scholarly journals Health system determinants of tuberculosis mortality in South Africa: a causal loop model

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Muhammad Osman ◽  
Aaron S Karat ◽  
Munira Khan ◽  
Sue-Ann Meehan ◽  
Arne von Delft ◽  
...  
Keyword(s):  
South Africa ◽  
Health System ◽  
Economic Status ◽  
Patient Empowerment ◽  
Causal Loop Diagram ◽  
Prevention Strategies ◽  
Loop Diagram ◽  
Causal Loop ◽  
Socio Economic Status ◽  
Related Mortality

Abstract Background Tuberculosis (TB) is a major public health concern in South Africa and TB-related mortality remains unacceptably high. Numerous clinical studies have examined the direct causes of TB-related mortality, but its wider, systemic drivers are less well understood. Applying systems thinking, we aimed to identify factors underlying TB mortality in South Africa and describe their relationships. At a meeting organised by the ‘Optimising TB Treatment Outcomes’ task team of the National TB Think Tank, we drew on the wide expertise of attendees to identify factors underlying TB mortality in South Africa. We generated a causal loop diagram to illustrate how these factors relate to each other. Results Meeting attendees identified nine key variables: three ‘drivers’ (adequacy & availability of tools, implementation of guidelines, and the burden of bureaucracy); three ‘links’ (integration of health services, integration of data systems, and utilisation of prevention strategies); and three ‘outcomes’ (accessibility of services, patient empowerment, and socio-economic status). Through the development and refinement of the causal loop diagram, additional explanatory and linking variables were added and three important reinforcing loops identified. Loop 1, ‘Leadership and management for outcomes’ illustrated that poor leadership led to increased bureaucracy and reduced the accessibility of TB services, which increased TB-related mortality and reinforced poor leadership through patient empowerment. Loop 2, ‘Prevention and structural determinants’ describes the complex reinforcing loop between socio-economic status, patient empowerment, the poor uptake of TB and HIV prevention strategies and increasing TB mortality. Loop 3, ‘System capacity’ describes how fragmented leadership and limited resources compromise the workforce and the performance and accessibility of TB services, and how this negatively affects the demand for higher levels of stewardship. Conclusions Strengthening leadership, reducing bureaucracy, improving integration across all levels of the system, increasing health care worker support, and using windows of opportunity to target points of leverage within the South African health system are needed to both strengthen the system and reduce TB mortality. Further refinement of this model may allow for the identification of additional areas of intervention.

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study was a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (policy, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key interacting themes emerged during the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on prevention by health systems and policy influence of tobacco and alcohol companies were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. These interacting themes were utilised to develop causal loop diagrams and system archetypes. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and policy influence. A multi-sectoral response led by the health system is urgently needed.

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework. The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W. Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n = 63) and focus group discussions (n = 12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework. The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.

scholarly journals The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective

2020 ◽  
Author(s):  
Sudesh Raj Sharma ◽  
Anna Matheson ◽  
Danielle Lambrick ◽  
James Faulkner ◽  
David W Lounsbury ◽  
...  
Keyword(s):  
Data Analysis ◽  
Alcohol Use ◽  
Health System ◽  
Health Systems ◽  
Social Determinants ◽  
Economic Status ◽  
Non Communicable Diseases ◽  
Causal Loop ◽  
Socio Economic Status

Abstract Background: Tobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal. Method: The study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n=63) and focus group discussions (n=12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework . The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders. Results: Three key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use. Conclusion: Tobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.

MODEL STRUKTUR EKONOMI RUMAH TANGGA PETANI PADI DI KABUPATEN INDRMAYU, PROVINSI JAWA BARAT (Suatu Analisis Menggunakan Sistem Thinking)

2016 ◽  
Vol 1 (1) ◽  
pp. 071
Author(s):  
Ivonne Ayesha
Keyword(s):  
System Thinking ◽  
Causal Loop Diagram ◽  
Loop Diagram ◽  
Causal Loop

Tujuan penelitian ini adalah untuk membangun pemahaman (understanding) tentang fenomena ekonomi rumah tangga petani penggarap secara clear dan distinct, dan menyusun model ekonomi rumah tangga petani penggarap yang dapat menjelaskan faktor-faktor yang penentu dan interaksi variabel-variabel yang saling terkait. Penelitian ini bersifat kualitatif dengan jenis studi fenomenologi. Responden dalam penelitian ini adalah petani padi yang tidak punya lahan (penyakap) yang melakukan usahatani di Kabupaten Indramayu, Provinsi Jawa Barat, sebanyak 7 orang dengan lokasi yang berbeda, namun masih dalam kabupaten yang sama. Di samping itu, responden juga diambil dari perangkat desa, tokoh masyarakat, dan PPL. Responen ditetapkan secara sengaja (purposive), sesuai dengan kebutuhan penelitian ini. Data yang digunakan adalah data primer, sedangkan analisis data menggunakan cara berfikir sistem (system thinking). Hasil analisis data ditampilkan dalam bentuk diagram sebab akibat (causal loop diagram), dengan menggunakan program Vensim PLE. Hasil penelitian menyimpulkan: 1) Rumah tangga petani penyakap sebagai unit ekonomi terkecil yang memiliki sumber pemasukan dan pengeluaran rumah tangga, baik dari dan untuk memenuhi kebutuhan usahatani maupun non usahatani. Meskipun nilai penerimaan yang diperoleh sangat sedikit, namun petani penyakap tetap melaksanakan usahatani padi dari musim ke musim. Kekurangan uang dalam rumah tangga diatasi dengan melakukan pinjaman ke para pelepas uang (rentenir) dan tengkulak. Sedikit sekali petani yang memanfaatkan jasa keuangan formal dalam mengatasi masalah ekonomi rumah tangga. Pola hidup konsumtif sering menyebabkan petani terjebak dalam lingkaran hutang, dan 2) Model ekonomi rumah tangga petani penyakap yang disusun mengandung 2 lingkar sebab akibat positif dan satu lingkar sebab akibat negatif. Lingkar sebab akibat positif terdapat pada struktur pinjaman usahatani dan struktur pinjaman non usahatani. Lingkar sebab akibat negatif terdapat pada struktur pengeluaran. Model ini menunjukkan bahwa uang dalam rumah tangga bertambah dengan adanya pemasukan dan berkurang dengan adanya pengeluaran. Variabel pemasukan merupakan akumulasi dari penghasilan bersih, pinjaman usahatani dan pinjaman non usahatani. Variabel pengeluaran ditentukan oleh total pengeluaran rumah tangga. Total pengelaran rumah tangga merupakan akumulasi dari: pengeluaran usahatani, pengeluaran non usahatani, pembayaran iyuran desa, biaya sosial, konsumsi rumah tangga, dan pembayaran hutang non usahatani

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