scholarly journals The complexity of scaling up an mHealth intervention: the case of SMS for Life in Tanzania from a health systems integration perspective

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carmen Sant Fruchtman ◽  
Selemani Mbuyita ◽  
Mary Mwanyika-Sando ◽  
Marcel Braun ◽  
Don de Savigny ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
Large Scale ◽  
Digital Health ◽  
Health Sector ◽  
Building Blocks ◽  
Scaling Up ◽  
Stock Management ◽  
Study Approach

Abstract Background SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. Its goal was to increase visibility to antimalarial stock-outs through the use of SMS technology. The objective of this case study was to show the multiple innovations that SMS for Life brought to the Tanzanian public health sector and to discuss the challenges of scaling up that led to its discontinuation from a health systems perspective. Methods A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Data collection was informed by the health system building blocks. We then carried out a thematic analysis using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework. This served to identify the key reasons for the discontinuation of the programme. Results SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after 4 years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers. Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system. Conclusion This study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.

scholarly journals The Complexity of Scaling Up an mHealth Intervention. SMS for Life: A Case Study from a Health Systems Integration Perspective

2020 ◽  
Author(s):  
Carmen Sant Fruchtman ◽  
Selemani Mbuyita ◽  
Mary Mwanyika-Sando ◽  
Marcel Braun ◽  
Don de Savigny ◽  
...  
Keyword(s):  
Health System ◽  
Large Scale ◽  
Digital Health ◽  
Scaling Up ◽  
Stock Management ◽  
Study Approach ◽  
Mhealth Intervention ◽  
Future Technologies ◽  
Document Review

Abstract BackgroundThe objective of this study was to apply systems thinking to examine the opportunities and challenges of scaling up and integrating a new electronic health technology into a complex health system. We used the implementation cycle of the supply chain management solution (SMS for Life 1.0) in Tanzania as a case study. SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. It aimed to bring visibility to antimalarial stock-outs through the use of SMS technology.MethodsA qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework, we carried out a joint thematic analysis and identified the key reasons for the discontinuation of the programme.ResultsSMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after four years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers.Despite its discontinuation, SMS for Life, together with co-existing technologies, triggered the development of the capacity to accommodate and integrate future technologies in the health system.ConclusionThis study shows the importance of engaging appropriate stakeholders from the outset, understanding and designing system-responsive interventions appropriately when scaling up and ensuring value to a broad range of health system actors. These shortcomings are common among digital health solutions and need to be better addressed in future implementations.

scholarly journals The complexity of scaling up an mHealth intervention. SMS for Life: A Case Study from a Health Systems Integration Perspective

2020 ◽  
Author(s):  
Carmen Sant Fruchtman ◽  
Selemani Mbuyita ◽  
Mary Mwanyika-Sando ◽  
Marcel Braun ◽  
Don de Savigny ◽  
...  
Keyword(s):  
Health System ◽  
Large Scale ◽  
Scaling Up ◽  
Stock Management ◽  
Study Approach ◽  
Mhealth Intervention ◽  
Key Stakeholders ◽  
Key Events ◽  
Document Review

Abstract Background The objective of this study was to apply systems thinking to examine the opportunities and challenges of scaling up and integrating a new electronic health technology into a complex health system. We used the implementation cycle of the supply chain management solution (SMS for Life 1.0) in Tanzania as a case study. SMS for Life was one of the earliest large-scale implementations of mHealth innovations worldwide. It aimed to bring visibility to antimalarial stock-outs through the use of SMS technology.Methods A qualitative case-study approach was used. This included a literature review, a document review of 61 project documents, a timeline of key events and the collection and analysis of 28 interviews with key stakeholders involved in or affected by the SMS for Life programme. Using the WHO mHealth Assessment and Planning for Scale (MAPS) Toolkit as a framework, we carried out a joint thematic analysis and identified the key reasons for the discontinuation of the programme.Results SMS for Life was reliable at scale and raised awareness of stock-outs with real-time monitoring. However, it was discontinued in 2015 after four years of a national rollout. The main reasons identified for the discontinuation were the programme’s failure to adapt to the continuous changes in Tanzania’s health system, the focus on stock-outs rather than ensuring appropriate stock management, and that it was perceived as costly by policy-makers.

scholarly journals Country-Wide Resilience Model for the Health System: A Case Study on Iran, under Coronavirus Outbreak

2021 ◽  
Author(s):  
Nazanin Pilevari ◽  
Mahyar Valeh Shiva
Keyword(s):  
Health System ◽  
Health Systems ◽  
Dynamic Capabilities ◽  
Health Information System ◽  
National Health System ◽  
Building Blocks ◽  
Interpretive Structural Modeling ◽  
System A ◽  
The Impact

