Operational challenges in africa
Download as PPTX, PDF1 like438 views
The document discusses operational challenges in health service delivery across four West African countries as part of a regional conference. It explores methodologies for understanding factors affecting primary health care, identifies bottlenecks in service delivery, and provides recommendations for improvement based on cross-country comparisons. Key insights indicate diverse obstacles in supply and demand sides, the importance of community engagement, and the necessity of context-specific solutions.
More Related Content
Similar to Operational challenges in africa (20)
More from Department of Public Health at the Institute of Tropical Medicine, Antwerp (13)
Operational challenges in africa
- 1. OPERATIONAL CHALLENGES IN FOUR WEST AFRICAN COUNTRIES Regional Conference on “Health District in Africa: Progress and Prospects 25 years after the Harare Declaration” 21-23 October, 2013 Dr Atsu Seake-Kwawu Ministry of Health (Ghana) / Ghana Health Service [email protected]
- 2. RESEARCH COMMISSIONERS & PARTNERS Commissioned in 2010 by o o o UNICEF/WCARO West African Health Organisation (WAHO) WHO Regional Office Conducted by o o Institute of Tropical Medicine, Antwerpen Country partner institutions Ghana Health Service (GHS), Ghana Institut de Recherche en Sciences de la Santé (IRSS), Burkina Faso Fraternité Médicale Guinée (FMG), Guinea-Conakry Instituto Nacional de Estudos e Pesquisa (INEP) GuineaBissau 2
- 3. OBJECTIVE OF THE STUDY To better understand the organisational features of effective and efficient PHC delivery, including the identification and analysis of Contextual variables as underlying causes & factors for successful service delivery Key health system bottle-necks to the delivery and scaling up of high impact interventions (HII) Leading question: “What intervention works, why, in which conditions, and for whom?” 3
- 4. METHODOLOGY Inspiration in the “Realist Evaluation” approach (Pawson & Tilley, 1997) Study of interplay between an intervention, the way how it is implemented and the context in which this takes place. Cross-country comparison of case studies in 4 countries 2 districts in each country: “good” vs. “poor” Cfr. Notion of “positive” and “negative” outliers 4
- 5. METHODOLOGY Ranking of study countries in terms of their development & their contributions to improve health status of their population 1. Demographic. & socio-economic situation 2. Health expenditure 3. Donor dependency 4. Health service availability 15 10 Guinea Conakry Ghana Burkina Faso Guinea Bissau 5. Governance 5 5
- 6. METHODOLOGY Development of a set of assumptions (“theories”) o Concerning managerial & organisational conditions in the health system for successful implementation of HII o Intervention-specific theory linking the profile of a given HII to a organisational configuration of service delivery Modalities in terms of organisation of health services and health care Profile of a HII constructed on basis of its specific features a b c d e ... -X -Y -Z Intervention –specific theories … 6
- 7. METHODOLOGY – LEVELS OF ANALYSIS Levels of analysis of bottlenecks and facilitating factors First level Second level Third level Fourth level Nature of bottlenecks & facilitating factors: all countries & all HII Frequency of bottlenecks & facilitating factors: all countries & all HII Most frequent bottlenecks & facilitating factors per country Most frequent bottlenecks & facilitating factors per delivery platform 7
- 8. METHODOLOGY - INTERFACES Resources Interfaces Level Interface 5 Community Human Resources Information & Knowledge Health Care Providers Interface 4 Users/ Patients Interface 3 Vertical Programme Managers MICRO Interface 2 Health System Managers MESO Infrastructure & Supplies Interface 1 Finances Policy makers MACRO 8
- 9. RESULTS First 3 levels of analysis led to the 4th one highlighting most frequently cited bottlenecks per delivery platform (all 4 countries combined) Community based / family oriented services 9
- 10. RESULTS Population based / schedulable services Population based / schedulable services Supply-side bottlenecks Demand-side bottlenecks 1 Inadequate supplies, equipment & infrastructure (21/ 79) 1 Limited awareness & demand (7/ 22) main factor: irregular supplies (10/ 21) 2 Inadequate financial motivation (11/ 79) main factor: poor motivation / incentive (7/ 11) 3 Lack of skilled staff (10/ 79) main factor: insufficient qualified staff (8/ 10) Significant: Plethora of staff (1/ 79) main factor: not responding to planned clinics (2/ 7) misconceptions & rumours (2/ 7) inadequate knowledge on use / advantages (2/ 7) 2 Problems in financial accessibility (6/ 22) main factor: financial barriers (5/ 6) 3 Socio-cultural barriers (6/ 22) main factor: socio-cultural obstacles (3/ 6) Disruptive effects of campaigns (1/ 79) 10
- 11. RESULTS Individual oriented / clinical services 11
- 12. RESULTS Nature of bottle-necks is very diverse Single solutions and/or magic bullets will not do: “and/and” vs. “or/or” Distinction between supply and demand side bottle-necks is useful; it gives the necessary nuance Supply side bottle-necks cited are usually the expected ones, but also less obvious ones such as poor dialogue between providers and community / patients, limited involvement of nonpublic actors… 12
- 13. RESULTS Similar factors emerge from all 4 study countries but they mean different things in different contexts (e.g.: inadequate infrastructure & equipment in Ghana & Guinea-Bissau) Relatively high frequency of less obvious factors (e.g.: involvement of non-public actors and need for permanence of health care) Community-based/family-oriented services require a good interface between professionals and patients/communities (more than is the case for the 2 other platforms) 13
- 14. RESULTS Growing tendency to create “single-purposed” CHWs, receiving financial incentives, is detrimental to the comprehensiveness of HS Disruptive effect of campaigns on populationbased/schedulable services (e.g. immunisation vs. curative services) Bottle-necks for individual-oriented clinical services for both delivery and curative care are relatively similar, but relative weight of infrastructure and geographical access problems much more prominent in case of delivery care 14
- 15. RECOMMENDATIONS BY INTERFACE 5. Design and develop community-based structures that are versatile, stable with paid health workers for a variety of tasks 3.Engage managers to dialogue with community in a process of diagnosis and identification of community resources 1.Strengthen institutional support to central policy-making level (stewardship) 4.Improve quality of interaction between HW and patients & invest in patient-centred care 2.Provide resources Emphasise good coordination of health activities implemented by all local actors Assure regular supportive supervision (health system managers & programme 15 managers)
- 16. LIMITATIONS OF THE STUDY RE methodology not applied as such, even if it deeply influenced conception of study and analysis of data Too high number of HII Insufficient in-depth interviews with policy-makers & programme managers Potential of “contrasting” local health systems did not really materialise, except for Ghana Attempt to streamline and standardise methodology difficult: investigator variability 16
- 17. BENEFITS OF THE STUDY Local level: information collected relevant for local decision makers National level: information collected relevant for national decision makers and for organising support to local level HHA level insight in bottle-necks and facilitating factors for successful implementation of HII evidence for contextualised country-specific action ITM & research partners enhance knowledge in management & organisation of HS acquire more hands-on experience in evaluation methods of complex interventions 17
- 18. CONCLUSIONS Identification of factors impeding & facilitating the implementation of HII; the “interpretation” of these factors needs to be put into context High-light of 5 key health system interfaces affecting change: “and/and” rather than “or/or” Avoidance of “copy and paste” of successful operational strategies: e.g. CHPS in Ghana. Context matters greatly! 18