Verbal Autopsy with Participatory Action Research (VA-PAR): Developing a people-centred health systems research methodology

Lead Research Organisation: University of Aberdeen
Department Name: Division of Applied Health Sciences

Abstract

Recent estimates suggest that two-thirds of the world's deaths pass unrecorded. This situation seriously limits the ability of health systems to respond to the needs of vulnerable and excluded populations. Developing methods to reliably understand why people die in populations with weak health systems is therefore an important strategy for saving lives.

Registering medical cause of death has long been considered essential for public health. Despite increasing globalisation, in many resource-poor countries, universal registration of vital events remains lacking and uncertain estimates provide an inadequate basis for policy and planning. In addition, the social inequalities and social contexts play an important role in shaping health for disadvantaged groups. Even with the data available, insufficient attention is paid to the root causes of mortality in resource poor settings.

Considering these factors, there is an urgent need to improve health information about and for marginalised populations to inform public health responses. The proposed research will develop an extension to an established method called Verbal Autopsy (VA). VA is used to measure the levels and causes of death in populations where large numbers die outside health facilities or without registration. The development will help local health systems to assess their own health situations, identify priorities and develop action plans for positive health change.

We will do this through three phases of work.
- Firstly, we will develop improved ways to classify causes of death by combing information on medical causes with data on the circumstances of deaths (seeking and using care at the time of death). In settings where health services are under-funded, weak and fragmented, these can often play a crucial role. The classifications will also be developed in consultation with local health planners to be of practical use.
- Secondly, we will develop an additional method to gain the views of local communities on long-standing health challenges. This will allow us to further understand how social, economic and health systems issues influence availability, accessibility, acceptability, and quality of care. The method may also help foster social inclusion in health.
- In the final phase, we will consult with higher levels of the health system about the method. This will help develop how we use the extended cause of death classifications combined with community knowledge. The aim here is to explore how the method could be used in an ongoing fashion to connect health surveillance to service organisation in an inclusive process. This approach encourages sustainable health gains.

Data, poverty and inequality exist in complex co-dependency: less data exist on the health of the poor than the rich, raising important questions about the relationship between material and data poverty. In settings where health systems are fragile and under-resourced, where new burdens of disease are rapidly emerging, and where large and diverse populations are excluded from access to health care, innovative approaches that connect the registration of vital events to health care systems in a people-centred approach are needed.

The approach employs a bottom up philosophy connecting with population data at source. In the longer term, it is envisaged that the method will contribute to more rigorous health data at population level in an inclusive process that can affect sustainable health gains through better data and improved capacity for evaluation.

The work will be conducted in an research centre in rural South Africa established for over 20 years. The extent of data available and the richness of experience in health research allows us to develop a method with partners who enact a broader commitment to registration of all individuals within a population.

Technical Summary

People-centred health systems (PCHS) is a recent progressive shift that has moved thinking beyond building-blocks models of health systems towards ones that centralise a human and relational nature. Despite the conceptual advance, empirical methods are lacking. The project seeks to develop methods for conducing and using Verbal Autopsy (VA) consistent with a PCHS approach by combining VA with Participatory Action Research (PAR) in a process connected to the health system at different levels. VA is a health surveillance technique that provides information on levels and causes of mortality in populations where deaths occur outside facilities and/or without registration. PAR is a process that aims to transform the roles of those participating from objects of research to active researchers and agents of change. It systematises local experience through collective analysis to generate valid forms of evidence on the relationships between health problems and their causes. Three phases of research are proposed. In Phase 1, we will conduct a secondary analysis of data gained through the application of the 2012 WHO VA standard in a Health and Demographic Surveillance Site (HDSS) in rural South Africa. Combing data on medical causes with new data on background characteristics of deaths, we will develop improved ways to classify causes in a method suitable for use at sub-district/district level. In Phase 2, local service users and providers will engage in a PAR process to review the results of Phase 1, set priorities for local services, and explore the potential for co-benefits related to empowerment and social inclusion. The final Phase 3 aims to consult at higher levels of the health system to consider how the method could be further applied and evaluated. The overall output is a practical and integrated methodology based on core standards that is contextually relevant and capable of affecting health gains by translating local priorities into actionable public health agendas.

