Health systems performance or performing health systems? Anthropological engagement with health systems research

Kielmann, Karina; Hutchinson, Eleanor; MacGregor, Hayley

doi:10.1016/j.socscimed.2022.114838

Cited by 13 publications

(2 citation statements)

References 31 publications

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“…34,35 While much qualitative research has focused on patients, an increasing body of ethnographic research in sub-Saharan Africa has shown that the detrimental effects of 'vertical', single-disease programming are felt 'all the way up' health systems. 36,37 It presents a challenge for the nurses and community health workers who provide the majority of care at primary level in sub-Saharan Africa. These frontline actors are trained to adhere to diseasespecific clinical practice guidelines that have limited applicability to patients with multimorbidity 38 and whose attendant paperwork and accountability draw time and attention away from the complexity of patient needs.…”

Section: Classificatory Legaciesmentioning

confidence: 99%

Making morbidity multiple: History, legacies, and possibilities for global health

Dixon

Mendenhall

Bosire

et al. 2023

Journal of Multimorbidity and Comorbidity

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Multimorbidity has been framed as a pressing global health challenge that exposes the limits of systems organised around single diseases. This article seeks to expand and strengthen current thinking around multimorbidity by analysing its construction within the field of global health. We suggest that the significance of multimorbidity lies not only in challenging divisions between disease categories but also in what it reveals about the culture and history of transnational biomedicine. Drawing on social research from sub-Saharan Africa to ground our arguments, we begin by describing the historical processes through which morbidity was made divisible in biomedicine and how the single disease became integral not only to disease control but to the extension of biopolitical power. Multimorbidity, we observe, is hoped to challenge single disease approaches but is assembled from the same problematic, historically-loaded categories that it exposes as breaking down. Next, we highlight the consequences of such classificatory legacies in everyday lives and suggest why frameworks and interventions to integrate care have tended to have limited traction in practice. Finally, we argue that efforts to align priorities and disciplines around a standardised biomedical definition of multimorbidity risks retracing the same steps. We call for transdisciplinary work across the field of global health around a more holistic, reflexive understanding of multimorbidity that foregrounds the culture and history of translocated biomedicine, the intractability of single disease thinking, and its often-adverse consequences in local worlds. We outline key domains within the architecture of global health where transformation is needed, including care delivery, medical training, the organisation of knowledge and expertise, global governance, and financing.

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Section: Classificatory Legaciesmentioning

confidence: 99%

Making morbidity multiple: History, legacies, and possibilities for global health

Dixon

Mendenhall

Bosire

et al. 2023

Journal of Multimorbidity and Comorbidity

View full text Add to dashboard Cite

show abstract

“… 2 Consequently, in many countries, healthcare services are undergoing major system change (MSC). 3 , 4 Hence, Perry and colleagues 5 work seeking to understand how to effectively achieve MSC — enablers, barriers, processes and outcomes — is relevant and vital for healthcare organisations everywhere.…”

Section: Introductionmentioning

confidence: 99%

A Gateway Framework to Guide Major Health System Changes; Comment on ""Attending to History" in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration"

Eljiz

Greenfield

Derrett

2023

Int J Health Policy Manag

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Recent events – on both a global scale and within individual countries - including the lockdowns associated with COVID-19 pandemic, inflation concerns and political tensions, have increased pressure to reconfigure social services for ongoing sustainability. Healthcare services across the world are undergoing major system change (MSC). Given the complexity and different contextual drivers across healthcare systems, there is a need to use a variety of perspectives to improve our understanding of the processes for MSC. To expand the knowledge base and develop strategies for MSC requires analysing change projects from different perspectives to distil the elements that drove the success. We offer the Gateway Framework as a collaborative transformational system tool to assess and reorganise operations, services, and systems of healthcare organisations. This framework and guiding questions, accounts for past events whilst being proactive, future orientated, and derived from externally defined and a standardised requirements to promote safe, high-quality care.

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Childbirth and Birth Care

Kok

2023

Handbook of Social Sciences and Global Public Health

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Health systems performance or performing health systems? Anthropological engagement with health systems research

Cited by 13 publications

References 31 publications

Making morbidity multiple: History, legacies, and possibilities for global health

Making morbidity multiple: History, legacies, and possibilities for global health

A Gateway Framework to Guide Major Health System Changes; Comment on ""Attending to History" in Major System Change in Healthcare in England: Specialist Cancer Surgery Service Reconfiguration"

Childbirth and Birth Care

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