Pub Date : 2016-07-02DOI: 10.1080/23288604.2016.1222793
T. Nyenswah, Cyrus Engineer, D. Peters
Abstract The Ebola epidemic of 2014–2015 was one of the most significant public health threats of the 21st century, a crisis that challenged leadership in West Africa and around the world. Using the experience of Liberia's epidemic control efforts, we highlight the critical role that leadership played during four phases of the epidemic response: (1) crisis recognition and early mobilization; (2) the emergency phase; (3) the declining epidemic; and (4) the long tail. We examine how the decisions and actions taken in each phase of the epidemic address key crisis leadership tasks, including sense-making, decision making, meaning-making, crisis termination, and learning, and assess how leadership approaches evolved during the different epidemic phases to accomplish these tasks. A contingency leadership theory lens is used to identify situations where strong leadership, good leader–member relations, and well-structured tasks can facilitate different leadership approaches. The first phase of the epidemic was hampered by insufficient attention to sense-making and weak decision making, in part because of the existing hierarchical leadership approach. This contributed to amplification of the epidemic. The emergency phase of the epidemic brought a change in leadership that focused on sense-making, decision-making, and meaning-making tasks. A distributed leadership approach replaced the old hierarchies. In addition to sharing leadership responsibility and authority, the distributed leadership approach involved strategically engaging stakeholders and communicating intensively. Although much of the hierarchical leadership approaches returned in the latter phases of the epidemic, there remain more empowered leaders at different levels across the country. Systematically tackling crisis leadership tasks, recognizing situations where different leadership approaches can be used, and employing a distributed leadership approach are helpful lessons to prepare for and respond to future crises.
{"title":"Leadership in Times of Crisis: The Example of Ebola Virus Disease in Liberia","authors":"T. Nyenswah, Cyrus Engineer, D. Peters","doi":"10.1080/23288604.2016.1222793","DOIUrl":"https://doi.org/10.1080/23288604.2016.1222793","url":null,"abstract":"Abstract The Ebola epidemic of 2014–2015 was one of the most significant public health threats of the 21st century, a crisis that challenged leadership in West Africa and around the world. Using the experience of Liberia's epidemic control efforts, we highlight the critical role that leadership played during four phases of the epidemic response: (1) crisis recognition and early mobilization; (2) the emergency phase; (3) the declining epidemic; and (4) the long tail. We examine how the decisions and actions taken in each phase of the epidemic address key crisis leadership tasks, including sense-making, decision making, meaning-making, crisis termination, and learning, and assess how leadership approaches evolved during the different epidemic phases to accomplish these tasks. A contingency leadership theory lens is used to identify situations where strong leadership, good leader–member relations, and well-structured tasks can facilitate different leadership approaches. The first phase of the epidemic was hampered by insufficient attention to sense-making and weak decision making, in part because of the existing hierarchical leadership approach. This contributed to amplification of the epidemic. The emergency phase of the epidemic brought a change in leadership that focused on sense-making, decision-making, and meaning-making tasks. A distributed leadership approach replaced the old hierarchies. In addition to sharing leadership responsibility and authority, the distributed leadership approach involved strategically engaging stakeholders and communicating intensively. Although much of the hierarchical leadership approaches returned in the latter phases of the epidemic, there remain more empowered leaders at different levels across the country. Systematically tackling crisis leadership tasks, recognizing situations where different leadership approaches can be used, and employing a distributed leadership approach are helpful lessons to prepare for and respond to future crises.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"4 1","pages":"194 - 207"},"PeriodicalIF":4.1,"publicationDate":"2016-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78889768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-02DOI: 10.1080/23288604.2016.1222794
S. Chunharas, D. S. Davies
Many Systems, Many Levels, Many Leaders Leadership is about Systems and Behavior, not Individuals So What Must We Do? References In global health development circles, leadership is known to be critical for the high performance of health systems and for ensuring good population health. Yet, for a field that claims to be driven by evidence and the need to know what works, the term leadership is often used vaguely without reflecting the complexities of health systems and the real world. Moreover, much of the peerreviewed literature on health leadership focuses on individuals at the national level and their role in steering health ministries or departments. We have chaired the Advisory Group for the Flagship Report on Leadership in Health of the Alliance for Health Policy and Systems Research because we believe that a new agenda for health leadership is needed, one that promotes collective leadership and recognizes the range of leaders at many levels who contribute in different ways to the strengthening of health systems. We consider leadership as the ability to identify priorities, set a vision, and mobilize the actors and resources needed to achieve them. We set out below why such an agenda is important and suggest what its initial priorities might be. Clearly, this list will not be exhaustive or even applicable across the myriad health systems around the world. But we do hope that it will spark new debates on the role of leadership in health systems, on those recognized as leaders in health, and what, as a global health development community, we can do to support this.