Planned Impact

The ultimate beneficiaries of the proposed research are populations in which large numbers die outside health facilities and/or without proper registration. Estimates suggest that over two thirds of deaths worldwide pass without registration of cause, with over three quarters of these in Sub-Saharan Africa and South-East Asia. Fragilities in health systems are exacerbated by poor civil registration and vital statistics systems (CRVS): without an understanding of the situations of poor, marginalised and excluded groups, the problems they face can neither be identified nor addressed. In this context there is an urgent need to improve health information about marginalised populations.

The research is also intended to have a positive impact on local communities, policy-makers and health planners within national, provincial, district and sub-district health offices. Information on cause-specific disease profiles, their health systems and social determinants, and priorities for actionable public health agendas will have been rigorously verified at local community and systems levels. Co-constructed practical knowledge will be thoroughly embedded in, and thus relevant to, local health systems contexts. These outputs will be disseminated in local communities and to health authorities to investigate their validity and relevance, and to reflect on the method as a means of sustainable and self-administered evaluation and planning.

In addition, the research responds to the World Health Organization (WHO)'s current effort to develop CRVS systems in low and middle-income countries (LMICs). The proposed research will provide the piloted VA-PAR method promoting democratic knowledge production, capacity building and evidence-based advocacy. In this sense, the research is also intended to provide important information for WHO on the adaption of VA-based models as a medium term strategy towards universal vital registration. To enable these impacts, methodological and technical discussions on a) extended biosocial classifications for unregistered deaths and b) the explanatory potential of routine participatory adjuncts in health and demographic surveillance will be conducted with WHO. We will hold dissemination workshops with WHO in which the methods will be discussed in terms of the potential for sustainable and self-administered evaluation and planning.

The Development Grant work also aims to facilitate further application and evaluation of the method among wider audiences. We therefore propose to hold two further workshops in South Africa and the UK to engage with academic and non-academic audiences on further application and evaluation of the method. Firstly, with the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH), a southern-based, southern-led umbrella organisation of 50 independent health research centres that operate 48 HDSS sites in 20 LMICs (http://www.indepth-network.org). The meeting will consider how and for whose purposes health information is generated for sustainable action towards improved health outcomes. This workshop will also explore the potential to create further spaces for application and evaluation of the method. Secondly, in the UK through the Public Engagement in Research Unit (PERU) at the University of Aberdeen (http://www.abdn.ac.uk/engage/), we will conduct a national workshop on the relationships between material and data poverty, and on methods and opportunities for generating routine people-centred health information. Here we will also explore further application and evaluation of the method to enable the impacts envisaged.

Publications


10 25 50
D'Ambruoso L (2017) The case for verbal autopsy in health systems strengthening. in The Lancet. Global health
 
Description Disseration projects (n=2) linking postgraduate students from the University of Aberdeen to MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), South Africa
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Launch of postgraduate taught course on Health Policy and Systems Research
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact In academic year 2015/16 the postgraduate taught course BU5568: Health Systems and Policy Research was launched at the University of Aberdeen. The course is led by labour economist Professor Ioannis Theodossiou and social scientist Dr Lucia D'Ambruoso as a cross-college collaboration. The course aims to take a global perspective on health policy and systems research (HPSR), providing students with knowledge and understanding of the key characteristics of health policy, health systems, and the contribution of research in this field. The course covers a wide variety of topics including health systems around the world, the effects of social inequalities on health inequalities and their repercussions for social policy, issues of public health policy, and how research can make credible contributions in this context. The principal aims are: • To introduce different health systems: what they are, how they are defined and financed and to encourage a critical and comparative perspective; • To explore health inequalities and health and social policy issues; • To provide an overview of HPSR. The course has also been registered with the Health Systems Global Training database. The course has been developed in response to work in the field of Health Policy and Systems Research, which has been through the Verbal Autopsy with Participatory Action Research (VAPAR) methodological development work (DFID/MRC/Wellcome Trust/ESRC Health Systems Research Initiative (MR/N005597/1) ).
URL http://www.abdn.ac.uk/msc/global-health
 
