scholarly journals Health system resilience in the face of crisis: analysing the challenges, strategies and capacities for UNRWA in Syria

2019 ◽  
Author(s):  
Zeina Jamal ◽  
Mohamad Alameddine ◽  
Karin Diaconu ◽  
Graham Lough ◽  
Sophie Witter ◽  
...  
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Model Building ◽  
Health Service Delivery ◽  
Crisis Response ◽  
Annual Reports ◽  
Group Model ◽  
Organizational Flexibility ◽  
The Face ◽  
System Resilience

Abstract Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. We examined the case of the United Nations Relief and Works Agency (UNRWA) and its delivery of services to Palestine refugees in Syria during the ongoing crisis to identify factors enabling system resilience. The study is a retrospective qualitative case study utilizing diverse methods. We conducted 35 semi-structured interviews with UNRWA clinical and administrative professionals engaged in health service delivery over the period of the Syria conflict. Through a group model building session with a sub-group of eight of these participants, we then elicited a causal loop diagram of health system functioning over the course of the war, identifying pathways of threat and mitigating resilience strategies. We triangulated analysis with data from UNRWA annual reports and routine health management information. The UNRWA health system generally sustained service provision despite individual, community and system challenges that arose during the conflict. We distinguish absorptive, adaptive and transformative capacities of the system facilitating this resilience. Absorptive capacities enabled immediate crisis response, drawing on available human and organizational resources. Adaptive capacities sustained service delivery through revised logistical arrangements, enhanced collaborative mechanisms and organizational flexibility. Transformative capacity was evidenced by the creation of new services in response to changing community needs. Analysis suggests factors such as staff commitment, organizational flexibility and availability of collaboration mechanisms were important assets in maintaining service continuity and quality. This evidence regarding alternative strategies adopted to sustain service delivery in Syria is of clear relevance to other actors seeking organizational resilience in crisis contexts.

scholarly journals Health system resilience in managing the COVID-19 pandemic: lessons from Singapore

2020 ◽  
Vol 5 (9) ◽  
pp. e003317
Author(s):  
Alvin Qijia Chua ◽  
Melisa Mei Jin Tan ◽  
Monica Verma ◽  
Emeline Kai Lin Han ◽  
Li Yang Hsu ◽  
...  
Keyword(s):  
Health System ◽  
Migrant Worker ◽  
Health Service Delivery ◽  
Contact Tracing ◽  
Legal Foundation ◽  
Imported Cases ◽  
Rapid Transmission ◽  
At Risk Populations ◽  
System Resilience ◽  
The Government

Singapore, one of the first countries affected by COVID-19, adopted a national strategy for the pandemic which emphasised preparedness through a whole-of-nation approach. The pandemic was well contained initially until early April 2020, when there was a surge in cases, attributed to Singapore residents returning from hotspots overseas, and more significantly, rapid transmission locally within migrant worker dormitories. In this paper, we present the response of Singapore to the COVID-19 pandemic based on core dimensions of health system resilience during outbreaks. We also discussed on the surge in cases in April 2020, highlighting efforts to mitigate it. There was: (1) clear leadership and governance which adopted flexible plans appropriate to the situation; (2) timely, accurate and transparent communication from the government; (3) public health measures to reduce imported cases, and detect as well as isolate cases early; (4) maintenance of health service delivery; (5) access to crisis financing; and (6) legal foundation to complement policy measures. Areas for improvement include understanding reasons for poor uptake of government initiatives, such as the mobile application for contact tracing and adopting a more inclusive response that protects all individuals, including at-risk populations. The experience in Singapore and lessons learnt will contribute to pandemic preparedness and mitigation in the future.

Technology Enabled Knowledge Translation

2010 ◽  
pp. 301-313 ◽  
Author(s):  
Kendall Ho
Keyword(s):  
Service Delivery ◽  
Knowledge Translation ◽  
Health System ◽  
Information And Communication Technologies ◽  
Health Informatics ◽  
Clinical Care ◽  
Health Service Delivery ◽  
Care Gaps ◽  
Information And Communication ◽  
E Learning

Because of the rapid growth of health evidence and knowledge generated through research, and growing complexity of the health system, clinical care gaps increasingly widen where best practices based on latest evidence are not routinely integrated into everyday health service delivery. Therefore, there is a strong need to inculcate knowledge translation strategies into our health system so as to promote seamless incorporation of new knowledge into routine service delivery and education to promote positive change in individuals and the health system towards eliminating the clinical care gaps. E-health, the use of information and communication technologies (ICT) in health which encompasses telehealth, health informatics, and e-learning, can play a prominently supportive role. This chapter examines the opportunities and challenges of technology enabled knowledge translation (TEKT) using ICT to accelerate knowledge translation in today’s health system with two case studies for illustration. Future TEKT research and evaluation directions are also articulated.

