Impact case study database

National policy

The IoI framework shapes current UK integration and social cohesion policy. In 2019 the Home Office (HO) and Department for Housing, Communities and Local Government launched a refreshed IoI framework (and toolkit) [1 & 2] with respect to which HO-funded refugee integration projects are expected to demonstrate their impact. Strang co-authored this framework, incorporating new research insights. The International Organisation for Migration (IOM UK) delivered HO-funded training on the toolkit (2019-2020) for Local Authorities and key stakeholders nationwide [3]. Specifications for the evaluation of the HO resettlement scheme and for a new ‘Refugee Transitions’ fund both reflect IoI domains. The latter responds to research by Strang (2016; 2017) and others demonstrating the need for long-term support for refugee ‘transition’ to effective participation.

The ‘New Scots’ Refugee Integration Strategy [4] uses IoI as its underpinning framework and embeds IoI principles. Strang chaired strategy development and implementation 2012 to 2018 [4], drawing on her research. Phase 2, 2018 – 2021 continues the IoI holistic approach, support from arrival and the involvement of communities. IGHD research briefings (Strang et al., 2014, 2015, 2016; 2017) regularly informed the strategy.

During the All Party Parliamentary Group on Social Integration Inquiry into Integration the Consortium of Scottish Local Authorities (COSLA) noted the effectiveness of the New Scots IoI-based structure for multi sector response (APPG Interim Report 2017). Integration policy in Wales and N. Ireland also reflects this. Strang represented ‘New Scots’ in the Scottish ‘Refugee Taskforce’ convened in 2015/6 which led to new cross-sector partnerships for resettling refugees.

National practice

Following the 2004 publication, Scottish Refugee Council (SRC), shifted focus to prioritise establishing ‘Integration Networks’ building ‘bridges’ between refugees and local people. ‘New Scots’ continues to provide impetus for cross-sectoral investment in community cohesion (Scottish Community Development Centre, 2018). Research on the Holistic Integration Service (HIS: 2013-16), led to improvements in statutory agencies’ practice: e.g. ‘Client Journey’ to process refugee benefit claims; shared understanding between partners (British Red Cross, Workers’ Educational Association, Glasgow Clyde College), and the development of new interventions e.g. the Family Keywork Service. SRC consistently uses the IoI framework and HIS research as a basis for securing funds, service provision, training, policy engagement and public awareness raising [5]. As a result, refugees and local communities benefit from increased access to health services, employment, welfare and education; and improved social connections and social cohesion.

NHS Greater Glasgow & Clyde commissioned Strang to employ social connections mapping to investigate social isolation and mental health amongst refugee men. Dissemination with policymakers and practitioners led to a pilot intervention, ‘Peer Education for Health’, later extended across Glasgow and shared in practitioner forums in UK, Europe and Australia. Scottish Government and AMIF have implemented the research implications by funding the Sharing lives, Sharing Languages’ programme to build social bridges through shared activity. [5].

In 2018, British Red Cross received funding to support the integration of approximately 800 reuniting refugee families. The service provides casework based on IoI, and interventions using the IoI lenses of ‘bonds’ and ‘bridges’. BRC and SRC are currently embedding the IGHD social connections mapping tool in case work to enhance caseworker practice and inform project planning [5 & 6].

Practice internationally

Large-scale examples of refugee support programmes informed by IoI include: Foundation House, Victoria; STARTTS, New South Wales, Australia; RISE, Colorado, USA [8], and the ‘Finland-My Home’ programme. UNHCR and World Bank [10] reference the research in examining approaches to refugee integration support.

Research using the social connections tool (Strang et al. 2020) enabled practice partners in Iraq to develop more locally sensitive humanitarian programming harnessing locally trusted resources and shaped the practice of organizations supporting refugees and other vulnerable populations [7].

International policy

The research has had particular influence on policy in Australia, as evidenced by the National Youth Settlement Framework 2020, where the IoI framework was a catalyst to bring together diverse principles of good practice into a rights based policy [8]. The IoI framework and research on social connections also helped shape the UN’s IOM DISC (Diversity, Inclusion & Social Cohesion) global strategy [3]. Research (based on IoI) in the USA has led to enhanced rights for refugee integration support in the state of Colorado [9].

