Thinking through health capacity development for Fragile States

Abstract

The purpose of this paper is to consider capacity development for healthcare in Fragile States and its roles, for example, in securing civil and political stability, as well as improved health, within the various contexts prevailing in fragile settings across the world. As a precursor to this, however, it is important to understand how, in rapidly changing environments, the role and contribution of different donors will have an impact in different ways. This paper sets out to interpret these issues, and what becomes apparent is the need to develop an understanding of the value base of donors, which we demonstrate through the development of a value-based framework. This highlights the separate motivations and choices made by donors, but what is apparent is that all remain within the positivist perspective perhaps for reasons of accountability and transparency. However, the emergence of new interpretations drawing on systems thinking, and followed by complexity theory more recently, in understanding contexts, suggests that the favouring of any one of these perspective can be counterproductive, without a consideration of the contexts in which they occur. In seeking an explanation of these environmental contexts, which also address the perspectives in use, we suggest the use of wider multi-ontology sense-making framework such as Cynefin. Through this approach, analytical insights can be given into the interpretation, decision and intervention processes available in these different and often changing environments, thus enabling greater coherence between donor values and recipient contexts.

Auditing Solomon Islands' health and medical governance

“…Textual analysis has been used extensively as a methodological foundation in research on health care and medical services (Mark and Jones, 2012; Knaapen et al , 2010; Boudes and Laroche, 2009; Ginsburg et al , 2009; Fraser and Moore, 2008; Mykhalovskiy and Weir, 2004). To accommodate reporting expectations of the MHMS's reporting, protocols on data sources and processes on the methods design were followed.…”

Leading in healthcare - foregrounding context: The theory and practice of context – Introduction to the Special Issue

“…We could go on and identify other gaps but this would be an arbitrary exercise. Or we could follow the example of Leitch and Palmer (2010) who sought to examine how context was being used in in Critical Discourse Analysis (CDA); a key element of this approach is that texts should be studied in context, much the same way we assert that leadership in healthcare needs to be studied as a contextualizing phenomenon, however extreme the context (Mark and Jones, 2012). Leitch and Palmer started from the premise that context is often taken for granted and is defined or described in many and varied ways.…”

“…They then go on to propose the use of the change approach known as positive deviance (PD) to facilitate the research and change process to contribute to an understanding of the interplay between leadership and power and the shaping of the process of self-organization. While the intervention can have positive outcomes, reminiscent perhaps of the Hawthorne Studies (Mayo, 1933, 1960), perhaps the most important impact was that, as one participant said: ‘Leaders changed their view of how to lead’ through this disruptive technique. Despite issues such as tension created by power distribution between the professions, ‘Doctors write orders, they don’t write ‘suggestions’’, and value conflicts between the public and private providers, they conclude shifts in power related to change and the emergence of new patterns of interaction from which leaders emerge, suggesting context of itself both influences and predicates leadership.…”

Mobility and health sector development in China and India

“…It has also become more critical over time, moving away from discussions of wholesale "transfer" or "borrowing" toward exploring the ways in which ideas and institutional forms mutate, interacting and melding with local knowledge and practices (Pritchett et al, 2012;Rodrik, 2008) to form "localized" (Acharay, 2004) or "vernacularized" (Levitt and Merry, 2009) versions. Many of these accounts acknowledge the difficulty of specifying exactly what such "capacity building" or "capacity strengthening" actually entails, but they recognize that it can and usually needs to take place on individual, institutional, and societal levels, and that it can involve a number of components ranging from the mastery of specific individual competencies and organizational reforms that improve overall functional capacity to shifts in perspective or attitude that are needed to change priorities or modes of work (Mark and Jones, 2013).…”