immunisation. Immunisation coverage has stagnated at 72% in SSA over the past 6 years. Due to evidence that full immunisation of children may be determined by place of residence, this study aimed at investigating the rural–urban differential in full childhood immunisation in SSA.Methods The data used for this study consisted of 26 241 children pooled from 23 Demographic and Health Surveys conducted between 2010 and 2018 in SSA. We performed a Poisson regression analysis with robust Standard Errors (SEs) to determine the factors associated with full immunisation status for rural and urban children. Likewise, a multivariate decomposition analysis for non-linear response model was used to examine the contribution of the covariates to the observed rural and urban differential in full childhood immunisation. All analyses were performed using Stata software V.15.0 and associations with a p<0.05 were considered statistically significant.Results More than half of children in urban settings were fully immunised (52.8%) while 59.3% of rural residents were not fully immunised. In all, 76.5% of rural–urban variation in full immunisation was attributable to differences in child and maternal characteristics. Household wealth was an important component contributing to the rural–urban gap. Specifically, richest wealth status substantially accounted for immunisation disparity (35.7%). First and sixth birth orders contributed 7.3% and 14.9%, respectively, towards the disparity while 7.9% of the disparity was attributable to distance to health facility.Conclusion This study has emphasised the rural–urban disparity in childhood immunisation, with children in the urban settings more likely to complete immunisation. Subregional, national and community-level interventions to obviate this disparity should target children in rural settings, those from poor households and women who have difficulties in accessing healthcare facilities due to distance.
Keywords	Medicine (General) ; R5-920 ; Infectious and parasitic diseases ; RC109-216
Subject code	360
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Towards Core Competencies for Health Policy and Systems Research (HPSR) Training

Meike J. Schleiff / Avanti Rangnekar / Francisco Oviedo Gomez / Gina Teddy / David H. Peters / Dina Balabanova

International Journal of Health Policy and Management, Vol 11, Iss 7, Pp 1058-

Results From a Global Mapping and Consensus-Building Process

2022 Volume 1068

Abstract: BackgroundAs the field of health policy and systems research (HPSR) continues to grow, there is a recognition of the need for training in HPSR. This aspiration has translated into a multitude of teaching programmes of variable scope and quality, ... ...

Abstract	BackgroundAs the field of health policy and systems research (HPSR) continues to grow, there is a recognition of the need for training in HPSR. This aspiration has translated into a multitude of teaching programmes of variable scope and quality, reflecting a lack of consensus on the skills and practices required for rigorous HPSR. The purpose of this paper is to identify an agreed set of core competencies for HPSR researchers, building on the previous work by the Health Systems Global (HSG) Thematic Working Group on Teaching & Learning. MethodsOur methods involved an iterative approach of four phases including a literature review, key informant interviews and group discussions with HPSR educators, and webinars with pre-post surveys capturing views among the global HPSR community. The phased discussions and consensus-building contributed to the evolution of the HPSR competency domains and competencies framework. ResultsEmerging domains included understanding health systems complexity, assessing policies and programs, appraising data and evidence, ethical reasoning and practice, leading and mentoring, building partnerships, and translating and utilizing knowledge and HPSR evidence. The development of competencies and their application were often seen as a continuous process spanning evidence generation, partnering, communicating and helping to identify new critical health systems questions. ConclusionThe HPSR competency set can be seen as a useful reference point in the teaching and practice of high-quality HPSR and can be adapted based on national priorities, the particularities of local contexts, and the needs of stakeholders (HPSR researchers and educators), as well as practitioners and policy-makers. Further research is needed in using the core competency set to design national training programmes, develop locally relevant benchmarks and assessment methods, ad evaluate their use in different settings.
Keywords	health systems research ; competency based education ; workforce ; stakeholder engagement ; Public aspects of medicine ; RA1-1270
Subject code	300
Language	English
Publishing date	2022-07-01T00:00:00Z
Publisher	Kerman University of Medical Sciences
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Utility and limitations of measures of health inequities

Olakunle Alonge / David H. Peters

Global Health Action, Vol 8, Iss 0, Pp 1-

a theoretical perspective

2015 Volume 9

Abstract: What is already known on this subject?Various measures have been used in quantifying health inequities among populations in recent times; most of these measures were derived to capture the socioeconomic inequalities in health. These different measures do ...

