scholarly journals Evidence of health system resilience in Myanmar during Cyclone Nargis: a qualitative analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e050700
Author(s):  
Pauline Yongeun Grimm ◽  
Sonja Merten ◽  
Kaspar Wyss
Keyword(s):  
Social Capital ◽  
Health System ◽  
System Analysis ◽  
System Level ◽  
Health Goals ◽  
Balanced Distribution ◽  
System Resilience ◽  
Barriers And Opportunities ◽  
Cyclone Nargis

ObjectiveThe aim of this study is to improve the understanding of the characteristics of health system resilience in Myanmar’s response to Cyclone Nargis and to explore ways to improve resilience at the system level.Design and settingThis is an explanatory qualitative study exploring the institutional capacity of resilience in Myanmar’s health system. Analysis proceeded using a data-driven thematic analysis closely following the framework method. This process enabled comparisons and contrasts of key emergent themes between the participants, which later generated key results describing the foundational assets, barriers and opportunities for achieving resilience in Myanmar.ParticipantsThe study comprised of 12 in-depth interviews conducted with representatives from international organisations and non-governmental organisations (NGOs). The inclusion criteria to recruiting the participants were that they had directly been a part of the Cyclone Nargis response at the time. There was a balanced distribution of participants across UN, bilateral and NGOs, and most of them were either Myanmar citizens or expatriates with extensive working experience based in Myanmar.ResultsKey findings elucidate the characteristics of resilience that have been salient or absent in Myanmar’s response to Cyclone Nargis. Strong social capital and motivation propelled by its deep-rooted culture and religion served as Myanmar’s greatest assets that filled major gaps in the system. Meanwhile, its postcolonial and military legacy posed barriers towards investing in building its long-term foundations towards resilience.ConclusionsThis study revealed that resilience in the health system can be built through strategic investments towards building the foundations of resilience to better prepare for future shocks. In the case of Myanmar, social capital and motivation, which surfaced as its foundational assets, can be channelled into opportunities that can help achieve its long-term health goals, accelerating its journey towards resilience in the health system.

scholarly journals What Makes Health Systems Resilient? A Qualitative Analysis of The Perspectives of Swiss NGOs

2021 ◽  
Author(s):  
Pauline Yongeun Grimm ◽  
Kaspar Wyss
Keyword(s):  
Global Health ◽  
Health System ◽  
Human Resource Development ◽  
Health Systems ◽  
Knowledge Exchange ◽  
Innovative Solutions ◽  
System Resilience ◽  
State Actors

Abstract Background: Resilience has become relevant than ever before with the advent of increasing and intensifying shocks on the health system and its amplified effects due to globalization. Using the example of non-state actors based in Switzerland, the aim of this study is to explore how and to what extent NGOs with an interest in global health have dealt with unexpected shocks on the health systems of their partner countries and to reflect on the practical implications of resilience for the multiple actors involved. Consequently, this paper analyses the key attributes of resilience that targeted investments may influence, and the different roles key stakeholders may assume to build resilience. Methods: This is a descriptive and exploratory qualitative study analysing the perspectives on health system resilience of Swiss-based NGOs through 20 in-depth interviews. Analysis proceeded using a data-driven thematic analysis closely following the framework method. An analytical framework was developed and applied systematically resulting in a complete framework matrix. The results are categorised into the expected role of the governments, the role of the NGOs, and practical future steps for building health system resilience. Results: The following four key ‘foundations of resilience’ were found to be dominant for unleashing greater resilience attributes regardless of the nature of shocks: ‘realigned relationships,’ ‘foresight,’ ‘motivation,’ and ‘emergency preparedness.’ The attribute to ‘integrate’ was shown to be one of the most crucial characteristics of resilience expected of the national governments from the NGOs, which points to the heightened role of governance. Meanwhile, as a key stakeholder group that is becoming inevitably more powerful in international development cooperation and global health governance, non-state actors namely the NGOs saw themselves in a unique position to facilitate knowledge exchange and to support long-term adaptations of innovative solutions that are increasing in demand. The strongest determinant of resilience in the health system was the degree of investments made for building long-term infrastructures and human resource development which are well-functioning prior to any potential crisis. Conclusions: Health system resilience is a collective endeavour and a result of many stakeholders’ consistent and targeted investments. These investments open up new opportunities to seek innovative solutions and to keep diverse actors in global health accountable. Strong governance, a bi-directional knowledge exchange, and the focus on leveraging science for impact can draw greater potential of resilience in the health systems. Governments and the NGOs have unique points of contribution in this journey towards resilience and may support governments to prioritise investing in the key ‘foundations of resilience’ in order to activate greater attributes of resilience.

