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Empirical evidence generated by UEL research has directly influenced the reform of health financing in two Indian states with total populations of 154 million through changes to provider behaviour, the organisation and use of funds, and treatment verification processes and package rates. The impacts of this work have been commended by the UK Department for International Development (DFID) and the World Bank, and attracted interest from states with similar healthcare schemes. More widely, it has helped policymakers in India and the UK recognise the importance of including high quality comprehensive primary care in India's strategic planning for universal health care, and the benefits to the UK in prioritising primary care collaboration with India.
The Millennium Development Goals placed improvement of maternal health and reduction of maternal mortality high on global policy agendas. Our research at King's College London takes this aim forward by producing detailed analyses of health systems barriers to timely access to maternal healthcare in a variety of settings in Africa and Asia, complemented by synthetic reviews of evidence to inform governments and international agencies. Our contribution has drawn international policy attention to the impact of healthcare financing mechanisms on delivery of maternity care and subsequent wellbeing, and the importance of effective emergency maternity referral systems. Our work has directly informed the design of referral systems in several countries.
Methods for valuing quality of life developed by Professor Devlin at City University London are used internationally to help governments make healthcare decisions. Her research focuses on a widely-used questionnaire for measuring patient reported health, the European Quality of Life 5-Dimensions (EQ-5D). Government organisations routinely use the EQ-5D to judge whether new medicines work and are cost-effective. Over 15 countries are undertaking EQ-5D studies using Professor Devlin's methods to inform decisions on pricing and provision of new medicines. These developments have been achieved through active dissemination to the academic community and governments and through Professor Devlin's scientific leadership of the European Quality of Life (EuroQol) Group. The impact of this research is highly significant in improving health and health care decision-making and has had wide reach throughout the UK and in many other countries.
Evidence about the need for and provision of health visiting services generated through research undertaken at King's College London (KCL) has underpinned major changes in national policies for health visiting. Our findings about health visitors' practice, availability and distribution of services and effectiveness in terms of parenting/child outcomes, revealed both shortfalls in provision and opportunities for improvement and led to the development of a new caseload weighting tool and funding model for service planning. The accumulated evidence from this research helped convince the UK Government in 2010 to commit to 4,200 more health visitors by 2015 — a workforce expansion of nearly 50% — in a time of austerity and restraint elsewhere in the public sector.
Public financing of health services in low income countries was challenged by the World Bank's Agenda for Reform in 1987, which advocated increased roles for private sector, private insurance and user fees. This was followed by a wave of reforms implementing this approach. McPake has been involved in researching the implications of this shift since this period and has published a series of influential articles that have had a demonstrable impact on this debate. Removal of user fees for all, or selected, services or for selected population groups has occurred in many countries, including 28 of 50 countries with the highest maternal and child health mortality included in a recent survey (http://bit.ly/17FUiDM). Witter is the lead researcher who has examined country level experiences of removing fees and it is demonstrable that her work has been applied in specific countries to shape the details of policy and has also had a major influence on the global debate.
The ECuity Project was a European Union (EU) funded research network that provided rigorous quantitative evidence on the extent of socioeconomic inequalities in health and health care across countries and over time. The Project pioneered a set of measurement tools to help understand what drives international differences and trends in health inequality. The methods developed within the Project have had a direct impact on the way in which international organisations, such as the Organisation for Economic Cooperation and Development (OECD), World Bank (WB) and World Health Organisation (WHO), define and measure health inequality and inequity. The Project provided international agencies and governments with tools to develop and target policies to address inequity and the evidence generated by the Project has extended their understanding of the issue in developed and developing countries, informing and shaping their policy advice.
Research undertaken at the Centre for Intellectual and Developmental Disabilities(CIDD), has significantly impacted upon:
Globally, there are around 290,000 maternal deaths per year, 83,000 of them in South Asia. Post-partum haemorrhage [PPH] is a major contributor to maternal mortality. Currently, oxytocin is advocated as a key life-saving drug for arresting/preventing PPH when administered immediately after birth. Edinburgh University research on home deliveries in India exposed one important but largely unacknowledged and unquantified risk-factor for maternal mortality: widespread misuse of oxytocin during labour to speed up the process. These and other findings in relation to the supply and unregulated use of pharmaceuticals in South Asia have been brought to the attention of advocacy groups and international donors, thus helping frame pharmaceuticals policy debate, e.g. by highlighting the need to reduce the diversion of oxytocin for dangerous use during labour. The research has also increased recognition of the importance of ethnographic research in facilitating evidence-based public-health policy-making and enhanced the capacity of advocacy groups to provide evidence-led input on crucial policy questions.
Adults with learning disabilities (LD) often cannot adequately report illness and there is evidence that treatable illnesses go undetected. As a direct result of Cardiff University research on health checking adults in primary care, the Welsh Government and the Department of Health now provide funding for all adults with LDs across England and Wales to receive an annual health check that employs Cardiff University methods. Current data on take-up (N=78,000 per year) and evaluation of results show that nearly 250,000 adults with LDs have had new health needs identified and treatments initiated during the REF assessment period (2008-2013). Nearly 40,000 adults per year will have new health needs identified and treatments initiated as a result of the health checks, with approximately 3,500 of these being potentially serious conditions.
Lancaster research has highlighted the pervasive health inequalities and inadequate services experienced by people with learning disabilities (LD). Our 2005 report commissioned by the Department of Health (DH) proposed the establishment of a specialist LD observatory for England. This proposal was taken up by a government-commissioned independent inquiry and accepted.
The same team is one of three partners who, through a competitive tender process, have since 2010 been operating the first specialist LD public health observatory in the world. The observatory collects, analyses and summarises health information to improve the data available to DH and other stakeholders thereby improving the health of people with LD.