Document Library – Health and Education Advice and Resource Team Providing DFID staff and other development actors with health, education and nutrition knowledge and expertise from around the world Fri, 02 Mar 2018 13:10:49 +0000 en-US hourly 1 The free healthcare initiative in Sierra Leone: Evaluating a health system reform, 2010‐ 2015 Wed, 14 Feb 2018 13:16:29 +0000 Read more]]> This article presents the findings of a theory‐based evaluation of the Sierra Leone Free Health Care Initiative (FHCI), using mixed methods. Analytical approaches included time‐series analysis of national survey data to examine mortality and morbidity trends, as well as modelling of impact using the Lives Saved Tool and expenditure trend analysis.

We find that the FHCI responded to a clear need in Sierra Leone, was well designed to bring about needed changes in the health system to deliver services to the target beneficiaries, and did indeed bring funds and momentum to produce important systemic reforms. However, its ambition was also a risk, and weaknesses in implementation have been evident in a number of core areas, such as drugs supply.

We conclude that the FHCI was one important factor contributing to improvements in coverage and equity of coverage of essential services for mothers and children. Modelled cost‐effectiveness is high—in the region of US$ 420 to US$ 444 per life year saved. The findings suggest that even—or perhaps especially—in a weak health system, a reform‐like fee removal, if tackled in a systematic way, can bring about important health system gains that benefit vulnerable groups in particular.

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Unpicking Power and Politics for Transformative Change: Towards Accountability for Health Equity. Workshop Report Tue, 10 Oct 2017 14:20:26 +0000 Read more]]> While ‘accountability’ has become an increasingly popular buzzword in health systems debates and health service delivery, it has multiple – and contested – meanings.

From 19-21 July 2017, Institute of Development Studies (IDS) brought together 80-plus activists, researchers, public health practitioners and policy makers to examine critically the forces that shape accountability in health systems, from local to global levels. Their partners in convening this workshop, as part of a new IDS programme on ‘Accountability for Health Equity’ were the Unequal Voices project, Future Health Systems, the Open Society Foundations, the Impact Initiative and Health Systems Global.

This is the workshop report for the event which is a record of the presentations and discussions that occurred over the course of these three days.

Read the related blog article by Erica Nelson for further insight into the Accountability for Health Equity workshop.

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Promoting Handwashing and Sanitation Behaviour Change in Low- and Middle-Income Countries: A Mixed-Method Systematic Review Mon, 18 Sep 2017 11:49:58 +0000 Read more]]> Diarrhoeal diseases are very common causes of death in low and middle-income countries. The aim for this systematic review was to show which promotional approaches might change handwashing and sanitation behaviour, and which implementation factors affect the success or failure of such promotional approaches.

For community-based approaches, involvement of the community, enthusiasm of community leaders, having a sense of ownership, the implementer being part of the community, gender of the implementer, trust, income generating activities, clear communication and developing a culture of cooperation facilitated the implementation. For sanitation and hygiene messaging, barriers identified were (SMS) messages that were too long or culturally inappropriate, passive teaching methods in schools, the need for longer intervention periods and frequent reminders with children, overlap of school level intervention with interventions in the community, and lack of interest and involvement from the family in case of a school intervention, as well as illiteracy. For the social marketing approach barriers were mainly about the use of sanitation loans (lack of communication to latrine business owners about which area to cover, sanitation loans not reaching poor people, attitude of the loan officers, interest rate of loans, loan processing times), lack of financial knowledge and poverty.

An important implication is that there is a need for a more uniform method of measuring and reporting on handwashing, latrine use, safe faeces disposal, and open defecation. This will facilitate making conclusions on the effects of promotional approaches in the future. It is also important to further assess barriers and facilitators, identified in this review, when implementing promotional approaches.

International Initiative for Impact Evaluation (3ie) have also produced a related Systematic Review Brief from their findings: Handwashing and Sanitation Behaviour Change in WASH Interventions

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Supporting Sustainable WASH Services in Difficult Operating Environments: A Case Study from Nicaragua Mon, 18 Sep 2017 11:38:24 +0000 Read more]]> If WASH services are to deliver continuous benefits to users, they must be supported by strong, responsive, permanent in-country institutions. Strengthening permanent institutions is very challenging in difficult operating environments and requires approaches that work beyond the delivery of taps and toilets alone. This document is aimed at WASH practitioners and policy-makers developing management and support processes that ensure service sustainability. It seeks to share WaterAid Nicaragua’s experiences of reinforcing sustainable WASH service provision in an
environment characterised by weak and under-resourced institutions, exposure to disasters, and a history of conflict and political polarisation.

To achieve this objective, WaterAid Nicaragua is strengthening the service delivery, strategic planning, financing, monitoring, coordination, accountability mechanisms and post-implementation support functions of permanent institutions. Barriers to sustainability and WaterAid’s approaches to addressing them are described in the proceeding sections.

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The Cost of Water Project Mon, 18 Sep 2017 11:30:24 +0000 Read more]]> The Cost of Water Project supports the effective planning and sustainable management of water supply systems in refugee camps and settlements. Launched in 2014 by the Water, Sanitation and Hygiene (WASH) Unit in DPSM’s Public Health Section in partnership with IRC, the project measures the overall costs of providing effective water systems in a variety of refugee hosting contexts to create a flexible decision-making tool specific to refugee situations.

