scholarly journals Trust is the engine of change: A conceptual model for trust building in health systems

2020 ◽  
Author(s):  
Mary B. Adam ◽  
Angela Joy Donelson
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Process Model ◽  
Theory Development ◽  
Building Blocks ◽  
Trust Building ◽  
Community Health Volunteers ◽  
Systems Research ◽  
Community Health Systems ◽  
Building Process

Abstract Background: Physicians, health care organizations, governments and communities are increasingly interested in how trust is built throughout the health system. Current science on building trust draws on diverse literature from business and consumer science to healthcare, and theory development has predominately focused on factor based models. We propose a process based theoretical model for trust building which may better reflect the complex and dynamic nature of trust itself. In doing so, we propose a new measurable dimension of the trust building process: reciprocity cycles. Cooperative reciprocal relationships are its building blocks, enabling stakeholders to “try out” their interactions with less risk, and to calibrate their level of effort, time and emotional investment. Reciprocity cycles includes three measurable elements: common goals, self-interests and gratitude/indebtedness.Methods: We applied the model, developing outcomes and measures in close-to-community health partnerships in Kenya. A 3-day workshop designed to stimulate problem solving and collaborative teamwork using human centered design principles was offered in 2 community health units in diverse contexts (rural agrarian and peri-urban flower farm slum), each with about 30 community health volunteers (CHVs) serving a population of approximately 5,000. Each unit formed separate teams representing specific villages; we followed these 9 teams between 18 to 24 months.Results: All 9 volunteer CHV teams delivered on self-directed public health outcomes across the spectrum of social determinants of health over the follow up period, with no funding, only using their own locally available resources. Projects were diverse, including immunization, composting toilets, hygiene, neonatal and reproductive health and public gardening. All 9 teams demonstrated trust building reciprocity cycles with articulation of common goal, self-interest, and gratitude/indebtedness. Conclusion: A process model of trust building, defined by reciprocity cycles, can be stimulated with a short intervention (illustrated here in close-to-community health systems) resulting in trusting relationships that drive agency and co-production of positive outcomes for health systems. In addition, it offers a simpler, more useful framework for trust building and measurement than traditional models of trust in health systems research. Early findings illustrate reciprocity cycles are scalable and adaptable, with potential utility at multiple levels of health systems.

scholarly journals COVID-19: Africa needs unprecedented attention to strengthen community health systems

The Lancet ◽  
2020 ◽  
Vol 396 (10245) ◽  
pp. 150-152
Author(s):  
Lyudmila Nepomnyashchiy ◽  
Bernice Dahn ◽  
Rachel Saykpah ◽  
Mallika Raghavan
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Community Health Systems

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.

Board Oversight of Patient Care Quality in Community Health Systems

2009 ◽  
Vol 25 (1) ◽  
pp. 34-41 ◽  
Author(s):  
Lawrence D. Prybil ◽  
Richard Peterson ◽  
Paul Brezinski ◽  
Gideon Zamba ◽  
William Roach ◽  
...  
Keyword(s):  
Patient Care ◽  
Community Health ◽  
Health Systems ◽  
Care Quality ◽  
Community Health Systems ◽  
Patient Care Quality

scholarly journals What Is COVID-19 Teaching Us About Community Health Systems? A Reflection From a Rapid Community-Led Mutual Aid Response in Cape Town, South Africa

2020 ◽  
Author(s):  
Manya van Ryneveld ◽  
Eleanor Whyle ◽  
Leanne Brady
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Cape Town ◽  
Safety Net ◽  
Community Action ◽  
Community Response ◽  
The State ◽  
System Response ◽  
Mutual Aid ◽  
Community Health Systems

The coronavirus disease 2019 (COVID-19) pandemic has exposed the wide gaps in South Africa’s formal social safety net, with the country’s high levels of inequality, unemployment and poor public infrastructure combining to produce devastating consequences for a vast majority in the country living through lockdown. In Cape Town, a movement of self-organising, neighbourhood-level community action networks (CANs) has contributed significantly to the community-based response to COVID-19 and the ensuing epidemiological and social challenges it has wrought. This article describes and explains the organising principles that inform this community response, with the view to reflect on the possibilities and limits of such movements as they interface with the state and its top-down ways of working, often producing contradictions and complexities. This presents an opportunity for recognising and understanding the power of informal networks and collective action in community health systems in times of unprecedented crisis, and brings into focus the importance of finding ways to engage with the state and its formal health system response that do not jeopardise this potential.

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