FHS Innovations for Equity

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                            FHS: Innovations for Equity
                        Theme-3 Facilitated Research Proposal

Part 1: Process


To develop a research proposal exploring the policy processes in selected countries by
the end of 2007


Need to explore an enhanced funding base, strengthened evaluation, and more systematic
approaches to the study of policy processes (and the influence of research for the poor)
from a multi-country perspective using the FHS lens of innovation.


The following is a process with proposed time-line for 2007:-
    Jan: initial discussions with countries and coordinators and defining a process
    Feb-Mar: review of work done within and outside FHS to review existing
       approaches; and defining methods for developing a research agenda resulting in
       an outline of potential research questions
    Apr-May: electronic meetings and conference calls to refine research questions
       and get country feedback to draft a research agenda for a proposal
    Jun-Jul: “proposal development workshop” will be the main vehicle for defining
       the disciplinary approaches, methods and analysis plan for the research and will
       be a joint activity; a draft proposal will be brought to the workshop to facilitate
       discussions; specific donors will also be invited to be part of the workshop;
       options for including partners outside of the current FHS remit will be kept open
    Aug-Sep: refinement and writing of proposal for submission to donor/s
    Oct-Dec: search for donors

    Framework and draft of proposal (Spring 07)
    Proposal development workshop (Summer 07)
    Completed proposal for submission to donors (Fall 07)
    Funding search (Winter 07)

Expected Outcomes:

A funded research activity will emerge in 2008 from this proposal which would be
considered one of the major products from FHS that mobilizes external funds to explores
policy processes in health systems with built-in focus on capacity development.

RPC/FHS-Theme 3                                                                              1

Part II: Proposed Research Proposal (Initial thoughts for discussion)


The main purpose of the Future Health Systems: Innovations for Equity, funded by the
Department for International Development (DFID), United Kingdom is to generate
knowledge that shapes health systems to benefit the world’s poor (Future Health
Systems: Innovations for Equity, 2007). FHS brings teams from selected countries to test
strategies in three key areas: financing of health care that can reduce people's risk of
poverty; improving access to health services within rapidly changing contexts; and
strengthening the health systems research-policy interface to promote the interests of the
poor. Consortium partners are based in countries that are critical to meeting the MDGs –
Afghanistan, Bangladesh, China, India, Nigeria, and Uganda. The lead agency is Johns
Hopkins University Bloomberg School of Public Health, USA, which along with Institute
of Development Studies, UK, will play key facilitating roles in working with partners,
national stakeholders, DFID, and other international agencies.


Countries participating in FHS have already planned to do substantive work in specific
areas of health system improvement. Many of these studies involve influencing health
policy at various level, either as a direct or indirect outcome of the proposed work. Some
of these colleagues in theme-3 of FHS have been working to develop a framework and
conceptual ideas around policy processes with a special focus on how research influences
policies. At the same time, the need for systematic analysis of strategies to study policy
processes, to secure additional funds for concerted research studies, and to generate
focused studies from the FHS consortium calls for exploring new research projects. This
proposal builds on this rationale and addresses a pressing need for innovative and pro-
poor health systems in the future.


To systematically explore policy processes in the health sector in selected low income
countries and assess the impact of specific strategies to influence such policy processes.

Specific objectives:

The specific objectives for the research proposal are:-
    To explore determinants of policy processes in health, with a specific focus on
       factors affecting the integration of research into policies
    To systematically identify which determinants are critical and modifiable in the
       short to medium term and strategically select interventions on this basis
    To assess the ability of specific strategies to influence policy processes, especially
       in promoting the uptake of research into policy, within a short to medium time

RPC/FHS-Theme 3                                                                              2

      To assess the social and contextual factors required to strengthen the
       institutionalization of such strategies to influence policy processes.


A phased approach will be taken to the research using a 2 year exploratory phase and a 3
year intervention phase.

Formative Phase:
    will focus on the first 2 objectives and involve the conduct of scoping studies
    such work might involved a survey of health researchers in the country, a round
       of interviews with policy makers and key stakeholders, discussions with donors if
       relevant, and the use of case study approaches for specific health issues and
       policies retrospectively
    will result in the identification of determinants of the policy processes and select
       appropriate factors which have high impact and are highly modifiable
    end with defining a set of strategies which will address the modifiable

Intervention Phase:
     will focus on testing the ability of a set of strategies to influence policy processes
       in health, especially to promote the update of research results (evidence) into
       health policy
     the attempt will be to conduct baseline assessments, periodic monitoring, and an
       evaluation at the end of a defined period of time
     will involve the development of innovative approaches to monitoring and timely
       feedback of data to decision makers
     will integrate capacity building of key stakeholders within countries and
       participating investigators across countries
     needs to build on existing work and plans within the FHS consortium
     needs to explore the potential value of (and limitation) engaging with partners and
       networks outside FHS

Please send all feedback or comments on this idea to:

Adnan Hyder (ahyder@jhsph.edu) who is volunteering to coordinate this process

RPC/FHS-Theme 3                                                                            3

Table 1: Potential strategies being considered in FHS country plans that might affect policy processes

Country                  Focus of Plan          Level of Application          Potential Strategy          Potential Opportunity
Afghanistan      Maternal health barriers to   National                  Consultative Group on           Well established
                 care                                                    Health & Nutrition              mechanism
Bangladesh       Informal health care          District/sub-district     Health watch                    National health watch
                 providers                                                                               launched already
China            Rural health insurance and    National                  Health development forum        Engagement of policy
                 financing of health                                                                     makers
India            Health financing              State/ provincial         Not clear?                      Influencing state level
                                                                                                         policy processes
Nigeria          Malaria drug provision        National                  Not clear (co-production of     Influencing drug
                                                                         policy)?                        enforcement of drug
Uganda           Quality, Access and cost of   National                  Not clear?                      Decisions on public
                 facilities                                                                              subsidies and
                                                                                                         contracting and

RPC/FHS-Theme 3                                                                       4

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