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"id":"48611367-5287-4966-82a1-bac60bfef085", "related_activity_context":"ID: GB-GOV-10-HPSR\nTitle: NIHR Global Health Policy and Systems Research\nDescription: The UK Department of Health and Social Care (DHSC) funds outstanding global health research through the National Institute for Health and Care Research (NIHR). The NIHR has identified health policy and systems research (HPSR) as a strategic global health research priority. Through a process of stakeholder consultation, NIHR aims to develop a portfolio of activities that will support health policy and systems research for the direct and primary benefit of people in low- and middle-income countries (LMIC).. 1) Support applied and implementation research that promotes the coverage, quality, efficiency and equity of health systems in LMICs. 2) Leverage NIHR expertise in health services and health systems research, and work with leading health research funders to develop initiatives that complement the existing global HSR funding landscape. 3) Contribute towards the achievement of Universal Health Coverage (SDG 3.8).\n \n ID: GB-GOV-10-HPSR_CA_130812\nTitle: NIHR HPSR-CA: Learning to Harness Innovation in Global Health for Quality Care (HIGH-Q)\nDescription: Essential technologies could improve quality and outcomes of care if they are successfully adopted but benefits in poorer countries are threatened by workforce shortages and a failure to consider all the obstacles to their use up and down the system. Thus, many technologies fail, for example it is reported there are over 200,000 failed mHealth apps. This wastes valuable resources, or can even worsen care quality. Our proposal addresses this key emerging issue in Kenya. In doing this we address the priority areas of Quality of Care, including families’ experiences of care; Health Workforce Management and Planning, as we explore how technologies can support or undermine routine work in settings with few staff; and Integrating Health Services & Improved Data Quality and Use, by exploring how information technologies might best support post-discharge care for sick babies.This research has the direct and primary aim of improving the health, wellbeing and economic development of people in low and middle income countries.. We have two broad objectives: \n1. To learn how technologies can be better designed and introduced in weak health systems to yield benefits and reduce harms and waste.\n2. To build capacity of government and researchers for these difficult but important evaluations so they help poorer countries strengthen their health systems.\nTo achieve these in Work-package 1 we will design and conduct an evaluation using multiple approaches of a large existing hospital technology intervention programme. We will deliberately change staff numbers to explore how this affects quality and technology adoption. In Work-package 2, we focus on using methods that involve staff and families to co-design an approach that helps schedule the care sick babies need after hospital discharge and ensures all health staff and families have access to key information needed for follow up care. This work will produce an outline technology for testing with new funding. In Work-package 3 we tackle cross-cutting issues including how technologies are changing the jobs people do and the skills they need individually and as teams to give quality care and explore what oversight mechanisms are needed to gain good evidence on the effects of introducing technologies in health. \n \n ID: GB-GOV-10-HPSR_CA_131145\nTitle: NIHR HPSR-CA: Prevalence, health impact and economic cost of substandard and falsified medicines in Indonesia\nDescription: Affordable, good quality medicines are a bedrock of strong health systems, something governments aspire to deliver as they expand health care to more citizens, especially the poorest. But budgets don't always match political aspirations or patient demand, and health authorities have to squeeze down spending on medicines or services. If prices are pushed too low, drug manufacturers sometimes cut corners, compromising quality. Hospitals also protect profits by pushing patients towards medicines not covered by insurance. Poor patients then buy on the internet or in street markets, where they are easy targets for criminals who sell fake medicines. So while expanding health systems are delivering more medicines, poorer people may be getting \"medicines\" that don't actually work, and which can cause real harm.\nThe World Health Organization says substandard and falsified medicines are a major problem in poorer countries with rapidly-growing markets, but no-one knows how bad the problem really is. Some prefer to turn a blind eye, worrying that quality enforcement could reverse progress towards wider access. And with no reliable numbers, it's easy for politicians to ignore the threat, at least for a while. Over time, though, bad quality medicines hurt patients, waste money, drive out responsible companies and undermine confidence in the whole health system. And if sub-par antibiotics don't deliver full doses to patients, they'll kill only the weaker bugs, allowing resistant infections to spread.\nWe want to help countries understand and measure the problem, so that they can plan effective action and track change over time. That's hard to do, because the market for medicines is huge and complex. We've been working in Indonesia to use information about price, sales outlet and company history to try and predict which medicines are most likely to be substandard or fake. We believe our model could be used to improve the efficiency of surveillance systems, helping governments to save money by sampling from the market and testing the medicines most likely to be poor quality. We also want to build simple tools to estimate the overall size of the problem in a country, and the toll it takes on health and on the economy.\nWe'll work with WHO to make these methods useful for many countries. First, we want to try the system in Indonesia, the world's fourth most populous country, where 106 million people live on less than £1.25 a day. In the last 5 years most of them have joined another 116 million citizens as members of the national health insurance scheme, which carries a deficit of £1.9 billion. Medicine prices have been slashed, and several recent scandals, as well as our research, suggest that poor quality medicines are common.\nWorking with the regulator, we plan to sample and test medicines from categories our model predicts are at risk (e.g. expensive medicines with recent shortages sold on the internet; or products sold for under 20% of a benchmark price). We'll work in 9 districts in 4 market regions, and use the results, together with assumptions based on market volumes, insurance claims and discussion with our policy partners, to estimate the prevalence, impact and cost of poor quality medicines in Indonesia. Those policy discussions can provide a springboard for action needed to ensure that quality is built in to medicine procurement, while the methods we develop will provide a blueprint for other countries facing similar challenges.. We aim to support national efforts to ensure that Indonesians, especially the poorest who rely on\ninsurance or informal markets, have consistent access to quality medicine. We will do this by working\nwith the medicine regulator and intersectoral partners to better understand and quantify the prevalence\nand distribution of substandard and falsified medecines nationally. In the process, we will:\n1. Trial new methods for risk-based sentinel surveillance for substandard and falsified medecines.\n2. Develop robust, adaptable tools to estimate the prevalence, health impact and cost of substandard and falsified medecines.\n3. Pioneer the use of the tools, making the first national estimates of substandard and falsified medecines in any low and middle-income country (LMIC).\n4. Engage continuously with policy partners to facilitate appropriate intersectoral responses in Indonesia, and to adapt tools for other LMICs.\n5. Promote institutionalisation of academic-policy partnerships to support the ongoing production and use of medicine policy research in Indonesia.\n \n ID: GB-GOV-10-HPSR_CA_131207\nTitle: NIHR HPSR-CA: Research for Health System Strengthening in northern Syria (R4HSSS)\nDescription: As the Syrian conflict enters its ninth year, 13.2 million Syrians are in need of health assistance. Displacement continues to be a major challenge for the country with 5.6 million refugees and 6.6 million internally displaced persons (IDPs) according to UNHCR as of April 2019. The conflict has caused a severe disruption in health services leading to a collapse of the health system in the most conflict-affected areas. Attacks on healthcare have been a major threat in Syria, in what has been described as a weaponisation of health care. The UN estimates that half of the health facilities in Syria are either only partially functional or destroyed. Physicians for Human Rights have documented 588 attacks on health facilities and 914 medical personnel killed between March 2011 and November 2019. Essential health services have been further disrupted by the increasing number of health professionals fleeing the country. This has left populations with limited access to healthcare leading to increased vulnerability to communicable and non-communicable diseases.\nRecently, there have been three distinctive territories in Syria corresponding to the different areas of control. About 60% of the Syrian territories, including the capital Damascus and most central and southern areas, are controlled by Assad regime. Kurdish armed groups, supported by the US, control around 25% of north east Syria, with a population of approximately 4 million. The remainder of opposition armed groups, supported by Turkey, control around 15% in the north west with a population of approximately 3.5 million. The health system in each territory developed different adaptation mechanisms to the conflict. For example, after the collapse of the health system in north west Syria, local medical networks - relying on limited local resources, the remanence of health infrastructure and equipment, and the humanitarian health resources - adopted a new bottom up approach to build a hybrid and kinetic health system that is currently functioning as an autonomous local health authority in the region. Whereas, the health system in north east Syria maintained a level of functionality throughout the conflict with a similar structure to the pre-conflict health system and some ties to the Damascus Ministry of Health.