OpenUCT :: Browsing by Author "Olivier, Jill"

Browsing by Author "Olivier, Jill"

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Open Access
A mixed method media analysis of the representation of the South African National Health Insurance Policy in the mainstream media from 2011 to 2019
(2021) Bust, Lynn Hazel; Olivier, Jill; Whyle, Eleanor
Media is a crucial factor in shaping public opinion and setting policy agendas. There is limited research on the role of media in health policy processes in low- and middle-income countries. This study profiles South Africa as a case example, currently in the process of implementing a major health policy reform, National Health Insurance (NHI). A descriptive, mixed methods study was conducted in five phases. Evidence was gathered through a scoping review of secondary literature; discourse analysis of global policy documents on universal health coverage and South African NHI policy documents; and a content and discourse analysis of South African print and online media texts focused on NHI. Representations in the media were analysed and dominant discourses that might influence the policy process were identified. Dominant discourses in SA media were identified relating to ‘health as a global public good', biopolitics, and corruption. Media representations focused on political contestation and the impact of NHI on elite actors. Representations in the media did not acknowledge the lived reality of most of the South African population. The discourses identified might influence the policy process by reinforcing socially dominant discourses and power structures, and hindering public participation. This might reinforce current inequalities in the health system, with negative repercussions for access to health care. This study highlights the need to understand mainstream media as part of a people centred health system, particularly in the context of universal health coverage reforms such as NHI. This would require the formation of collaborative and sustainable networks of policy actors, including actors within media, to develop strategies to counter-act harmful representations in the media that might reinforce inequalities and prevent successful implementation of NHI. Strategies should also investigate how to leverage media within health policy processes to decrease inequalities and increase access to health care. Research should be undertaken to explore media in other diverse formats and languages, and in other contexts, particularly low- and middle-income countries, to further understand media's role in health policy processes.
Open Access
The aims of the primary health care reforms in Finland between 1993-2015: a systematic review
(2018) Malinen, Sanna; Olivier, Jill
Aims: Empirical research has proven that a strong primary health care (PHC) system produces better health outcomes and therefore, PHC is an important part of a country's health system. This systematic review focuses on the intended aims and targets of PHC reforms conducted in Finland from 1993 onwards. It describes the challenges that the Finnish PHC system has faced, comparing the objectives and the problem with other similar countries, providing lessons from the Finnish experiences for other countries. Methods: A Campbell-styled systematic review was conducted. Databases including Ebsco, Pubmed/MEDLINE, Scopus, Google Scholar and a Finnish health science database Medic were searched. The keywords and MeSH Terms for the review included terms relating to 'health systems', 'primary care', 'reform', and 'Finland' (see Appendix B). English terms were used when using Medline, Scopus and EBSCO, and both Finnish and English terms were used when using Medic. Reference lists of included papers were also searched. Data was extracted and analysed by utilising thematic analysis. Results: 13 relevant papers were found that dealt with PHC policies or reforms implemented in Finland between 1993 and 2015. The aims of the reforms were classified under five themes, which were developed based on a prior scoping review and then tested during data extraction. The themes were: efficient governance and financing, adequate and equitable access, improved quality, increased patient choice and cooperation and integration of services. Conclusions: A number of policies and reforms have been implemented which have directly or indirectly aimed to strengthen the Finnish PHC system. Some policies have intended to strengthen PHC overall while others have focused on only one aspect or challenge. There has recently been a strong tendency to re-centralise health services, and the importance of patient choice and service integration have become increasingly important. Integration and cooperation of different service providers is one of the newest solutions when finding ways to strengthen weak PHC systems. This study shows that in policy success context matters. PHC strengthening needs to be high on the political agenda, and enough resources are needed. This study showed that there have been few durable or sustainable solutions, and further research is needed especially from the overall health systems perspective.
Open Access
Attitudes and perception of healthcare workers in health facilities with regards to the 'Intention to Use' of the Road to Health Booklet (RtHB)
(2016) Khumalo, Nanziwe Kelly; Olivier, Jill
Introduction: That low and middle income countries (LMICs) are plagued with high burdens of disease and limited health resources is well documented in the literature. These two realities necessitate the availability of good quality and reliable information to enable the efficient distribution of recourses and services. Growing recognition of the importance of health information has seen the introduction of numerous health information systems (HIS). The goal of these HIS is to attain preventative and curative treatment for those that need them, in adequate quantities, promptly, reliably and at equitable cost. Amongst the variety of HIS is the Road-to-Health Booklet (RtHB) in South Africa. This is a paper-based, patient-held medical record given to new mothers, intended to monitor all contact children have with the healthcare system. Due to the dearth of local research and increasing need for strong HIS, more research is needed in the implementation of the HIS and its use by healthcare workers (HCWs) in the African context. Methods: The aim of this study is to explore and understand the influence HCWs' attitudes and perceptions have on the implementation of the RtHB within the Khayelitsha Sub-District of Cape Town, South Africa. A qualitative case study was conducted utilising in-depth interviews, naturalistic observations, document review and mind mapping to explore HCWs' attitudes and perceptions on the RtHB. A combination of purposive and snowball sampling was used to identify participants with insights on the RtHB.
