Pub Date : 2025-02-28DOI: 10.1016/j.ssmhs.2025.100059
Anna Kalbarczyk , Daniel Krugman , Shatha Elnakib , Elizabeth Hazel , Amy Luo , Anju Malhotra , Rosemary Morgan
Given the many approaches to and definitions of gender responsive monitoring and evaluation (M&E) for health programs and interventions there is a lack of clarity on how to operationalize it including what to measure and how to measure it. We conducted a scoping review to understand what makes M&E gender responsive. We included 31 studies and conducted two rounds of extraction to delineate ways in which gender was integrated into M&E. Twelve articles described the use of theory to guide M&E though most were not related to gender. Twelve articles employed a gender score in data collection, most of which measured Likert scale responses related to gender equity. Even though most studies did not use a specific gender framework, most incorporated gender domains in their analysis. Seven studies used participatory methods in the design and implementation of M&E. Most studies conducted M&E on programs or interventions that were designed to be gender intentional and related to gender issues. Gender responsive M&E intentionally integrates gender into the M&E process, regardless of how gender-intentional the program or intervention is. Gender dimensions can be identified through gender theories, models, scores, and frameworks to inform tool development, data collection, analysis, and stakeholder engagement processes.
{"title":"Towards a common understanding of gender-responsive monitoring and evaluation for health programs and interventions: Evidence from a scoping review","authors":"Anna Kalbarczyk , Daniel Krugman , Shatha Elnakib , Elizabeth Hazel , Amy Luo , Anju Malhotra , Rosemary Morgan","doi":"10.1016/j.ssmhs.2025.100059","DOIUrl":"10.1016/j.ssmhs.2025.100059","url":null,"abstract":"<div><div>Given the many approaches to and definitions of gender responsive monitoring and evaluation (M&E) for health programs and interventions there is a lack of clarity on how to operationalize it including what to measure and how to measure it. We conducted a scoping review to understand what makes M&E gender responsive. We included 31 studies and conducted two rounds of extraction to delineate ways in which gender was integrated into M&E. Twelve articles described the use of theory to guide M&E though most were not related to gender. Twelve articles employed a gender score in data collection, most of which measured Likert scale responses related to gender equity. Even though most studies did not use a specific gender framework, most incorporated gender domains in their analysis. Seven studies used participatory methods in the design and implementation of M&E. Most studies conducted M&E on programs or interventions that were designed to be gender intentional and related to gender issues. Gender responsive M&E intentionally integrates gender into the M&E process, regardless of how gender-intentional the program or intervention is. Gender dimensions can be identified through gender theories, models, scores, and frameworks to inform tool development, data collection, analysis, and stakeholder engagement processes.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100059"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143550582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-27DOI: 10.1016/j.ssmhs.2025.100061
Tolib Mirzoev , Ana Manzano , Irene Akua Agyepong , Bui Thi Thu Ha , Linda Lucy Yevoo , Elizabeth Awini , Anthony Danso-Appiah , Leveana Gyimah , Do Thi Hanh Trang , Le Minh Thi , Kimberly Lakin , Sumit Kane
Health systems responsiveness is a key health systems goal, operationalised as an outcome measured across domains such as dignity and confidentiality. It also reflects values and inputs towards improved health. In this realist synthesis, we critically reviewed underpinning theories, examined mechanisms, and propose a theoretical model of health systems responsiveness. Four theories enhance the understanding of responsiveness: Complex Adaptive Systems, Human Agency, Health Equity, Justice and Social Accountability, and Cultural Capital. It is a social construct reflecting what people expect from the system within social and cultural contexts; and what systems actors (providers, managers) expect from people in the context of standards of care and available resources. Responsiveness is shaped by the societal context of care and the health systems context. Domains of responsiveness are inter-related and comprise values, processes and resources. Our proposed theory highlights the importance of favourable social and organisational contexts in triggering sense of agency, literacy and empowerment that contribute to enhanced people’s capacity to engage with health systems and health system’s capacity to respond to people’s expectations. We hope it offers a useful heuristic to inform efforts in improving health systems responsiveness.