\nLittle is understood about how contemporary conflicts shape emergent health ‘systems’. It is important to study these different adaptation mechanisms and explore various strategies to strengthen these health systems and ways to integrate them into a national health system in what will now be the post conflict phase. Throughout the Syrian conflict, research has been focused largely on Syrian refugees in neighbouring countries and in Europe with very little focus on health issues within the country. Our project will study the experience of health systems in north west and north east Syria in relation to four elements of health system adaptation and strengthening; provision of health services – by comparing different models of health service provision, health education and medical training, health financing, and the use of digital solutions in health information system to inform future post conflict systems strengthening (SDG 3 and 6).. The main aim of Research for Health System Strengthening in northern Syria is to produce a model on health system strengthening in conflict settings which could be applied in other contexts affected by protracted and complex conflicts.\n \n ID: GB-GOV-10-HPSR_CA_131237\nTitle: NIHR HPSR-CA: Innovative management practices to enhance hopital quality and save lives in Malawi\nDescription: Every year 2.5 million newborns die. Most of these deaths happen in hospital and could be prevented. Babies in their first 28 days of life represent some of the most vulnerable users of the health system, as they can die quickly. Malawi was one of the fastest progressing countries in Africa for newborn survival, but progress has stalled. Now that most births happen in health facilities, there is an urgent need to improve hospital care for newborns and their families. \nThere is strong evidence that health technologies (e.g. drugs, equipment) are a necessary ingredient for improving survival of small and sick babies. However, in practice, babies do not always get these clinical interventions even when resources are available. Commonplace problems, such as drug stockouts, absent staff, and power outages, are due to organisational failings that are rooted in poor management. Improving management practices – so that hospitals effectively manage staff, drugs and medical supplies, have sound financial management and are data-driven in how they make decisions – offers the potential to turn the situation around. \nBuilding on an existing platform, Newborn Essential Solutions & Technologies (NEST360), we will identify practical ways to enhance management practices in the 36 largest hospitals (43,000 babies admitted per year) in Malawi, to improve quality of care and reduce newborn deaths. We will address what are three fundamental gaps in knowledge. First, until recently, we did not have the tools to measure the extent to which hospitals adopt management practices. Building on recent advances, we will adapt and validate tools for Malawi to measure management practices. Second, no interventions to enhance hospital management practices have been rigorously evaluated in low-resource settings. Working in partnership with the Ministry of Health, experts and other key partners, we will design a management intervention and then evaluate it using the gold-standard of a randomised controlled trial and other complementary methods. This will inform scale up to the entire country and generate findings that can inform policy in other countries. Third, it is rarely possible to measure lives saved in such health systems research. By building on the existing NEST360 network of 36 hospitals with detailed patient level information on newborns admitted to hospital, we will examine which management practices matter most for quality of care.\nAt the core of the research is an equitable partnership between College of Medicine, University of Malawi and London School of Hygiene & Tropical Medicine. A multi-disciplinary team of health system researchers, epidemiologists, health economists, social scientists, clinicians, implementation scientists and statisticians will partner with the Ministry of Health to generate high quality evidence that has direct relevance for policy and practice in Malawi, the African region, and beyond. At all stages of the research, from the design through to the communication of the findings, we will engage with the local community. Our goal is to enhance the management of hospitals, ultimately for the benefit of small and sick neonates admitted to hospital.. The research aims to examine whether enhanced management practices can improve health outcomes and clinical quality for newborns in hospitals in Malawi. A multi-disciplinary team from College of Medicine, University of Malawi, and London School of Hygience & Tropical Medine will address the following interlinked objectives:\n1. Adapt and validate measures of hospital and district management practices.\n2. Examine the association between management practices and quality of clinical care, and its variation by facility characteristics.\n3. Co-design a problem-focused hospital management intervention and scalable delivery model.\n4. Evaluate effectiveness of the intervention on neonatal mortality and secondary outcomes (including hospital-acquired infections) through a cluster randomised trial.\n5. Assess the intervention’s acceptability, fidelity, and mechanisms through qualitative research and estimate its cost-effectiveness.\n \n ID: GB-GOV-10-HPSR_CA_131273\nTitle: NIHR HPSR-CA: Development and evaluation of an integrated community-based management for chronic diseases in Tanzania and Uganda\nDescription: We are the NIHR Group on the Management and Prevention of HIV-infection, Diabetes and Hypertension. In our NIHR Group award we had an ambitious objective to bring together vertically delivered HIV services (generally well-resourced and protected) and diabetes and hypertension care (currently less structured and poorly resourced), under one roof in Tanzania and Uganda. This approach was innovative, unique and risky. With support and in partnership with policy makers and disease control programme managers, we have successfully established and are currently evaluating this “integrated care clinic” model. However, the prevalence of chronic conditions is so high that clinic-based care alone cannot meet demand. Our NIHR Group is being urged by health services to evaluate decentralising integrated care to the community-level.\nOur primary research question for the proposed research is:\nHow can we design community-based integrated management of HIV-infection, diabetes and hypertension, and what is its effectiveness in comparison to clinic-based integrated management of these conditions in terms of patient outcomes?\nMoreover, we want to know how an effective model of community-based integrated management can be scaled up and sustained across different country contexts in Africa.\nThe proposed research will likely be more challenging than clinic-based integration, in part, because examples of community management, particularly of an integrated nature, are rare. The agenda has been defined after almost 2 years of discussions with African health policy makers in Tanzania and Uganda, and with input from patient and community representatives.. Our primary question is: \nHow can we design community-based integrated management of HIV-infection, diabetes and hypertension, and what is its effectiveness in comparison to clinic-based integrated management of these conditions in terms of patient outcomes?\nMoreover, we want to know how an effective model of community-based integrated management can be scaled up and sustained across different country contexts in Africa.\n \n ID: GB-GOV-10-HPSR_DA_129848\nTitle: NIHR HPSR-DA: Perioperative health systems to support surgical treatment\nDescription: Safe and affordable surgery is a global health priority. For surgical procedures to effectively improve patient outcomes, health systems must also provide high-quality perioperative care (the care before, during and after surgery). There is now strong evidence that health systems failures around the time of surgery are a key factor limiting the net improvements in health which could be achieved through greater worldwide access to surgery. In this proposal, we will build the foundations of a major global health research unit to study and improve perioperative health systems. We will map perioperative care pathways in different resource limited hospitals. We will co-produce a list of research priorities, and a core dataset for quality assurance, clinical trials and implementation research. We will perform initial community engagement work, a research capacity needs analysis and develop the dissemination plans essential for a major research programme in perioperative care.. 1) Establish partnerships with five higher education institutions in low- and middle-income countries (LMICs)\n2) Map perioperative care pathways in different LMIC hospitals and identify common research themes, using literature review, observation and interviews with healthcare staff and patients\n3) Co-produce priority questions with patients, healthcare staff and policy-makers for future mixedmethods research, using surveys and stakeholder workshops\n4) Co-produce a patient dataset which is relevant and feasible to collect in resource limited hospitals, and build a simple online database to capture this information\n5) Complete a research capacity needs assessment at local and national levels in LMICs and a workforce plan for research delivery\n6) Develop a pathways to policy impact plan for future research\n \n ID: GB-GOV-10-HPSR_DA_129877\nTitle: NIHR HPSR-DA: Identification of research priorities for a safe systems approach to road safety in Nepal\t\nDescription: The death rate for road traffic injuries in Nepal is now estimated at 22.7/100 000, ranking Nepal as 30th of 195 countries worldwide (Global Burden of Disease 2019). This study will identify the priorities for road safety research that would support the development of a multi-sectoral ‘safe system’ for road users in Nepal. The World Health Organization has identified five ‘pillars’ of road safety; road safety management, safe roads, safe people, safe vehicles and having an effective post-crash response. Through existing networks we will engage up to 25 stakeholders for each of the five pillars. Interviews with each stakeholder will identify individual views on the evidence gaps. At a series of five workshops collated issues for each pillar will be discussed and ranked. The output will be consensus on the priorities for a programme of road safety research in Nepal.. 