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How can health systems better prepare for the next pandemic? A qualitative study of lessons learned from the COVID-19 response in Nigeria

SSM - Health Systems

Pub Date : 2025-01-10 DOI: 10.1016/j.ssmhs.2025.100052

Chinyere Cecilia Okeke , Nkolika Pamela Uguru , Benjamin Uzochukwu , Obinna Onwujekwe

Fragile health systems can become overwhelmed during public health crises, further exacerbating the human, economic, and political toll. It is then necessary as a country, to assess, understand, document, and report the activities/measures that are considered nationally and sub-nationally significant, both in terms of COVID-19 responses and strengthening of the health system for the future. Data collection was through a scoping review of 198 publications that were comprised of official documents, journal articles, and media reports that were published from December 2019 to December 2020. Journal articles were sourced from online journals in PubMed, Google Scholar, and Scopus using search terms/queries. Published official documents were retrieved from relevant websites of government agencies and development partners and media searches were performed in FACTIVA. In addition, qualitative data using in-depth interviews of key informants were collected from 38 respondents in April 2022. The transcripts from the IDIs were coded, and thematic analysis and narrative synthesis of data were done using NVivo version 12 using Palagyi et al.’s framework. Our findings revealed the need to institutionalize some COVID-19 response activities and to efficiently prioritize financial and material resources during a pandemic response. Also, to introduce flexibility in financial response activities. Pooling and funds management was found useful but the integration of response activities into already existing epidemic response pillars must be prioritized. Research should be incorporated early in pandemic responses. The need to use evidence in decision-making and include all levels of government in planning response actions was found necessary to enhance trust and compliance. This study demonstrates the value of applying the Palagyi et al. framework on systems preparedness towards emerging infectious diseases to understand how the health systems can be better prepared for the next pandemic. It highlighted specific strengths and areas of potential growth for pandemic response in Nigeria.

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引用次数: 0

Women’s experiences of and interactions with the health system in post-Doi Moi Vietnam

SSM - Health Systems

Pub Date : 2025-01-09 DOI: 10.1016/j.ssmhs.2025.100051

Kimberly Lakin , Dinh Thu Ha , Bui Thi Thu Ha , Tolib Mirzoev , Irene Akua Agyepong , Sumit Kane

How people experience their interactions with their health systems are central to the notion of health systems responsiveness. These experiences may be ‘personal’, but they are also shaped by the broader historical, political, cultural, social, and economic contexts within which they occur. Yet, few studies on people’s experiences of care, particularly those focused on health systems responsiveness, explicitly take this into account. In this study, and drawing on in-depth interviews with 28 pregnant and postpartum women in a rural province of Vietnam, we use a novel approach that draws on the work of Archer and Chalari to uncover and analyse women’s ‘internal conversations’, in which they reflect upon and make sense of their maternity care-related experiences. Women’s ‘internal conversations’ reflected their need for short waiting times and high-quality ultrasonography, concerns regarding privacy and confidentiality, expectations of receiving dignified care, and their experiences of decision-making relating to caesarean section. Our findings reveal how women’s preferences, demands, and expectations have likely evolved in response to the Doi Moi-related shifts that have changed the organisation and structure of Vietnam’s economy, society, and health system. We make the case for health systems researchers and actors to consciously take into account the society and health system-level evolutions and changes when researching or developing interventions for improving responsive health systems.

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引用次数: 0

Management of hospital care during the COVID-19 pandemic: Lessons learnt from five European countries

SSM - Health Systems

Pub Date : 2025-01-07 DOI: 10.1016/j.ssmhs.2025.100050

Markus Kraus , Christoph Stegner , Miriam Reiss , Monika Riedel , Anne Sofie Børsch , Karsten Vrangbæk , Morgane Michel , Kathleen Turmaine , Krisztián Horváth , Gergő Túri , Roberto Dandi , Angelo Rossi Mori , Thomas Czypionka

Background

The COVID-19 pandemic required significant adjustments in hospital management across Europe. This article explores the challenges faced and lessons learnt in managing hospital care, aiming to improve future pandemic preparedness and resilience.

Methods

Hospital management during the pandemic in Denmark, France, Germany, Hungary and Italy was investigated using a qualitative case study approach based on document analysis and 57 semi-structured interviews with senior hospital staff conducted in the spring and summer of 2022. The country case studies were subjected to an overarching analysis focusing on successes and failures in hospital pandemic management.

