Bruno Marchal
Dados Biográficos
| ID | 197749 |
|---|---|
| NOME | Bruno Marchal |
| PRENOMES | Bruno |
| SOBRENOME | Marchal |
| ASSINATURA | MARCHAL B |
| AFILIAÇÕES | Instituut voor Tropische Geneeskunde |
| ORCID | 0000-0001-7185-022X |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 46 |
| TOTAL DE CITAÇÕES | 54 |
| TOTAL COMO AUTOR | 46 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 2004 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 4 |
Getting unstuck
The concepts of health systems strengthening and health systems resilience are conceptually different but often used interchangeably in health policy and systems research and practice. Operationalising them can be difficult, but both are particularly relevant in contexts of conflict, violence and institutional fragility. In the current landscape of increasing complexity of humanitarian crises and constrained resources, understanding their meaning…
Eliciting the Initial Programme Theory in a Realist Evaluation of Facility-Based Maternal Death Reviews in Benin
The initial program theory (IPT) is a core element of realist evaluation. An IPT presents a hypothesis about how, for whom, why, and in what contexts an intervention is effective. Despite their importance within realist studies, methodological guidance on how to develop an IPT is relatively scarce. We describe the methodological process of eliciting an IPT of facility-based maternal death reviews (FbMDRs), a multicomponent intervention to improve…
Initiating systemic capacity development for leadership from the bottom-up
The need for leadership within district health systems is critical for the effective delivery of services and for inter-sectoral collaboration for health. Leadership capacity development (LCD) has not, however, been prioritized within health systems, and the systemic capacity (i.e. roles, structures and processes) that is needed to develop managers who can lead is not always in place. This paper aims to contribute to understanding how to build su…
Context and generalizability in health policy and systems research
In this article, we address the conundrum of context in health policy and systems research, zooming in on research on implementation of programmes, policies, and interventions. We review how the field draws on non-linear paradigms to better take into account ‘context’ in causal explanation, and we compare paradigms and the way in which they can inform more context-sensitive research, policies, and programmes. We propose a theorizing praxis that i…
Revisiting health systems to integrate perinatal mental health into maternal and child health services
box There is a growing call for actionable recommendations to promote perinatal mental health and to prevent and treat perinatal mental health conditions, particularly in Africa
How Does the Context Shape the Technical Support from the Provincial Health Administration to District Health Management Teams in the Democratic Republic of Congo? A Realist Evaluation
Since 2014, the health sector in the Democratic Republic of the Congo has been undergoing reforms aimed at strengthening the Provincial Health Administration (PHA) to better support health district development through technical support to district health management teams (DHMTs). However, there is limited understanding of how, for whom, and under what conditions this support works. Using a realist evaluation approach, this study aimed to test an …
Evaluation study of the urban governance of the Covid-19 crisis in the city of Antwerp
Local governments are important to develop tailored strategies and organise a locally relevant crisis response in cities. They need expertise and agency, with enough flexibility to experiment. To harness promising practices and avoid repeating errors in future crises, it is crucial to develop a system that better evaluates and monitors local responses, before, during and after crises
How do urban green spaces influence heat-related mortality in elderly? A realist synthesis
Looking into the impact of urban green spaces on heat-related mortality in elderly, researchers and policy makers should take interest in the role of social capital
Conditions for health system resilience in the response to the Covid-19 pandemic in Mauritania
INTRODUCTION: A country's ability to manage a crisis depends on its level of resilience. Efforts are made to clarify the concept of health system resilience, but its operationalisation remains little studied. In the present research, we described the capacity of the local healthcare system in the Islamic Republic of Mauritania, in West Africa, to cope with the COVID-19 pandemic. METHODS: We used a single case study with two health districts as un…
Making ‘resilience’ useful again
How to develop a realist programme theory using Margaret Archer’s structure–agency–culture framework
Realist evaluation is in essence a theory-building and testing approach. We argue that in practice, the theory-building potential of realist evaluation, review and research is not fully exploited in the field of global health. Our assumption is that the Structure-Agency-Culture explanatory framework of critical realist Margaret Archer could stimulate realist evaluators to conceptualize and systematically explore how structural and cultural condit…
A perspective on urban health systems and research for equitable healthcare in Africa
