Www.rebuildconsortium.com Leads: Prof. Tim Martineau, Liverpool University, UK Prof. Barbara McPake...

www.rebuildconsortium.com

Leads:

Prof. Tim Martineau, Liverpool University, UK

Prof. Barbara McPake – Queen Margaret University, UK

Date: 14th May 2012

1

ReBUILD A brief introduction

(Research for Building Pro-poor Health Systems During the Recovery from Conflict)

http://www.rebuildconsortium.com/

1.1. destruction of destruction of infrastructure; infrastructure;

2.2. flight of health flight of health professionals; professionals;

3.3. displacement of displacement of communities; communities;

4.4. interruption of drug supply; interruption of drug supply;

5.5. disruption of disease disruption of disease control programmes;control programmes;

6.6. capacity for coordination, capacity for coordination, regulation and trust.regulation and trust.

Why ReBUILD? Implications of conflict

for health system functioning

2Makerere University College of Health Sciences

Issues faced in rebuilding health system post-conflict

1. Pressure to produce quick and measurable improvements in service delivery;

2. Focus on urban areas where there is some health infrastructure – leaving rural areas without services;

3. Focused on alleviating immediate suffering than on planning for sustainability and long-term capacity;

4. Proliferation of non-state agencies (I-NGOs);

5. Aid mechanisms play important roles in rebuilding the system and health impacts (Kruk and Freedman, 2010) Coordination, contracting, regulation, joint financing schemes


Overall purpose and research “hypothesis”

Purpose: to deliver new knowledge to inform the development and implementation of pro-poor health systems in countries recovering from political and social conflict.

Hypothesis: decisions made in the early post-conflict period can set the long-term direction of development for the health system – path dependency


Research Themes

Focus is post-conflict health system;

Research themes:

1. Health Financing;

2. Human Resources for Health;

3. Intersection Between 1 and 2:

Incentives for workforce management

Contracting for health systems

Aid architecture and effectiveness


Consortium Structure (2011 – 2017)

The consortium is structured so that we have two perspectives on this hypothesis:1. Distant conflicts (Cambodia and Sierra Leone)

What was done 10-20 years ago? Can we trace the implications of those decisions for today’s health systems?

2. Recent conflicts (Zimbabwe and Northern Uganda)

What can be implemented? How does the environment of the immediate aftermath of conflict constraint that?

North – South Partnership (Liverpool & Queen Margareta Universities)

Leadership of the consortium; Capacity Building, Knowledge Synthesis and Uptake

Implementation partnership – Uganda MOH, Prime Minister’s Office, CSOs in Gulu Gulu University – Institute for Peace and Strategic Studies


Background to post-conflict northern Uganda

20 year conflict from 1987 – 2007: Lords Resistance Army;

Most affected districts = Kitgum, Pader and Gulu: 1.8 million people displaced by early 1990s; Congestion of towns & social facilities (hospitals & churches);

Influx of humanitarian assistance 1990s – early 2000s: Camp-based health care services.

Transition from camps to “home” environment since 2007; How is the health system transforming to to meet the needs of

resettling communities?


Study Area: Acholi Sub-region


Transition back to rural settlements


Hardware Interventions by Govt and Development Partners

Makerere University College of Health Sciences

10


11

Hardware Interventions by Govt and Development Partners

Software Interventions Re-establishing livelihoods

Re-institutionalization of community structures– Markets & production– Leadership & community

level organizations – Gender relationships – Collective governance

and accountable systems


Interventions – Other Health Determinants


Thematic Studies for ReBUILD in Uganda

1. Health Financing (project 1)

Evolution of household-level expenditures for health care

2. Workforce Recruitment (project 2)

Process evolution for workforce posting

3. Workforce Incentives (project 4)

Evolution livelihoods & incentives for workforce

4. Aid effectiveness (project 5)

Evolution of inter-agency relationships for service delivery


Updates 2011Rebuild Launch and Stakeholder consultations Annual Consortium Meeting 2011


Methodology Mix Secondary data analysis:

Household surveys (1990s to 2010) Econometric analyses - health expenditures

Qualitative inquiries: Livelihood of poor households - health expenditures Livelihoods of health workers & their incentives

Systems mapping: Recruitment and posting process of workforce

Social network analyses: Organizational surveys for aid effectiveness for key health

services


Research capacity building - challenges and opportunities

Sustaining researchers’ capacity as it is created: High attrition of Health Systems Scientists

Need to anchor individuals within institutions thru research etc; Longer-term research grants to academic institutions work well;

Making research institutions attractive: Institutional support systems; Laboratories, management capacity; Overhead costs and related policies

Expanding research partnerships: North-South and South-South partnerships Benefits from partnerships;

Need to re-balance power and resource allocation


Models for Research Capacity Building

1. Multi-theme Knowledge Programs – DIFD1. Health Systems, Disease control, etc

2. Theme specific funding: Biomedical Research - KEMRI-Welcome Trust Research

Programme Health Systems – Health Systems Trusts by South African

Govt.

3. Institutional capacity grants: Welcome Trust – THRIVE Project Consortia: Institution to institution – University Twining program by the

Gates Foundation


THANK YOU


19

Www.rebuildconsortium.com Leads: Prof. Tim Martineau, Liverpool University, UK Prof. Barbara McPake...

Documents

Transcript of Www.rebuildconsortium.com Leads: Prof. Tim Martineau, Liverpool University, UK Prof. Barbara McPake...