{"title":"Theoretical foundations and mechanisms of health systems responsiveness: a realist synthesis","authors":"Tolib Mirzoev , Ana Manzano , Irene Akua Agyepong , Bui Thi Thu Ha , Linda Lucy Yevoo , Elizabeth Awini , Anthony Danso-Appiah , Leveana Gyimah , Do Thi Hanh Trang , Le Minh Thi , Kimberly Lakin , Sumit Kane","doi":"10.1016/j.ssmhs.2025.100061","DOIUrl":"10.1016/j.ssmhs.2025.100061","url":null,"abstract":"<div><div>Health systems responsiveness is a key health systems goal, operationalised as an outcome measured across domains such as dignity and confidentiality. It also reflects values and inputs towards improved health. In this realist synthesis, we critically reviewed underpinning theories, examined mechanisms, and propose a theoretical model of health systems responsiveness. Four theories enhance the understanding of responsiveness: Complex Adaptive Systems, Human Agency, Health Equity, Justice and Social Accountability, and Cultural Capital. It is a social construct reflecting what people expect from the system within social and cultural contexts; and what systems actors (providers, managers) expect from people in the context of standards of care and available resources. Responsiveness is shaped by the societal context of care and the health systems context. Domains of responsiveness are inter-related and comprise values, processes and resources. Our proposed theory highlights the importance of favourable social and organisational contexts in triggering sense of agency, literacy and empowerment that contribute to enhanced people’s capacity to engage with health systems and health system’s capacity to respond to people’s expectations. We hope it offers a useful heuristic to inform efforts in improving health systems responsiveness.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100061"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Knowledge dissemination and awareness raising is a common strategy for fostering antimicrobial stewardship and tackling antimicrobial resistance (AMR). However, empirical evidence suggests that the dissemination of technical/biomedical information about AMR, alone, is insufficient to improve antibiotic use in resource-poor settings. This is because antibiotic users’ decisions are based not only on biomedical knowledge but also on social and clinical information that is specific to local healthcare realities, and healthcare providers’ clinical knowledge and judgement. In this article, we propose a framework that identifies knowledge critical to deciding a course of antibiotic treatment for possible infection in resource-poor settings, and how to improve the knowledge flow to improve antibiotic use. Specifically, we focus on understanding three domains of knowledge that guide antibiotic users’ decisions: 1) scientific evidence, and evidence-based treatment guidelines; 2) local knowledge of infection patterns and risks, and the susceptibility of organisms causing infection to different antibiotics; and 3) personal and social characteristics of the patient. Drawing from the theory of information asymmetry and empirical data from West Bengal, India, we show that all three domains of knowledge demonstrated degrees of asymmetry, and community-level practitioners’ knowledge was not effectively taken into account in clinical guidance. We conclude that interventions targeting AMR need to reflect all three knowledge domains to be effective in clinical settings.
