RESPONSE

Project Details

The socio-economic growth in many low and middle-income countries (LMICs) has resulted in more available – though not equitably accessible - healthcare. Such growth has also increased demands from citizens for their health systems to be more responsive to their health needs. A family waiting at a hospital reception in Hanoi, VietnamResponsiveness, a key goal of any national health system is “…when institutions… are cognisant and respond appropriately to the universally legitimate expectations of individuals... safeguarding of rights of patients to adequate… care” (de Silva, 2000; p.3) and its improvement is the focus of our study.

This study seeks to contribute to improving health systems responsiveness in LMICs through case studies of addressing neglected health needs of vulnerable groups  in Ghana and Vietnam. We will co-produce, implement and evaluate context-sensitive interventions to improve systems responsiveness to the needs and expectations of pregnant women, particularly those with neglected mental health problems.

Project objectives
Our core question is: “In what way can health systems become more responsive to neglected health needs of vulnerable groups within the contexts of lower-middle-income countries? The project objectives are to:

1. Conduct in-depth analyses of how health systems responsiveness is understood and enacted by key health systems actors, and to what degree the local health systems are responsive to these expectations;
2. Co-produce, implement and evaluate context-sensitive interventions to improve health systems responsiveness to neglected health needs of vulnerable groups;
3. Develop an empirically based and theoretically grounded model of complex relations between the contexts, the mechanisms and the outcomes of the interventions to improve health systems responsiveness;
4. Develop transferable best practices for scalability and generalisability of the pilot-tested interventions
5. Strengthen research capacity through extending existing collaborations into strong South-South and South-North exchange and learning within and between Ghana, Vietnam, Australia and the UK.

The study comprises three Phases.

In Phase 1, we will understand actors’ expectations of responsive health systems, identify key priorities for systems responsiveness, using evidence from the realist synthesis will develop initial programme theory. We will also generate a baseline through reviewing relevant documents and analyse facility records, conduct in-depth interviews, focus groups and community survey.

In Phase 2, we will co-produce the context-sensitive interventions to improve health systems responsiveness. The interventions will seek to improve internal (i.e. within health system) and external (i.e. people-systems) interactions through participatory workshops with health workers and communities, addressing priorities from Phase 1. The co-production will be through meetings with key local, district, regional and national actors, to be led by relevant health authorities and carefully documented by researchers.

In Phase 3, we will implement and evaluate the interventions. The implementation will be through existing structures and processes. In the evaluation, we will test and refine our initial theory through comparing the intended design to the interventions’ actual performance. We will also assess interventions’ feasibility, acceptability and processes.

Researchers

• Professor Sumit Kane (Principal Investigator)
• Kimberly Lakin

Collaborators

London School Of Hygiene And Tropical Medicine

• Prof Tolib Mirzoev (Principal Investigator and Project Coordinator)
• Dr Anna Cronin de Chavez

University of Leeds (Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences; School of Sociology and Social Policy)

• Dr Ana Manzano
• Dr Joseph Hicks
• Mrs Judy Wright

Ghana Health Service

• Professor Irene Agyepong (Principal Investigator, Ghana Team Lead)
• Dr Elizabeth Awini
• Ms Linda (Lucy) Yevoo
• Dr Mary Ashinyo

Mental Health Authority, Ghana

• Dr Leveana Gyimah

University of Ghana

• Dr Anthony Danso-Appiah

Hanoi University of Public Health

• Professor Bui Thi Thu Ha (Principal Investigator, Vietnam Team Lead)
• Dr Do Thi Hanh Trang
• Dr Doan Duong
• Dr Le Minh Thi
• Mrs Quynh Chi Nguyen
• Dr Le Thi Vui

Funding

Joint MRC / ESRC / DFID / Wellcome Health Systems Research Initiative

Research Publications

Trang, D. T. H., Ha, B. T. T., Vui, L. T., Chi, N. T. Q., Thi, L. M., Duong, D. T. T., Hung, D. T., Cronin de Chavez, A., Manzano, A., Lakin, K., Kane, S., & Mirzoev, T. (2024). Understanding the barriers to integrating maternal and mental health at primary health care in Vietnam. Health Policy and Planning, 39(6), 541-551. https://doi.org/10.1093/heapol/czae027

Lakin, K., & Kane, S. (2022). Peoples’ expectations of healthcare: A conceptual review and proposed analytical framework. Social Science & Medicine, 292, 114636. https://doi.org/https://doi.org/10.1016/j.socscimed.2021.114636

Lakin, K., & Kane, S. (2023). What can one legitimately expect from a health system? A conceptual analysis and a proposal for research and action. BMJ Global Health, 8(7), e012453. https://doi.org/10.1136/bmjgh-2023-012453