Description Placement project (n=1) linking University of Aberdeen postgraduate students to MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), South Africa
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
 
Description AFZ Giles Scholarship 2015/2016
Amount £500 (GBP)
Organisation University of Aberdeen 
Sector Academic/University
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 05/2016 
End 05/2016
 
Description Health Systems Research Initiative
Amount £689,219 (GBP)
Organisation Joint Health Systems Research Initiative MRC/ESRC 
Sector Academic/University
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 04/2017 
End 05/2022
 
Description Making the Most of the Masters/Careers Service University of Aberdeen 2015
Amount £500 (GBP)
Organisation University of Aberdeen 
Sector Academic/University
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 06/2016 
End 08/2016
 
Description Shaping Health: Exchanging on social power in health
Amount £16,000 (GBP)
Organisation Training and Research Support Centre 
Sector Charity/Non Profit
Country United Kingdom of Great Britain & Northern Ireland (UK)
Start 11/2016 
End 02/2018
 
Title Extending Verbal Autopsy (VA) to Collect Information on Local Circumstances 
Description Verbal autopsy (VA) is a health surveillance technique used in low and middle-income countries to determine medical causes of death (CODs) for people who die outside hospitals and/or without registration. By virtue of the deaths it investigates, VA is also an opportunity to examine social exclusion from access to health systems. The aims were to develop a classification system for deaths investigated in VA cognisant of broader social and health systems determinants. A short set of questions on social and health systems circumstances at and around the time of death were developed and integrated into the WHO 2012 short form VA (SF-VA). Data was analysed from two census rounds 2012-13 in the Agincourt HDSS in rural South Africa where the SF-VA had been applied. InterVA-4 was used to develop cause-specific mortality fractions (CSMFs). Descriptive analyses were performed examining whether and how the new indicators varied by medical conditions and age/sex sub-groups. This work was conducted as part of the Verbal Autopsy with Participatory Action Research (VAPAR) methodological development work (DFID/MRC/Wellcome Trust/ESRC Health Systems Research Initiative (MR/N005597/1) ), Phase 1 
Type Of Material Model of mechanisms or symptoms - human 
Year Produced 2016 
Provided To Others? Yes  
Impact New ways to understand deaths investigated in VA: An analysis of 1,200 deaths investigated in Agincourt with VA containing new WHO indicators on social and health systems factors has been used to develop a novel classification system. The system complements data on medical causes and has identified multiple, reinforcing barriers to access including unaffordable costs, unavailable transport and under-utilisation of facility-based care. Supplementing VA with questions on background circumstances provides complementary information to CSMFs relevant for health planning. 
 
Title Participatory Action Research (PAR) to gain local knowledge on health and illness, including Photovoice 
Description The method aims to develop community partnerships to co-construct and act on new knowledge on health in rural settings. The method provides a means to engage with communities in a participatory process to review mortality data and extended COD classifications from Agincourt HDSS, to further amplify these data with local knowledge, to set priorities for local services, and explore the potential for benefits related to empowerment and social inclusion. The method has been developed as part of the Verbal Autopsy with Participatory Action Research (VAPAR) methodological development work (DFID/MRC/Wellcome Trust/ESRC Health Systems Research Initiative (MR/N005597/1) ), Phase 2. 
Type Of Material Model of mechanisms or symptoms - human 
Provided To Others? No  
Impact - PAR process with local communities: Using the new VA outputs in a deliberative process with village-based groups, new insights have been gained on specific mechanisms through which health risks are accumulated and access to services is limited. Issues identified include transactional sex, harmful traditional practices, alcohol/substance abuse and debt, compounded by denial of treatment, insensitive staff and poor confidentiality in clinics. Photovoice was also used to explore participatory photography - Partnerships: the process has been developed with Mpumalanga provincial health authority and local communities in Agincourt. The partnerships are evidenced in a paper, conference abstract and the current application co-authored by health authority representatives and researchers. The health authority also plans to initiate a community health forum responding to needs expressed in the PAR element. 
 