scholarly journals Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords

2019 ◽  
Vol 9 (1) ◽  
pp. 6-16 ◽  
Author(s):  
My Fridell ◽  
Sanna Edwin ◽  
Johan von Schreeb ◽  
Dell D. Saulnier
Keyword(s):  
Health System ◽  
Health Systems ◽  
Scoping Review ◽  
World Health ◽  
Systems Research ◽  
Quality Health ◽  
System Resilience ◽  
Health Organization ◽  
Key Terms

Background: Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept. Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords "health system" and "resilience" for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience. Discussion: No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience.

scholarly journals Making healthcare accessible for single adults with complex needs experiencing long-term homelessness: A realist evaluation protocol

2021 ◽  
Vol 3 ◽  
pp. 73
Author(s):  
Rikke Siersbaek ◽  
John Ford ◽  
Clíona Ní Cheallaigh ◽  
Sara Burke ◽  
Steve Thomas
Keyword(s):  
Health System ◽  
Performance Management ◽  
System Performance ◽  
Realist Review ◽  
Realist Evaluation ◽  
System Level ◽  
Health System Performance ◽  
Programme Theory ◽  
Healthcare Accessibility

Background: Over the last several years, homelessness has increased in Ireland and across Europe. Rates have recently declined since the coronavirus disease 2019 (COVID-19) pandemic, but it is unclear whether emergency housing measures will remain in place permanently. Populations experiencing long-term homelessness face a higher burden of multi-morbidity at an earlier age than housed populations and have poorer health outcomes. However, this population also has more difficulty accessing appropriate health services. A realist review by the authors found that important health system contexts which impact access are resourcing, training, funding cycles, health system fragmentation, health system goals, how care is organised, culture, leadership and flexibility of care delivery. Using a realist evaluation approach, this research will explore and refine key system-level factors, highlighted in our realist review, in a local health care system. Aim: The aim of this study is to understand how funding procedures and health system performance management impact service settings, staff, providers and their ability to make services accessible to populations experiencing homelessness. Methods: A realist evaluation will be undertaken to explain how funding and health system performance management impact healthcare accessibility for populations experiencing homelessness. Data will be collected using qualitative and realist interview techniques and focus group methodology. Secondary data such as policy documents and budgets will utilised. The analysis will follow Pawson and Tilley’s iterative phases starting with building an Initial programme theory, then data collection, data analysis, synthesis and finally building a refined programme theory. Conclusion: Building on a realist review conducted by the same research team, this study will further test and refine findings that explain how health system factors impact healthcare accessibility for populations experiencing homelessness. The study has the potential to inform policy makers, health planners and managers of contextual factors that can be modified to increase healthcare accessibility.

The case for value chain resilience

2020 ◽  
Vol 43 (12) ◽  
Author(s):  
Igor Linkov ◽  
Savina Carluccio ◽  
Oliver Pritchard ◽  
Áine Ní Bhreasail ◽  
Stephanie Galaitsi ◽  
...  
Keyword(s):  
Value Chain ◽  
Design Methodology ◽  
System Level ◽  
Value Chain Analysis ◽  
Content Type ◽  
Chain Analysis ◽  
Future Value ◽  
System Resilience ◽  
Current Value

