Browsing by Author "Evans, Timothy G"

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Explaining equity gains in child survival in Bangladesh: scale, speed, and selectivity in health and development
(© 2013 The Lancet, 2013) Adams, Alayne M; Rabbani, Atonu; Ahmed, Shamim; Mahmood, Shehrin Shaila; Al-Sabir, Ahmed; Rashid, Sabina F; Evans, Timothy G
By disaggregating gains in child health in Bangladesh over the past several decades, signifi cant improvements in gender and socioeconomic inequities have been revealed. With the use of a social determinants of health approach, key features of the country's development experience can be identifi ed that help explain its unexpected health trajectory. The systematic equity orientation of health and socioeconomic development in Bangladesh, and the implementation attributes of scale, speed, and selectivity, have been important drivers of health improvement. Despite this impressive pro-equity trajectory, there remain signifi cant residual inequities in survival of girls and lower wealth quintiles as well as a host of new health and development challenges such as urbanisation, chronic disease, and climate change. Further progress in sustaining and enhancing equity-oriented achievements in health hinges on stronger governance and longer-term systems thinking regarding how to eff ectively promote inclusive and equitable development within and beyond the health system.
Explaining equity gains in child survival in Bangladesh: scale, speed, and selectivity in health and development
(© 2013 The Lancet, 2013) Adams, Alayne M; Rabbani, Atonu; Ahmed, Shamim; Mahmood, Shehrin Shaila; Al-Sabir, Ahmed; Rashid, Sabina F; Evans, Timothy G
By disaggregating gains in child health in Bangladesh over the past several decades, signifi cant improvements in gender and socioeconomic inequities have been revealed. With the use of a social determinants of health approach, key features of the country's development experience can be identifi ed that help explain its unexpected health trajectory. The systematic equity orientation of health and socioeconomic development in Bangladesh, and the implementation attributes of scale, speed, and selectivity, have been important drivers of health improvement. Despite this impressive pro-equity trajectory, there remain signifi cant residual inequities in survival of girls and lower wealth quintiles as well as a host of new health and development challenges such as urbanisation, chronic disease, and climate change. Further progress in sustaining and enhancing equity-oriented achievements in health hinges on stronger governance and longer-term systems thinking regarding how to eff ectively promote inclusive and equitable development within and beyond the health system.
Harnessing pluralism for better health in Bangladesh
(© 2013 The Lancet, 2013) Ahmed, Syed Masud; Evans, Timothy G; Standing, Hilary; Mahmud, Simeen
How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defi ned by the participation of a multiplicity of diff erent stakeholders and agents and by ad hoc, diff used forms of management has contributed to these outcomes by creating conditions for rapid change. We use a combination of data from offi cial sources, research studies, case studies of specifi c innovations, and in-depth knowledge from our own long-term engagement with health sector issues in Bangladesh to lay out a conceptual framework for understanding pluralism and its outcomes. Although we argue that pluralism has had positive eff ects in terms of stimulating change and innovation, we also note its association with poor health systems governance and regulation, resulting in endemic problems such as overuse and misuse of drugs. Pluralism therefore requires active management that acknowledges and works with its polycentric nature. We identify four key areas where this management is needed: participatory governance, accountability and regulation, information systems, and capacity development. This approach challenges some mainstream frameworks for managing health systems, such as the building blocks approach of the WHO Health Systems Framework. However, as pluralism increasingly defi nes the nature and the challenge of 21st century health systems, the experience of Bangladesh is relevant to many countries across the world.
Harnessing pluralism for better health in Bangladesh
(© 2013 The Lancet, 2013) Ahmed, Syed Masud; Evans, Timothy G; Standing, Hilary; Mahmud, Simeen
How do we explain the paradox that Bangladesh has made remarkable progress in health and human development, yet its achievements have taken place within a health system that is frequently characterised as weak, in terms of inadequate physical and human infrastructure and logistics, and low performing? We argue that the development of a highly pluralistic health system environment, defi ned by the participation of a multiplicity of diff erent stakeholders and agents and by ad hoc, diff used forms of management has contributed to these outcomes by creating conditions for rapid change. We use a combination of data from offi cial sources, research studies, case studies of specifi c innovations, and in-depth knowledge from our own long-term engagement with health sector issues in Bangladesh to lay out a conceptual framework for understanding pluralism and its outcomes. Although we argue that pluralism has had positive eff ects in terms of stimulating change and innovation, we also note its association with poor health systems governance and regulation, resulting in endemic problems such as overuse and misuse of drugs. Pluralism therefore requires active management that acknowledges and works with its polycentric nature. We identify four key areas where this management is needed: participatory governance, accountability and regulation, information systems, and capacity development. This approach challenges some mainstream frameworks for managing health systems, such as the building blocks approach of the WHO Health Systems Framework. However, as pluralism increasingly defi nes the nature and the challenge of 21st century health systems, the experience of Bangladesh is relevant to many countries across the world.
Universal health care in Bangladesh—promises and perils
(The Lancet, 2018-01) Adams, Allayne M; Ahmed, Syed Masud; Evans, Timothy G