1) Identify what research needs to be done, and what information needs to be found, to create a safe system for road users in Nepal. \n2) Identify 20-25 stakeholders whose experience and knowledge is relevant to each of the five pillars of road safety. \n3) Interview each stakeholder to identify what they think are the main gaps in our knowledge.\n4) Collate the ideas from the stakeholders and present them at a workshop to which all of the stakeholders will be invited. Support participants to rank the evidence gaps in order of importance and share the results and give everyone the chance to rank the list again. \n5) Generate a prioritised programme of research to reduce road traffic deaths and injuries in Nepal. \n \n ID: GB-GOV-10-HPSR_DA_129915\nTitle: NIHR HPSR-DA: Co-developing an Evidence-based Plan to Strengthen the Health Care System and Inform Policy to Reduce Cancer Burden in Mongolia\t\nDescription: Mongolia has the highest cancer death rates in Asia-Pacific and cancer incidence is expected to double by 2040. The proposed study represents the first step of a health policy and systems research (HPSR) programme aiming to reduce cancer burden in Mongolia by strengthening its health care system and supporting evidence-based service planning and policy development. Collaborative preliminary work identified cancer prevention and early detection as the early focus of the HPSR Programme. In this developmental phase we will work with local stakeholders to describe current early detection and cancer prevention initiatives in Mongolia, and to identify and develop plans for future HPSR research and capacity building activities. We will conduct a scoping review, undertake a needs-and-gaps analysis, use consensus-elicitiation techniques to identify priorities, provide capacity-building training in Mongolia and the UK, and co-develop plans to advance our collaborative HPSR programme.. 1) Conduct a review of published and grey literature regarding early detection and cancer prevention in Mongolia\n2) Undertake a needs-and-gaps analysis (key informant interviews, online survey, consensus workshop) to identify, refine and prioritise research questions\n3) Design an interdisciplinary collaborative research programme focusing on improving early detection and cancer prevention in Mongolia\n4) Establish a community advisory steering group to contextualise and sustain the partnership and assist with dessimination of research results into usable findings\n5) Develop and expand (according to HSPR Programme needs) the current Queens University Belfast (QUB)-National Cancer Centre of Mongolia (NCC) partnership\n6) Contribute to capacity building, skill development and knowledge transfer\n7) Formulate and sign a Memorandum of Understanding between QUB and NCC.\n \n ID: GB-GOV-10-HPSR_DA_130036\nTitle: NIHR HPSR-DA: Equitable access to quality trauma systems in Lower and Middle Income Countries. Assessing gaps and developing priorities\nDescription: Deaths from trauma, especially due to road traffic collisions, are prevalent in lower and middle income countries (LMICs); trauma causes a substantial burden of disability in survivors. Equitable access to quality health care is essential to treat trauma patients. Expanding on our preliminary work in Rwanda, this project will: - Convene workshops with providers and policy makers to delineate barriers, knowledge, and priorities in access to care in three contrasting countries - Map access to trauma care as a complex health system problem - Collect data from patients on their experiences of barriers to and quality of care - Build research capacity in partner countries to enable further work - Develop a network of trauma researchers - Convene a meeting of investigators, patient representatives, and policy makers to discuss findings and, in combination with ongoing studies and literature review results, identify and agree upon priorities for a programme for future research. 1) Develop an evidence-based approach, drawing on existing global evidence to decision making (EtD) frameworks, to guide the adaptation of the WHO EDL to national health system needs and establish a Research Initiative for Evidence-based diagnostics in Africa. 2) Engage with decision makers in health policy and practice in East Africa to jointly decide on information needs and the development of methods, skills and capacity required. \n3) Conduct a systematic stakeholder analysis to identify local, national, regional and international stakeholders responsible for the EDL in Kenya and Uganda. \n4) Conduct a needs analysis thorough literature review and engagement with the identified stakeholders to identify the desired and current status of the EDL lists, decision-making and health system barriers to their adaption and implementation, desired local decision-making approaches and finally refine our proposed research question and study methods. \n \n ID: GB-GOV-10-HPSR_DA_130041\nTitle: NIHR HPSR-DA: Collaborative partnerships addressing the effects of urban violence on youth access to health services in South Africa and Brazil\nDescription: This project will build partnerships towards developing selected health system interventions to address the impact of urban violence on youth access to health services in South Africa and Brazil. The objectives are: 1) Build collaborations with South Africa and Brazil, as countries affected by urban violence particularly in low-income neighbourhoods 2) Carry out a scoping review of the evidence on the influence of urban violence on treatment seeking and health systems and interventions to address this 3) Engage with stakeholders in local health services and socio-economic development, and youth in affected communities, to increase understanding of health systems issues and interventions to decrease the impact of urban violence on youth healthcare access 4) Through collaborative partnerships, work towards developing context appropriate specific health systems micro and meso interventions in South Africa and Brazil for proof-of-concept testing in a future proposal. 1) Develop a collaboration between University partners in UK, South Africa and Brazil who together have expert knowledge and/or experience in violence, health systems research, health policy and public engagement.\n2) Carry out a scoping review of the evidence on urban violence’s influence on treatment seeking and health systems and potential interventions that may help.\n3) Engage with multilevel stakeholders in different sectors in Cape Town, São Paulo and Porto Alegre to identify health systems-related issues and possible interventions. This will include developing an advisory group in each site as well as interviews and workshops with youth groups and healthcare providers in affected communities, health and development policy makers and non-governmental organisations\n4) Develop further research plans for a proof-of-concept intervention study to see if the interventions would be feasible and could work. This would include both social and health system elements. \n \n ID: GB-GOV-10-HPSR_DA_130086\nTitle: NIHR HPSR-DA: Supporting those most in need: A partnership approach to strengthen health policy and systems research capacity in China and beyond\nDescription: This project seeks to build a platform to enable and support higher education and research institutions within and beyond China to systematically advance health policy and systems research (HPSR) to generate evidence for health systems strengthening in the most disadvantaged settings in the region and beyond, with lessons learned from the partnership benefitting low resource countries elsewhere. . 1) Establish a partnership between Sun Yat-sen University Global Health Institute (SGHI), China, and the London School of Hygiene & Tropical Medicine(LSHTM), UK\n2) Develop a consortium of SGHI-LSHTM and research collaborators from disadvantaged provinces in China (Gansu, Inner Mongolia) and Nepal\n3) Conduct a review of health system challenges for most disadvantaged populations across China (Tibetan, Muslim and Mongol) and Nepal\n4) Work with local stakeholders and communities using structured workshops to identify policy and HPSR priorities at regional level\n5) Prepare a grant proposal addressing identified priorities using rigorous, multidisciplinary HPSR methods and approaches.\n \n ID: GB-GOV-10-HPSR_DA_130103\nTitle: NIHR HPSR-DA: Building collaborations to strengthen health systems to respond to the needs of newly urbanised populations in Africa and Asia\nDescription: Many developing countries are experiencing rapid and unplanned urbanisation. Previous research has shown that this can create a variety of new health risks from communicable and noncommunicable diseases, and that newly-urbanised people can find it more difficult to access health services. Through this award, we will develop the research design, methods and partnerships for a large participatory project examining these issues in four countries across South Asia and sub-Saharan Africa. A pilot study in Nepal will be used to trial a series of participatory research methods (Participatory Video, Participatory Photo and Participatory Mapping) to capture the experiences and perceptions of both newly-urbanised people and providers of health services, to bring these into dialogue with health planners and policymakers, and to learn lessons for a larger-scale funding proposal. Meanwhile, preparatory work and network building will be carried out in Ghana, Bangladesh and one other African country.. 1) Develop the partnerships and methods, and prioritise research questions, to inform a larger programme of research which will use a participatory approach to i) better understand lived experiences of the health costs/benefits of urbanisation; and ii) identify mechanisms to enhance the accountability and responsiveness of health systems to the needs of the newly-urbanised. \n2) Develop and refine various participatory methods to enable newly-urbanised people, as well as health system stakeholders, to work with us to identify priority areas for research and action, through conducting a pilot study in Nepal\n3) Involve partners from other countries in the pilot, enabling consideration of how the methods can be adapted and applied in Bangladesh, Ghana and one other country\n4) Build relationships with municipal governments, service providers and other health system stakeholders in each country and determine their priorities for research\n5) Build institutional and individual capacity and strengthen partnerships\n6) Conduct systematic literature reviews and identify suitable study sites in Bangladesh and Ghana (plus one other country)\n7) Develop the ethical protocols for the project’s participatory approach.