Bruno Marchal

Bruno Marchal
Institute of Tropical Medicine | ITM · Department of Public Health, Complexity and Health unit

MD, MPH, PhD

About

247
Publications
97,950
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4,326
Citations
Introduction
Bruno Marchal is associate professor at the Complexity and Health unit, Department of Public Health, Institute of Tropical Medicine. Bruno does research in Health Policy and Systems, with a specific focus on local health systems and research methodology for complex issues in health. Current research themes include urbanisation and health, and Ecohealth.
Additional affiliations
January 2013 - present
School of Public Health, University of the Western Cape, Cape Town
Position
  • Visiting researcher

Publications

Publications (247)
Article
Full-text available
### Summary box Ridde recently called for a commitment to implementation science and for ‘better quality research in order to have a greater understanding of how to implement health interventions’.1 He argued for better use of theory and implementation science studies that contribute to theory. This is indeed of paramount importance, especially fo...
Article
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The 400 million indigenous people worldwide represent a wealth of linguistic and cultural diversity, as well as traditional knowledge and sustainable practices that are invaluable resources for human development. However, indigenous people remain on the margins of society in high, middle and low-income countries, and they bear a disproportionate bu...
Article
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In this paper, we respond to a paper by Jamal and colleagues published in Trials in October 2015, taking the opportunity to continue the much-needed debate about what applied scientific realism is. The paper by Jamal et al. is useful because it exposes the challenges of combining a realist evaluation approach (as developed by Pawson and Tilley) wit...
Article
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Objectives: This paper presents the results of a realist evaluation that aimed to understand how, why and under what circumstances a Red Cross (RC) capacitybuilding intervention influences the motivation and the performance of RC community health volunteers involved in the delivery of an immunisation programme in Kampala, Uganda. Method: Given the...
Article
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Health Facility Assessments (HFAs) assessing facilities’ readiness to provide services are well-established. However, HFA questionnaires are typically quantitative and lack depth to understand systems in which health facilities operate—crucial to designing context-oriented interventions. We report lessons from a multiple embedded case study explori...
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Realist evaluation (RE) is a theory-driven evaluation approach inspired by scientific realism. It has become increasingly popular in the field of global health where it is often applied in low- and middle-income countries. This makes it timely to discuss RE's relationship to the emerging decolonisation of global health movement. In this short persp...
Article
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Introduction Despite a strong evidence base for developing interventions to reduce child mortality and morbidity related to pregnancy and delivery, major knowledge–implementation gaps remain. The Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) in sub-Saharan Africa project aims to overcome these gaps through strengthe...
Article
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Background Insufficient reductions in maternal and neonatal deaths and stillbirths in the past decade are a deterrence to achieving the Sustainable Development Goal 3. The majority of deaths occur during the intrapartum and immediate postnatal period. Overcoming the knowledge-do-gap to ensure implementation of known evidence-based interventions dur...
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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 Afri...
Article
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Introduction: The objective of this study was to identify the factors that influenced the poor performance of the Community Observatory on Access to Health Services (OCASS) project during its implementation from 2014 to 2017 in Guinea and to formulate recommendations for the rest of the project. Methods: This was a qualitative study using the mu...
Article
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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 worke...
Article
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Objectives This paper presents the iterative process of participatory multistakeholder engagement that informed the development of a new national tuberculosis (TB) policy in Georgia, and the lessons learnt. Methods Guided by realist evaluation methods, a multistakeholder dialogue was organised to elicit stakeholders’ assumptions on challenges and p...
Article
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Background As part of health system strengthening in South Africa (2012–2017) a new district health manager, taking a bottom-up approach, developed a suite of innovations to improve the processes of monthly district management team meetings, and the practices of managers and NGO partners attending them. Understanding capacity as a property of the h...
Article
Background: . Implementation of healthcare regulatory policies, especially in low- and middle-income countries where the private health sector is predominant, is challenging. Karnataka, a southern state in India, enacted the Karnataka Private Medical Establishments Act (KPMEA) with an aim to ensure quality of care in the private healthcare establi...
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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 we...
Preprint
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Background As part of health system strengthening in South Africa (2012- 2017) a new district health manager, taking a bottom-up approach to developing managerial capacity, developed a suite of innovations to improve the processes and practices of managers and NGO partners in monthly district management team meetings. Using a systems perspective on...
Preprint
Full-text available
Background As part of health system strengthening in South Africa (2012- 2017) a new district health manager, taking a bottom-up approach to developing management capacity, developed a suite of innovations to improve the processes and practices of managers and NGO partners in monthly district management team meetings. Understanding capacity as a pr...
Article
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Background: Access to qualitative and equitable healthcare is a major challenge in Mauritania. In order to support the country's efforts, a health sector strengthening programme was set up with participatory action research at its core. Reinforcing a health system requires a customised and comprehensive approach to face the complexity inherent to...
Article
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Objectives: This study aimed at opening the black box of the relationship between leadership and motivation of health workers by focusing on a high-performance hospital in Morocco. Design: We adopted the realist evaluation approach and used the case study design to test the initial programme theory we formulated on the basis of a scoping review...
