Health systems and MNCH outcomes in West Africa : a study of conducive and limiting health systems factors to improving mother, new born and child health in West Africa

The presentation provides demographic information/graphs regarding child mortality rates over time (1990-2013) in sub-Sharan African countries, and specifically focuses on countries involved in the West African Health Organization (WAHO) Innovating for Maternal and Child Health in Africa (IMCHA) project: Benin, Burkina Faso, Ghana, Mali, Nigeria, and Senegal. It reviews significant factors within the project regarding motivation, barriers, competencies and conducive and limiting health system factors

“Wood already touched by fire is not hard to set alight” Comment on “Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries”

A major constraint to the application of any form of knowledge and principles is the awareness, understanding and acceptance of the knowledge and principles. Systems Thinking (ST) is a way of understanding and thinking about the nature of health systems and how to make and implement decisions within health systems to maximize desired and minimize undesired effects. A major constraint to applying ST within health systems in Low- and Middle-Income Countries (LMICs) would appear to be an awareness and understanding of ST and how to apply it. This is a fundamental constraint and in the increasing desire to enable the application of ST concepts in health systems in LMIC and understand and evaluate the effects; an essential first step is going to be enabling of a wide spread as well as deeper understanding of ST and how to apply this understandin

Why district assemblies disburse resources to district health systems for service delivery at district level in the context of decentralization: a comparative study of two districts in the Volta Region of Ghana

ObjectivesTo explore why the District Assembly disburses financial and other resources to the District Health System.DesignMultiple case study with a single unit of analysis (holistic) using quantitative and qualitative methods of data collection involving a desk review, analysis of routine health management information system data and key informant interviews.SettingTwo districts in the Volta Region of Ghana.ParticipantsTwelve key officials of each district assembly and the district health system (24 total) who had worked in the district at least a year or more.InterventionsNone.ResultsBoth District Assemblies had moderate decision space which was influenced by their capacity, power and contextual factors like politics, economics, legal and situational factors. Disbursement of financial and other resources to the District Health Systems was influenced by financial capacity, use of power by stakeholders, context and the decision space of the District Assembly. Political actors appeared to have more power in resource disbursement decision making than community members and technocrats in a context of resource constraints and inadequate funding. The funding available was used predominantly for capital investments, mainly construction of Community Based Health Planning and Services (CHPS) compounds.ConclusionIt is important to make policies that will regulate the relative power among the political appointees like the District Chief Executives (DCEs), public and civil servants in decentralized departments and agencies and Community members to make resource disbursement more sensitive to communities and decentralized departments

When ‘solutions of yesterday become problems of today': crisis-ridden decision making in a complex adaptive system (CAS)—the Additional Duty Hours Allowance in Ghana

Implementation of policies (decisions) in the health sector is sometimes defeated by the system's response to the policy itself. This can lead to counter-intuitive, unanticipated, or more modest effects than expected by those who designed the policy. The health sector fits the characteristics of complex adaptive systems (CAS) and complexity is at the heart of this phenomenon. Anticipating both positive and negative effects of policy decisions, understanding the interests, power and interaction between multiple actors; and planning for the delayed and distal impact of policy decisions are essential for effective decision making in CAS. Failure to appreciate these elements often leads to a series of reductionist approach interventions or ‘fixes'. This in turn can initiate a series of negative feedback loops that further complicates the situation over time. In this paper we use a case study of the Additional Duty Hours Allowance (ADHA) policy in Ghana to illustrate these points. Using causal loop diagrams, we unpack the intended and unintended effects of the policy and how these effects evolved over time. The overall goal is to advance our understanding of decision making in complex adaptive systems; and through this process identify some essential elements in formulating, updating and implementing health policy that can help to improve attainment of desired outcomes and minimize negative unintended effect

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

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

Boundary-spanning: reflections on the practices and principles of Global Health.

As Global Health evolves, not merely as a metaphor for international collaboration, but as a distinct field of practice, it warrants greater consideration of how it is practiced, by whom, and for what goals. We believe that, to become more relevant for the health systems and communities that are their intended beneficiaries, Global Health practices must actively span and disrupt boundaries of geography, geopolitics and constituency, some of which are rooted in imbalances of power and resources. In this process, fostering cross-country learning networks and communities of practice, and building local and national institutions with a global outlook in low and middle-income countries, are critically important. Crucially, boundary-spanning practices in Global Health require a mindset of inclusiveness, awareness of and respect for different coexisting realities

Advancing the application of systems thinking in health : realist evaluation of the Leadership Development Programme for district manager decision-making in Ghana

This paper seeks to address how and why the Leadership Development Programme (LDP) works when it is introduced into a district health system in Ghana, and whether or not it supports systems thinking in district teams. The LDP was a valuable experience for district managers, and teams were able to attain short-term outcomes because the novel approach supported teamwork, initiative-building, and improved prioritisation. However, the LDP was not institutionalised in district teams and did not lead to increased systems thinking. This was related to the context of high uncertainty within the district, and hierarchical authority of the system

Incorporating research evidence into decision-making processes: researcher and decision-maker perceptions from five low- and middle-income countries.