Purpose Value chain analyses that help businesses build competitive advantage must include considerations of unpredictable shocks and stressors that can create costly business disruptions. Enriching value chain analysis with considerations of system resilience, meaning the ability to recover and adapt after adverse events, can reduce the imposed costs of such disruptions. Design/methodology/approach The paper provides a perspective on resilience as both an expansion and complement of risk analysis. It examines applications of both concepts within current value chain literature and within supply chain literature that may inform potential directions or pitfalls for future value chain investigations. Established frameworks from the broader field of resilience research are proposed for value chain resilience analysis and practice. Findings The synthesis reveals a need to expand value chain resilience analysis to incorporate phases of system disruption. Current explorations in the literature lack an explicit acknowledgement and understanding of system-level effects related to interconnectedness. The quantification methods proposed for value chain resilience analysis address these gaps. Originality/value Using broader resilience conceptualizations, this paper introduces the resilience matrix and three-tiered resilience assessment that can be applied within value chain analyses to better safeguard long-term business feasibility despite a context of increasing threats.

scholarly journals How accessible is healthcare for single adults experiencing long-term homelessness and complex needs? A realist evaluation protocol

2020 ◽  
Vol 3 ◽  
pp. 73 ◽  
Author(s):  
Rikke Siersbaek ◽  
John Ford ◽  
Clíona Ní Cheallaigh ◽  
Sara Burke ◽  
Steve Thomas
Keyword(s):  
Health System ◽  
Performance Management ◽  
System Performance ◽  
Realist Review ◽  
Realist Evaluation ◽  
System Level ◽  
Health System Performance ◽  
Programme Theory ◽  
Healthcare Accessibility

Background: Over the last several years, homelessness has increased in Ireland and across Europe. Rates have recently declined since the coronavirus disease 2019 (COVID-19) pandemic, but it is unclear whether emergency housing measures will remain in place permanently. Populations experiencing long-term homelessness face a higher burden of multi-morbidity at an earlier age than housed populations and have poorer health outcomes. However, this population also has more difficulty accessing appropriate health services. A realist review by the authors found that important health system contexts which impact access are resourcing, training, funding cycles, health system fragmentation, health system goals, how care is organised, culture, leadership and flexibility of care delivery. Using a realist evaluation approach, this research will explore and refine key system-level factors, highlighted in our realist review, in a local health care system. Aim: The aim of this study is to understand how funding procedures and health system performance management impact service settings, staff, providers and their ability to make services accessible to populations experiencing homelessness. Methods: A realist evaluation will be undertaken to explain how funding and health system performance management impact healthcare accessibility for populations experiencing homelessness. Data will be collected using qualitative and realist interview techniques and focus group methodology. Secondary data such as policy documents and budgets will utilised. The analysis will follow Pawson and Tilley’s iterative phases starting with building an Initial programme theory, then data collection, data analysis, synthesis and finally building a refined programme theory. Conclusion: Building on a realist review conducted by the same research team, this study will further test and refine findings that explain how health system factors impact healthcare accessibility for populations experiencing homelessness. The study has the potential to inform policy makers, health planners and managers of contextual factors that can be modified to increase healthcare accessibility.

scholarly journals BUILDING HEALTH SYSTEM RESILIENCE DURING COVID-19 CRISIS

2020 ◽  
Vol 8 (2) ◽  
pp. 1
Author(s):  
Amanatul Ainiyah Firda ◽  
Setya Haksama
Keyword(s):  
Health System ◽  
Infected People ◽  
The Social ◽  
Health Threats ◽  
New Type ◽  
System Resilience ◽  
Coming Crisis ◽  
The Impact

Coronavirus is a type of virus that causes long-term health threats because coronavirus can adapt to new environments through mutations and recombination which is relatively simple.  Whereas in 2019, a new type of coronavirus was founded and known as the COVID-19 pandemic. The COVID-19 pandemic has resulted not only in the high number of infected people and the number of deaths but also in the social, cultural, and economic fields. To reduce the impact of the crisis recurrence, it is necessary to reduce risks and build resilience systems. One of the resilience systems that can deal with disasters, especially the coming crisis is a health system resilience.