Background: The outbreak of the COVID-19 virus has had many destructive impacts on socio-economic and health systems. The health systems of countries could be supportive in crisis management, but they also are affected by the impact of the crisis, consequently, their operational level has declined. This study pursued resilience in an overall national health system under pandemic stress. Methods: Based on WHO building blocks, by interviewing informants of the Ministry of Health and Medical Education, in Tehran-Iran, early 2021 a rich picture of the current situation depicted, the resilience model was extracted via a mixed method of Soft System Methodology (SSM) and total interpretive structural modeling (TISM). Dynamic capabilities were applied for the orchestration of the Iranian health system. Results: Particular functional and structural suggestions applicable for designing a ubiquitous resilience model for the country-wide health system are presented in this study. The variables of crisis sensing, opportunity seizing, and reconfiguration are the cornerstones of health system resilience. Conclusion: Well-suited health technology assessment (HTA) and health information system (HIS) play significant roles in the overall strengthening of the health system. All reforms for resilience will have a lasting result when the capabilities created by the resilience model are learned and reused in a dynamic cycle.

Digitalising Healthcare in Developing Economies

2020 ◽  
pp. 332-353
Author(s):  
Mansah Preko ◽  
Richard Osei-Boateng ◽  
Adekunle Ezekiel Durosinmi
Keyword(s):  
Health Systems ◽  
Developing Economies ◽  
Digital Health ◽  
Contextual Factors ◽  
Multiple Case Study ◽  
Healthcare Industry ◽  
Study Approach ◽  
Multiple Case ◽  
Increasing Demand

There is an increasing demand for the healthcare industry in developing economies to reform their existing fragmented paper-based systems to take advantage of the several opportunities that digitalisation brings. However, the existence of specific contextual factors constrains the process of digitalisation in most developing economies. Underpinned by the concepts of installed base and cultivation, this chapter adopts a qualitative multiple-case study approach to examine the contextual factors that influence the development, implementation, and adoption of digital health systems in the Ghanaian and Nigerian contexts. Results of this chapter reveal 13 key challenges and their corresponding mitigating strategies that were adopted in specific instances to facilitate digitalisation in both contexts. A comparison of findings for the two contexts is also discussed.

scholarly journals Overcoming institutionalised barriers to digital health systems: An autoethnographic study of the judicialization of a digital health tool.

2021 ◽  
Author(s):  
Dudzai Mureyi
Keyword(s):  
Health Systems ◽  
Digital Health ◽  
Health Sector ◽  
Pharmaceutical Advertising ◽  
Institutional Work ◽  
Digital Tool ◽  
Medicines Information ◽  
Regulatory Bodies

Abstract Background The deployment of digital health systems may be impeded by barriers that or are linked to underlying enduring institutions. Attempting to challenge the barriers without addressing the underpinning institution may be ineffective. This study reflects on ways actors may surmount institutionalised barriers to the uptake of digital tools in health systems. Methods Institutional theory concepts were applied to an autoethnographic case study of efforts to introduce a digital tool to provide citizens with medicines information. Results The tool’s uptake was impeded because of state regulators’ institutionalised interpretation of pharmaceutical advertising laws, which rendered the tool illegal. The regulators’ institutionalised interpretation of pharmaceutical advertising laws was successfully challenged through various actions by the author- a pharmacist, and by allies beyond the health sector. These actions included: framing the tool as legal and constitutional, litigation, and redefining these concepts: ‘advertising’, ‘health institution’, and the role of regulatory bodies vis a vis innovation. Conclusion After identifying a barrier as being institutionalised or linked to an institution, actors might challenge such barriers by engaging in institutional work; i.e. deliberate efforts to challenge the relevant institution (e.g. a law, norm or shared belief). Institutional work may require the actions of multiple actors within and beyond the health sector, including judicial actors. Such cross-sectoral alliances are efficacious because they provide institutional workers with a broader range of strategies, framings, concepts and forums with which to challenge institutionalised barriers. However, actors beyond the health system (e.g. the judiciary) must be inquisitive about the potential implications of the digital health interventions they champion.

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 Health system gaps in cardiovascular disease prevention and management in Nepal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Archana Shrestha ◽  
Rashmi Maharjan ◽  
Biraj Man Karmacharya ◽  
Swornim Bajracharya ◽  
Niharika Jha ◽  
...  
Keyword(s):  
Human Resources ◽  
Health System ◽  
Health Systems ◽  
National Health ◽  
Task Force ◽  
Health Spending ◽  
Building Blocks ◽  
Critical System ◽  
Government Organizations ◽  
The Government

Abstract Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services.

