167 research outputs found
Understanding internal accountability in Nigeriaâs routine immunization system: perspectives from government officials at the national, state, and local levels
BACKGROUND: Routine immunization coverage in Nigeria has remained low, and studies have identified a lack of accountability as a barrier to high performance in the immunization system. Accountability lies at the heart of various health systems strengthening efforts recently launched in Nigeria, including those related to immunization. Our aim was to understand the views of health officials on the accountability challenges hindering immunization service delivery at various levels of government.
METHODS: A semi-structured questionnaire was used to interview immunization and primary healthcare (PHC) officials from national, state, local, and health facility levels in Niger State in north central Nigeria. Individuals were selected to represent a range of roles and responsibilities in the immunization system. The questionnaire explored concepts related to internal accountability using a framework that organizes accountability into three axes based upon how they drive change in the health system.
RESULTS: Respondents highlighted accountability challenges across multiple components of the immunization system, including vaccine availability, financing, logistics, human resources, and data management. A major focus was the lack of clear roles and responsibilities both within institutions and between levels of government. Delays in funding, especially at lower levels of government, disrupted service delivery. Supervision occurred less frequently than necessary, and the limited decision space of managers prevented problems from being resolved. Motivation was affected by the inability of officials to fulfill their responsibilities. Officials posited numerous suggestions to improve accountability, including clarifying roles and responsibilities, ensuring timely release of funding, and formalizing processes for supervision, problem solving, and data reporting.
CONCLUSION: Weak accountability presents a significant barrier to performance of the routine immunization system and high immunization coverage in Nigeria. As one stakeholder in ensuring the performance of health systems, routine immunization officials reveal critical areas that need to be prioritized if emerging interventions to improve accountability in routine immunization are to have an effect
How gender is socially constructed in policy making processes: a case study of the adolescent and youth health policy in South Africa
Background: Gender equality remains an outstanding global priority, more than 25 years after the landmark Beijing Platform for Action. The disconnect between global health policy intentions and implementation is shaped by several conceptual, pragmatic and political factors, both globally and in South Africa. Actor narratives and different framings of gender and gender equality are one part of the contested nature of gender policy processes and their implementation challenges. The main aim of this paper is to foreground the range of policy actors, describe their narratives and different framings of gender, as part exploring the social construction of gender in policy processes, using the Adolescent Youth Health Policy (AYHP) as a case study
The importance of gender analysis in research for health systems strengthening
This editorial discusses a collection of papers examining gender across a range of health policy and
systems contexts, from access to services, governance, health financing, and human resources for
health. The papers interrogate differing health issues and core health systems functions using a gender
lens. Together they produce new knowledge on the multiple impacts of gender on health experiences
and demonstrate the importance of gender analyses and gender sensitive interventions for
promoting well-being and health systems strengthening. The findings from these papers collectively
show how gender intersects with other axes of inequity within specific contexts to shape experiences
of health and health seeking within households, communities and health systems; illustrate how
gender power relations affect access to important resources; and demonstrate that gender norms,
poverty and patriarchy interplay to limit womenâs choices and chances both within household interactions
and within the health sector. Health systems researchers have a responsibility to promote the
incorporation of gender analyses into their studies in order to inform more strategic, effective and
equitable health systems interventions, programmes, and policies. Responding to gender inequitable
systems, institutions, and services in this sector requires an âall hands-on deckâ approach. We cannot
claimto take a âpeople-centred approachâ to health systems if the status quo continues
Maternal and Newborn Health Implementation Research: Programme Outcomes, Pathways of Change and Partnerships for Equitable Health Systems in Uganda
Editorial special issue: MANIFEST - maternal and neonatal implementation for equitable systems study.DFI
A scoping review of the determinants of foetal alcohol spectrum disorder in South Africa: an intersectional perspective
Fetal alcohol spectrum disorder (FASD) affects babies born to mothers who consume alcohol while pregnant. South Africa has the highest prevalence of FASD in the world. We review the social determinants underpinning FASD in South Africa and add critical insight from an intersectional feminist perspective. We undertook a scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. Drawing from EBSCOhost and PubMed, 95 articles were screened, with 21 selected for analysis. We used the intersectionality wheel to conceptualize how the social and structural determinants of FASD identified by the literature are interconnected and indicative of broader inequalities shaping the women and children affected. Key intersecting social determinants that facilitate drinking during pregnancy among marginalized populations in South Africa documented in the existing literature include social norms and knowledge around drinking and drinking during pregnancy, alcohol addiction and biological dependence, gender-based violence, inadequate access to contraception and abortion services, trauma and mental health, and moralization and stigma. Most of the studies found were quantitative. From an intersectional perspective, there was limited analysis of how the determinants identified intersect with one another in ways that exacerbate inequalities and how they relate to the broader structural and systemic factors undermining healthy pregnancies. There was also little representation of pregnant womenâs own perspectives or discussion about the power dynamics involved. While social determinants are noted in the literature on FASD in South Africa, much more is needed from an intersectionality lens to understand the perspectives of affected women, their social contexts and the nature of the power relations involved. A critical stance towards the victim/active agent dichotomy that often frames women who drink during pregnancy opens up space to understand the nuances needed to support the women involved while also illustrating the contextual barriers to drinking cessation that need to be addressed through holistic approaches
