Discursive gaps in the implementation of public health policy guidelines in India: The case of HIV testing

Sheikh, Kabir; Porter, John D.

doi:10.1016/j.socscimed.2010.09.019

Cited by 18 publications

(22 citation statements)

References 20 publications

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“…Another important potential function of HPSR is to examine software elements such as power and trust that have been demonstrated to be key determinants of health systems performance, and success of health policies [12],[13]. However, the current focus of the field of research is frequently framed around the hardware of health systems, and less around its software (See Figure 1).…”

Section: The New Interest In Hpsrmentioning

confidence: 99%

Building the Field of Health Policy and Systems Research: Framing the Questions

et al. 2011

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Section: The New Interest In Hpsrmentioning

confidence: 99%

Building the Field of Health Policy and Systems Research: Framing the Questions

et al. 2011

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“…Relativist HPSR studies focus, for example, on how health system actors understand and experience particular services or policies [7], and what social and political processes, including power relations, influence them [8],[9]. The development and testing of middle range theory is also supported by studies that adopt a critical realist position.…”

Section: Knowledge Paradigmsmentioning

confidence: 99%

Building the Field of Health Policy and Systems Research: Social Science Matters

et al. 2011

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“…Decentralized, equitable and responsive primary health services are essential for achieving population health outcomes. Despite this, research demonstrates that primary-level health services remain weak across many LMICs, with evidence of inconsistent or low quality of care ( Das 2004 ; Nolan et al 2001 ; Peabody et al 2006 ); poor service environments and drug stockouts ( Schneider et al 2006a ); low morale and negative attitudes among front-line health workers ( Bassett et al 1997 ; Jewkes et al 1998 ) and irregular or unethical conduct ( Jesani 1998 ; Maestad and Mwisongo 2011 ; Sheikh and Porter 2010 ).…”

Section: Introductionmentioning

confidence: 99%

Understanding the dynamic interactions driving Zambian health centre performance: a case-based health systems analysis

Topp

Chipukuma

Hanefeld

2014

Health Policy and Planning

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Background Despite being central to achieving improved population health outcomes, primary health centres in low- and middle-income settings continue to underperform. Little research exists to adequately explain how and why this is the case. This study aimed to test the relevance and usefulness of an adapted conceptual framework for improving our understanding of the mechanisms and causal pathways influencing primary health centre performance.Methods A theory-driven, case-study approach was adopted. Four Zambian health centres were purposefully selected with case data including health-care worker interviews (n = 60); patient interviews (n = 180); direct observation of facility operations (2 weeks/centre) and key informant interviews (n = 14). Data were analysed to understand how the performance of each site was influenced by the dynamic interactions between system ‘hardware’ and ‘software’ acting on mechanisms of accountability.Findings Structural constraints including limited resources created challenging service environments in which work overload and stockouts were common. Health workers’ frustration with such conditions interacted with dissatisfaction with salary levels eroding service values and acting as a catalyst for different forms of absenteeism. Such behaviours exacerbated patient–provider ratios and increased the frequency of clinical and administrative shortcuts. Weak health information systems and lack of performance data undermined providers’ answerability to their employer and clients, and a lack of effective sanctions undermined supervisors’ ability to hold providers accountable for these transgressions. Weak answerability and enforceability contributed to a culture of impunity that masked and condoned weak service performance in all four sites.Conclusions Health centre performance is influenced by mechanisms of accountability, which are in turn shaped by dynamic interactions between system hardware and system software. Our findings confirm the usefulness of combining Sheikh et al.’s (2011) hardware–software model with Brinkerhoff’s (2004) typology of accountability to better understand how and why health centre micro-systems perform (or under-perform) under certain conditions.

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Discursive gaps in the implementation of public health policy guidelines in India: The case of HIV testing

Cited by 18 publications

References 20 publications

Building the Field of Health Policy and Systems Research: Framing the Questions

Building the Field of Health Policy and Systems Research: Framing the Questions

Building the Field of Health Policy and Systems Research: Social Science Matters

Understanding the dynamic interactions driving Zambian health centre performance: a case-based health systems analysis

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