Description Collaboration with ASH Scotland (Taking Action on Smoking and Health) 
Organisation Action on Smoking and Health (Scotland ASH)
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Charity/Non Profit 
PI Contribution The Verbal Autopsy with Participatory Action Research (VAPAR) methodological development work (DFID/MRC/Wellcome Trust/ESRC Health Systems Research Initiative (MR/N005597/1) ) has underscored the need to do research that generates information that is relevant to policy/practitioners. An ongoing collaboration with ASH Scotland has been further fostered by this awareness. ASH Scotland do important work nationally and internationally to reduce harm caused by tobacco. Working with the Chief Executive ASH Scotland through an annual seminar generously provided to the University of Aberdeen has provided important insights on how to conduct research for policy and practice, and engage more broadly to maximise impacts. The collaboration with ASH Scotland has been prioritised this year to extend insights from the group to the VAPAR work.
Collaborator Contribution Annual seminar
Impact Annual seminar at the University of Aberdeen: Creating a tobacco free generation: how far have we come from and where to next? 16 February 2016 Sheila Duffy, CEO, ASH Scotland
Start Year 2014
 
Description Collaboration with Aberdeen City Council 
Organisation Aberdeen City Council
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Public 
PI Contribution Methods developed in the Verbal Autopsy with Participatory Action research (VAPAR) Development Award DFID/MRC/Wellcome Trust/ESRC Health Systems Research Initiative (MR/N005597/1), have been applied locally in a dissertation (Masters) project. Conducted in the Summer of 2015, this project engaged with community members in a deprived area of Aberdeen City to examine food poverty and insecurity in the context of the use of food banks using participatory methodologies developed in the VAPAR work. More broadly, the work reflects an awareness of the importance to link research projects with health and other authorities to ensure from the outset that research is designed to provide information that is of practical relevance, as part of a health systems and policy research approach.
Collaborator Contribution The Community Learning and Development Officer, Ms Emma McPherson helped gain access to the local community, which whom a series of facilitated discussions were held on the nature and extent of food insecurity.
Impact Student dissertation: Household food insecurity and food poverty in North East Scotland: a community-based participatory research study. A thesis presented for the degree of Master of Science (MSc) Global Health and Management, University of Aberdeen. July 2015. Student: Khyati Thaker, Bachelor of Physiotherapy, Rajiv Gandhi University of Health Sciences, India
Start Year 2015
 
Description Collaboration with Malaria Consortium 
Organisation Malaria Consortium Africa, Kampala
Country Uganda, Republic of 
Sector Charity/Non Profit 
PI Contribution Conference organisation, co-authoring Lancet Global Health commentary on VA in health systems
Collaborator Contribution Conference presentation, co-authoring Lancet Global Health commentary on VA in health systems
Impact Conference proceedings, commentary in Lancet Global Health
Start Year 2016
 
Description Collaboration with Mpumalanga Department of Health Maternal Child Women and Youth Health (MCWYH) Directorate (Province) 
Organisation Mpumalanga Department of Health
Country South Africa, Republic of 
Sector Public 
PI Contribution The Verbal Autopsy with Participatory Action Research (VAPAR) methodological development work (DFID/MRC/Wellcome Trust/ESRC Health Systems Research Initiative (MR/N005597/1) ) has been developed with Mpumalanga provincial health authority and local communities in Agincourt. The partnerships are evidenced in a paper, conference abstract and the new application to Call 3 of the Health Systems Research Initiative co-authored by health authority representatives and researchers (D'Ambruoso et al, 2015; 2016a; 2016b). The health authority also plans to initiate a community health forum responding to needs expressed in the PAR element (Personal communication, 2015). D'Ambruoso L, Kahn K, Wagner R, Twine R, van der Merwe M. Moving from medical to health systems classifications of deaths. Manuscript submitted to BMC Glob Health Res Pol, 2015. D'Ambruoso L et al. Capturing community priorities. Fourth Glob Symp Health Sys Res; 2016a. D'Ambruoso L et al. Verbal Autopsy with Participatory Action Research (VAPAR): expanding the knowledge base through partnerships for action on health equity. Outline Application to DFID/ESRC/MRC/Wellcome Health Systems Research Initiative; 2016b. Personal Communication. S Masinga Mpumalanga Department of Health, 2015.
Collaborator Contribution Partners at the Department of Health have contributed through facilitated discussions, through co-authoured manuscripts for publication in international journals and through development of a funding proposal.
Impact PAPERS D'Ambruoso L, Kahn K, Wagner R, Twine R, van der Merwe M. Moving from medical to health systems classifications of deaths. Manuscript submitted to BMC Glob Health Res Pol, 2015. CONFERENCE ABSTRACTS D'Ambruoso L et al. Capturing community priorities. Fourth Glob Symp Health Sys Res; 2016a. FUNDING APPLICATIONS D'Ambruoso L et al. Verbal Autopsy with Participatory Action Research (VAPAR): expanding the knowledge base through partnerships for action on health equity. Outline Application to DFID/ESRC/MRC/Wellcome Health Systems Research Initiative; 2016b. EXPRESSED INTENTION BY PROVINCIAL DEPT. OF HEALTH TO INITIATE A COMMUNITY-EDUCATION FORUM AS A RESULT OF THE VAPAR DEVELOPMENT WORK Personal Communication. S Masinga Mpumalanga Department of Health, 2015.
Start Year 2015
 