scholarly journals Influence of Politics on Accountability of Health Professionals in Bangladesh: An Analysis of the Quality of Health Service Delivery

2017 ◽  
Vol 12 (1) ◽  
pp. 75-82
Author(s):  
Mohammad Shafiqul Islam
Keyword(s):  
Health Service ◽  
Service Delivery ◽  
Health System ◽  
Healthcare Delivery ◽  
Health Service Delivery ◽  
Elected Officials ◽  
Political Commitment ◽  
Healthcare Provision ◽  
Administrative Authority ◽  
Political Actors

This study explored the role and responsibility of elected officials including political actors and addressed the factors of politics, decentralisation, bureaucratic management, and political commitment to understanding accountability in health service delivery. This study used qualitative case studies for which a total of 68 in-depth interviews and five focus group discussions were conducted in two areas of rural and urban Bangladesh. The findings show that political actors have poor commitment to improving accountability and healthcare delivery. The elected officials are not interested in organising regular meetings and they are even reluctant to organise a health service committee to make health officials accountable. The opposition political parties have no participation in health service organisations as the existing political culture does not allow it. Moreover, elected officials have a limited administrative authority because of an inadequate decentralised health system that leads to poor accountability and inadequate healthcare delivery. Further, bureaucrats want to capture power and are unwilling to decentralise the health system. The policy recommendation includes the decentralisation of healthcare provision and increased participation of elected representatives in a decentralised system. Abbreviations: ADP – Annual Development Plan; MP – Member of Parliament; NGO – Non Government Organisation; UHC – Upazilia Health Complex; UP – Upazilia Parishad.

Technology Enabled Knowledge Translation

2011 ◽  
pp. 147-159
Author(s):  
Kendall Ho
Keyword(s):  
Service Delivery ◽  
Knowledge Translation ◽  
Health System ◽  
Information And Communication Technologies ◽  
Health Informatics ◽  
Clinical Care ◽  
Health Service Delivery ◽  
Care Gaps ◽  
Information And Communication ◽  
E Learning

Because of the rapid growth of health evidence and knowledge generated through research, and growing complexity of the health system, clinical care gaps increasingly widen where best practices based on latest evidence are not routinely integrated into everyday health service delivery. Therefore, there is a strong need to inculcate knowledge translation strategies into our health system so as to promote seamless incorporation of new knowledge into routine service delivery and education to promote positive change in individuals and the health system towards eliminating the clinical care gaps. E-health, the use of information and communication technologies (ICT) in health which encompasses telehealth, health informatics, and e-learning, can play a prominently supportive role. This chapter examines the opportunities and challenges of technology enabled knowledge translation (TEKT) using ICT to accelerate knowledge translation in today’s health system with two case studies for illustration. Future TEKT research and evaluation directions are also articulated.

scholarly journals Opportunities and challenges for delivering non-communicable disease management and services in fragile and post-conflict settings: perceptions of policy-makers and health providers in Sierra Leone

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Sophie Witter ◽  
Guanyang Zou ◽  
Karin Diaconu ◽  
Reynold G. B. Senesi ◽  
Ayesha Idriss ◽  
...  
Keyword(s):  
Health System ◽  
Sierra Leone ◽  
Prevention And Control ◽  
Model Building ◽  
Communicable Disease ◽  
Group Model ◽  
Financial Barriers ◽  
Post Conflict ◽  
Conflict Settings ◽  
And Control

Abstract Background The growing burden of non-communicable diseases in low- and middle-income countries presents substantive challenges for health systems. This is also the case in fragile, post-conflict and post-Ebola Sierra Leone, where NCDs represent an increasingly significant disease burden (around 30% of adult men and women have raised blood pressure). To date, documentation of health system challenges and opportunities for NCD prevention and control is limited in such settings. This paper aims to identify opportunities and challenges in provision of NCD prevention and care and highlight lessons for Sierra Leone and other fragile states in the battle against the growing NCD epidemic. Methods This paper focuses on the case of Sierra Leone and uses a combination of participatory group model building at national and district level, in rural and urban districts, interviews with 28 key informants and review of secondary data and documents. Data is analysed using the WHO’s health system assessment guide for NCDs. Results We highlight multiple challenges typical to those encountered in other fragile settings to the delivery of preventive and curative NCD services. There is limited government and donor commitment to financing and implementation of the national NCD policy and strategy, limited and poorly distributed health workforce and pharmaceuticals, high financial barriers for users, and lack of access to quality-assured medicines with consequent high recourse to private and informal care seeking. We identify how to strengthen the system within existing (low) resources, including through improved clinical guides and tools, more effective engagement with communities, and regulatory and fiscal measures. Conclusion Our study suggests that NCD prevention and control is of low but increasing priority in Sierra Leone; challenges to addressing this burden relate to huge numbers with NCDs (especially hypertension) requiring care, overall resource constraints and wider systemic issues, including poorly supported primary care services and access barriers. In addition to securing and strengthening political will and commitment and directing more resources and attention towards this area, there is a need for in-depth exploratory and implementation research to shape and test NCD interventions in fragile and post-conflict settings.