Key messages Urbanisation in Africa poses complex challenges for health due to ill-informed planning and governance, worsening gaps in the built environment and the quadruple burden of disease. Achieving equitable urban (health) benefits requires a framework for understanding how urban health systems are conceptualised, planned and governed. Five approaches and frameworks for analysing or implementing urban health strategies in sub-Saharan Africa…
Applying the Realist Evaluation Approach to the Complex Process of Policy Implementation—The Case of the User Fee Exemption Policy for Cesarean Section in Benin
Realist evaluation is making inroads in the field of health policy and systems research to a large extent because of its good fit with complex issues. Until now, most realist studies focused on evaluating interventions or projects related to health care delivery, organization of health services, education, management, and leadership of health workers in high income countries. With this paper, we apply the realist approach to the study of national…
Systematic Review on the Impact of Conditional Cash Transfers on Child Health Service Utilisation and Child Health in Sub-Saharan Africa
Background: Conditional cash transfers (CCTs) are interventions which provide assistance in the form of cash to specific vulnerable groups on the condition that they meet pre-defined requirements. The impact of conditional cash transfers on children's access to health services and on their overall health has not been established in sub-Saharan Africa. Method: We conducted a systematic review aimed at summarising the available information on the i…
Bottom-up innovation for health management capacity development
District managers are well placed to design local capacity development innovations and must draw on systems thinking, tacit and experiential knowledge to enable relevant 'bottom-up' capacity development in district health systems. By drawing on soft skills and the policy resources (hardware) of the system they can influence motivation and buy-in to improve management practices. From a systems perspective, we argue that capacity development can be…
What role can health policy and systems research play in supporting responses to Covid-19 that strengthen socially just health systems
To say that we live in turbulent times is a massive understatement. COVID-19 ruthlessly exposes the fault lines of health services and systems, and the responses put in place to prevent its spread or mitigate its effects may affect people more than the actual infection. The outbreak in Wuhan quickly grew to a pandemic that has affected countries and regions all over the world in many, and as of yet, little understood ways. This is a global infect…
Opening the ‘implementation black-box’ of the user fee exemption policy for caesarean section in Benin
To improve access to maternal health services, Benin introduced in 2009 a user fee exemption policy for caesarean sections. Similar to other low- and middle-income countries, its implementation showed mixed results. Our study aimed at understanding why and in which circumstances the implementation of this policy in hospitals succeeded or failed. We adopted the realist evaluation approach and tested the initial programme theory through a multiple …
What's in a Realist Configuration? Deciding Which Causal Configurations to Use, How, and Why
Background: Realist studies represent an increasingly popular approach for exploring complex interventions' successes and failures. The theory-driven approach seeks to explain 'what works, how, why, in which contexts, for whom, and to what extent' using context-mechanism-outcome (CMO) configurations. When the approach was first developed, CMO configurations were the method for expressing causal explanations. Increasingly, realist studies have bee…
Using the realist interview approach to maintain theoretical awareness in realist studies
Realist evaluation submits that theories and models of how, why, for whom and under what circumstances programs work could be formulated by conceptualizing the relational links between the context within which programs are implemented, the generative mechanisms the programs trigger, and the outcomes of interest. Qualitative and quantitative data collection and analysis allow for the description of the relevant context, the generative mechanisms, …
The Theological Trap
I explain why theology and the spiritual research are always near a fatal trap which is intrinsic to their subject matter, and why religion can easily lead to pseudo-science and pseudo-religion, leading itself toward hate, war, and misery. \nI suggest how we might be able to prevent this. I have to warn that such prevention can, of course, be misused by dishonest or excessively naïve people with motivations usually unrelated to religion, but rela…
A qualitative study of the dissemination and diffusion of innovations
Those driving reform processes from 'the top' must remember to develop well planned dissemination strategies that give lower-level managers relevant information and, as part of those strategies, provide ongoing opportunities for bottom up input into key decisions and processes. Managers in districts must be recognised as leaders of change, not only as implementers who are at the receiving end of dissemination strategies from those at the top. The…