Open Access
Barriers to healthcare access by undocumented migrants in low-and middle-income countries: A qualitative systematic review
(2023) Adnan, Salman Amirah; Olivier, Jill
Undocumented migrants experience many barriers to accessing health systems around the globe. Although these barriers are well documented in the context of migration from low- and middle- to high-income countries, less attention has been paid to irregular migration within low- and middle-income countries (LMICs). This study reviewed and synthesized the available literature on barriers to accessing health systems among undocumented migrants in LMICs. Thirty-one studies published either on English, Portuguese or Spanish and published between 2013 and 2022 were included. As a growing body of evidence demonstrates, undocumented migrants are among the most vulnerable populations with access to health care services impacted by high costs, legal barriers, document requirements and unclear policy messages. By applying a health policy and systems research lens, this review found that these barriers are interrelated and further complicated by individual and institutional discrimination, xenophobia, and perceptions that undocumented migrants are less deserving and compete for local resources, among others. Delayed care and limited primary healthcare access with critical health consequences were described in all such cases. The review suggests that barriers to healthcare access require intersectoral action that needs to be guided by embedded, comprehensive evaluations to generate the knowledge that is necessary to inform effective policy-responses and implementation.
Open Access
A case study of the drivers and barriers of implementation of the Baby Friendly Hospital Initiative (BFHI) within a rural sub-district in South Africa
(2015) Brittin, Katherine; Stinson, Kathryn; Olivier, Jill
Exclusive breastfeeding is recognised as a key child survival strategy in the South African context and the Baby Friendly Hospital Initiative (BFHI) accreditation for maternity facilities is recommended by the National Department of Health (NDOH) as crucial to improving the standards of care required for optimal support for mothers to successfully breastfeed. The Cape Winelands District in the Western Cape is a region that needs to improve the accreditation rate for its facilities. Key informant interviews were conducted within rural maternity services in the Breede Valley Sub-District. Interviews identified the barriers and enablers related to the health system building block 'information'. An additional goal was to examine communication and how information was disseminated throughout all levels of the health system to achieve the aim of successful policy implementation of the BFHI. Findings demonstrated that personal experiences of healthcare personnel may impact on the information offered to mothers. In addition, the operational manager of a facility possessed significant influence to ensure a policy was implemented and adhered to. Recommendations include advocating for education promoting breastfeeding in all healthcare programmes especially during the antenatal period by providing consistent, non-conflicting messages. Management should provide vision and strong leadership around implementation of the BFHI policy and ensure effective communication strategies around significant changes in the policy. Implementing BFHI is a complex context specific activity and to ensure optimal implementation of "Step three" (inform pregnant women of the benefits and management of breastfeeding) it is necessary to examine this particular area by using the recommendations as a framework in order to probe further.
Open Access
Community systems strengthening project: the successes and challenges perceived and experienced in Gugulethu, South Africa
(2022) Mautsa, Tafadzwa Forsina; London, Leslie; Olivier, Jill
Community participation is an effective strategy for strengthening health systems and progressively realising health rights. For meaningful community participation to occur, the capacity of formal or informal community organisations and mechanisms involved in addressing social determinants of health needs to be strengthened. One way of doing this is through training. There is minimal research on the efforts of community structures set up to address social determinants of health and health needs in communities, following training to strengthen their capacity. This study sought to evaluate the successes and challenges of a particular Community Systems Strengthening Project which, between 2016 and 2019, set out to train health committee members and community health activists in Gugulethu, South Africa. In so doing, it investigated whether and how the health committee members and Community Health Activists assumed an activist role in the community and are engaging in meaningful community participation. A mixed methods evaluative study was conducted in two phases during 2020-2021. The first phase was a scoping review of available literature, followed by an evaluative study including review of project documents, observation by attending events organised by the project and other community organisations, and in-depth interviews with health committee members (2), community health activists (4) and project staff (4). The training intervention was found to have influenced the health committee members and Community Health Activists thinking, understanding and practice in their community efforts to address social determinants of health. Therefore, adequate support, training, and an enabling environment can facilitate meaningful community participation in health. Ultimately, these measures will contribute to the progressive realisation of the right to health and the right to community participation, and ultimately health system transformation. The limited adaptability of the intervention, limited resources, participant perceptions and sustainability were found to be obstacles to meaningful community participation. This dissertation consists of two parts. The study protocol, Part A, outlines the rationale of undertaking this research and the proposed methods. Part B consists of the journal ready manuscript which presents the results and discussion of the research findings.
