Research:
Research at IIHD focuses on the interplay of policy and practice within the fields of social development and international health. Core areas of work include organisational culture and strategy, human resource development, AIDS/HIV, health system development and health governance in fragile states; livelihoods and health in poverty reduction, reconstruction, psychosocial intervention and gender and health. Projects involve collaboration with a wide range of academic institutions and non-governmental organisations across Europe, North America, Latin America, sub-Saharan Africa and South Asia.
With a growing postgraduate research school, IIHD welcomes applications from graduates with interest in its core areas of work, particularly those with experience in the inter-governmental, non-governmental and governmental health sectors. In addition to self-funding and part-time registration for PhD programmes, IIHD regularly advertises funded research studentships related to specific research questions. Research students receive training in research methodology as a routine component of their postgraduate training programme. Fieldwork generally involves periods of work overseas.
Technical assistance:
IIHD staff and associates frequently carry out technical assistance on behalf of international agencies. Technical assistance not only makes a strategic contribution to the international health arena but also informs teaching and research development at the Institute. The focus for IIHD technical assistance is human resource development in the health sector (particularly in the field of family medicine, nursing, health science and management); strategies for psychosocial assistance; health sector decentralisation and reform, and organisational analysis, health governance and coordination; and service delivery and coordination by non-state actors.
Current and recent research and technical assistance projects include:
IIHD Research Portfolio (Word Doc 20.6KB)
QMU eResearch
http://eresearch.qmu.ac.uk/
Contributions to the World Health Report 2005 and 2006
The World Health Report is the annual review of the global health situation prepared by the World Health Organisation. For the last two years, IIHD has been commissioned to provide technical inputs on its successive themes: Maternal Health (2005) and Human Resources for Health (2006).
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Health Systems Development Programme
This 5 year knowledge programme, funded by the Department of International Development was headed by Professor Barbara McPake. The purpose of the Health Systems Development Knowledge Programme is: ‘To inform policy and practice and influence the climate of opinion about how health systems can be more accessible to poor people and deliver better health services’.
The structure of the programme has three dimensions – topics, probes and countries.
The topics fall under the following list: Human resources, Health system structure, Processes: policy, Processes: operation, Global and regional initiatives, Use, Civil society, Methodology.
We used the idea of ‘probes’ of health system functioning: specific conditions and services through which we would examine detailed questions likely to have system wide relevance. The main probes used were maternal health, tuberculosis, HIV and STIs, and diabetes (type 1). The main countries in which work was conducted are Bangladesh, Russia, South Africa and Uganda, but we have also worked in Armenia, Brazil, Bulgaria, Cameroon, Ethiopia, Georgia, Kazakhstan, Malawi, Mozambique, Tanzania, Turkmenistan, Yemen, Zambia and Zimbabwe.
For further information please see www.hsd.lshtm.ac.uk
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Financing Health Care in Georgia
Following the collapse of the communist regime in Georgia, health status and life expectancy worsened and a crisis in government financing of health care emerged. Per capita health expenditure declined. One characteristic of the current health financing situation is a high level of catastrophic costs associated with out-of-pocket health expenditure, capable of propelling families into poverty. This situation indicates the failure of risk pooling in the health system: insurance arrangements have failed to bolster this function in the wake of declining government coverage of adequate services for the whole population. IIHD is working with WHO to advise the government on mechanisms for strengthening risk sharing and reducing catastrophic expenditures through improving financing arrangements.
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The role of the migrant care workforce in the development of the care economy in Scotland
The aim of this project is to examine the economic and legal position of migrant care workers, and their implications for the incentives for human capital investment and quality of care in care homes for older people.
We are currently conducting an initial analysis of the area prior to the development of a full scale proposal for external research funding on this topic. We are reviewing the literature on the Scottish labour market and its implications for the local supply of care workers; the patterns of employment of migrant workers in care homes; and the legal position of migrant workers from different regions, and carrying out some preliminary analysis of existing data sets (for example Scottish Social Services Council).
