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The Institute for Global Health and Development

Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/9

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Author: search.filters.author.D'Ambruoso, Lucia

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    Learning sites for health systems research: Reflections on five programs in Africa, Asia, and Central America
    (2024-12-04) Witter, Sophie; Regmi, Shophika; Raven, Joanna; Nzinga, Jacinta; van der Merwe, Maria; Flores, Walter; D'Ambruoso, Lucia
    Introduction: Learning sites have supported intervention development and testing in health care, but studies reflecting on lessons relating to their deployment for health policy and system research (HPSR) in low‐ and middle‐income settings are limited. Methods: This experience report draws from learning over three continents and five research and community engagement programs—the oldest starting in 2010—to reflect on the challenges and benefits of doing embedded HPSR in learning sites, and how those have been managed. Its objective is to generate better understanding of their potential and constraints. The report draws from team members' experiential insights and program publications. Results: Challenges relating to initial engagement in the sites included building and maintaining trust, managing partner expectations, and negotiating priority topics and stakeholders. Once the embedded research was underway, sustaining engagement, and managing power dynamics within the group, supporting all participants in developing new skills and managing rapidly changing settings were important. Finally, the complexity of reflecting on action and assessing impact are outlined, along with potential approaches to managing all of these challenges and the variety of gains that have been noted across the programs. Conclusions: We highlight the potential of learning sites to develop relationships, capacities, and local innovations which can strengthen health systems in the long term and some lessons in relation to how to do that, including the importance of stable, long‐term funding as well as developing and recognizing facilitation skills among researchers. Supporting spaces for learning is particularly important when health systems face resource constraints and everyday or acute stressors and shocks.
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    Understanding non-communicable diseases: Combining health surveillance with local knowledge to improve rural primary health care in South Africa
    (Taylor & Francis, 2020-12-24) Cowan, Eilidh; D'Ambruoso, Lucia; van der Merwe, Maria; Witter, Sophie; Byass, Peter; Ameh, Soter; Wagner, Ryan G.; Twine, Rhian
    Background: NCDs are non-infectious, long-term conditions that account for 40 million deaths per annum. 87% of premature NCD mortality occurs in low- and middle-income countries.
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    Building cooperative learning to address alcohol and other drug abuse in Mpumalanga, South Africa: A participatory action research process
    (Taylor & Francis, 2020-03-02) Oladeinde, Oladapo; Mabetha, Denny; Twine, Rhian; Hove, Jennifer; van der Merwe, Maria; Byass, Peter; Witter, Sophie; Kahn, Kathleen; D'Ambruoso, Lucia; Wall, Stig
    Background: Alcohol and other drug (AOD) abuse is a major public health challenge disproportionately affecting marginalised communities. Involving communities in the development of responses can contribute to acceptable solutions.
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    Verbal Autopsy with Participatory Action Research (VAPAR) programme in Mpumalanga, South Africa: Protocol for evaluation
    (BMJ, 2020-02-04) Witter, Sophie; van der Merwe, Maria; Twine, Rhian; Mabetha, Denny; Hove, Jennifer; Goosen, Gerhard; D'Ambruoso, Lucia
    Introduction There is a growing recognition of the importance of developing learning health systems which can engage all stakeholders in cycles of evidence generation, reflection, action and learning from action to deal with adaptive problems. There is however limited evaluative evidence of approaches to developing or strengthening such systems, particularly in low-income and middle-income settings. In this protocol, we aim to contribute to developing and sharing knowledge on models of building collaborative learning platforms through our evaluation of the Verbal Autopsy with Participatory Action Research (VAPAR) programme.
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    Rethinking collaboration: developing a learning platform to address under-five mortality in Mpumalanga province, South Africa
    (Oxford University Press, 2019-06-26) D'Ambruoso, Lucia; van der Merwe, Maria; Wariri, Oghenebrume; Byass, Peter; Goosen, Gerhard; Kahn, Kathleen; Masinga, Sparara; Mokoena, Victoria; Spies, Barry; Tollman, Stephen; Witter, Sophie; Twine, Rhian
    Following 50 years of apartheid, South Africa introduced visionary health policy committing to the right to health as part of a primary health care (PHC) approach. Implementation is seriously challenged, however, in an often-dysfunctional health system with scarce resources and a complex burden of avoidable mortality persists. Our aim was to develop a process generating evidence of practical relevance on implementation processes among people excluded from access to health systems. Informed by health policy and systems research, we developed a collaborative learning platform in which we worked as co-researchers with health authorities in a rural province. This article reports on the process and insights brought by health systems stakeholders. Evidence gaps on under-five mortality were identified with a provincial Directorate after which we collected quantitative and qualitative data. We applied verbal autopsy to quantify levels, causes and circumstances of deaths and participatory action research to gain community perspectives on the problem and priorities for action. We then re-convened health systems stakeholders to analyse and interpret these data through which several systems issues were identified as contributory to under-five deaths: staff availability and performance; service organization and infrastructure; multiple parallel initiatives; and capacity to address social determinants. Recommendations were developed ranging from immediate low- and no-cost re-organization of services to those where responses from higher levels of the system or outside were required. The process was viewed as acceptable and relevant for an overburdened system operating ‘in the dark’ in the absence of local data. Institutional infrastructure for evidence-based decision-making does not exist in many health systems. We developed a process connecting research evidence on rural health priorities with the means for action and enabled new partnerships between communities, authorities and researchers. Further development is planned to understand potential in deliberative processes for rural PHC.
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    ‘Water is life’: developing community participation for clean water in rural South Africa
    (BMJ, 2019-06-11) Hove, Jennifer; D'Ambruoso, Lucia; Mabetha, Denny; van der Merwe, Maria; Byass, Peter; Kahn, Kathleen; Khosa, Sonto; Witter, Sophie; Twine, Rhian
    Background South Africa is a semiarid country where 5 million people, mainly in rural areas, lack access to water. Despite legislative and policy commitments to the right to water, cooperative governance and public participation, many authorities lack the means to engage with and respond to community needs. The objectives were to develop local knowledge on health priorities in a rural province as part of a programme developing community evidence for policy and planning. Methods We engaged 24 participants across three villages in the Agincourt Health and Socio-Demographic Surveillance System and codesigned the study. This paper reports on lack of clean, safe water, which was nominated in one village (n=8 participants) and in which women of reproductive age were nominated as a group whose voices are excluded from attention to the issue. On this basis, additional participants were recruited (n=8). We then held a series of consensus-building workshops to develop accounts of the problem and actions to address it using Photovoice to document lived realities. Thematic analysis of narrative and visual data was performed. Results Repeated and prolonged periods when piped water is unavailable were reported, as was unreliable infrastructure, inadequate service delivery, empty reservoirs and poor supply exacerbated by droughts. Interconnected social, behavioural and health impacts were documented combined with lack of understanding, cooperation and trust between communities and authorities. There was unanimity among participants for taps in houses as an overarching goal and strategies to build an evidence base for planning and advocacy were developed. Conclusion In this setting, there is willingness among community stakeholders to improve water security and there are existing community assemblies to support this. Health and Socio-Demographic Surveillance Systems provide important opportunities to routinely connect communities to resource management and service delivery. Developing learning platforms with government and non-government organisations may offer a means to enable more effective public participation in decentralised water governance.