Does public service motivation matter in Moroccan public hospitals? A multiple embedded case study
This study highlights the presence of PSM as a driver of motivation among health workers in four Moroccon hospitals, and the prominence of intrinsic motivation and compassion in the motivation of frontline health workers. Religious beliefs were found to shape the expression of PSM in Morocco
Determinants of effective organisational capacity training
Training, even if relevant and applicable, makes no more than a 'latent' contribution, one which is activated and realised through alignment of clusters of interacting contextual and relational factors related to the target institutions and trained personnel. While not predictable, implementers need to focus more deliberately on the likely interaction and best possible alignments between training relevance, student selection for potential to cont…
A systems perspective on the importance of global health strategy developments for accomplishing today’s Sustainable Development Goals
A systems perspective on the importance of global health strategy developments for accomplishing today’s Sustainable Development Goals
Priority setting within health systems has not led to accountable, fair and sustainable solutions to improving population health. Providers, users and other stakeholders each have their own health and service priorities based on selected evidence, own values, expertise and preferences. Based on a historical account, this article analyses if contemporary health systems are appropriate to optimize population health within the framework of cross cut…
Using the realist interview approach to maintain theoretical awareness in realist studies
Realist evaluation submits that theories and models of how, why, for whom and under what circumstances programs work could be formulated by conceptualizing the relational links between the context within which programs are implemented, the generative mechanisms the programs trigger, and the outcomes of interest. Qualitative and quantitative data collection and analysis allow for the description of the relevant context, the generative mechanisms, …
What's in a Realist Configuration? Deciding Which Causal Configurations to Use, How, and Why
Background: Realist studies represent an increasingly popular approach for exploring complex interventions' successes and failures. The theory-driven approach seeks to explain 'what works, how, why, in which contexts, for whom, and to what extent' using context-mechanism-outcome (CMO) configurations. When the approach was first developed, CMO configurations were the method for expressing causal explanations. Increasingly, realist studies have bee…
Realist RCTs of complex interventions - An oxymoron
What role can health policy and systems research play in supporting responses to Covid-19 that strengthen socially just health systems
To say that we live in turbulent times is a massive understatement. COVID-19 ruthlessly exposes the fault lines of health services and systems, and the responses put in place to prevent its spread or mitigate its effects may affect people more than the actual infection. The outbreak in Wuhan quickly grew to a pandemic that has affected countries and regions all over the world in many, and as of yet, little understood ways. This is a global infect…
Interface flow process audit
The interface flow process audit appears a useful method for regular in-service self-evaluation. Its practice enabled to address a wide scope of clinical, managerial and economical problems. Bridging the primary-secondary care gap, interface flow process audit's focus on the patient's career combined with the broad scope of problems that can be analysed are particularly powerful features. The methodology would benefit from an evaluation of its pr…
Patients Are Not Following the [Adherence] Club Rules Anymore
There is growing evidence that differentiated care models employed to manage treatment-experienced patients on antiretroviral therapy could improve adherence to medication and retention in care. We conducted a realist evaluation to determine how, why, for whom, and under what health system context the adherence club intervention works (or not) in real-life implementation. In the first phase, we developed an initial program theory of the adherence…
How to develop a realist programme theory using Margaret Archer’s structure–agency–culture framework
Realist evaluation is in essence a theory-building and testing approach. We argue that in practice, the theory-building potential of realist evaluation, review and research is not fully exploited in the field of global health. Our assumption is that the Structure-Agency-Culture explanatory framework of critical realist Margaret Archer could stimulate realist evaluators to conceptualize and systematically explore how structural and cultural condit…
Interface flow process audit
The interface flow process audit appears a useful method for regular in-service self-evaluation. Its practice enabled to address a wide scope of clinical, managerial and economical problems. Bridging the primary-secondary care gap, interface flow process audit's focus on the patient's career combined with the broad scope of problems that can be analysed are particularly powerful features. The methodology would benefit from an evaluation of its pr…
Global Health Actors Claim To Support Health System Strengthening—Is This Reality or Rhetoric?