Description Consultations with PhotoVoice 
Organisation Photovoice
Country United Kingdom of Great Britain & Northern Ireland (UK) 
Sector Charity/Non Profit 
PI Contribution Several exchanges have been held with PhotoVoice, a charity group based in London who provide technical advice and support to groups working with participatory photography methodologies. The process and outputs of Phase 2 of the Verbal Autopsy with Participatory Action Research (VAPAR) methodological development work (DFID/MRC/Wellcome Trust/ESRC Health Systems Research Initiative (MR/N005597/1) ) have been discussed with PhotoVoice before and during the data collection. The intention is to continue to engage with this group as the results are prepared and to explore areas for further collaborative work.
Collaborator Contribution Reporting and discussing the Phase 2 community based study in the VAPAR project before and during the data collection.
Impact Informed the development of study protocols. Informed the conduct of the data collection. The intention is that the methods are fully captured in the write up of this Phase of the VAPAR work.
Start Year 2015
 
Description Poverty as a human rights issue: Rights, social participation and ways of increasing children's voice in the debate Scottish Universities Insight Institute Friday, 26 June 2015 from 10:00 to 16:00 (BST) Aberdeen, United Kingdom 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact 50-100 academics, local authority professionals and representatives of civil society groups attended this event to examine poverty as a human rights issue. The theme of the workshop, on rights, social participation and ways of increasing children's voice in the debate was of direct relevance to the Verbal Autopsy with Participatory Action Research (VAPAR) study (DFID/MRC/Wellcome Trust/ESRC Health Systems Research Initiative (MR/N005597/1)). A range of new contacts was made with with local groups who expressed interests to use the methods being developed. This subsequently led to a postgraduate (Masters) dissertation project using participatory methodologies to examine food poverty and insecurity in deprived areas in Aberdeen City in the Summer of 2015.
Year(s) Of Engagement Activity 2015
 
Description Creating new multi-site, multi-sectoral research collaborations in HDSS | 18-19 Nov 2016 | INDEPTH Network AGM Kampala Uganda 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The piloted methodology is intended for further application and evaluation in other settings to further evaluate issues related to costs, scalability and sustainability. To this end, the final phase of the proposed research involves a workshop with representatives of INDEPTH (the International Network for the Demographic Evaluation of Populations and Their Health). This workshop will explore the potential to create further spaces to apply and evaluate the method, and document the knowledge and action gained. INDEPTH is a southern-based and southern-led umbrella organisation of 50 independent health research centres that operate 48 HDSS sites in 20 LMICs (http://www.indepth-network.org). "Recognising that there are no quick fixes in terms of achieving universal individual registration of populations in LMICs, the Network represents a medium-term attempt to break the link between material and data poverty" (Sankoh & Byass, 2012:579). The long-standing links between the research project team and INDEPTH are highly relevant to realising the pathways to impact.

