Browsing by Subject "Health Systems Specialization"

Now showing 1 - 3 of 3
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    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.
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    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.
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    Open Access
    Migration and Health Systems performance in low- and middle- income countries
    (2022) Khama, Stephen; Olivier, Jill
    Increased migration is one of the main challenges impacting on health system performance. The World Health Organisation (WHO) framed responsiveness, fair financing, and equity as the intrinsic goals of a health system. In line with this framework, we attempted to map existing research on migration and health system performance. A qualitative systematic review was conducted. We followed the processes indicated for evidence mapping synthesis reviews, which included choosing the scope and research topic, searching, and selecting evidence, reporting findings, and identifying the evidence. We improved the primary review by first performing a brief scoping review, which served as the analytical basis for the systematic review extraction process. Articles found during the scoping review were evaluated again during the bigger systematic review phase. We refined the study's eligibility criteria as well as the data extraction items. Seventy-two articles were considered for the review. Out of this total (55/72) were published between 2016 and 2021. Our analysis showed fairness in financing, weak governance and leadership, the absence of a universally acceptable definition of migration, limited access of migrants to healthcare, equity, health worker attitude towards migrants, dignity, and health care quality to migrants as key challenges that affect health system performance. The mapping exercise shows more literature on migration and health system performance, but also shows gaps requiring urgent attention, including integration of the health system goals in implementing health interventions. We conclude that countries are recognising the challenges of migration on health system performance. Migration is slowly being included in national health policies in low- and middle- income countries, however challenges to implementation of such policies exist. Migration is recognised as a human right and the ethical obligation of health institutions. More agenda setting and funding for bridging work on migration and health system performance is recommended.