BACKGROUND: The 'Sponsoring National Processes for Evidence-Informed Policy Making in the Health Sector of Developing Countries' program was launched by the Alliance for Health Policy and Systems Research, WHO, in July 2008. The program aimed to catalyse the use of evidence generated through health policy and systems research in policymaking processes through (1) promoting researchers and policy advocates to present their evidence in a manner that is easy for policymakers to understand and use, (2) creating mechanisms to spur the demand for and application of research evidence in policymaking, and (3) increased interaction between researchers, policy advocates, and policymakers. Grants ran for three years and five projects were supported in Argentina, Bangladesh, Cameroon, Nigeria and Zambia. This paper seeks to understand why projects in some settings were perceived by the key stakeholders involved to have made progress towards their goals, whereas others were perceived to have not done so well. Additionally, by comparing experiences across five countries, we seek to illustrate general learnings to inform future evidence-to-policy efforts in low- and middle-income countries. METHODS: We adopted the theory of knowledge translation developed by Jacobson et al. (J Health Serv Res Policy 8(2):94-9, 2003) as a framing device to reflect on project experiences across the five cases. Using data from the projects' external evaluation reports, which included information from semi-structured interviews and quantitative evaluation surveys of those involved in projects, and supplemented by information from the projects' individual technical reports, we applied the theoretical framework with a partially grounded approach to analyse each of the cases and make comparisons. RESULTS AND CONCLUSION: There was wide variation across projects in the type of activities carried out as well as their intensity. Based on our findings, we can conclude that projects perceived as having made progress towards their goals were characterized by the coming together of a number of domains identified by the theory. The domains of Jacobson's theoretical framework, initially developed for high-income settings, are of relevance to the low- and middle-income country context, but may need modification to be fully applicable to these settings. Specifically, the relative fragility of institutions and the concomitantly more significant role of individual leaders point to the need to look at leadership as an additional domain influencing the evidence-to-policy process

Une vie saine pour les femmes et les enfants vulnérables : application de la recherche sur les systems de santé

Version anglaise disponible dans la Bibliothèque numérique du CRDI : Healthy lives for vulnerable women and children : applying health systems researchIl existe encore des défis importants à relever afin de garantir que les populations les plus vulnérables, y compris les femmes, les enfants et les adolescents, puissent vivre en bonne santé et profiter du mieux-être promis dans les Objectifs de développement durable. Leurs mauvaises conditions de santé sont souvent causées par la pauvreté, l’inégalité entre les sexes, le manque d’éducation et la marginalisation sociale, ainsi que par des services de soins de santé inaccessibles. Des systèmes de santé solides, équitables et bien gérés peuvent contribuer à améliorer de manière durable leurs conditions de vie. Toutefois, établir des systèmes de santé solides n’est pas facile. Ce livre fait fond sur 15 années de travaux de recherche sur les systèmes de santé financés par le Centre de recherches pour le développement international (CRDI) et menés par des chercheurs qui ont travaillé en étroite collaboration avec les communautés et les décideurs. Ils ont produit des données probantes pertinentes au contexte à l’échelle locale, nationale, régionale et mondiale afin de s’attaquer à ces difficultés propres aux systèmes de santé. Six leçons ont été tirées pour éclairer et inspirer une nouvelle génération de dirigeants et de chercheurs en matière de santé, alors que certaines réflexions critiques sur les défis restants sont échangées avec d’autres membres de la communauté de la santé mondiale, y compris les organismes subventionnaires

Multilevel Governance and Control of the COVID-19 Pandemic in the Democratic Republic of Congo: Learning from the Four First Waves

The COVID-19 pandemic continues to impose a heavy burden on people around the world. The Democratic Republic of the Congo (DRC) has also been affected. The objective of this study was to explore national policy responses to the COVID-19 pandemic in the DRC and drivers of the response, and to generate lessons for strengthening health systems’ resilience and public health capacity to respond to health security threats. This was a case study with data collected through a literature review and in-depth interviews with key informants. Data analysis was carried out manually using thematic content analysis translated into a logical and descriptive summary of the results. The management of the response to the COVID-19 pandemic reflected multilevel governance. It implied a centralized command and a decentralized implementation. The centralized command at the national level mostly involved state actors organized into ad hoc structures. The decentralized implementation involved state actors at the provincial and peripheral level including two other ad hoc structures. Non-state actors were involved at both levels. These ad hoc structures had problems coordinating the transmission of information to the public as they were operating outside the normative framework of the health system. Conclusions: Lessons that can be learned from this study include the strategic organisation of the response inspired by previous experiences with epidemics; the need to decentralize decision-making power to anticipate or respond quickly and adequately to a threat such as the COVID-19 pandemic; and measures decided, taken, or adapted according to the epidemiological evolution (cases and deaths) of the epidemic and its effects on the socio-economic situation of the population. Other countries can benefit from the DRC experience by adapting it to their own context