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Stimulating innovations

Through the stimulating innovations theme, FHS is testing new models of service delivery with government and non-governmental organisations (NGOs) interested in improving the quality, coverage and affordability of health services to disadvantaged populations.


Recent FHS publications on 'stimulating innovations'

Publications

Xiao, Y, Husain, L and Bloom, G (2018) Evaluation and learning in complex, rapidly changing health systems, Globalization and Health, 14:112, DOI: 10.1186/s12992-018-0429-7

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.

Khan NU, Rasheed S, Sharmin T, Siddique AK, Dibley M and Alam A (2018) How can mobile phones be used to improve nutrition service delivery in rural Bangladesh?, BMC Health Services Research, 18(1):530, DOI: 10.1186/s12913-018-3351-z

Nutrition has been integrated within the health services in Bangladesh as it is an important issue for health and development. High penetration of mobile phones in the community and favourable policy and political commitment of the Government of Bangladesh has created possibilities of using Information Communication Technology such as mobile phones for nutrition programs. In this paper the implementation of nutrition services with a specific focus on infant and young child feeding was explored and the potential for using mobile phones to improve the quality and coverage of nutrition services was assessed.

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.

Bloom G, Wilkinson A and Bhuiya A  (2018) Health system innovations: adapting to rapid change, Globalization and Health, 14:29, DOI: 10.1186/s12992-018-0347-8

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. 

Khatun F, Heywood AE, Hanifi SM, Rahman MS, Ray PK, Liaw ST and Bhuiya A (2017) Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh, BMC health services research, 17:573, DOI: 10.1186/s12913-017-2523-6

Traditional gender roles result in women lagging behind men in the use of modern technologies, especially in developing countries. Although there is rapid uptake of mobile phone use in Bangladesh, investigation of gender differences in the ownership, access and use of mobile phones in general and mHealth in particular has been limited. This paper presents gender differentials in the ownership of mobile phones and knowledge of available mHealth services in a rural area of Bangladesh.

Khatun F, Heywood AE, Ray PK, Bhuiya A, Liaw S-T (2016) Community readiness for adopting mHealth in rural Bangladesh: A qualitative exploration, International Journal of Medical Informatics, Volume 93, pp 49–56, DOI: 10.1016/j.ijmedinf.2016.05.010

There are increasing numbers of mHealth initiatives in middle and low income countries aimed at improving health outcomes. Bangladesh is no exception with more than 20 mobile health (mHealth) initiatives in place. A recent study in Bangladesh examined community readiness for mHealth using a framework based on quantitative data. Given the importance of a framework and the complementary role of qualitative exploration, this paper presents data from a qualitative study which complements findings from the quantitative study.

The objective of this brief is to introduce the Photovoice method, highlight how it helped capture the voices of mothers in the Sundarbans, and demonstrate how the method can bridge the gap between communities and local decision-makers. 

Husain, L (2016) Looking for ‘New Ideas That Work’: county innovation in China’s health system reforms—the case of the New Cooperative Medical Scheme, Journal of Contemporary China, Volume 25, Issue 99, pages 438-452, DOI: 10.1080/10670564.2015.1104911

The article presents a case study of a low tech and ‘second best’ reimbursement mechanism developed sub-nationally under the New Cooperative Medical Scheme, China’s rural health insurance framework, and its spread and incorporation into national policy. It argues for the importance of local government development of ‘appropriate’ policy mechanisms (jizhi) as underpinning central reforms and system adaptation.

Since the beginning of reforms in the late 1970s, China has developed rapidly, transforming itself into a middle-income country, raising hundreds of millions out of poverty and, latterly, developing broad-based social protection systems. The country’s approach to reform has been unorthodox, leading many to talk of a specific Chinese model of development. This paper analyses the role of innovation (chuangxin) and experimentation in the Chinese government repertoire and their contribution to management of change during the rapid, complex and interconnected reforms that China is undergoing.