Systems Thinking Analyses for Health Policy and Systems Development

2021 ◽  
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Open Access ◽  
Health Systems ◽  
Systems Thinking ◽  
Low Income ◽  
Systems Development ◽  
Previous Scholarship ◽  
Health Policy And Systems

Health systems are fluid and their components are interdependent in complex ways. Policymakers, academics and students continually endeavour to understand how to manage health systems to improve the health of populations. However, previous scholarship has often failed to engage with the intersections and interactions of health with a multitude of other systems and determinants. This book ambitiously takes on the challenge of presenting health systems as a coherent whole, by applying a systems-thinking lens. It focuses on Malaysia as a case study to demonstrate the evolution of a health system from a low-income developing status to one of the most resilient health systems today. A rich collaboration of multidisciplinary academics working with policymakers who were at the coalface of decision-making and practitioners with decades of experience, provides a candid analysis of what worked and what did not. The result is an engaging, informative and thought-provoking intervention in the debate. This title is Open Access.

scholarly journals Local ownership of health policy and systems research in low-income and middle-income countries: a missing element in the uptake debate

2019 ◽  
Vol 4 (4) ◽  
pp. e001523 ◽  
Author(s):  
Kudakwashe Paul Vanyoro ◽  
Kate Hawkins ◽  
Matthew Greenall ◽  
Helen Parry ◽  
Lynda Keeru
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Health Systems ◽  
Low Income ◽  
Middle Income ◽  
Middle Income Countries ◽  
Country Level ◽  
Systems Research ◽  
Research Findings ◽  
Health Policy And Systems

Health policy and systems researchers (HPSRs) in low-income and middle-income countries (LMICs) aim to influence health systems planning, costing, policy and implementation. Yet, there is still much that we do not know about the types of health systems evidence that are most compelling and impactful to policymakers and community groups, the factors that facilitate the research to decision-making process and the real-world challenges faced when translating research findings into practice in different contexts. Drawing on an analysis of HPSR from LMICs presented at the Fifth Global Symposium on Health Systems Research (HSR 2018), we argue that while there is a recognition in policy studies more broadly about the role of co-production, collective ownership and the value of localised HPSR in the evidence-to-policy discussion, ‘ownership’ of research at country level is a research uptake catalyst that needs to be further emphasised, particularly in the HPSR context. We consider embedded research, participatory or community-initiated research and emergent/responsive research processes, all of which are ‘owned’ by policymakers, healthcare practitioners/managers or community members. We embrace the view that ownership of HPSR by people directly affected by health problems connects research and decision-making in a tangible way, creating pathways to impact.

scholarly journals The Value of Anthropology in Child Health Policy

2018 ◽  
Vol 25 (1) ◽  
pp. 29-40 ◽  
Author(s):  
Julie Spray
Keyword(s):  
Health Policy ◽  
Child Health ◽  
Social Relations ◽  
Low Income ◽  
Active Role ◽  
Policy Makers ◽  
Child Health Policy ◽  
Streptococcus A ◽  
Government Initiative

AbstractWorking at the nexus of medical anthropology and the anthropology of childhood, this article challenges three assumptions often embedded in child health policy: (1) children are the passive recipients of healthcare; (2) children’s knowledge of illness and their body can be assumed based on adult understandings; and (3) children’s healthcare can be isolated from their social relations. I explore these themes through the case study of a 2011 New Zealand government initiative to reduce the rates of rheumatic fever affecting low-income Māori and Pasifika children. Drawing on fieldwork with around 80 children at an Auckland primary school, I show how the ‘sore throat’ programme does not merely treat streptococcus A infections, but plays an active role in constituting children’s experiences and understandings of their bodies and illness, and in shaping healthcare practices in ways unintended by policy-makers.

Drifting the goals archetype: a systemic study

Kybernetes ◽  
2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Virupaxi Bagodi ◽  
Biswajit Mahanty
Keyword(s):  
Decision Making ◽  
Systems Thinking ◽  
Decision Makers ◽  
Content Type ◽  
Area Of Interest ◽  
Complex Decision Making ◽  
Complex Decision ◽  
Current Reality

PurposeManagerial decision-making is an area of interest to both academia and practitioners. Researchers found that managers often fail to manage complex decision-making tasks and system thinkers assert that generic structures known as systems archetypes help them to a great deal in handling such situations. In this paper, it is demonstrated that decision makers resort to lowering of goal (quick-fix) in order to resolve the gap between the goal and current reality in the “drifting the goals” systems archetype.Design/methodology/approachA real-life case study is taken up to highlight the pitfalls of “drifting the goals” systems archetype for a decision situation in the Indian two-wheeler industry. System dynamics modeling is made use of to obtain the results.FindingsThe decision makers fail to realize the pitfall of lowering the goal to resolve the gap between the goal and current reality. It is seen that, irrespective of current less-than-desirable performance, managers adopting corrective actions other than lowering of goals perform better in the long run. Further, it is demonstrated that extending the boundary and experimentation results in designing a better service system and setting benchmarks.Practical implicationsThe best possible way to avoid the pitfall is to hold the vision and not lower the long term goal. The managers must be aware of the pitfalls beforehand.Originality/valueSystems thinking is important in complex decision-making tasks. Managers need to embrace long-term perspective in decision-making. This paper demonstrates the value of systems thinking in terms of a case study on the “drifting the goals” systems archetype.

