An NGO code of conduct for health systems strengthening: Maximizing the
                        performance of nongovernmental organizations to support broad health system
                        development

Abstract Background The recent 2018 Declaration of Astana recognized primary health care (PHC) as a means to achieve universal health coverage (UHC) and the health-related Sustainable Development Goals (SDGs). Following this declaration, country progress on operationalization of the PHC agenda and attainment of UHC has been stalled by the new challenges posed by the COVID-19 pandemic. The pandemic has also disrupted the continuity of essential health service provision and tested the resilience of the region’s health systems. Methods In accordance with this, the WHO Regional Office for Africa convened the Fifth Health Sector Directors’ Planning and Policy Meeting across the 47 Member States of the Region. The two-day forum focused on building health system resilience to facilitate service continuity during health threats, PHC revitalization, and health systems strengthening towards UHC. Results The Regional Forum provided evidence on building resilient health systems in the WHO African Region and engaged participants in meaningful and critical discussion. It is from these discussions that four key themes emerged: (1) working multisectorally/intersectorally, (2) moving from fragmentation to integration, (3) ensuring implementation and knowledge exchange, and (4) rethinking resilience and embracing antifragility. These discussions and associated groupings by thematic areas lend themselves to recommendations for the WHO. Conclusions This paper details the proceedings and key findings on building resilient health systems, the four themes that emerged from participant deliberation, and the recommendations that have emerged from the meeting. Deliberations from the Regional Forum are critical, as they have the potential to directly inform policy and program design, given that the meeting convenes health sector technocrats, who are at the helm of policy design, action, and implementation.

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A cross-sectional study on the pursuit of happiness among healthcare workers in the context of health systems strengthening: The case of Meru County, Kenya.

F1000Research ◽

10.12688/f1000research.51203.2 ◽

2021 ◽

Vol 10 ◽

pp. 163

Author(s):

Rose Nabi Deborah Karimi Muthuri ◽

Flavia Senkubuge ◽

Charles Hongoro

Keyword(s):

Health System ◽

Health Systems ◽

Healthcare Workers ◽

Public Hospitals ◽

Health Systems Strengthening ◽

Physical Work ◽

Water Type ◽

Cross Sectional ◽

Orientations To Happiness ◽

Significant Factors

Background: Happiness is one of the ultimate goals of every human being. Happiness is a significant factor of health system efficiency. Healthcare workers are at the core of every health system. However, up-to-date literature on happiness among healthcare workers is limited. The purpose of this study is to investigate the factors influencing the self-assessed happiness among healthcare workers in public and mission hospitals in Meru County, Kenya. Methods: Using a cross-sectional design, a total of 553 healthcare workers in 24 hospitals completed the Orientations to Happiness questionnaire between June and July 2020. Results: Healthcare workers’ overall happiness was significantly different between hospitals of public and mission ownership (p<0.05). The orientations to happiness mean scores of both pursuits of pleasure and meaning were significantly different between public and mission hospitals (p<0.05). However, there were no statistically significant differences in the pursuit of engagement among the healthcare workers between public and mission hospitals (p<0.05). In both public and mission hospitals, income and the type of toiletry facility were significant factors of overall happiness (p<0.05 or p<0.1). In mission hospitals, eight more variables were statistically significant factors of overall happiness namely type of employment, occurrence of water unavailability, safe drinking water, acceptable main source of water, type of toiletry facility, hospital disposal of garbage, availability of water for hand washing, and overall safety of the hospital working environment (p<0.05 or p<0.1). In public hospitals, additional statistically significant factors of overall happiness were qualification level, and a functional workplace safety and health committee (p<0.05 or p<0.1). Conclusion: Demographic, work-related, and physical work environment factors significantly contribute to healthcare workers overall happiness in both mission and public hospitals. The findings present possible areas of focus for policy and practical implications related to healthcare workers’ happiness aimed at health workforce and health systems strengthening in Kenya.