{"title":"Leadership in Health Systems: A New Agenda for Interactive Leadership","authors":"S. Chunharas, D. S. Davies","doi":"10.1080/23288604.2016.1222794","DOIUrl":"https://doi.org/10.1080/23288604.2016.1222794","url":null,"abstract":"Many Systems, Many Levels, Many Leaders Leadership is about Systems and Behavior, not Individuals So What Must We Do? References In global health development circles, leadership is known to be critical for the high performance of health systems and for ensuring good population health. Yet, for a field that claims to be driven by evidence and the need to know what works, the term leadership is often used vaguely without reflecting the complexities of health systems and the real world. Moreover, much of the peerreviewed literature on health leadership focuses on individuals at the national level and their role in steering health ministries or departments. We have chaired the Advisory Group for the Flagship Report on Leadership in Health of the Alliance for Health Policy and Systems Research because we believe that a new agenda for health leadership is needed, one that promotes collective leadership and recognizes the range of leaders at many levels who contribute in different ways to the strengthening of health systems. We consider leadership as the ability to identify priorities, set a vision, and mobilize the actors and resources needed to achieve them. We set out below why such an agenda is important and suggest what its initial priorities might be. Clearly, this list will not be exhaustive or even applicable across the myriad health systems around the world. But we do hope that it will spark new debates on the role of leadership in health systems, on those recognized as leaders in health, and what, as a global health development community, we can do to support this.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"19 1","pages":"176 - 178"},"PeriodicalIF":4.1,"publicationDate":"2016-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79309778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-02DOI: 10.1080/23288604.2016.1220775
M. Reich, A. Yazbeck, P. Berman, R. Bitrán, T. Bossert, M. Escobar, W. Hsiao, A. Johansen, H. Samaha, P. Shaw, W. Yip
Abstract In 2016, the Flagship Program for improving health systems performance and equity, a partnership for leadership development between the World Bank and the Harvard T.H. Chan School of Public Health and other institutions, celebrates 20 years of achievement. Set up at a time when development assistance for health was growing exponentially, the Flagship Program sought to bring systems thinking to efforts at health sector strengthening and reform. Capacity-building and knowledge transfer mechanisms are relatively easy to begin but hard to sustain, yet the Flagship Program has continued for two decades and remains highly demanded by national governments and development partners. In this article, we describe the process used and the principles employed to create the Flagship Program and highlight some lessons from its two decades of sustained success and effectiveness in leadership development for health systems improvement.
{"title":"Lessons from 20 Years of Capacity Building for Health Systems Thinking","authors":"M. Reich, A. Yazbeck, P. Berman, R. Bitrán, T. Bossert, M. Escobar, W. Hsiao, A. Johansen, H. Samaha, P. Shaw, W. Yip","doi":"10.1080/23288604.2016.1220775","DOIUrl":"https://doi.org/10.1080/23288604.2016.1220775","url":null,"abstract":"Abstract In 2016, the Flagship Program for improving health systems performance and equity, a partnership for leadership development between the World Bank and the Harvard T.H. Chan School of Public Health and other institutions, celebrates 20 years of achievement. Set up at a time when development assistance for health was growing exponentially, the Flagship Program sought to bring systems thinking to efforts at health sector strengthening and reform. Capacity-building and knowledge transfer mechanisms are relatively easy to begin but hard to sustain, yet the Flagship Program has continued for two decades and remains highly demanded by national governments and development partners. In this article, we describe the process used and the principles employed to create the Flagship Program and highlight some lessons from its two decades of sustained success and effectiveness in leadership development for health systems improvement.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"7 1","pages":"213 - 221"},"PeriodicalIF":4.1,"publicationDate":"2016-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78360480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-02DOI: 10.1080/23288604.2016.1223978
M. Reich, D. Javadi, A. Ghaffar
This special issue on “Effective Leadership for Health Systems” is organized and sponsored by the Alliance for Health Policy and Systems Research, along with a flagship report on health leadership,...