Afghan refugees’ experience of Iran’s health service delivery

2016 ◽  
Vol 9 (2) ◽  
pp. 75-85 ◽  
Author(s):  
Abbas Heydari ◽  
Rana Amiri ◽  
Nahid Dehghan Nayeri ◽  
Vedadhir AboAli
Keyword(s):  
Health Care ◽  
Health Service ◽  
Service Delivery ◽  
Health System ◽  
Health Care Providers ◽  
Medical Science ◽  
Health Service Delivery ◽  
Care Providers ◽  
Content Type ◽  
Afghan Refugees

Purpose – The purpose of this paper is to explore experiences of Afghan refugees from health service delivery in Mashhad, Iran. Design/methodology/approach – This is a descriptive study with contextual and qualitative design. Semi-structured interview conducted with 19 Afghan refugees and their caregivers and a focus group session were held with Afghan medical science students. Purposive sampling technique was used to select participants. Data were analysed by qualitative content analysis of Graneheim and Lundman. Lincoln and Guba’s criteria were implemented to ensure trustworthiness. Findings – The results with the core concept of “position of immigrants in the health system” were presented at four themes of “perceived discrimination”, “snowed with loneliness”, “feeling inferior”, and “gratitude”. Research limitations/implications – This study has some implications for researchers and practitioners. The present study is the first study that was done on the health of Afghan refugees in Iran, therefore it can be a ground for further research. In addition, it has valuable results regarding the Afghan immigrants’ experience of health care system of Iran. Practical implications – It can be useful for improving the condition of immigrants in Iran and for improving Iran’s health system. In order to improve the health system in Iran, authorities should pay much attention to transcultural caring and needs of minorities. Furthermore, health workers should be trained to appropriately take care of all patients, without prejudice. Originality/value – Overall the study revealed that there is inequity in access to health services among Afghan refugees in Iran. The findings, although not generalized, offer important insights into health care providers in Iran which should be delivering health service without prejudice. The authors recommended that policies of public medical insurance and assistance programme should be implemented for providing affordable health care services for Afghan refugees.

scholarly journals An analysis of the impact of newborn survival policies in Pakistan using a policy triangle framework

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jamil Ahmed ◽  
Carmen Huckel Schneider ◽  
Ashraful Alam ◽  
Camille Raynes-Greenow
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Policy Making ◽  
Implementation Process ◽  
Newborn Health ◽  
Health Service Delivery ◽  
Newborn Mortality ◽  
Slow Progress ◽  
Effective Policy ◽  
The Impact

Introduction Pakistan has made slow progress towards reducing the newborn mortality burden; as a result, it has the highest burden of newborn mortality worldwide. This article presents an analysis of the current policies, plans, and strategies aimed at reducing the burden of newborn death in Pakistan for the purpose of identifying current policy gaps and contextual barriers towards proposing policy solutions for improved newborn health. Methods We begin with a content analysis of federal-level policies that address newborn mortality within the context of health system decentralization over the last 20 years. This is then followed by a case study analysis of policy and programme responses in a predominantly rural province of Pakistan, again within the context of broader health system decentralization. Finally, we review successful policies in comparable countries to identify feasible and effective policy choices that hold promise for implementation in Pakistan, considering the policy constraints we have identified. Results The major health policies aimed at reduction of newborn mortality, following Pakistan’s endorsement of global newborn survival goals and targets, lacked time-bound targets. We found confusion around roles and responsibilities of institutions in the implementation process and accountability for the outcomes, which was exacerbated by an incomplete decentralization of healthcare policy-making and health service delivery, particularly for women around birth, and newborns. Such wide gaps in the areas of target-setting, implementation mechanism, and evaluation could be because the policy-making largely ignored international commitments and lessons of successful policy-making in comparable regional counties. Conclusions Inclusion of clear goals and targets in newborn survival policies and plans, completion of the decentralization process of maternal and child healthcare service delivery, and policy-making and implementation by translating complex evidence and using regional but locally applicable case studies will be essential to any effective policy-making on newborn survival in Pakistan.

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