Evidence review of what works for health systems strengthening, where and when?

Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a “strong health system.” We highlight that current findings on “what works” are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment

Dynamical cluster-decay model for hot and rotating light-mass nuclear systems, applied to low-energy 32^{32}S + 24^{24}Mg →56\to ^{56}Ni reaction

The dynamical cluster-decay model (DCM) is developed further for the decay of hot and rotating compound nuclei (CN) formed in light heavy-ion reactions. The model is worked out in terms of only one parameter, namely the neck-length parameter, which is related to the total kinetic energy TKE(T) or effective Q-value $Q_{eff}(T)$ at temperature T of the hot CN, defined in terms of the both the light-particles (LP), with $A \leq$ 4, Z $\leq$ 2, as well as the complex intermediate mass fragments (IMF), with $4 2$, is considered as the dynamical collective mass motion of preformed clusters through the barrier. Within the same dynamical model treatment, the LPs are shown to have different characteristics as compared to the IMFs. The systematic variation of the LP emission cross section $\sigma_{LP}$, and IMF emission cross section $\sigma_{IMF}$, calculated on the present DCM match exactly the statistical fission model predictions. It is for the first time that a non-statistical dynamical description is developed for the emission of light-particles from the hot and rotating CN. The model is applied to the decay of $^{56}$Ni formed in the $^{32}$S + $^{24}$Mg reaction at two incident energies E$_{c.m.}$ = 51.6 and 60.5 MeV. Both the IMFs and average $\bar{TKE}$ spectra are found to compare reasonably nicely with the experimental data, favoring asymmetric mass distributions. The LPs emission cross section is shown to depend strongly on the type of emitted particles and their multiplicities

"Bibliocircuitry and the Design of the Alien Everyday"

Curatorial note from Digital Pedagogy in the Humanities: “Bibliocircuitry and the Design of the Alien Everyday” details student exploration of the concept of reflective design through projects that investigate the book as interface. This activity perfectly highlights the way that exposure to and emphasis on process leads to unforeseen insight. These student authors also emphasize that digital work requires consideration of hardware and physical and tactile design. Instructors inspired by this article might select a particular type of object and ask students to devise ways to alter or enhance users’ interaction with it. Students would demonstrate learning not only through their work in designing and redesigning objects but also through oral or written presentations of them (much as the student authors of this journal article have done)

What, why and how do health systems learn from one another? Insights from eight low- and middle-income country case studies

Background All health systems struggle to meet health needs within constrained resources. This is especially true for low-income countries. It is critical that they can learn from wider contexts in order to improve their performance. This article examines policy transfer and evidence use linked to it in low- and middle-income settings. The objective was to inform international investments in improved learning across health systems. Methods The article uses a comparative case study design, drawing on case studies conducted in Bangladesh, Burkina Faso, Cambodia, Ethiopia, Georgia, Nepal, Rwanda and Solomon Islands. One or two recent health system reforms were selected in each case and 148 key informants were interviewed in total, using a semi-structured tool focused on different stages of the policy cycle. Interviewees were selected for their engagement in the policy process and represented political, technical, development partner, non-governmental, academic and civil society constituencies. Data analysis used a framework approach, allowing for new themes to be developed inductively, focusing initially on each case and then on patterns across cases. Results The selected policies demonstrated a range of influences of externally imposed, co-produced and home-grown solutions on the development of initial policy ideas. Eventual uptake of policy was strongly driven in most settings by local political economic considerations. Policy development post-adoption demonstrated some strong internal review, monitoring and sharing processes but there is a more contested view of the role of evaluation. In many cases, learning was facilitated by direct personal relationships with local development partner staff. While barriers and facilitators to evidence use included supply and demand factors, the most influential facilitators were incentives and capacity to use evidence. Conclusions These findings emphasise the agency of local actors and the importance of developing national and sub-national institutions for gathering, filtering and sharing evidence. Developing demand for and capacity to use evidence appears more important than augmenting supply of evidence, although specific gaps in supply were identified. The findings also highlight the importance of the local political economy in setting parameters within which evidence is considered and the need for a conceptual framework for health system learning.This work was conducted with funding from the Bill and Melinda Gates Foundation. The funding body was involved in the overall design of the study. However, the funders had no involvement in data collection, analysis, interpretation and writing of the paper

What, why and how do health systems learn from one another? Insights from eight low- and middle-income country case studies

Sophie Witter - orcid: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Background - All health systems struggle to meet health needs within constrained resources. This is especially true for low-income countries. It is critical that they can learn from wider contexts in order to improve their performance. This article examines policy transfer and evidence use linked to it in low- and middle-income settings. The objective was to inform international investments in improved learning across health systems.Methods - The article uses a comparative case study design, drawing on case studies conducted in Bangladesh, Burkina Faso, Cambodia, Ethiopia, Georgia, Nepal, Rwanda and Solomon Islands. One or two recent health system reforms were selected in each case and 148 key informants were interviewed in total, using a semi-structured tool focused on different stages of the policy cycle. Interviewees were selected for their engagement in the policy process and represented political, technical, development partner, non-governmental, academic and civil society constituencies. Data analysis used a framework approach, allowing for new themes to be developed inductively, focusing initially on each case and then on patterns across cases.Results - The selected policies demonstrated a range of influences of externally imposed, co-produced and home-grown solutions on the development of initial policy ideas. Eventual uptake of policy was strongly driven in most settings by local political economic considerations. Policy development post-adoption demonstrated some strong internal review, monitoring and sharing processes but there is a more contested view of the role of evaluation. In many cases, learning was facilitated by direct personal relationships with local development partner staff. While barriers and facilitators to evidence use included supply and demand factors, the most influential facilitators were incentives and capacity to use evidence.Conclusions - These findings emphasise the agency of local actors and the importance of developing national and sub-national institutions for gathering, filtering and sharing evidence. Developing demand for and capacity to use evidence appears more important than augmenting supply of evidence, although specific gaps in supply were identified. The findings also highlight the importance of the local political economy in setting parameters within which evidence is considered and the need for a conceptual framework for health system learning.This work was conducted with funding from the Bill and Melinda Gates Foundation. The funding body was involved in the overall design of the study. However, the funders had no involvement in data collection, analysis, interpretation and writing of the paper.17 [9]pubpu