Governance for Equity in Health Systems (GEHS) / Gouvernance pour l’équité dans les systèmes de santé (GESS)
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IDRC’s Governance for Equity in Health Systems
Poor living conditions. Gender and social discrimination. Overstretched public services. Weak data systems. Inadequate health care. Improving health in developing countries takes more than groundbreaking vaccines and new hospitals. It also requires stronger health systems and a profound understanding of the root causes of the problem, such as social and economic inequities that fuel poverty, and governance issues that hinder change. IDRC’s Governance for Equity in Health Systems program funds research in developing countries that helps to redress health inequities and improve health services, systems, and policies, for all.
Le programme Gouvernance pour l'équité dans les systèmes de santé du CRDI
Fort de la conviction qu’un système de santé équitable est l’un des fondements d’une société bien portante, le programme Gouvernance pour l'équité dans les systèmes de santé du CRDI finance la réalisation, dans les pays en développement, de travaux de recherche qui contribuent à combattre les inégalités en matière de santé et à améliorer les services, les systèmes et les politiques de santé pour le bien de tous.
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Item A quién acudimos cuando buscamos salud?(Programa de las Naciones Unidas para el Desarrollo (PNUD), Guatemala City, GT, 2008) Garcés de Marcilla del Valle, Ana Lucía; Garcés de Marcilla del Valle, Clara IsabelItem À quoi un système de santé africain financièrement accessible et durable devrait-il ressembler au XXIe siècle(CRDI, Ottawa, ON, CA, 2006) Yonkeu, SamuelItem Abolishing user fees for patients in West Africa : lessons for public policy(Agence française de développement (AFD), 2013-05) Ridde, Valéry; Olivier de Sardan, Jean-PierreThis work is based on five articles that focus on three poor West African countries: Mali, Niger and Burkina Faso. The articles address healthcare fee exemption policies, more specifically: decision making processes, free healthcare, the targeted clientele, actual implementation procedures, quality of care, difficulties encountered and some results of the studies. Due to lack of preparation, communication, effective management and most of all, adequate funding, the operation of measures is chaotic and inconsistent in most cases. Many unexpected effects were revealed by the research, notably the fact that quality of care is far from reliable due to shortages in supplies.Item Abolition sélective du paiement direct en Afrique subsaharienne : une opportunité pour le renforcement des systèmes de santé?(2011) Ridde, Valéry; Meessen, Bruno; Kouanda, SeniEn Afrique, nombreux sont ceux qui recommandent l’abolition ciblée du paiement direct des soins de santé pour les femmes et les enfants de moins de cinq ans. Mais des difficultés de mise en oeuvre sont apparues au cours d’expériences menées par quelques pays précurseurs d’Afrique de l’Ouest. De nombreux goulots d’étranglement du système de santé sont apparus et cet article permet d’en mettre au jour un certain nombre. Mais en même temps, nous croyons qu’ils constituent autant d’opportunités de renforcement des systèmes de santé, si l’on envisage de procéder notamment aux changements suivants : accroître de manière significative le financement de la santé et en améliorer la fiabilité, adopter des politiques de santé érigeant l’équité au rang de priorité, mettre en oeuvre des réformes alignées sur les principes de la « Nouvelle Gestion Publique », assurer l’apport en intrants de qualité, renforcer les différentes composantes du secteur de la santé, et réaliser davantage d’évaluations dans ce même secteur.Item Accesibilidad y participación ciudadana en el sistema de salud : una mirada desde la psicología(Editorial Fin de Siglo, Montevideo, UY, 2009) Rudolf, Susana; Bagnato, Maria Jose; Güida, Carlos; Rodríguez, Ana Carina; Ramos, Federico; Suárez, Zulema; Arias, Maria AlejandraItem Accompagnement stratégique dans un contexte de changement : la recherche des outils de gestion du processus de décentralisation au Cameroun(Zenü Network, Bafoussam, CM, 2010) Djateng, FlaubertItem Acercamiento a la articulación local y distrital en salud y desplazamiento : informe de proceso(Pontificia Universidad Javeriana, Bogotá, CO, 2005) Naranjo Gómez, Claudia; Hernández Bello, AmparoItem Achieving community participation in primary health care service delivery : what should we do?