1. Health Systems: How to make innovations contagious? Improving health worldwide www.iceh.org.uk www.lshtm.ac.uk Karl Blanchet September 2012 IAPB 9 th GA, India

2. Research needs (Blanchet et al. 2012)

3. How do we look at systems?

4. Paradigm shifts – Connected – Unique – Embedded – Fluid

5. Connected The whole system (de Savigny, 2010) Social Network Analysis (Borgatti, 2010) Study in Ghana 2011 (Blanchet and James, 2011 and 2012)

6. Connected Improving health worldwide www.iceh.org.uk www.lshtm.ac.uk 2006

7. Connected Improving health worldwide www.iceh.org.uk www.lshtm.ac.uk 2010

8. Unique No standard model Diversity Measuring – Performance (equity, efficiency...?) – Sustainability (Sustainability Analysis Process) – Resilience

9. Embedded

10. Eye Health Systems Assessment (EHSA) Guideline Country reports – Ghana – Sierra Leone

11. Fluid Flows and Dynamics Complex adaptive system Diffusion of innovations Theory (Rogers, 1985)

12. Attributes of innovations Relative advantage (5=very high relative advantage) Compatibility (5=very highly compatible- 1=very incompatible) Complexity (5=not complex – 1=very highly complex) Triability (5=very highly triable – 1=very highly untriable) Observability (5=very highly observable – 1=very highly unobservable) Total (max = 25) Continue ? Facility-based Consultations 5551319 Yes Cataract surgery 5521518 Yes Outreach activities 5221313 No School health5211110 No Blanchet and James, Submitted

13. HSR: What for?

14. Health Systems Dashboard

15. Thank you Thank you to our Donors: Swiss Red Cross CBM Handicap International Sightsavers Improving health worldwide www.iceh.org.uk www.lshtm.ac.uk