The Institute for Global Health and Development
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Item Informing adaptation strategy through mapping the dynamics linking climate change, health, and other human systems: Case studies from Georgia, Lebanon, Mozambique and Costa Rica(Public Library of Science, 2023-04-19) Loffreda, Giulia; Chikovani, Ivdity; Mocumbi, Ana O.; Asmar, Michele Kosremelli; Blanco, Laura C.; Grant, Liz; Ager, AlastairWhile scientific research supporting mitigation of further global temperature rise remains a major priority, CoP26 and CoP27 saw increased recognition of the importance of research that informs adaptation to irreversible changes in climate and the increasing threats of extreme weather events. Such work is inevitably and appropriately contextual, but efforts to generalise principles that inform local strategies for adaptation and resilience are likely crucial. Systems approaches are particularly promising in this regard. This study adopted a system dynamics framing to consider linkages between climate change and population health across four low- and middle-income country settings with a view to identifying priority inter-sectoral adaptation measures in each. On the basis of a focused literature review in each setting, we developed preliminary causal loop diagrams (CLD) addressing dynamics operating in Mozambique, Lebanon, Costa Rica, and Georgia. Participatory workshops in each setting convened technical experts from different disciplines to review and refine this causal loop analysis, and identify key drivers and leverage points for adaptation strategy. While analyses reflected the unique dynamics of each setting, common leverage points were identified across sites. These comprised: i) early warning/preparedness regarding extreme events (thus mitigating risk exposure); ii) adapted agricultural practices (to sustain food security and community livelihoods in changing environmental conditions); iii) urban planning (to strengthen the quality of housing and infrastructure and thus reduce population exposure to risks); iv) health systems resilience (to maintain access to quality healthcare for treatment of disease associated with increased risk exposure and other conditions for which access may be disrupted by extreme events); and v) social security (supporting the livelihoods of vulnerable communities and enabling their access to public services, including healthcare). System dynamics modelling methods can provide a valuable mechanism for convening actors across multiple sectors to consider the development of adaptation strategies.Item How do participatory methods shape policy? Applying a realist approach to the formulation of a new tuberculosis policy in Georgia(2021-06-29) Marchal, Bruno; Abejirinde, Ibukun-Oluwa Omolade; Sulaberidze, Lela; Chikovani, Ivdity; Uchaneishvili, Maia; Shengelia, Natia; Diaconu, Karin; Vassall, Anna; Zoidze, Akaki; Giralt, Ariadna Nebot; Witter, SophieThis paper presents the iterative process of participatory multistakeholder engagement that informed the development of a new national tuberculosis (TB) policy in Georgia, and the lessons learnt. Guided by realist evaluation methods, a multistakeholder dialogue was organised to elicit stakeholders' assumptions on challenges and possible solutions for better TB control. Two participatory workshops were conducted with key actors, interspersed by reflection meetings within the research team and discussions with policymakers. Using concept mapping and causal mapping techniques, and drawing causal loop diagrams, we visualised how actors understood TB service provision challenges and the potential means by which a results-based financing (RBF) policy could address these. The study was conducted in Tbilisi, Georgia. A total of 64 key actors from the Ministry of Labour, Health and Social Affairs, staff of the Global Fund to Fight AIDS, TB and Malaria Georgia Project, the National Centre for Disease Control and Public Health, the National TB programme, TB service providers and members of the research team were involved in the workshops. Findings showed that beyond provider incentives, additional policy components were necessary. These included broadening the incentive package to include institutional and organisational incentives, retraining service providers, clear redistribution of roles to support an integrated care model, and refinement of monitoring tools. Health system elements, such as effective referral systems and health information systems were highlighted as necessary for service improvement. Developing policies that address complex issues requires methods that facilitate linkages between multiple stakeholders and between theory and practice. Such participatory approaches can be informed by realist evaluation principles and visually facilitated by causal loop diagrams. This approach allowed us leverage stakeholders' knowledge and expertise on TB service delivery and RBF to codesign a new policy. [Abstract copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.]Item Addressing challenges in tuberculosis adherence via performance-based payments for integrated case management: Protocol for a cluster randomized controlled trial in Georgia(BMC, 2019-08-28) Chikovani, Ivdity; Diaconu, Karin; Duric, Predrag; Sulaberidze, Lela; Uchaneishvili, Maia; Mohammed, Nuredin Ibrahim; Zoidze, Akaki; Witter, SophieBackground: Tuberculosis is one of the greatest global health concerns and disease management is challenging particularly in low- and middle-income countries. Despite improvements in addressing this epidemic in Georgia, tuberculosis remains a significant public health concern due to sub-optimal patient management. Low remuneration for specialists, limited private-sector interest in provision of infectious disease care and incomplete integration in primary care are at the core of this problem.