Results

Hospitals faced an overwhelming surge of patients, leading to the conversion of regular wards into COVID-19 units and the postponement of elective surgery, affecting the care of chronically ill and non-urgent patients. Telemedicine was crucial but faced challenges in terms of acceptance by elderly patients and physicians. Staff shortages and high workloads affected patient care and staff wellbeing. In addition, shortages of medical supplies led to a re-evaluation of logistics and warehousing. Many hospitals found existing policies and pandemic plans inadequate, leading to the formation of internal task forces.

Conclusion

The pandemic highlighted gaps in hospital preparedness and the need for improved resilience. Strategies to improve pandemic resilience, such as better working conditions and collaboration with primary care, would also improve health system performance in "normal times". Pandemic-specific measures, such as postponing elective surgery, are necessary but need to be carefully managed to minimise the negative impact on overall patient care.

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引用次数: 0

Rigorously accounting for the role of social values in health systems: Guidance for health policy and systems researchers

SSM - Health Systems

Pub Date : 2025-01-03 DOI: 10.1016/j.ssmhs.2025.100049

Eleanor Beth Whyle, Jill Olivier

Health systems are complex social systems and play an important role in reinforcing social values. This capacity to communicate social values is a product of systems complexity and, over time, social values become institutionalised in health systems. This means that social values are not only drivers of policy change, but also form part of the context in which policy processes unfold, and constrain change. However, in health policy and systems research, social values are often studied only as drivers of policy change. We present an analytical framework to guide analysts in accounting for values-based complexity in health systems change. Rigorously accounting for social values as both driving and constraining change requires recognising that policy processes unfold in complex social health systems; that social values comprise part of an ideational context that constrains actor choices; that this ideational context may change in important ways over time; and that past policy decisions embed values in social institutions, creating feedback loops that constrain change. The analytical framework centres moments of policy decision-making in their ideational context; emphasises the points of interaction between health systems, policy decisions and social values; and points the analyst towards the tangible contextual realities that shape the ideational context.

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引用次数: 0

Exploring the determinants of readiness to utilize knowledge translation tools among health planning teams in Tanzania: A qualitative study

SSM - Health Systems

Pub Date : 2024-12-24 DOI: 10.1016/j.ssmhs.2024.100044

Pius Kagoma , Richard Mongi , Joel Seme Ambikile , James Kengia , Albino Kalolo

Background

Knowledge translation (KT) tools are vital for achieving universal health coverage (UHC) through Evidence-Informed Decision-Making (EIDM). While EIDM is known to improve decision outcomes, the use of KT tools in public health, especially among health planning teams, is less documented. This study aimed to evaluate the readiness of health planning teams to use KT tools in Tanzania's public health system and identify associated factors.

Methods

A qualitative approach was used, involving health planning team members from regional and local government authorities. Data were collected through focus group discussions with six planning teams and in-depth interviews with 34 key informants at the council, regional, and national levels. The information was transcribed verbatim and analyzed thematically.

Results

Participants were generally ready to use KT tools, but readiness varied based on contextual factors. Key factors influencing readiness included; access to research experts or knowledge-producing institutions, such as universities, availability of facilities like reliable internet and computers, funding to make KT tools available, capability to access and use KT tools, and availability of KT tools in their settings.

Conclusion

The study revealed that the readiness to use KT tools was low and varied based on the availability of resources and support structures. The findings emphasize the need for interventions like capacity building, policy integration, improved collaboration, regular monitoring, and the development of a knowledge management framework to enhance the use of KT tools during health planning.

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引用次数: 0

Paradoxes in the implementation of public policies in mental health: A case study of the Colombian context

SSM - Health Systems

Pub Date : 2024-12-21 DOI: 10.1016/j.ssmhs.2024.100048

Felipe Agudelo-Hernández , Laura Inés Plata-Casas , Helena Vélez-Botero

Objective

Mental health policies are essential to promote and encourage a comprehensive approach to mental health. The objective of this research was to explore the challenges for the implementation of public mental health policy in Colombia from the experience and perspective of key actors in mental health.

Methods

A qualitative approach research was carried out, whose data were collected through semi-structured interviews and a recorded and transcribed discussion group, in which 447 mental health professionals from multiple regions of Colombia participated, within the framework of a strategy to strengthen the primary health care. The data were analyzed thematically for causal loop diagram.

Results

Four relevant categories were identified, which question the effectiveness of the guidelines that guide mental health in Colombia, around the meanings attributed to human rights, financial profitability, quality and access to services, and stigma and discrimination. The thematic analysis allowed the construction of a diagram of causal loops that involve the categories described above, evidencing the interrelationships between the different factors identified in the thematic analysis that influence the effective implementation of public mental health policies in Colombia.

