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Strengthening health system responsiveness to citizen feedback in South Africa and Kenya

加强南非和肯尼亚卫生系统对公民反馈的响应能力

基本信息

批准号：
MR/R013365/1
负责人：
Jill Olivier
金额：
$ 76.16万
依托单位：
University of Cape Town
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2018
资助国家：
英国
起止时间：
2018 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FR013365%2F1
关键词：
Strengthening health system responsiveness citizen

项目摘要

Citizens in LMICs experience a range of problems with public and private health services: from poor quality of services to rights violations. In spite of numerous calls and interventions for increased community participation in health, service users and citizens often do not have adequate opportunities to engage with the system about their problems and induce appropriate responses and remedies. Responsiveness to citizens' rights and needs is an essential quality of health systems, and is necessary in order to provide inclusive and accountable services, ensure the social rights of citizens and improve the quality of services. Mechanisms for feedback and response are varied and result in dispersed and sometimes conflicting feedback. These range from conventional facility-based complaints boxes and exit surveys to strategies such as community report cards, social audits, and hotlines. Citizen feedback at community-level has also been sought by implementing health facility committees, intersectoral forums, and community monitoring systems. Growing access to information technology in LMICs has often empowered citizens to raise their concerns through social media, the mainstream press, and even through social protest. Health system responsiveness is gaining global currency as an intrinsic goal of health systems alongside service delivery outcomes, financial fairness and equity. However our current understanding of health system responsiveness is extremely limited, and there is a significant evidence gap about the structure, implementation and effectiveness of citizen feedback and the related response mechanisms about health services currently in place in LMICs. In this study, we aim to address these knowledge gaps by asking: What policies and mechanisms (formal and informal) work for receiving and responding to citizen feedback on health systems in South Africa and Kenya? How can health systems responsiveness be strengthened towards the development of learning, equitable health systems?The proposed study is an interdisciplinary mixed methods study, running from 2018 to 2020. The study will be conducted in three phases, and we will apply several, primarily qualitative methods and tools. The first phase will consist of 'mapping' of policies, feedback mechanisms and pathways for system responsiveness in the study provinces (as well as theoretical and methodological framing relating to responsiveness). Many governments in LMICs are recognising the pressing need to improve health system responsiveness, and both countries in this study have recently implemented significant policy reforms aimed at improving responsiveness to citizen feedback on health services. We will capitalise on this window of opportunity, with the second in-depth phase consisting of case studies in each country, tracking the implementation experience of a particular innovation in this area. The third phase will focus on knowledge translation and cross-country comparison. This project will contribute to a deeper and more systematic understanding of health system responsiveness in South Africa and Kenya, with relevance for other comparable LMICs. By applying an embedded approach to HPSR, it is intended that the research will also have a health system strengthening effect: creating space for reflective practice, strengthening feedback and response within the system, and improving decision-making opportunities for HS leaders. Therefore, this study on responsiveness to citizen feedback should also improve the responsiveness of the health systems in which it is implemented. In each country, we have partnered with policy decision-makers engaged in implementing reforms for greater health system responsiveness, and this study will directly help bring about improvements in these policies. We will also engage with other health system and civil society leaders to identify strategies to strengthen health system responsiveness.

中低收入国家的公民在公共和私营保健服务方面遇到一系列问题：从服务质量差到权利受到侵犯。尽管有许多呼吁和干预措施要求社区更多地参与保健工作，但服务使用者和公民往往没有足够的机会就其问题与系统接触，并得到适当的回应和补救。对公民的权利和需求作出反应是卫生系统的一项基本素质，是提供包容性和负责任的服务、确保公民的社会权利和提高服务质量的必要条件。反馈和反应机制各不相同，导致反馈分散，有时相互矛盾。这些措施包括传统的基于设施的投诉箱和退出调查，以及社区报告卡、社会审计和热线等策略。还通过建立保健设施委员会、部门间论坛和社区监测系统，在社区一级征求公民的反馈意见。中低收入国家越来越多地获得信息技术，这往往使公民有能力通过社交媒体、主流媒体，甚至通过社会抗议提出他们的关切。卫生系统的反应能力正日益成为卫生系统的一个内在目标，与提供服务的成果、财政公平和公正并列。然而，我们目前对卫生系统响应能力的了解极其有限，而且公民反馈的结构、实施和有效性以及LMICs目前实施的卫生服务相关响应机制存在显着的证据差距。在这项研究中，我们的目标是解决这些知识差距，问：什么政策和机制（正式和非正式）的工作，以接收和回应公民对卫生系统在南非和肯尼亚的反馈？如何加强卫生系统的应对能力，以发展学习和公平的卫生系统？拟议的研究是一项跨学科的混合方法研究，从2018年到2020年。这项研究将分三个阶段进行，我们将采用几种主要是定性的方法和工具。第一阶段将包括“绘制"政策、反馈机制和研究省份的系统响应途径（以及与响应有关的理论和方法框架）。许多中低收入国家的政府认识到迫切需要提高卫生系统的响应能力，本研究中的两个国家最近都实施了重大的政策改革，旨在提高对公民对卫生服务反馈的响应能力。我们将利用这一机会之窗，第二个深入阶段包括每个国家的案例研究，跟踪该领域特定创新的实施经验。第三阶段将侧重于知识翻译和跨国比较。该项目将有助于更深入和更系统地了解南非和肯尼亚卫生系统的反应能力，并与其他可比的中低收入国家有关。通过将嵌入式方法应用于HPSR，旨在使研究也具有卫生系统强化效果：为反思实践创造空间，加强系统内的反馈和响应，并改善HS领导者的决策机会。因此，这项关于对公民反馈的反应的研究也应该提高实施该研究的卫生系统的反应能力。在每个国家，我们都与参与实施改革的政策决策者合作，以提高卫生系统的反应能力，这项研究将直接帮助改善这些政策。我们还将与其他卫生系统和民间社会领导人合作，确定加强卫生系统反应能力的战略。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Exploring mechanisms for receiving and responding to citizen feedback in LMIC health systems: a mixed methods evidence mapping of the Western Cape province of South Africa

探索中低收入国家卫生系统中接收和响应公民反馈的机制：南非西开普省的混合方法证据映射

DOI：
发表时间：
2020
期刊：
影响因子：
0
作者：
Sutherns T
通讯作者：
Sutherns T

Health systems in the news: The influence of media representations on health system functioning in the Western Cape health system

新闻中的卫生系统：媒体报道对西开普省卫生系统卫生系统运作的影响

DOI：
发表时间：
2019
期刊：
影响因子：
0
作者：
Gopal T
通讯作者：
Gopal T

Health system responsiveness: a systematic evidence mapping review of the global literature.

DOI：
10.1186/s12939-021-01447-w
发表时间：
2021-05-01
期刊：
International journal for equity in health
影响因子：
4.8
作者：
Khan G;Kagwanja N;Whyle E;Gilson L;Molyneux S;Schaay N;Tsofa B;Barasa E;Olivier J
通讯作者：
Olivier J

Mapping the Multiple Health System Responsiveness Mechanisms in One Local Health System: A Scoping Review of the Western Cape Provincial Health System of South Africa.