{"title":"Understanding the complex knowledge economy toward antimicrobial stewardship in West Bengal, India","authors":"Ayako Ebata , Meenakshi Gautham , Anne-Sophie Jung , Mathew Hennessey , Sanghita Bhattacharyya , Gerald Bloom","doi":"10.1016/j.ssmhs.2025.100063","DOIUrl":"10.1016/j.ssmhs.2025.100063","url":null,"abstract":"<div><div>Knowledge dissemination and awareness raising is a common strategy for fostering antimicrobial stewardship and tackling antimicrobial resistance (AMR). However, empirical evidence suggests that the dissemination of technical/biomedical information about AMR, alone, is insufficient to improve antibiotic use in resource-poor settings. This is because antibiotic users’ decisions are based not only on biomedical knowledge but also on social and clinical information that is specific to local healthcare realities, and healthcare providers’ clinical knowledge and judgement. In this article, we propose a framework that identifies knowledge critical to deciding a course of antibiotic treatment for possible infection in resource-poor settings, and how to improve the knowledge flow to improve antibiotic use. Specifically, we focus on understanding three domains of knowledge that guide antibiotic users’ decisions: 1) scientific evidence, and evidence-based treatment guidelines; 2) local knowledge of infection patterns and risks, and the susceptibility of organisms causing infection to different antibiotics; and 3) personal and social characteristics of the patient. Drawing from the theory of information asymmetry and empirical data from West Bengal, India, we show that all three domains of knowledge demonstrated degrees of asymmetry, and community-level practitioners’ knowledge was not effectively taken into account in clinical guidance. We conclude that interventions targeting AMR need to reflect all three knowledge domains to be effective in clinical settings.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100063"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-25DOI: 10.1016/j.ssmhs.2025.100062
Amit Aryal , Emma Clarke-Deelder , Doris Osei Afriyie , Souksanh Phommalangsy , Günther Fink
Background
In Lao People’s Democratic Republic (Lao PDR), health care is provided through a public system comprised of central, provincial and district hospitals, health centers, and a growing private sector. Despite efforts to strengthen primary care, recent data suggests that Laotians often bypass primary care facilities. This study aims to understand the factors influencing health facility selection in an urban setting in Lao PDR.
Methods
We conducted a qualitative study using 16 focus-group discussions in four districts in Vientiane capital. Guided by Constructivist Grounded theory, we analyzed the findings using the Framework Method.
Results
The study revealed several key factors influencing health facility selection among urban residents of Vientiane capital. Accessibility of care facilities was a primary consideration. Participants preferred tertiary-level hospitals because of their perceived clinical superiority and modern amenities, however, they were unsatisfied with long waiting times, confusing procedures, and demands for informal payments. Lack of respect and empathy drove participants to private providers, which were perceived to be efficient and friendly.
Conclusion
We found that key factors influencing facility selection included accessibility, perceived severity of illness, cost, perceived clinical competence of health workers, respectfulness of health workers and staff, standards of health facilities, timeliness of care and personal connections. Among the key findings of this study was that lack of respect and empathy drove individuals towards private providers, which were perceived to offer a friendlier atmosphere. This study underscores the need to consider primary care models that foster a culture of respect and empathy.
{"title":"Factors influencing healthcare facility selection in an urban setting in Lao PDR: Findings from a qualitative study","authors":"Amit Aryal , Emma Clarke-Deelder , Doris Osei Afriyie , Souksanh Phommalangsy , Günther Fink","doi":"10.1016/j.ssmhs.2025.100062","DOIUrl":"10.1016/j.ssmhs.2025.100062","url":null,"abstract":"<div><h3>Background</h3><div>In Lao People’s Democratic Republic (Lao PDR), health care is provided through a public system comprised of central, provincial and district hospitals, health centers, and a growing private sector. Despite efforts to strengthen primary care, recent data suggests that Laotians often bypass primary care facilities. This study aims to understand the factors influencing health facility selection in an urban setting in Lao PDR.</div></div><div><h3>Methods</h3><div>We conducted a qualitative study using 16 focus-group discussions in four districts in Vientiane capital. Guided by Constructivist Grounded theory, we analyzed the findings using the Framework Method.</div></div><div><h3>Results</h3><div>The study revealed several key factors influencing health facility selection among urban residents of Vientiane capital. Accessibility of care facilities was a primary consideration. Participants preferred tertiary-level hospitals because of their perceived clinical superiority and modern amenities, however, they were unsatisfied with long waiting times, confusing procedures, and demands for informal payments. Lack of respect and empathy drove participants to private providers, which were perceived to be efficient and friendly.</div></div><div><h3>Conclusion</h3><div>We found that key factors influencing facility selection included accessibility, perceived severity of illness, cost, perceived clinical competence of health workers, respectfulness of health workers and staff, standards of health facilities, timeliness of care and personal connections. Among the key findings of this study was that lack of respect and empathy drove individuals towards private providers, which were perceived to offer a friendlier atmosphere. This study underscores the need to consider primary care models that foster a culture of respect and empathy.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100062"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Less than 1 % of the population in Bangladesh has access to health insurance (HI). Accordingly, the health care financing is largely reliant on out-of-pocket expenses. We explored determinants of client satisfaction with HI for a comprehensive model and made effort to identify the bottlenecks for HI expansion in Bangladesh.