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The good, the bad, and the disruptive of performance- based financing on the Mozambican health system: results from a process evaluation

Sociedade e Cultura ◽

10.5216/sec.v21i2.56312 ◽

2018 ◽

Vol 21 (2) ◽

Author(s):

Jessica Gergen ◽

Yogesh Rajkotia ◽

Nirmala Ravishankar

Keyword(s):

Health System ◽

Work Environment ◽

Health Systems ◽

Health Workers ◽

Clinical Care ◽

Health Systems Strengthening ◽

Positive Effects ◽

Financial Autonomy ◽

Performance Based Financing ◽

Systems Transformation

A significant debate is unfolding around whether performance basedfinancing (PBF) is a mechanism of achieving broader health systems transformation. This study aims to contribute to this dialogue by assessing how PBF fostered positive, perverse and disruptive effects on the health system in two provinces of Mozambique. The study used qualitative methods to collect data in 24 PBF health facilities from 60+ health workers and facility administrators. PBF improved the facility’s work environment through improved local financial capacity and autonomy, resulting in greater planning. Health workers perceived incentives as a source of motivation, however the allocation of incentives among staff as unfair and lacking transparency. Major improvements in data qualityand completeness was observed in facility registers, verified quarterly. However, a heavier workload and enhanced focus on information systems were disruptive to time spent on clinical care. PBF remains a health systems strengthening intervention that results in targeted and program-driven changes that are not yet institutionalized or uniformly applied. Sustaining positive effects will requires greater focus on institutionalizing changes to governance, management structures, and financial autonomy, while enhancing inclusiveness of the demand-side.

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Guiding principles for quality, ethical standards and ongoing learning in implementation research: multicountry learnings from participatory action research to strengthen health systems

Health Policy and Planning ◽

10.1093/heapol/czaa123 ◽

2020 ◽

Vol 35 (Supplement_2) ◽

pp. ii137-ii149

Author(s):

Kim Ozano ◽

Laura Dean ◽

Oluwatosin Adekeye ◽

Anthony K Bettee ◽

Ruth Dixon ◽

...

Keyword(s):

Action Research ◽

Health System ◽

Participatory Action Research ◽

Health Systems ◽

Implementation Research ◽

Health Systems Strengthening ◽

Ethical Standards ◽

Participatory Action ◽

Implementation Challenges ◽

Guiding Principles

Abstract Global health gains can be achieved through strengthening health systems to identify and address implementation challenges in low- and middle-income countries. Participatory research, that promotes joint problem and solution finding between communities and different health systems actors, supports policy implementation analysis at all levels. Within the neglected tropical disease programmes in Liberia and Nigeria, we applied participatory action research (PAR) to address programmatic and health system bottlenecks with health systems strengthening embedded. This paper shares learning from 20 interviews with co-researchers, from national and sub-national levels and academic researchers who worked collaboratively to understand challenges, co-create solutions and advocate for policy change. Through analysis and reflections of existing PAR principles, we inductively identified five additional guiding principles for quality, ethical standards and ongoing learning within PAR projects that aim to strengthen health systems. (1) Recognize communities as units of identity and define stakeholder participation to ensure equitable engagement of all actors; (2) enable flexible action planning that builds on existing structures whilst providing opportunities for embedding change; (3) address health systems and research power differentials that can impede co-production of knowledge and solution development; (4) embed relational practices that lead to new political forms of participation and inquiry within health systems and (5) develop structures for ongoing learning at multiple levels of the health system. PAR can strengthen health systems by connecting and co-creating potentially sustainable solutions to implementation challenges. Additional research to explore how these five additional principles can support the attainment of quality and ethical standards within implementation research using a PAR framework for health systems strengthening is needed.

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A checklist to improve health system resilience to infectious disease outbreaks and natural hazards

BMJ Global Health ◽

10.1136/bmjgh-2020-002429 ◽

2020 ◽

Vol 5 (8) ◽

pp. e002429 ◽

Cited By ~ 1

Author(s):

Diane Meyer ◽

David Bishai ◽

Sanjana J Ravi ◽

Harunor Rashid ◽

Shehrin Shaila Mahmood ◽

...

Keyword(s):

Infectious Disease ◽

Health System ◽

Natural Hazards ◽

Health Systems ◽

Disease Outbreaks ◽

Health Systems Strengthening ◽

Effective Response ◽

Health Security ◽

Infectious Disease Outbreaks ◽

System Resilience

Recent infectious disease outbreaks, including the ongoing global COVID-19 pandemic and Ebola in the Democratic Republic of the Congo, have demonstrated the critical importance of resilient health systems in safeguarding global health security. Importantly, the human, economic and political tolls of these crises are being amplified by health systems’ inabilities to respond quickly and effectively. Improving resilience within health systems can build on pre-existing strengths to enhance the readiness of health system actors to respond to crises, while also maintaining core functions. Using data gathered from a scoping literature review, interviews with key informants and from stakeholders who attended a workshop held in Dhaka, Bangladesh, we developed a Health System Resilience Checklist (‘the checklist’). The aim of the checklist is to measure the specific capacities, capabilities and processes that health systems need in order to ensure resilience in the face of both infectious disease outbreaks and natural hazards. The checklist is intended to be adapted and used in a broad set of countries as a component of ongoing processes to ensure that health actors, institutions and populations can mount an effective response to infectious disease outbreaks and natural hazards while also maintaining core healthcare services. The checklist is an important first step in improving health system resilience to these threats, but additional research and resources will be necessary to further refine and prioritise the checklist items and to pilot the checklist with the frontline health facilities that would be using it. This will help ensure its feasibility and durability for the long-term within the health systems strengthening and health security fields.