{"title":"Introduction to the Special Issue on “Effective Leadership for Health Systems”","authors":"M. Reich, D. Javadi, A. Ghaffar","doi":"10.1080/23288604.2016.1223978","DOIUrl":"https://doi.org/10.1080/23288604.2016.1223978","url":null,"abstract":"This special issue on “Effective Leadership for Health Systems” is organized and sponsored by the Alliance for Health Policy and Systems Research, along with a flagship report on health leadership,...","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"13 1","pages":"171 - 175"},"PeriodicalIF":4.1,"publicationDate":"2016-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81805667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-07-02DOI: 10.1080/23288604.2016.1220778
N. Fujita, M. Nagai, I. Diouf, Takayuki Shimizu, Toyomitsu Tamura
Abstract This article presents the Vision Tokyo 2010 Network, a unique model of peer learning and information sharing among human resources for health (HRH) managers in Francophone African countries. It describes the network's origins, achievements, and factors underlying its success. The network's origins lie in an overseas training program in Tokyo between 2010 and 2014. Participants included directors and heads of HRH management departments at federal and provincial levels across nine Francophone African countries: Benin, Burkina Faso, Burundi, the Democratic Republic of Congo, Côte d'Ivoire, Niger, Mali, Senegal, and Togo. The network itself was established in 2012 based on the common strategic vision (Vision Tokyo 2010) developed during the training program, with an objective of tackling major problems to improve the performance of human resource development systems in the health systems of participants' countries. Some of the main outcomes of the network, demonstrated during the Ebola outbreak include: improved use of human resource information systems in Senegal established as a result of peer learning within the network and technical cooperation between the Democratic Republic of Congo and Côte d'Ivoire to develop standard operational procedures and to train health workers in the management of Ebola. Having a common strategic vision and contextualized framework—African house of solidarity—as a symbol for HRH system development, strong ownership by core members, participatory processes, a positive peer learning environment, and coaching-style support by partners were key elements of success in this initiative. The biggest challenge for this network thus far has been financial sustainability. However, steps are being taken to demonstrate the cost-effectiveness of networks such as these in order to garner further support from partners to invest in networked approaches rather than siloed, country-specific programs.
{"title":"The Role of a Network of Human Resources for Health Managers in Supporting Leadership for Health Systems Strengthening in Francophone African Countries","authors":"N. Fujita, M. Nagai, I. Diouf, Takayuki Shimizu, Toyomitsu Tamura","doi":"10.1080/23288604.2016.1220778","DOIUrl":"https://doi.org/10.1080/23288604.2016.1220778","url":null,"abstract":"Abstract This article presents the Vision Tokyo 2010 Network, a unique model of peer learning and information sharing among human resources for health (HRH) managers in Francophone African countries. It describes the network's origins, achievements, and factors underlying its success. The network's origins lie in an overseas training program in Tokyo between 2010 and 2014. Participants included directors and heads of HRH management departments at federal and provincial levels across nine Francophone African countries: Benin, Burkina Faso, Burundi, the Democratic Republic of Congo, Côte d'Ivoire, Niger, Mali, Senegal, and Togo. The network itself was established in 2012 based on the common strategic vision (Vision Tokyo 2010) developed during the training program, with an objective of tackling major problems to improve the performance of human resource development systems in the health systems of participants' countries. Some of the main outcomes of the network, demonstrated during the Ebola outbreak include: improved use of human resource information systems in Senegal established as a result of peer learning within the network and technical cooperation between the Democratic Republic of Congo and Côte d'Ivoire to develop standard operational procedures and to train health workers in the management of Ebola. Having a common strategic vision and contextualized framework—African house of solidarity—as a symbol for HRH system development, strong ownership by core members, participatory processes, a positive peer learning environment, and coaching-style support by partners were key elements of success in this initiative. The biggest challenge for this network thus far has been financial sustainability. However, steps are being taken to demonstrate the cost-effectiveness of networks such as these in order to garner further support from partners to invest in networked approaches rather than siloed, country-specific programs.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"22 1","pages":"254 - 264"},"PeriodicalIF":4.1,"publicationDate":"2016-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75074204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-04-02DOI: 10.1080/23288604.2016.1179085
M. Castro