Methods
We used an explanatory sequential mixed-methods approach, surveying 291 active HI subscribers on satisfaction with service quality, claim settlement, premium, coverage, deductible, co-payment and company support. Experience-based perceptions on availing HI, premium payment, client service, claim settlement and HI benefit package were recorded on a Likert scale. Further, we conducted 25 key informant interviews to understand the bottlenecks for HI expansion in Bangladesh. We used thematic framework approach to analyse qualitative data. Principal Component Analysis was carried out to generate indices. Determinants of HI satisfaction were identified using multiple linear regression.
Results
Among experience-based perception domains, client service and claim settlement were key factors in HI satisfaction, with client service having a greater impact (coefficients: 0.45 and 0.30). Adding dependent healthcare and longer coverage enhanced client satisfaction. Though 74 % of clients were willing to recommend their HI scheme establishing good satisfaction level, issues related to low awareness, lack of specialized providers, high taxes, and an image crisis hinder HI expansion in Bangladesh
Conclusions
Improving client satisfaction and hence, expanding HI market requires quality service and better claim settlement. Strengthening awareness and building the image for HI in Bangladesh need collaborative efforts.
{"title":"Unveiling health insurance satisfaction: Exploring key determinants and bottlenecks in Bangladesh","authors":"Rumana Huque , S.M. Abdullah , Tahia Anan Dhira , Salina Siddiqua , Deepa Barua , Md. Abdullah , Muhammod Abdus Sabur , Nazma Begum , Omara Dogar , Md. Nurul Amin , Mohd. Shahadat Hossain Mahmud","doi":"10.1016/j.ssmhs.2025.100058","DOIUrl":"10.1016/j.ssmhs.2025.100058","url":null,"abstract":"<div><h3>Background</h3><div>Less than 1 % of the population in Bangladesh has access to health insurance (HI). Accordingly, the health care financing is largely reliant on out-of-pocket expenses. We explored determinants of client satisfaction with HI for a comprehensive model and made effort to identify the bottlenecks for HI expansion in Bangladesh.</div></div><div><h3>Methods</h3><div>We used an explanatory sequential mixed-methods approach, surveying 291 active HI subscribers on satisfaction with service quality, claim settlement, premium, coverage, deductible, co-payment and company support. Experience-based perceptions on availing HI, premium payment, client service, claim settlement and HI benefit package were recorded on a Likert scale. Further, we conducted 25 key informant interviews to understand the bottlenecks for HI expansion in Bangladesh. We used thematic framework approach to analyse qualitative data. Principal Component Analysis was carried out to generate indices. Determinants of HI satisfaction were identified using multiple linear regression.</div></div><div><h3>Results</h3><div>Among experience-based perception domains, client service and claim settlement were key factors in HI satisfaction, with client service having a greater impact (coefficients: 0.45 and 0.30). Adding dependent healthcare and longer coverage enhanced client satisfaction. Though 74 % of clients were willing to recommend their HI scheme establishing good satisfaction level, issues related to low awareness, lack of specialized providers, high taxes, and an image crisis hinder HI expansion in Bangladesh</div></div><div><h3>Conclusions</h3><div>Improving client satisfaction and hence, expanding HI market requires quality service and better claim settlement. Strengthening awareness and building the image for HI in Bangladesh need collaborative efforts.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100058"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-18DOI: 10.1016/j.ssmhs.2025.100060
Roberto Rubem da Silva-Brandão , Katherine Kenny , Michelle Peterie , Alex Broom
The growing concern over the rise of antimicrobial resistance (AMR) has brought to light the ways AMR is produced through interconnected structural, political, clinical, and biological factors. In this study, set in São Paulo, Brazil, we articulate how healthcare bureaucracies feature in this production of AMR in primary care by drawing on a series of interviews with primary care-based health professionals, health services managers, and policymakers, completed between late 2021 and early 2023. Our results show how expanding and contracting bureaucracies are highly politicized and variously contribute to the production of AMR in primary care. In particular, healthcare labour force dynamics and managerial relations within healthcare settings contribute to the bureaucratic elements of AMR risks in clinical practice. We argue that the invisibility of AMR in everyday practice is deeply entwined with its bureaucratic form; that is, with the instability between institutions and individual action, public and private sectors, work and clinical practice, and social and clinical entanglements of resistance.