\n \n ID: GB-GOV-10-HPSR_DA_130125\nTitle: NIHR HPSR-DA: Re_Emerge: Research to accelerate progress on emergency preparedness and universal health coverage in four Ebola-affected countries\nDescription: Equitable access to healthcare is a key element of emergency preparedness. However, in low-income countries, efforts to strengthen preparedness tend to be disconnected from actions to achieve universal health coverage (UHC). We aim to provide decision-makers with the evidence they need to pursue preparedness and equity goals in synergy. By establishing the Re_Emerge consortium, we aim to produce the evidence needed by key stakeholders working in disease outbreak-affected low-income countries (LIC), so that they can align their efforts, and advance preparedness and UHC through integrated governance and synergistic decision-making. The consortium will conduct research in four low-income countries (LICs) - Sierra Leone, Liberia, Guinea and the Democratic Republic of Congo (DRC) - which recently experienced (and, in DRC’s case, is currently experiencing) outbreaks of Ebola Virus Disease (EVD). We intend to use the development grant to lay the groundwork for this by consolidating an emerging multi-partner collaboration on achieving integrated approaches to health systems strengthening in Ebola-affected settings – led by the University of Edinburgh (UK) and the College of Medicine and Allied Health Sciences (Sierra Leone). . 1) Establish arrangements for consortium governance \n2) Set up an advisory board of key stakeholders\n3) Define capacity needs of our partners\n4) Conduct a synthesis of existing data to establish strategic priorities and key evidence needs\n5) Construct an initial theory of change, setting out pathways from evidence needs to real-world impact\n6) Draft and publish academic/policy outputs from the synthesis\n7) Establish plans for a competitive funding application to the NIHR.\n \n ID: GB-GOV-10-HPSR_DA_130136\nTitle: NIHR HPSR-DA: Addressing Health System Fragmentation to Advance Universal Health Coverage (UHC) for Low Income Populations in Latin America\nDescription: This project strengthens an existing collaboration between UK-Brazil and extends this to other Latin America countries. It will develop a policy-relevant research agenda to understand and address health system inadequacies in the region, including their impact on Universal Health Coverage (UHC). The main output will be a research proposal focused on health system fragmentation in Latin America, which is widespread in the region and has an especially negative impact on the health of low-income populations. To identify policy-relevant evidence gaps for the proposed research programme, we will undertake a needs assessment and research planning in Brazil and two other countries. This will involve: 1) active, fully integrated stakeholder involvement and engagement (involving policy-makers, non-governmental organisations and civil society); 2) a literature review; 3) identification and curation of data sources; 4) formulation of a research team, covering key methodological requirements; 5) capacity building.. 1) Develop a research programme proposal focused on health system fragmentation in Latin America Countries. This setting affords valuable learning to policy-makers in many low- and middle-income countries (LMICs) wishing to advance UHC given fragmentation plagues even mature health systems despite policy innovations to address this. To identify policy-relevant evidence gaps for the proposed research programme, we will undertake a needs assessment and research planning in Brazil and two other countries. \n \n ID: GB-GOV-10-HPSR_DA_130180\nTitle: NIHR HPSR-DA: Strengthening health systems in South Africa to achieve universal health coverage for people with stroke \nDescription: In South Africa(SA), stroke is a leading cause of death and disability and over 30,000 people have a stroke each year. Stroke incidence is increasing due to rising prevalence of risk factors such as obesity and hypertension. While efforts are made to prevent stroke, provision of stroke care remains largely unmet and where available, is limited in quality and accessibility. We will establish a SA-UK partnership to build a consortium, drawing together people with stroke, their families, rural communities, health professionals, researchers and policy planners, which can inform policy makers on context-appropriate stroke care for the new universal health coverage(UHC) bill in SA. Together, we will consider: (i)healthcare needs of people with stroke (ii)how the Health System can meet these needs through a people-centred approach. Our findings will identify priorities for research, generate recommendations for health system planners and inform a subsequent Research Program. 1) Establish a Stellenbosch University (SU) and London School of Hygiene & Tropical Medicine (LSHTM) partnership to build a consortium (3-5 institutions) to identify and address research priorities to improve stroke care in SA\n2)Determine the current provision of healthcare for people with stroke in SA\n3)Identify appropriate economic evaluation methods for a future Research Program\nWithin two provinces purposively selected for comparison, the Eastern Cape (the poorest) and the Western Cape (second wealthiest), our objectives are to:\n4)Interrogate networks of health service provision for people with stroke\n5)Determine the needs of people with stroke and their families in accessing health services\n \n ID: GB-GOV-10-HPSR_DA_130201\nTitle: NIHR HPSR-DA: Accelerating the development of Health Policy and Systems Research capacity in Western Pacific Region for health system strengthening\nDescription: Health systems in many countries in the WHO Western Pacific Region (WPR) must respond to changing health needs driven by demographic and economic transition, demanding strengthening of universal health coverage and health system reforms. Yet there is limited health policy and systems research (HPSR) capacity to inform these changes. This project will build HPSR capacity, which is critical to strengthening health systems. A training programme based on global HPSR competencies will be implemented in Malaysia and extended to other WPR countries where there is buy-in, with the aim of creating an international community of practice and a body of policy-relevant research to support health reform. It will be delivered by a consortium comprising the Institute for Health Systems Research (IHSR), the United Nations University-International Institute for Global Health (UNU-IIGH), University of the Philippines Manila (UP Manila) and the London School of Hygiene & Tropical Medicine(LSHTM).. 1) Design and field-test an HPSR training programme in Malaysia. An initial needs assessment will help tailor this to diverse audiences. Internationally agreed HPSR competencies will be adapted to the country context, creating a package that is supported by key actors and can be scaled up nationally. An innovative theory of change will be applied to track training outcomes and processes,documenting what works, where, and when.\n2) Undertake HPSR capacity mapping in Malaysia and selected WPR countries where there is demand, to identify capacity gaps, national priorities and opportunities to align HPSR training with national health policies (e.g. the Philippines).\n3) Learn from the Malaysian experience to develop locally-led, country-specific plans and strategies for scaling up HPSR capacity in these WPR countries.\n4) Develop proposals for HPSR projects that address important health system or health service needs in Malaysia and elsewhere in WPR and seek national/regional endorsement and funding.\n5) Document and disseminate Malaysian and WPR country experiences through Health Systems Global (HSG), providing a roadmap to accelerate the expansion of HPSR capacity in other low and middle-income countries.\n \n ID: GB-GOV-10-HPSR_DA_130219\nTitle: NIHR HPSR-DA: Improving equitable access to essential medicines in Ghana through bridging the gaps in implementing medicines pricing policy\nDescription: Availability of affordable medicines is critical for any national health system to ensure equitable access to healthcare. Medicine prices in Ghana are high compared to international reference prices. Between 2012 and 2017, the Government of Ghana introduced four major policies to regulate and reduce medicine prices. These policies are at different stages of implementation and to-date have not yielded the anticipated outcome. Our core focus is to understand, together with policymakers, why these presumed effective policies are not producing anticipated effects on medicine price reduction. Then - drawing on available published evidence and our understanding of how and why the policies are not effective in Ghana – we will co-develop a feasible action plan to facilitate implementation of these policies and generate a policy-driven research agenda to inform and address the information needs of policy makers. Our core question is “Why are these presumed effective medicine price control policies not producing the anticipated effects in implementation in the Ghanaian context?”. 1) Develop an in-depth understanding of major determinants of effectiveness of implementing medicine pricing policies in different contexts\n2) Develop a shared understanding of main facilitators and barriers to the implementation of medicine pricing policies in the Ghanaian context\n3) Drawing on the results of No1 and 2, facilitate: (a) development of a feasible action plan to improve implementation of the four key policies to improve access to essential medicines and (b) coproduction of policy-relevant research agenda to address the information needs of key policymakers \n \n ID: GB-GOV-10-HPSR_DA_130222\nTitle: NIHR HPSR-DA: Essential diagnostics: developing methods, guidelines and capacity for effective national programmes\nDescription: The World Health Organization (WHO) has set up the Essential Diagnostics List (EDL) to complement the established Essential Medicine List (EML). Point of care diagnostics are increasingly available and affordable and have great potential. WHO decisions can put tests on the agenda, but countries need to consider whether they wish to purchase them, their role in the health system, and the development of feasible and effective standardised care pathways. These decisions require a range of specific scientific and local knowledge to inform their decisions on policy changes. We aim to develop an evidence-based approach to guide the adaptation of the WHO EDL to national health system needs and establish a Research Initiative for Evidence-based diagnostics in Africa. We will start this process by engagement with decision makers in health policy and practice in East Africa to jointly decide on information needs, methods and capacity.. 