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SOCIAL INNOVATION TO ADVANCE UNIVERSAL HEALTH COVERAGE IN UGANDA THROUGH RESEARCH, CAPACITY AND ADVOCACY

TDR Webinar, 28 October 2020

DR PHYLLIS AWOR, RESEARCHER, MAKERERE UNIVERSITY SCHOOL OF PUBLIC HEALTH, SIHI UGANDA LEAD

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1. The role of social innovation in health care delivery: “The drug shop integrated management of childhood illness” in Uganda.

2. SIHI country research hubs to convene stakeholders and embed research in social innovation for evidence and impact.

3. Research to scale up: the collaboration with UNICEF, UNDP, TDR and SIHI Uganda to replicate/scale up the drug shop innovation to India and Tanzania.

4. Advancing social innovation in the context of COVID-19: The effects of COVID-19 on our work and the role of social innovation to respond to health emergencies.

Outline

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The role of social innovation in health care delivery

• SIHI, the Social Innovation in Health Initiative, was established by TDR and partners.

• SIHI is a global network of partners dedicated to advancing social innovation in health through research, capacity and advocacy.

• The Drug Shop Integrated Care was selected in 2015 as one of the 23 research case studies conducted by SIHI.

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The Drug Shops Integrated Care Project in Uganda

Challenge

• Malaria, diarrhoea and pneumonia are responsible for three quarters of deaths in children under the age of five.

Approach

• Leveraging local private drug shops to improve delivery of quality services for malaria, pneumonia and diarrhoea in children through integrated community case management (shifting tasks).

• Partnership between Makerere University, the Ministry of Health, Karolinska Institute and Sida.

Outcomes

• 88% of children with fever who accessed care at the intervention drug shops were tested and treated for malaria.

• The quality of diarrhea management increased 13-fold, compared with control drug stores.

• The quality of respiratory illness management increased 3-fold, compared with control drug stores.

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Safety

Interpersonal relations

Quality health care

Access to services 

Technical competence Effectiveness Efficiency

Equity

Continuity

We have studied how to improve quality of care across the dimensions above

at drug shops

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Research to guide the way forward

• Awor Phyllis, Meenakshi Gautham, Stefan Peterson (2018). Delivering child health interventions through the private sector in low and middle income settings: challenges, opportunities and potential next steps. British Medical Journal. BMJ2018;362:k2950

• Awor P. (2016) Drug shops in integrated community case management of malaria, pneumonia and diarrhea in Uganda: Appropriateness of care and adherence to treatment guidelines. PhD Thesis. Bergen Open Research Archive

• Denise Buchner, Awor P (2015). A protocol for engaging unlicensed private drug shops in rural eastern Uganda for integrated community case management of malaria, pneumonia and diarrhea in children under 5 years of age. BMJOpen 2015; 5:e009133

• Awor P, Wamani H, Tylleskar T, Peterson S (2015). Drug seller adherence to clinical protocols with integrated management of malaria, pneumonia and diarrhoea at drug shops in Uganda. Malaria Journal. 2015, 14:277

• Awor P, Wamani H, Tylleskar T, Jagoe G, Peterson S (2014). Increased Access to Care and Appropriateness of Treatment at Private Sector Drug Shops with Integrated Management of Malaria, Pneumonia and Diarrhoea: A Quasi-Experimental Study in Uganda. PLoS ONE 9(12): e115440. doi:10.1371/journal.pone.0115440

• Awor P, Miller J, Peterson S (2014). Systematic literature review of integrated community case management and the private sector in Africa: Relevant experiences and potential next steps. J Glob Health. Dec 2014; 4(2): 020414.

• Awor P, Wamani H, Bwire G, Jagoe G, Peterson S (2012). Private sector drug shops in integrated community case management of malaria, pneumonia, and diarrhea in children in Uganda. Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):92-6

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Mission: To provide a one stop platform that links social innovators, policy-makers, funders, researchers and communities, in order to support the use of community-based solutions to improve health outcomes.

Value proposition: We provide multisectoral expertise on social innovation in health and connect actors in order to advance community-based solutions to improve health outcomes in Uganda.

Core values: Inclusiveness, partnership, integrity and excellence.

SIHI Uganda research hub

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SIHI Uganda Activities 2017-2020

Three social innovation calls

Case study research

Health Innovators Fellowship

Student research grants

Partnership with Ghana and Nigeria

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SIHI Uganda activities 2017-2020

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In 2020 – 2021, strengthening partnerships to disseminate the social innovation approach further in Africa through:

Objective 1: Introducing the identification and promotion of social innovation in health in other African countries (Ghana and Nigeria in West Africa).

Objective 2: Embedding social innovation into the university education system of participating universities. Students participate in public health solution finding through field research and evaluation projects.

Disseminating social innovation across Africa

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1. Partner with stakeholders who are interested in supporting social innovation identification and scale-up in Africa.

2. Support the embedding of social innovation into national health policies and programmes through stakeholder engagement.

3. Work with the ministries of health and other partners to periodically identify, evaluate and categorize innovations for uptake and scale-up by the government.

4. Seek funding for different activities including: open calls, case study research, capacity building fellowship, stakeholder workshops, and scale-up of the innovations.

SIHI Uganda – Critical next steps

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Scaling-up: SIHI Uganda, TDR, UNICEF and UNDP Research Partnership

SIHI Uganda innovation part of second prize awarded by UNICEF and UNDP’s “Big Think Challenge”

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Aim:

To catalyze systematic engagement of private frontline service providers to deliver quality child health services:

• Perform country situation assessments;

• Develop action plans for private provider engagement in two countries, with focus on frontline services at the primary health care level; and

• Develop technical guidance for governments on strengthening the engagement of private frontline providers for improved child health outcomes which serves as a foundation for UNICEF and UNDP country offices to provide support.

Partnering with governments and international agencies for improved child health

Expected Outcome:

Improved understanding of private sector service delivery models and effective models of engagement for governments, UNICEF and UNDP to strengthen public-private collaboration for quality child health services in selected countries

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• SIHI Uganda, working through Ministry of Health technical working groups, has contributed to the development of private sector guidelines for managing patients during the COVID-19 crisis and distribution of guidelines and communication materials.

• Engagement activities: Smaller meeting groups and numerous electronic meetings have been scheduled.

• Prolongation of timeline to accommodate the expected delays from closure of universities and bans on public gatherings.

Social innovation in the context of COVID-19

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The “Drug shop integrated management of childhood illness” illustrates the value of social innovation to contribute to universal health coverage.

Universities are well positioned to convene stakeholders and embed research in social innovation for evidence and impact. (SIHI Uganda)

Partnerships are critical to scale up innovations. (UNICEF, UNDP, TDR and SIHI Uganda)

Social innovations play a great role in the response to health emergencies (public trust, adaptability, ability to continue health care delivery during emergencies).

Key messages

THANK YOU

Made possible with the support of TDR.

TDR is able to conduct its work thanks to the commitment and support from a variety of funders: See: https://www.who.int/tdr/about/funding/en/

This project is also supported by additional targeted funding from the Swedish International Development Cooperation Agency (Sida)