Working Towards Inclusive, Socially Accountable and Resilient Community Health Systems: An Introduction to a Special Issue

Michelo, Charles; Hurtig, Anna-Karin; Schneider, Helen

doi:10.34172/ijhpm.2021.166

Cited by 4 publications

(12 citation statements)

References 21 publications

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“…CHS can be viewed through the programmatic, relational, collective action, and critical lenses (24,25). The four lenses are used to approach, understand, and dissect or evaluate CHS.…”

Section: Introductionmentioning

confidence: 99%

“…The four lenses are used to approach, understand, and dissect or evaluate CHS. The programmatic lens entails looking 'into CHS' as the site of formal programming (design) (24,25). It is concerned with health systems building blocks such as human resources, nancing, technologies, and infrastructure (24,25).…”

Section: Introductionmentioning

confidence: 99%

“…The programmatic lens entails looking 'into CHS' as the site of formal programming (design) (24,25). It is concerned with health systems building blocks such as human resources, nancing, technologies, and infrastructure (24,25). The relational lens shifts the focus from the what (design) of programmes to the how (implementation).…”

Section: Introductionmentioning

confidence: 99%

“…It views the CHS as a 'peopled' system of relationships -formal or informal. It focuses on multiple interactions and feedback loops, interests and expressions of power among the actors that together constitute a social system (24,25). The collective action lens is concerned with mechanisms and processes that enable actors in the CHS to mobilize, collaborate, and act collectively in identifying, prioritizing, and owning solutions to health problems (24,25).…”

Section: Introductionmentioning

confidence: 99%

“…It focuses on multiple interactions and feedback loops, interests and expressions of power among the actors that together constitute a social system (24,25). The collective action lens is concerned with mechanisms and processes that enable actors in the CHS to mobilize, collaborate, and act collectively in identifying, prioritizing, and owning solutions to health problems (24,25). The critical lens examines CHS issues from a political-economy perspective, including what lies behind programmes and how to decolonize programmes or make them contextually relevant (24,25).…”

Section: Introductionmentioning

confidence: 99%

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Specifying implementation strategies used in delivering services for HIV, gender-based violence and sexual and reproductive health to adolescent girls and young women in community health systems in Zambia

Zulu,

Maritim,

Silumbwe

et al. 2024

Preprint

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Background Adolescent girls and young women (AGYW) in Zambia experience challenges including gender-based violence (GBV) and difficulty obtaining care for sexual and reproductive health (SRH) and treatment for HIV. Implementation strategies for delivering GBV, SRH and HIV services targeted to AGYW in community health systems (CHS) have not been fully specified. We sought to define and specify common implementation strategies being used in Zambia. Methods In a qualitative case study in 3 districts, we interviewed 29 key informants from government bodies, NGOs, and community leaders; we also conducted 23 in-depth interviews with AGYW aged between 10 and 24 years. Analysis of the data used thematic analysis based on the four CHS lenses (programmatic, relational, collective action, and critical lenses) and on the Expert Recommendations for Implementing Change (ERIC) compilation of implementation strategies. Results Implementation strategies identified under the programmatic lens were 1) changing infrastructure, which included increasing health facilities and delivering adolescent- and young people-friendly services; 2) training and educating stakeholders, which consisted of increasing capacity building, developing and using educational materials, ongoing training and educational outreach visits; and 3) adapting and tailoring services to context, which included delivering integrated services and developing by-laws. Relational lens strategies were 1) developing stakeholder interrelationships such as building a coalition of service providers; and 2) using new funding through cost-sharing among stakeholders. Under the collective action lens, implementers mainly engaged consumers, by increasing demand using community networks, using mass media to share information, and intervening with patients to enhance uptake of services. The critical lens showed that effective implementation of GBV, SRH and HIV services was affected by structural and socio- cultural factors such as social stigma and cultural norms. Conclusion This study builds on the ERIC compilation of implementation strategies by identifying and specifying implementation strategies used in the delivery of HIV, GBV and services for AGYW in community health systems. We provide additional evidence on the importance of relational and collective-action approaches in strengthening community-engaged implementation and dissemination.