Conclusions and implications for practice

The findings of this study show the paradoxes and challenges faced by the implementation of public policies on mental health in Colombia. Despite having some solid regulatory elements consistent with international guidelines, it has other regulations that make the implementation of this evidence difficult, especially in financing.

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引用次数: 0

Exploring the socio-ecological factors of healthcare-seeking behaviour among patients/people from Rural Unqualified Health Providers in the rural settings in West Bengal, India

SSM - Health Systems

Pub Date : 2024-12-18 DOI: 10.1016/j.ssmhs.2024.100046

Dhiman Debsarma , Bikramaditya Kumar Choudhary

Rural Unqualified Health Practitioners (RUHPs) are popular among the rural population for primary healthcare in India. The RUHPs primarily provide basic healthcare for minor illnesses to millions of people. Patients/people in the rural areas often seek healthcare from RUHPs due to multiple social, economic, and cultural factors. Therefore, using the “social-ecological model (SEM)” as the theoretical base, this study attempts to explore the significant factors that influence health-seeking behaviour, with medical shops of RUHPs being the preferred option, in West Bengal state in India. Using SEM, we developed a comparative analysis between user experiences and provider perceptions. We conducted a primary survey using the pre-prepared semi-structured and unstructured open-ended guide. The household heads (n = 150), RUHPs (n = 75), Primary Health Centres (PHCs), and Sub-Centre staff (n = 30) were the participants in this survey. Transcripts were coded using the thematic content analysis method. Based on SEM, we grouped socio-ecological factors of seeking care into four significant levels: Individual (people’s traditional beliefs, poor health education, gender, and predisposed experiences), Interpersonal (strong social cohesion, tight social bondage, trust and networks, and social support), Community (neighborhood effect, primary resource based activities and livelihood, economic hardship, and density of the medical shop) and Institutional (uneven facility distribution, odd location, resource-related issues, limited and poor quality of services, and gender of staff at Sub-centres). Therefore, the study highlighted that multiple social-ecological factors are responsible for pushing people to RUHP for healthcare in rural areas in West Bengal.

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引用次数: 0

A situational analysis of rehabilitation policy and systems in Brazil

SSM - Health Systems

Pub Date : 2024-12-14 DOI: 10.1016/j.ssmhs.2024.100045

Vinicius Delgado Ramos , Sarah Polack , Veronika Reichenberger , Nathaniel Scherer , Loveday Penn-Kekana , Indyara de Araujo Morais , Hannah Kuper , Christina May Moran de Brito

Multiple health system components, supported by good policy, are needed for the provision of quality rehabilitation care. This study used the Missing Billion Health System Framework to structure a situational analysis of publicly funded rehabilitation services within the Unified Health System in Brazil, focusing on: governance, leadership, health financing, data and evidence, autonomy and awareness, affordability, human resources, health facilities, and assistive technology. We reviewed online policy documents, Health Information System data and published literature and conducted semi-structured interviews with 87 people with disabilities and 57 health and rehabilitation providers in São Paulo, Santos, Brasília, and Arcoverde. The situational analysis showed that the Brazilian policy framework is broadly supportive of rehabilitation provision, and a defined leadership structure assists rehabilitation provision at the national, state, and municipality level. However, there are challenges to rehabilitation service provision including insufficient funding and service availability, and inadequate numbers of rehabilitation professionals, with variation by cadre and region. For service users with disabilities, key challenges to accessing rehabilitation include high costs of transport, communication and information barriers, and long wait times. Available data indicate high-need and low coverage for rehabilitation, although there is a gap in reliable data on service need. In conclusion, this situational analysis highlighted rehabilitation programme and policy strengths in Brazil that could be replicated in other settings, such as the supportive policy and leadership structure. However, there are gaps to be addressed, including geographic inequalities in the availability of rehabilitation professionals and barriers to access for service users.