Managing the effectiveness of the regional health system

2020 ◽  
Vol 26 (3) ◽  
pp. 698-720
Author(s):  
E.V. Lobkova ◽  
A.S. Petrichenko
Keyword(s):  
Public Health ◽  
Health System ◽  
System Analysis ◽  
Health Indicators ◽  
Krasnoyarsk Krai ◽  
Regional Health ◽  
Luenberger Observer ◽  
Efficiency Assessment ◽  
Public Health Indicators

Subject. This article studies the mechanism of State health regulation and methods of management of efficiency of regional healthcare institutions. Objectives. The article aims to analyze the territorial health system in the context of the urgent need to optimize budget expenditures and address public health problems, as well as develop directions to improve the effectiveness of the regional health system of the Krasnoyarsk Krai. Methods. For the study, we used the method of index numbers and calculation of dynamics indicators using official statistics data. Results. We have developed and now present a system of indicators of regional health efficiency assessment, focused mainly on public health indicators and quality of medical services. We also offer our own version of the Luenberger observer modification adapted to the objectives of the regional health system analysis. Conclusions and Relevance. The article concludes that it is necessary to optimize the regional health system using the parameters of medical and social efficiency of the system. The proposed approach to assessing the effectiveness of regional health system can be used as a mechanism to develop recommendations for the management of the network of medical and prophylactic institutions of the region.

Percepción de la Población Pobre de Santiago sobre el Mercado Laboral en Chile al año 2011 y evolución desde el año 2003

Oikos ◽  
2015 ◽  
Vol 15 (31) ◽  
pp. 153
Author(s):  
Marcelo Yáñez Pérez
Keyword(s):  
Social Capital ◽  
Labor Market ◽  
Equal Opportunities ◽  
Capital Social ◽  
Union Power ◽  
Family Labor ◽  
The Poor ◽  
State Unemployment ◽  
Poor Population

RESUMENEl artículo muestra los principales resultados de la investigación Percepción de la Población Pobre de Santiago sobre el Mercado Laboral en Chile, realizada durante 9 años consecutivos desde 2003, por la Escuela de Administración y Economía de la Universidad Católica Silva Henríquez. El estudio incluye antecedentes sobre las concepciones de empleo y desempleo de este grupo de la población, así como la identificación de quienes –a su juicio– serían los responsables de que las personas pobres obtengan un trabajo y la calificación que le asignan a su gestión. También contempla sus percepciones en torno al apoyo del Estado, nivel de desempleo, influencia del capital social, respeto por los trabajadores, igualdad de oportunidades, poder de los sindicatos, entre otros aspectos, además del nivel de desempleo familiar y tipo de problemas laborales que han enfrentado.Palabras clave: mercado laboral, pobreza, percepciones, equidad.Este estudio ha sido realizado en el contexto de la investigación “Percepción de la población pobre de Santiago sobre las condiciones de acceso, equidad y satisfacción en la obtención de bienes básicos y públicos – año 2011: visión evolutiva desde el año 2003”, que es parte del Programa de Investigación de la Escuela de Administración y Economía de la UCSH. Esta investigación ha sido financiada desde sus inicios y en su totalidad con fondos propios de esta Universidad.Perception of the Poor Population from Santiago of The Labor Market in Chile in the year 2011 and evolution from 2003ABSTRACTThe paper shows the main results of a long-term investigation on the perceptions of the poor of Santiago of the labor market in Chile, which began in 2003 and was carried out by the School of Management and Economics at the Universidad Católica Silva Henríquez. The study includes background on the concepts of employment and unemployment in this group of the population, and the identification of those who, in his opinion, would be responsible for the poor to get a job and the rating assigned to their management. It also includes their perceptions of the support of the state, unemployment, social capital influence, respect for workers, equal opportunities, union power, among other things, besides the level of unemployment and type of family labor problems they have faced.Keywords: labor market, poverty, perceptions, equity.

