An approach to addressing governance from a health system framework perspective

Mikkelsen-Lopez, Inez; Wyss, Kaspar; Savigny, Don de

doi:10.1186/1472-698x-11-13

Cited by 106 publications

(119 citation statements)

References 22 publications

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“…These aspects of HSG have been found to be weak in evaluations of HSGs in other LMICs [9], including other Emerald study sites [32]. Ethiopia has benefited from a strong tradition of population level mental health research which has served to quantify the extent and burden of mental disorders within Ethiopia and strengthen arguments underpinning advocacy efforts [18].…”

Section: Discussionmentioning

confidence: 99%

Health system governance to support scale up of mental health care in Ethiopia: a qualitative study

Hanlon

Eshetu

Alemayehu

et al. 2017

Int J Ment Health Syst

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BackgroundEthiopia is embarking upon a ground-breaking plan to address the high levels of unmet need for mental health care by scaling up mental health care integrated within primary care. Health system governance is expected to impact critically upon the success or otherwise of this important initiative. The objective of the study was to explore the barriers, facilitators and potential strategies to promote good health system governance in relation to scale-up of mental health care in Ethiopia.MethodsA qualitative study was conducted using in-depth interviews. Key informants were selected purposively from national and regional level policy-makers, planners and service developers (n = 7) and district health office administrators and facility heads (n = 10) from a district in southern Ethiopia where a demonstration project to integrate mental health into primary care is underway. Topic guide development and analysis of transcripts were guided by an established framework for assessing health system governance, adapted for the Ethiopian context.ResultsFrom the perspective of respondents, particular strengths of health system governance in Ethiopia included the presence of high level government support, the existence of a National Mental Health Strategy and the focus on integration of mental health care into primary care to improve the responsiveness of the health system. However, both national and district level respondents expressed concerns about low baseline awareness about mental health care planning, the presence of stigmatising attitudes, the level of transparency about planning decisions, limited leadership for mental health, lack of co-ordination of mental health planning, unreliable supplies of medication, inadequate health management information system indicators for monitoring implementation, unsustainable models for specialist mental health professional involvement in supervision and mentoring of primary care staff, lack of community mobilisation for mental health and low levels of empowerment and knowledge undermining meaningful involvement of stakeholders in local mental health care planning.ConclusionsTo support scale-up of mental health care in Ethiopia, there is a critical need to strengthen leadership and co-ordination at the national, regional, zonal and district levels, expand indicators for routine monitoring of mental healthcare, promote service user involvement and address widespread stigma and low mental health awareness.Electronic supplementary materialThe online version of this article (doi:10.1186/s13033-017-0144-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Health system governance to support scale up of mental health care in Ethiopia: a qualitative study

Hanlon

Eshetu

Alemayehu

et al. 2017

Int J Ment Health Syst

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“…Stewardship is a term that is often used interchangeably with governance 5,6 which is a much more widely used and understood concept probably because of the work of international agencies such as the World Bank, 7 the United Nations Development Program (UNDP), 8 and the Institute on Governance 9 that ensure governance remains topical in their policy agenda. At a broader level, the definition of governance focuses on political and public administration of societies.…”

Section: Introductionmentioning

confidence: 99%

Analysing the Stewardship Function in Botswana’s Health System: Reflecting on the Past, Looking to the Future

Seitio-Kgokgwe

Gauld

Hill

et al. 2016

Int J Health Policy Manag

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Background: In many parts of the world, ongoing deficiencies in health systems compromise the delivery of health interventions. The World Health Organization (WHO) identified four functions that health systems need to perform to achieve their goals: Efforts to strengthen health systems focus on the way these functions are carried out. While a number of studies on health systems functions have been conducted, the stewardship function has received limited attention. In this article, we evaluate the extent to which the Botswana Ministry of Health (MoH) undertook its stewardship role. Methods: We used the WHO Health Systems Performance Assessment Frame (HSPAF) to guide analysis of the stewardship function of the Botswana’s MoH focusing on formulation of national health policies, exerting influence through health regulation, and coalition building. Data were abstracted from published and unpublished documents. We interviewed 54 key informants comprising staff of the MoH (N = 40) and stakeholder organizations (N = 14). Data from documents was analyzed through content analysis. Interviews were transcribed and analyzed through thematic analysis. Results: A lack of capacity for health policy development was identified. Significant policy gaps existed in some areas. Challenges were reported in policy implementation. While the MoH made efforts in developing various statutes that regulated different aspects of the health system, some gaps existed in the regulatory framework. Poor enforcement of legislation was a challenge. Although the MoH had a high number of stakeholders, the mechanisms for stakeholder engagement in the planning processes were weak. Conclusion: Problems in the exercise of the stewardship function posed challenges in ensuring accountability and limited the health system’s ability to benefit from its stakeholders. Ongoing efforts to establish a District Health System under control of the MoH, attempts to improve service delivery at a national level and political will to strengthen public-private engagement mechanisms are some of the prospects that can improve the MoH’s stewardship function.

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“…While governance, an essential component of a health system, remains a misunderstood concept (Siddiqi et al, 2009;Thidar et al, 2017), different conceptual frameworks have been proposed to define and measure governance, and its potential effect on health system performance and health service delivery (Lopez et al, 2011;Anwari et al, 2015). While this diversity of frameworks help in understanding governance as a construct in the context of health, these do not illustrate ways to apply effective governing practices in the fragile and conflict affected environments (Anwari et al, 2015).…”

Section: Discussion Governancementioning

confidence: 99%

Assessment of impediments affecting health systems response to neurocysticercosis in two districts (Gulu and Amuru) of Northern Uganda: A cross sectional study

Alarakol¹,

Loum²,

Yagos³

et al. 2018

J. Public Health Epidemiol.

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Northern Uganda is recovering from the effects of prolonged war which devastated most of the health systems in the region. The aim of the study was to identify health sector impediments affecting health systems response to Neurocysticercosis in the districts of Gulu and Amuru. A cross sectional study was conducted on two hospitals and 10 health centers. Two hundred and three (n=203) respondents were involved. Questionnaires were used to collect the data. One hundred and forty two (70.0%) of the respondents are permanently employed (P=0.01). Seventy three point nine percent (73.9%) of respondents are residents from Gulu districts (P=0.024). One hundred and nine (53.4%) of respondents reported they received training on infectious diseases (P=0.507). One hundred and forty three (70%) reported their health facilities have polices (P=0.04). One hundred and forty seven (72.4%) reported incharges reside at health facilities (P=0.01). One hundred and twenty four (61%) of the respondents reported Government is the primary source of funding (P=0.02). One hundred and seventeen (57.6%) of the respondents reported funding are irregular (P=0.23). Eighty seven percent (87%) reported inadequate physical infrastructure (P=0.04). Seventy three point six have limited knowledge on the diagnosis of Neurocysticercosis (P=0.01) and many prescribe anti-helminthic drugs to patients (P=0.27). Despite improvement in the healthcare services in the health sectors, health systems response to Neurocysticercosis in Gulu and Amuru, Northern Uganda is weak with most health facilities operating minimally. There is need for holistic approach to improvement of health systems in the region through increased Government funding and advocacy.

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An approach to addressing governance from a health system framework perspective

Cited by 106 publications

References 22 publications

Health system governance to support scale up of mental health care in Ethiopia: a qualitative study

Health system governance to support scale up of mental health care in Ethiopia: a qualitative study

Analysing the Stewardship Function in Botswana’s Health System: Reflecting on the Past, Looking to the Future

Assessment of impediments affecting health systems response to neurocysticercosis in two districts (Gulu and Amuru) of Northern Uganda: A cross sectional study

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