Browsing by Subject "Health Systems Specialisation"
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- ItemOpen AccessHealth 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, VirginiaThere 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.
- ItemOpen AccessPublic-private engagement and systems resilience in times of health worker strikes in Ghana: Case study of the CHAG-STATE interaction(2023) Buabeng-Baidoo, Bettina; Olivier, JillGlobally, health worker strikes pose a threat to the fundamental human right to the highest level of health, and the realisation of universal health coverage and the effects have been argued to be worse in low- and middle-income countries (LMICs). During health worker strikes in LMICs, private providers have been identified as crucial to maintaining service continuity. However, poor engagement with the private sector might result in compromising the quality of care received at this time and may accrue financial hardship for the population, especially the poor. Ghana has been the site of numerous public sector, nationwide health worker strikes over the past two decades. During these strikes, the grouping of faith-based health providers, networked mainly by the Christian Health Association of Ghana (CHAG), is thought to play an important role in ensuring the continuation of services. However, no study has yet described or explored private and public sector engagement during health worker strikes and whether these interactions may contribute to health system resilience. This case study described and explored the engagement between CHAG and the Government of Ghana (through its Ministry of Health) during public sector health worker strikes from 2010-2016 and its implications for health system resilience. Following an initial scoping literature study, three strike incidents were chosen as embedded units for further analysis. The initial scoping review was followed by a desk-based review of additional data from peer-reviewed literature, institutional databases, and media archives. A secondary analysis of interview transcripts from a related project was also undertaken, and expert consultations were undertaken. Data was analysed using a qualitative thematic approach. Our findings showed that health worker strikes in Ghana were a chronic stressor. We found evidence of system-level interactions between CHAG and the government, where the government publicly directed patients to CHAG facilities to allow for 'absorptive' and 'adaptive' resilience strategies. This was possible due to CHAG's non-striking convention, the two actors' unique secondment policy, and the presence of a National Health Insurance System. We discovered that system 'software' components, including trust, shared values, and power influenced the dynamics of this interaction. However, there was limited evidence of additional support from the government to CHAG facilities during strikes or increased collaboration between the two actors. Additionally, it was found that chronic delays in reimbursements from the National Health Insurance System to private providers may impede the ability of CHAG to provide care and that there were challenges to CHAG's non-striking convention from within and outside the organisation. The study highlights the critical role that private providers can play in enhancing the resilience of the health system during strikes in Ghana. To this end, the government should establish close and proactive partnerships with private providers to guarantee adequate support during such disruptions- including responding to challenges with the National Health Insurance System and scaling up resources at private facilities during strikes. The study also showed that important complexities (including challenges to CHAG's non-striking convention) need to be considered moving forward. Additionally, the government should (with a keen awareness of the complex adaptive nature of health systems) engage in joint efforts with relevant stakeholders to proactively address human resource-related challenges. The case study highlights the continued and expanding significance of private providers (in particular non-profit providers) in the strengthening and resilience of mixed health systems. The study showed the need for further research on the impact of strikes on health systems in LMICs and the strategies (including collaboration with the private sector) that nations can implement to respond effectively. LMICS must plan for strikes by fostering collaborative relationships with the private sector and developing strike preparedness strategies and policies to ensure the continuation of emergency and essential services during these times.
- ItemOpen AccessThe Development of Post-Soviet Health Systems: A Mixed Methods Historical Case Study(2022) Hotchner, Blaser Rebecca; Olivier, JillAfter independence, post-Soviet countries embarked on various trajectories of health system development, some more successfully than others. Several countries throughout the region, limited by political and economic constraints, continue to struggle with health systems strengthening, leading to negative downstream effects on population health. For countries further behind in their development trajectories, learning from successful reform experiences could support health policymaking, though health policy and systems research on this topic is scarce, particularly in the former Soviet Union. To begin to address this gap, a mixed-methods historical case study was conducted, analysing and comparing two post-Soviet health system development experiences—in Estonia and Moldova. The cases were selected on the basis of specific differentiators, to capture a wider range of regional experiences. The country case studies focused analysis on four health systems areas, in accordance with the European Observatory on Health Systems and Policies' Health Systems in Transition framework—namely organisation and governance, financing, physical and human resources, and provision of services. Quantitative and qualitative data were synthesized, with quantitative data including select demographic, macroeconomic, and population health indicators, and qualitative data including thematic analysis of policy and research materials. The study utilised a combined complex adaptive systems and historical institutionalist perspective. The subsequent cross-country comparative analysis sought to identify ‘good health at low cost' practices appropriate to a post-Soviet context, with the aim of drawing lessons towards health systems strengthening in the broader region. Study findings suggest that political commitment to the health system development project is key; specific policies around revenue collection and pooling mechanisms are important; privatisation should be applied strategically; a holistic strategy around service provision is necessary, balancing hospital, primary health care, and public health reform; engaging external organisations in terms of financial and technical assistance can be advantageous; and health worker supply issues must be addressed. Given the contextual dissimilarities between the two country case studies, overlapping reform trends are likely indicative of regional specificities. Such knowledge can be leveraged to benefit other post-Soviet states, towards optimal health system development along the post-Soviet historical pathway.