Open Access
Complex interventions in complex health systems: Hepatitis B birth-dose vaccination programs in the African region
(2023) Rakiep, Tasneem; Olivier, Jill; Amponsah-Dacosta Edina
Background: Of the 296 million chronic carriers of hepatitis B virus (HBV) infection worldwide, the majority are found in the African and Western Pacific regions. Neonates who acquire the infection from their mothers (mother-to-child transmission or MTCT) carry a 90% risk of chronicity. To prevent serious liver complications such as liver cancer, cirrhosis, and premature death, the World Health Organization (WHO) recommends hepatitis B vaccination at birth, followed by vaccination during infancy. Despite the longstanding implementation of universal hepatitis B infant vaccination programs, the African region maintains the highest prevalence (2.5%) of chronic HBV infection among children ≤5 years of age. While optimal coverage of the hepatitis B birth-dose vaccine could avert further infections in this region, weak implementation and poor program performance have raised global concern. This study provides a comprehensive update on the status of HBV MTCT in Africa and explores how complex interactions between intervention and the health system may influence the performance of hepatitis B birth-dose vaccination programs in the region. Methods: This qualitative systematic review study was conducted in two phases where phase 1 involved a scoping review and phase 2 the systematic review. The scoping review mapped current evidence on HBV MTCT and hepatitis B birth-dose vaccination programs in Africa. In addition, the scoping phase informed the development of an adapted systems-based logic model for assessing complexity in the design or causal pathway of hepatitis B birth-dose vaccination programs. For the qualitative systematic review, a Boolean search strategy was utilized to retrieve relevant peer-reviewed literature published between 2009–2022 indexed in PubMed, EBSCOhost databases, Scopus, and Web of Science, with supplementary searches conducted to identify any missed articles. No language restrictions were applied. Data extraction, synthesis and analysis were guided by the systems-based logic model tailored to systematic reviews of complex interventions. Results: Findings from the scoping review provided compelling evidence on the risk of HBV MTCT in Africa, spurred by the considerable burden of HIV co-infections in the region. Despite this, only 15 WHO African member states have so far adopted hepatitis B birth-dose vaccination programs, with noteworthy inconsistenciesin performance. Previous scoping reviews exploring the determinants of program success have been limited by the scanty representation of evidence from the African region. Furthermore, these reviews have failed to adequately address the complexities within the intervention or the multiple interactions across the intervention, the health systems and contexts which deliver them. Our systematic review search yielded 672 published records. Of these, 28 were judged to be eligible for inclusion. Among the 12 African states represented, the origin of evidence weighted highest in Nigeria (n=12) and Senegal (n=5). The performance of hepatitis B birth-dose vaccination programs across African states highlighted underlying complexities across multiple themes. The findings further emphasized the need for improved compliance with global recommendations when formulating national vaccine policies and guidelines; limitations of current vaccine supply chain systems; the need for renewed commitment towards intensified domestic investments complemented by donor support; ensuring capable and skilled cadres of health care workers, accurate and appropriate data collection and usage; expanded immunization services with outreach programs, and developments in maternal education and socio-economic status. Conclusion: We highlight the complex interactions between hepatitis B birth-dose vaccination programs and the health systems that deliver them. We further demonstrate how these complex interactions contribute to the sub-optimal performance of hepatitis B birth-dose vaccination programs in the African region. By identifying sources of complexity at the intersection of hepatitis B birth-dose vaccination programs and health systems in Africa, we can better inform the design of immunization programs responsive to the contexts they are embedded in. Ultimately, the performance of hepatitis B birth-dose vaccination programsin Africa extends beyond vaccine supply and is further driven by a multiplicity of program-specific, system-wide determinants that should be considered if the region is to progress towards improved control of HBV MTCT
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The contribution of Religious Entities to Health Sub-Saharan Africa
(2008-05) Schmid, Barbara; Thomas, Elizabeth; Olivier, Jill; Cochrane, James R
Background: While most partners in providing health care in sub-Saharan Africa agree that religious entities play an important role in providing health services, there is little comprehensive data about the scope and scale of their contribution, beyond data held by particular religious entities about their own health related work. In addition not much is known, beyond claims and often repeated statements, about the ways in which such health care is different from services provided in the public health system. 2. Aims and Objectives The overall purpose of this study was to provide a description of the contribution of faith based organisations (FBOs), institutions, and networks to the health of vulnerable populations in resource-poor areas of sub-Saharan Africa (SSA); and to identify key areas for investment that would accelerate, scale up and sustain access to effective services, and/or encourage policy and resource advocacy among and in African countries. There were two main parts to the objectives: 1) To give an overview for SSA of the coverage, role, and core health related activities of religious entities, including major networks, vis a vis public and other private sector health services delivery, and their relationship to government and to each other. 2) To give more detailed information for three country case studies in Mali, Uganda and Zambia: a) describing the capacity of faith based organisations to deliver health services and impact on health behaviour; the financial and/or material support they receive and how they are perceived by stakeholders; b) characterizing key faith based networks and describing how they work; c) describing how faith based organisations collaborate with each other and with governments. From these were to be drawn recommendations about key areas for potential investment that would improve population health outcomes. 3. Research overview: The research was conducted under the auspices of the African Religious Health Assets Programme (ARHAP), a research networks focussed on gaining a better understanding of the contribution of religious health assets to public health in Africa. The team of ARHAP researchers, from the University of Cape Town and the Medical Research Council was supported by an international, inter-disciplinary and multi-religious advisory group as well as in-country researchers.
