Impact of organizational change on the delivery of reproductive services: a review of the literature

Ensor, Tim; Ronoh, Jeptepkeny

doi:10.1002/hpm.810

Cited by 13 publications

(15 citation statements)

References 26 publications

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“…At the same time the organization is given the necessary resources and discretion over their use, to permit these objectives to be met" [42]. The conceptual shift that is required is to examine what approaches and parts of decentralization work in which local contexts, and to adjust the decentralizing reform to match this [36].…”

Section: Reviewmentioning

confidence: 99%

Strategic management of the health workforce in developing countries: what have we learned?

Fritzen

2007

Hum Resour Health

103

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The study of the health workforce has gained in prominence in recent years, as the dynamic interconnections between human resource issues and health system effectiveness have come into sharper focus. This paper reviews lessons relating to strategic management challenges emerging from the growing literature in this area. Workforce issues are strategic: they affect overall system performance as well as the feasibility and sustainability of health reforms. Viewing workforce issues strategically forces health authorities to confront the yawning gaps between policy and implementation in many developing countries.Lessons emerge in four areas. One concerns imbalances in workforce structure, whether from a functional specialization, geographical or facility lens. These imbalances pose a strategic challenge in that authorities must attempt to steer workforce distribution over time using a limited range of policy tools. A second group of lessons concerns the difficulties of central-level steering of the health workforce, often critically weak due to the lack of proper information systems and the complexities of public sector decentralization and service commercialization trends affecting the grassroots.A third cluster examines worker capacity and motivation, often shaped in developing countries as much by the informal norms and incentives as by formal attempts to support workers or to hold them accountable. Finally, a range of reforms centering on service contracting and improvements to human resource management are emerging. Since these have as a necessary (but not sufficient) condition some flexibility in personnel practices, recent trends towards the sharing of such functions with local authorities are promising.The paper identifies a number of current lines of productive research, focusing on the relationship between health policy reforms and the local institutional environments in which the workforce, both public and private, is deployed.

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Section: Reviewmentioning

confidence: 99%

Strategic management of the health workforce in developing countries: what have we learned?

Fritzen

2007

Hum Resour Health

103

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“…Decentralization of services is one key approach that has been employed in several countries in an attempt to increase access to health services. In decentralized systems, local healthcare facilities and workers are allowed a degree of autonomy over financial and human resources and thus can tailor services and resources to their community's challenges and needs [5]. …”

Section: Introductionmentioning

confidence: 99%

Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda: A Prospective Cohort Study

Nathan

Shi

Plewniak

et al. 2015

Matern Child Health J

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To evaluate the effectiveness of decentralizing ambulatory reproductive and intrapartum services to increase rates of antenatal care (ANC) utilization and skilled attendance at birth (SAB) in Rwanda. A prospective cohort study was implemented with one control and two intervention sites: decentralized ambulatory reproductive healthcare and decentralized intrapartum care. Multivariate logistic regression analysis was performed with primary outcome of lack of SAB and secondary outcome of ≥3 ANC visits. 536 women were entered in the study. Distance lived from delivery site significantly predicted SAB (p = 0.007), however distance lived to ANC site did not predict ≥3 ANC visits (p = 0.81). Neither decentralization of ambulatory reproductive healthcare (p = 0.10) nor intrapartum care (p = 0.40) was significantly associated with SAB. The control site had the greatest percentage of women receive ≥3 ANC visits (p < 0.001). Receiving <3 ANC visits was associated with a 3.98 times greater odds of not having SAB (p = 0.001). No increase in adverse outcomes was found with decentralization of ambulatory reproductive health care or intrapartum care. The factors that predict utilization of physically accessible services in rural Africa are complex. Decentralization of services may be one strategy to increase rates of SAB and ANC utilization, but selection biases may have precluded accurate analysis. Efforts to increase ANC utilization may be a worthwhile investment to increase SAB.

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“…A final implication of the analysis is to reinforce recent calls in the literature (Franco, Bennett & Kanfer, 2002;Atkinson, Cohn, Ducci & Gideon, 2003;World Bank, 2004;Ensor and Ronoh, 2005) for further work and attention to strengthening the institutional environment underpinning health clinic performance. A framework for analyzing the set of pressures and incentives felt by clinic personnel and various other key stakeholders is proposed in this paper (figure 1 above).…”

Section: Discussionmentioning

confidence: 66%

Legacies of primary health care in an age of health sector reform: Vietnam's commune clinics in transition

Fritzen

2007

Social Science & Medicine

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Developing countries that were early, enthusiastic adopters of Primary Health Care often developed an extensive -but eventually dilapidated and under-utilized -network of public clinics at the grassroots. As paradigms and investment patterns of health sector reform have shifted, the question of what role these public clinics can meaningfully play, and how best to revitalize them, has become important in a number of countries. This paper evaluates the strategy taken by, and outcomes of, a major attempt in Vietnam to revitalize the grassroots infrastructure of primary health care against the backdrop of the country's economic transition. The project's substantial supply-side investments in infrastructure led to marginal increases in utilization and the quality of preventive health services provided by the centers. But because the project failed to take adequate stock of broader, public sector-wide trends and reforms over the transition, the investments had little impact on the incentives, accountability patterns and capacities of clinic staff and the local authorities. Such institutional factors are heavily implicated, in Vietnam as elsewhere, in the substantial and often increasing disparities in service access and quality that continue to afflict transitional health sectors.

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Impact of organizational change on the delivery of reproductive services: a review of the literature

Cited by 13 publications

References 26 publications

Strategic management of the health workforce in developing countries: what have we learned?

Strategic management of the health workforce in developing countries: what have we learned?

Decentralizing Maternity Services to Increase Skilled Attendance at Birth and Antenatal Care Utilization in Rural Rwanda: A Prospective Cohort Study

Legacies of primary health care in an age of health sector reform: Vietnam's commune clinics in transition

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