IVerbal Autopsy with Participatory Action Research (VAPAR): expanding the knowledge base through partnerships for action on health equity (360G-Wellcome-208410_Z_17_Z)

Health systems are increasingly considered in terms beyond 'building blocks' models, as complex, adaptive, human and relational. Despite the conceptual advances, people-centered health systems research methods remain underdeveloped. The proposed work will connect two issues: the lack of information on the health of people excluded from access to health systems, and the low utilisation of research evidence by health systems stakeholders. The proposal is to institutionalise a process to strengthen data on mortality registration, combine with local knowledge, and interpret, plan and act on this basis in the health system at different levels. The method combines Verbal Autopsy (VA) with Participatory Action Research (PAR). VA is a method to determine levels, causes and circumstances of deaths. In PAR, communities organise evidence for action. 3 phases are proposed. In Phase 1, a series of 3 reflection and action cycles will be conducted to generate evidence, analyse, plan and act. Data will be generated on levels, causes and circumstances of deaths (using VA) and on health needs and priorities for action (using PAR) with communities. Data will be analysed with provincial level policy makers, action plans will be developed and implemented by district-level practitioners, and progress will be re-assessed in subsequent cycles. In Phase 2, participants and researchers will evaluate the process using realist and political economy methods to understand changes in care, outcomes and progress towards health equity. In Phase 3, sustainability and transferability will be developed with authorities, research and technical groups, health systems stakeholders and communities in the study site, and to the public. The output will be a process based on international standards, that is contextually relevant in health systems at different levels, and capable of translating local priorities into actionable agendas for health systems strengthening as a means towards health equity.