Open Access
Estimating the development assistance for health provided to faith-based organizations, 1990-2013
(Public Library of Science, 2015) Haakenstad, Annie; Johnson, Elizabeth; Graves, Casey; Olivier, Jill; Duff, Jean; Dieleman, Joseph L
BACKGROUND: Faith-based organizations (FBOs) have been active in the health sector for decades. Recently, the role of FBOs in global health has been of increased interest. However, little is known about the magnitude and trends in development assistance for health (DAH) channeled through these organizations. Material and METHODS: Data were collected from the 21 most recent editions of the Report of Voluntary Agencies. These reports provide information on the revenue and expenditure of organizations. Project-level data were also collected and reviewed from the Bill & Melinda Gates Foundation and the Global Fund to Fight AIDS, Tuberculosis and Malaria. More than 1,900 non-governmental organizations received funds from at least one of these three organizations. Background information on these organizations was examined by two independent reviewers to identify the amount of funding channeled through FBOs. RESULTS: In 2013, total spending by the FBOs identified in the VolAg amounted to US$1.53 billion. In 1990, FB0s spent 34.1% of total DAH provided by private voluntary organizations reported in the VolAg. In 2013, FBOs expended 31.0%. Funds provided by the Global Fund to FBOs have grown since 2002, amounting to $80.9 million in 2011, or 16.7% of the Global Fund's contributions to NGOs. In 2011, the Gates Foundation's contributions to FBOs amounted to $7.1 million, or 1.1% of the total provided to NGOs. CONCLUSION: Development assistance partners exhibit a range of preferences with respect to the amount of funds provided to FBOs. Overall, estimates show that FBOS have maintained a substantial and consistent share over time, in line with overall spending in global health on NGOs. These estimates provide the foundation for further research on the spending trends and effectiveness of FBOs in global health.
Open Access
Evidence map of knowledge translation strategies, outcomes, facilitators and barriers in African health systems
(BioMed Central, 2019-02-07) Edwards, Amanda; Zweigenthal, Virginia; Olivier, Jill
Abstract Background The need for research-based knowledge to inform health policy formulation and implementation is a chronic global concern impacting health systems functioning and impeding the provision of quality healthcare for all. This paper provides a systematic overview of the literature on knowledge translation (KT) strategies employed by health system researchers and policy-makers in African countries. Methods Evidence mapping methodology was adapted from the social and health sciences literature and used to generate a schema of KT strategies, outcomes, facilitators and barriers. Four reference databases were searched using defined criteria. Studies were screened and a searchable database containing 62 eligible studies was compiled using Microsoft Access. Frequency and thematic analysis were used to report study characteristics and to establish the final evidence map. Focus was placed on KT in policy formulation processes in order to better manage the diversity of available literature. Results The KT literature in African countries is widely distributed, problematically diverse and growing. Significant disparities exist between reports on KT in different countries, and there are many settings without published evidence of local KT characteristics. Commonly reported KT strategies include policy briefs, capacity-building workshops and policy dialogues. Barriers affecting researchers and policy-makers include insufficient skills and capacity to conduct KT activities, time constraints and a lack of resources. Availability of quality locally relevant research was the most reported facilitator. Limited KT outcomes reflect persisting difficulties in outcome identification and reporting. Conclusion This study has identified substantial geographical gaps in knowledge and evidenced the need to boost local research capacities on KT practices in low- and middle-income countries. Evidence mapping is also shown to be a useful approach that can assist local decision-making to enhance KT in policy and practice.
Open Access
Exploring knowledge translation mechanisms in the Western Cape Provincial Health System
(2018) Edwards Amanda; Olivier, Jill; Zweigenthal, Virginia
The persistent gap between health research, policy and practice has led to a burgeoning interest in the field of knowledge translation (KT). However, there remains little clarity on what KT mechanisms work in different contexts, particularly in low and middle-income countries. Using mixed methodology this project explores KT mechanisms, barriers, facilitators and outcomes as they function in South Africa’s Western Cape provincial health system. Document review and key informant interviews with health system researchers and provincial health policymakers were synthesised with findings from a random sample of provincial study protocols registered on the National Health Research Database. An evidence-mapping of the literature on KT in African settings complemented this data. Findings indicate variations in the use of health-related research by provincial policymakers and diversity in the mechanisms employed for KT. The important role of organisations, characteristics of available research, relationships and networks play a facilitating role for KT in this context. Resource constraints, system conflicts and politics served as notable barriers. These findings have implications for health researchers and provincial policymakers seeking to “do” KT in the Western Cape health system – including the need for recognition of the important role of context, of the ethical dilemmas within KT processes, and the need for a more systematic approach to KT that includes embedded learning systems.