Hubris, humility and humanity: expanding evidence approaches for improving and sustaining community health programmes
Community-based approaches are a critical foundation for
many health outcomes, including reproductive, maternal,
newborn and child health (RMNCH). Evidence is a vital part
of strengthening that foundation, but largely focuses on
the technical content of what must be done, rather than on
how disparate community actors continuously interpret,
implement and adapt interventions in dynamic and varied
community health systems. We argue that efforts to
strengthen evidence for community programmes must
guard against the hubris of relying on a single approach or
hierarchy of evidence for the range of research questions
that arise when sustaining community programmes
at scale. Moving forward we need a broader evidence
agenda that better addresses the implementation realities
influencing the scale and sustainability of community
programmes and the partnerships underpinning them
if future gains in community RMNCH are to be realised
A shared agenda for gender and Covid-19 research: Priorities based on broadening engagement in science
While the acute and collective crisis from the pandemic is
over, an estimated 2.5million people died from COVID-19
in 2022, tens of millions suffer from long COVID and
national economies still reel from multiple deprivations
exacerbated by the pandemic. Sex and gender biases
deeply mark these evolving experiences of COVID-19,
impacting the quality of science and effectiveness
of the responses deployed. To galvanise change by
strengthening evidence-informed inclusion of sex and
gender in COVID-19 practice, we led a virtual collaboration
to articulate and prioritise gender and COVID-19 research
needs. In addition to standard prioritisation surveys,
feminist principles mindful of intersectional power
dynamics underpinned how we reviewed research gaps,
framed research questions and discussed emergent
findings
Does women's mobile phone ownership matter for health? Evidence from 15 countries
Mobile phones have the potential to increase access to health information, improve patient-provider communication, and influence the content and quality of health services received. Evidence on the gender gap in ownership of mobile phones is limited, and efforts to link phone ownership among women to care-seeking and practices for reproductive maternal newborn and child health (RMNCH) have yet to be made. This analysis aims to assess household and women's access to phones and its effects on RMNCH health outcomes in 15 countries for which Demographic and Health Surveys data on phone ownership are available. Multilevel logistic regression models were used to explore factors associated with women's phone ownership, along with the association of phone ownership to a wide range of RMNCH indicators. Study findings suggest that (1) gender gaps in mobile phone ownership vary, but they can be substantial, with less than half of women owning mobile phones in several countries; (2) the gender gap in phone ownership is larger for rural and poorer women; (3) women's phone ownership is generally associated with better RMNCH indicators; (4) among women phone owners, utilisation of RMNCH care-seeking and practices differs based on their income status; and (5) more could be done to unleash the potential of mobile phones on women's health if data gaps and varied metrics are addressed
Government helper and citizen advocate? A case study of the multiple roles and pressures facing a nongovernmental organization contracted by government to strengthen community health in northern India
While nongovernmental organizations (NGOs) can potentially
strengthen valuable citizen political engagement, NGOs that are
increasingly oriented towards donor and government contracts may
instead contribute to depoliticizing development. Amidst competing
pressures, NGO experiences and agency in managing multiple roles
require examination. We present a qualitative case study of an NGO
implementing a governmentâdesigned intervention to strengthen
Village Health, Sanitation, and Nutrition Committees (VHSNCs) in
rural north India. Despite a challenging context of community
scepticism and poor government services, the NGO did successfully
form VHSNCs by harnessing its respected interlocutor status,
preexisting relationships, and ability to âsellâ the VHSNC as a
mechanism for improving local wellâbeing. While the VHSNC enabled
community members to voice concerns to government officials,
improvements often failed to meet community expectations. NGO
staff endured community frustration on one hand and rebuffs from
lowerâlevel officials on the other, while feeling undersupported by
the government contract. Consequently, although contracted to
strengthen a community institution, the NGO increasingly worked
alongside VHSNC members to try to strengthen the public sector.
Contrary to assumptions that NGOs become âtamedâ through taking government contracts, being contracted to deliver inputs for
community participation was intertwined with microlevel political
action, though this came at a cost to the NGO
From pre-implementation to institutionalization: Lessons from sustaining a perinatal audit program in South Africa
Maternal and perinatal death surveillance and response (MPDSR), or related forms of maternal and perinatal
death audits, can strengthen health systems. We explore the history of initiating, scaling up, and institutionalizing a national
perinatal audit program in South Africa. : Data collection involved 56 individual interviews, a systematic document review, administration of a semistructured
questionnaire, and 10 nonparticipant observations of meetings
related to the perinatal audit program. Fieldwork and data collection in the subdistricts occurred from September 2019 to
March 2020. Data analysis included thematic content analysis
and application of a tool to measure subdistrict-level implementation.
This study expands on case study research applied to 5 Western
Cape subdistricts with long histories of implementation
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