Drivers of health system strengthening: learning from implementation of maternal and child health programmes in Mozambique, Nepal and Rwanda

Samuels, Fiona; Amaya, Ana B.; Balabanova, Dina

doi:10.1093/heapol/czx037

Cited by 33 publications

(37 citation statements)

References 23 publications

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“…41 We focused our engagement with people at the micro-level and meso-level of the health system as this is where the effect of policies is experienced. 16 This allowed us to recognise their challenges and solutions and feed them back to policymakers at the macro-level. 15 17 Participants were recruited by fieldworkers with site familiarity, working through organisations with experience of community-level research.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements

et al. 2020

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IntroductionWith COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities.MethodsIn seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns.ResultsBetween March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate.ConclusionSlum residents’ ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements

et al. 2020

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“…One of the key mechanisms for improving outcomes was seen to be collaborative working approaches involving different stakeholders working in synergy to achieve long‐term strategic reform goals across all levels of the health system from facility to national and within the public sphere There is evidence that governance‐specific interventions, including civil participation and engaging community members with health service structures and processes, can lead to tangible improvements in health (focusing usually on maternal and child health outcomes) as well as better service uptake and quality of care Leadership capacity development and mentoring are central for effective governance.…”

Section: State Of the Evidencementioning

confidence: 99%

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Witter

Palmer

Balabanova

et al. 2019

Health Planning & Management

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Summary Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a “strong health system.” We highlight that current findings on “what works” are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.

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“…Later relabelled ‘leadership and governance’ ( WHO 2007 , 2008 ), this element has increasingly been recognized as a critical lever for health system development ( de Savigny and Adams 2009 ; Frenk 2010 ). Indeed, longitudinal analyses of health system change in specific settings, such as Thailand ( Tangcharoensathien 2018 ), as well as cross-country analyses ( Balabanova et al 2013 ; Samuels et al 2017 ), have demonstrated this leverage role. The particular importance of leadership, specifically, was also affirmed by the Alliance for Health Policy and Systems Research (AHPSR) 2016 Flagship Report ‘Open Mindsets: Participatory Leadership for Health’ ( AHPSR 2016 ).…”

Section: What Is the Importance Of Leadership And Related Research mentioning

confidence: 99%

Strengthening health system leadership for better governance: what does it take?

Gilson

Agyepong

2018

Health Policy and Planning

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This editorial provides an overview of the six papers included in this special supplement on health leadership in Africa. Together the papers provide evidence of leadership in public hospital settings and of initiatives to strengthen leadership development. On the one hand, they demonstrate both that current leadership practices often impact negatively on staff motivation and patient care, and that contextual factors underpin poor leadership. On the other hand, they provide some evidence of the positive potential of new forms of participatory leadership, together with ideas about what forms of leadership development intervention can nurture new forms of leadership. Finally, the papers prompt reflection on the research needed to support the implementation of such interventions.

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Drivers of health system strengthening: learning from implementation of maternal and child health programmes in Mozambique, Nepal and Rwanda

Cited by 33 publications

References 23 publications

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

Strengthening health system leadership for better governance: what does it take?

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