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Shocks, stress and everyday health system resilience: experiences from the Kenyan coast

Health policy and planning, 2020-06, Vol.35 (5), p.522-535 [Peer Reviewed Journal]

The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. 2020 ;The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. ;ISSN: 0268-1080 ;EISSN: 1460-2237 ;DOI: 10.1093/heapol/czaa002 ;PMID: 32101609

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Title:
Shocks, stress and everyday health system resilience: experiences from the Kenyan coast
Author: Kagwanja, Nancy ; Waithaka, Dennis ; Nzinga, Jacinta ; Tsofa, Benjamin ; Boga, Mwanamvua ; Leli, Hassan ; Mataza, Christine ; Gilson, Lucy ; Molyneux, Sassy ; Barasa, Edwine
Subjects: Absorptivity ; Adaptive systems ; Autonomy ; Decentralization ; Delivery of Health Care - methods ; Delivery of Health Care - organization & administration ; Devolution ; Government Programs ; Health administration ; Health care ; Health Planning Organizations - organization & administration ; Health Resources - supply & distribution ; Hospital Administration - methods ; Human resource management ; Human resources management ; Humans ; Kenya ; Learning ; Learning styles ; Original ; Politics ; Qualitative analysis ; Resilience ; Resource management ; Scarcity ; State role ; Workforce - organization & administration
Is Part Of: Health policy and planning, 2020-06, Vol.35 (5), p.522-535
Description: Abstract Health systems are faced with a wide variety of challenges. As complex adaptive systems, they respond differently and sometimes in unexpected ways to these challenges. We set out to examine the challenges experienced by the health system at a sub-national level in Kenya, a country that has recently undergone rapid devolution, using an ‘everyday resilience’ lens. We focussed on chronic stressors, rather than acute shocks in examining the responses and organizational capacities underpinning those responses, with a view to contributing to the understanding of health system resilience. We drew on learning and experiences gained through working with managers using a learning site approach over the years. We also collected in-depth qualitative data through informal observations, reflective meetings and in-depth interviews with middle-level managers (sub-county and hospital) and peripheral facility managers (n = 29). We analysed the data using a framework approach. Health managers reported a wide range of health system stressors related to resource scarcity, lack of clarity in roles and political interference, reduced autonomy and human resource management. The health managers adopted absorptive, adaptive and transformative strategies but with mixed effects on system functioning. Everyday resilience seemed to emerge from strategies enacted by managers drawing on a varying combination of organizational capacities depending on the stressor and context.
Publisher: England: Oxford University Press
Language: English
Identifier: ISSN: 0268-1080
EISSN: 1460-2237
DOI: 10.1093/heapol/czaa002
PMID: 32101609
Source: Oxford Journals Open Access Collection
GFMER Free Medical Journals
MEDLINE
PubMed Central

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Shocks, stress and everyday health system resilience: experiences from the Kenyan coast

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