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The HIV related needs of African minority and ethnic communities in Scotland: HIV Scotland
Oonagh O’Brien is working with Elizabeth Grant from Edinburgh University to carry out a rapid mapping exercise to ascertain the availability of support for people affected by HIV from African and minority ethnic populations in Scotland. Funding for this work has come from the Scottish Government Health Department and the work is being carried out for HIV Scotland.
The purpose of this work is to carry out an assessment of HIV support for people from African and minority ethnic populations from a broad range of services to ascertain:
- Perceived needs in relation to providing support for people affected and infected with HIV
- Assess capacity to deliver accessible HIV support services for the client group
- Perceived needs in relation to race awareness and equality and diversity issues
In recent years the pattern of HIV infection in Scotland has changed; the majority of new infections used to be through injecting drug use and sex between men. Although new infections attributed to sex between men continue to rise, we are now seeing a large increase in new infections attributed to heterosexual transmission, particularly heterosexual transmission acquired abroad. Exposure in Africa (including Scots who have travelled and Africans who believe they were infected there) is attributed to 91% of these cases. This is in the context of a rapid increase in numbers of people with HIV in general. The Brownlee Centre in Glasgow for example, has seen an increase from around 300 people with HIV to over 600 in a period of three years.
In response to these changes, HIV Scotland is carrying out a rapid mapping exercise to ascertain the availability of support for people affected by HIV from African and minority ethnic populations in Scotland. Since January 2005 interviews have been carried out with service providers across Scotland working in Clinical HIV services, voluntary organisations working in both the HIV field and those working with minority ethnic communities. The work is being carried out by Oonagh O’Brien, a lecturer at the Institute for International Health and Development (IIHD) at Queen Margaret University and Dr Liz Grant from the Department of Community Health Sciences at the University of Edinburgh.
Asians form the largest ethnic group in Scotland, in particular those from Pakistan, Bangladesh and India. Other ethnicities who are visible to date in this study are Asian and South East Asian, Eastern European and Chinese. It appears that very few of these are HIV positive, but there are some people from these ethnic groups who are clearly vulnerable to STIs and HIV who have been identified in outreach work in cruising areas or with men selling sex. Apart from the Asian community, other ethnic communities are small in Scotland and even though the African population is also small, Africans are currently the ethnic group most affected by HIV in Scotland.
This has resulted in a gap in support services. Most of the organisations established to support minority ethnic communities are Asian, so Africans have few support services or social support structures in Scotland. Early findings from the mapping exercise have shown that some clinical HIV services are seeing a substantial increase in Africans but this is not always matched by an increase in Africans in support services. The change in service users in Scotland has been identified as having happened in the last three years, despite a long history of high HIV rates in Africa. There are some examples of excellent practice, and other areas where services are only beginning to respond to these changes.
One strategy for moving forward in a sustainable way is to link with ethnic community organisations. However more attention needs to be paid to this strategy with resources facilitating the building of bridges between groups.
So far the examples of good practice are where African and minority ethnic communities and HIV issues are closely linked together. However there are other examples where few connections are being made, either because of lack of resources or lack of training and skilled staff.
Some organisations are in a stage of transition, as the process for taking on issues of minority ethnic communities with their HIV work or vice versa, result in changes which can be challenging for staff and for the organisation. There is a need for clear guidance about what support is available for these changes in the forms of training, materials and resources. Most of these materials and resources are already available but from the work carried out to date, it appears that they are not being shared widely across Scotland.
The final report from this work will identify ways in which this information can be streamlined and made available to the range of services involved in caring for people from minority ethnic communities who are HIV positive. It will identify gaps in materials, training needs and linkages and propose ways in which experience and good practice can be shared.
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Evaluating participatory, community-based sexual health interventions
This 5 year knowledge programme, funded by the Department of International Development was headed by Professor Barbara McPake and concluded in 2006. The purpose of the Health Systems Development Knowledge Programme is: ‘To inform policy and practice and influence the climate of opinion about how health systems can be more accessible to poor people and deliver better health services’.
The structure of the programme has three dimensions – topics, probes and countries.