Open Access
Exploring mechanisms for receiving and responding to citizen feedback in LMIC health system: a mixed methods evidence mapping of the Western Cape Province of South Africa
(2020) Sutherns, Tamaryn; Olivier, Jill
Despite national governments striving for responsive health systems and the implementation of mechanisms and interventions to foster citizen feedback and participation in health, current evidence does not adequately address these mechanisms and interventions in low-income and middle-income countries (LMICs). This mixed method descriptive and exploratory study ‘maps' types of health system responsiveness mechanisms and their functionality in the South African health system, with a focus on the Western Cape Province, based on the available descriptive evidence. Multiple forms of data are scrutinized and synthesized to provide a deeper, contextual understanding of ´formal´ mechanisms that are constituted or mandated into South African and Western Cape policies and guidelines. This research shows that while national, provincial and district policies make strong provisions for health system responsiveness, including mechanisms to foster citizen feedback, in reality, implementation is not standardised and sometimes non-functional. Many of these mechanisms also currently exist in isolation, failing to feed into an overarching strategy of health system responsiveness, where feedback mechanisms may complement one another and lead to quality improvement in the health system. While there are cases for effective and well-functioning mechanisms for receiving and responding to citizen feedback, government on all levels is often hampered by resources and other constraints. These findings have implications for health researchers as well as national and provincial policymakers, seeking to enhance health system functioning.
Open Access
Factors influencing dignity in sub-Saharan African health systems: a qualitative systematic review
(2022) Bald, Sarah MacGregor; Olivier, Jill
Dignity, as a basic human right, is demonstrated across numerous leading human rights declarations, covenants, conventions and is reflected in many national constitutions globally. The World Health Organization, along with corresponding United Nations agencies, have also regularly identified dignity as a guiding principle for health systems, service provision, and reform, as dignity is commonly used to measure or achieve quality, person-centred, respectful, and responsive health systems. The prioritization of dignity is argued to improve health outcomes, strengthen professional dignity, and contribute to stronger, more responsive, and rights-based health systems. Yet despite these perceived benefits and the pervasiveness of dignity as a core issue and right, there is a surprising lack of evidence documenting what role dignity has in a health system, for example, whether it influences systems functioning or performance. To address this gap, a qualitative systematic review was conducted in two parts, starting with an initial global scoping review of evidence on dignity in health systems, followed by a systematic review to identify facilitators and barriers to supporting dignity in sub- Saharan African health systems according to the three levels of the health system: interpersonal (micro), organizational (meso), and system-wide (macro). This study found facilitators and barriers to dignity are prominent and present within the health system; and that facilitators and barriers can mainly be viewed as manifestations of prevailing socio-political and health system contexts which shape organizational hardware and software and influence interpersonal engagements between health system actors. For example, national contexts of health care worker shortages and strikes resulted in inadequate staffing levels at facilities, which attributed to decreased supervision, deviations from standards of care, strained professional dignity, and influenced organizational culture normalizing verbal abuse against patients. These contexts ultimately shaped rushed and hostile interactions between a patient and healthcare workers and consequently acted as a barrier to both patient and professional dignity in the health system. Like any system, barriers and facilitators to dignity were closely related to each other and were observed at all levels of the health system. Policy, discrimination, resource availability, organizational culture, staffing and professional dignity, and accountability were re-occurring, and interconnecting factors described as facilitators of and barriers to dignity in SSA health systems. While enabling international guidelines and human-rights declarations, health policy, private, nongovernmental, primary health care (PHC) facilities, birth companions, training, and health care worker resiliency were identified as supportive factors to dignity in health systems, overwhelmingly challenges associated with pervasive discrimination, organizational culture, and structural inadequacies described at health facilities acted as an unequivocal barrier to both patient and professional dignity in sub-Saharan African health systems. This systematic review study confirms that dignity is a critically important issue to health systems and health policy and systems research – but that it is still poorly conceptualized, theorized, or evidenced in relation to how it influences systems functioning and performance.
