scholarly journals Why didn’t you write this in your diary? Or how nurses (mis)used clinic diaries to (re)claim shared reflexive spaces in Senegal

2019 ◽  
Vol 39 (2) ◽  
pp. 205-221 ◽  
Author(s):  
Diane Duclos ◽  
Tidiane Ndoye ◽  
Sylvain L Faye ◽  
Mareme Diallo ◽  
Loveday Penn-Kekana
Keyword(s):  
Supply Chain ◽  
Family Planning ◽  
Health System ◽  
Health Systems ◽  
Lived Experiences ◽  
Research Process ◽  
Coordination Mechanisms ◽  
Data Reporting ◽  
Shared Experiences ◽  
Qualitative Component

Between 2015 and 2017, we implemented the clinic diaries project as part of the qualitative component of an evaluation of a supply chain intervention for family planning in Senegal. This project combined different tools including the diaries and participatory workshops with nurses. At the intersection between writings and silences, this paper explores the role played by the clinic diaries to mediate ethnographic encounters, and the iterative nature of ‘doing fieldwork’ to produce knowledge in hierarchical health systems. This paper also reflects on the processes through which the diaries created a space where accounts of lived experiences routinely unfolding in health facilities could be shared, in the context of a health system increasingly dominated by metrics, performances and vertical reporting mechanisms. The clinic diaries research process therefore sheds light on the limits of approaching bureaucratic norms and practices as coming from the top, an approach reinforced by data reporting and coordination mechanisms in the Senegalese pyramidal health system. In contrast, the diaries suggest a role for participative ethnography to identify collegial spaces to reflect on shared experiences in and of bureaucratic spaces.

Integration vs. Collaborative Redesign Strategies of Health Systems’ Supply Chains in the Post-COVID-19 New Normal using Cross-Sectional Survey Across the United States (Preprint)

2021 ◽  
Author(s):  
Jiban Khuntia ◽  
Frances Mejia ◽  
Xue Ning ◽  
Jeff Helton ◽  
Rulon Stacey
Keyword(s):  
United States ◽  
Supply Chain ◽  
Health System ◽  
Supply Chains ◽  
Health Systems ◽  
The United States ◽  
Supply Chain Integration ◽  
Strategic Choices ◽  
New Normal ◽  
Service Outcomes

BACKGROUND How are health systems shaping strategies to restore the supply chain disruptions in 2021? Do they want to improve the supply chain integration? Do they want to collaborate with new start-ups to revamp the supply chain? Given the widespread disruptions to supply chains in 2020 because of the COVID-19 pandemic, these questions are essential to have confidence in health systems’ supply chain model strategies. Plausibly, health systems have an opportunity for redesign, growth, and innovation by utilizing collaborative strategies now, compared to the usual strategies of integrating their existing supply chains to reduce inefficiencies. This study is focused on teasing out the nuance of supply chain integration vs. collaboration strategies for health systems in the post-COVID “new normal.” OBJECTIVE We focus on two research questions. First, we explore the impact of perceived supply chain challenges and disruptions on health systems’ supply chain integration (SC-INTEGRATION) and collaborative redesign (SC-REDESIGN) strategies. Second, we examine the outcomes of integration and collaborative redesign strategic choices on growth and service outcomes. METHODS We surveyed a robust group of health system chief executive officers (CEOs) (N=625) across the United States from February to March 2021. Twenty-two percent of the CEOs (135) responded to our survey. We considered supply chain relevant strategy and outcome variables from the literature and ratified them via expert consensus. We collected secondary data from the AHRQ Compendium of the U.S. Health Systems, leading to a matched data set from the 124 health systems. Then, we employed ordered logit model estimation to examine CEO preferences for partnership strategies to address current supply disruptions and the outcomes of strategy choices. RESULTS Health systems with higher disruptions would choose integration over redesign, indicating that they still trust the existing partners. Integration strategy is perceived to result in better service outcomes while collaborations are perceived to lead to greater growth opportunities; however, the role of integration on growth is not completely ruled out. Plausibly, some health systems would choose both integration and collaborative redesign models, which have a significant relationship with both service and growth, establishing the importance of mixed strategies for health systems. CONCLUSIONS The cost of healthcare continues to rise, and supply-related costs constitute a large portion of a hospital’s expenditure. Understanding supply chain strategic choices are essential for the success of a health system. Although collaborative revamp is an option; but still focusing on and improving existing integration dynamics is helpful to foster both growth and services for health systems.

