Improving access to health services, building sustainable health systems and harnessing a spirit of innovation to improve equity are among the themes covered in seven new briefing papers on scaling up in the health sector.

The papers follow a workshop held at IDS earlier this summer in which more than 40 academics, policy makers and innovators came together to:

• Explore approaches that have fostered innovation, rapid learning and large-scale impact in the health sector and have context and social arrangements as central to learning and change
• Identify practical approaches for collaboration between innovators, researchers, governments and funding agencies in order to strengthen the capacity of health systems to meet the needs of the poor.

The workshop was one element in a collaboration between Future Health Systems Research Programme Consortium and the STEPS Centre on a stream of work that aims to look beyond traditional narratives in order to uncover the multiple pathways of change influencing the shape of future health services. Both Future Health Systems and STEPS are based at IDS.

Real world challenges

The workshop shed light on real-world challenges experienced by those working directly in the health sector.

A common challenge was tailoring global goals or donor expectations to the local context. Jeff Mecaskey, of Health Partners International, explained how The Partnership for Reviving Routine Immunisation in Northern Nigeria recognised that internationally-instigated health system reform measures entail a significant transfer and allocation of resources and are therefore a profoundly political process. An important part of the programme's work was therefore around understanding and building on different political interests, and in particular identifying which interests might be drivers for change.

Abbas Bhuiya, from ICDDR,B in Bangladesh, explained how scale up efforts need to engage with the informal sector who make up 95 per cent of the health workforce. These providers earn their living by selling drugs, and over prescription and other harmful practices are common.

The private sector was also a focus of the paper by Barun Kanjilal, of the Indian Institute of Health Management Research, who outlined how a major change in the relative roles of market and state since 1990 in India had been reflected in the health sector with a rapid spread of largely unregulated private actors as well as an expansion of opportunities for modern medicines and innovations.

Social justice and equity

Citizen-state relations was another area of focus. A case study on the Treatment Action Campaign in South Africa, a movement to support the right of people living with HIV to access quality comprehensive prevention and treatment services and to live a healthy life, illustrated how an initial bio-medical focus had led to campaigning on a broader set of vulnerabilities and socio-economic rights as treatment access became more widespread.

A shift in focus from health care provision and access to issues of social justice, equity and the experiences of marginalised groups was also central to the paper on indigenous people in Brazil, given by Alex Shankland, an IDS research fellow.

The resulting seven briefing papers provide more information on each of the following areas:

• Framings of scaling up (PDF 1.57MB)
• Large scale health interventions (PDF 1MB)
• Local innovations (PDF 2.95MB)
• Scaling up in context of transition (PDF 1.69MB)
• Information and communication technologies (PDF 1.1MB)
• Citizen and health system relations (PDF 1.72MB)
• Building evidence to support rapid change (PDF 2.94MB)