1) Map access to trauma care as a complex health system problem \n2) Collect data from patients on their experiences of barriers to and quality of care \n3) Build research capacity in partner countries to enable further work \n4) Develop a network of trauma researchers \n5) Convene a meeting of investigators, patient representatives, and policy makers to discuss findings and, in combination with ongoing studies and literature review results, identify and agree upon priorities for a programme for future research\n \n ID: GB-GOV-10-HPSR_DA_130250\nTitle: NIHR HPSR-DA: Integrating HIV Pre-exposure Prophylaxis and diagnostic STI care: an individualised public health approach (iPreP-STI)\t\nDescription: South Africa has some of the highest sexually transmitted infection (STI) and HIV rates globally. Syndromic treatment of STIs has poor sensitivity and specificity and could fuel antimicrobial resistance. STIs increase HIV transmission and acquisition; STIs and HIV disproportionately affect the most vulnerable groups in society resulting in poor health and economic burden. Taking advantage of the current roll-out of HIV Pre-Exposure Prophylaxis (PrEP) for adolescent girls and young women in South Africa, we aim to evaluate integrated models of diagnostic STI care using an individualised public health approach. We will 1) establish equitable research partnerships with a view to strengthening health system and research capacity for diagnostic STI care 2) engage policy makers, healthcare providers and patients in discrete choice experiments to establish preferences for diagnosis and treatment of STIs and assess the feasibility of integrating these within the South African health-system.. 1) Set up equitable interdisciplinary partnerships to strengthen the health system, and build research capacity, in diagnostic STI care \n2) Use novel research methods to engage policy makers, facility managers, providers and service users in choice experiments in order to understand gaps in STI care and elicit their preferences for diagnoses and treatment \n3) Use interviews and focus group discussions to assess how feasible, acceptable and practical it would be to integrate a range of diagnostic and treatment approaches within the provision of PrEP.\n \n ID: GB-GOV-10-HPSR_DA_130266\nTitle: NIHR HPSR-DA: The political economy of universal health coverage reforms: building capacity and engagement of francophone West Africa\nDescription: Achieving Universal Health Coverage (UHC) is a global priority to ensure health for all and reduce health inequalities (SDG3.8). However, progress towards UHC is an inherently political process. Political Economy Analysis (PEA) is an essential tool in the field of health policy and system research to shed light on the barriers and facilitators of UHC reforms. Although recent work has been done to develop PEA frameworks for UHC and to apply PEA, francophone West Africa remains understudied and underrepresented in the research arena. This project aims to develop a strong, effective and equitable research partnership between research institutions in the UK and francophone West Africa (initially in Benin, to be expanded to other countries during the grant period), to strengthen research capacity and frameworks and to build networks with stakeholders and communities. This will enable us to launch cutting-edge research on UHC and collectively to improve progress towards it in this region.. 1) Develop a research partnership to catalyse a formative, collaborative programme of work and to strengthen research management, dissemination capacity and research skills in the domain of PEA applied to UHC. \n2) Establish an active and engaged programme of PEA research in francophone West Africa to support UHC progress, grounded in collaboration with a variety of stakeholders, from government bodies to civil society groups. \n3) Develop a future research project focused on the application of PEA and the creation of a network of national observatories to generate prospective evidence on the political dynamics underlying UHC reforms\n \n ID: GB-GOV-10-HPSR_DA_130285\nTitle: NIHR HPSR-DA: Supporting the design of a whole system approach to facilitate the baby friendly community initiative in the Kenyan health system\nDescription: This project aims to build capacity & strengthen understanding of stakeholder research needs to facilitate the effective functioning of the Baby Friendly Community Initiative (BFCI; a community-based public health programme supporting health, growth & development of infants) within African primary care health systems. Members of our team have shown the BFCI’s efficacy within a randomised controlled trial (RCT) in Kenya and the Kenyan government is committed to scaling the BFCI. The challenge of this transition from RCT to scale is to embed the programme effectively into the health system working with existing resources. . Engage with community, national and regional stakeholders to;\n1) Share understanding of the BFCI \n2) Identify needs for research and develop a whole systems-based strategy for the BFCI uptake and dissemination in Kenya and into other African health systems\n3) Build capacity in health economics and systems science between the UK & Kenyan teams.\n \n ID: GB-GOV-10-HPSR_DA_130307\nTitle: NIHR HPSR-DA: Post-tuberculosis lung damage amongst pulmonary tuberculosis survivors in East Africa: health system challenges and research priorities\nDescription: Current guidelines for tuberculosis (TB) management focus on microbiological cure and survival, with no follow-up of patients beyond TB treatment completion. However, data suggest that TB survivors have a high burden of disabling residual lung damage, recurrent TB disease, and increased rates of mortality. There is an unmet need to develop post-TB care pathways to improve the long-term wellbeing of TB survivors. Clinical tools for post-TB care are under development. However, existing health systems in East Africa are poorly equipped to deliver these services and there has been little planning of how post-TB care could be achieved. This project will build on the partnership between London School of Tropical Medicine (LSTM) and African Institute for Development Policy (AFIDEP) to engage stakeholders in Malawi and Kenya in order to review existing management practices, and outline potential models of post-TB care for the region. This work will form the basis of future large-scale funding applications, and policy and implementation work.. 1. Consolidate the existing academic partnership between Liverpool School of Tropical Medicine (LSTM) and the African Institute for Development Policy (AFIDEP)\n2. Develop relationships with the wider policy-making and academic community working in post-tuberculosis (TB) care in the region\n3. Perform a systematic review of post-TB management guidelines and practices in the region\n4. Engage in dialogue with in-country stakeholders in Kenya and Malawi to identify potential models of post-TB care, barriers to implementation, and existing data gaps.\n \n ID: GB-GOV-10-HPSR_RL_150067\nTitle: NIHR HPSR-RL: Health Financing Fragmentation and Universal Health Coverage in Brazil, Colombia, Mexico and India\nDescription: The way different health systems in different countries are organised, financed, and managed have major implications for the healthcare services different people have access to, the quality and scope of these services, how much they have to pay, and how effective these services are at improving and protecting their health. In many low- and middle-income countries, health systems are fragmented. This means there may be separate health systems covering different populations, different organisations providing competing or overlapping services, different service packages offered to different people, and be diverse and complex mechanisms for paying for different services.\n\nHealth system fragmentation affects how efficiently, effectively, and equitably health services function. This project will carry a broad range of research to understand health system fragmentation and how fragmentation affects the health system functioning. The research will include collecting and analysing data from four study countries (Brazil, Colombia, India and Mexico) as well as assessing fragmentation globally. It will examine whether different types of fragmentation affect how well health systems perform.\n\nThe project will also involve a deep-dive analyses on specific policy reforms related to fragmentation in each country and will understand the impacts on services and population health. Surveys and bespoke data collection activities will support these analyses. It will also study the political and economics determinants of fragmentation and understand why different health systems are fragmented differently and what policy options are available to improve performance.\n\nThis project is being jointly led by Imperial College London and the Institute for Health Policy Studies in Brazil with four collaborating institutions – the National University of Colombia, , the Center for Health Systems Research of the National Institute of Public Health in Mexico, O.P. Jindal Global University in India, and the University of York in the UK. These institutions cover the four main study countries where the work is being carried out (Brazil, Colombia, India and Mexico) with support from the UK. The project will run from Oct 2022 to Sept 2026.\n\nThis work aims to generate knowledge and evidence to improve health systems and inform policies. In the long run, it aims to strengthen health systems to improve their functioning and improve population health and well-being.. 1. Collate data from multiple sources to quantitatively measure the fragmentation of health financing systems in Brazil, Colombia, India and Mexico;\n2. Understand the nature of health financing fragmentation and how this varies within and between health systems in the four countries;\n3. Assess whether fragmentation is associated with progress towards health systems goals including universal health coverage, quality, improved health and financial protection;\n4. Understand how factors such as local governance arrangements and major events such as COVID-19 have affected health system fragmentation and related achievement of health system goals;\n5. Evaluate recent health system reforms in Brazil, Colombia, India and Mexico and measures health system and health impacts;\n6. Document key political and institutional drivers of health financing fragmentation and identify enablers and hurdles for policy reform;\n7. Strengthen collaborations between collaborating institutions and build capacity for longer-term health systems research;\n8. Engaged communities and stakeholders throughout the research to foster uptake and increase policy relevance.