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Towards universal health coverage in the WHO African Region: assessing health system functionality, incorporating lessons from COVID-19

BMJ Global Health ◽

10.1136/bmjgh-2020-004618 ◽

2021 ◽

Vol 6 (3) ◽

pp. e004618

Author(s):

Humphrey Cyprian Karamagi ◽

Prosper Tumusiime ◽

Regina Titi-Ofei ◽

Benson Droti ◽

Hillary Kipruto ◽

...

Keyword(s):

Health System ◽

Health Systems ◽

Universal Health Coverage ◽

System Development ◽

Health Coverage ◽

African Region ◽

Policy Action ◽

Related Services ◽

Essential Services ◽

Universal Health

The move towards universal health coverage is premised on having well-functioning health systems, which can assure provision of the essential health and related services people need. Efforts to define ways to assess functionality of health systems have however varied, with many not translating into concrete policy action and influence on system development. We present an approach to provide countries with information on the functionality of their systems in a manner that will facilitate movement towards universal health coverage. We conceptualise functionality of a health system as being a construct of four capacities: access to, quality of, demand for essential services and its resilience to external shocks. We test and confirm the validity of these capacities as appropriate measures of system functionality. We thus provide results for functionality of the 47 countries of the WHO African Region based on this. The functionality of health systems ranges from 34.4 to 75.8 on a 0–100 scale. Access to essential services represents the lowest capacity in most countries of the region, specifically due to poor physical access to services. Funding levels from public and out-of-pocket sources represent the strongest predictors of system functionality, compared with other sources. By focusing on the assessment on the capacities that define system functionality, each country has concrete information on where it needs to focus, in order to improve the functionality of its health system to enable it respond to current needs including achieving universal health coverage, while responding to shocks from challenges such as the 2019 coronavirus disease. This systematic and replicable approach for assessing health system functionality can provide the guidance needed for investing in country health systems to attain universal health coverage goals.

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Book Review: ‘Till We Win - India’s fight against the COVID-19 Pandemic’

Indian Journal of Community Health ◽

10.47203/ijch.2020.v32i04.028 ◽

2020 ◽

Vol 32 (4) ◽

pp. 755-756

Author(s):

Rakesh Kakkar ◽

Pradeep Aggarwal

Keyword(s):

Health System ◽

Health Systems ◽

Human Activities ◽

Health Systems Strengthening ◽

The Novel ◽

Comprehensive Overview ◽

Pandemic Response ◽

Novel Coronavirus

‘Till We Win’ is a book which provides a comprehensive overview of India’s journey. It deliberates how India, as a nation, fought and continue to fight against the novel coronavirus, SARS CoV-2. It documents and analyses the COVID-19 pandemic responses and provides lessons for health systems strengthening. The book has four section and eleven chapters. The first section focuses upon why viruses are likely to cause pandemic and how human activities are increasing the risks of outbreaks and epidemics. The next section deliberates on India’s pandemic response and how the policies had evolved with every new emerging condition. The authors argue that none of the country was fully prepared for the pandemic of the such a magnitude which eventually had disrupted even ‘so called’ better performing health system.

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Current Status and Future Directions of mHealth Interventions for Health System Strengthening in India: Systematic Review (Preprint)

10.2196/preprints.11440 ◽

2018 ◽

Cited By ~ 1

Author(s):

Abhinav Bassi ◽

Oommen John ◽

Devarsetty Praveen ◽

Pallab K Maulik ◽

Rajmohan Panda ◽

...

