ICT-facilitated accountability and engagement in health systems: a review of Making All Voices Count mHealth for accountability projects

Information and communication technologies (ICTs) and mHealth innovations hold great potential to improve health systems and health outcomes while at the same time enhancing citizen engagement and accountability. Yet there has been little assessment of the impact of mHealth innovations on the ground. This paper reviews the experiences of seven mHealth initiatives funded by the Making All Voices Count programme. It discusses the accountability model adopted by each project, and the challenges they faced. The report concludes that there are limits to what technology can deliver in terms of augmenting citizen voice and enhancing accountability, particularly in the absence of other offline activities such as engaging citizens in meaningful ways and building good relationships with key government actors and departments. The initiatives discussed include: OurHealth, eThekwini WACs and Thuthuzela Voices (all in South Africa), Mobile Mapping for Women’s Health (Tanzania), Text2Speak (Nigeria), SMS Gateway (Indonesia), and Citizen Journalism for Quality Governance of Universal Health Insurance Scheme (also Indonesia).DFIDUSAIDSidaOmidyar Networ

Pandemic Preparedness

Phase 2This rapid literature review aims to provide initial insights into emerging lessons on pandemic preparedness in the wake of the Covid-19 pandemic. It pays special attention to research generated by the Covid Collective research partners, contextualising it within the perspectives and lessons from the broader literature and debates on preparedness. The report especially considers evidence which indicates how future approaches to pandemic preparedness (based on what we have learned from our research) can really serve the interests of those in different societies who experience the greatest levels of vulnerability, exclusion, and marginalisation

Accountability in Health Systems and the Potential of mHealth

The rapid spread of information and communication technologies (ICTs) (and of mobile phones in particular) across low- and middle-income countries (LMICs) has generated considerable excitement in development circles regarding their potential to revolutionise service delivery in health systems. Broadly speaking, such innovations, widely referred to as mHealth, make possible new ways of collecting, collating and managing health and health service-related data, and novel means of communication between and among citizens, civil society, health service personnel and government actors. This can empower citizens to better understand, care and advocate for their own health; health workers to deliver improved services; and government actors to enforce or build health policies that uphold the health rights of all citizens, including poor and marginalised groups who are often systematically excluded from health systems. As mHealth is in its infancy, and most projects to date have been small in scale, this potential is still being tested. Furthermore, most research has focused on the extent to which mHealth has improved service delivery and/or health outcomes in the short term. There has been little explicit attention given to whether and how mHealth might improve accountability for public health services – that is, to what extent mHealth can enhance citizens’ abilities to demand improved services from providers and government in line with their rights, and/or augment the capacity and willingness of providers and government to respond to citizens’ needs and demands – both in the short and the long term. This Working Paper aims to begin to fill this gap by exploring literature on accountability in health systems and on mHealth and to build theoretical and empirical bridges between them. In so doing, we lay out a clearer understanding of the role that mHealth can play in accountability for public health services in LMICs, as well as its limitations. At the centre of this role is technology-facilitated information which, for instance, can help governments enforce and improve existing health policy, and which can assist citizens and civil society to communicate with each other to learn more about their rights, and to engage in data collection, monitoring and advocacy. Ultimately however, information, facilitated as it may be by mHealth, does not automatically lead to improved accountability. Different forms of health care come with different accountability challenges to which mHealth is only variably up to task. Furthermore, health systems, embedded as they are in diverse political, social and economic contexts, are extremely complex, and accountability requires far more than information. Thus, mHealth can serve as a tool for accountability, but is likely only able to make a difference in institutional systems that support accountability in other ways (both formal and informal) and in which political actors and health service providers are willing and able to change their behaviour.Future Health Systems Research Programme ConsortiumMaking All Voices CountUnited States Agency for International DevelopmentSwedish International Development Cooperation AgencyOmidyar NetworkUK Department for International DevelopmentEconomic and Social Research Counci

Evidence Review: Achieving COVID-19 Vaccine Equity in Ealing and North West London