\n \n ID: GB-GOV-10-HPSR_RL_150089\nTitle: A ‘safe systems’ approach for enabling traffic injury prevention in Nepal (SAFETrIP Nepal)\nDescription: This programme of research aims to improve collaboration between health and other agencies to reduce road traffic deaths and injuries in Nepal.\n\nIt is being conducted through a collaboration between the University of the West of England, Bristol UK and Kathmandu Medical College, Kathmandu, Nepal, together with; Safe and Sustainable Travel Nepal (a charity advocating for safer travel in Nepal), MIRA (a non-governmental organisation in Nepal that supports research), emergency care experts in Nepal and colleagues at Imperial College London.\n\nThis research is important because road traffic injuries are the 12th most common cause of death globally, and the leading cause of death in 5-29 year olds. Approximately 1.3 million people die and over 50 million people are injured in road traffic crashes each year, with over 90% of victims being from low- and middle-income countries. Nepal, a low-income country, has recently had a big road-building programme and there has been a large increase in vehicle ownership. However, without good road safety leadership, coordination and funding, the number of road traffic injuries have increased and there is no national ambulance service to provide prehospital care to those injured. Road traffic injuries are one of the most preventable causes of death, injury and disability. A ‘Safe Systems’ approach, in which all agencies work together to create an environment which keeps road users safe, has been shown to lead to significant reductions in rates of road traffic injuries.\n\nBetween 01/11/2022 and 31/10/2026 we will conduct three work packages that will support the development of a safe road system in Nepal and will map to two of the United Nations Sustainable Development Goals; 3.6 (halve global road traffic deaths and injuries) and 11.2 (provide access to safe, affordable, accessible and sustainable transport systems for all, and improving road safety). The work packages focus on: (1) Supporting leadership and action for road safety at local and provincial government levels; (2) Strengthening public transport safety (specifically bus travel); and (3) Improving the care of those with injuries following a traffic crash. A fourth work package will improve researcher’s awareness of how to keep research data safe whilst still maximising its use.. The objectives of our four work packages are:\n\nWork Package 1:\n• To identify existing policies and programmes at local, provincial and national levels of government in Nepal that can be linked to evidence-based recommendations for safer road systems\n• To understand the current reach and implementation of these policies and programmes\n• To identify the barriers and enablers to further implementation of these policies and programmes\n• To develop a toolkit for those working at local and provincial government level to help them improve road safety\n\nWork Package 2:\n• To identify the factors that influence how bus transport is currently provided in Nepal, and how those factors affect bus safety\n• To establish how these factors affect the current provision of bus transport and which factors can best be used as levers towards safer buses and bus services\n• To identify which established, cost-effective, interventions are needed to shift current practice and policy\n• To generate agreement across sectors on recommendations to make bus travel safer\n\nWork Package 3:\n• To determine the health, social and economic impacts of being injured in a road traffic crash in Nepal.\n• To understand the facilitators and barriers to optimal handover of road traffic injured patients from prehospital carers to hospital emergency department staff\n• To establish stakeholder agreement on a best practice care pathway for road traffic injured patients to be used in hospital emergency departments\n\nWork Package 4:\n• To deliver five, seven-week online good data governance courses between 2023 and 2026\n• To develop and make available training materials that enable the safe collection, use and storage of research data\n• To strengthen the capacity for peer-to-peer learning on good data governance within and between low and middle-income countries.\n \n ID: GB-GOV-10-HPSR_RL_150146\nTitle: Community Voices in Health Governance - Participation into Practice in Pluralistic Health System\nDescription: India, Brazil and South Africa are countries with public health care systems with forms of citizen participation in health care institutionalised in different ways (for example health committees). These systems are pluralistic when relying on combining public and private provision of services. This proposal addresses the implications of both, community participation and pluralistic health systems, for the goals of improving population health and wellbeing. We assume that citizen participation helps to align bureaucracies, politicians and health professionals around these goals. Therefore, this research program aims to enhance understanding of a) How citizen participation is working in these systems; b) How is it adapting to ongoing changes; c) What is needed in term of resources, institutional design, community involvement and training of public officials to fulfil its potential contribution.\nSince the 2000’s, cities in these countries began to expand access to health care through private provision. Preliminary evidence suggests that models of purchasing public health care involving private and philanthropic providers hired to manage public facilities and deliver public services can, under certain conditions, help expand and improve access to care quickly in marginalised communities in urban areas. At the same time, there is much resistance to this development because it is seen to introduce a private logic in the public system. Moreover, if officials lack the skills or experience to negotiate contracts with private providers, there is a risk of fraud and dysfunction in the health system. Pluralistic models of public service provision may help improve the agility of systems but may simultaneously impact negatively population health interests given the influence of private interests.\nWe propose a multi country study focused on mapping and improving the state of community participation mechanisms in selected districts in the cities of Mumbai, Bengaluru, São Paulo, Fortaleza, Gqebhera and Cape Town, where pluralistic models of managing and providing services are either in place or in the making. This research seeks to understand the crucial role community participation can play in pluralistic health systems and how it could strengthen and enhance Universal Health System, helping to create an accountable health system with democratic governance. It seeks to identify a model for effective and meaningful participation within the pluralistic health system.. The overarching research question is “How can community participation, framed as a human right, facilitate the promotion of population health and wellbeing in pluralistic health systems?”\nObjectives:\n1. Identify and characterise the existing international evidence on the extent of community participation mechanisms, processes and structures under plural health systems and reasons for success or failure;\n2. Map the current national and provincial policy context for urban health committees in three countries;\n3. Characterise the extent to which states are able to extend their human rights obligations to ensure meaningful social participation in health, to non-state providers\n4. Describe the contexts and identify the mechanisms that impede or facilitate intensified community engagement in pluralized health systems aimed at UHSs.\n5. Explore how communities’ views, needs and perceptions of health service adequacy are and/or could be more adequately incorporated into contracting arrangements under pluralized health systems\n6. Co-develop, test, and implement participatory approaches pilots to empower community voice in the policy cycle.\n7. Evaluation of capacity building and implemented participation pilots\n8. Compare and synthesize findings across different sites with a view to dissemination.\n \n ID: GB-GOV-10-HPSR_RL_150178\nTitle: C-it DU-it: Community Data Use for Integrated ANC\nDescription: Timeline: 4 years (Oct 2022 – Sep 2026)\nLocation: 4 counties in western Kenya (Homa Bay, Migori, Kisumu, Kakamega).\nPartners:\n• LVCT Health - the Lead Agency\n• Kenya Medical Research Institute (KEMRI) – Collaborator\n• Liverpool School of Tropical Medicine (LSTM) – Collaborator\n• GinD - Collaborator\n\n\nThis research project aims to strengthen community health systems in Kenya by increasing antenatal care (ANC) uptake through a health systems strengthening approach. The approach will link digital data platforms and train community Work Improvement Teams (WITs) to use the data they collect to identify problems and develop local solutions. The project entails ‘seeing’ linked data (C-it) and ‘doing’ or acting on the data (DU-it). The study seeks to answer the question, “What is the effect of ‘C-it DU it’ on community health systems strengthening and what is required for effective transfer and scale-up?”\n\nThe project will enable smooth integration of data collected at both facility and community levels to track individuals from the community to facilities and back again. The study will pilot in Homa Bay County so as to introduce “C-IT DU-it” and increase the number of pregnant women achieving eight scheduled ANC contacts with a healthcare provider. The project will, from year 3, be scaled-up to the other three Kenyan Counties as an ideal way of transferring lessons.\n\nThe project will use mixed methods implementation research design with four components:\na) Realist evaluation will generate, empirically test and refine a transferrable programme theory to understand the causal relationship between context, participant response and outcomes.\nb) A 3-arm, cluster-randomised controlled trial in Homa Bay County will determine the efficacy of ‘C-it’ and ‘C-it DU-it’ to increase ANC contacts when compared to the standard of care.