When completed, the tool will improve data collection, planning and budgeting for water projects, making information easily available and comparable for UNHCR staff, partners and donors, and lead to more efficient water service delivery to refugees and other displaced people across UNHCR operations.

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Scoping Urban Sanitation Services in Three Countries Mon, 18 Sep 2017 11:23:24 +0000 Read more]]> In early 2017, WSUP commissioned a situation analysis of urban sanitation services in Bangladesh, Ghana and Kenya, in order to identify potential research areas as part of the DFID-funded Urban Sanitation Research Initiative. Here, Goufrane Mansour (Aguaconsult, lead expert for the study) and Sam Drabble (WSUP, Research and Evaluation Manager) reflect on common findings across the three countries.

Looking at the scale of the needs and the constraints of urban settings, achieving universal access to basic sanitation by 2030 – let alone increasing access to safely managed services – seems overly optimistic. Unless certain basic requirements fall into place quickly, some countries will find themselves still trailing behind. The scoping studies commissioned by WSUP have highlighted a number of gaps related to the policy environment as well as institutional and financing arrangements for the urban sanitation sector, which need to be addressed if fast-track progress towards the SDG is to be achieved.

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Sustainability Assessment of Rural Water Service Delivery Models: Findings of a Multi-Country Review Mon, 18 Sep 2017 11:15:38 +0000 Read more]]> This policy brief summarizes the key findings from a multi-country sustainability assessment of rural water service delivery models conducted in 2016–17. This assessment used a case-study approach to identify good practices and challenges towards building sector capacity and strengthening sustainable service delivery models for rural areas. It does not focus on the critical planning, design, and implementation phase of developing rural water supply facilities, but rather analyzes the long-term ongoing service delivery approach for rural water.

The added value of this assessment lies in the development of a comprehensive analytical framework to analyze and operationalize a more sustainable service delivery approach for rural water supply. The assessment also documents a rich set of cases and good practices informing the global body of sector knowledge and identifies a set of policy recommendations to improve the sustainability of services depending on sector development stage and rural service delivery context.

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What can the United States Learn from the Scaling Up Nutrition (SUN) Movement? Examining Country Leadership in Zambia, Kenya and Bangladesh Mon, 18 Sep 2017 10:54:20 +0000 Read more]]> Country-led political and financial commitments to nutrition goals are widely recognized as critical to reducing malnutrition at scale. This report seeks to examine the relationship between country-level nutrition policy, implementation leadership, donor support and coordination, and nutrition outcomes at a national or subnational level. The analysis focuses on reducing the prevalence of stunting in countries targeted by the U.S. government global food and nutrition security initiative, Feed the Future. Drawing from progress of and lessons learned within the Scaling Up Nutrition (SUN) movement, it furnishes recommendations for Feed the Future to improve its engagement both with SUN and with broader country-level nutrition policies and aligned resources.

This report seeks to understand whether select countries that have more fully embraced and championed the SUN strategy have also witnessed greater progress in mounting a scalable and effective response to malnutrition. It explores whether multilateral coinvestments in nutrition policy and planning, in line with SUN aims and objectives, translate into change on the ground that sustains local ownership and leadership.

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Sustainability Assessment of Rural Water Service Delivery Models: Findings of a Multi-Country Review Mon, 18 Sep 2017 10:54:08 +0000 Read more]]> With 2.1 billion people – mostly in rural areas – lacking safely managed drinking water and reported low rural water supply functionality rates, the Sustainable Development Goals pose a triple challenge: to reach unserved mostly rural population groups, to raise service levels, and to sustain existing and future services. This assessment uses a multi-country case study approach to identify good practices and challenges toward building sector capacity and strengthening sustainable service delivery models for rural areas.

Recognizing the limitations of the Demand Responsive Approach, the emergence of various management models, the identified need for ongoing support to rural service providers, and the critical role of enabling institutions and policies beyond the community-level, the added value of this assessment lies in: i)the development of a comprehensive analytical framework that can be used to analyze and operationalize a more sustainable service delivery approach for rural water supply; ii) the rich set of cases and good practices from the 16 countries informing the global body of “knowledge in implementation,” and iii) the formulation of recommendations and policy directions to improve the sustainability of services depending on sector development stage. Policy recommendations are centered around five areas: institutional capacity, financing, asset management, water resources management, and monitoring and regulatory oversight.

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Situation Analysis of the Urban Sanitation Sector in Ghana Mon, 18 Sep 2017 10:53:53 +0000 Read more]]> This report, part of WSUP’s Urban Sanitation Research Initiative, explores the background to the urban sanitation sector in Ghana. Ghana is a fast-growing economy that has made notable progress in reducing poverty but urban infrastructure has not kept pace with cities’ expansion and high levels of rural-urban migration. Only a fraction of urban residents use improved sanitation facilities as per the Joint Monitoring Programme (JMP) definition, but transport and treatment services are developing.

Furthermore, well-developed legal, policy, and strategy frameworks exist but need to be fully implemented. It’s important to note that sanitation has not been a public funding priority and households bear the bulk of the costs. To conclude, from lack of prioritisation to insufficient demand and limited supply, barriers to developing pro-poor sanitation services remain significant.

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