Link to INDEPTH AGM Kapamla Uganda http://www.indepth-network.org/news-events/events/newsindepth-agm-2016-kampala-uganda

EventBrite Information

The Verbal Autopsy and Participatory Action Research (VAPAR) project has developed a method to connect health authorities, communities and researchers to do partnerships research. This work has been progressed with the DFID/MRC/ESRC/Wellcome Health Systems Research Initiative and the Agincourt Health and Socio-Demographic Surveillance Site of Wits University, Mpumalanga Provincial Department of Health, and the Universities of Aberdeen in Scotland and Umea in Sweden. In VAPAR, researchers, communities and health systems stakeholders worked together to generate evidence on disease profiles levels and causes, their health systems and social determinants, and priorities for action. These outputs are being disseminated to reflect on the method as a means of sustainable and self-administered evaluation and planning. The workshop will present the method and explore the potential for uptake through new multi-site partnerships.
Year(s) Of Engagement Activity 2016
URL https://www.eventbrite.co.uk/e/creating-new-multi-site-multi-sectoral-research-collaborations-in-hds...
 
Description Government Consultation - Scottish Government International Development discussion event - Glasgow University's Randolph Hall - Wednesday 9 March 2016 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Scottish Government International Development discussion event - Glasgow University's Randolph Hall - Wednesday 9 March 9.00am - 11.00am

The Minister for Europe and International Development, Humza Yousaf MSP, and officials from the Scottish Government's International Development Team held an event for members of academic institutions with an interest in international development, in order to have a focussed discussion on international development policy. The group that I participated in had a rich discussion about approaches to create spaces for more collaborative research and public engagement within and between Scottish Universities working in global health and development. The recommendations and suggestions were for the creation of a regular forum for HE in global health and development, to prioritise South-South exchanges with research evidence and outputs, consideration of alternative forms of evidence from local knowledge and generated using participatory methodologies, and to prioritise capacity strengthening through technology and social media. Several of these views have developed as a result of the Verbal Autopsy with Participatory Action research (VAPAR) Development Grant work (DFID/MRC/Wellcome Trust/ESRC Health Systems Research Initiative (MR/N005597/1)). And some of the points (on creation of a Scottish HE/GHD forum, on the use of technology and social media and on South-South exchange) were reiterated by the Minister in the closing remarks.
Year(s) Of Engagement Activity 2016
URL https://www.eventbrite.co.uk/e/scottish-government-international-development-consultation-academia-e...
 
Description Health systems research: a partnerships approach to health in Mpumalanga | 14 Nov 2016 | The Winklet Nelspruit Mpumalanga 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The research has generated information relevant to the study settings on cause-specific disease profiles, their health systems and social determinants, and priorities for actionable public health agendas that have been rigorously verified at community and health systems levels. Co-constructed practical knowledge built from multiple perspectives is thoroughly embedded in, and thus relevant to, the local health systems context. With a focus on non-academic beneficiaries, these outputs will be disseminated in local communities and to health authorities to investigate their validity and relevance, and to reflect on the method as a means of sustainable and self-administered evaluation and planning.

EventBrite information (for dissemination to health authorities)

The Verbal Autopsy and Participatory Action Research (VAPAR) project has developed a method to connect health authorities, communities and researchers to do partnerships research of mutual benefit. This work has been progressed with the DFID/MRC/ESRC/Wellcome Health Systems Research Initiative and the Agincourt Health and Socio-Demographic Surveillance Site of Wits University, Mpumalanga Provincial Department of Health, and the Universities of Aberdeen in Scotland and Umea in Sweden.

In VAPAR, researchers, communities and health systems stakeholders worked together to generate evidence on disease profiles levels and causes, their health systems and social determinants, and priorities for action. With a focus on non-academic beneficiaries, these outputs are being disseminated to investigate their relevance, and to reflect on the method as a means of sustainable and self-administered evaluation and planning. The workshop will present three elements of the method for discussion with health systems colleagues.

(1) New ways to routinely record and understand deaths investigated in Verbal Autopsy (VA) in related to the circumstances of mortality;
(2) Participatory action research (PAR) as a method to generate evidence with communities on social and health systems avoidable mortality
(3) Working with health systems practitioners to interpret e VA and PAR data, producing actionable public health agendas.