\nc) Health economic evaluation and equity analysis will compare health expenditure of women accessing and engaging with ANC care and determine costs and cost-effectiveness of C-it Du-it from a health systems perspective.\nd) Qualitative interviews will assess transferability and iterative scale-up of C-it DU-it across the three remaining counties using toolkits developed in Homa Bay.. The study objectives are:\n1. To increase ANC uptake and quality in Western Kenya by\na. linking community and facility digital ANC data systems, creating a system able to track an individual woman throughout pregnancy and schedule appointments (‘C-it’)\nb. strengthening the capacity of community work improvement teams to use ‘C-it’ data for quality improvement and of CHVs to deliver community-based ANC contacts (‘DU-it’).\n2. To co-develop research strategies with county policymakers that address evidence gaps to scale-up community health systems strengthening through ‘C-it DU-it’:\na. to evaluate what worked or did not work for whom and why\nb. to establish the real-world effectiveness of ‘C-it’ and ‘C-it DU it’ on the number of ANC contacts\nc. to determine the costs and cost-effectiveness of ‘C-it’ and ‘C-it DU it’ from different perspectives\nd. to assess the transferability of our approach to other counties, countries, and contexts\n3. To strengthen the capacity of communities, county managers, Kenyan researchers, and institutions to set the community health research agenda and deliver major implementation research\n\nTarget Population: Pregnant women in 4 counties in Western Kenya. These 4 counties (Homa Bay, Migori, Kisumu and Kakamega) have the highest maternal mortality rate in Kenya.\n\nProject Outcomes: This study aims to strengthen community health systems in Kenya through antenatal care (ANC) data linkage and use while learning lessons for other contexts. Through this study the researchers will: 1) determine how counties can use digital data to integrate community-based with facility-based delivery of ANC services; 2) demonstrate how to scale up data use alongside digital data linkage at the community-facility interface and 3) improve the global frameworks for using robust data to track progress towards Universal Health Care (UHC).\n \n ID: GB-GOV-10-HPSR_RL_150232\nTitle: Strengthening health systems by addressing community health workers’ mental wellbeing and agency\nDescription: Although community health workers (CHWs) play a crucial human resource role in health systems of many low and middle-income countries, they are largely invisible, under supported and not adequately recognised. Lack of support generates many stressors for CHWs which are further exacerbated when delivering services in challenging contexts (e.g COVID-19, informal settlements, remote areas). Chronic job-related stressors can have a lasting impact on CHW wellbeing which ultimately affects their performance and capacity to effectively undertake their important role as frontline health workers. Drawing on wellbeing and resilience frameworks while considering the hardware (e.g. training) and software (e.g. community cohesion and support) components of the health system, we aim to identify the stressors, challenges, constraints and opportunities faced by CHWs and communities. We will utilise this evidence to co-develop, pilot and evaluate a holistic health systems support package for CHWs in two different LMIC contexts to support CHW wellbeing and agency, ultimately contributing to enhanced health systems resilience. We will focus specifically on integrating support for the mental wellbeing of CHWs, a previously neglected area. .. Objectives:\n1. To identify strategies and programmes to enhance CHWs’ wellbeing, with a specific focus on mental health that is equitable, sustainable and acceptable in LMIC settings.\n2. To co-design and test innovative health system interventions that are responsive to the diverse personal and job-related stressors (social, material and human) experienced by CHWs.\n3. To enhance the quality and equity of existing support approaches to ensure a focus on mental wellbeing that prioritises the diverse needs of CHWs.\n4. To contribute evidence and knowledge to inform and advocate for support of CHWs mental wellbeing in future research and programme design in other health systems\nMethods: Our research will apply ‘Community Based Participatory Research’ (CBPR) situating CHWs and stakeholders as equitable partners and co-researchers who are central to data collection, analyses and co-designing solutions. We will:\n1) Undertake analysis of existing global and national policies and practices that support CHWs wellbeing.\n2) Conduct interdisciplinary research with CHWs, supervisors and key decision/policy makers using qualitative, participatory methods (photo-voice, stepping stones, body mapping), quantitative surveys, and embedded participatory evaluation to generate evidence on their experiences and challenges.\n3) Utilize evidence to co-produce interventions with CHWs and key stakeholders, to support CHWs’ mental wellbeing, promoting their resilience and agency to strengthen health system resilience.\n4) Pilot and evaluate interventions for cost, equity, feasibility, acceptability and scale-up.\nTeam: Our interdisciplinary team comprises researchers, implementers, policy makers, with direct engagements and collaborations with CHWs, government, non-governmental organisations, or in each country.\n \n ID: GB-GOV-10-HPSR_RL_150244\nTitle: NIHR HPSR-RL: Tulong, Ugnayan ng Lingap At gabaY (TULAY): Co-designing Philippines' Community Physical Rehabilitation\nDescription: Rehabilitation is care that can help people get back, keep, or improve functions that are needed for daily life. These may be physical, mental, and/or cognitive (thinking and learning) and is help is almost always needed following stroke or other physical illnesses. Unlike in the UK, where there are very effective recovery programmes, in the Philippines, these services are almost non-existent. We intend to design, with the help of patients, carers and health workers, a programme of activities to help people manage their recovery from physical illness, such as stroke, themselves. We are doing this because the evidence from research strongly supports this type of help, which will be given by trained municipal and barangay (village) health workers, alongside family carers, who work in the island areas of the Philippines, away from towns and cities.\nThe joint team of researchers and health professionals from the UK and Philippines will work together with stroke survivors and families to develop recovery care delivered within the community setting. This programme is intended to be adapted for other physical conditions in the Philippines and other low to middle income countries. To do this we will use a mixture of approaches to find out about current services, what people want before designing a programme, jointly with patients, carers and health workers, that meets local needs. We will train local health workers and village people to help to deliver it. The University of Plymouth, in the UK, and De La Salle University, in the Philippines are leading this project, having spent time meeting with policy makers, clinicians, and patient/carer groups, as well as the Philippine Academy of Rehabilitation Medicine (PARM) and national therapy organisations to involve them in this work.\nThe project will start in October 2022 and continue until 2026, when we hope to have this model approved as part of the Philippines’ Universal Healthcare Scheme, to help others to manage themselves after physical illness. This work will help the health system to improve patient and family health, using a sustainable model that reflects the diversity and culture of the Philippines.. To work together with stroke survivors and families to develop a programme of activities to help people manage their recovery from physical illness, such as stroke, themselves. This will be delivered within rural community settings, by trained local health workers and village people.\nTo do this we will:\n1. Record current services, key people and organisations involved in the delivery of care following stroke and other physical illnesses at national, regional and local (village) levels. We want to find out about what current care following stroke is provided, with a focus on community delivery of care (not in towns and cities). We will also review the evidence about community-based rehabilitation in low to middle income countries. The outcome will be a report that includes initial recommendations that can be shared more widely in the Philippines and form the basis for discussions in the regions where the self-management programme will be developed, so we can make sure the new programme fits with what is currently available.\n2. Find out what Filipinos want, by talking to stroke patients, carers and health professionals in the Philippines about their needs and experiences following stroke. The outcome will be a summary of needs that will be used in the co-design stage of the project.\n3. Co-design a programme that meets their local needs of people following stroke. To do this we will work with around 3-6 stroke survivors per village (barangay) in three main regions of the Philippines. We will aim to train at least 60 barangay (village) workers across the three regions. The outcome of this work will be a report detailing the development of the self-management programme for stroke rehabilitation in community settings for delivery at local level, and a ‘teach the teachers’ toolkit/package of support for wider use.\n4. Seek feedback to find out what worked well, what needed changing when we move to a new region of the Philippines and gather basic information about the costs of delivering the programme. To do this we will seek information from key people from the three regions who have already been involved in the research, including stroke survivors, carers, health workers and other officials. The outcome will be a report that describes the implementation and evaluation of the programme, which can be used by policymakers in the Philippines and other similar countries as well as a report that simply describes the costs of delivering the recovery support programme.\n \n ID: GB-GOV-10-HPSR_RL_150261\nTitle: Implementation of the community health system innovatiON project in low- and middle-income countries\nDescription: The COmmunity HEalth System InnovatiON (COHESION) project was a 3-year project that started in 2016 as a collaboration between research teams from Mozambique, Nepal, Peru and Switzerland. It enabled formative research to be conducted at policy, health system and community levels using tracer chronic conditions that included non-communicable diseases (NCDs) (diabetes and hypertension), and a specific neglected tropical disease (NTDs) (Schistosomiasis in Mozambique, Leprosy in Nepal and Epilepsy resulting from neurocysticercosis in Peru).