The topics fall under the following list: Human resources, Health system structure, Processes: policy, Processes: operation, Global and regional initiatives, Use, Civil society, Methodology.
We used the idea of ‘probes’ of health system functioning: specific conditions and services through which we would examine detailed questions likely to have system wide relevance. The main probes used were maternal health, tuberculosis, HIV and STIs, and diabetes (type 1).
The main countries in which work was conducted are Bangladesh, Russia, South Africa and Uganda, but we have also worked in Armenia, Brazil, Bulgaria, Cameroon, Ethiopia, Georgia, Kazakhstan, Malawi, Mozambique, Tanzania, Turkmenistan, Yemen, Zambia and Zimbabwe.
For further information please see www.hsd.lshtm.ac.uk
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Research on the Social Impact of HIV treatment in Rural Uganda
Oonagh O’Brien has commenced research in collaboration with Sarah Ssali, a lecturer at Makarere University in Kampala, Uganda to assess the social impact of HIV treatment in rural Uganda.
We have identified two communities in South West Uganda surrounding the hospitals of Kisiizi in Rukungiri district and Kambuga in Kanungu district where we will be carrying out research. Two field researchers will be located in the communities with supervision from Makarere and QMUC.
This first phase of the research aims to:
- frame questions relating to broad socio-economic issues surrounding the introduction of ART.
- develop appropriate qualitative methodologies to examine community impacts of ART for use in longer term research
- obtain funding for longer term collaboration between Makerere and QMU Universities.
- locate the research within relevant theoretical debates within social science literature, identify initial findings and disseminate them through engagement with relevant policy makers and health workers and publish in academic journals.
Broad areas of investigation will include:
- Well-being and livelihoods: does ART improve well-being and livelihoods or are there hidden costs and unexpected consequences which are detrimental?
- Gender relations: there are differences between the ways men and women have been affected by HIV which relate to their gender roles. Currently more women are on free treatment and involved in support groups than men in the areas we will be working in. How does this alter or affect gender relations?
- Changes in stigma, which might increase with ART (more visibility for those taking treatment) or reduce (less ill health and death).
- Resilience in the face of unexpected events such as drought or crop failure. Does ART allow families to build up and retain assets which can assist resilience?
- A high rate of HIV infection has affected the ability of children, especially girls, to go to school and has also affected teachers. Is ART reversing this?
- Equity of Access to treatment: who is getting treatment and who is not getting treatment? Is it free or not? What is the impact on people who are not HIV positive if their relatives start treatment? How are decisions made?
- What is the importance of community based organizations and support in successful treatment regimes? How have rituals and community structures altered with the advent of treatment?
- How is hope and investment in the future for the whole community, altered by the availability of treatment?
This current phase of research is funded with a grant for International Collaboration from the British Academy and Association of Commonwealth Universities and will be completed in early 2007. It is hoped that this will form part of a longer piece of research which will develop greater understanding around the interaction of HIV treatment and social development.
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Social Impact of Antiretroviral Therapy for HIV and AIDS in Africa
Oonagh O’Brien was seconded to the MRC Social & Public Health Sciences Unit in Glasgow to coordinate this one day workshop which was held in London on March 27 th 2006 at the Royal College of Physicians in Regents Park, London and was lead by Professor Graham Hart.
The aim of the workshop to bring together researchers to develop a social scientific research agenda for this new phase of the HIV epidemic.
Since the early days of the HIV pandemic social scientists have identified the social impact that the morbidity, mortality and stigma of HIV and AIDS have had on individuals and communities. Many countries in Africa are among those with the highest rates of HIV in the world and as a result, livelihoods, kinship patterns, gender relations, rituals, social and power relations and many other socio-economic and cultural structures have changed dramatically. Treatment for HIV became available in the countries of the North in 1996 and had an immediate effect in reducing both morbidity and mortality. The result is a change in epidemiology with HIV rates sing year after year, but rates of AIDS diagnoses and death dropping rapidly and stabilizing at these low rates. The global campaign to bring these treatments to poorer communities in the South has now resulted in a ‘roll out’ of Antiretroviral Therapy (ART) in what is the largest coordinated treatment programme ever delivered on a mass scale in Africa. While there has been attention directed to the issues facing health systems having to deliver this treatment, there is still little understanding about the wider social and economic impacts of treatment in resource poor settings in parts of the world such as Africa.