The process provided more real data, rigorously validated at community and health systems levels addressing previously unknown issues and developing actionable plans. The method has been appraised as a robust and innovative partnerships approach to collaborative research, and viewed as acceptable and relevant for health systems use.

The workshop will disseminate the methods and findings. The workshop will strengthen partnerships for practical and problem oriented research, provide feedback on policy initiatives at different levels, extend contextually relevant approaches to VA, and continue to engage with communities through PAR.

This workshop brings together individuals from academic and non-academic backgrounds to explore methods and opportunities to generate 'people-centred', 'action-oriented' information on health inequalities. By people-centred information, we mean information developed by and for people who are directly affected by the issues being investigated. By action-oriented information, we mean information that is developed for and with, and embedded in, forms of acting upon the information provided.

The main aim is to extend the method into a process to act on the evidence generated. This adds a crucial link that goes beyond the identification of problems and solutions towards action and implementing change.
Year(s) Of Engagement Activity 2016
URL https://www.eventbrite.co.uk/e/health-systems-research-a-partnerships-approach-to-health-in-mpumalan...
 
Description Improving data improving health: Verbal Autopsy for health systems strengthening | 17 October 2016 | University College London 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The VAPAR Development Grant has generated a piloted methodology that promotes democratic knowledge production, capacity building and evidence-based advocacy. It has also explored innovations in mobile and digital technologies for scalable and efficient data collection and interpretation (Mobile Verbal Autopsy, MIVA and PhotoVoice). In this sense, the research provides important information for WHO in terms of the adaption of VA-based models for CVRS as a medium term strategy towards universal vital registration. This is a dissemination workshop with WHO with a focus on the methodological results in terms of a) biosocial classification systems for unregistered deaths and b) routine participatory adjuncts for health and demographic surveillance that are considered in the context of this broader methodological transition.

EventBrite Information:

Improving data improving health: Verbal Autopsy for health systems strengthening

The majority of deaths in Africa and Asia are never recorded. Verbal autopsy (VA) is a method to determine causes of death using an interview with witnesses of the death, data from which are interpreted to conclude medical causes. In this seminar, we will reflect on innovations in VA including automated and mobile VA, and examine contextualised approaches to understanding why people die outside facilities or without registration. We will also explore how information from VA can be made available as part of a health systems approach. The aim of the event is to consolidate methods that have the potential to bring together communities and policy makers with better data and improved capacity for evaluation. Join participants from the Information, Evidence and Research Unit at WHO, the Umeå WHO Collaborating Centre for VA, the Malaria Consortium, the Africa Centre, University College London Institute for Global Health and Lancet Global Health.

0900 Coffee and Registration

PART 1 OPEN MEETING HALDANE ROOM

0930 Welcome, introduction and opening remarks I Abubakar UCL Z Mullan, LGH (Chair)
0945 Keynote 1: Beyond research: VA in Civil Registration T Boerma, WHO
1000 Keynote 2: Making people count: advancing pragmatic approaches P Byass, UCGHR
1020 Presentation 1: Mobile VA, technological advances and ethical priorities E Fottrell, UCL
1040 Coffee
1100 Keynote 3: Social Autopsy, a method to examine barriers to health care, risky behaviours and missed opportunities for health intervention K Källander, Malaria Consortium
1120 Presentation 2: Verbal Autopsy and Participatory Action research (VAPAR): People-centred and action-oriented methods in South Africa L D'Ambruoso, UOA
1140 Presentation 3: Interfacing: making connections within and between states, through data dynamics, and with the international community K Herbst, Africa Centre
1200 Panel discussion Closing remarks Panel discussant to give closing remarks + Chair's closing remarks
1230 Lunch

PART 2 INVITED ROUNDTABLE SOUTH WING COUNCIL ROOM
1330 Roundtable discussion: Priorities for VA methods in health systems
- InterVA and mobile applications: opportunities to scale, ethical priorities and implementation opportunities
- VA/SA and VAPAR: embedding research in health systems / communicating evidence and the power and potential of local knowledge
- OUTPUT: Priorities for VA suite of approaches for health systems strengthening, developing a commentary 'We have the methods, how do we now use them in health systems?'

