India, the world’s 10th largest economy, has witnessed a decline in the incidence of poverty during the last few decades largely due to economic liberalization. But one-third of its population still remain below the poverty line subsisting on less than a dollar a day. With economic advancement has come new vulnerabilities, inequalities, and insecurities in all development areas, including health.
Research in the second half of the century established that poor are less entitled to public subsidies and more likely to financial shock owing to out of pocket expenditures on health.
The situation is understandably worse for regions like the Sundarbans in West Bengal, where poverty stricken islanders have to cope with adverse geo-climatic conditions. Against this backdrop the FHS India research initiative was launched with the guiding principle of “putting the poor first”.
FHS Phase 1
In the initial phase of FHS India, research was carried out to gain a systematic understanding of determinants and consequences of inequity in health, healthcare, healthcare utilization and healthcare financing. Towards the later part of the research period, FHS India focused on the Sundarbans, a chronically handicapped region of West Bengal.
For the first time, FHS India generated systematic evidence on burden of ill-health in the Sundarbans based on household surveys, chronic morbidities suffered by older adults, healthcare utilization, choice of providers, issues in access to healthcare amidst extreme geographical barriers and issues in maternal and child healthcare. Further, a preliminary understanding of the healthcare delivery mechanisms in the Sundarbans was also gathered through a systematic survey of public health facilities, semi/unskilled rural medical practitioners and charitable trusts.
One of the major focus areas of FHS I was to build up a partnership for research that will be successful in influencing health policy and service delivery mechanism in the state of West Bengal.
FHS Phase 2
Evidence-based research from the first phase identified a need for greater community exposure, learning and identification of key systemic gaps and mitigation strategies. Through audience friendly communication methods, technology use, health services provider training and a prompt, need-based support, in this phase FHS India will work to formulate a feasible and comprehensive strategy for tackling health service delivery in the Sundarbans.
For the next five years, FHS India will concentrate on research focusing on systematic understanding of the multidimensional nature of crisis in child healthcare access in delta region of the Sundarbans. However, given that child health care shares the common fundamental problems with overall primary health care system, the uptake of research is expected to significantly impact the overall system.
We are planning operational research that will be piloted to learn about and demonstrate the effectiveness of the proposed model.
A common knowledge platform will be established, which helps to establish a communication link not only between the FHS team and the stakeholders but also among the stakeholders themselves.
A Centre for Sundarban Studies will be established to operationalize the concept, which as an institutional body, will generate more resources to provide research and technical support to local stakeholders.
FHS Partners in India
News and announcements from FHS India
Recent FHS India publications
Morgan R, Ayiasi RM, Barman D, Buzuzi S, Ssemugabo C, Ezumah N, George AS, Hawkins K, Hao X, King R, Liu T, Molyneux S, Muraya KW, Musoke D, Nyamhanga T, Ros B, Tani K, Theobald S, Vong S and Waldman L (2018) Gendered health systems: evidence from low- and middle-income countries, Health Research Policy and Systems, 16:58, DOI: 10.1186/s12961-018-0338-5
Gender is often neglected in health systems, yet health systems are not gender neutral. Within health systems research, gender analysis seeks to understand how gender power relations create inequities in access to resources, the distribution of labour and roles, social norms and values, and decision-making. This paper synthesises findings from nine studies focusing on four health systems domains, namely human resources, service delivery, governance and financing. It provides examples of how a gendered and/or intersectional gender approach can be applied by researchers in a range of low- and middle-income settings (Cambodia, Zimbabwe, Uganda, India, China, Nigeria and Tanzania) to issues across the health system and demonstrates that these types of analysis can uncover new and novel ways of viewing seemingly intractable problems.
The Sundarbans, the mangrove forest delta shared both by India and Bangladesh, is among the worst hit regions of climate change in the world. Even though food insecurities due to climate change are felt across the region, the distribution of vulnerabilities is largely uneven depending upon existing climatic and social intersections.
Within the context of socio-cultural and political dynamics, and rapid globalization, efforts to respond to, mitigate, or adapt to climate change needs to address issues of equity and social justice, posing both challenges and opportunities.
World-wide, women experience a higher burden of visual impairments than men, and this increases with age. This short film from the FHS India team - based on research by IIHMR University, FHS and RinGs - highlights the gendered dimension of seeking eye health care in the Indian Sundarbans - a climatically vulnerable setting.
Ghosh U, Bose S, Bramhachari R (2017) Geo-climatically Vulnerable Sundarbans: A social network analysis of mother’s social ties and child care, International Journal for Population, Development and Reproductive Health, Volume 1, Issue 1, pp. 27 - 41
Present paper explores mother's individual and system level social ties to support in taking care of children in resource scarce setting of the Indian Sundarbans. Climatic uncertainties resulted in male out-migration in search of alternative livelihoods leading towards female-headed households. Women now face triple burden of works – livelihood, household chores and childcare. Hence it is pertinent to know how and to what extent social ties support child care in female headed households in comparison to male headed households.
Paina L, Wilkinson A, Tetui M, Ekirapa-Kiracho E, Barman D, Ahmed T, Mahmood SS, Bloom G, Knezovich J, George A and Bennett S (2017) Using Theories of Change to inform implementation of health systems research and innovation: experiences of Future Health Systems consortium partners in Bangladesh, India and Uganda, Health Research Policy and Systems, 15(Suppl 2):109, DOI: 10.1186/s12961-017-0272-y
The Theory of Change (ToC) is a management and evaluation tool supporting critical thinking in the design, implementation and evaluation of development programmes. We document the experience of Future Health Systems (FHS) Consortium research teams in Bangladesh, India and Uganda with using ToC. We seek to understand how and why ToCs were applied and to clarify how they facilitate the implementation of iterative intervention designs and stakeholder engagement in health systems research and strengthening.