scholarly journals Building the capacity of users and producers of evidence in health policy and systems research for better control of endemic diseases in Nigeria: a situational analysis

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Obinna Onwujekwe ◽  
Enyi Etiaba ◽  
Chinyere Mbachu ◽  
Uchenna Ezenwaka ◽  
Ifeanyi Chikezie ◽  
...  
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Health System ◽  
Policy Decision ◽  
Situational Analysis ◽  
Endemic Diseases ◽  
Systems Research ◽  
The Government ◽  
High Level ◽  
Health Policy And Systems

Abstract Background There is a current need to build the capacity of Health Policy and Systems Research + Analysis (HPSR+A) in low and middle-income countries (LMICs) as this enhances the processes of decision-making at all levels of the health system. This paper provides information on the HPSR+A knowledge and practice among producers and users of evidence in priority setting for HPSR+A regarding control of endemic diseases in two states in Nigeria. It also highlights the HPSR+A capacity building needs and interventions that will lead to increased HPSR+A and use for actual policy and decision making by the government and other policy actors. Methods Data was collected from 96 purposively selected respondents who are either researchers/ academia (producers of evidence) and policy/decision-makers, programme/project managers (users of evidence) in Enugu and Anambra states, southeast Nigeria. A pre-tested questionnaire was the data collection tool. Analysis was by univariate and bivariate analyses. Results The knowledge on HPSR+A was moderate and many respondents understood the importance of evidence-based decision making. Majority of researcher stated their preferred channel of dissemination of research finding to be journal publication. The mean percentage of using HPSR evidence for programme design & implementation of endemic disease among users of evidence was poor (18.8%) in both states. There is a high level of awareness of the use of evidence to inform policy across the two states and some of the respondents have used some evidence in their work. Conclusion The high level of awareness of the use of HPSR+A evidence for decision making did not translate to the significant actual use of evidence for policy making. The major reasons bordered on lack of autonomy in decision making. Hence, the existing yawning gap in use of evidence has to be bridged for a strengthening of the health system with evidence.

scholarly journals Factors that influence the scale up of new interventions in low-income settings: a qualitative case study of the introduction of chlorhexidine cleansing of the umbilical cord in Bangladesh

2020 ◽  
Vol 35 (4) ◽  
pp. 440-451
Author(s):  
Jennifer A Callaghan-Koru ◽  
Munia Islam ◽  
Marufa Khan ◽  
Ardy Sowe ◽  
Jahrul Islam ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
Umbilical Cord ◽  
Low Income ◽  
Qualitative Case Study ◽  
National Level ◽  
Scale Up ◽  
New Drugs ◽  
Low Income Countries

Abstract There is a well-recognized need for empirical study of processes and factors that influence scale up of evidence-based interventions in low-income countries to address the ‘know-do’ gap. We undertook a qualitative case study of the scale up of chlorhexidine cleansing of the umbilical cord (CHX) in Bangladesh to identify and compare facilitators and barriers for the institutionalization and expansion stages of scale up. Data collection and analysis for this case study were informed by the Consolidated Framework for Implementation Research (CFIR) and the WHO/ExpandNet model of scale up. At the national level, we interviewed 20 stakeholders involved in CHX policy or implementation. At the district level, we conducted interviews with 31 facility-based healthcare providers in five districts and focus group discussions (FGDs) with eight community-based providers and eight programme managers. At the community level, we conducted 7 FGDs with 53 mothers who had a baby within the past year. Expanded interview notes were thematically coded and analysed following an adapted Framework approach. National stakeholders identified external policy and incentives, and the engagement of stakeholders in policy development through the National Technical Working Committee for Newborn Health, as key facilitators for policy and health systems changes. Stakeholders, providers and families perceived the intervention to be simple, safe and effective, and more consistent with family preferences than the prior policy of dry cord care. The major barriers that delayed or decreased the public health impact of the scale up of CHX in Bangladesh’s public health system related to commodity production, procurement and distribution. Bangladesh’s experience scaling up CHX suggests that scale up should involve early needs assessments and planning for institutionalizing new drugs and commodities into the supply chain. While the five CFIR domains were useful for categorizing barriers and facilitators, additional constructs are needed for common health systems barriers in low-income settings.

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