ReBUILD overview presentation 3rd health researchers forum - Nick Hooton
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Presentation given at 3rd Cambodian Health Researchers' Forum held at the National Institute of Public Health in Phnom Penh, 20th January 2017.
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ReBUILD overview presentation 3rd health researchers forum - Nick Hooton
- 1. Nick Hooton – ReBUILD Research Programme Consortium 3rd Health Researchers Forum Strengthening Health Research Governance in Cambodia National Institute of Public Health, Cambodia 20th January 2017 The ReBUILD Research Programme Consortium and supporting national capacity for evidence-based health systems strengthening in Cambodia
- 2. Background on ReBUILD • A UK Aid funded research programme consortium • Formed in 2011, running until 2017 • To explore different approaches to health system development in countries that have been affected by political and social conflict. Research for Building pro-poor health systems in countries affected by conflict or crisis
- 3. Background on ReBUILD • Decisions made during the post-conflict period can set the long-term direction of development for the health system. • Yet health systems research has tended to neglect these contexts, because it may be more difficult to carry out studies in difficult environments, and relevant capacity can be weak. • Current strong focus by international agencies on fragile and conflict-affected states, and a need to understand how post- conflict trajectories play out Rationale:
- 4. The ReBUILD team and partners • Cambodia • National Institute of Public Health • Sierra Leone • College of Medicine and Allied Health Sciences • Uganda • Makerere University School of Public Health • Zimbabwe • Biomedical Training and Research Institute • UK partners: • Liverpool School of Tropical Medicine • Institute for Global Health and Development, Queen Margaret University Edinburgh • Consortium affiliates working in additional countries: • Cote d'Ivoire, Nigeria and South Africa; Sri Lanka, Gaza and Liberia
- 5. ReBUILD research • Rebuilding the foundations for universal health coverage with equity in Zimbabwe • Health Systems Resilience: A Systems Analysis • Health Workers’ Remuneration, Incentives and Accountability in Sierra Leone • Psychosocial support and service provision for adolescent girls in post-conflict settings • Access to obstetric care and referral in rural Cambodia Health financing Gender & equity Health workforce Aid effectiveness Contracting models ReBUILD’s research Research for stronger health systems post conflict Affiliate projectsCore team’s projects
- 6. Background on ReBUILD • Reflect different stages in recovery from conflict or crisis • Enables us to look at how the post-conflict period has played out over a long time period (Cambodia) a medium period (Sierra Leone) and more recently (northern Uganda and Zimbabwe). • Affiliates can link us to further countries that can enable us to explore relationships further A range of countries and contexts:
- 7. Resources at
- 9. Research into policy and practice • Aim: to ensure that the knowledge that we generate is useful to decision makers and practitioners, both within partner countries and internationally. • We work with stakeholders from government, academia, donors, professional bodies and civil society to ensure our research is relevant to needs, and contributes to real change that makes a significant impact.
- 11. National capacity for evidence-based health systems development Important additional ReBUILD objective is to support: • National systems for identifying and conducting health systems research relevant to the needs and priorities of decision-makers and implementers • Structures and systems for dialogue between decision- makers, implementers and researchers
- 12. Sierra Leone: • Ebola crisis in a country with still weakened health systems after conflict • "the only thing positive about the Ebola outbreak is that it has created a window of opportunity to prioritise health systems research and strengthening” • Dr Haja Wurie, Sierra Leone ReBUILD supporting national capacity for evidence-based health systems development
- 13. Zimbabwe: • Ongoing political and economic crisis • Environment of fear and uncertainty which affects ability to raise and discuss policy issues, even when based on research. • Also affects the whole process of conducting research ReBUILD supporting national capacity for evidence-based health systems development
- 14. Cambodia: NIPH leading engagement with stakeholders Health Researchers Forum November 2015: 1st HRF: • Mapping & planning health systems research in Cambodia August 2016: 2nd HRF January 2017 – 3rd HRF: • Strengthening health research governance in Cambodia
- 15. អរគុណ Thank you • ReBUILD is funded by UK Aid, from the UK Department for International Development
- 16. Cross-cutting research findings, shared at international level
- 17. Cross-cutting thematic areas emerging from ReBUILD's research
Notas del editor
- Some 1.2 billion people are estimated to live in fragile and post conflict states, The key starting point for ReBUILD was that decisions made early post-conflict and post crisis can steer the long-term development of the health system In countries affected by conflict, health systems often break down, and emergency assistance is often the main source of care. As recovery begins so should the process of rebuilding health systems. However, in practice not enough is known about the effectiveness of different approaches to health systems strengthening in these settings. Yet ….
- Some 1.2 billion people are estimated to live in fragile and post conflict states, The key starting point for ReBUILD was that decisions made early post-conflict and post crisis can steer the long-term development of the health system In countries affected by conflict, health systems often break down, and emergency assistance is often the main source of care. As recovery begins so should the process of rebuilding health systems. However, in practice not enough is known about the effectiveness of different approaches to health systems strengthening in these settings. Yet ….
- The ReBUILD partners include: Cambodia Development Resources Institute and now the National Institute of Public Health in Phnom Penh College of Medicine and Allied Health Sciences in Sierra Leone Makerere SPH in Uganda Biomedical research and training Institute in Zimbabwe The UK partners are Queen Margaret University Edinburgh and LSTM, which has the contract with DFID, our funder This picture was at an early consortium meeting, but shows Barbara McPake, co-research director and presenter by distance on my right; Tom Merrick (please stand) – Chairman of the Consortium Advisory Committee – on my left; and Christopher Samkange in front of the poster – on of our very supportive CAG members (please stand). I will ask other members of the audience to stand at various points, so that you know who they are and can talk to them in the breaks and over lunch. So what have we done?