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“…CHS can be viewed through the programmatic, relational, collective action, and critical lenses (24,25). The four lenses are used to approach, understand, and dissect or evaluate CHS.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Specifying implementation strategies used in delivering services for HIV, gender-based violence and sexual and reproductive health to adolescent girls and young women in community health systems in Zambia

Zulu,

Maritim,

Silumbwe

et al. 2024

Preprint

View full text Add to dashboard Cite

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Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia

Zulu,

Maritim,

Halwiindi

et al. 2024

Arch Public Health

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Background Decentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings. Our research aimed to delineate the specific implementation strategies employed in managing MDR TB in Zambia. Methods Our qualitative case study involved 112 in-depth interviews with a diverse group of participants, including healthcare workers, community health workers, patients, caregivers, and health managers in nine districts. We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) compilation and later grouped them into three CHS lenses: programmatic, relational, and collective action. Results The programmatic lens comprised four implementation strategies: (1) changing infrastructure through refurbishing and expanding health facilities to accommodate management of MDR TB, (2) adapting and tailoring clinical and diagnostic services to the context through implementing tailored strategies, (3) training and educating health providers through ongoing training, and (4) using evaluative and iterative strategies to review program performance, which involved development and organization of quality monitoring systems, as well as audits. Relational lens strategies were (1) providing interactive assistance through offering local technical assistance in clinical expert committees and (2) providing support to clinicians through developing health worker and community health worker outreach teams. Finally, the main collective action lens strategy was engaging consumers; the discrete strategies were increasing demand using community networks and events and involving patients and family members. Conclusion This study builds on the ERIC implementation strategies by stressing the need to fully consider interrelations or embeddedness of CHS strategies during implementation processes. For example, to work effectively, the programmatic lens strategies need to be supported by strategies that promote meaningful community engagement (the relational lens) and should be attuned to strategies that promote community mobilization (collective action lens).

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Exploring community health systems interventions that strength implementation of maternal and child health services: The case of community health assistants in Zambia

Akinola,

Banda,

Silumbwe

et al. 2024

Preprint

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Introduction: Many low-and middle-income countries, including Zambia experience human resource for health challenges, which affect the delivery of maternal and child health (MCH) services. The Clinton Health Access Initiative (CHAI) in collaboration with Ministry of Health in Zambia through its community health systems (CHS) initiative provided additional support to the Community Health Assistants (CHA) programme from 2019 to 2021 to enhance provision of MCH services. In this study, we explore the different interventions that influenced the CHA’s ability to deliver MCH the services. Methodology: The study was conducted in November and December 2021 using data from the HealthManagement Information System (HMIS) and qualitative interviews with the CHA and program staff. A total of 244 qualitative interviews were conducted in 10 provinces and 2,506 respondents participated in quantitative interviews. Qualitative data were analysed using thematic analysis while for quantitative data we used descriptive statistics. Results: The HMIS data showed that health facilities that had CHAs performed better than those without. Survey data further indicated that health facilities where CHAs had worked for two or more years recorded better access to MCH services compared those where CHAs had only worked for a year. The CHS strengthening interventions including provision of training manuals, enhanced recruitment and deployment policies, capacity building of CHA supervisors, provision of transport and monthly remuneration to some CHAs contributed to improved delivery and acceptability of MCH services. Further, the involvement of community networks, linkages and partnerships when delivering these services, including the traditional and religious leaders contributed to improved delivery, coverage and acceptability of MCH services. Meanwhile, health systems barriers such as limited supplies in some health facilities, shortage of health workers, persistent transportation challenges and failure to fully abide the CHA recruitment and selection criteria affected delivery and acceptability of MCH services. Conclusion: This study builds on existing evidence on importance of building a stronger community–based primary health care to effectively address maternal and child health related. We emphasize the need to integrate strategies such as provision of training manuals, enhanced recruitment and deployment policies, capacity building of supervisors, provision of transport and remuneration within the CHA programme to enhance provision of maternal and child health services.

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Working Towards Inclusive, Socially Accountable and Resilient Community Health Systems: An Introduction to a Special Issue

Cited by 4 publications

References 21 publications

Specifying implementation strategies used in delivering services for HIV, gender-based violence and sexual and reproductive health to adolescent girls and young women in community health systems in Zambia

Specifying implementation strategies used in delivering services for HIV, gender-based violence and sexual and reproductive health to adolescent girls and young women in community health systems in Zambia

Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia

Exploring community health systems interventions that strength implementation of maternal and child health services: The case of community health assistants in Zambia

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