Lakin, K., Ha, D. T., Mirzoev, T., Ha, B. T. T., Agyepong, I. A., & Kane, S. (2024). “We can't expect much”: Childbearing women's ‘horizon of expectations’ of the health system in rural Vietnam. Health & Place, 85, 103166. https://doi.org/https://doi.org/10.1016/j.healthplace.2023.103166

Lakin, K., Huong, N. T., & Kane, S. Childbearing Women’s Experiences of and Interactions With the Health System in Vietnam: A Critical Interpretive Synthesis. Community Health Equity Research & Policy, 0(0), 2752535X241277678. https://doi.org/10.1177/2752535x241277678

Lakin, K., Ha, D. T., Thu Ha, B. T., Mirzoev, T., Agyepong, I. A., & Kane, S. (2024). 27 Childbearing women’s experiences of and interactions with the health system in post-Doi Moi Vietnam. BMJ Open, 14(Suppl 1), A10. https://doi.org/10.1136/bmjopen-2024-UCL-QHRN2024.27

Lakin, K., Ha, D. T., Ha, B. T. T., Mirzoev, T., Agyepong, I. A., & Kane, S. (2025). Women’s experiences of and interactions with the health system in post-Doi Moi Vietnam. SSM - Health Systems, 4, 100051. https://doi.org/https://doi.org/10.1016/j.ssmhs.2025.100051

Mirzoev, T., Manzano, A., Agyepong, I. A., Thi Thu Ha, B., Yevoo, L. L., Awini, E., Danso-Appiah, A., Gyimah, L., Trang, D. T. H., Thi, L. M., Lakin, K., & Kane, S. (2025). Theoretical foundations and mechanisms of health systems responsiveness: a realist synthesis. SSM - Health Systems, 100061. https://doi.org/https://doi.org/10.1016/j.ssmhs.2025.100061

Vui, L. T., Quy, L. X., Thi, L. M., de Chavez, A. C., Manzano, A., Lakin, K., Kane, S., Ha, B. T. T., Hicks, J., Mirzoev, T., Ha, N. T., Trang, D. T. H., & Chi, N. T. Q. (2024). Health systems responsiveness towards needs of pregnant women in Vietnam. BMC Health Services Research, 24(1), 1618. https://doi.org/10.1186/s12913-024-12040-6

Yevoo, L. L., Manzano, A., Gyimah, L., Kane, S., Awini, E., Danso-Appiah, A., Agyepong, I. A., & Mirzoev, T. (2024). Conceptualizing maternal mental health in rural Ghana: a realist qualitative analysis. Health Policy and Planning, 40(2), 244-258. https://doi.org/10.1093/heapol/czae116

Gyimah, L., Agyepong, I. A., Owiredu, D., Awini, E., Yevoo, L. L., Ashinyo, M. E., Aye, S. G. E. V., Abbas, S., Cronin de Chavez, A., Mirzoev, T., & Danso-Appiah, A. (2024). Tools for screening maternal mental health conditions in primary care settings in sub-Saharan Africa: systematic review [Systematic Review]. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1321689

Thi, L. M., Manzano, A., Ha, B. T. T., Vui, L. T., Quynh-Chi, N. T., Duong, D. T. T., Lakin, K., Kane, S., Mirzoev, T., & Trang, D. T. H. (2024). Mental health stigma and health-seeking behaviors amongst pregnant women in Vietnam: a mixed-method realist study. International Journal for Equity in Health, 23(1), 163. https://doi.org/10.1186/s12939-024-02250-z

Mirzoev, T., Cronin de Chavez, A., Manzano, A., Agyepong, I. A., Ashinyo, M. E., Danso-Appiah, A., Gyimah, L., Yevoo, L., Awini, E., Ha, B. T. T., Do Thi Hanh, T., Nguyen, Q.-C. T., Le, T. M., Le, V. T., Hicks, J. P., Wright, J. M., & Kane, S. (2021). Protocol for a realist synthesis of health systems responsiveness in low-income and middle-income countries. BMJ Open, 11(6), e046992. https://doi.org/10.1136/bmjopen-2020-046992

Mirzoev, T., Manzano, A., Ha, B. T. T., Agyepong, I. A., Trang, D. T. H., Danso-Appiah, A., Thi, L. M., Ashinyo, M. E., Vui, L. T., Gyimah, L., Chi, N. T. Q., Yevoo, L., Duong, D. T. T., Awini, E., Hicks, J. P., Cronin de Chavez, A., & Kane, S. (2021). Realist evaluation to improve health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam: Study protocol. PLoS One, 16(1), e0245755. https://doi.org/10.1371/journal.pone.0245755