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Systems approaches are currently being advocated and implemented to address complex challenges in Public Health. These approaches work by bringing multi-sectoral stakeholders together to develop a collective understanding of the system, and then to identify places where they can leverage change across the system. Systems approaches are unpredictable, where cause-and-effect cannot always be disentangled, and unintended consequences – positive and negative – frequently arise. Evaluating such...
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Introduction:The Most Significant Change (MSC) technique is a complex-aware monitoring and evaluation tool, widely recognized for various adaptive management purposes. The documentation of practical examples using the MSC technique for an ongoing monitoring purpose is limited. We aim to fill the current gap by documenting and sharing the experience and lessons learned of The Challenge Initiative (TCI), which is scaling up evidence-based family planning (FP) and adolescent and youth sexual...
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Technical assistance is provided to country governments as part of international development programmes to support policymaking or strengthen state capability. This article presents the conceptual evolution of ‘technical assistance’ linked to capacity development, starting with programmes aiming exclusively to enhance individual capacity in the 1950s to 1970s and progressing to complex systems approaches in the past ten years. It also presents some of the frequent challenges in designing and...
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The first case of COVID-19 in Nigeria was confirmed on 27 February 2020, with the first lockdown orders issued on 30 March 2020. The pandemic and resultant containment measures have had farreaching socio-cultural, economic, financial and political implications, globally as well as in Nigeria. For the Partnership to Engage, Reform and Learn (PERL) and its partners, the pandemic has required considerable adaptation of their strategic approach and working practices. This report reflects on...
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The coronavirus pandemic poses unprecedented challenges to science, policy and the interface between the two. How – and how quickly – policy-makers, practitioners and researchers react to this emerging and complex crisis is making a profound difference to people’s lives and livelihoods (WHO, 2020). But how can we ensure effective collective decision-making on the basis of emerging evidence, changing trends and shifting scientific understanding, all in the face of considerable uncertainty?...
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Evaluative Tools for Improving Campaign Effectiveness Public health campaigns aim to control disease or deliver essential health services and products through time-limited and periodic channels. Many countries use campaigns to augment or replace routine service delivery, to target certain populations, or to accelerate progress towards coverage targets. The Root Cause Analysis and Rapid Evaluation, Action, and Learning toolkits present a systematic but flexible approach to identifying the...
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Healthcare systems are increasingly recognised as complex, in which a range of non-linear and emergent behaviours occur. China’s healthcare system is no exception. The hugeness of China, and the variation in conditions in different jurisdictions present very substantial challenges to reformers, and militate against adopting one-size-fits-all policy solutions. As a consequence, approaches to change management in China have frequently emphasised the importance of sub-national experimentation,...
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Fifteen to twenty years is how long it takes for the billions of dollars of health-related research to translate into evidence-based policies and programs suitable for public use. Over the past 15 years, an exciting science has emerged that seeks to narrow the gap between the discovery of new knowledge and its application in public health, mental health, and health care settings. Dissemination and implementation (D&I) research seeks to understand how to best apply scientific advances in the...
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There are increasing criticisms of dominant models for scaling up health systems in developing countries and a recognition that approaches are needed that better take into account the complexity of health interventions. Since Reform and Opening in the late 1970s, Chinese government has managed complex, rapid and intersecting reforms across many policy areas. As with reforms in other policy areas, reform of the health system has been through a process of trial and error. There is increasing...
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Impact Summary The Ebola epidemic that began in the Guinea-Sierra Leone-Liberia border region in December 2013 spread fast through the villages, cities and trade routes of this highly-peopled,...
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• There is considerable interest in the concept of adaptive development and what it may look like in different sectors, including health. • Adaptive types of programming from the health sector are relatively advanced; as we work towards the Sustainable Development Goals (SDGs), experiences in health can provide useful lessons for other areas of development. • The international health community may not use the label ‘adaptive development’, but many are already conducting adaptive work....
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Interest in implementation research is growing, largely in recognition of the contribution it can make to maximizing the beneficial impact of health interventions. As a relatively new and, until recently, rather neglected field within the health sector, implementation research is something of an unknown quantity for many. There is therefore a need for greater clarity about what exactly implementation research is, and what it can offer. This Guide is designed to provide that clarity. Intended...
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Debate is ongoing about the nature and use of evidence in public health decision making, and there seems to be an emerging consensus that the "hierarchy of evidence" may be difficult to apply in other settings. It may be unhelpful however to simply abandon the hierarchy without having a framework or guide to replace it. One such framework is discussed. This is based around a matrix, and emphasises the need to match research questions to specific types of research. This emphasis on...
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