1630 Closing remarks and next steps Z Mullan, Chair
1700 Meeting close

LGH Lancet Global Health; UCGHR: Umea Centre for Global Health research; UCL University College London; UOA: University of Aberdeen
Year(s) Of Engagement Activity 2016
URL https://www.eventbrite.co.uk/e/improving-data-improving-health-verbal-autopsy-for-health-systems-str...
 
Description Lecture as part of the Queen Margaret University Grad Challenge Lecture Series at the Institute of Global Health and Development 25th February 2016 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact 25 February 2016 IGHD Grand Challenges Seminar
"WHAT YOU COUNT IS WHAT YOU DO": COUNTING AND ACCOUNTABILITY IN RESEARCH ON MATERNAL DEATH AND DISABILITY IN LOW AND MIDDLE-INCOME COUNTRIES

This talk examines methods to investigate maternal mortality and severe morbidity in resource poor settings. Three applied examples - a practitioner-based confidential enquiry, a verbal autopsy survey, and a community-based review drawn from work in Indonesia, Burkina Faso and South Africa - are presented to illustrate the implications of methodological choices for the evidence base about women, families and communities, and for policy, practice and services.

The session was broadcast online, conducted in the format of a webinar.

http://www.qmu.ac.uk/iihd/whats%20on/whats_on_2016.htm?platform=hootsuite#DAmbruoso

Preliminary results from the Verbal Autopsy with Participatory Action Research (VAPAR) methodological development work (DFID/MRC/Wellcome Trust/ESRC Health Systems Research Initiative (MR/N005597/1) ) were presented at this seminar.
Year(s) Of Engagement Activity 2016
URL http://www.qmu.ac.uk/iihd/whats%20on/whats_on.htm#DAmbruoso
 
Description Whose voices count? Doing research on the health of the poor | 7 Nov 2016 | University of Aberdeen 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact To facilitate application and evaluation of the method to wider audiences, we will hold a final dissemination workshop in the UK to engage with academic and non-academic audiences. Through the Public Engagement in Research Unit (PERU) at the University of Aberdeen (http://www.abdn.ac.uk/engage), we will conduct a workshop on the links between material and data poverty and methods and opportunities for people-centred health information. This meeting will consider the issues in the global knowledge economy, with reference to emerging mHealth innovations applying mobile and digital technologies for knowledge production on issues of health equity and social justice. At this meeting, we will discuss how and for whose purposes health information can be generated and shared for sustainable action towards improved health outcomes.

EventBrite information:

Part of the ESRC Festival of Social Science 2016
How should we be doing research with people living in poverty, who are hard to reach, vulnerable, disadvantaged and social excluded? People living in deprived conditions have crucial perspectives on health and social inequalities, and through authentic engagement can provide important evidence for public policy. This seminar brings together researchers working in different world regions to explore how we can do 'people-centred' and 'action-oriented' research on social and health inequalities. By people-centred research, we mean working with and for people who are directly affected by the issues being investigated. By action-oriented, we mean research that is embedded in contexts where knowledge outputs can be acted on for positive change. At the seminar, we will also launch the Centre for Global Development at the University of Aberdeen, a centre of excellence committed to equity, social justice and sustainable futures.

PROGRAMME
1130 Registration

1200 Centre for Global Development: Welcome and opening remarks | Professor P Abbott, Director Centre for Global Development (CGD)

1220 Making people count: the unequal world of global health data | Prof P Byass, Director Umea Centre for Global Health Research, Umea University, Sweden

1300 Lunch

1400 Working with people: a people-centred, action-oriented research project in South Africa | Dr L D'Ambruoso, Lecturer CGD

1440 Coffee

1500 What do 'the people' want? Arab voices in a troubled world, the Arab TRANS project | Dr A Teti, Director, Centre for Global Security & Governance

1540 Closing remarks and next steps: implications in the context of global development | Prof P Abbott, CGD, Dr L D'Ambruoso, CGD, Dr N Dower, CGD, Dr P Mtika, CGD

1600 Close
Year(s) Of Engagement Activity 2016
URL https://www.eventbrite.co.uk/e/whose-voices-count-doing-research-on-the-health-of-the-poor-tickets-2...