{"title":"Brazilian healthcare bureaucracies and the production of antimicrobial resistance","authors":"Roberto Rubem da Silva-Brandão , Katherine Kenny , Michelle Peterie , Alex Broom","doi":"10.1016/j.ssmhs.2025.100060","DOIUrl":"10.1016/j.ssmhs.2025.100060","url":null,"abstract":"<div><div>The growing concern over the rise of antimicrobial resistance (AMR) has brought to light the ways AMR is produced through interconnected structural, political, clinical, and biological factors. In this study, set in São Paulo, Brazil, we articulate how healthcare bureaucracies feature in this production of AMR in primary care by drawing on a series of interviews with primary care-based health professionals, health services managers, and policymakers, completed between late 2021 and early 2023. Our results show how expanding and contracting bureaucracies are highly politicized and variously contribute to the production of AMR in primary care. In particular, healthcare labour force dynamics and managerial relations within healthcare settings contribute to the bureaucratic elements of AMR risks in clinical practice. We argue that the invisibility of AMR in everyday practice is deeply entwined with its bureaucratic form; that is, with the instability between institutions and individual action, public and private sectors, work and clinical practice, and social and clinical entanglements of resistance.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100060"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ssmhs.2025.100056
Sonia A.W. Gbratto-Dobe , Hugues B. Segnon
This paper analyses the effect of mothers’ education on the nutritional status of children under 5 in Côte d’Ivoire. We used data on 8743 children aged 0–59 months, of the MICS5–2016 conducted in Côte d’Ivoire. Child nutritional status was measured with their height-for-age and weight-for-age, according to WHO standards. Multilogistic estimates were carried out using Stata 17. We find that children whose mothers had at least primary education were less at risk of having moderate stunting as well as moderate underweight. Those whose mothers reached a higher level were less at risk of having severe stunting as well as severe underweight. Controlling by significant variables such as child's sex and age, paternal education, household place of residence, household wellbeing index, and mother access to media slightly increased the impact of mothers’ education. Mothers’ education is essential to improving child nutritional status during his first 5 years of life. Her impact in reducing child malnutrition is greater on stunting than on underweight, suggesting an improvement in the long-term. Promoting women's education, by improving their access to formal education is fundamental to fight against child malnutrition. Considering multi-sectoral actions in the fight against malnutrition could make this objective more effective.