This review sets out key considerations for improving vaccine equity – as well as broader health equity – in the North West London (NWL) borough of Ealing. It foregrounds the political, economic and social dynamics which have perpetuated health inequalities during and prior to COVID-19, and how they have manifested to shape COVID-19 vaccine accessibility and uptake among different social groups. It also highlights how local actors have sought to address these inequalities. By bringing together data and insights from existing social science research and consultations with people involved in local COVID-19 vaccination efforts (in local authorities, the NHS and community groups), we point to ways local authorities and healthcare providers, in collaboration with local people and organisations, can support vaccine equity – and health equity more broadly – now, and into the future. Critical to this are further efforts to integrate sensitivity to context, sustain collaborative working, build trust and meaningfully engage citizens (especially vulnerable groups), and support a robust civil society. The review begins with summary key considerations for operational actors. This review was produced by SSHAP in collaboration with Ealing Council. It was authored by Tabitha Hrynick and Santiago Ripoll, and reviewed by Maddy Gupta-Wright, Ellen Schwartz, and Nikita Simpson. It is the responsibility of SSHAPWellcome TrustFCD

Efectos Más Amplios Sobre La Salud Ante Respuestas Verticales Al Covid-19 En Países De Ingresos Medianos Y Bajos (Pimb)

The COVID-19 pandemic has undermined capacity and efforts to address other health needs that are just as pressing as the virus itself, particularly in low- and middle-income countries (LMICs). Pressure on governments to act on COVID-19 now to save “immediately identifiable lives” rather than “statistical lives at risk”1 has had and will continue to have harmful short- and long-term consequences for other areas of health. This paper reviews the effects of vertical responses to COVID-19 on health systems, services, and people’s access to and use of them in LMICs, where historic and ongoing under-investments heighten vulnerability to a multiplicity of health threats. We use the term ‘vertical response’ to describe decisions, measures and actions taken solely with the purpose of preventing and containing COVID-19, often without adequate consideration of how this affects the wider health system and pre-existing resource constraints. Through four main sections focused on 1) characterising vertical response, 2) the drivers of broader health impacts, 3) evidence of impacts, and finally 4) suggestions for mitigation, we provide insight for actors in government, agencies, organisations and communities to design and implement more proportionate, appropriate, comprehensive and socially just responses that address COVID-19 without compromising other aspects of health.La pandémie de COVID-19 a compromis la capacité et les mesures visant à répondre à d’autres besoins en matière de santé qui sont tout aussi urgents que le virus lui-même, en particulier dans les pays à revenu faible et intermédiaire (PRFI). Les pressions exercées sur les gouvernements pour qu’ils prennent des mesures immédiates contre la COVID-19 afin de sauver des « vies immédiatement identifiables » plutôt que des « vies statistiques à risque » ont eu et continueront d’avoir des conséquences négatives à court et à long terme pour d’autres domaines de la santé. Le présent document examine les répercussions des ripostes verticales contre la COVID- 19 sur les systèmes et services de santé, ainsi que sur leur accès et utilisation par les populations dans les PRFI, au sein desquels les sous-investissements historiques et continus contribuent à renforcer la vulnérabilité à un grand nombre de menaces pour la santé. Nous utilisons le terme « riposte verticale » pour décrire les décisions et les mesures prises uniquement dans le but de prévenir et de contenir la COVID-19, souvent sans tenir suffisamment compte de la manière dont cela affecte le système de santé dans son ensemble et des manques de ressources préexistants. À travers quatre sections principales axées sur 1) la caractérisation de la riposte verticale, 2) les facteurs inhérents aux répercussions plus générales sur la santé, 3) les preuves des répercussions, et enfin 4) des suggestions d’atténuation, nous fournissons un aperçu pour les intervenants au sein du gouvernement, des agences, des organisations et des communautés afin de concevoir et de mettre en oeuvre des ripostes plus proportionnées, appropriées, globales et socialement équitable pour lutter contre la COVID-19 sans compromettre d’autres aspects de la santé.La pandemia de COVID-19 ha deteriorado la capacidad y los esfuerzos para tratar otras necesidades de salud que son tan urgentes como el virus en sí, especialmente en los países de ingresos medianos y bajos (PIMB). La presión sobre los gobiernos para actuar sobre el COVID-19 y salvar "las vidas infectadas primero" en lugar de "las vidas estadísticamente en riesgo" tuvo y seguirá teniendo graves consecuencias a corto y largo plazo en otras áreas de la salud. Este documento revisa los efectos de las respuestas verticales al COVID-19 en los sistemas y servicios de salud, y el uso y acceso de las personas a los mismos en los PIMB. Allí, la histórica y continua falta de inversión intensifica la vulnerabilidad a múltiples amenazas para la salud. Usamos el término "respuesta vertical" para describir decisiones, medidas y acciones tomadas únicamente para prevenir y contener el COVID-19. Por lo general, sin tomar adecuadamente en consideración cómo esto impacta en el sistema de salud más general ni las limitaciones preexistentes de recursos. Este documento se divide en cuatro secciones principales sobre 1) las características de la respuesta vertical, 2) las causas de los efectos más amplios sobre la salud, 3) la evidencia de los efectos y finalmente 4) las sugerencias para mitigarlos. Mediante estas secciones, ofrecemos perspectivas para que los actores en el gobierno, las agencias, las organizaciones y las comunidades diseñen e implementen respuestas dirigidas al COVID-19 más proporcionadas, apropiadas, integrales y socialmente justas sin que comprometan otros aspectos de la salud.Please note: there is an accompanying infographic summarising the key points from the briefing.Wellcome TrustFCD

