scholarly journals Operationalising health systems thinking: a pathway to high effective coverage

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Lara M. E. Vaz ◽  
Lynne Franco ◽  
Tanya Guenther ◽  
Kelsey Simmons ◽  
Samantha Herrera ◽  
...  
Keyword(s):  
Strategic Planning ◽  
Global Health ◽  
Health System ◽  
Health Systems ◽  
Systems Thinking ◽  
Monitoring And Evaluation ◽  
Health Interventions ◽  
Maternal And Newborn Health ◽  
High Coverage ◽  
Effective Coverage

Abstract Background The global health community has recognised the importance of defining and measuring the effective coverage of health interventions and their implementation strength to monitor progress towards global mortality and morbidity targets. Existing health system models and frameworks guide thinking around these measurement areas; however, they fall short of adequately capturing the dynamic and multi-level relationships between different components of the health system. These relationships must be articulated for measurement and managed to effectively deliver health interventions of sufficient quality to achieve health impacts. Save the Children’s Saving Newborn Lives programme and EnCompass LLC, its evaluation partner, developed and applied the Pathway to High Effective Coverage as a health systems thinking framework (hereafter referred to as the Pathway) in its strategic planning, monitoring and evaluation. Methods We used an iterative approach to develop, test and refine thinking around the Pathway. The initial framework was developed based on existing literature, then shared and vetted during consultations with global health thought leaders in maternal and newborn health. Results The Pathway is a robust health systems thinking framework that unpacks system, policy and point of intervention delivery factors, thus encouraging specific actions to address gaps in implementation and facilitate the achievement of high effective coverage. The Pathway includes six main components – (1) national readiness; (2) system structures; (3) management capacity; (4) implementation strength; (5) effective coverage; and (6) impact. Each component is comprised of specific elements reflecting the range of facility-, community- and home-based interventions. We describe applications of the Pathway and results for in-country strategic planning, monitoring of progress and implementation strength, and evaluation. Conclusions The Pathway provides a cohesive health systems thinking framework that facilitates assessment and coordinated action to achieve high coverage and impact. Experiences of its application show its utility in guiding strategic planning and in more comprehensive and effective monitoring and evaluation as well as its potential adaptability for use in other health areas and sectors.

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.

Harnessing instability as an opportunity for health system strengthening: A review of health system resilience

2019 ◽  
Vol 32 (3) ◽  
pp. 128-135 ◽  
Author(s):  
Caroline Chamberland-Rowe ◽  
François Chiocchio ◽  
Ivy Lynn Bourgeault
Keyword(s):  
Global Health ◽  
Health System ◽  
Health Systems ◽  
Health System Strengthening ◽  
Operational Model ◽  
Academic Literature ◽  
System Resilience

In recent years, resilience has emerged as a prominent topic in global health systems discourse as a result of the increasing variety and volume of sources of instability inflicting strain on systems. In line with this study’s intent to bring together existing literature on health system resilience as a means to understand the process through which systems achieve resilience, a review of academic literature related to health system resilience was conducted. Emerging from this review is an operational model of resilience that builds on existing health systems frameworks. The model highlights health system resilience as a process through which leaders in all sectors need to be mobilized in order to harness instability as an opportunity for health system strengthening rather than a threat to the system’s sustainability and integrity.

scholarly journals 30 years of polio campaigns in Ethiopia, India and Nigeria: the impacts of campaign design on vaccine hesitancy and health worker motivation

2021 ◽  
Vol 6 (8) ◽  
pp. e006002
Author(s):  
Abigail H Neel ◽  
Svea Closser ◽  
Catherine Villanueva ◽  
Piyusha Majumdar ◽  
S D Gupta ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
System Level ◽  
Vaccine Hesitancy ◽  
High Coverage ◽  
Frontline Staff ◽  
Polio Vaccination ◽  
Worker Motivation ◽  
The Impact ◽  
Over Time

IntroductionThe debate over the impact of vertical programmes, including mass vaccination, on health systems is long-standing and often polarised. Studies have assessed the effects of a given vertical health programme on a health system separately from the goals of the vertical programme itself. Further, these health system effects are often categorised as either positive or negative. Yet health systems are in fact complex, dynamic and tightly linked. Relationships between elements of the system determine programme and system-level outcomes over time.MethodsWe constructed a causal loop diagram of the interactions between mass polio vaccination campaigns and government health systems in Ethiopia, India and Nigeria, working inductively from two qualitative datasets. The first dataset was 175 interviews conducted with policymakers, officials and frontline staff in these countries in 2011–2012. The second was 101 interviews conducted with similar groups in 2019, focusing on lessons learnt from polio eradication.ResultsPursuing high coverage in polio campaigns, without considering the dynamic impacts of campaigns on health systems, cost campaign coverage gains over time in weaker health systems with many campaigns. Over time, the systems effects of frequent campaigns, delivered through parallel structures, led to a loss of frontline worker motivation, and an increase in vaccine hesitancy in recipient populations. Co-delivery of interventions helped to mitigate these negative effects. In stronger health systems with fewer campaigns, these issues did not arise.ConclusionIt benefits vertical programmes to reduce the construction of parallel systems and pursue co-delivery of interventions where possible, and to consider the workflow of frontline staff. Ultimately, for health campaign designs to be effective, they must make sense for those delivering and receiving campaign interventions, and must take into account the complex, adaptive nature of the health systems in which they operate. 

scholarly journals Beyond Health System Contact: Measuring and Validating Quality of Childbirth Care Indicators in Primary Level Facilities of Northern Ethiopia

