scholarly journals Health system responsiveness: a systematic evidence mapping review of the global literature

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Gadija Khan ◽  
Nancy Kagwanja ◽  
Eleanor Whyle ◽  
Lucy Gilson ◽  
Sassy Molyneux ◽  
...  
Keyword(s):  
Health System ◽  
Grey Literature ◽  
Feedback Loops ◽  
Theoretical Development ◽  
World Health ◽  
Evidence Map ◽  
Evidence Mapping ◽  
Mapping Review ◽  
System Responsiveness ◽  
Health System Responsiveness

Abstract Background The World Health Organisation framed responsiveness, fair financing and equity as intrinsic goals of health systems. However, of the three, responsiveness received significantly less attention. Responsiveness is essential to strengthen systems’ functioning; provide equitable and accountable services; and to protect the rights of citizens. There is an urgency to make systems more responsive, but our understanding of responsiveness is limited. We therefore sought to map existing evidence on health system responsiveness. Methods A mixed method systemized evidence mapping review was conducted. We searched PubMed, EbscoHost, and Google Scholar. Published and grey literature; conceptual and empirical publications; published between 2000 and 2020 and English language texts were included. We screened titles and abstracts of 1119 publications and 870 full texts. Results Six hundred twenty-one publications were included in the review. Evidence mapping shows substantially more publications between 2011 and 2020 (n = 462/621) than earlier periods. Most of the publications were from Europe (n = 139), with more publications relating to High Income Countries (n = 241) than Low-to-Middle Income Countries (n = 217). Most were empirical studies (n = 424/621) utilized quantitative methodologies (n = 232), while qualitative (n = 127) and mixed methods (n = 63) were more rare. Thematic analysis revealed eight primary conceptualizations of ‘health system responsiveness’, which can be fitted into three dominant categorizations: 1) unidirectional user-service interface; 2) responsiveness as feedback loops between users and the health system; and 3) responsiveness as accountability between public and the system. Conclusions This evidence map shows a substantial body of available literature on health system responsiveness, but also reveals evidential gaps requiring further development, including: a clear definition and body of theory of responsiveness; the implementation and effectiveness of feedback loops; the systems responses to this feedback; context-specific mechanism-implementation experiences, particularly, of LMIC and fragile-and conflict affected states; and responsiveness as it relates to health equity, minority and vulnerable populations. Theoretical development is required, we suggest separating ideas of services and systems responsiveness, applying a stronger systems lens in future work. Further agenda-setting and resourcing of bridging work on health system responsiveness is suggested.

scholarly journals Mapping the Multiple Health System Responsiveness Mechanisms in One Local Health System: A Scoping Review of the Western Cape Provincial Health System of South Africa

2021 ◽  
Author(s):  
Tammy Sutherns ◽  
Jill Olivier
Keyword(s):  
Health System ◽  
Scoping Review ◽  
Grey Literature ◽  
Secondary Analysis ◽  
Local Health ◽  
Western Cape ◽  
Cross Sectional ◽  
Middle Income ◽  
System Responsiveness ◽  
Health System Responsiveness

Background: Despite governments striving for responsive health systems and the implementation of mechanisms to foster better citizen feedback and strengthen accountability and stewardship, these mechanisms do not always function in effective, equitable, or efficient ways. There is also limited evidence that maps the diverse array of responsiveness mechanisms coherently across a particular health system, especially in low- and middle-income country (LMIC) contexts. Methods: This scoping review presents a cross-sectional ‘map’ of types of health system responsiveness mechanisms; the regulatory environment; and evidence available about these; and assesses what is known about their functionality in a particular local South African health system; the Western Cape (WC) province. Multiple forms of indexed and grey literature were synthesized to provide a contextualized understanding of current ‘formal’ responsiveness mechanisms mandated in national and provincial policies and guidelines (n = 379). Various forms of secondary analysis were applied across quantitative and qualitative data, including thematic and time-series analyses. An expert checking process was conducted, with three local field experts, as a final step to check the veracity of the analytics and conclusions made. Results: National, provincial and district policies make provision for health system responsiveness, including varied mechanisms intended to foster public feedback. However, while some are shown to be functioning and effective, there are major barriers faced by all, such as resource and capacity constraints, and a lack of clarity about roles and responsibilities. Most mechanisms exist in isolation, failing to feed into an overarching strategy for improved responsiveness. Conclusion: The lack of synergy between mechanisms or analysis of varied forms of feedback is a missed opportunity. Decision-makers are unable to see trends or gaps in the flow of feedback, check whether all voices are heard or fully understand whether/how systemic response occurs. Urgent health system work lies in the research of macro ‘whole’ systems responsiveness (levels, development, trends).

scholarly journals Making health care responsive to the needs of older people

2019 ◽  
Vol 48 (6) ◽  
pp. 785-788 ◽  
Author(s):  
Jackie Bridges ◽  
Catherine Pope ◽  
Jeffrey Braithwaite
Keyword(s):  
Health Care ◽  
Older People ◽  
Health System ◽  
Health Needs ◽  
Age Related ◽  
System Responsiveness ◽  
Inpatient Nursing ◽  
Health System Responsiveness ◽  
The Individual ◽  
Individual Clinician