(2015) Centre for Population and Environmental Development (CPED); Onokerhoraye, Andrew G.The survey of primary health care facilities in Delta State shows that community involvement in the management and delivery of primary health services is lacking. The empowerment and participation of women of child bearing age is needed as a key component of any strategy to involve community members towards effective delivery of maternal and child health care. This policy brief is based on the findings of ongoing research, “Strengthening the health system in Nigeria through improved equitable access to Primary Health Care (PHC): The Case of Delta State, Niger Delta region.”Item Action learning for health system governance : the reward and challenge of co-production(Oxford University Press, 2014) Lehmann, Uta; Gilson, LucyHealth policy and systems research (HPSR) is centrally concerned with people, their relationships and the actions and practices they can implement towards better health systems. These concerns suggest that HPS researchers must work in direct engagement with the practitioners and practice central to the inquiry, acknowledging their tacit knowledge and drawing it into generating new insights into health system functioning. Social science perspectives are of particular importance in this field because health policies and health systems are themselves social and political constructs. However, how can social science methodologies such as action research and narrative and appreciative enquiry enable such research, and how can methodologies from different disciplines be woven together to construct and make meaning of evidence for ‘this’ field? This article seeks to present ‘methodological musings’ on these points, to prompt wider discussion on the practice of HPSR. It draws on one long-term collaborative action learning research project being undertaken in Cape Town, South Africa. The District Innovation and Action Learning for Health System Development project is an action research partnership between two South African academic institutions and two health authorities focused, ultimately, on strengthening governance in primary health care. Drawing on this experience, the article considers three interrelated issues: The diversity and complexities of practitioner and research actors involved in co-producing HPSR; The nature of co-production and the importance of providing space to grapple across different systems of meaning; The character of evidence and data in co-production. There is much to be learnt from research traditions outside the health sector, but HPSR must work out its own practices—through collaboration and innovation among researchers and practitioners. In this article, we provide one set of experiences to prompt wider reflection and stimulate engagement on the practice of HPSR for people-centred health systems.Item Action pour la santé et la recherche médicale en faveur des personnes vulnérables et des pays émergents : VIe Forum des jeunes chercheurs(Les Études Hospitalières, 2012-06) Duguet, Anne-MarieItem Active case treatment lebih cost effective untuk pengobatan TB paru tahap awal(Pusat Kebijakan dan Manajemen Kesehatan, Universitas Gadjah Mada, Yogyakarta, ID, 2012) Ketut Ardani, Ni; Nurul Rochmah, Thinni; Umbul Wahyuni, ChatarinaBackground: Estimated one third of world population have been infected with Mycobacterium tuberculosis. Infected person will lose 3-4 months work time and will decrease 20%- 30% of income per year. Finding and treating TB patients are the best endeavor to stop TB spreading with a correct intervention. Jember Regency is executing Passive Case Treatment (PCT), which lung TB patients should come to puskesmas to take the Tuberculosis Drug (ATD) in a certain day and hour. The method was not effective, proven by the increase of default rate for 3 years: 5.08% in 2007, 5.14% in 2008 and 6.18% in 2009, followed by the decrease of conversion rate for 3 years: 95.26% in 2007, 93.09% in 2008 and 92.08% in 2009. It is raising alertness for increased re-treatment which will lead to MDR, where MDR is clearly affecting TB patients’ quality of life. Afterward, an idea to create an ATD delivery to patients’ homes was executed, it is called Active Case Treatment (ACT). Method: This study was a Quasy Experimental Research with a prospective design. Conducted in 16 Puskesmas with default rate more than 5% and conversion rate less than 80% in 2009. Begin in September until November 2010, using total sampling technique. The sample was all lung TB patients who came for treatment in September 2010, with criteria were: new case, 15-50 years of age, did not suffer HIV and Diabetes Mellitus, was not malnourished, and was not allergic to ATD. Data collection was done through interview, filling questionnaires and exploring documents. Then followed the calculation of the total cost (direct and indirect cost) and Quality of Life (QoL) of both PCT and ACT. Later, total cost was compared to QoL, the lesser amount was considered more cost effective. Result: Research result showed that to increase 1 scale of Quality of Life (QoL) of PCT needed an amount of IDR. 35,295.00, while to increase 1 QoL scale ACT was IDR 14,377.00. ACT was smaller than PCT. Conclution: Conclusion derived from the result was that ACT is more cost effective than PCT. Recommendation to be presented is to endorse lung TB treatment