Suchergebnisse

Few interventions that succeed in improving healthcare locally end up becoming spread and sustained more widely. This indicates that we need to think differently about spreading improvements in practice. Drawing on a focused review of academic and grey literature, the authors outline how spread, scale-up, and sustainability have been defined and operationalised, highlighting areas of ambiguity and contention. Following an overview of relevant frameworks and models, they focus on three specific approaches and unpack their theoretical assumptions and practical implications: the Dynamic Sustainability Framework, the 3S (structure, strategy, supports) infrastructure approach for scale-up, and the NASSS (non-adoption, abandonment, and challenges to scale-up, spread, and sustainability) framework. Key points are illustrated through empirical case narratives and the Element concludes with actionable learning for those engaged in improvement activities and for researchers. This title is also available as Open Access on Cambridge Core.

AbstractNetworked models are often proposed as a means to enhance health research capacity‐building in Africa. This paper addresses a knowledge gap on what works and does not in capacity‐building in African research settings. It provides an analysis of how multi‐partner networks are built and how their success depends on building institutional level capacity‐strengthening within partner institutions. To do this, the paper focuses on the Wellcome Trust's African Institutions initiative, drawing on initial learning and evaluation project data. We identify priority areas for policy attention and share emerging early insights on mechanisms and strategies being implemented by consortia to address key challenges. Copyright © 2012 John Wiley & Sons, Ltd.

AbstractHealthcare systems with limited resources face rising demand pressures. Healthcare decision-makers increasingly recognise the potential of innovation to help respond to this challenge and to support high-quality care. However, comprehensive and actionable evidence on how to realise this potential is lacking. We adopt sociotechnical systems and innovation systems theoretical perspectives to examine conditions that can support and sustain innovating healthcare systems. We use primary data focussing on England (with 670 contributions over time) and triangulate findings against globally-relevant literature. We discuss the complexity of factors influencing an innovating healthcare system's ability to support the development and uptake of innovations and share practical learning about changes in policy, culture, and behaviour that could support system improvement. Three themes are examined in detail: skills, capabilities, and leadership; motivations and accountabilities; and collaboration and coordination. We also contribute to advancing applications of sociotechnical systems thinking to major societal transformation challenges.

The past few decades have seen a number of medical breakthroughs that enabled the effective treatment of a range of conditions, transforming them from fatal into manageable ones. Examples include certain cancers and HIV. Conversely, progress on dementia has been limited. There are currently no treatments that will cure or even alter the progressive course of dementia, despite ongoing research investigating new therapies and care options. The UK Department of Health is interested in the potential to learn from other disease areas to better understand the particular social, economic, political, legislative and scientific contexts that have contributed to accelerating progress and breakthroughs in treatment. Such learning could helpfully inform dementia research and innovation efforts, and help identify levers for supportive policy development. This project analysed breakthroughs in the treatment of four selected conditions of ill health and seeks to identify potentially transferable lessons for the dementia context. Using evidence review and key informant interviews we sought to identify the series of "events" that eventually led to a given breakthrough, and the key milestones in the process that have helped improve understanding and potential for treatment. We also aimed to capture the temporal and causal relationships between "notable" events looking at a variety of factors implicated in the breakthrough pathway. The focus of this work was on political, economic, social, scientific and technological, and legal, regulatory and environmental factors.

There is increasing policy demand for real-time evaluations of research and capacity-building programmes reflecting a recognition of the management, governance and impact gains that can result. However, the evidence base on how to successfully implement real-time evaluations of complex interventions in international development efforts is scarce. There is therefore a need for reflective work that considers methodologies in context. This article shares learning from the experience of conducting a participatory, real-time, 'theory driven' evaluation of the African Institutions Initiative, a Wellcome Trust-funded programme that aimed to build sustainable health research capacity in Africa at institutional and network levels, across seven research consortia. We reflect on the key challenges experienced and ways of managing them, highlight opportunities and critical success factors associated with this evaluation approach, compared with alternative evaluation approaches.

As bio-capital in the form of medical knowledge, skills and investments moves with greater frequency from its origin in First World industrialized settings to resource-poor communities with weak or little infrastructure, countries with emerging economies are starting to expand new indigenous science bases of their own. The case studies here, from the UK, West Africa, Sri Lanka, Papua New Guinea, Latin America and elsewhere, explore the forms of collaborative knowledge relations in play and the effects of ethics review and legal systems on local communities, and also demonstrate how anthropologically-informed insights may hope to influence key policy debates. Questions of governance in science and technology, as well as ethical issues related to bio-innovation, are increasingly being featured as topics of complex resourcing and international debate, and this volume is a much-needed resource for interdisciplinary practitioners and specialists in medical anthropology, social theory, corporate ethics, science and technology studies