Theory and practice – a case study of coordination and ownership in the Bangladesh health SWAp

BACKGROUND: In the past decade the sector-wide approach (SWAp) model has been promoted by donors and adopted by governments in several countries. The purpose of this study is to look at how partners involved in the health SWAp in Bangladesh define ownership and coordination, in their daily work and to analyse the possible implications of these definitions. METHODOLOGY: The study object was a process of decision-making in the Government of Bangladesh in 2003. Information was collected through participant observations, interviews and document review. RESULTS: During the study period the Government of Bangladesh decided to reverse a decision to unify the two wings of the Ministry of Health and Family Welfare. The decision led to disagreements with development partners, which had serious implications for cooperation between key actors in the Bangladesh health sector leading to deteriorated relationships and suspension of donor funds. The donor community in itself was also in disagreement which led to inconsistencies in the dialogue between the development partners and the Government of Bangladesh. CONCLUSION: The case shows that main actors in the Bangladesh health SWAp interpret ownership and coordination, fundamental aspects of SWAp, differently. As long as work ran smoothly, the different definitions did not create any problems, but when disagreements arose they became an obstacle. It is concluded that partners in development should devote more effort to their working relationships and that responsibilities within a SWAp need to be more clearly delineated

Sistemas de Información en Salud: de sistemas cerrados a la ciudadanía social. Un desafío en la reducción de desigualdades en la gestión local Health Information Systems: from closed systems to social citizenship. A challenge for the reduction of inequalities in local management

La forma tradicional de concepción de los Sistemas de Información en Salud (SIS) presenta innúmeros problemas en dar soporte a la gestión local orientada a la reducción de desigualdades en salud. &iquest;Cómo diseñar un SIS en el nivel local y cuáles serían sus características? Entendemos a los SIS como sistemas abiertos, complejos y en los que somos parte constitutiva de los mismos. La hipótesis es que un SIS que dé soporte a la gestión local debe ser concebido como un conjunto procesual de elementos formado por dato, información, conocimiento, comunicación y acción (DICCA). El dato es una estructura compleja constituida por cinco componentes. La información es un conjunto de datos procesados; mientras que en la producción de conocimiento existe una comprensión del fenómeno y de apropiación por parte del sujeto. La comunicación es el eje articulador de los conceptos anteriores con la acción. Las acciones estratégicas y comunicativas deben ser jerarquizadas en la gestión local. La propuesta está orientada a que los SIS den soporte a la gestión en la eliminación de desigualdades en salud y en la construcción de una sociedad de inclusión.<br>The traditional concept of health information systems (HIS) poses numerous problems when attempting to support local management orientated to the reduction of health inequalities. How does one design a local HIS, and what would its characteristics be? We view HIS as open and complex systems of which we ourselves are a part. The hypothesis is that a HIS that provides support to local management must be conceived as a set of processes including data, information, knowledge, communication, and action (DIKCA). Data constitute a complex structure with five components. Information is a set of processed data; meanwhile knowledge output involves a subject's understanding and grasp of the phenomenon. Communication links the previous concepts to action. Strategic and communicative actions should be priorities in local management. This proposal aims at management support by the HIS to eliminate health inequalities and build an inclusive society