with ACT in Jember Regency particularly in Puskesmas with the same characteristics with this research.Item Acuerdos y compromisos del "Diálogo de proyectos y organizaciones que trabajan en salud de la población desplazada, con instituciones y autoridades del Distrito Capital", Bogotá, Hotel Bacatá, feb. 18 2005(Pontificia Universidad Javeriana, Bogotá, CO, 2005) Hernández Bello, Amparo; Ariza Montoya, John FranciscoItem Added value of multiple IMCHA research projects on maternal, newborn and child health policy and practice in Nigeria(2022-02) Johnson, Ermel; Sombié, IssiakaThe Innovating for Maternal and Child Health in Africa (IMCHA) initiative was designed to generate findings that could influence policies and practices at national and subnational levels. This case study documents the added value of IMCHA projects on maternal, newborn and child health policy and practice in Nigeria. Three research teams implemented five research projects representative of different country contexts, allowing analysis of different facets of MNCH problems including barriers to service utilisation and perinatal depression, as well as impacts of the projects. Future research funding could build on the IMCHA model to ensure political involvement and ownership at national level.Item Addressing the social determinants of health : a case study from the Mitanin (community health worker) programme in India(London School of Hygiene and Tropical Medicine, 2014) Nandi, Sulakshana; Schneider, HelenAction on social determinants of health (defined as ‘the circumstances in which people are born, grow up, live, work and age’) involved raising awareness on rights, mobilizing women’s collectives, revitalizing local political structures and social action targeting both the community and government service providers. Through these processes, the Mitanins (Community Health Workers) developed identities as agents of change and advocates for the community, both with respect to local cultural and gender norms and in ensuring accountability of service providers. The role of the Mitanins and the relative autonomy of the Mitanin Programme infrastructure were some factors underpinning empowerment and successful action.Item Addressing unmet need for contraceptives among adolescents using community-embedded intervention : highlights of stakeholder engagement meeting(2019-10) Mbachu, Chinyere Ojiugo; Ikwuakor, Chinyere; Obi, Shalom; Ajibo, Ifeanyi; Agu, Ifunanya; Eze, Irene; Onwujekwe, Obinna; Ezumah, NkoliThis one-page report provides an overview of the workshop, which included representative stakeholders from all levels in adolescent and sexual health, including the Senior Special Adviser (SSA) to the State Governor on health, the State Coordinator of Sustainable Development Goals (SDG) and the Commissioner for Health. In advance of the research, the meeting generated discussion on adolescent sexual health, and with the help of participants to determine the particular communities to be targeted for the study, as well as implementation sites.Item L'adolescence au Niger : contours et déterminants majeurs(2022-05) Hamidou, Issaka Maga; Allagbada, Didier; Sandi, Goza Nana Aicha; Boureima, DiadiéItem Adolescent perinatal depression : a neglected public health issue(2020) Gureje, OyeThe presentation reports on a study regarding perinatal depression, with findings that show the rate of perinatal depression is much higher among adolescents compared to adults. A suggested course of action is reviewed: “Responding to the challenge of Adolescent Perinatal Depression (RAPiD).” Pregnant adolescents are often ostracized and receive little or no support from family members. The RAPiD programme provides training and resources for pregnant teenagers. This is a global health issue: WHO estimates 11% of all births are to girls aged 15-19 years. The highest rates are in sub-Saharan Africa (30% of live births are to girls under 18 years of age).Item Adolescents in rural Tanzania : a qualitative study(Research Square, 2020) Mweteni, Wemaeli; Kabirigi, Julieth; Matovelo, Dismas; Laisser, Rose; Yohani, VictoriaPregnant adolescents (ages 10-19) seeking antenatal services are compromised by a complex power imbalance that involves financial dependence, lack of choice, lack of personal autonomy in decision making, experiences of social stigma, judgement, violence and abuse. The study analyzed experiences of pregnant adolescents in accessing antenatal care in Misungwi district, Mwanza Region, Tanzania. Low and middle-income countries, including Tanzania, bear the largest proportion of adolescent perinatal deaths globally. Most adolescent girls in Tanzania do not access antenatal care at health facilities. Multi-level interventions are needed to empower adolescent girls, and to address policies and social constructs that may contribute to power imbalances.Item Adoption des CFU : leçons des analyses de mise en œuvre(2018-09-18) Coumaré, F.; Bicaba, A.; Haddad, S.; Traoré, M. N.