Program overview: System reform is complex, long-term, and involves multiple stakeholders. Traditional evaluation methods, which often focus on short-term outcomes and linear cause-effect relationships, are often not well suited to informing or evaluating system change. The George Institute’s Evaluation and System Reform Program focuses on furthering the role of evaluation in system reform in recognition of the power of evaluative data to contribute to social change - this has implications for what is evaluated and how evaluations are conducted. There is an implicit equity agenda – recognising that systems need to reform to benefit those who need them most. We are concerned with: Conducting ‘mission critical’ evaluations, which in practice means scale, reach and equity Using participatory approaches at all stages, since this increases the potential of evaluation findings being relevant and used Building regular and timely cycles of feedback to imple

Program overview: Economic evaluation involves an assessment of the costs of outcomes of health sector interventions to determine their value for money to governments and other payers. This involves cost effectiveness or cost-utility or cost-benefit studies, carried out alongside intervention trials. The evidence from such studies is critical in informing government to optimize their investment decisions in the health sector. Health technology assessment (HTA) is a framework which governments use to embed the use of cost-effectiveness evidence in their decisions to fund new drugs, devices and medical procedures. It is increasing being used by governments around the world to ensure evidence-based investment of scarce health care resources and provides them a tool to achieve universal health coverage in a financially sustainable manner. We have an extensive ongoing program of economic evaluation and HTA studies led by our team of health economists along with researchers at the Insti

Program overview: While health workers drive population health outcomes, investments into their training, recruitment and retention often do not align with system goals resulting in wasted resources and worse health. This program investigates sustainable ways to build the workforce needed for universal health coverage. Using methods like discrete choice experiments, economic evaluations and analyses of survey and administrative datasets, we investigate health system incentives, policy interventions and financing models to improve the motivation, retention and training of health workers, reduce corruption and investigate the economic impacts and investment case for greater use of non-physician health workers. Program objectives: The program aims to contribute to the development and scale-up of sustainable interventions to tackle global workforce challenges and improve population health. View projects Program lead

Program overview: The number of older people globally is growing rapidly, yet many national health systems remain unprepared to meet their needs. A driving factor is that governments do not have adequate evidence to guide the design and delivery of appropriate health and social care services for older adults. The Ageing and Health Systems Program aims to produce new evidence to inform effective national and local health system responses to population ageing. The program includes applied policy studies and implementation research, embedding participatory co-design and priority setting methodologies to maximize translational impact. Program objectives: The overarching objectives of this program are to: Conduct participatory assessments of healthy ageing policy, program and service priorities to inform an effective health system response to population ageing. Harness the capacity of population health data to identify priority populations and opportunities to deliver e

Program overview: The health policy analysis group of the Health Systems Science Program seeks to understand and improve how agendas are set, policies are developed, and how these policies can shape - and be shaped by- health systems, societal understanding of health, and its determinants. The group is transdisciplinary in nature, and integrates expertise across health economics, sociology, political science, public health, international relations, modelling and qualitative research to conduct health policy analysis across the spectrum to conduct policy analysis across a range of approaches such as: Outcome oriented approaches: with the intent to identify the 'best' policy solution, through undertaking objective analyses of possible solutions by mapping or quantitatively assessing effectiveness, equity, or feasibility of implementing policies Mainstream approaches: to identify and analyse actors, interactions between them policy process and or to analyse how power and re

Healthcare around the world is changing. Improvements in technology, diagnostics and treatments mean that many people around the world are living longer, healthier lives. But not everyone is able to benefit, and significant health inequities remain. We’re harnessing the power of innovation to tackle the world’s most pressing health challenges, with a focus on those who need them most. By combining quality research, emerging technologies, and strategic partnerships, we are transforming innovative ideas into real-world solutions. From enhancing healthcare delivery to addressing unmet global health needs, we aim to create lasting impact through collaboration and creativity. Cydonie Greenaway Genovate program manager at The George Institute, on stage at the UNSW Founders Health10x awards Key areas of innovation Re-imagining large scale clinical trial design, boosting diagnostic accuracy with AI and building the skills of tomorrow’s leaders are just some of t