{"title":"Is mother's education essential to improving the nutritional status of children under five in Côte d′Ivoire?","authors":"Sonia A.W. Gbratto-Dobe , Hugues B. Segnon","doi":"10.1016/j.ssmhs.2025.100056","DOIUrl":"10.1016/j.ssmhs.2025.100056","url":null,"abstract":"<div><div>This paper analyses the effect of mothers’ education on the nutritional status of children under 5 in Côte d’Ivoire. We used data on 8743 children aged 0–59 months, of the MICS5–2016 conducted in Côte d’Ivoire. Child nutritional status was measured with their height-for-age and weight-for-age, according to WHO standards. Multilogistic estimates were carried out using Stata 17. We find that children whose mothers had at least primary education were less at risk of having moderate stunting as well as moderate underweight. Those whose mothers reached a higher level were less at risk of having severe stunting as well as severe underweight. Controlling by significant variables such as child's sex and age, paternal education, household place of residence, household wellbeing index, and mother access to media slightly increased the impact of mothers’ education. Mothers’ education is essential to improving child nutritional status during his first 5 years of life. Her impact in reducing child malnutrition is greater on stunting than on underweight, suggesting an improvement in the long-term. Promoting women's education, by improving their access to formal education is fundamental to fight against child malnutrition. Considering multi-sectoral actions in the fight against malnutrition could make this objective more effective.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100056"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-30DOI: 10.1016/j.ssmhs.2025.100057
Warren Dodd , Laura Jane Brubacher , Monica Bustos , Melinda Kelly Mijares , Krisha Lim-Mar , Matthew Little , Lincoln Lau
Introduction
Community health workers (CHWs) are uniquely positioned to act as a bridge between local maternal and child health needs and the broader health system. However, there is a need to examine the specific strategies CHWs use to facilitate intersectoral collaboration and support community-level maternal and child health service delivery.
Methods
This study was conducted in partnership with a Philippines-based NGO and their CHW program. In total, 64 semi-structured interviews were conducted with CHWs from six locations in Negros Oriental, Philippines. Data collection focused on CHWs’ efforts to address maternal and child health and collaborate across sectors to support health service delivery. Qualitative data were analyzed with a hybrid inductive-deductive approach.
Results
CHWs (all females; ages 21–60) leveraged the multiple roles and social networks they held, including with local health system and government actors, to address maternal and child health. CHWs viewed their role as addressing service gaps and providing continuity of care with the public health system (service extenders); liaising between communities and both the NGO and public sector to support service navigation (cultural brokers); and working to address complex social and ecological determinants of health within their communities (social change agents).
Conclusion
This study provides insights into how NGO-public sector collaboration is facilitated by CHWs to support maternal and child health in communities. In addition, this study demonstrates how broader health system governance arrangements and decentralization may impact the experiences and roles of CHWs affiliated with NGO-led programs.
{"title":"“I am the bridge”: Examining intersectoral collaboration among community health workers to address maternal and child health in the Philippines","authors":"Warren Dodd , Laura Jane Brubacher , Monica Bustos , Melinda Kelly Mijares , Krisha Lim-Mar , Matthew Little , Lincoln Lau","doi":"10.1016/j.ssmhs.2025.100057","DOIUrl":"10.1016/j.ssmhs.2025.100057","url":null,"abstract":"<div><h3>Introduction</h3><div>Community health workers (CHWs) are uniquely positioned to act as a bridge between local maternal and child health needs and the broader health system. However, there is a need to examine the specific strategies CHWs use to facilitate intersectoral collaboration and support community-level maternal and child health service delivery.</div></div><div><h3>Methods</h3><div>This study was conducted in partnership with a Philippines-based NGO and their CHW program. In total, 64 semi-structured interviews were conducted with CHWs from six locations in Negros Oriental, Philippines. Data collection focused on CHWs’ efforts to address maternal and child health and collaborate across sectors to support health service delivery. Qualitative data were analyzed with a hybrid inductive-deductive approach.</div></div><div><h3>Results</h3><div>CHWs (all females; ages 21–60) leveraged the multiple roles and social networks they held, including with local health system and government actors, to address maternal and child health. CHWs viewed their role as addressing service gaps and providing continuity of care with the public health system (service extenders); liaising between communities and both the NGO and public sector to support service navigation (cultural brokers); and working to address complex social and ecological determinants of health within their communities (social change agents).</div></div><div><h3>Conclusion</h3><div>This study provides insights into how NGO-public sector collaboration is facilitated by CHWs to support maternal and child health in communities. In addition, this study demonstrates how broader health system governance arrangements and decentralization may impact the experiences and roles of CHWs affiliated with NGO-led programs.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100057"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-18DOI: 10.1016/j.ssmhs.2025.100054
Samina Idrees , Megann Dong , Gillian Young , Leslie Meredith , Dana Ryan , Yona Lunsky , Maria Mathews
Background
The community care sector manages the delivery of health and social services in people’s homes and local communities. The sector supports individuals with intellectual and developmental disabilities, physical disabilities, and complex medical needs. Person-centred plans (PCPs) have been recognized as evidence-based practice across various care settings, however there is limited literature on the factors impacting this process. This study aims to identify the supports and barriers to creating and implementing PCPs in the community care sector.