Abstract This commentary highlights the importance of health system responsiveness to older people living with complex health needs. Age-related changes and associated morbidity can present barriers to identifying an individual’s health needs, expectations, values and preferences, and so sufficient time, skill and resource is required to inform the development of a tailored plan for each individual. A focus on responsiveness moves thinking beyond the responsibilities of the individual clinician in the single encounter, and allows us to identify elements of the wider system that may constrain how well the clinician is able to respond. Setting the goal of responsive health care requires us to assess the suitability of wider health system features and processes for meeting the diverse needs of individual people throughout their journey, and the extent to which the system can adapt dynamically as needs change. Standardised approaches to care prescribed across organisations (such as time-based targets or routinised approaches to inpatient nursing care) are likely to result in low responsiveness as individual complexity grows, disadvantaging patients with needs that do not fit the prescribed approach. Responsiveness is high when individual practitioners and clinical teams have the resources, decentralised authority, flexibility and autonomy to provide the care required. Building a more responsive health system requires a greater understanding of how these conditions can be achieved.

scholarly journals A review of the impact of financing mechanisms on maternal health care in Australia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Haylee Fox ◽  
Stephanie M. Topp ◽  
Emily Callander ◽  
Daniel Lindsay
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health System ◽  
Search Engine ◽  
Grey Literature ◽  
Maternal Health Care ◽  
World Health ◽  
Google Search ◽  
The Impact ◽  
Out Of Pocket Costs

Abstract Background The World Health Organization states there are three interrelated domains that are fundamental to achieving and maintaining universal access to care - raising sufficient funds for health care, reducing financial barriers to access by pooling funds in a way that prevents out-of-pocket costs, and allocating funds in a way that promotes quality, efficiency and equity. In Australia, a comprehensive account of the mechanisms for financing the health system have not been synthesised elsewhere. Therefore, to understand how the maternal health system is financed, this review aims to examine the mechanisms for funding, pooling and purchasing maternal health care and the influence these financing mechanisms have on the delivery of maternal health services in Australia. Methods We conducted a scoping review and interpretative synthesis of the financing mechanisms and their impact on Australia’s maternal health system. Due to the nature of the study question, the review had a major focus on grey literature. The search was undertaken in three stages including; searching (1) Google search engine (2) targeted websites and (3) academic databases. Executive summaries and table of contents were screened for grey literature documents and Titles and Abstracts were screened for journal articles. Screening of publications’ full-text followed. Data relating to either funding, pooling, or purchasing of maternal health care were extracted for synthesis. Results A total of 69 manuscripts were included in the synthesis, with 52 of those from the Google search engine and targeted website (grey literature) search. A total of 17 articles we included in the synthesis from the database search. Conclusion Our study provides a critical review of the mechanisms by which revenues are raised, funds are pooled and their impact on the way health care services are purchased for mothers and babies in Australia. Australia’s maternal health system is financed via both public and private sources, which consequentially creates a two-tiered system. Mothers who can afford private health insurance – typically wealthier, urban and non-First Nations women - therefore receive additional benefits of private care, which further exacerbates inequity between these groups of mothers and babies. The increasing out of pocket costs associated with obstetric care may create a financial burden for women to access necessary care or it may cause them to skip care altogether if the costs are too great.

scholarly journals Health system responsiveness in maternity care at Hadiya zone public hospitals in Southern Ethiopia: Users’ perspectives

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258092
Author(s):  
Ritbano Ahmed Abdo ◽  
Hassen Mosa Halil ◽  
Biruk Assefa Kebede ◽  
Abebe Alemu Anshebo ◽  
Minychil Demelash Ayalew ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Health System ◽  
Maternity Care ◽  
Public Hospitals ◽  
Southern Ethiopia ◽  
Factors Associated ◽  
Multivariable Logistic Regression ◽  
System Responsiveness ◽  
Health System Responsiveness ◽  
Hadiya Zone

Background Health system responsiveness refers to non-financial, non-clinical qualities of care that reflect respect for human dignity and interpersonal aspects of the care process. The non-clinical aspects of the health system are therefore essential to the provision of services to patients. Therefore, the main purpose of this study was to assess the responsiveness in maternity care, domain performance and factors associated with responsiveness in maternity care in the Hadiya Zone public Hospitals in Southern Ethiopia. Methods A hospital-based cross-sectional study was employed on 413 participants using a systematic sampling technique from 1 July to 1 August 2020. An exit interviewer–administered questionnaire was used to collect data. EpiData (version 3.1) and SPSS (version 24) software were used for data entry and analysis, respectively. Bivariate and multivariable logistic regression were computed to identify the associated factors of health system responsiveness in maternity care at 95% CI. Results The findings indicated that 53.0% of users gave high ratings for responsiveness in delivery care. In the multivariable logistic regression analysis, mothers aged ≥ 35 (AOR = 0.4; 95% CI = 0.1–0.9), urban resident (AOR = 2.5; 95% CI = 1.5–4.8), obstetrics complications during the current pregnancy (AOR = 2.1; 95% CI = 1.1–3.0), and caesarean delivery (AOR = 0.4; 95% CI = 0.2–0.7) were factors associated with poor ratings for responsiveness in maternity care. Conclusion In the hospitals under investigation, responsiveness in maternity care was found to be good. The findings of this study suggest that the ministry of health and regional health bureau needs to pay attention to health system responsiveness as an indicator of the quality of maternity care.

scholarly journals Assessing health system responsiveness to the needs of older people

2021 ◽  
Vol 45 ◽  
pp. 1-7
Author(s):  
Emmanuel Gonzalez-Bautista ◽  
Patricia Morsch ◽  
Mallika Mathur ◽  
Angelo Goncalves Bos ◽  
Carolina Hommes ◽  
...  
Keyword(s):  
Older People ◽  
Health System ◽  
System Responsiveness ◽  
Health System Responsiveness
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