SMARThealth offers a new approach to disease detection, management and treatment – strengthening primary care systems, building the capacity of health workers, and improving health outcomes for patients. SMARThealth (Systematic Medical Appraisal, Referral and Treatment for common health conditions) was developed by The George Institute for the management of chronic diseases. It leverages a low-cost, digital platform which can be used by health workers to significantly improve patient care, especially in contexts where health services are limited. Deployed on hand-held digital devices, SMARThealth uses evidence-based algorithms and guidelines to help community health workers assess chronic disease risks for people in their communities. People identified to be needing further care are then referred via the platform for clinician follow up. Extending SMARThealth The first iteration of SMARThealth was ‘HealthTracker’ used in Australia in 2009 to analyse the electronic health records o

By utilising a life-course approach to the prevention of non-communicable diseases, when women are screened during pregnancy. The physiological changes in a woman’s body during pregnancy to support fetal growth and wellbeing and prepare for labour and birth have been compared to a nine-month marathon that finishes with a sprint. For some women, this pregnancy “stress test” will result in medical complications of pregnancy, such as gestational diabetes (“GDM”, affecting approximately 1 in 7 pregnancies globally), high blood pressure disorders (affecting up to 1 in 10 pregnancies globally) and anaemia (10-40%). Existing mental and physical health conditions may also worsen. The course of a woman’s pregnancy also gives a window into a woman’s future health, as the effect of pregnancy complications on mother and child do not end with the pregnancy. For example, after hypertensive pregnancy there is at least doubled risk of cardiovascular disease (beginning within 5-10 years of

Globally efforts to improve women’s health largely focus on maternal health, overlooking women’s health needs beyond pregnancy and childbirth. The weight given to the maternal health outcome neglects the full range of women’s health. Diseases that affect women are substantially under-studied and under resourced. Gynaecological cancers and conditions like endometriosis, uterine fibroids, poly cystic syndrome, and cervical cancers might have been better understood if they also affected men. Since these are women-specific health issues that affect a woman’s quality of life across her lifespan, there has been little investment, particularly in low-and middle-income countries, to improve early diagnosis and treatment. For example, approximately 180 women globally with endometriosis remain undiagnosed and suffer from its symptoms like pain and infertility for almost seven years before getting diagnosed. Hence, more research and concerted action is needed to improve women’s health and to ensure tha

We conduct large scale work to influence global health policies and practice. For example, a large scale cohort study recruiting 40,000 people in 21 low and middle-income countries is informing development of better fracture care in resource-poor settings. In India, we have reviewed national injury surveillance systems and made recommendations to Government regarding their strengthening and expansion. We evaluated the pilot cashless scheme of health insurance for road crashes victims and made recommendations for effective coverage and performance benchmarking. The findings have contributed to expansion of the scheme across all National Highway’s in India , under the Motor Vehicle (Amendment) bill 2016.

The George Institute has a highly skilled team which works to conceptualise, develop, and deliver innovative and impactful clinical trials, characterised by the following features: Reducing trial ‘waste’ Ensuring that clinical trials are efficient is crucial to minimising research ‘waste’, which most commonly results from the costs associated with poorly conceived research questions, inappropriate study design, failure to adequately report on all areas being analysed, and inefficient operational conduct. Trial efficiency can be improved via two key mechanisms- by design and by conduct. Trial design involves the development and application of innovative statistical methods including adaptive and pragmatic designs. The first involves adapting some elements of the design as the trial progresses (rather than waiting for the trial to end). A pragmatic trial evaluates a health intervention in a setting as close as possible to real-world conditions. Adaptive designs help to gener

The health of women and girls, people with variations in sex characteristics (intersex people) and trans and gender-diverse people has been understudied in health and medical research. An almost exclusive focus on male cells, male animals and men in health and medical research has led to poorer health outcomes and evidence gaps for women, intersex people, and trans and gender-diverse people, and inefficient health spending. Women’s health research often focuses only on their sexual, reproductive, and maternal health rather than the leading causes of death and disability for women. Research on intersex and gender-diverse people is even less developed and availability of health data remains a challenge. For some health conditions, we also have very little information on men and boys, given the conditions occur predominantly in women. The Centre for Sex and Gender Equity in Health and Medicine is addressing these inequities through world-class research, advocacy for policy change, and capacity building