This one day workshop brought together fifty social scientists who are working in the field of HIV and AIDS to share work that is currently being carried out and to identify key topics for future research. A particular aim of the workshop was to allow individual social scientists to make links across different disciplines and traditional areas of study so that new partnerships can be formed in order to generate research in this area. The workshop was organized and funded by The Medical Research Council and the Economic and Social Research Council.
A number of presentations presented early findings from research. Dr Janet Seeley from the School of Development Studies at the University of East Anglia gave a presentation which was based on work being carried out in South Western Uganda following a treatment delivery programme which is termed a ‘rolls royce’ delivery approach with health workers delivering treatment to people's door and following up individuals who are having problems. Janet then presented a number of questions and issues about the impact of this treatment in allowing individuals to ‘return to a normal life’, the life they had before illness, which was something they aspired to do.
Dr Brent Wolff from the MRC /UVRI Ugandan Unit on AIDS then presented a summary of current and planned social science work on ART being carried out by the MRC in Uganda. This presentation presented existing studies and their findings as well as highlighting research agendas for future work.
Finally, Professor Tony Barnett from the LSE gave a presentation which raised key questions about the benefits of ART and the potential problems. His first slides gave an overview of dramatic reductions in death resulting from AIDS in both the USA and Brazil. He also emphasized the socio-demographic context of ART provision and the long term nature of HIV epidemics. A number of workshops enabled people to discuss some of the potential research topics around the impact of ART in more detail:
- Health systems
- Economics and ART
- Impact mitigation and social development
- Stigma
- Behaviour change
Professor Graham Hart closed the workshop with the comments that all the groups had come up with very impressive research issues in a short time which spanned macro, meso and Micro organisational issues. The challenge in social science is to link the micro with the macro. He commented that the workshop had presented all of us with the opportunity to achieve that. It was hoped that the workshop would result in people stepping out of disciplinary ‘silo’s’ to make links and develop cross cutting themes.
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The Psychosocial Working Group
IIHD are founding partners of the Psychosocial Working Group with Alison Strang and Emma Wright providing the coordinating hub for the consortium. The group was established, with support from the Andrew Mellon Foundation, to facilitate dialogue between and amongst academics and practitioners within humanitarian agencies regarding different approaches to psychosocial interventions. The group comprises representatives from IIHD, the RSC, Harvard and Columbia universities, the International Rescue Committee, Save the Children US, the Christian Children's Fund and Medecins sans Frontieres-Holland. Its work programme includes the development of a unifying conceptual framework for psychosocial intervention; the provision of an inventory of key resources within the 'grey' literature; the definition of a research and development agenda; and a number of small scale collaborative applied field studies. Alison Strang and Ruth Marsden are now leading a new initiative on behalf of the consortium to explore and promote effective approaches to networking in the psychosocial sector.
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Strengthening the Health Management Course: Link with Benue State University, Nigeria
QMU, Edinburgh has been chosen by the DFID-funded Benue State Health Fund to pursue a collaborative link with Benue State University (BSU). The purpose of the link is to strengthen the BSU Advanced Diploma in Health Management in order to enable health services managers to undertake relevant education in management locally, and to increase the sustainability of quality health services in Benue State. Mr Fred Tamen, co-ordinator of the link at BSU, has been selected to work at IIHD as an associate as part of the programme. Staff from IIHD will also visit BSU to co-monitor the development of the course and its teaching and delivery. The overall aim is to mutually develop BSU and QMU, Edinburgh as collaborative learning organisations.
