Nossal Institute for Global Health - Research Publications

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    Strategies for capacity building for health research in Bangladesh: Role of core funding and a common monitoring and evaluation framework
    Mahmood, S ; Hort, K ; Ahmed, S ; Salam, M ; Cravioto, A (BMC, 2011-07-28)
    BACKGROUND: There is increasing interest in building the capacity of researchers in low and middle income countries (LMIC) to address their national priority health and health policy problems. However, the number and variety of partnerships and funding arrangements can create management problems for LMIC research institutes. This paper aims to identify problems faced by a health research institute in Bangladesh, describe two strategies developed to address these problems, and identify the results after three years of implementation. METHODS: This paper uses a mixture of quantitative and qualitative data collected during independent annual reviews of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) between 2006 and 2010. Quantitative data includes the number of research activities according to strategic priority areas, revenues collected and expenditure. Qualitative data includes interviews of researchers and management of ICDDR,B, and of research users and key donors. Data in a Monitoring and Evaluation Framework (MEF) were assessed against agreed indicators. RESULTS: The key problems faced by ICDDR,B in 2006 were insufficient core funds to build research capacity and supporting infrastructure, and an inability to direct research funds towards the identified research priorities in its strategic plan. Two strategies were developed to address these problems: a group of donors agreed to provide unearmarked pooled core funding, and accept a single common report based on an agreed MEF. On review after three years, there had been significant increases in total revenue, and the ability to allocate greater amounts of money on capacity building and infrastructure. The MEF demonstrated progress against strategic objectives, and better alignment of research against strategic priorities. There had also been changes in the sense of ownership and collaboration between ICDDR,B's management and its core donors. CONCLUSIONS: The changes made to funding relationships supported and monitored by an effective MEF enabled the organisation to better align funding with research priorities and to invest in capacity building. This paper identified key issues for capacity building for health research in low and middle income countries. The findings have relevance to other research institutes in similar contexts to advocate and support research capacity strengthening efforts.
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    Cost-effectiveness of invitation to food supplementation early in pregnancy combined with multiple micronutrients on infant survival: analysis of data from MINIMat randomized trial, Bangladesh
    Shaheen, R ; Persson, LA ; Ahmed, S ; Streatfield, PK ; Lindholm, L (BMC, 2015-05-28)
    BACKGROUND: Absence of cost-effectiveness (CE) analyses limits the relevance of large-scale nutrition interventions in low-income countries. We analyzed if the effect of invitation to food supplementation early in pregnancy combined with multiple micronutrient supplements (MMS) on infant survival represented value for money compared to invitation to food supplementation at usual time in pregnancy combined with iron-folic acid. METHODS: Outcome data, infant mortality (IM) rates, came from MINIMat trial (Maternal and Infant Nutrition Interventions, Matlab, ISRCTN16581394). In MINIMat, women were randomized to early (E around 9 weeks of pregnancy) or usual invitation (U around 20 weeks) to food supplementation and daily doses of 30 mg, or 60 mg iron with 400 μgm of folic acid, or MMS with 15 micronutrients including 30 mg iron and 400 μgm of folic acid. In MINIMat, EMMS significantly reduced IM compared to UFe60F (U plus 60 mg iron 400 μgm Folic acid). We present incremental CE ratios for incrementing UFe60F to EMMS. Costing data came mainly from a published study. RESULTS: By incrementing UFe60F to EMMS, one extra IM could be averted at a cost of US$907 and US$797 for NGO run and government run CNCs, respectively, and at US$1024 for a hypothetical scenario of highest cost. These comparisons generated one extra life year (LY) saved at US$30, US$27, and US$34, respectively. CONCLUSIONS: Incrementing UFe60F to EMMS in pregnancy seems worthwhile from health economic and public health standpoints. TRIAL REGISTRATION: Maternal and Infant Nutrition Interventions, Matlab; ISRCTN16581394 ; Date of registration: Feb 16, 2009.
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    Adapting to social and political transitions The influence of history on health policy formation in the Republic of the Union of Myanmar (Burma)
    Grundy, J ; Annear, P ; Ahmed, S ; Biggs, B-A (PERGAMON-ELSEVIER SCIENCE LTD, 2014-04)
    The Republic of the Union of Myanmar (Burma) has a long and complex history characterized by internal conflict and tense international relations. Post-independence, the health sector has gradually evolved, but with health service development and indicators lagging well behind regional expectations. In recent years, the country has initiated political reforms and a reorientation of development policy towards social sector investment. In this study, from a systems and historical perspective, we used publicly available data sources and grey literature to describe and analyze links between health policy and history from the post-independence period up until 2012. Three major periods are discernable in post war health system development and political history in Myanmar. The first post-independence period was associated with the development of the primary health care system extending up to the 1988 political events. The second period is from 1988 to 2005, when the country launched a free market economic model and was arguably experiencing its highest levels of international isolation as well as very low levels of national health investment. The third period (2005-2012) represents the first attempts at health reform and recovery, linked to emerging trends in national political reform and international politics. Based on the most recent period of macro-political reform, the central state is set to transition from a direct implementer of a command and control management system, towards stewardship of a significantly more complex and decentralized administrative order. Historical analysis demonstrates the extent to which these periodic shifts in the macro-political and economic order acts to reset the parameters for health policy making. This case demonstrates important lessons for other countries in transition by highlighting the extent to which analysis of political history can be instructive for determination of more feasible boundaries for future health policy action.