\nThe results from this formative research were utilised as part of a process for identifying adequate interventions through a participatory approach with communities, primary healthcare (PHC) workers, and regional health authorities. Meetings with different stakeholders were carried out between 2017 and 2018 to propose context- relevant interventions oriented to address the challenges of providing care for people affected by NCDs and NTDs. During the meetings, participants provided feedback regarding problems and potential solutions for chronic care and health services in general and proposed possible areas of intervention. Upon completion of all the meetings, each country identified the main components to be included in their interventions that were focussed on communities, health workers and facilities. The suggested intervention components in Mozambique include: (i) radio and pamphlets to inform population about hypertension, (ii) development of facility based guideline/algorithm, training in hypertension and clear communication, and group discussions on challenges and opportunities to manage chronic diseases, and (iii) establishment of a medical appointment system for people with chronic diseases.\nTaking the work forward, this proposed project has two main objectives: first, the implementation and evaluation of the context specific co-created interventions in the three countries – Mozambique, Nepal and Peru (Component 1), and secondly, explore the possibilities to translate the experience and the lessons learnt to other countries (India) for adaptation of the COHESION approach in a different context (Component 2).. The COHESION - I project had two objectives: (i) The implementation and evaluation of the context specific co-created interventions in three countries – Mozambique, Nepal and Peru (Component 1). (ii) Explore the possibilities to translate the experience and the lessons learnt to other countries (India) for adaptation of the project in a different context (Component 2)\n\nComponent 1\nWe propose to work in six communities in Mozambique, Nepal and Peru. Two communities (A&B) where we worked between 20017 - 2019 as part of the formative work will receive the co-created/co-designed intervention encompassing activities with the community’s health service users and health providers. Two other communities (C&D) will receive a co-designed only intervention of the same duration, the idea being evaluate if interventions that were co-created in other communities will work in new communities with similar characteristics. Finally, two different communities (E&F) will receive no intervention (“usual care arm”) to enable meaningful comparisons between intervention arms and usual care.\nThe current project will enable us to evaluate the impact of a co-designed strategy in terms of (a) improved responsiveness of primary healthcare and patient satisfaction, and (b) improved health care provision for chronic conditions. We will compare the impacts of the co-designed intervention to those of the non-co designed intervention and usual care in terms of two major outcomes, responsiveness and patient satisfaction, as well as other health system-related outcomes.\n\nComponent 2\nIn India, we will follow the approach taken in COHESION study and conduct a policy analysis, health system assessment and community perception study. A co-creation process will follow this to develop context-relevant interventions to improve the provision of care for people affected by non-communicable diseases and neglected tropical diseases. The co-created interventions will be pilot tested in the field for feasibility, acceptability, and preliminary effectiveness. If the COHESION approach proved to be locally adaptable in India, a protocol for the COHESION methodology will be developed that can be adapted to different settings.\n \n ID: GB-GOV-10-HPSR_RL_150287\nTitle: IMPACT: Innovations using mhealth for people with dementia and co-morbidity and their carers\nDescription: Health systems in low- and middle-income countries are ill-equipped to cope with rapidly aging populations. Dementia is a particular problem in Peru and challenges the health system on many fronts. People with dementia often have other health problems as well (co-morbidities) which go untreated, cause suffering and cost money. There is little social care infrastructure and care is provided almost entirely by over-stretched family members.\n\nOur goal is to strengthen the health system in Peru to meet the challenges of dementia by using technology and trained community health workers to bring expert diagnosis, treatment and support right to where it is needed – to the homes of patients and carers. To achieve this, we will run four linked lines of work to:\n\n1) assess whether the healthcare system can care for more people with dementia\n2) improve the diagnosis of dementia\n3) improve the care of people with dementia and their carers\n4) evaluate the costs of dementia to society\n\nHealth systems readiness: We will interview people with dementia, carers, health professionals and government officials. We will find out about current dementia care in Peru and what is needed to improve it\n\nDiagnosis: Dementia is hard to diagnose in people who live far from health centres or have little formal education. We will make an ‘app’ to help community health workers diagnose people with dementia. We will test how well this app works in 3200 people across four distinct regions of this diverse country.\n\nCare: Although there is no cure for dementia, support and advice, group-based activities and physical exercise all help people to live well with dementia. But this type of care is not readily available in Peru. A project in the USA has developed a way of providing this care with smartphones. Because most Peruvians have smartphones, we can use them to develop a similar service, testing whether providing this care is feasible in Peru.\n\nCosts: We will measure the cost of dementia and comorbidities in Peru. The health system needs to know how much dementia care will cost, so that it can introduce cost-effective plans for better care.\n\nWe will work with dementia charities in Peru and around the world to keep our research focused on patients. We will collaborate with the Peruvian Ministry of Health to develop a National Plan for Dementia. We focus on Peru in order to understand the context in depth but are confident that our findings will be applicable much more widely in Latin America.. The aim of IMPACT is to strengthen health systems in Peru, using dementia as a tracer condition, through sustainable, integrated, community-delivered, technology-enabled innovations. Specific research objectives, embedded in our five Work Packages are:\n\n1. Evaluate health system readiness to diagnose, treat and support people with dementia and their carers\na. To understand the needs of and resources available for people with dementia and their carers\nb. To assess the readiness of the Peruvian health system to implement innovative tools for the diagnosis of dementia, and an intervention for people with dementia and their carers\nc. To adapt and scale-up the health system readiness tools for use across Latin America\n\n2. Develop and implement an mHealth-enabled system for diagnosis of dementia\na. Design and develop an mHealth, task-shifting diagnostic system for dementia and co-morbidities\nb. Assess the accuracy and acceptability of the diagnostic system in four regions of Peru\nc. Integrate the dementia diagnostic system in primary health care across the four study regions.\n\n3. Determine the feasibility of an intervention to support people with dementia and their carers\na. Adapt an existing intervention from the USA aimed at improving health-related quality of life for people with dementia and their carers in Peru\nb. Assess the feasibility of delivering this intervention in Peru and its acceptability to people with dementia and their carers\nc. Identify appropriate ways to measure health-related quality of life and multimorbidity outcomes in people with dementia and their carers\n\n4. Assess the economic burden of dementia in Peru and estimate the costs of rolling out the diagnosis tool at a national level\na. Estimate the economic burden of dementia in Peru from a societal perspective and the additional costs of comorbidities\nb. Assess the health-related quality of life of people with dementia and their carers and its variation with additional comorbidities\nc. Determine the cost to the health system of implementing the diagnostic screen for dementia\n\n5. Optimise internal and external communications to deliver health systems improvements in Peru\na. Manage resources to deliver the project to plan, within time and budget, including risk management and quality control procedures\nb. Ensure effective communication and work dynamics with attention to interactions between work packages\nc. Engage with communities, healthcare workers, policy makers and other stakeholders\n \n ID: GB-GOV-10-HPSR_HSR\nTitle: NIHR Global Health Policy and Systems Research community of interest development \nDescription: To inform the development of a dedicated NIHR-led Health Policy and Systems Research (HPSR) programme and the co-creation of strategic partnerships addressing global HPSR, NIHR is undertaking outreach and consultation activities to establish areas where there is an unmet need or skill shortage, and areas which are under-funded or under-researched. Universities UK will undertake a research project to develop a community of interest to support engagement in NIHR Global HPSR programme calls, knowledge sharing and in the identification of research priorities for Global HPSR. . Initial aims are to build interest and engagement in NIHR global health systems research opportunities and facilitate meaningful exchange, collaborations and learning, focusing on:\nMobilising UK research interest via HSRUK’s (Health Services Research UK) membership and academic networks; Deploying the whole community to contribute priority research themes and wider insights; encouraging uptake of funding and collaborative opportunities; supporting researchers to answer policy-relevant questions to improve health systems; sharing knowledge within and beyond the community to increase capacity and impact. \n", "_version_":1865393004371509248 }] } }