2020 ◽  
Author(s):  
Haftom Gebrehiwot Weldearegay ◽  
Araya Abrha Medhanyie ◽  
Hagos Godefay ◽  
Alemayehu Bayray Kahsay
Keyword(s):  
Health System ◽  
Population Level ◽  
Health Interventions ◽  
Receiver Operating Curve ◽  
Maternal And Newborn Health ◽  
Northern Ethiopia ◽  
Primary Level ◽  
Individual Level ◽  
Basic Care

Abstract Background: Measurement of quality of health care has been largely overlooked and continues to be a major health system bottleneck in monitoring performance and quality to evaluate progress against defined targets for better decision making. Hence, metrics of maternity care are needed to advance from health service contact alone to content of care. We assessed the accuracy of indicators that describe the quality of basic care for childbirth functions both at the individual level as well as at the population level in Northern Ethiopia. Methods: A validation study was conducted by comparing women’s self-reported coverage of maternal and newborn health interventions during intra-partum and immediate postpartum care received in primary level care facilities of Northern Ethiopia against a gold standard of direct observation by a trained third party (n=478). Sensitivity, specificity and individual-level reporting accuracy via the area under the receiver operating curve (AUC) and inflation factor (IF) to estimate population-level accuracy for each indicator was applied for validity analysis. Findings: 455(97.5%) of women completed the survey describing health interventions. Thirty-two (43.2%) of the 93-basic quality child birth care indicators that were assessed could be accurately measure at the facility and population level (AUC>0.60 and 0.75

Introduction to the Health of a Population

2021 ◽  
pp. 1-14
Author(s):  
Rifat Atun
Keyword(s):  
Health System ◽  
Population Health ◽  
Health Systems ◽  
Systems Thinking ◽  
Human Behavior ◽  
Dynamic Complexity ◽  
Repeated Events ◽  
Over Time

Chapter 1 conceptualizes a health system as a collection of interacting elements that are designed to produce outputs that lead to better population health. A system’s elements both “hang together” as a whole and continually interact and affect each other as they interoperate to produce their final result. Systems thinking is one of the most important disciplines enabling one to understand and characterize systems that display dynamic complexity. Systems thinking in health is a framework for seeing interrelationships and repeated events rather than individual activities, for discerning patterns of change, understanding responses to policies, and for deciphering human behavior within health systems and over time.

Norm diffusion and health system strengthening: The persistent relevance of national leadership in global health governance

2014 ◽  
Vol 40 (5) ◽  
pp. 877-896 ◽  
Author(s):  
GARRETT WALLACE BROWN
Keyword(s):  
Global Health ◽  
Health System ◽  
Health Systems ◽  
Central Element ◽  
Health System Strengthening ◽  
Local Health ◽  
Governance Mechanisms ◽  
Health Governance ◽  
Norm Diffusion ◽  
National Leadership

AbstractAcademics and policymakers often argue that global health policy greatly affects and influences national health systems because these policies transfer and implant ‘best practice’ norms and accountability techniques into local health systems. On the whole these arguments about the ‘diffusion of norms’ have merit since there is considerable evidence to suggest the existence of a positive correlation between global norms and national behaviour. Nevertheless, this article argues that traditional analytical frameworks to explain norm diffusion underplay the fact that norms are significantly ‘glocalised’ by national actors and further discount the role that national leadership plays in strengthening health systems. In response, this article presents a ten-year comparative paired study of the participatory governance mechanisms of the South African health system and its health strengthening measures. In doing so, the role of the national government in their relations with the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) will be examined and how key ‘partnership’ norms were amalgamated into health governance mechanisms. It will be argued that although global policy plays an important guiding role, health norms are never transcribed straightforwardly and a central element to successful health governance remains vested in the nation and the leadership role it exerts.

scholarly journals Integrating Prevention of Mother-to-Child Transmission of HIV Care into General Maternal Child Health Care in Western Kenya

2020 ◽  
Vol 10 (1) ◽  
pp. 19-28
Author(s):  
Michelle Berlacher ◽  
Timothy Mercer ◽  
Edith O. Apondi ◽  
Winfred Mwangi ◽  
Edwin Were ◽  
...  
Keyword(s):  
Child Health ◽  
Global Health ◽  
Health System ◽  
Health Systems ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Maternal Child Health ◽  
Child Transmission ◽  
Sub Saharan ◽  
Maternal Child

Background: Health systems integration is becoming increasingly important as the global health community transitions from acute, disease-specific health programming to models of care built for chronic diseases, primarily designed to strengthen public-sector health systems. In many countries across sub-Saharan Africa, including Kenya, prevention of mother-to-child transmission of HIV (pMTCT) services are being integrated into the general maternal child health (MCH) clinics. The objective of this study was to evaluate the benefits and challenges for integration of care within a developing health system, through the lens of an evaluative framework. Methods: A framework adapted from the World Health Organization’s six critical health systems functions was used to evaluate the integration of pMTCT services with general MCH clinics in western Kenya. Perspectives were collected from key stakeholders, including pMTCT and MCH program leadership and local health providers. The benefits and challenges of integration across each of the health system functions were evaluated to better understand this approach. Results: Key informants in leadership positions and MCH staff shared similar perspectives regarding benefits and challenges of integration. Benefits of integration included convenience for families through streamlining of services and reduced HIV stigma. Concerns and challenges included confidentiality issues related to HIV status, particularly in the context of high-volume, crowded clinical spaces. Conclusion and Global Health Implications: The results from this study highlight areas that need to be addressed to maximize the effectiveness and clinical flow of the pMTCT-MCH integration model. The lessons learned from this integration may be applied to other settings in sub-Saharan Africa attempting to integrate HIV care into the broader public-sector health system. Key words: • HIV prevention • Maternal-child health • Prevention of maternal-to-child transmission • Health services • Integration • Kenya • Sub-Saharan Africa Copyright © 2020 Berlacher et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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