Research progress update PI presentations www.rebuildconsortium.com Annual Workshop 4, Liverpool, September 2013

1. Funded by Research progress update PI presentations www.rebuildconsortium.com Annual Workshop 4, Liverpool, September 2013

2. Order of presentations • Cambodia • Sierra Leone • Uganda • Zimbabwe

3. Research progress update ( Cambodia ) Sreytouch Vong www.rebuildconsortium.com Annual Workshop 4, Liverpool, September 2013

4. Outline • Overview of ReBUILD Cambodia • Health organizational structure • Progress on • Research projects • RU • Success • Challenges

5. ReBUILD Cambodia • Project 1: Impact of Health Financing Policy Change on Patterns of Poor Household Expenditure for Healthcare • Project 2: Policies to Attract and Retain Health Workers in Rural Areas • Project 3: The Change Process of Contracting Arrangement in Cambodia Health Sector

6. Health Infrastructure in Cambodia

12. One important or interesting finding

13. Success • Building network in national and sub-national level for the study • Build capacity of researchers in health research

14. Challenges • Research ethic approval is time consuming • Limited data and documents: health expenditure and equity, staff management in the 1980s and mid-1990s • The interview of life history takes more time • Take time to make appointment for interviews and consent form signed and tape record

15. Thank you SreytouchVong sreytouch@cdri.org.kh On behalf of ReBUILD consortium www.rebuildconsortium.com

16. Research Progress Update (Sierra Leone) Joseph Edem Hotah www.rebuildconsortium.com Annual Workshop 4, Liverpool, September 2013

17. First phase ReBUILD Projects in Sierra Leone • Health expenditure of households in Sierra Leone (Project 1) • Health Workers Incentives (Project 2) • Contracting in the health service delivery system in Sierra Leone (Project 3) • The study sites are as listed below: • Western Area (Urban/Rural) District • · Kenema District (Eastern Province) • · Bonthe District (Southern Province) • · Koinadugu District (Northern Province) • These are representative of the different regions, urban/rural variations, remoteness/hard to reach areas, and measures of poverty/need.

18. Project 1 - Health expenditure of households in Sierra Leone Overall aim • To understand how the budgets of the poorest households have been affected by health financing policy as it has evolved throughout the pre and post-conflict period • To investigate the level and distribution of out-of-pocket health care expenditures in the poorest households

19. Progress :Project 1 – Health financing

20. Progress: Project 1 – Health financing

21. Health Workers Incentive(Project 2) • This project focuses on Human Resources for Health and, in particular, on the incentives established for health workers and their dynamics over the post-conflict period Overall aim • to understand the post-conflict dynamics for these workers • deduce how to reach and maintain incentive environments for them to support access to affordable, appropriate and equitable health services.

22. Progress: Project 2 – Health Worker Incentive

23. Progress: Project 2 – Health Worker Incentive

24. Project 2: Stakeholder Mapping - Plotting actors for influence and interest

25. Contracting in the Health Service Delivery System in Sierra Leone Overall aim • To understand the change process and consequences of contracting in support of the process of decentralisation within the health system in Sierra Leone during the post conflict period

26. Progress: Project 3 – Contracting within the Health System

27. Progress: Project 3

28. One Important or Interesting Finding

29. Successes and challenges Successes • Project 2 almost complete • Project 1 fieldwork almost complete • Capacity building • Effective networking – DFID, World Bank, MoHS, Regulatory bodies and policy makers Challenges • Difficult to reach terrains especially the riverine areas (Bonthe and Koinadugu Districts) • Communication – within and internationally

30. Thank you Dr Joseph Edem-Hotah jedemhotah@yahoo.com On behalf of ReBUILD consortium SL www.rebuildconsortium.com

31. Research progress update (Uganda) Freddie Ssengooba for Uganda Team www.rebuildconsortium.com Annual Workshop 4, Liverpool, September 2013

32. Research project update: Project 1 ANALYSING PATTERNS IN HOUSEHOLD HEALTH EXPENDITURE IN GULU DISTRICT, NORTHERN UGANDA (1989-2010)

33. Main Objective & Methods • Main Objective: • To establish changes in health expenditure patterns for poor households pre, during and after the conflict in Northern Uganda. • Main Method: • Econometrics Analysis of National Household Survey Data • In depth Interviewing (Life Histories and KII)

34. Project 1: Analysing Patterns in Household Health Expenditure in Gulu District (1989-2010)

35. One important or interesting finding • While the post conflict phase is associated with reconstruction of health facilities, new partnerships in health services provision and free health care, the people considered costs of health care to be higher than during the conflict because of reduced livelihoods and limited opportunities

36. Successes and challenges • Successes • All necessary quantitative data secured • Life histories data collection accomplished • Key Informant Interviews conducted • All qualitative interviews transcribed • Challenges • The quantitative and qualitative components are each massive, with lots of data to analyse. • Time to conduct econometric data analysis

37. Research project update: Project 2 Evolution of Health Worker Incentives

38. Main Objective & Methods • Main Objective: • To understand the evolution of incentives for health workers, during and after the conflict in Northern Uganda. • Main Method: • Work histories for health workers that stayed thru the conflict and key informants at national level.

39. Project 2: Evolution of Workforce Incentives

40. One important or interesting finding • Commitment to stay and work during conflict was arising from” • A strong sense of community service to home folks; • Mentorship & socialization by religious institutions especially before and during training; • Strong ties to the communities they served; • Social ties like family, marriage, etc; • Sponsorship and bonding arrangements;

41. Successes and challenges • Successes • Project 2 has been a front runner; • A lot of qualitative data was generated; • Preliminary findings shared to the Sydney iHEA Congress July 2013. • Challenges • Time intensive transcription & analysis; • Attrition of team membership; • Expanded workload for fewer members.

42. Project 4 Evolution of Health Worker Posting Systems

43. Main Objective & Methods • Main Objective: • To describe the current deployment policies and systems and changes over time since the emergence from conflict; • To assess policy impacts on the staffing of rural areas. • Main Method: • Documents reviews, key informant interviews and routine staffing analysis.

44. Progress project 4: Evolution of Workforce Posting Systems

45. One important or interesting finding • Most of the health facilities were closed during the insurgency and were later opened when peace returned. What shaped the deployment during the insurgency was not the policy but security

46. Successes and challenges • Successes • Have conducted the data collection with key informants, document and record review, IDI and life histories; districts and Lacor hospital cooperated • Challenges • A lot of gaps in the document and records review • Workers who were in service during the insurgency are few

47. Project 5 Aid Architecture for Service Delivery

48. Main Objective & Methods • Main Objective: • To assess the aid relationships among agencies central to the implementation of of selected health services at the district level. • To analyze the aid effectiveness parameters within district-level network of agencies over a period of 2-3 years. • Main Method: • Relationship mapping for the delivery of key services using social network analysis; • Organization survey for resource exchange and interdependencies.

49. Progress project 5: Aid Architecture

50. Marked differences in service architecture: HIV services HIV Treatment Service Networks Kitgum District Gulu District Amuru District Legend