Project rationale

The socio-economic growth in many low and middle-income countries (LMICs) has resulted in more available – though not equitably accessible - healthcare. Such growth has also increased demands from citizens for their health systems to be more responsive to their health needs. Responsiveness, a key goal of any national health system is “…when institutions… are cognisant and respond appropriately to the universally legitimate expectations of individuals... safeguarding of rights of patients to adequate… care” (de Silva, 2000; p.3) and its improvement is the main focus of our study.

Aims and objectives

Our core research question is: “In what way can health systems become more responsive to neglected health needs of vulnerable groups within the contexts of lower-middle-income countries?” The project objectives are to:

1. Conduct in-depth analyses of how health systems responsiveness is understood and enacted by key health systems actors, and to what degree the local health systems are responsive to these expectations;
2. Co-produce, implement and evaluate context-sensitive interventions to improve health systems responsiveness to neglected health needs of vulnerable groups;
3. Develop an empirically based and theoretically grounded model of complex relations between the contexts, the mechanisms and the outcomes of the interventions to improve health systems responsiveness;
4. Develop transferable best practices for scalability and generalisability of the pilot-tested interventions;
5. Strengthen research capacity through extending existing collaborations into strong South-South and South-North exchange and learning within and between Ghana, Vietnam, Australia and the UK.

Theoretical framework

We approach health systems responsiveness as a dynamic social action which is produced via relationships between different actors within contexts of particular socio-economic arrangements as they negotiate experiences of professional, citizen, consumer and patient rights and responsibilities.

Health systems responsiveness involves two socially-constructed interactions:

• internal (i.e. between policymakers, managers and service providers, for example in resource allocation, target-setting, staff supervision and performance appraisal);
• external (i.e. between people and the system, typically during service provision).

Experiences of these interactions shape degree of health systems responsiveness across its eight domains: dignity, autonomy, confidentiality, attention, access to networks, quality of amenities, choice of service provider and trust. People’s engagements with health systems (e.g. to seek healthcare) and system’s responses to these engagements (e.g. service delivery) are shaped by their initial expectations from each side.

Impact

Decision-makers from facility, district, Health professionals in Ghana regional and national levels in both Ghana and Vietnam will be continuously engaged through embedding research into policy and practice.

Key study outcomes and impacts will be:

1. Improved health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam and;
2. An empirically-grounded and theoretically-informed model of complex relationships Patients waiting at a clinic in Hoa Binh City in Northern Vietnam between the contexts, mechanisms and outcomes of the interventions, along with transferable best practices for scalability (i.e. expansion within similar contexts) and generalisability (i.e. to different contexts, such as other health areas and countries) for future health systems strengthening.