Open Access
Faith-based mental health provision in Africa: a mixed methods systematic review
(2022) Nanji, Nadine; Olivier, Jill
Faith-based mental health provision as a model of mental health service delivery is not widely acknowledged or researched, despite being highly utilised, especially in the African context. There is currently limited empirical research or review work on the various types of faith-based health providers which contribute mental health services, the magnitude of these services, or their quality. This mixed-methods systematic review study looked at these aspects of faith-based mental health provision in the African context. In the first phase of this study, we conducted a scoping review with a wider, which resulted in a typology of models of faith-based mental health provision The typology included five different types of faith-based health individual and organisational providers (herbalists, traditional and faith healers, Christian and Muslim clergy, faith-based organisations, and chaplains). In the second phase of the study, we conducted a systematic review based on the typology in which we assessed these models of FBHP against service type and level (facility or community, individual or organisational providers); medical provision type (biomedical or alternative). There were 53 studies included in this systematic review and the findings suggest that there is a wide array of types of faith-based providers providing a variety of mental health services across Africa. The research question formulated for the purposes of the systematic review aim to address the types, magnitude and quality of faith-based mental health services in Africa. For the purposes of this review, magnitude was categorised as including frequency of utilisation and availability of faith-based mental health services, but the information was limited. In addition, there are red flags regarding the quality of these mental health services which include human rights abuses that were discussed in this review. This exploratory review demonstrates some of the challenges in dealing with the complex variety of 'religious entities' in Africa. To some degree, developing conclusions that are applicable to all faith-based mental health providing entities is counterproductive - and instead a main conclusion is that future research and engagement needs to take this variety into account. There are a few common trends - for example challenges facing most faith-based providers in relation to faith-based provision of mental health services is financial support for mental health services. Regarding both traditional/alternative and biomedical mental health services, it has been noted that, there is a need to consider cost to the patient (e.g., reduce out of pocket payments). In addition, the literature suggests that better training for some types of faith-based health providers is urgently needed, especially those working close to community. Community mental health education interventions could strengthen faith-based provision of mental healthcare, and prevent some human rights abuses (religious perils), and improve the quality of faith-based mental health service provision. Better referral systems and improved communication between faith-based health providers and biomedical practitioners is required. In addition, varied types of faith-based health providers need to be included in mental health policy development and implementation. Finally, the most comprehensive conclusion of this exploratory review, is that further research is needed on specific types of faith-based providers engaged in mental health service provision, and further research is needed on the integration of mental health services in African health systems.
Open Access
Health care providers' experience of research activities in public sector health facilities in the Western Cape Province of South Africa
(2020) Ndlovu, Linda; Olivier, Jill; Zweigenthal, Virginia
There is a significant amount of public health research conducted within provincial health facilities in South Africa, whose findings have a positive impact on the delivery of health services. This includes clinical, epidemiological, health systems and health services research, often initiated by post‐graduate students, independent academics researchers, as well as research institutions. Although researchers commonly commit to providing feedback to the provincial department and facilities, there is little evidence to confirm that research feedback is subsequently provided. Little contextualized empirical evidence is available to guide action, particularly for frontline health care providers, who often have the responsibility to host these research activities. The aim of this study was to explore the experiences of healthcare providers with research activities hosted in health facilitiesin the Western Cape province of South Africa. A mixed-method, cross-sectional study was conducted utilising an online survey (n= 19), and semi-structured interviews (n=3) with frontline health care providers (research gatekeepers). Descriptive analyses characterized respondents and their experience of research. Qualitative thematic analysis took on an inductive approach by identifying themes as they emerged from the data and cross comparing these with findings from the scoping literature review. Findings provided insight into how research conduct is experienced by those on the frontline in public health facilities on the provincial district platform. This is particular to the Western Cape province, which has a specific health department administration system. The following themes emerged: perception of research burden on services, understanding of the research approval process, autonomy to deny researchers access to the health facility due to overburden of research, the frequency or occurrence of research feedback after completion of a project, and interpersonal dynamics between researchers and gatekeepers as it relates to research conduct in facilities. This research reports on empirical evidence of perspectives from frontline health care providers on their experience with health research in a particular provincial context. The findings could form the basis of a study with a much larger sample size to inform how research feedback can be translated in a way that directly impacts on the uptake in the frontline.