scholarly journals Lived Experiences and Perceptions of Childbirth among Pastoralist Women in North-Eastern Ethiopia: A Multimethod Qualitative Analysis to the WHO Health Systems Responsiveness Framework

2021 ◽  
Vol 18 (23) ◽  
pp. 12518
Author(s):  
Nejimu Biza Zepro ◽  
Araya Abrha Medhanyie ◽  
Afework Mulugeta Bezabih ◽  
Natalie Tarr ◽  
Sonja Merten
Keyword(s):  
Social Support ◽  
Health System ◽  
Health Systems ◽  
Lived Experiences ◽  
Phenomenological Approach ◽  
Care Providers ◽  
Eastern Ethiopia ◽  
Skilled Delivery ◽  
Values And Beliefs ◽  
Prompt Attention

Maternity should be a time of hope and joy. However, for women in pastoralist communities in Ethiopia, the reality of motherhood is often grim. This problem is creating striking disparities of skilled birth uptake among the agrarian and pastoral communities in Ethiopia. So far, the depth and effects of the problem are not well understood. This study is intended to fill this research gap by exploring mothers’ lived experiences and perceptions during skilled birthing care in hard-to-reach communities of Ethiopia. An Interpretive Phenomenological approach was employed to analyse the exploratory data. Four key informant interviews, six in-depth interviews, six focus group discussions, and twelve focused observations were held. WHO responsiveness domains formed the basis for coding and analysis: dignity, autonomy, choice of provider, prompt attention, communication, social support, confidentiality, and quality of basic amenities. The skilled birthing experience of nomadic mothers is permeated by a deep-rooted and hidden perceived neglect, which constitutes serious challenges to the health system. Mothers’ experiences reflect not only the poor skilled delivery uptake, but also how health system practitioners are ignorant of Afar women’s way of life, their living contexts, and their values and beliefs regarding giving birth. Three major themes emerged from data analysis: bad staff attitude, lack of culturally acceptable care, and absence of social support. Nomadic mothers require health systems that are responsive and adaptable to their needs, beliefs, and values. The abuse and disrespect they experience from providers deter nomadic women from seeking skilled birthing care. Women’s right to dignified, respectful, skilled delivery care requires the promotion of woman-centred care in a culturally appropriate manner. Skilled birthing care providers should be cognizant of the WHO responsiveness domains to ensure the provision of culturally sensitive birthing care.

scholarly journals Aligning policymaking in decentralized health systems: Evaluation of strategies to prevent and control non-communicable diseases in Nigeria

2021 ◽  
Vol 1 (11) ◽  
pp. e0000050
Author(s):  
Whenayon Simeon Ajisegiri ◽  
Seye Abimbola ◽  
Azeb Gebresilassie Tesema ◽  
Olumuyiwa O. Odusanya ◽  
Dike B. Ojji ◽  
...  
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Health Systems ◽  
Care Delivery ◽  
Policy Formulation ◽  
Coordination Mechanisms ◽  
Noncommunicable Diseases ◽  
Strategic Intent ◽  
National Governments ◽  
And Control

Noncommunicable diseases (NCDs) are leading causes of death globally and in Nigeria they account for 29% of total deaths. Nigeria’s health system is decentralized. Fragmentation in governance in federalised countries with decentralised health systems is a well-recognised challenge to coherent national health policymaking. The policy response to the rising NCD burden therefore requires strategic intent by national and sub-national governments. This study aimed to understand the implementation of NCD policies in Nigeria, the role of decentralisation of those policies, and to consider the implications for achieving national NCD targets. We conducted a policy analysis combined with key informant interviews to determine to what extent NCD policies and strategies align with Nigeria’s decentralised health system; and the structure and process within which implementation occurs across the various tiers of government. Four inter-related findings emerged: NCD national policies are ‘top down’ in focus and lack attention to decentralisation to subnational and frontline care delivery levels of the health system; there are defective coordination mechanisms for NCD programmes which are underpinned by weak regional organisational structures; financing for NCDs are administratively burdensome and fragmented; and frontline NCD service delivery for NCDs are not effectively being integrated with other essential PHC services. Despite considerable progress being made with development of national NCD policies, greater attention on their implementation at subnational levels is needed to achieve more effective service delivery and progress against national NCD targets. We recommend strengthening subnational coordination mechanisms, greater accountability frameworks, increased and more efficient funding, and greater attention to integrated PHC service delivery models. The use of an effective bottom-up approach, with consideration for decentralization, should also be engaged at all stages of policy formulation.