{"title":"A situational analysis of rehabilitation policy and systems in Brazil","authors":"Vinicius Delgado Ramos , Sarah Polack , Veronika Reichenberger , Nathaniel Scherer , Loveday Penn-Kekana , Indyara de Araujo Morais , Hannah Kuper , Christina May Moran de Brito","doi":"10.1016/j.ssmhs.2024.100045","DOIUrl":"10.1016/j.ssmhs.2024.100045","url":null,"abstract":"<div><div>Multiple health system components, supported by good policy, are needed for the provision of quality rehabilitation care. This study used the Missing Billion Health System Framework to structure a situational analysis of publicly funded rehabilitation services within the Unified Health System in Brazil, focusing on: governance, leadership, health financing, data and evidence, autonomy and awareness, affordability, human resources, health facilities, and assistive technology. We reviewed online policy documents, Health Information System data and published literature and conducted semi-structured interviews with 87 people with disabilities and 57 health and rehabilitation providers in São Paulo, Santos, Brasília, and Arcoverde. The situational analysis showed that the Brazilian policy framework is broadly supportive of rehabilitation provision, and a defined leadership structure assists rehabilitation provision at the national, state, and municipality level. However, there are challenges to rehabilitation service provision including insufficient funding and service availability, and inadequate numbers of rehabilitation professionals, with variation by cadre and region. For service users with disabilities, key challenges to accessing rehabilitation include high costs of transport, communication and information barriers, and long wait times. Available data indicate high-need and low coverage for rehabilitation, although there is a gap in reliable data on service need. In conclusion, this situational analysis highlighted rehabilitation programme and policy strengths in Brazil that could be replicated in other settings, such as the supportive policy and leadership structure. However, there are gaps to be addressed, including geographic inequalities in the availability of rehabilitation professionals and barriers to access for service users.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100045"},"PeriodicalIF":0.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176586","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}

引用次数: 0

The gender stereotype landscape in Tanzania: A national study with healthcare leaders

SSM - Health Systems

Pub Date : 2024-12-14 DOI: 10.1016/j.ssmhs.2024.100047

Doreen Mucheru , Jacqueline Harley , Elizabeth Lulu Genda , Brynne Gilmore , Anosisye M. Kesale , Eilish McAuliffe , Agnes Mpinga , Cinty Narcis , Henry Mollel

Over the past two decades, women’s participation in the workforce has increased, but their representation in senior roles remains suboptimal. In Tanzania, women comprise 70 % of the health workforce, but occupy only 17.4 % of senior and middle-management positions. This disparity highlights the presence of barriers to women's leadership advancement. To better understand gender in healthcare leadership, this study conducted a national cross-sectional survey with healthcare leaders between June and September 2023 to assess contemporary gender stereotypes and their characterisation among Tanzanian healthcare leaders. Men comprised more than half (59 %) of the sample (N = 200). While 62.5 % of participants indicated no preference for the gender of their leader, 22 % preferred a man. Mean overall agency ratings were higher for men compared to women, whereas mean communality ratings were higher for women. Analysis of communality scores revealed a significant difference (U = 3110, p = 0.032), with men rating their own gender higher compared to the ratings given by women. Assessments of agency indicated that women rated women higher than men did, with differences approaching statistical significance (U= 3530 p = 0.059). These patterns indicate the presence of gender-based stereotyping. Each gender also viewed themselves more positively, as demonstrated by higher ratings of their own gender compared to ratings of the opposite gender. These findings may have adverse implications for women's representation in Tanzania's healthcare leadership landscape. Findings highlight the significant potential gender sensitivity and equality initiatives have in the Tanzanian context, as they could help mitigate stereotypes and their deleterious effects on women's leadership.

{"title":"The gender stereotype landscape in Tanzania: A national study with healthcare leaders","authors":"Doreen Mucheru , Jacqueline Harley , Elizabeth Lulu Genda , Brynne Gilmore , Anosisye M. Kesale , Eilish McAuliffe , Agnes Mpinga , Cinty Narcis , Henry Mollel","doi":"10.1016/j.ssmhs.2024.100047","DOIUrl":"10.1016/j.ssmhs.2024.100047","url":null,"abstract":"<div><div>Over the past two decades, women’s participation in the workforce has increased, but their representation in senior roles remains suboptimal. In Tanzania, women comprise 70 % of the health workforce, but occupy only 17.4 % of senior and middle-management positions. This disparity highlights the presence of barriers to women's leadership advancement. To better understand gender in healthcare leadership, this study conducted a national cross-sectional survey with healthcare leaders between June and September 2023 to assess contemporary gender stereotypes and their characterisation among Tanzanian healthcare leaders. Men comprised more than half (59 %) of the sample (N = 200). While 62.5 % of participants indicated no preference for the gender of their leader, 22 % preferred a man. Mean overall agency ratings were higher for men compared to women, whereas mean communality ratings were higher for women. Analysis of communality scores revealed a significant difference (U = 3110, p = 0.032), with men rating their own gender higher compared to the ratings given by women. Assessments of agency indicated that women rated women higher than men did, with differences approaching statistical significance (U= 3530 p = 0.059). These patterns indicate the presence of gender-based stereotyping. Each gender also viewed themselves more positively, as demonstrated by higher ratings of their own gender compared to ratings of the opposite gender. These findings may have adverse implications for women's representation in Tanzania's healthcare leadership landscape. Findings highlight the significant potential gender sensitivity and equality initiatives have in the Tanzanian context, as they could help mitigate stereotypes and their deleterious effects on women's leadership.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100047"},"PeriodicalIF":0.0,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143176531","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}