Open Access
Health system's barriers hindering implementation of public-private partnership policy in the health sector at district level: A case study of partnership for improved reproductive and child health services provision in Bagamoyo district, Tanzania
(2015) Kamugumya, Denice Cyprian; Olivier, Jill
The role of the private sector in improving health systems performance in lower to middle income countries is increasingly gaining more recognition. Public-private partnership (PPP) has been suggested as a tool, to assist governments fulfil their responsibilities in the efficient delivery of health services. In Tanzania, although the idea of PPP has existed for many years in the health sector, there has been limited coordination, especially at a district level - which has contributed to limited health gains or systems strengthening obviously seen as a result of PPP. In 2009 a formal PPP policy was introduced in Tanzania, which directs the appropriate allocation of resources, and describes risk and rewards that can be achieved by building on the expertise of each partner. The Health Sector Strategic Plan III (2009-2015) further emphasises the need for service level agreements (SLAs), which are seen as an important indicator of improved PPP. This case study that draws on the decision-space framework, was conducted in the Bagamoyo district of Tanzania, and employed in-depth interviews, document reviews, and observations methods. The study findings reveal several forms of informal partnerships between the local government and non-state actors. The lack of SLAs for facilities that receive subsides from the government is argued to contribute to inappropriate distribution of risk and reward leading to moral hazards. This is evidenced by non-state actors who pursue their own interests, diverting from public social goals. Furthermore, findings highlight weak capacity of governing bodies to exercise oversights and sanctions, which is acerbated by weak accountability linkages and power differences. Moreover, restricted flexibility in spending is seen to deter prompt actions to address evolving population needs, given limited local fiscal space. It is concluded that effective PPP policy implementation at a local level depends on the capacity of local government officials to make choices that would embrace relational elements dynamics in strategic plans. Disempowered Council Health Services Board in relation to engaging non-state actors is shown to impede PPP initiatives that are conceptualized at local and national levels. This study highlights a need to consider initiatives that would foster new social contracts with non-state actors at the local level and in return build a people-centred district health system. This study is intended to improve knowledge on health systems policy interventions, strengthen future policy implementation at the sub-national level, and strengthen the district health systems as a result of PPP in a country with similar contextual elements.
Open Access
Health systems and social values: the case of the South African health system
(2023) Whyle, Eleanor; Olivier, Jill
Health systems are complex social systems – driven by people and the relationships between them, characterised by feedback loops and path-dependency, and open to contextual influences. This entails that social values are an important determinant of health system change. In addition, health systems play a vital social role as generators of social value. However, the influence of social values on health systems is an under-explored field of study, and the evidence-based on the topic is weakened by conceptual confusion, a lack of theoretical models to support rigorous research, a dearth of empirical evidence, and methodological challenges attendant to the study of intangible factors such as values. In this theory-building study I explore the relationship between health systems and social values. Firstly, I use evidence mapping, interpretive synthesis and scoping review approaches to identify gaps in the existing evidence-base, develop an initial explanatory theory for the social value of health systems, and integrate insights from social sciences to establish a working definition of values, explore the social dynamics of values, and develop an account of the relationship between social systems – including health systems – and social values. Secondly, I conduct a case study of social values in the South African National Health Insurance policy process in its social and political context to gather empirical evidence on the role of social values in health system reform processes, and the mechanisms by which health systems shape social values. Lastly, I integrate the findings from the first two phases to develop a conceptual framework of the relationship between health systems and social values and offer methodological and conceptual insights intended to support further research on the topic. This study finds that social values, often borne out of social and political history, are cemented in health systems through daily practices and procedures. In this way, health systems serve to shape social values – by changing the way people think about what is just with respect to healthcare, their health rights and entitlements, and the appropriate role of the state in providing healthcare and regulating the behaviour of other health system actors.
Open Access
Health systems constraints and facilitators of national immunization programs in low- and middle- income countries
(2019) Amponsah-Dacosta, Edina; Olivier, Jill; Kagina, Benjamin
Like most health interventions, National Immunization Programs (NIPs) are embedded within health systems. This means that NIPs and health systems exist in a constant interaction. Vaccine preventable diseases are widely recognized as the chief cause of morbidity, disability and mortality worldwide and NIPs are understood to be one of the most cost-effective interventions against this burden. In low and middle- income countries (LMICs), where the burden of disease is high, NIPs have been reported to perform at suboptimal levels. It has been suggested that this suboptimal performance of NIPs can be associated with the poor state of health systems in LMIC. Despite this, the interaction between NIPs and health systems is poorly understood. In addition to this, systematic evidence on how health systems constraints and facilitators impact on the performance of NIPs in LMICs is scarce. To address this evidence gap, a systematic review study was conducted, that involved an initial scoping review of the evidence-base on NIPs and health systems in LMICs from which a logic model was developed. This logic model was then applied as a guide for a qualitative systematic review aimed at assessing the health systems constraints and facilitators of NIP performance in sub-Saharan Africa. The findings of this review suggest that well-performing NIPs are those that operate within enabling health systems, characterized by the availability of strong political endorsement for vaccines, clear governance structures and effective collaboration with global partners. Despite this, significant health systems constraints persist and include the limited capacity of health workers in sub-Saharan Africa, weak country infrastructure, poor service delivery, inadequate vaccine communication and ineffective community engagement in immunization programs. This systematic review study contributes to our limited understanding of the interaction between NIPs and health systems. In addition, the findings show how system-wide constraints and facilitators impact on the performance of NIPs. These findings have relevance for ongoing health systems strengthening initiatives, especially where NIPs are concerned.