Key Considerations: Achieving COVID-19 Vaccine and Health Equity in Ealing and North West London

This brief illustrates how COVID-19 vaccine (in)equity has played out on the ground and offers key considerations for how it can be improved in the North West London (NWL) borough of Ealing. We conducted a review of literature and several informal consultations with local actors involved in COVID-19 vaccination efforts in statutory bodies (local authorities and the NHS) and the community in order to build a picture of and contextualise COVID-19 vaccine uptake in Ealing. Key considerations and lessons for achieving greater vaccine and health equity are presented, followed by additional context of interest to responders within statutory authorities and the community. This brief was produced by SSHAP in collaboration with partners in Ealing Council. It was authored by Tabitha Hrynick and Santiago Ripoll and is the responsibility of SSHAP.Please note: there is an accompanying infographic summarising the key points from the briefing.Wellcome TrustFCD

Roundtable Report: Health and Food Insecurity Crisis in the Greater Horn of Africa. Session 1 - Regional Focus. September 2022

SSHAP convened and hosted a virtual roundtable discussion with partners engaged at the regional level response of the health and food insecurity crisis in the Greater Horn of Africa region. The objective was to discuss the critical needs for the response to the Horn of Africa crisis. The priorities under consideration were organised under the themes of health, community engagement and data management. Broader matters of strengthening coordination of the response were also discussed. This report offers a summary of the main discussion points and a list of resources shared during the discussion, it was compiled by Tabitha Hrynick (IDS) and Olivia Tulloch (Anthrologica). The views expressed here are a summary of those presented and do not necessarily represent a consensus of the individual participant agencies. This brief is the responsibility of SSHAP. There will be future roundtables focused either at the national level for affected countries or thematically focused.Foreign, Commonwealth & Development Office (FCDO)Wellcome Trus

Guidance Note on Community Engagement for Cholera Outbreak Response in the East and Southern Africa Region

Cholera outbreaks have been on the rise in the East and Southern Africa Region (ESAR) since January 2023, with widespread and extended transmission in Malawi and Mozambique and outbreaks reported in Tanzania, South Africa, Zimbabwe, Burundi, and Zambia.1 There is risk of further spread caused by the effects of Cyclone Freddy, which hit Madagascar, Malawi, and Mozambique in March 2023. Outbreaks are continuing in Somalia, Ethiopia, Kenya, and South Sudan, where countries are experiencing drought after multiple failed rainy seasons.1 The response context in ESAR is complex. This is due to the strained public health resources, including shortages of oral cholera vaccines, and the multiple concurrent public health and humanitarian emergencies, including the re-emergence of wild poliovirus. Community engagement in cholera outbreak responses is essential, especially while the impact of COVID-19 continues to be felt in the region, particularly on trust in public health and vaccination efforts.2,3 The purpose of this guidance note is to support Ministries of Health, UNICEF, and other response partners to design and implement effective, community-centred, and data-driven community engagement for cholera outbreak response. This guidance note was written in April 2023 by Megan Schmidt-Sane and Tabitha Hrynick (IDS), with input from Stellar Murumba (Internews), Ngonidzashe Macdonald Nyambawaro (IFRC), Eva Niederberger (Anthrologica), Santiago Ripoll (IDS), Nadine Beckmann (LSHTM), Mariana Palavra (UNICEF), and Rachel James (UNICEF). This guidance note draws on the Social Science in Humanitarian Action Platform (SSHAP)'s past work on cholera.Foreign, Commonwealth & Development Office (FCDO)Wellcome Trus