Abstract	What is already known on this subject?Various measures have been used in quantifying health inequities among populations in recent times; most of these measures were derived to capture the socioeconomic inequalities in health. These different measures do not always lend themselves to common interpretation by policy makers and health managers because they each reflect limited aspects of the concept of health inequities.What does this study add?To inform a more appropriate application of the different measures currently used in quantifying health inequities, this article explicates common theories underlying the definition of health inequities and uses this understanding to show the utility and limitations of these different measures. It also suggests some key features of an ideal indicator based on the conceptual understanding, with the hope of influencing future efforts in developing more robust measures of health inequities. The article also provides a conceptual ‘product label’ for the common measures of health inequities to guide users and ‘consumers’ in making more robust inferences and conclusions.This paper examines common approaches for quantifying health inequities and assesses the extent to which they incorporate key theories necessary for explicating the definition of health inequity. The first theoretical analysis examined the distinction between inter-individual and inter-group health inequalities as measures of health inequities. The second analysis considered the notion of fairness in health inequalities from different philosophical perspectives. To understand the extent to which different measures of health inequities incorporate these theoretical explanations, four criteria were used to assess each measure: 1) Does the indicator demonstrate inter-group or inter-individual health inequalities or both; 2) Does it reflect health inequalities in relation to socioeconomic position; 3) Is it sensitive to the absolute transfer of health (outcomes, services, or both) or income/wealth between groups; 4) ...
Keywords	health inequities ; program evaluation ; theory of social justice ; measures of inequality ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2015-09-01T00:00:00Z
Publisher	Taylor & Francis Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: The effectiveness of supervision strategies to improve health care provider practices in low- and middle-income countries

Samantha Y. Rowe / Dennis Ross-Degnan / David H. Peters / Kathleen A. Holloway / Alexander K. Rowe

Human Resources for Health, Vol 20, Iss 1, Pp 1-

secondary analysis of a systematic review

2022 Volume 12

Abstract: Abstract Background Although supervision is a ubiquitous approach to support health programs and improve health care provider (HCP) performance in low- and middle-income countries (LMICs), quantitative evidence of its effects is unclear. The objectives ... ...

Abstract	Abstract Background Although supervision is a ubiquitous approach to support health programs and improve health care provider (HCP) performance in low- and middle-income countries (LMICs), quantitative evidence of its effects is unclear. The objectives of this study are to describe the effect of supervision strategies on HCP practices in LMICs and to identify attributes associated with greater effectiveness of routine supervision. Methods We performed a secondary analysis of data on HCP practice outcomes (e.g., percentage of patients correctly treated) from a systematic review on improving HCP performance. The review included controlled trials and interrupted time series studies. We described distributions of effect sizes (defined as percentage-point [%-point] changes) for each supervision strategy. To identify attributes associated with supervision effectiveness, we performed random-effects linear regression modeling and examined studies that directly compared different approaches of routine supervision. Results We analyzed data from 81 studies from 36 countries. For professional HCPs, such as nurses and physicians, primarily working at health facilities, routine supervision (median improvement when compared to controls: 10.7%-points; IQR: 9.9, 27.9) had similar effects on HCP practices as audit with feedback (median improvement: 10.1%-points; IQR: 6.2, 23.7). Two attributes were associated with greater mean effectiveness of routine supervision (p < 0.10): supervisors received supervision (by 8.8–11.5%-points), and supervisors participated in problem-solving with HCPs (by 14.2–20.8%-points). Training for supervisors and use of a checklist during supervision visits were not associated with effectiveness. The effects of supervision frequency (i.e., number of visits per year) and dose (i.e., the number of supervision visits during a study) were unclear. For lay HCPs, the effect of routine supervision was difficult to characterize because few studies existed, and effectiveness in those studies varied ...
Keywords	Developing countries ; Health workers ; Performance ; Supervision ; Quality improvement ; Systematic review ; Medicine (General) ; R5-920 ; Public aspects of medicine ; RA1-1270
Subject code	150
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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