Methods
We partnered with PHSS, a not-for-profit community care organization based in Ontario, Canada. We conducted a total of 42 semi-structured interviews, 18 with persons receiving care (i.e., persons-supported) at PHSS, 1 with a family member of a person-supported, 11 with frontline staff at PHSS, and 12 with representatives from different community care organizations in Ontario, Canada. We asked participants about the PCP process at their organization, including relevant supports and barriers. We analyzed the data thematically, using a pragmatic, qualitative, descriptive approach.
Results
We identified four key factors impacting the creation and implementation of PCPs: (1) the health and capacity of the person-supported, (2) community care sector challenges, (3) integration across community care and health sectors, and (4) community connections, accessibility, and inclusion. Participants described how the health and capacity of the person-supported could impact the PCP process, particularly for individuals who were non-speaking or had difficulty communicating. Inadequate funding and staffing were described as community care sector challenges. Participants also described a need for increased integration with other sectors including acute care systems. Strong connections with the community were integral to implementing PCPs; participants also encountered barriers to inclusion and accessibility.
Conclusions
The creation and implementation of PCPs is impacted by individual health and capacity, organizational funding and staffing, intersectoral integration, and broader community factors. These findings highlight the importance of addressing challenges through targeted intervention strategies designed to optimize PCP creation and implementation and ensure equitable outcomes across diverse populations.
{"title":"Supports and barriers to creating and implementing person-centred plans in the community care sector in Canada: A qualitative analysis of three perspectives","authors":"Samina Idrees , Megann Dong , Gillian Young , Leslie Meredith , Dana Ryan , Yona Lunsky , Maria Mathews","doi":"10.1016/j.ssmhs.2025.100054","DOIUrl":"10.1016/j.ssmhs.2025.100054","url":null,"abstract":"<div><h3>Background</h3><div>The community care sector manages the delivery of health and social services in people’s homes and local communities. The sector supports individuals with intellectual and developmental disabilities, physical disabilities, and complex medical needs. Person-centred plans (PCPs) have been recognized as evidence-based practice across various care settings, however there is limited literature on the factors impacting this process. This study aims to identify the supports and barriers to creating and implementing PCPs in the community care sector.</div></div><div><h3>Methods</h3><div>We partnered with PHSS, a not-for-profit community care organization based in Ontario, Canada. We conducted a total of 42 semi-structured interviews, 18 with persons receiving care (i.e., persons-supported) at PHSS, 1 with a family member of a person-supported, 11 with frontline staff at PHSS, and 12 with representatives from different community care organizations in Ontario, Canada. We asked participants about the PCP process at their organization, including relevant supports and barriers. We analyzed the data thematically, using a pragmatic, qualitative, descriptive approach.</div></div><div><h3>Results</h3><div>We identified four key factors impacting the creation and implementation of PCPs: (1) the health and capacity of the person-supported, (2) community care sector challenges, (3) integration across community care and health sectors, and (4) community connections, accessibility, and inclusion. Participants described how the health and capacity of the person-supported could impact the PCP process, particularly for individuals who were non-speaking or had difficulty communicating. Inadequate funding and staffing were described as community care sector challenges. Participants also described a need for increased integration with other sectors including acute care systems. Strong connections with the community were integral to implementing PCPs; participants also encountered barriers to inclusion and accessibility.</div></div><div><h3>Conclusions</h3><div>The creation and implementation of PCPs is impacted by individual health and capacity, organizational funding and staffing, intersectoral integration, and broader community factors. These findings highlight the importance of addressing challenges through targeted intervention strategies designed to optimize PCP creation and implementation and ensure equitable outcomes across diverse populations.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100054"},"PeriodicalIF":0.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-14DOI: 10.1016/j.ssmhs.2025.100053
Samuel Owusu Achiaw, Claudia Geue, Eleanor Grieve
Background
Launched in 2003, Ghana’s National Health Insurance Scheme (NHIS) was a move towards Universal Health Coverage. There is a dearth of studies that have since investigated the effect of the scheme on non-communicable diseases (NCDs) like hypertension. While a major cause of mortality and morbidity, hypertension remains mostly undiagnosed in Ghana. Secondary prevention comprising early detection and prompt treatment is, hence, important in reducing disease burden. This study assessed the association between active NHIS membership and the likelihood of having early-onset hypertension detected and treated.