Sexual and Reproductive Health and Rights (SRHR) and Maternal, Neonatal and Child Health (MNCH) in Bangladesh: Impacts of the Covid-19 Pandemic

The Covid-19 pandemic has exacerbated and drawn fresh attention to long-standing systemic weaknesses in health and economic systems. The virus – and the public health response – has wrought significant disruption on sexual and reproductive health and rights (SRHR) and maternal, neonatal and child health (MNCH) in Bangladesh. Known negative health outcomes include increased domestic and gender-based violence, child marriage, negative mental health, and adverse child health outcomes. This scoping paper for the Covid-19 Learning, Evidence and Research Programme for Bangladesh (CLEAR) aims to inform future research and policy engagement to support response, recovery, progress, and future health system resilience for SRHR and MNCH in Bangladesh, following the Covid-19 crisis. We present what is known on disruptions and impacts, as well as evidence gaps and priority areas for future research and engagement.Foreign, Commonwealth & Development Offic

Consideraciones clave: Consideraciones prácticas para desarrollar resiliencia comunitaria para la respuesta y recuperación ante el COVID-19

As the unequal impact of the COVID-19 pandemic continues, there is a need to robustly support vulnerable communities and bolster ‘community resilience.’ A community resilience approach means to work in partnership with communities and strengthen their capacities to mitigate the impact of the pandemic, including its social and economic fallout. However, this is not resilience which returns the status quo. This moment demands transformative change in which inequalities are tackled and socioeconomic conditions are improved. While a community resilience approach is relatively new to epidemic preparedness and response, it frames epidemic shocks more holistically and from the perspective of a whole system. While epidemic response often focuses on mitigating vulnerabilities, there is an opportunity to use a resilience framework to build existing capacities to manage health, social, psychosocial, and economic impacts of an epidemic. This makes a resilience approach more localised, adaptable, and sustainable in the long-term, which are key tenets of an epidemic response informed by social science. This brief presents considerations for how health and humanitarian practitioners can support communities to respond to and recover from COVID-19 using a community resilience approach. This brief was developed for SSHAP by IDS (led by Megan Schmidt-Sane with Tabitha Hrynick) with Anthrologica (Eva Niederberger).Please note: there is an accompanying infographic summarising the key points from the briefing.في ضوء استمرار استشراء جائحة فيروس كورونا المستجد، ثمة حاجة إلى تقديم الدعم القوي للمجتمعات الأكثر تأثرا بالأزمات وتعزيز المرونة المجتمعية. نهج "المرونة المجتمعية" يعني الشراكة مع المجتمعات المحلية وتعزيز قدراتها بهدف التخفيف من تداعيات الجائحة، ومن ضمنها التداعيات الاجتماعية والاقتصادية. 1–3 لذا لا مجال للعودة إلى الوضع الذي كان سائداً قبل الجائحة، بل لا بد من إحداث تغيير جذري يتطرق لأوجه عدم المساواة ويعمل على تحسين الظروف الاجتماعية والاقتصادية. وفي حين أن النهج القائم على تعزيز قدرة المجتمع على الصمود لا يزال جديد نسبيًا فيما يتعلق بالتأهب لمواجهة الأوبئة والتصدي لها، فإنه يضع إطاراً للتعامل مع الصدمات الوبائية بطريقة شاملة ومن خلال إتباع نهج يشمل نظاما كاملا. 4–6 وبينما تركز الاستجابة للوباء والتصدي له على التخفيف من أوجه الضّعف، يمكن اللجوء إلى النهج القائم على تعزيز الصمود لبناء القدرات الحالية بهدف إدارة الآثار الصحية والاجتماعية والنفسية والاقتصادية الناتجة عن الوباء. وهذا يعزز من إضفاء الطابع المحلي على هذا النهج ومن قدرته على التكيف والاستدامة على المدى الطويل، ما يمثل المبادئ الأساسية للاستجابة للوباء وفقا للعلوم الاجتماعية. 