Institute of Development Studies (IDS)
IDS is an international centre of excellence in multi-disciplinary analysis, teaching, and practice of development based at the University of Sussex in Brighton, UK. Its areas of expertise include poverty dynamics, social policy analysis, processes for involving stakeholders, strategies for making health services more accountable to their community; and research methods that combine quantitative and qualitative evaluation of performance of health systems. The organisation has experience working on health and social protection in China, Uganda, and other Asian and African countries, innovative strategies to improve provider performance in China and Bangladesh, and developing analytic frameworks to bring together development and public health approaches to understanding health systems.
Who we work with at IDS
- Dr Gerry Bloom (FHS publications, Profile at IDS, Google Scholar profile)
- Tom Barker, FHS Policy Influence and Research Uptake Manager (FHS publications, Profile at IDS)
- Dr Henry Lucas (FHS publications, Profile at IDS)
- Dr Hilary Standing (FHS publications, Profile at IDS)
- Dr Hayley MacGregor (FHS publications, Profile at IDS)
- Dr Linda Waldman (FHS publications, Profile at IDS)
Recent FHS publications involving IDS
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.
This article poses questions, challenges, and dilemmas for health system researchers striving to better understand how gender shapes accountability mechanisms, by critically examining the relationship between accountability and gender in health systems. It raises three key considerations, namely that: (1) power and inequities are centre stage: power relations are critical to both gender and accountability, and accountability mechanisms can transform health systems to be more gender-equitable; (2) intersectionality analyses are necessary: gender is only one dimension of marginalisation and intersects with other social stratifiers to create different experiences of vulnerability; we need to take account of how these stratifiers collectively shape accountability; and (3) empowerment processes that address gender inequities are a prerequisite for bringing about accountability. We suggest that holistic approaches to understanding health systems inequities and accountability mechanisms are needed to transform gendered power inequities, impact on the gendered dimensions of ill health, and enhance health system functioning.
In July 2017, IDS hosted a workshop on ‘Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity’, with the aim of generating dialogue and mutual learning among activists, researchers, policymakers, and funders working towards more equitable health systems and a commitment to Universal Health Coverage (UHC). This issue of the IDS Bulletin is based around three principal themes that emerged from the workshop as needing particular attention. First, the nature of accountability politics ‘in time’ and the cyclical aspects of efforts towards accountability for health equity. Second, the contested politics of ‘naming’ and measuring accountability, and the intersecting dimensions of marginalisation and exclusion that are missing from current debates. Third, the shifting nature of power in global health and new configurations of health actors, social contracts, and the role of technology.For the first time in IDS Bulletin history, themes are explored not only in text but also through a selection of online multimedia content, including a workshop video, a photo story and a documentary. This expansion into other forms of communication is explicitly aimed at galvanising larger numbers of people in a movement towards UHC and the linked agenda of accountability for health equity.The articles and multimedia in this IDS Bulletin reflect the fact that while the desired outcome might be the same – better health for all – accountability strategies are as diverse as the contexts in which they have developed.
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.
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.
Recent FHS blogs from IDS
September 1978. October 2018. July 2004? My guess is that the first two dates will ring a bell for those with a passing knowledge of ‘global health’ and the third will make you scratch your heads. This year we celebrated the 40th anniversary of the the Alma-Ata Declaration of 1978, which established primary health care and community involvement as core to the achievement of ‘health for all’. Whether the goals of Alma Ata are ‘still relevant’ was a hotly debated topic at the biennial gathering of the Health Systems Global community in Liverpool. Just weeks later in Astana, yet another global gathering of health folks marked the anniversary with a reaffirmation of ‘the fundamental right of every human being to the enjoyment of the highest attainable standard of health without distinction of any kind’. In ten years time we will mark it again, using the moment to consider what progress has been made (or not) towards this grand goal of a universal human right to health. Why this third date? Why July 2004?
Some years ago, Tony Saich likened doing research on local government in China to the story of the blind men and the elephant – the complexity of China, and the differences between places, mean that different people experience different things, and describe different realities. China has always provided avenues for interesting research. Many of the debates that Tony Saich was reflecting on were around China’s rapid industrialisation, development of markets, and the ways in which local governments steered reforms. Fifteen years on, while the debates have progressed and the amount of research and analysis on China has increased dramatically, some of the fundamental questions remain.
At the upcoming Global Symposium on Health Systems Research, we will be running a participatory session that builds on research from Uganda, Bangladesh and Nepal, entitled Amplifying Marginalised Voices: Towards Meaningful Inclusion in Social Accountability Mechanisms for Health. This session applies an intersectional lens to accountability mechanisms, asking about the inclusion of specific, marginalised categories within communities in mainstream accountability initiatives.
There is growing scientific evidence that infections that are resistant to antibiotics are a serious global health challenge. This has stimulated wide agreement on a Global Action Plan for Addressing AMR and many countries have produced National Action Plans. It is important that these action plans take into account the local context. This is especially important in countries with a pluralistic health system in which people seek health care from a wide variety of public and private providers of drugs and medical care. One lesson from the work of the Future Health Systems Consortium is the need to take a systems approach for tackling health challenges in these countries. This blog highlights some priority issues that this kind of approach needs to take into account.
Quite a lot has changed in the last 40 years, right? And yet, four decades since the 1978 signing of the international Alma Ata declaration in Almaty, Kazakhstan, meeting the essential health needs of people through primary health care has once again been highlighted as the key to the attainment of Health for All by a ‘new’ global movement.
We had three days. That was it. We had three days: to gather, to share ideas and experiences, to make new connections, to strengthen existing ones, and to wrestle with the conceptual beast that is “accountability.” The aim? To bring sharp minds, creative problem-solvers and pragmatic innovators together under one roof so that we might get a few steps closer to our common goal of greater health equity. Did it work? Yes. With caveats. You can be the judge.