Methods
A cross-sectional analysis of the 2014 Ghana Demographic and Health Survey (male dataset) was conducted. Unadjusted analysis used binary logistic regression with active NHIS membership as the independent variable and detection of early-onset hypertension as the dependent variable. Early-onset hypertension was defined as the onset of hypertension at 55 years or younger. Covariates for the adjusted regression models were age, BMI, smoking status, place of residence, wealth, and education level. The association between membership and treatment was also assessed.
Results
Unadjusted and adjusted results showed that the odds of early-onset hypertension being detected in participants with active NHIS membership were respectively 2.4 (95 % CI:1.56 – 3.59, p = 0.000) and 2.2 (95 % CI 1.43 – 3.24, p = 0.000) that of those without active membership. There was no significant association between membership and treatment.
Conclusion
This study suggests that NHIS membership may play a beneficial role in the secondary prevention of NCDs in Ghana. Further research is, nevertheless, needed to understand how membership, NCDs, and other contextual factors are interrelated.
{"title":"The role of universal health coverage in secondary prevention: A case study of Ghana’s National Health Insurance Scheme and early-onset hypertension","authors":"Samuel Owusu Achiaw, Claudia Geue, Eleanor Grieve","doi":"10.1016/j.ssmhs.2025.100053","DOIUrl":"10.1016/j.ssmhs.2025.100053","url":null,"abstract":"<div><h3>Background</h3><div>Launched in 2003, Ghana’s National Health Insurance Scheme (NHIS) was a move towards Universal Health Coverage. There is a dearth of studies that have since investigated the effect of the scheme on non-communicable diseases (NCDs) like hypertension. While a major cause of mortality and morbidity, hypertension remains mostly undiagnosed in Ghana. Secondary prevention comprising early detection and prompt treatment is, hence, important in reducing disease burden. This study assessed the association between active NHIS membership and the likelihood of having early-onset hypertension detected and treated.</div></div><div><h3>Methods</h3><div>A cross-sectional analysis of the 2014 Ghana Demographic and Health Survey (male dataset) was conducted. Unadjusted analysis used binary logistic regression with active NHIS membership as the independent variable and detection of early-onset hypertension as the dependent variable. Early-onset hypertension was defined as the onset of hypertension at 55 years or younger. Covariates for the adjusted regression models were age, BMI, smoking status, place of residence, wealth, and education level. The association between membership and treatment was also assessed.</div></div><div><h3>Results</h3><div>Unadjusted and adjusted results showed that the odds of early-onset hypertension being detected in participants with active NHIS membership were respectively 2.4 (95 % CI:1.56 – 3.59, p = 0.000) and 2.2 (95 % CI 1.43 – 3.24, p = 0.000) that of those without active membership. There was no significant association between membership and treatment.</div></div><div><h3>Conclusion</h3><div>This study suggests that NHIS membership may play a beneficial role in the secondary prevention of NCDs in Ghana. Further research is, nevertheless, needed to understand how membership, NCDs, and other contextual factors are interrelated.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100053"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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