7–9 يناقش هذا الموجز الاعتبارات المتعلقة بكيفية تقديم العاملين في القطاع الصحي والإنساني الدعم للمجتمعات من أجل الاستجابة والتعافي من فيروس كورونا المستجد باستخدام نهج المرونة المجتمعية. تم تطوير هذا الموجز لـصالح منصة العلوم الاجتماعية في العمل الإنساني من قبل معهد دراسات التنمية (تحت إشراف ميغان شميدت- ساين وتابيثا هرينيك بالتعاون مع أنثرولوجيكا (إيفا نايدربيرغر) وهو يقع ضمن مسؤولية منصة العلوم الاجتماعية في العمل الإنساني.Tandis que les répercussions inégales de la pandémie de COVID-19 se poursuivent, il est nécessaire de soutenir fermement les communautés vulnérables et de renforcer la « résilience communautaire ». Une approche de résilience communautaire implique de travailler en partenariat avec les communautés et de renforcer leurs capacités à atténuer l'impact de la pandémie, y compris ses conséquences sociales et économiques. Toutefois, ce n’est pas la résilience qui rétablit le statu quo. Ce moment exige un changement transformateur dans le cadre duquel les inégalités sont combattues et les conditions socioéconomiques améliorées. Bien qu’une approche de résilience communautaire soit relativement nouvelle dans le cadre de la préparation et de la riposte contre les épidémies, elle permet d'encadrer les chocs épidémiques de façon plus globale et du point de vue de l’ensemble d’un système. Bien que la riposte contre les épidémies soit souvent axée sur l’atténuation des vulnérabilités, il est possible d’utiliser un cadre de résilience pour renforcer les capacités existantes afin de gérer les impacts sanitaires, sociaux, psychosociaux et économiques d’une épidémie. Cela rend l’approche de résilience plus localisée, adaptable et durable à long terme, ce qui constitue les principes clés d’une riposte épidémique éclairée par les sciences sociales. La présente note stratégique expose des considérations quant à la manière dont les professionnels de la santé et de l’aide humanitaire peuvent aider les communautés à réagir à la COVID-19 et à se rétablir grâce à une approche de résilience communautaire. Cette note stratégique a été élaborée pour la SSHAP par l'IDS (sous la direction de Megan Schmidt-Sane et de Tabitha Hrynick) avec la collaboration d'Anthrologica (Eva Niederberger) et la responsabilité inhérente revient à la SSHAP.A medida que la pandemia de COVID-19 sigue afectando de diferentes formas, es necesario ofrecer un apoyo firme a las comunidades vulnerables y fortalecer la "resiliencia comunitaria". Un enfoque de resiliencia comunitaria implica trabajar en conjunto con las comunidades y reforzar sus capacidades para mitigar el impacto de la pandemia, incluso sus efectos sociales y económicos. Sin embargo, no se trata de resiliencia que restablece el orden actual. Este momento exige un cambio transformador en el que se aborden las desigualdades y se mejoren las condiciones socioeconómicas. Si bien este tipo de enfoque es relativamente nuevo para la preparación y respuesta ante una epidemia, formula las conmociones de las epidemias de una forma más holística y desde la perspectiva del sistema completo. A menudo, la respuesta ante una epidemia se enfoca en mitigar las vulnerabilidades. Pero hay una oportunidad de usar un marco de resiliencia para desarrollar las capacidades disponibles a fin de gestionar los impactos sanitarios, sociales, psicosociales y económicos de una epidemia. Esto permite que el enfoque de resiliencia sea más localizado, adaptable y sostenible a largo plazo, preceptos clave de la respuesta ante una epidemia informada por las ciencias sociales. Este resumen presenta consideraciones sobre cómo los profesionales humanitarios y de la salud pueden apoyar a las comunidades para responder ante el COVID-19 y recuperarse usando un enfoque de resiliencia comunitaria. Este resumen fue desarrollado para SSHAP por IDS (a cargo de Megan Schmidt-Sane y Tabitha Hrynick) con Anthrologica (Eva Niederberger). Este documento es responsabilidad de SSHAP.Wellcome TrustFCD