Overcoming the Challenges of Experimental Research: Lessons From a Criminal Justice Case Study Involving TASER Exposure

2018 ◽  
Vol 42 (3) ◽  
pp. 358-385 ◽  
Author(s):  
Natalie Todak ◽  
Michael D. White ◽  
Lisa M. Dario ◽  
Andrea R. Borrego
Keyword(s):  
Criminal Justice ◽  
Large Scale ◽  
Human Subjects ◽  
Controlled Trial ◽  
Human Subjects Research ◽  
Case Study Approach ◽  
Study Approach ◽  
Randomized Controlled ◽  
The Impact

Objective: To provide guidance to criminologists for conducting experiments in light of two common discouraging factors: the belief that they are overly time-consuming and the belief that they can compromise the ethical principles of human subjects’ research. Method: A case study approach is used, based on a large-scale randomized controlled trial experiment in which we exposed participants to a 5-s TASER shock, to describe how the authors overcame ethical, methodological, and logistical difficulties. Results: We derive four pieces of advice from our experiences carrying out this experimental trial: (1) know your limitations, (2) employ pilot testing, (3) remain flexible and patient, and (4) “hold the line” to maintain the integrity of the research and the safety of human subjects. Conclusions: Criminologists have an obligation to provide the best possible evidence regarding the impact and consequences of criminal justice practices and programs. Experiments, considered by many to be the gold standard of empirical research methodologies, should be used whenever possible in order to fulfill this obligation.

scholarly journals Beyond the building blocks: integrating community roles into health systems frameworks to achieve health for all

2019 ◽  
Vol 3 (Suppl 3) ◽  
pp. e001384 ◽  
Author(s):  
Emma Sacks ◽  
Melanie Morrow ◽  
William T Story ◽  
Katharine D Shelley ◽  
D Shanklin ◽  
...  
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Health Sector ◽  
Building Blocks ◽  
Health Systems Strengthening ◽  
Health It ◽  
The Sustainable Development ◽  
Health Goals ◽  
Effective Community ◽  
Community Roles

Achieving ambitious health goals—from the Every Woman Every Child strategy to the health targets of the sustainable development goals to the renewed promise of Alma-Ata of ‘health for all’—necessitates strong, functional and inclusive health systems. Improving and sustaining community health is integral to overall health systems strengthening efforts. However, while health systems and community health are conceptually and operationally related, the guidance informing health systems policymakers and financiers—particularly the well-known WHO ‘building blocks’ framework—only indirectly addresses the foundational elements necessary for effective community health. Although community-inclusive and community-led strategies may be more difficult, complex, and require more widespread resources than facility-based strategies, their exclusion from health systems frameworks leads to insufficient attention to elements that need ex-ante efforts and investments to set community health effectively within systems. This paper suggests an expansion of the WHO building blocks, starting with the recognition of the essential determinants of the production of health. It presents an expanded framework that articulates the need for dedicated human resources and quality services at the community level; it places strategies for organising and mobilising social resources in communities in the context of systems for health; it situates health information as one ingredient of a larger block dedicated to information, learning and accountability; and it recognises societal partnerships as critical links to the public health sector. This framework makes explicit the oft-neglected investment needs for community health and aims to inform efforts to situate community health within national health systems and global guidance to achieve health for all.

‘The Color of Heart is More Important’: Korean Kindergarteners Exploring Racial Diversity through Poem Writing

2017 ◽  
Vol 42 (1) ◽  
pp. 60-69
Author(s):  
So Jung Kim ◽  
Su-Jeong Wee ◽  
Youngmi Lee
Keyword(s):  
Multicultural Education ◽  
Large Scale ◽  
Racial Diversity ◽  
Kindergarten Children ◽  
Early Childhood Classroom ◽  
Study Approach ◽  
Poetry Writing ◽  
Current Article ◽  
Written Materials

ALTHOUGH THE BENEFITS OF poem writing have been emphasised in a variety of contexts, there has been an understandable lack of knowledge about how to promote young children's multicultural/multiracial awareness using poetry writing. Adopting a qualitative case study approach, the current article explores how poem writing after reading and discussing multicultural picture books helps Korean kindergarten children develop an understanding of racial diversity and equality. As part of a large-scale research project on multicultural education in South Korea, this study focuses on data collected over a five-month period including participatory observations, in-depth interviews and written materials. Findings suggest that writing poetry can function as a means to foster children's critical awareness of racial diversity and equality and can help them find their own identities. How to make poetry-writing activities more meaningful and effective in the early childhood classroom is discussed.

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