Mapping of health system functions to strengthen priority programs. The case of maternal health in Mexico

Abstract

BackgroundHealth system strengthening is critical to ensure the integration and scaling-up of priority health promotion, disease prevention and control programs. Normative guidelines are available to address health system function imbalances while strategic and analytical frameworks address critical functions in complex systems. Tacit knowledge-based health system constructs can help identify actors' perspectives, contributing to improve strengthening strategies. Using maternal health as an example, this paper maps and analyses the health system functions that critical actors charged with formulating and delivering priority health programs consider important for their success.MethodsUsing concept mapping qualitative and statistical methods, health system functions were mapped for different categories of actors in high maternal mortality states of Mexico and at the federal level. Functions within and across maps were analyzed for degree of classification, importance, feasibility and coding.ResultsHospital infrastructure and human resource training are the most prominent functions in the maternal health system, associated to federal efforts to support emergency obstetric care. Health policy is a highly diffuse function while program development, intercultural and community participation and social networks are clearly stated although less focused and with lower perceived importance. The importance of functions is less correlated between federal and state decision makers, between federal decision makers and reproductive health/local health area program officers and between state decision makers and system-wide support officers. Two sets of oppositions can be observed in coding across functions: health sector vs. social context; and given structures vs. manageable processes.ConclusionsConcept mapping enabled the identification of critical functions constituting adaptive maternal health systems, including aspects of actor perspectives that are seldom included in normative and analytical frameworks. Important areas of divergence across actors' perceptions were identified to target capacity strengthening efforts towards better integrated, performing health systems.

Conceptualizing a Mobile App for Foster Youth Transitioning to Adulthood: A Mixed-Method Approach

“…These characteristics of the methodology make it suitable for answering the aforementioned research questions. Other than child welfare, CM has been used in areas of public health (e.g., Gonzalez-Block, Rouvier, Becerril, & Sesia, 2011), education (e.g., Abrahams, 2010), mental health and well-being (Bedi, 2006), and community organizing (Ridings et al, 2011), to name a few. The application of this methodological approach for this study is unique.…”

Syndemic Approach in Preventing Perinatal Near Miss before First Phase of Three Delay Model

“…There are many factors related to health system and quality of care which can affects the maternal and neonatal outcome [19,30]. A study in Brazil shows lack of emergency care facilities in obstetric unit as a predictor of poorer outcome among patients with eclampsia [13].…”

System tools for system change

“…Through the mapping of existing system configuration, planners have been enabled to better understand the barriers and facilitators to large-scale change, leading to the selection of targeted transformation strategies, such as the reform of maternal healthcare in Mexico (table 2). In this exercise, concept maps explored the impact of decentralisation on the performance of the maternal healthcare system, with results demonstrating tensions between decentralised service delivery and centrally sustained funding and policy environments 20. These findings provided system planners with insights into possible leverage points where policy change initiatives could be directed.…”