Background
Health services are generally very poor in low and middle income countries and the very poor, women and disadvantaged groups receive particularly bad service. It is vital that strategies to deliver health services are feasible for the context, are sustainable and can be scaled up to the whole country.
Aim & Objectives
To develop and test locally appropriate strategies for delivery of health services (including care and/or control of communicable and non-communicable diseases) in low and middle income countries; and to support development of operational plans, tools and training methods and materials to enable and encourage large scale implementation of successful strategies by partner governments and other health service providers. The main diseases to be addressed are tuberculosis (TB), malaria, neglected tropical diseases, sexually transmitted infections, HIV/AIDS, diabetes and hypertension.
Particular issues to be addressed are: encouraging appropriate demand for services; improving access to services; improving primary care; developing community-based initiatives; improving services in urban areas, particularly slums; maintaining and improving quality of services; and avoiding development of drug resistance.
Methods
Many different quantitative and qualitative methods will be used: typical approaches are as follows.
Strategy development: quantitative and qualitative operational research methods, working with local populations and health providers to identify needs, constraints, opportunities etc.
Strategy assessment: quantitative methods including randomised controlled trials, cohort studies, comparisons of outcomes before and after implementation; and qualitative methods (generally individual interviews and focus group discussions using a thematic approach to analysis) to better understand the outcomes.
Encouraging large-scale implementation: participatory workshops involving government and other partners throughout development and implementation of the research, to produce operational plans, tools and training methods and materials, and encourage ownership, commitment and scale-up.
Intended Results
Development of many proven strategies, including strategies to:
- improve migrants’ access to services
- deliver community-based care for multi-drug resistant TB
- integrate screening (eg for chronic cough and diabetes) and interventions in south Asia
- expand community-based networks for onchocerciasis elimination to include mass drug administration for other major neglected tropical diseases
- implement public private partnerships for health service provision in urban areas where public provision cannot be improved
- contextually adapt and institutionalise the use of evidence-based guidelines, enhanced supervision and performance monitoring
- provide basic health services for residents of slums
- to contain drug and insecticide resistance.
Impact
We are aiming for substantial impact, with effective strategies developed, adopted by national disease control programmes and implemented nationwide, thereby directly influencing the health of many millions of people.
Partners & Collaborators
Bangladesh – National Tuberculosis Control Programme, BRAC, SEED.
China – National Tuberculosis Programme.
Nepal – National Tuberculosis Control Programme; HERD.
Pakistan – National Tuberculosis Control Programme; ASD.
Ghana – Kwame Nkrame University of Science & Technology.
Swaziland – Good Shepherd Hospital.
Tanzania – Ifakara Health Institute.
Uganda – Malaria Consortium Africa; Makarere University.
UK – Malaria Consortium; University of Leeds.
COMDIS team at the University of Leeds:
Research: James Newell (co-PI), John Walley (co-PI), Zafar Ullah, Kamran Siddiqi, Rebecca King.
Administration: Anthonia James, Lynn Auty.
Funding Agency: UK Department for International Development
Grant Value: £7.5 million
Project Period: January 2011 to December 2016
For further information contact James Newell, John Walley or Anthonia James. You can download further details here and here.