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Jigawa Urban Water and Sanitation Project
This DFID funded project managed by IBG Switzerland http://www.ibgrombach.com/ aims to provide assistance to the Ministry of Water Resources in Jigawa State in Northern Nigeria to rehabilitate and extend the water supplies to four towns, to develop a piped supply in a further town and to conduct a hygiene promotion programme in communities and primary schools where sanitary latrines are being built. The engineering component of the project is informed and supported by a communications component. Margaret Leppard, through Water Management Consultants http://www.watermc.com/home/ led on the design of formative research conducted in association with Professor Ruqayattu Ahmed Rufai (Bayero University, Kano), Dr Salisu Abdullahi (Bayero University, Kano) and Nasser Yakubu (Darl-Hab Ltd) to investigate local cultural practices relating to water and sanitation. Findings included high prevalence of use of the bush for defecation, gendered use of latrines where they existed, significant fly nuisance in homesteads associated with proximity of animals to cooking areas and living quarters, understanding of triggers for handwashing and current sources of water and perceptions of quality of water for domestic use. These findings informed the development of a communications programme using mass media (radio, posters and billboards), interpersonal communication using multidisciplinary teams from health, community development and education departments of local government authorities and in-school child to out-of-school child education, all supplemented by brochures. Further research went into the pre-testing of communication materials. The summative research following rehabilitation and building of water supplies and school latrines is about to start (July 2006) . Already we are aware that there are community requests for a domestic adaptation of the school latrine design. For more information about the research contact mleppard@qmu.ac.uk
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Approaches to Psychosocial Needs Assessment in Sri Lanka post Tsunami
Alison Strang and Ruth Marsden have been working closely with long-term colleagues in Sri Lanka who played a central role in coordinating the psychosocial response in the aftermath of the December 2004 tsunami. In autumn 2005, IIHD conducted a study for UNICEF Sri Lanka looking at needs assessment processes in psychosocial programmes. It reviewed a selection of the huge range of psychosocial programmes established since the tsunami and explored some of the challenges agencies face in assessing needs and planning effective and culturally appropriate programmes. The study is now being used as a basis of ongoing discussions about more effective needs assessment in national and local forums. We have continuing plans for joint research with colleagues in Sri Lanka, including collaboration on a new centre for psychosocial research and evaluation.
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Promoting Psychosocial Networking
A UNICEF funded feasibility study is currently being conducted into ways of promoting networking in the psychosocial field to facilitate more effective practice. Recognising that formal and informal networks of relationships between organisations play many useful functions, the study sought to analyse the kinds of networking activity that already exists and look at potential ways these could be linked and developed further. IIHD are conducting this research on behalf of the Psychosocial Working Group (PWG). Following on from the feasibility study, there are plans for a second phase to strengthen and build networking initiatives in the field, together with UNICEF and other members of the PWG.
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Refugee Integration
Alison Strang and Ruth Marsden are working with practitioner and policy colleagues to support the integration of refugees and asylum seekers in the UK. The Indicators of Integration (hotlink to e-version? Would need to find web address) study funded by the European Refugee Fund and undertaken on behalf of the Home Office explored understandings of integration in UK communities amongst refugees and non refugees. A 'profile' of refugee integration has been drawn out from this study and is being used in project evaluation and policy development. This work is now being developed on a Europe wide basis.
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Psychosocial Professional Development in Difficult Environments
The Lloyds TSB Foundation for Scotland is supporting a two year programme at IIHD responding to the emerging priorities for psychosocial professional development in Sri Lanka and Indonesia. In both countries, we have established relationships with local colleagues who are addressing the longer term needs emerging from the combination of the devastating impact of the December 2004 tsunami and the context of ongoing conflict. Alison Strang will lead the programme working with universities, government ministries, and other local leading institutions (e.g. unions, professional bodies, local NGOs, local coordinating networks), building collaborative relationships to provide:
- Advice, support, professional mentoring and facilitation of strategic planning
- Higher educational teaching, training, seminars, workshops (involving both direct training and facilitating ‘south to south’ learning)
- Higher education course development and curriculum development
- Technical support for research design and research collaboration
- Collaborative writing
- Links with international resources and initiatives
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