引用次数: 0

The role of routine health information systems in supporting the COVID-19 pandemic response in the Philippines and Indonesia

SSM - Health Systems

Pub Date : 2024-12-05 DOI: 10.1016/j.ssmhs.2024.100043

Mingqi Song , Lutfan Lazuardi , Raymond Francis R. Sarmiento , Brian Sahar Afifah , Gabi Ceria , Razel G. Custodio , Zahrotul Kamilah , Romeo Luis A. Macabasag , Tiara Marthias , Monica B. Sunga , Karen A. Grépin

The COVID-19 pandemic highlighted the importance of high-quality, geographically disaggregated, and high-frequency data for real-time evidence-based decision-making in health systems. Routine health information systems (RHIS) collect and aggregate such data but to date there have been few case studies of how RHIS were used to support COVID-19 responses in low and middle-income countries. From July-October 2021, we conducted 112 in-depth key informant interviews (KII) and seven focus group discussions (FGDs) with policymakers in Indonesia and the Philippines to better understand the role of RHIS in supporting national responses to COVID-19. Data were analysed thematically to answer key research questions: (1) How did the pandemic affect RHIS data processes? (2) How were COVID-specific data collected and integrated into RHIS? (3) How were RHIS data used to inform response measures? (4) How did RHIS interact with other health system building blocks? We found that pandemic disrupted RHIS processes, leading to a decline in the quantity, quality, and availability of RHIS data. But the pandemic also increased awareness and appreciation of RHISs, creating opportunities to strengthen and improve the utilization of the system. RHIS data and processes were directly leveraged in critical ways to strengthen the COVID-19 response, such as contact tracing and vaccination. It also indirectly supported responses via other health system building blocks, for example, by providing important data to support the design of a COVID-19 benefit package design. However, the study also identified pre-existing challenges that limited the ability of health system planners and policymakers to optimally leverage RHIS data during the pandemic. Strengthening RHIS should be integrated into future pandemic planning activities as RHIS data and processes played critical roles during the pandemic in both countries.

{"title":"The role of routine health information systems in supporting the COVID-19 pandemic response in the Philippines and Indonesia","authors":"Mingqi Song , Lutfan Lazuardi , Raymond Francis R. Sarmiento , Brian Sahar Afifah , Gabi Ceria , Razel G. Custodio , Zahrotul Kamilah , Romeo Luis A. Macabasag , Tiara Marthias , Monica B. Sunga , Karen A. Grépin","doi":"10.1016/j.ssmhs.2024.100043","DOIUrl":"10.1016/j.ssmhs.2024.100043","url":null,"abstract":"<div><div>The COVID-19 pandemic highlighted the importance of high-quality, geographically disaggregated, and high-frequency data for real-time evidence-based decision-making in health systems. Routine health information systems (RHIS) collect and aggregate such data but to date there have been few case studies of how RHIS were used to support COVID-19 responses in low and middle-income countries. From July-October 2021, we conducted 112 in-depth key informant interviews (KII) and seven focus group discussions (FGDs) with policymakers in Indonesia and the Philippines to better understand the role of RHIS in supporting national responses to COVID-19. Data were analysed thematically to answer key research questions: (1) How did the pandemic affect RHIS data processes? (2) How were COVID-specific data collected and integrated into RHIS? (3) How were RHIS data used to inform response measures? (4) How did RHIS interact with other health system building blocks? We found that pandemic disrupted RHIS processes, leading to a decline in the quantity, quality, and availability of RHIS data. But the pandemic also increased awareness and appreciation of RHISs, creating opportunities to strengthen and improve the utilization of the system. RHIS data and processes were directly leveraged in critical ways to strengthen the COVID-19 response, such as contact tracing and vaccination. It also indirectly supported responses via other health system building blocks, for example, by providing important data to support the design of a COVID-19 benefit package design. However, the study also identified pre-existing challenges that limited the ability of health system planners and policymakers to optimally leverage RHIS data during the pandemic. Strengthening RHIS should be integrated into future pandemic planning activities as RHIS data and processes played critical roles during the pandemic in both countries.</div></div>","PeriodicalId":101183,"journal":{"name":"SSM - Health Systems","volume":"4 ","pages":"Article 100043"},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143175514","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}

引用次数: 0