Suchergebnisse

Many developing countries are looking to scale-up what works through major systems strengthening investments. With leadership, conviction and commitment, systems thinking can facilitate and accelerate the strengthening of systems to more effectively deliver interventions to those in need and be better able to improve health in an equitable way. Systems thinking is not a panacea. Its application does not mean that resolving problems and weaknesses will come easily or naturally or without overcoming the inertia of the established way of doing things. But it will identify, with more precision, wh

En este informe se investiga de qu manera el pensamiento sist mico permite profundizar en los fundamentos te ricos y pr cticos de las iniciativas que tienen por objeto el fortalecimiento de los sistemas de salud. En este informe insignia de la Alianza para la Investigaci n en Pol ticas y Sistemas de Salud se exponen los argumentos en favor del pensamiento sist mico de manera f cilmente comprensible por una amplia audiencia interdisciplinaria en la que tienen cabida, entre otros, los rectores de los sistemas de salud, los ejecutores de programas, los investigadores, los evaluadores y los asociados en la financiaci n. En el informe se presenta una definici n del pensamiento sist mico y lo que significa para un sistema de salud; un ejemplo ilustrativo tomado del sistema de salud para exponer los "Diez pasos hacia el pensamiento sist mico", que es una orientaci n pr ctica sobre la aplicaci n de este m todo; las dificultades y oportunidades de aplicar el pensamiento sist mico en situaciones concretas y un programa para ampliar la aplicaci n del pensamiento sist mico al fortalecimiento de los servicios de salud.

Interest in implementation research is growing largely in recognition of the contribution it can make to maximising the beneficial impact of health interventions. As a relatively new and until recently rather neglected field within the health sector implementation research is something of an unknown quantity for many. There is therefore a need for greater clarity about what exactly implementation research is and what it can offer. This Guide is designed to provide that clarity. Intended to support those conducting implementation research those with responsibility for implementing programmes and those who have an interest in both the Guide provides an introduction to basic implementation research concepts and language briefly outlines what it involves and describes the many opportunities that it presents. The main aim of the Guide is to boost implementation research capacity as well as demand for implementation research that is aligned with need and that is of particular relevance to health systems in low- and middle-income countries (LMICs). Research on implementation requires the engagement of diverse stakeholders and multiple disciplines in order to address the complex implementation challenges they face. For this reason the Guide is intended for a variety of actors who contribute to and/or are impacted by implementation research. This includes the decision-makers responsible for designing policies and managing programmes whose decisions shape implementation and scale-up processes as well as the practitioners and front-line workers who ultimately implement these decisions along with researchers from different disciplines who bring expertise in systematically collecting and analysing information to inform implementation questions. The opening chapters (1-4) make the case for why implementation research is

Abstract Background Evaluation of interventions on road traffic injuries (RTI) going beyond the assessment of impact to include factors underlying success or failure is an important complement to standard impact evaluations. We report here how we used a qualitative approach to assess current interventions implemented to reduce RTIs in Peru. Methods We performed in-depth interviews with policymakers and technical officers involved in the implementation of RTI interventions to get their insight on design, implementation and evaluation aspects. We then conducted a workshop with key stakeholders to analyze the results of in-depth interviews, and to further discuss and identify key programmatic considerations when designing and implementing RTI interventions. We finally performed brainstorming sessions to assess potential system-wide effects of a selected intervention (Zero Tolerance), and to identify adaptation and redesign needs for this intervention. Results Key programmatic components were consistently identified that should be considered when designing and implementing RTI interventions. They include effective and sustained political commitment and planning; sufficient and sustained budget allocation; training, supervision, monitoring and evaluation of implemented policies; multisectoral participation; and strong governance and accountability. Brainstorming sessions revealed major negative effects of the selected intervention on various system building blocks. Conclusions Our approach revealed substantial caveats in current RTI interventions in Peru, and fundamental negative effects on several components of the sectors and systems involved. It also highlighted programmatic issues that should be applied to guarantee an effective implementation and evaluation of these policies. The findings from this study were discussed with key stakeholders for consideration in further designing and planning RTI control interventions in Peru.

Cost-effectiveness analysis (CEA) is potentially an important aid to public health decision-making but, with some notable exceptions, its use and impact at the level of individual countries is limited. A number of potential reasons may account for this, among them technical shortcomings associated with the generation of current economic evidence, political expediency, social preferences and systemic barriers to implementation. As a form of sectoral CEA, Generalized CEA sets out to overcome a number of these barriers to the appropriate use of cost-effectiveness information at the regional and country level. Its application via WHO-CHOICE provides a new economic evidence base, as well as underlying methodological developments, concerning the cost-effectiveness of a range of health interventions for leading causes of, and risk factors for, disease. The estimated sub-regional costs and effects of different interventions provided by WHO-CHOICE can readily be tailored to the specific context of individual countries, for example by adjustment to the quantity and unit prices of intervention inputs (costs) or the coverage, efficacy and adherence rates of interventions (effectiveness). The potential usefulness of this information for health policy and planning is in assessing if current intervention strategies represent an efficient use of scarce resources, and which of the potential additional interventions that are not yet implemented, or not implemented fully, should be given priority on the grounds of cost-effectiveness. Health policy-makers and programme managers can use results from WHO-CHOICE as a valuable input into the planning and prioritization of services at national level, as well as a starting point for additional analyses of the trade-off between the efficiency of interventions in producing health and their impact on other key outcomes such as reducing inequalities and improving the health of the poor.