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.


  • Professor Sumit Kane (Principal Investigator)
  • Kimberly Lakin


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


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

Research Publications

Lakin K, Kane S What can one legitimately expect from a health system? A conceptual analysis and a proposal for research and action
BMJ Global Health 2023;8:e012453.

Research Group

Social & Cultural Dimensions of Health Systems

School Research Themes

Prevention and management of non-communicable diseases (including cancer), and promotion of mental health, Disparities, disadvantage and effective health care, Data science, health metrics and disease modeling

Key Contact

For further information about this research, please contact the research group leader.

Department / Centre

Nossal Institute for Global Health

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