scholarly journals Application of system thinking concepts in health system strengthening in low‐income settings: a proposed conceptual framework for the evaluation of a complex health system intervention: the case of the BHOMA intervention in Z ambia

2014 ◽  
Vol 22 (1) ◽  
pp. 112-121 ◽  
Author(s):  
Wilbroad Mutale ◽  
Dina Balabanova ◽  
Namwinga Chintu ◽  
Margaret Tembo Mwanamwenge ◽  
Helen Ayles
Keyword(s):  
Health System ◽  
Conceptual Framework ◽  
Low Income ◽  
System Thinking ◽  
Health System Strengthening ◽  
System Intervention ◽  
Health System Intervention

scholarly journals Crossing borders: the PACK experience of spreading a complex health system intervention across low-income and middle-income countries

2018 ◽  
Vol 3 (Suppl 5) ◽  
pp. e001088 ◽  
Author(s):  
Ruth Cornick ◽  
Camilla Wattrus ◽  
Tracy Eastman ◽  
Christy Joy Ras ◽  
Ajibola Awotiwon ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Low Income ◽  
Resource Constraints ◽  
Care Delivery ◽  
Middle Income ◽  
System Intervention ◽  
Learning Health System ◽  
Primary Care Delivery ◽  
Health System Intervention

Developing a health system intervention that helps to improve primary care in a low-income and middle-income country (LMIC) is a considerable challenge; finding ways to spread that intervention to other LMICs is another. The Practical Approach to Care Kit (PACK) programme is a complex health system intervention that has been developed and adopted as policy in South Africa to improve and standardise primary care delivery. We have successfully spread PACK to several other LMICs, including Botswana, Brazil, Nigeria and Ethiopia. This paper describes our experiences of localising and implementing PACK in these countries, and our evolving mentorship model of localisation that entails our unit providing mentorship support to an in-country team to ensure that the programme is tailored to local resource constraints, burden of disease and on-the-ground realities. The iterative nature of the model’s development meant that with each country experience, we could refine both the mentorship package and the programme itself with lessons from one country applied to the next—a ‘learning health system’ with global reach. While not yet formally evaluated, we appear to have created a feasible model for taking our health system intervention across more borders.

scholarly journals Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

2020 ◽  
Vol 5 (1) ◽  
pp. e001937
Author(s):  
Mike English ◽  
David Gathara ◽  
Jacinta Nzinga ◽  
Pratap Kumar ◽  
Fred Were ◽  
...  
Keyword(s):  
Health System ◽  
Low Income ◽  
Health Workers ◽  
Newborn Care ◽  
Well Being ◽  
Public Hospitals ◽  
Urban Setting ◽  
Health System Strengthening ◽  
Research Approach ◽  
Systems Research

There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses’ well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.

O362 Safe delivery - A Swedish health system intervention

2009 ◽  
Vol 107 ◽  
pp. S195-S195
Author(s):  
C. Grunewald ◽  
M. Nyström ◽  
S. Håkansson ◽  
K. Källén ◽  
I. Wiklund ◽  
...  
Keyword(s):  
Health System ◽  
Safe Delivery ◽  
System Intervention ◽  
Health System Intervention

Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda

2016 ◽  
Vol 95 ◽  
pp. 309-314 ◽  
Author(s):  
Anthony T. Fuller ◽  
Michael M. Haglund ◽  
Stephanie Lim ◽  
John Mukasa ◽  
Michael Muhumuza ◽  
...  
Keyword(s):  
Health System ◽  
Referral Hospital ◽  
System Intervention ◽  
Mulago National Referral Hospital ◽  
Health System Intervention ◽  
National Referral Hospital

scholarly journals Advancing a Science for Sustaining Health: Establishing a Model Health District in Madagascar

2017 ◽  
Author(s):  
Matthew H. Bonds ◽  
Andres Garchitorena ◽  
Laura Cordier ◽  
Ann C. Miller ◽  
Margaret McCarty ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Low Income ◽  
Building Blocks ◽  
International Standards ◽  
Health District ◽  
Health System Strengthening ◽  
Systems Research ◽  
Data Platform ◽  
Government District

AbstractObjectiveWe demonstrate a replicable model health district for Madagascar. The governments of many low-income countries have adopted health policies that follow international standards, and yet there are four hundred million people without basic access to primary care. Closing this global health delivery gap is typically framed as an issue of scale-up, accomplished primarily through integrating international donor funds with broad-based health system strengthening (HSS) efforts. However, there is no established process by which healthcare systems measure improvements at the point of service and how those, in turn, impact population health. There is no gold standard, equivalent to randomized trials of individual-level interventions, for health systems research. Here, we present a framework for a model district in Madagascar where national policies are implemented along with additional health system interventions to allow for bottom-up adaptation.SettingThe intervention takes place in a government district in Madagascar, which includes 1 district hospital, 20 primary care health centers, and a network of community health workers.InterventionThe program simultaneously strengthens the WHO’s six building blocks of HSS at all levels of the health system within a government district and pioneers a data platform that includes 1) strengthening the district’s health management information systems; 2) monitoring and evaluation dashboards; and 3) a longitudinal cohort demographic and health study of over 1,500 households, with a true baseline in intervention and comparison groups.ConclusionThe integrated intervention and data platform allows for the evaluation of system output indicators as well as population-level impact indicators, such as mortality rates. It thus supports field-based implementation and policy research to fill the know-do gap, while providing the foundation for a new science of sustaining health.Data Sharing StatementData can be made available upon request by [email protected].

scholarly journals Nuancing the need for speed: temporal health system strengthening in low-income countries

2019 ◽  
Vol 4 (4) ◽  
pp. e001816
Author(s):  
Tom Bashford ◽  
Alexis Joannides ◽  
Kamal Phuyal ◽  
Santosh Bhatta ◽  
Julie Mytton ◽  
...  
Keyword(s):  
Health System ◽  
Low Income ◽  
Health System Strengthening ◽  
Low Income Countries
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