- In the planning of ReBUILD we wanted to broaden our reach both in terms of related research areas and geographically. Groups that were signed up as affiliates to ReBUILD were invited to submit proposals for our Responsive Fund. Five were selected. They are all briefly described in the Overview brief with references to written outputs. TARSC in Zimbabwe looked at UHC and equity in Zimbabwe – Renee Loewenson led on this work – please stand Alastair Ager – now back at QMU – led on Health Systems Resilience work using a systems dynamics approach to understand, predict and identify mechanisms that influence the resilience of health systems in contexts of adversity, using case studies in Northern Nigeria, Eastern Cape Province in South Africa and Côte d’Ivoire Maria Bertone carried out a study on health workers’ remuneration, incentives and accountability in Sierra Leone – alongside ReBUILD’s core work on health workers Fiona Samuels from ODI (please stand) carried out work on Psychosocial support and service provision for adolescent girls in post-conflict settings in Sri Lanka, Gaza and Liberia. And a team at Leeds university working with ReBUILD partners in Cambodia used an Appreciative Inquiry approach to investigate Access to obstetric care and referral in rural Cambodia So since 2011, when ReBUILD started, we covered a lot of ground. About 18 months ago, as many of the individual projects were nearing completion, we started to look more carefully at the body of knowledge emerging from ReBUILD.
- Some 1.2 billion people are estimated to live in fragile and post conflict states, The key starting point for ReBUILD was that decisions made early post-conflict and post crisis can steer the long-term development of the health system In countries affected by conflict, health systems often break down, and emergency assistance is often the main source of care. As recovery begins so should the process of rebuilding health systems. However, in practice not enough is known about the effectiveness of different approaches to health systems strengthening in these settings. Yet ….
- Before I finish – let me make a plug for the resources we have available on the website and introduce Nick Hooton who has been responsible for pulling these together and all our research uptake work at an international level
- Some 1.2 billion people are estimated to live in fragile and post conflict states, The key starting point for ReBUILD was that decisions made early post-conflict and post crisis can steer the long-term development of the health system In countries affected by conflict, health systems often break down, and emergency assistance is often the main source of care. As recovery begins so should the process of rebuilding health systems. However, in practice not enough is known about the effectiveness of different approaches to health systems strengthening in these settings. Yet ….
- Some 1.2 billion people are estimated to live in fragile and post conflict states, The key starting point for ReBUILD was that decisions made early post-conflict and post crisis can steer the long-term development of the health system In countries affected by conflict, health systems often break down, and emergency assistance is often the main source of care. As recovery begins so should the process of rebuilding health systems. However, in practice not enough is known about the effectiveness of different approaches to health systems strengthening in these settings. Yet ….
- Some 1.2 billion people are estimated to live in fragile and post conflict states, The key starting point for ReBUILD was that decisions made early post-conflict and post crisis can steer the long-term development of the health system In countries affected by conflict, health systems often break down, and emergency assistance is often the main source of care. As recovery begins so should the process of rebuilding health systems. However, in practice not enough is known about the effectiveness of different approaches to health systems strengthening in these settings. Yet ….
- Some 1.2 billion people are estimated to live in fragile and post conflict states, The key starting point for ReBUILD was that decisions made early post-conflict and post crisis can steer the long-term development of the health system In countries affected by conflict, health systems often break down, and emergency assistance is often the main source of care. As recovery begins so should the process of rebuilding health systems. However, in practice not enough is known about the effectiveness of different approaches to health systems strengthening in these settings. Yet ….
- The ReBUILD partners include: Cambodia Development Resources Institute and now the National Institute of Public Health in Phnom Penh College of Medicine and Allied Health Sciences in Sierra Leone Makerere SPH in Uganda Biomedical research and training Institute in Zimbabwe The UK partners are Queen Margaret University Edinburgh and LSTM, which has the contract with DFID, our funder This picture was at an early consortium meeting, but shows Barbara McPake, co-research director and presenter by distance on my right; Tom Merrick (please stand) – Chairman of the Consortium Advisory Committee – on my left; and Christopher Samkange in front of the poster – on of our very supportive CAG members (please stand). I will ask other members of the audience to stand at various points, so that you know who they are and can talk to them in the breaks and over lunch. So what have we done?
- Some 1.2 billion people are estimated to live in fragile and post conflict states, The key starting point for ReBUILD was that decisions made early post-conflict and post crisis can steer the long-term development of the health system In countries affected by conflict, health systems often break down, and emergency assistance is often the main source of care. As recovery begins so should the process of rebuilding health systems. However, in practice not enough is known about the effectiveness of different approaches to health systems strengthening in these settings. Yet ….
- Conflict and crisis creates change Change in the supply of health services: for example damaged infrastructure such as hospitals, health centres, electricity, water; death or flight of health workers; risks to health workers; disruption in supply of medicines and materials Change in the demand – the changing health needs of the population, for example, trauma – physical as well as psychological; changes in households; increased poverty can lead to illness and difficulty in accessing healthcare This can lead to enhanced vulnerability of the health system And what we want our research to contribute to is the development a stronger, pro-poor, health system post conflict and crisis From our overall research to answer the question : how can decisions made early post conflict or crisis steer the long term development of the health system? …. Three thematic areas have emerged: – institutions, health workers and communities We will address these thematic areas in more detail shortly … ReBUILD has been working with decision makers, implementers and development partners within partner countries and at international level to support the use of the research in policy and practice. Findings from individual partner countries have been shared through relevant national dialogues, while the cross-cutting findings outlined in this series have formed the basis of international-level engagements with implementers, donors and technical support organisations.