Keyword(s):

Health Care ◽

Service Delivery ◽

Health System ◽

Health Systems ◽

Health Care Delivery ◽

Care Delivery ◽

Health Systems Strengthening ◽

Noncommunicable Disease ◽

Health Initiatives

BACKGROUND With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for health care delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening health care systems. OBJECTIVE We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution, and target users and assesses the quality of the available literature. METHODS A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database, and Clinical Trial Registry of India. The World Health Organization health system building block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, US tools. RESULTS The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies, and opinion articles=193). A sharp increase was seen after 2012, driven primarily by noncommunicable disease–focused articles. Majority of the primary studies had their sites in the south Indian states, with no published articles from Jammu and Kashmir and north-eastern parts of India. Service delivery was the primary focus of 57.6% (72/125) of the selected articles. A majority of these articles had their focus on 1 (36.0%, 45/125) or 2 (45.6%, 57/125) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving the health system. More than 91.2% (114/125) of the studies, which lacked a sample size justification, had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least 2 categories. CONCLUSIONS In conclusion, mHealth initiatives are being increasingly tested to improve health care delivery in India. Our review highlights the poor quality of the current evidence base and an urgent need for focused research aimed at generating high-quality evidence on the efficacy, user acceptability, and cost-effectiveness of mHealth interventions aimed toward health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support the generation of evidence for health systems strengthening on strategically important outcomes.

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Pursuing health systems strengthening through disease-specific programme grants: experiences in Tanzania and Sierra Leone

BMJ Global Health ◽

10.1136/bmjgh-2021-006615 ◽

2021 ◽

Vol 6 (10) ◽

pp. e006615

Author(s):

Charlotte Devon Hemingway ◽

Mohamed Bella Jalloh ◽

Richard Silumbe ◽

Haja Wurie ◽

Esther Mtumbuka ◽

...

Keyword(s):

Health System ◽

Sierra Leone ◽

Health Systems ◽

Geographical Location ◽

Health Systems Strengthening ◽

Health System Strengthening ◽

Local Health ◽

Structured Interviews ◽

Health Partnership ◽

Disease Specific

IntroductionDisease-specific ‘vertical’ programmes and health system strengthening (HSS) ‘horizontal’ programmes are not mutually exclusive; programmes may be implemented with the dual objectives of achieving both disease-specific and broader HSS outcomes. However, there remains an ongoing need for research into how dual objective programmes are operationalised for optimum results.MethodsA qualitative study encompassing four grantee programmes from two partner countries, Tanzania and Sierra Leone, in the Comic Relief and GlaxoSmithKline ‘Fighting Malaria, Improving Health’ partnership. Purposive sampling maximised variation in terms of geographical location, programme aims and activities, grantee type and operational sector. Data were collected via semi-structured interviews. Data analysis was informed by a general inductive approach.Results51 interviews were conducted across the four grantees. Grantee organisations structured and operated their respective projects in a manner generally supportive of HSS objectives. This was revealed through commonalities identified across the four grantee organisations in terms of their respective approach to achieving their HSS objectives, and experienced tensions in pursuit of these objectives. Commonalities included: (1) using short-term funding for long-term initiatives; (2) benefits of being embedded in the local health system; (3) donor flexibility to enable grantee responsiveness; (4) the need for modest expectations; and (5) the importance of micro-innovation.ConclusionHealth systems strengthening may be pursued through disease-specific programme grants; however, the respective practice of both the funder and grantee organisation appears to be a key influence on whether HSS will be realised as well as the overall extent of HSS possible.

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Health systems strengthening for noncommunicable disease control and healthy aging: integrated actions in Aruba and Curaçao

Revista Panamericana de Salud Pública ◽

10.26633/rpsp.2019.55 ◽

2019 ◽

Vol 43 ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Malhi Cho ◽

Melissa Marchand ◽

Enrique Vega ◽

Reynaldo Holder ◽

Silvana Luciani ◽

...

Keyword(s):

Health System ◽

Health Systems ◽

Healthy Aging ◽

Health Systems Strengthening ◽

Noncommunicable Disease ◽

Noncommunicable Diseases ◽

Term Care ◽

Financing Policy ◽

Care Community ◽

Demographic Transitions

Caribbean countries are experiencing social, epidemiological, and demographic transitions shaped by the growing elderly population and the rise of noncommunicable diseases (NCDs)—now responsible for 78% of all deaths. These circumstances demand rethinking the model of care to improve health outcomes and build more sustainable health systems with new orientations in policy, service delivery, organization, training, technology, and financing. Policy must be aimed towards healthy living, leveraging interventions that ensure healthy aging. The health system must proactively structure interventions to reduce the incidence of new NCD cases and to prevent related complications. Interventions should be focused on optimizing the individual’s capacity, functional ability, and autonomy within adapted environments, as well as with the necessary preventive, long-term care, self-care, community care, and health system support.

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