Our review found that, on the ground, very different interventions are imple
How to develop a theory-driven evaluation design? Lessons learned from an adolescent sexual and reproductive health programme in West Africa
The six-step framework proved useful as it allowed for a systematic development of the protocol. We describe the challenges at each step. We found that there is little practical guidance in the existing literature, and also a mix up of terminology of theory-driven evaluation approaches. There is a need for empirical methodological development in order to refine the tools to be used in theory driven evaluation. We conclude that ex-post evaluations…
Turning around an ailing district hospital
This study shows how a hospital management team in Ghana succeeded in resuscitating an ailing hospital. Their high commitment management approach led to the active involvement and empowerment of staff. It also showed how a realist evaluation approach such as this, could be used in the research of the management of health care organisations to explain how management interventions may or may not work
The Health System Dynamics Framework
Frameworks can clarify concepts and improve understanding of underlying mechanisms in the domain of health systems research and strengthening. Many existing frameworks have a limited capacity to analyze interactions and equilibriums within a health system overlooking values as an underlying steering mechanism. This paper introduces the health system dynamics framework and demonstrates its application as a tool for analysis and modelling. The adde…
Research, evidence and policymaking
This study refined an initial MRT on KT in policymaking in the health sector in Uganda that was based on a literature review. It provides a framework that can be used in empirical research of the process of KT on specific policy issues
Health systems frameworks in their political context
Health systems theories and frameworks frame health, health systems and policies in particular political and public health paradigms. While there is a clear trend to try to understand the complexity of and dynamic relationships between elements of health systems, there is also a demand to provide frameworks that distinguish between health system interventions, and that allow mapping with a view of analysing their returns. The choice for a particu…
Is realist evaluation keeping its promise? A review of published empirical studies in the field of health systems research
This overview aims to stimulate conceptual and practical discussions to help unlock the full potential of realist evaluation in health systems research. Based on a structured literature search, this review maps how the concepts of realist evaluation are applied in health systems research and which methodological problems are encountered. We found a great diversity in the depth of application of the philosophical concepts, use of terminology and s…
Realist RCTs of complex interventions - An oxymoron
Measuring the health systems impact of disease control programmes
As with frameworks in general, the WHO Building Blocks framework is valuable because it creates a common language and shared understanding. However, for applied research, it falls short of what is needed to holistically evaluate the impact of specific interventions on health systems. We propose that if researchers use the framework, it should be adapted and made context-specific
NeoNeoplatonism
In this short paper I will argue that theology, or at least Platonist theology can be done with the scientific method, but that, perhaps paradoxically at first sight, this does not prevent the role of religion, nor the necessity of a dialog between science and theology (making it in part into a dialog internal to science) or between science and religion, seen as possible applied theology. It is important to keep in mind that science, well underst…
Analyzing Katana referral hospital as a complex adaptive system
This study deals with the adaptation of Katana referral hospital in Eastern Democratic Republic of Congo in a changing environment that is affected for more than a decade by intermittent armed conflicts. His objective is to generate theoretical proposals for addressing differently the analysis of hospitals governance in the aims to assess their performance and how to improve that performance. The methodology applied approach uses a case study usi…
A Short Note on the Scienti?c Attitude, the Religious Attitude and the Surrational
