NICHE seeks to strengthen international health systems through policy-relevant and empirical-based research and education.
NICHE was established in 2007, and now hosts some 15 researchers from both the Netherlands and low-income countries. We conduct scientific research and collaborate with implementing agencies to foster the transfer of knowledge into health. In our analysis, we preferably adopt a health-systems wide perspective, but we also carry out disease-oriented analyses concentrating on HIV/AIDS and Sexual and Reproductive Health. NICHE combines quantitative and qualitative research techniques to both evaluate policy impact and understand policy processes, and hence foster the generalisability of study findings.
NICHE performs projects in three research programmes.
i) Improving access for the poor
NICHE identifies socio-economic, cultural and geographic barriers that limit access to health services, and evaluates interventions to reduce them. For example, in Ghana, NICHE evaluates strategies to enhance enrolment among the poor in the National Health Insurance Scheme, using experimental designs. In Mozambique, NICHE identifies barriers to the uptake of ARV by HIV/AIDS patients, and evaluates the use of food and transport subsidies. NICHE also carries out systematic literature reviews, eg. on the potential of health insurance to improve access to care for the poor.
ii) Ensuring value for money
Economic evaluation in health compares costs and outcomes of competing health interventions, to guide policy makers in their budget decisions. NICHE conducts cost-effectiveness analysis throughout the developing world, e.g. on HIV/AIDS control among injecting drug users in Indonesia and the general population in South-Africa, or on breast cancer control in ten different countries. NICHE has developed multi-criteria decision analysis in health as an innovative approach to prioritise interventions taking into account both efficiency and equity concerns. Work takes place in Indonesia, Thailand and Tanzania.
iii) Revitalising primary health care
Primary health care is back on the global agenda, as a promising approach to achieve community participation, strengthened primary-care facilities, and intersectoral action linking health and development. NICHE is active in the Commission on Social Determinants of Health, and runs projects on identifying determinants of health and on the performance of primary health care worldwide.
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