scholarly journals Strengthening Health Systems in Humanitarian Settings: Multi-Stakeholder Insights on Contraception and Postabortion Care Programs in the Democratic Republic of Congo and Somalia

2020 ◽  
Author(s):  
Nguyen Toan Tran ◽  
Janet Meyers ◽  
Bibiche Malilo ◽  
Julien Chabo ◽  
Jean-Baptiste MUSELEMU ◽  
...  
Keyword(s):  
Family Planning ◽  
Health System ◽  
Health Systems ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Health System Strengthening ◽  
World Health ◽  
Republic Of Congo ◽  
Humanitarian Settings ◽  
Postabortion Care

Abstract BackgroundIn humanitarian settings, strengthening health systems while responding to the health needs of crisis-affected populations is challenging and marked with evidence gaps. Drawing from a decade of family planning and postabortion care programming in humanitarian settings, this paper aims to identify strategic components that contribute to health system strengthening in such contexts. MethodsA diverse range of key informants from North Kivu (Democratic Republic of Congo, DRC) and Puntland (Somalia), including female and male community members, adolescents and adults, healthcare providers, government and community leaders, participated in qualitative interviews, which applied the World Health Organization health system building blocks framework. Data were thematically analyzed according to this framework.ResultsFindings from the focus group discussions (11 in DRC, 7 in Somalia) and key informant interviews (7 in DRC, 4 in Somalia) involving in total 54 female and 72 male participants across both countries indicate that health programs in humanitarian settings, such as Save the Children’s initiative on family planning and postabortion care, could contribute to strengthening health systems by positively influencing national policies and guidance, strengthening local coordination mechanisms, capacitating the healthcare workforce with competency-based training and supportive supervision (benefiting facilities supported by the project and beyond), developing the capacity of Ministry of Health staff in the effective management of the supply chain, actively and creatively mobilizing the community to raise awareness and create demand, and providing quality and affordable services. Financial sustainability is challenged by the chronically limited healthcare expenditure experienced in both humanitarian contexts.ConclusionsIn humanitarian settings, carefully designed healthcare interventions, such as those that address the family planning and postabortion care needs of crisis-affected populations, are able not only to increase access to essential services but also contribute to strengthening several components of the health system while increasing the government capacity, ownership, and accountability.

scholarly journals Strengthening Health Systems in Humanitarian Settings: Multi-Stakeholder Insights on Contraception and Postabortion Care Programs in the Democratic Republic of Congo and Somalia

2021 ◽  
Vol 2 ◽  
Author(s):  
Nguyen Toan Tran ◽  
Janet Meyers ◽  
Bibiche Malilo ◽  
Julien Chabo ◽  
Jean-Baptiste Muselemu ◽  
...  
Keyword(s):  
Family Planning ◽  
Health System ◽  
Health Systems ◽  
Democratic Republic ◽  
Democratic Republic Of Congo ◽  
Health System Strengthening ◽  
World Health ◽  
Republic Of Congo ◽  
Humanitarian Settings ◽  
Postabortion Care

Background: In humanitarian settings, strengthening health systems while responding to the health needs of crisis-affected populations is challenging and marked with evidence gaps. Drawing from a decade of family planning and postabortion care programming in humanitarian settings, this paper aims to identify strategic components that contribute to health system strengthening in such contexts.Materials and Methods: A diverse range of key informants from North Kivu (Democratic Republic of Congo, DRC) and Puntland (Somalia), including female and male community members, adolescents and adults, healthcare providers, government and community leaders, participated in qualitative interviews, which applied the World Health Organization health system building blocks framework. Data were thematically analyzed according to this framework.Results: Findings from the focus group discussions (11 in DRC, 7 in Somalia) and key informant interviews (seven in DRC, four in Somalia) involving in total 54 female and 72 male participants across both countries indicate that health programs in humanitarian settings, such as Save the Children's initiative on family planning and postabortion care, could contribute to strengthening health systems by positively influencing national policies and guidance, strengthening local coordination mechanisms, capacitating the healthcare workforce with competency-based training and supportive supervision (benefiting facilities supported by the project and beyond), developing the capacity of Ministry of Health staff in the effective management of the supply chain, actively and creatively mobilizing the community to raise awareness and create demand, and providing quality and affordable services. Financial sustainability is challenged by the chronically limited healthcare expenditure experienced in both humanitarian contexts.Conclusions: In humanitarian settings, carefully designed healthcare interventions, such as those that address the family planning and postabortion care needs of crisis-affected populations, have the potential not only to increase access to essential services but also contribute to strengthening several components of the health system while increasing the government capacity, ownership, and accountability.