Comparative assessment of morphological mechanisms of maintaining structural liver homeostasis in the dynamics of exposure to coal-rock dust and sodium fluoride on the body

2020 ◽  
pp. 189-194
Author(s):  
M. S. Bugaeva ◽  
O. I. Bondarev ◽  
N. N. Mikhailova ◽  
L. G. Gorokhova
Keyword(s):  
Sodium Fluoride ◽  
Morphological Changes ◽  
The Body ◽  
System Level ◽  
Production Factor ◽  
Coal Rock ◽  
The Impact ◽  
Structural Homeostasis ◽  
Rock Dust

Introduction. The impact on the body of such factors of the production environment as coal-rock dust and fluorine compounds leads to certain shift s in strict indicators of homeostasis at the system level. Maintaining the relative constancy of the internal environment of the body is provided by the functional consistency of all organs and systems, the leading of which is the liver. Organ repair plays a crucial role in restoring the structure of genetic material and maintaining normal cell viability. When this mechanism is damaged, the compensatory capabilities of the organ are disrupted, homeostasis is disrupted at the cellular and organizational levels, and the development of the main pathological processes is noted.The aim of the study is to compare the morphological mechanisms of maintaining structural homeostasis of the liver in the dynamics of the impact on the body of coal-rock dust and sodium fluoride.Materials and methods. Experimental studies were conducted on adult white male laboratory rats. Features of morphological mechanisms for maintaining structural homeostasis of the liver in the dynamics of exposure to coal-rock dust and sodium fluoride were studied on experimental models of pneumoconiosis and fluoride intoxication. For histological examination in experimental animals, liver sampling was performed after 1, 3, 6, 9, 12 weeks of the experiment.Results. The specificity of morphological changes in the liver depending on the harmful production factor was revealed. It is shown that chronic exposure to coal-rock dust and sodium fluoride is characterized by the development of similar morphological changes in the liver and its vessels from the predominance of the initial compensatory-adaptive to pronounced violations of the stromal and parenchymal components. Long-term inhalation of coal-rock dust at 1–3 weeks of seeding triggers adaptive mechanisms in the liver in the form of increased functional activity of cells, formation of double-core hepatocytes, activation of immunocompetent cells and endotheliocytes, ensuring the preservation of the parenchyma and the general morphostructure of the organ until the 12th week of the experiment. Exposure to sodium fluoride leads to early disruption of liver compensatory mechanisms and the development of dystrophic changes in the parenchyma with the formation of necrosis foci as early as the 6th week of the experiment.Conclusions. The study of mechanisms for compensating the liver structure in conditions of long-term exposure to coal-rock dust and sodium fluoride, as well as processes that indicate their failure, and the timing of their occurrence, is of theoretical and practical importance for developing recommendations for the timely prevention and correction of pathological conditions developing in employees of the aluminum and coal industry.The authors declare no conflict of interests.

Multi-level Barriers for Utilization of Youth Friendly Reproductive Health Services (YFRHS) among Youths

2020 ◽  
Vol 8 ◽  
pp. 95-108
Author(s):  
Shanti Prasad Khanal
Keyword(s):  
Reproductive Health ◽  
Health Services ◽  
Health System ◽  
System Level ◽  
Mixed Method Research ◽  
Reproductive Health Services ◽  
Group Discussions ◽  
Personal Level ◽  
Multi Level ◽  
Youth Friendly

 The present study aims to examine the multi-level barriers to utilize by the youth-friendly reproductive health services (YFRHS) among the school-going youths of the Surkhet valley of Nepal. This study is based on the sequential explanatory research design under mixed-method research. The quantitative data were collected using the self- administered questionnaire from the 249 youths, aged between the 15-24 years, those selected by using random sampling. The qualitative data were collected using the Focus Group Discussions (FGDs) from the 12 participants who were selected purposively. The study confirmed that school-going youths do not have appropriate utilization of YFHS due to multi-layered barriers. However, the utilization of the service was higher among females, those the older age group, studying in the upper classes, the upper castes, and married youths. The key findings and themes are recognized as multi-layered barriers including personal-level, health system-level, community-level, and policy-level on the entire socio-ecological field. Among them, the existing health system is the foremost barrier. Multi-level interventions are, therefore, required to increase the YFRHS utilization and improve concerns for school-going-youths.  

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