Improving health service delivery organisational performance in health systems: a taxonomy of strategy areas and conceptual framework for strategy selection

Abstract

Health systems strengthening (HSS) is a priority for global health funders, policy-makers and practitioners. Although many HSS efforts have focused on policy levers such as financing approaches, payment schemes or regulatory reforms, less attention has been directed to targeting the organisations that deliver health services such as hospitals, health centres and clinics. Evidence suggests that the impact of organisation-level interventions varies by context; however, we lack a general framework for integrating organisational context into performance improvement strategies for health service delivery organisations. Drawing on open systems theories from organisational behaviour and management as well as a review of 181 empirical studies of health service delivery organisations in low- and middle-income countries, we propose a taxonomy of seven strategy areas for improving organisational performance as well as a multistage conceptual framework for selecting among them. We propose that the choice of strategy for improving health service delivery organisational performance should be informed by: (i) the root cause of the organisation's performance gap; (ii) the environmental conditions facing the organisation; and (iii) the implementation capability of the organisation. We also highlight conditions under which different strategy areas may be expected to be optimally effective. The approaches presented in this paper offer a way for health system decision-makers and researchers to systematically assess and incorporate organisational context in the process of developing strategies to improve the performance of health service delivery organisations and, ultimately, of health systems.

Using a plant health system framework to assess plant clinic performance in Uganda

“…The plant clinic approach represents a shift from a 'vertical' (single crop or single pest) to a 'horizontal' approach (any problem in any crop). Just as primary care in human health has proven to be an effective platform for health system strengthening in several countries (Kruk et al 2010;Pallas et al 2012), plant clinics have turned out to be a valuable entry point for strengthening plant health. Results from pioneer plant clinics in Nicaragua 2005-2007 demonstrated the clinics' potential to create synergies between different actors in plant health, thus making better use of existing resources (Danielsen et al 2013a).…”

Co-operation, a Solution to Health Service Provision Problems in Tanzania: Case of the Co-operated Health Care Facilities in Dodoma Region

“…Source; modified from [22]. (1) Root causes of the moderate status of health services provision Through the findings presented in this study, the root causes of health services provision problems in Dodoma urban and Kondoa districts were; running costs, budget in the health sector, infrastructure and business oriented notion, management of health plans, ethical conducts for workers, health education to patients and health facilities and income of the society.…”

“…If those problems are not solved the health services provision will not be sufficient even if there is good cooperation in the two districts. Thus to overcome the problems various procedures (as were adopted and modified from [22] and summarized in Figure 4) must be considered. These are as follows:…”

The Quality of Health Services in Tawaeli Health Center, Tawaeli District, Palu City

“…Puskesmas can provide inpatient services in addition to outpatient services. To provide good services, of course, it is always endeavored to improve the quality of services in order to achieve optimal health status for the whole community (Komljenovic, Loiselle, & Kumral, 2017;Lluch, 2011;Pallas, Curry, Bashyal, Berman, & Bradley, 2012;Rojatz & Forster, 2017;Weed et al, 2016).…”