We explain that the scientific attitude, with a “good understanding” of what is science, might be the most genuinely religious attitude, and that in fact, religion and science are much closer than what we are usually told. Nevertheless they cannot be identified effectively in any terrestrial applications without leading to inconsistency, but are truly, and thus non effectively, identical in the ever guessed true realm
Cost and impact of policies to remove and reduce fees for obstetric care in Benin, Burkina Faso, Mali and Morocco
We conclude that the policies were effective in meeting financial protection goals and probably health and equity goals, at sustainable cost, but that a range of measures could increase their effectiveness and equity. These include broadening the exempted package (especially for those countries which focused on caesarean sections alone), better calibrated payments, clearer information on policies, better stewardship of the local health system to …
Fair publication of qualitative research in health systems
10.1186/s12939-016-0368-y
Should we naturalize mind, or should we arithmetize matter
Self and Soul, from Logic to Experience
Building a middle-range theory of free public healthcare seeking in sub-Saharan Africa
Realist reviews are a new form of knowledge synthesis aimed at providing middle-range theories (MRTs) that specify how interventions work, for which populations, and under what circumstances. This approach opens the 'black box' of an intervention by showing how it triggers mechanisms in specific contexts to produce outcomes. We conducted a realist review of health user fee exemption policies (UFEPs) in sub-Saharan Africa (SSA). This article prese…
Theory and Realist Methods
Religion, science and theology, similarity and differences
In this short paper I explain why the discovery of the universal machine is a major discovery, totally unexpected, and quite extraordinary. I will explain, as much as possible in layman terms, what meant “theology” in the general sense of the Greeks who invented the theological science, and I will explain why the universal machine has a canonical theology in that sense. Some knowledge of the notion of functions is required. \nI do not claim any o…
Patients Are Not Following the [Adherence] Club Rules Anymore
There is growing evidence that differentiated care models employed to manage treatment-experienced patients on antiretroviral therapy could improve adherence to medication and retention in care. We conducted a realist evaluation to determine how, why, for whom, and under what health system context the adherence club intervention works (or not) in real-life implementation. In the first phase, we developed an initial program theory of the adherence…
The Theological Trap
I explain why theology and the spiritual research are always near a fatal trap which is intrinsic to their subject matter, and why religion can easily lead to pseudo-science and pseudo-religion, leading itself toward hate, war, and misery. \nI suggest how we might be able to prevent this. I have to warn that such prevention can, of course, be misused by dishonest or excessively naïve people with motivations usually unrelated to religion, but rela…
A qualitative study of the dissemination and diffusion of innovations
Those driving reform processes from 'the top' must remember to develop well planned dissemination strategies that give lower-level managers relevant information and, as part of those strategies, provide ongoing opportunities for bottom up input into key decisions and processes. Managers in districts must be recognised as leaders of change, not only as implementers who are at the receiving end of dissemination strategies from those at the top. The…
Does public service motivation matter in Moroccan public hospitals? A multiple embedded case study
This study highlights the presence of PSM as a driver of motivation among health workers in four Moroccon hospitals, and the prominence of intrinsic motivation and compassion in the motivation of frontline health workers. Religious beliefs were found to shape the expression of PSM in Morocco
Determinants of effective organisational capacity training
Training, even if relevant and applicable, makes no more than a 'latent' contribution, one which is activated and realised through alignment of clusters of interacting contextual and relational factors related to the target institutions and trained personnel. While not predictable, implementers need to focus more deliberately on the likely interaction and best possible alignments between training relevance, student selection for potential to cont…
Medicine (27 obras) · Political science (25 obras) · Computer Science (22 obras) · Sociology (20 obras) · Nursing (17 obras) · Public relations (17 obras) · Global Maternal and Child Health (16 obras) · Public health (16 obras) · Business (15 obras) · Economic growth (15 obras)