Broader influence is evidenced by international research papers reporting research on refugee integration using the work, invitations to present the research at international forums, (Finland, Russia, Australia & New Zealand, Japan, South Korea), and to contribute to policy consultations (EC, ECRE, NATO) along with direct enquiries from researchers and policymakers.

Impact on the PBF community of practice: driving the debate

The 2012 Cochrane review was widely debated, including by the PBF Community of Practice, a group of 3,000 global PBF experts. Findings of our subsequent studies reached practitioners, policy-makers and donors through the “Health Financing” blog, HSG webinar (52 attendees) and satellite session (c. 100 attendees). This body of work improved the understanding of PBF, shaped the debate around the advantages and risks of PBF and established Witter and team as leading experts and advisers on innovative health financing and PBF (a).

Impact on policy and practice of key international actors and organisations

The research informed changes in the funding priorities, operational strategies and practices of major global organizations by identifying health financing areas with innovation potential and recommending an integrated and contextualized approach to PBF design and implementation.

Based on their expertise on innovative health financing, Witter and Bertone have been invited to expert meetings and worked in close collaboration with the World Health Organisation, the global health normative leader, to develop resource documents and guidelines on health financing in fragile settings and strategic purchasing (b, c). These documents are part of the WHO e-Learning Course on Health Financing Policy for universal health coverage which has trained teams from more than 40 countries. Training and guidance enable WHO to provide guidance on health financing reforms; e.g. 20 countries were supported with technical advice in 2018 (d).

Via the Health Results Innovation Trust Fund, the World Bank has spent more than $380 million on PBF schemes, affecting health service delivery, access and utilization, and health outcomes of communities and people in 29 countries. In response to the 2012 Cochrane review, the World Bank funded a large set of impact evaluations on PBF, under the Health Results Innovation Trust Fund (e). Findings of our work on PBF in humanitarian settings were discussed at a World Bank meeting (November 2018) on health financing in fragile settings. In line with our research recommendations, the World Bank’s Global Financing Facility (investing $602 million in 26 countries’ health systems) has recognized that applying the conditionality of funding to implementation of PBF in a blanket fashion is inappropriate (f).

In recognition of our leading work on innovative health financing in fragile settings, in 2015 Witter was asked to join a consultation to review the Global Fund to fight HIV/AIDS, TB and Malaria’s strategies in Complex Operating Environments (COEs). This resulted in adoption of improved global strategies for tailored investments by the Board of the Global Fund (g). In 2016, Witter was asked to lead a consultation on health system strengthening in COEs. This led to new guidelines, which are now used by the Technical Review Panels for assessing proposals from COEs. The guidelines have been used to provide more flexible funding for COEs, where the Global Fund is the major investor in communicable disease control (h). In 2020, Witter and team also provided a tailored review for the Global Fund into how to support PBF and direct facility financing across its portfolio.

Our research on health financing and PBF has been incorporated into document reviews for the UK’s Department for International Development (DFID – now FCDO), for example on payment and performance of health workers. We have developed trusted relations with DfID’s health systems team, which can be confirmed by Jo Keatinge, Health System Strengthening advisor (corroborators list). The team consults us informally on what further research they should be commissioning on PBF and we have regularly presented our work at internal seminars and workshops and provided summary briefs and guidance.

Impact on policy and practice at national level

Our research is designed and carried out in ways that ensure relevance for national policy-makers. In 2016, Witter supported the Government of Zimbabwe in collaboration with European Union and World Bank to reshape the PBF model in Zimbabwe (i). Key recommendations made by the team were adopted by the PBF steering committee (corroborator: Chenjerai Sismayi). In 2017, in Sierra Leone, Witter and Bertone’s research was cited in the updated Human Resources for Health (HRH) Profile and Strategy in the aftermath of the Ebola epidemic. Our findings on financial and non-financial incentives for health workers (including PBF) provided evidence for decision-making, in a context where data are extremely scarce (corroborator: Noemi Schramm). Witter and Diaconu have worked with a local research institution and the Ministry of Health in Georgia to provide evidence and guidance to policy-makers in developing, piloting and evaluating a PBF model for integrated tuberculosis care (j).