scholarly journals 1.F. Workshop: The barriers to effective hypertension care: a focus on the patient's journey

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Lived Experiences ◽  
Chronic Conditions ◽  
The Philippines ◽  
Economic Consequences ◽  
Middle Income ◽  
Health System Change ◽  
Disadvantaged Populations ◽  
Technical Innovations

Abstract Millions of people across the world depend on health systems that simply do not work. They struggle to find someone who can help and, when they do, can face catastrophic bills for often substandard care. But we fail to listen to those whose needs, desires, and expectations are most unmet. We assume their understanding of health and illness is the same as ours and we ignore the coping strategies developed over years that they use to overcome the barriers that those who design health systems place in their way. They live their lives unseen and unheard by those who make the decisions that will determine whether they live or die. This workshop explores issues that arise when researchers actively engage with disadvantaged populations. It reports our experiences from the RESPOND project (Responsive and Equitable Health Systems - Partnership for Non-Communicable Diseases), working with disadvantaged communities in Malaysia and the Philippines to view the health system from the perspective of people whose health depends on a long-term relationship with it. We use a mixed methods approach, involving household surveys, in-depth interviews and digital diaries, where participants use mobile phones to record their experiences of living with chronic conditions and seeking care for it. The aim of this workshop is to demonstrate why it is important to listen to those in disadvantaged populations, in order to understand the barriers they face and the ways that they seek to overcome them as they seek care for a chronic disorder. We will illustrate this by achieving five objectives: To show why we need to look beyond the biomedical approach to illness;To recognise the many different journeys that patients follow;To understand the economic consequences of the choices that they make;To describe the theoretical and technical innovations developed as part of the RESPOND project to do this; andTo illustrate how bringing such insights together can be used to implement equitable health system change. The workshop will be chaired and moderated by Dina Balabanova and Martin McKee, two globally recognised leaders researching chronic conditions and health system reforms in low- and middle-income countries. The first three presentations will introduce people living with chronic conditions from the study communities, and will examine the challenges they face, their options and the choices they make to treat it. All five presentations, but particularly the remaining two, will describe the theoretical and technical innovations developed as part of the RESPOND project used to capture the voices and lived experiences of disadvantaged populations so that they may be better represented in the planning of health systems and services. The remaining 30 minutes will be devoted to guided interactive discussion with the audience on how we are using this people-centred evidence to implement change in each country, and how these approaches may be applied in other settings. Key messages Designing effective and responsive health systems that leave no one behind must account for the lived experiences of all beneficiaries, including those groups whose voices often go unheard. We present evidence from Malaysia and the Philippines from studies that used innovative methods to capture the lived experiences of disadvantaged populations seeking care for chronic conditions.

scholarly journals Key factors to facilitate locally driven family planning programming: a qualitative analysis of urban stakeholder perspectives in Africa and Asia

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Lisa Mwaikambo ◽  
Sarah Brittingham ◽  
Saori Ohkubo ◽  
Ruwaida Salem ◽  
Denis Joel Sama ◽  
...  
Keyword(s):  
Family Planning ◽  
Health Systems ◽  
Thematic Analysis ◽  
Urban Areas ◽  
Local Governments ◽  
Scale Up ◽  
Analytical Framework ◽  
Essential Elements ◽  
Evidence Based ◽  
Country Ownership

Abstract Background There has been greater recognition of the importance of country ownership in global health and development. However, operationalising country ownership to ensure the scale up and sustainability of proven interventions remains elusive at best. To address this challenge, we undertook a thematic analysis of interviews collected from representatives of local governments, public health systems, and communities in poor urban areas of East Africa, Francophone West Africa, India, and Nigeria, supported by The Challenge Initiative (TCI), aiming to rapidly and sustainably scale up evidence-based reproductive health and family planning solutions. Methods The main objective of this study was to explore critical elements needed for implementing and scaling evidence-based family planning interventions. The research team conducted thematic analysis of 96 stories collected using the Most Significant Change (MSC) technique between July 2018 and September 2019. After generating 55 unique codes, the codes were grouped into related themes, using TCI’s model as a general analytical framework. Results Five key themes emerged: (1) strengthening local capacity and improving broader health systems, (2) shifting mindsets of government and community toward local ownership, (3) institutionalising the interventions within existing government structures, (4) improving data demand and use for better planning of health services, and (5) enhancing coordination of partners. Conclusion While some themes feature more prominently in a particular region than others, taken together they represent what stakeholders perceive to be essential elements for scaling up locally-driven health programmes in urban areas in Africa and Asia.