Article
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Objectives: We aimed at exploring the underlying mechanisms and contextual conditions by which leadership may influence 'public service motivation' of health providers in Moroccan hospitals. Design: We used the realist evaluation (RE) approach in the following steps: eliciting the initial programme theory, designing the study, carrying out the d...
Article
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Background: In India, heterogenous tribal populations are grouped together under a common category, Scheduled Tribe, for affirmative action. Many tribal communities are closely associated with forests and difficult-to-reach areas and have worse-off health and nutrition indicators. However, poor population health outcomes cannot be explained by geog...
Article
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Background: Health systems in sub-Saharan Africa face multifaceted capacity challenges to fulfil their mandates of service provision and governance of their resources. Four academic institutions in Africa implemented a World Health Organisation-funded collaborative project encompassing training, curriculum development, and partnership to strengthe...
Article
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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...
Article
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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 co...
Article
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Background: The motivation of health workers is a key concern of policy makers, practitioners and researchers. Public Service Motivation (PSM), defined as the altruistic desire to serve the common interest, to serve others and to help patients and their families regardless of financial or external rewards, has been shown to be key to the performan...
Preprint
Background Health systems in sub-Saharan Africa face multifaceted capacity challenges to fulfil their mandates of service provision and governance of their resources. Four academic institutions in Africa implemented a World Health Organisation-funded collaborative project encompassing training, curriculum development, and partnership to strengthen...
Article
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Corrigendum: Change co-author name to Stephen Maluka. Article abstract czz042: 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...
Article
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Background: Improving access to paediatric HIV treatment requires large-scale antiretroviral treatment programmes and medication adapted to infants and children's needs. The World Health Organisation recommends lopinavir/ritonavir plus two nucleoside reverse transcriptase inhibitors as first-line treatment for all HIV-infected children younger tha...
Article
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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 contemp...
Article
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Background: An estimated 7.9 million people were living with HIV in South Africa in 2017, with 63.3% of them remaining in antiretroviral therapy (ART) care and 62.9% accessing ART. Poor retention in care and suboptimal adherence to ART undermine the successful efforts of initiating people living with HIV on ART. To address these challenges, the ant...
Chapter
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L’évaluation réaliste (ER) explicite les mécanismes causaux des résultats d’une intervention dans différents contextes. En s’appuyant sur l’évaluation de la mise en œuvre d’une politique de santé en Afrique de l’Ouest, ce chapitre illustre les différentes étapes du cycle de l’ER. À la première étape, les questions de recherche sont formulées. La va...
Article
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Lehoux and colleagues plea for a health systems perspective to evaluate innovations. Since many innovations and their scale-up strategies emerge from processes that are not (centrally) steered, we plea for any assessment with a dynamic, instead of a sequential, approach. We provide further guidance on how to adopt such dynamic approach, in order to...
Article
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Introduction In 2016, Georgian researchers and policymakers were developing a policy to improve the performance of the national tuberculosis (TB) control programme. The research programme ‘Designing and Evaluating Provider Results-Based Financing for Tuberculosis Care in Georgia: Understanding Costs, Mechanisms of Effect and Impact (Results4TB)’ wa...
Article
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Background In 2012 the South African National Department of Health (SA NDoH) set out, using a top down process, to implement several innovations in eleven health districts in order to test reforms to strengthen the district health system. The process of disseminating innovations began in 2012 and senior health managers in districts were expected to...
Article
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Background Although empirical evidence suggests that the adherence club model is more effective in retaining people living with HIV in antiretroviral treatment care and sustaining medication adherence compared to standard clinic care, it is poorly understood exactly how and why this works. In this paper, we examined and made explicit how, why and f...
Data
Interview guide–health care providers. (DOCX)
Article
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Background: Digital innovations have shown promise for improving maternal health service delivery. However, low- and middle-income countries are still at the adoption-utilization stage. Evidence on mobile health has been described as a black box, with gaps in theoretical explanations that account for the ecosystem of health care and their effect on...
Article
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Background The integration of mental health services into primary care is essential to improve the coverage of mental health services in low resource settings, but the evaluation of this remains challenging. We used a programme’s Theory of Change (ToC) as a conceptual framework to determine what combination(s) of conditions at facility and communit...
Article
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Background Youth-friendly health care services can facilitate young people’s access to health care services and promote their health, including their mental health. In Sweden, a network of youth health centers exist since the 1970s, incorporated within the public health system. Even if such centers take a holistic approach to youth health, the focu...
Data
S1_-_Observation_guide – Supplemental material for “Patients Are Not Following the [Adherence] Club Rules Anymore”: A Realist Case Study of the Antiretroviral Treatment Adherence Club, South Africa
Data
S2_-_Interview_guide-clinicians – Supplemental material for “Patients Are Not Following the [Adherence] Club Rules Anymore”: A Realist Case Study of the Antiretroviral Treatment Adherence Club, South Africa
Data
S3_-_Interview_guide-patients – Supplemental material for “Patients Are Not Following the [Adherence] Club Rules Anymore”: A Realist Case Study of the Antiretroviral Treatment Adherence Club, South Africa