Screening Criteria Medical Care for Children with Microcephaly Reproductive Health and Abortion Understanding and Communicating the Risk of Microcephaly Vector Control References In 1947, Zika virus was first identified in Uganda. On February 1, 2016, a World Health Organization (WHO) emergency committee declared clusters of birth defects suspected of being linked to an epidemic of Zika virus in the Americas as a public health emergency of international concern. The 69year period between these two events was, for the most part, uneventful with regard to research and international awareness. When the virus made its way to the Americas, however, history changed course. An association between Zika infections during pregnancy and the birth of babies with microcephaly was first suggested by Brazilian physicians in August 2015, and in November microcephaly cases potentially associated with Zika started to be recorded; three months later the WHO made its announcement. In Brazil, the country hit hardest by the epidemic so far, there have been 6,906 suspected cases of microcephaly as of April 2, 2016; 1,046 have been confirmed for microcephaly, 1,814 have been discarded, and 4,046 remain under investigation. The exact number of Zika infections in Brazil is not known, but autochthonous transmission of the virus has been confirmed in all 27 states in Brazil. In addition, as of April 7 autochthonous transmission of Zika virus has been confirmed in 34 countries/territories of the Americas. The unfolding story of Zika virus in the Americas is much more than a mosquito-borne disease that may affect fetal development. It is the story of a disease that exposed problems and raised challenges that the affected health systems and governments cannot ignore. Next, based largely on lessons provided by Brazil’s Zika epidemic, we discuss five critical problems and challenges and reflect on opportunities to remedy them.
{"title":"Zika Virus and Health Systems in Brazil: From Unknown to a Menace","authors":"M. Castro","doi":"10.1080/23288604.2016.1179085","DOIUrl":"https://doi.org/10.1080/23288604.2016.1179085","url":null,"abstract":"Screening Criteria Medical Care for Children with Microcephaly Reproductive Health and Abortion Understanding and Communicating the Risk of Microcephaly Vector Control References In 1947, Zika virus was first identified in Uganda. On February 1, 2016, a World Health Organization (WHO) emergency committee declared clusters of birth defects suspected of being linked to an epidemic of Zika virus in the Americas as a public health emergency of international concern. The 69year period between these two events was, for the most part, uneventful with regard to research and international awareness. When the virus made its way to the Americas, however, history changed course. An association between Zika infections during pregnancy and the birth of babies with microcephaly was first suggested by Brazilian physicians in August 2015, and in November microcephaly cases potentially associated with Zika started to be recorded; three months later the WHO made its announcement. In Brazil, the country hit hardest by the epidemic so far, there have been 6,906 suspected cases of microcephaly as of April 2, 2016; 1,046 have been confirmed for microcephaly, 1,814 have been discarded, and 4,046 remain under investigation. The exact number of Zika infections in Brazil is not known, but autochthonous transmission of the virus has been confirmed in all 27 states in Brazil. In addition, as of April 7 autochthonous transmission of Zika virus has been confirmed in 34 countries/territories of the Americas. The unfolding story of Zika virus in the Americas is much more than a mosquito-borne disease that may affect fetal development. It is the story of a disease that exposed problems and raised challenges that the affected health systems and governments cannot ignore. Next, based largely on lessons provided by Brazil’s Zika epidemic, we discuss five critical problems and challenges and reflect on opportunities to remedy them.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"67 1","pages":"119 - 122"},"PeriodicalIF":4.1,"publicationDate":"2016-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74946986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-04-02DOI: 10.1080/23288604.2016.1166307
H. Schneider, U. Lehmann
Abstract —Community health workers (CHWs) have reemerged as significant cadres in low- and middle-income countries and are now seen as an integral part of achieving the goal of universal health coverage (UHC). In international guidance and support, the emphasis is increasingly shifting from a focus on the outcomes of CHW-based interventions to the systems requirements for implementing and sustaining CHW programs at scale. A major challenge is that CHW programs interface with both the formal health system (requiring integration) and community systems (requiring embedding) in context-specific and complex ways. Collectively, these elements and relationships can be seen as constituting a unique sub-system of the overall health system, referred to by some as the community health system. The community health system is key to the performance of CHW programs, and we argue for a more holistic focus on this system in policy and practice. We further propose a definition and spell out the main actors and attributes of the community health system and conclude that in international debates on UHC, much can be gained from recognizing the community health system as a definable sphere in its own right.