scholarly journals The impact of economic sanctions on health and health systems in low- and middle-income countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Suhrcke ◽  
M Pinna Pintor ◽  
C Hamelmann
Keyword(s):  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Grey Literature ◽  
Economic Sanctions ◽  
Political Crisis ◽  
Middle Income ◽  
Financial Flows ◽  
Adverse Health ◽  
The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

scholarly journals 22.F. Workshop: What makes for resilient health systems? Evidence from the State of Health in the EU country profiles

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Building Blocks ◽  
The State ◽  
Lessons Learned ◽  
Three Dimensions ◽  
Health System Strengthening ◽  
New Work ◽  
State Of Health ◽  
The Eu

Abstract The European Commission's State of Health in the EU (SoHEU) initiative aims to provide factual, comparative data and insights into health and health systems in EU countries. The resulting Country Health Profiles, published every two years (current editions: November 2019) are the joint work of the European Observatory on Health Systems and Policies and the OECD, in cooperation with the European Commission. They are designed to support the efforts of Member States in their evidence-based policy making and to contribute to health care systems' strengthening. In addition to short syntheses of population health status, determinants of health and the organisation of the health system, the Country Profiles provide an assessment of the health system, looking at its effectiveness, accessibility and resilience. The idea of resilient health systems has been gaining traction among policy makers. The framework developed for the Country Profiles template sets out three dimensions and associated policy strategies and indicators as building blocks for assessing resilience. The framework adopts a broader definition of resilience, covering the ability to respond to extreme shocks as well as measures to address more predictable and chronic health system strains, such as population ageing or multimorbidity. However, the current framework predates the onset of the novel coronavirus pandemic as well as new work on resilience being done by the SoHEU project partners. This workshop aims to present resilience-enhancing strategies and challenges to a wide audience and to explore how using the evidence from the Country Profiles can contribute to strengthening health systems and improving their performance. A brief introduction on the SoHEU initiative will be followed by the main presentation on the analytical framework on resilience used for the Country Profiles. Along with country examples, we will present the wider results of an audit of the most common health system resilience strategies and challenges emerging from the 30 Country Profiles in 2019. A roundtable discussion will follow, incorporating audience contributions online. The Panel will discuss the results on resilience actions from the 2019 Country Profiles evidence, including: Why is resilience important as a practical objective and how is it related to health system strengthening and performance? How can countries use their resilience-related findings to steer national reform efforts? In addition, panellists will outline how lessons learned from country responses to the Covid-19 pandemic and new work on resilience by the Observatory (resilience policy briefs), OECD (2020 Health at a Glance) and the EC (Expert Group on Health Systems Performance Assessment (HSPA) Report on Resilience) can feed in and improve the resilience framework that will be used in the 2021 Country Profiles. Key messages Knowing what makes health systems resilient can improve their performance and ability to meet the current and future needs of their populations. The State of Health in the EU country profiles generate EU-wide evidence on the common resilience challenges facing countries’ health systems and the strategies being employed to address them.

scholarly journals How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links

2021 ◽  
Vol 18 (8) ◽  
pp. 3860
Author(s):  
Katarzyna Krot ◽  
Iga Rudawska
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health System ◽  
Health Systems ◽  
Quantitative Research ◽  
Public Trust ◽  
Complex Problem ◽  
Health Care Consumption ◽  
Mediating Role ◽  
Countries In Transition

Overconsumption of health care is an ever-present and complex problem in health systems. It is especially significant in countries in transition that assign relatively small budgets to health care. In these circumstances, trust in the health system and its institutions is of utmost importance. Many researchers have studied interpersonal trust. Relatively less attention, however, has been paid to public trust in health systems and its impact on overconsumption. Therefore, this paper seeks to identify and examine the link between public trust and the moral hazard experienced by the patient with regard to health care consumption. Moreover, it explores the mediating role of patient satisfaction and patient non-adherence. For these purposes, quantitative research was conducted based on a representative sample of patients in Poland. Interesting findings were made on the issues examined. Patients were shown not to overconsume health care if they trusted the system and were satisfied with their doctor-patient relationship. On the other hand, nonadherence to medical recommendations was shown to increase overuse of medical services. The present study contributes to the existing knowledge by identifying phenomena on the macro (public trust in health care) and micro (patient satisfaction and non-adherence) scales that modify patient behavior with regard to health care consumption. Our results also provide valuable knowledge for health system policymakers. They can be of benefit in developing communication plans at different levels of local government.

Sign in / Sign up

Export Citation Format

Share Document