Open Access
Health systems determinants of delivery and uptake of maternal vaccines in low and middle-income countries: A qualitative systematic review
(2022) Davies, Bronte; Olivier, Jill; Amponsah-Dacosta, Edina
Maternal vaccination has been widely recognised as a key component of the comprehensive package of antenatal care aimed at improving maternal and child health. Low- and middle-income countries (LMICs) are currently falling short of maternal and neonatal mortality targets, with gaps in quality health coverage and a high burden of vaccine-preventable diseases that affect both maternal and child health (MCH). There is a variety and increase of grey and published literature in recent years from LMICs on maternal vaccination programmes and their importance in addressing these gaps in MCH. However, there is a gap in the available literature for research on the role of health systems in the functioning of maternal vaccination programmes, particularly in LMICs. Based on available evidence, understanding health systems determinants of maternal vaccine uptake and delivery requires qualitative insight to inform maternal vaccine programming. A qualitative systematic review was conducted in two phases: a rapid scoping review exploring maternal vaccination and health systems was followed by a systematic review to identify health systems determinants of maternal vaccine delivery and uptake in LMICs. The systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines. Six electronic databases were searched for primary research from LMICs published in English between 2009 and 2021. A qualitative approach to data extraction and evidence synthesis was guided by conceptual health systems framing developed through the scoping review. Thematic analysis identified key descriptive and analytical themes to explore the health systems barriers and enablers of maternal vaccine delivery and uptake in LMICs. Of the 1 242 records identified through database searches, 47 studies were included in the systematic review from 28 LMICs. The majority of included studies were from the South America region (28/47) and included pregnant women as the primary population study group (38/47). Included literature explored mainly Influenza (25/47) and Tetanus toxoid (18/47) maternal vaccine uptake and delivery. Health systems enablers of maternal vaccine uptake included high level of maternal trust in healthcare providers and policy-makers. Barriers to uptake include out-of-pocket spending for vaccination services. Poor communication of policy and guidelines between policy-makers and public/private healthcare providers was identified as a barrier to vaccine delivery, in addition to reliance on external donor funding for vaccine programme implementation and reliance on paper-based antenatal and vaccination records. Urban residence and shorter travelling times to facilities enabled vaccine uptake during pregnancy, while influence of family and influential community members serves as a barrier to vaccine uptake. Limited healthcare worker capacity and subsequent decreased time spent educating patients is a barrier to both vaccine uptake and delivery for pregnant women. Health systems determinants of maternal vaccine delivery and uptake identified and explored in this review study highlight the need for improved communication of vaccine policy guidelines and safety between healthcare providers, policy-makers, pregnant women and the broader community. Monitoring and reporting systems for vaccine delivery in MCH need to be strengthened to inform service delivery policies. This review study provides a health systems approach to maternal vaccination and contributes to the increasing body of work in MCH that can inform future introduction of new maternal vaccines in LMICs.
Open Access
Health systems in the news: The influence of media representations on health system functioning in the Western Cape health system
(2018) Gopal, Thania; Olivier, Jill
Health systems are complex systems characterised by constant change and a web of interwoven relationships, connections, and interactions. Health Policy and Systems Research has called for multidisciplinary approaches to understanding health systems. Like health systems, the media has also been described as an important social institution in modern society that is deeply embedded within the sociocultural and political context. The role of the media as societal watchdog; as a mechanism to improve accountability; as a platform for debate; and as a facilitator of community engagement has been recognised. Within public health, the role of mass media as a tool in health promotion and health communication campaigns is well-established. Media representation research involves the analysis of discourses in media and has been used to study a range of public health issues. However, there is a major gap in representation studies of health systems, in high-, middle- and low income countries. This mixed methods study aimed to describe representations of the South African Western Cape provincial health system by analysing dominant discourses emerging from the English-language mainstream print and online news media (1994-2018). A media content analysis was first conducted to highlight the main themes, followed by a discourse analysis to provide a deeper interrogation of underlying issues. This study suggests that the way a health system is represented in the media potentially influences health system functioning in a variety of ways – for example, how ‘people’ in the system make meaning of discourses, which in turn influences decision-making. ‘Negative’ representations (for example, of a weak or stressed health system), may contribute to a lack of both health worker and patient trust in the health system with a host of undesirable repercussions, such as low health worker morale, health workers failing to speak up for patients, or poor quality of care. The study recommends capacity building of a diversity of people (such as citizens, communities, health workers, civil society) at different levels of the health system to enable them to engage with the media, and mitigate the less desirable repercussions. Further research is needed to, a) consider the effects of media on health systems more carefully, more frequently, and in more contexts; b) find more effective ways to think of media as part of the health system, rather than an instrumental tool, or an external influence; c) to understand how media architecture (the social, political and economic environment in which media are situated) may influence emerging discourses; and d) to understand how media can influence people’s agency and community participation, particularly in the context of responsive and people-centred health systems.

Browsing by Author "Olivier, Jill"

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