{"title":"From Community Health Workers to Community Health Systems: Time to Widen the Horizon?","authors":"H. Schneider, U. Lehmann","doi":"10.1080/23288604.2016.1166307","DOIUrl":"https://doi.org/10.1080/23288604.2016.1166307","url":null,"abstract":"Abstract —Community health workers (CHWs) have reemerged as significant cadres in low- and middle-income countries and are now seen as an integral part of achieving the goal of universal health coverage (UHC). In international guidance and support, the emphasis is increasingly shifting from a focus on the outcomes of CHW-based interventions to the systems requirements for implementing and sustaining CHW programs at scale. A major challenge is that CHW programs interface with both the formal health system (requiring integration) and community systems (requiring embedding) in context-specific and complex ways. Collectively, these elements and relationships can be seen as constituting a unique sub-system of the overall health system, referred to by some as the community health system. The community health system is key to the performance of CHW programs, and we argue for a more holistic focus on this system in policy and practice. We further propose a definition and spell out the main actors and attributes of the community health system and conclude that in international debates on UHC, much can be gained from recognizing the community health system as a definable sphere in its own right.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"12 1","pages":"112 - 118"},"PeriodicalIF":4.1,"publicationDate":"2016-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90500029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-04-02DOI: 10.1080/23288604.2016.1148802
D. Nambiar, K. Sheikh
Abstract —India's goal of universal health coverage underscores the need for scale in community action for health. Among the few successes in community programs is Chhattisgarh's Mitanin Program, designed and maintained at the scale of the entire state (covering almost 20 million). Evaluations of scaled-up interventions typically examine population health outcomes, placing less emphasis on how programs succeed or fail. To address this knowledge gap, we undertook a qualitative research study to explore the role of the State Health Resource Centre (SHRC), a state technical agency, in scaling up Chhattisgarh's Mitanin health worker program over a ten-year period commencing in 2002. We undertook observation, policy documentary review, in-depth interviews, and focus group discussions with policy/program developers, facilitators and trainers, community health workers, and representatives of civil society. Data analysis followed an inductive approach of qualitative data analysis and data were thematically organized in the form of folk theories including interlinked contexts, mechanisms, and outcomes reflecting the experience of the SHRC in scaling up community action for health in the state. The first folk theory links the enabling context of the formation of a new state with mechanisms of pluralistic and multistakeholder governance of the SHRC and avoidance of overt political patronage of the program, contributing to the sustainability of the program through multiple administrative and political transitions. The second folk theory elaborates how equity-focused mechanisms such as linking the program to locally important, intersectoral agendas for marginalized communities and attentiveness to career trajectories of female frontline workers created space for these workers to organize and demand livelihood rights against a broader context where the indigenous tribal minority and women are widely excluded from the social and political mainstream. These exploratory findings illustrate how the pluralistic governance structure of the SHRC, coupled with a set of unique contextual strategies, contributed to the longevity of the program and professional growth and opportunities for female community health workers, with lessons for other low- and middle-income country decision makers.
