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In my previous post, I discussed the need for a more integrated approach to health, recognizing the deep connections between health and socioeconomic factors. Now, I’d like to share a concrete example of how this integration can be achieved at the community level.

This project highlights the crucial role of Community Health Workers (CHWs or kader) as agents of change, bridging health, environment, and food security by leveraging their local knowledge and community trust. As health outcomes depend on addressing environmental and food security challenges, CHWs are spearheading community programs such as maternal & neonatal health post (posyandu) and grow your own food movement (GYOF). The project emphasizes the interconnectedness of these domains.

For years, I worked tirelessly in infectious disease control, specifically HIV. It often felt like a treadmill. We’d make progress, but it never seemed to be enough. Treatment wasn’t optimal - not enough access, improper prescriptions, or patients not adhering to instructions. On the prevention side, we weren’t faring much better. Containing outbreaks, promoting healthy behaviors - all fronts felt suboptimal.

    Pessimist: "Glass is half empty"
    Optimist: "Glass is half full" 
    Realist: "Glass is half water, half air"

We all know the famous “glass half-full or half-empty” metaphor, a classic illustration of optimist vs. pessimist perspectives. But this analogy often overlooks a crucial perspective: the realist. Realists assess the situation as it is, considering both the potential and the limitations. This resonates deeply with my approach to health system strengthening, where I combine realist evaluation, systems thinking, and pragmatism.

In today’s world, understanding why things work or don’t work can be a real challenge, especially in health interventions where numerous factors can influence the success or failure of a program. Realist evaluation is a research method that helps us unravel this complexity and gain a deeper understanding of how and why interventions work (or don’t work) in different contexts.

Realist evaluation is a type of qualitative research that seeks to explain the underlying mechanisms that produce outcomes. The central idea behind realist evaluation is the C-M-O configuration, which stands for Context-Mechanism-Outcome. This framework suggests that interventions work (or don’t work) because of the interplay between the context in which they are implemented, the mechanisms they trigger, and the outcomes they produce.

Ever found yourself juggling too many factors while making a decision? That’s where Multi-Criteria Decision Analysis (MCDA) comes in. MCDA is a systematic approach that involves evaluating multiple criteria or factors simultaneously to make informed decisions. It’s a fancy term, but the idea is simple: break down complex decisions into smaller parts and weigh each part based on what matters most to you.

Think of it like choosing a laptop. You might want a sleek design, long battery life, and a good price, but how do you balance these competing desires? MCDA helps you assign weights to each factor (design, battery, price) and score different laptops against those factors. This way, you can see which laptop comes out on top based on your priorities.

The 8th INAHEA Biennial Scientific Meeting, themed “Health System Transformation: Demographic Transition and Economic Challenges,” was held on October 25-27, 2023, at Universitas Indonesia, Depok. During this meeting, I had the privilege of conducting a workshop on Multi-Criteria Decision Analysis (MCDA), a powerful tool for navigating complex decisions in healthcare.     In the workshop, I introduced the basic principles of MCDA and its application in health settings, especially HTA. I also presented a case study on the use of MCDA for prioritizing new TB diagnostics for Indonesia.