{"title":"How a Technical Agency Helped Scale Up a Community Health Worker Program: An Exploratory Study in Chhattisgarh State, India","authors":"D. Nambiar, K. Sheikh","doi":"10.1080/23288604.2016.1148802","DOIUrl":"https://doi.org/10.1080/23288604.2016.1148802","url":null,"abstract":"Abstract —India's goal of universal health coverage underscores the need for scale in community action for health. Among the few successes in community programs is Chhattisgarh's Mitanin Program, designed and maintained at the scale of the entire state (covering almost 20 million). Evaluations of scaled-up interventions typically examine population health outcomes, placing less emphasis on how programs succeed or fail. To address this knowledge gap, we undertook a qualitative research study to explore the role of the State Health Resource Centre (SHRC), a state technical agency, in scaling up Chhattisgarh's Mitanin health worker program over a ten-year period commencing in 2002. We undertook observation, policy documentary review, in-depth interviews, and focus group discussions with policy/program developers, facilitators and trainers, community health workers, and representatives of civil society. Data analysis followed an inductive approach of qualitative data analysis and data were thematically organized in the form of folk theories including interlinked contexts, mechanisms, and outcomes reflecting the experience of the SHRC in scaling up community action for health in the state. The first folk theory links the enabling context of the formation of a new state with mechanisms of pluralistic and multistakeholder governance of the SHRC and avoidance of overt political patronage of the program, contributing to the sustainability of the program through multiple administrative and political transitions. The second folk theory elaborates how equity-focused mechanisms such as linking the program to locally important, intersectoral agendas for marginalized communities and attentiveness to career trajectories of female frontline workers created space for these workers to organize and demand livelihood rights against a broader context where the indigenous tribal minority and women are widely excluded from the social and political mainstream. These exploratory findings illustrate how the pluralistic governance structure of the SHRC, coupled with a set of unique contextual strategies, contributed to the longevity of the program and professional growth and opportunities for female community health workers, with lessons for other low- and middle-income country decision makers.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"244 1","pages":"123 - 134"},"PeriodicalIF":4.1,"publicationDate":"2016-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76550961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-04-02DOI: 10.1080/23288604.2016.1164278
A. Yazbeck
What Can We Learn from the National Health Account Story? Other Misused Three-Letter Tools A Way Forward for HTA References Prioritization in health has always fascinated me, so when I saw that the 2016 Prince Mahidol Awards Conference (PMAC) had “Priority Setting” as the theme for the event (http://pmaconference.mahidol.ac.th/), I was really excited. An early draft of the agenda, however, tempered some of the excitement and raised in my mind an issue that the health sector continues to struggle with when it comes to approaches to prioritization: falling in love with technocratic approaches. Global conversations about prioritization always risk being dominated by a highly technocratic agenda that caters more to a donor-focused environment than national needs for lowand middle-income countries. The most recent of these technocratic approaches, on display at PMAC, is health technology assessments (HTAs). Though there is no doubt that HTAs can and should play an important role in prioritization of limited resources for health, there is a long history of overselling technical answers and in some cases causing more harm than good. The January 2016 issue of Health Systems and Reform, “Special Issue: PrinceMahidol AwardConference 2016: Priority Setting for Universal Health Coverage,” offers some hope. The issue included several commentaries and articles that urge a balanced approach to prioritization, and others explore the limitations of empirical tools like cost effectiveness and HTA. The main question for me is the following: Will the zeal for a technical answer win over the more pragmatic commentary presented in these articles ofHealth Systems&Reform?
{"title":"The Newest Three-Letter Fad in Health: Can HTA Escape the Fate of NHA, CEA, GBD?","authors":"A. Yazbeck","doi":"10.1080/23288604.2016.1164278","DOIUrl":"https://doi.org/10.1080/23288604.2016.1164278","url":null,"abstract":"What Can We Learn from the National Health Account Story? Other Misused Three-Letter Tools A Way Forward for HTA References Prioritization in health has always fascinated me, so when I saw that the 2016 Prince Mahidol Awards Conference (PMAC) had “Priority Setting” as the theme for the event (http://pmaconference.mahidol.ac.th/), I was really excited. An early draft of the agenda, however, tempered some of the excitement and raised in my mind an issue that the health sector continues to struggle with when it comes to approaches to prioritization: falling in love with technocratic approaches. Global conversations about prioritization always risk being dominated by a highly technocratic agenda that caters more to a donor-focused environment than national needs for lowand middle-income countries. The most recent of these technocratic approaches, on display at PMAC, is health technology assessments (HTAs). Though there is no doubt that HTAs can and should play an important role in prioritization of limited resources for health, there is a long history of overselling technical answers and in some cases causing more harm than good. The January 2016 issue of Health Systems and Reform, “Special Issue: PrinceMahidol AwardConference 2016: Priority Setting for Universal Health Coverage,” offers some hope. The issue included several commentaries and articles that urge a balanced approach to prioritization, and others explore the limitations of empirical tools like cost effectiveness and HTA. The main question for me is the following: Will the zeal for a technical answer win over the more pragmatic commentary presented in these articles ofHealth Systems&Reform?","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"195 1","pages":"102 - 105"},"PeriodicalIF":4.1,"publicationDate":"2016-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80475460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-04-02DOI: 10.1080/23288604.2016.1178521
J. Antoun, M. Reich
This issue of Health Systems & Reform comes after a very successful special issue produced with the Prince Mahidol Awards Conference (PMAC) on “Priority Setting for Universal Health Coverage” and s...
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