Gender-sensitive health service framework for women prisoners in Thailand: A qualitative study

BackgroundThe WHO health systems Building Blocks framework has become ubiquitous in health systems research. However, it was not developed as a research instrument, but rather to facilitate investments of resources in health systems. In this paper, we reflect on the advantages and limitations of using the framework in applied research, as experienced in three empirical vaccine studies we have undertaken.DiscussionWe argue that while the Building Blocks framework is valuable because of its simplicity and ability to provide a common language for researchers, it is not suitable for analysing dynamic, complex and inter-linked systems impacts. In our three studies, we found that the mechanical segmentation of effects by the WHO building blocks, without recognition of their interactions, hindered the understanding of impacts on systems as a whole. Other important limitations were the artificial equal weight given to each building block and the challenge in capturing longer term effects and opportunity costs. Another criticism is not of the framework per se, but rather how it is typically used, with a focus on the six building blocks to the neglect of the dynamic process and outcome aspects of health systems.We believe the framework would be improved by making three amendments: integrating the missing “demand” component; incorporating an overarching, holistic health systems viewpoint and including scope for interactions between components. If researchers choose to use the Building Blocks framework, we recommend that it be adapted to the specific study question and context, with formative research and piloting conducted in order to inform this adaptation.SummaryAs with frameworks in general, the WHO Building Blocks framework is valuable because it creates a common language and shared understanding. However, for applied research, it falls short of what is needed to holistically evaluate the impact of specific interventions on health systems. We propose that if researchers use the framework, it should be adapted and made context-specific.

Qualitative exploration of health system response to COVID-19 pandemic applying the WHO health systems framework: Case study of a Nigerian state

This chapter summarises the key messages and lessons that cut across the individual chapters of this book while also assessing the interactions between the different building blocks of the WHO health system framework. This includes a critique of the WHO health systems framework and some suggestions for other countries that might wish to analyse their own health systems. A key issue discussed in the chapter is the importance of Malaysia’s socio-political and economic context to the development of its health system. The chapter highlights recent developments and the current challenges facing both the health system and the state of the Malaysian population’s health, and it makes some recommendations for future health systems policy.

BackgroundPrimary health care plays an important role in addressing the burden of non-communicable diseases (NCDs) in low- and middle-income countries. In light of the rapid urbanization of Vietnam, this study aims to explore health professionals’ views about the responsiveness of primary health care services at commune health stations, particularly regarding the increase of NCDs in urban settings.MethodsThis qualitative study was conducted in Hanoi from July to August 2015. We implemented 19 in-depth interviews with health staff at four purposely selected commune health stations and conducted a brief inventory of existing NCD activities at these commune health stations. We also interviewed NCD managers at national, provincial, and district levels. The interview guides reflected six components of the WHO health system framework, including service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. A thematic analysis approach was applied to analyze the interview data in this study.ResultsSix themes, related to the six building blocks of the WHO health systems framework, were identified. These themes explored the responsiveness of commune health stations to NCDs in urban Hanoi. Health staff at commune health stations were not aware of the national strategy for NCDs. Health workers noted the lack of NCD informational materials for management and planning. The limited workforce at health commune stations would benefit from more health workers in general and those with NCD-specific training and skills. In addition, the budget for NCDs at commune health stations remains very limited, with large differences in the implementation of national targeted NCD programs. Some commune health stations had no NCD services available, while others had some programming. A lack of NCD treatment drugs was also noted, with a negative impact on the provision of NCD-related services at commune health stations. These themes were also reflected in the inventory of existing NCD related activities.ConclusionsHealth professionals view the responsiveness of commune health stations to NCDs in urban Hanoi, Vietnam as weak. Appropriate policies should be implemented to improve the primary health care services on NCDs at commune health stations in urban Hanoi, Vietnam.

Harnessing pluralism for better health in Bangladesh

IntroductionSince the World Health Report in 2000, Health System Performance Assessment (HSPA) has been established as a tool for the evaluation and evidence-informed governance of health systems. So far, the population perspective has not been integrated into HSPA in a systematic manner, although people's experiences and expectations are of great importance to improve health systems and especially to strengthen patient-centered care. Therefore, this study aims to conduct an HSPA of Germany's health system from the population's perspective covering all eight goals of WHO’s Health Systems Framework, and to identify strengths and needs for improvement. MethodsIn 2018, 32,000 people insured with the German sickness fund ‘AOK Nordost’ were invited by mail to participate in the survey. The questionnaire contained a total of 43 items covering the eight goals of WHO's Health Systems Framework (e.g., access, quality, safety) plus socioeconomics and other characteristics of the insured persons. The data on the health system goals were analyzed descriptively and by subgroups (age, sex, income, chronic conditions, health literacy). ResultsThe sample (n=1,481; response rate 4.6%) was 54.8% female and had a mean age of 59.1 years (±18.5). Altogether, the participants saw several needs for improvement within the German health system. For instance, 60.0% found quality differences between hospitals to be big, and between 3.9% and 8.5% reported mistakes related to their treatment or prescription medication in the previous two years. A big need for reform was especially seen regarding out-of-pocket payments (51.5%) and the coordination of ambulatory care physicians among each other (44.2%) and with hospitals (41.9%). In addition, big subgroup differences were seen, especially for income and health literacy. Of the participants in the lower income group, 37.2% reported a (very) strong financial burden due to out-of-pocket payments (vs. 20.7%). People with limited health literacy (52.1%) assessed the access to care generally as not being good, and they perceived greater quality differences and needs for reform, compared to their counterparts. For instance, 36.6% had experienced discrimination in the previous year (vs. 19.9%). DiscussionThe survey results provide a comprehensive picture of Germany's health system from the population perspective. In some areas, previous findings were confirmed (e.g., a lack of coordination between providers). Other results expand existing knowledge (e.g., the role of health literacy in health care provision) or raise new questions (e.g., the difference between the subjectively assessed burden from out-of-pocket payments and the objective measures currently used). The great differences between subgroups are a call to action on the level of both politics and practice to better consider the individual's needs in order to make health better for everyone. Further research could provide deeper insights in this regard. ConclusionStrengthening the population perspective in HSPA allows for a better understanding and evaluation of health systems and, in particular, helps to identify areas for improvement in patient-centered care.

BackgroundThe Health in Prisons European Database (HIPED) aims to periodically collect data on prison health systems, services and health outcomes to inform equivalence of care for people living in prison. Recognized as the United Nations hub for health data in prisons, HIPED lacked an established framework to define its domains and indicators to measure progress. Therefore, the objectives of developing this framework were to inform surveillance systems at prison, local, regional, national and international level and to use it to guide improvement of prison health systems and cross-country comparison.MethodsThe framework was conceptualized through identification of policy priorities and existing frameworks, notably the WHO Health System Framework. A consultation with a range of WHO stakeholders was conducted evaluating the components of existing frameworks and their relevance to the prison health context, as well as identifying areas needing further emphasis. The final stage identified the structure of the framework.ResultsThe framework consists of three main building blocks. The first captures the system-level aspects of prison health care (or inputs) whilst the second captures delivery aspects of prison health care (or outputs). These building blocks are in turn modified by two influencing factors. Ultimately, all these elements impact on the third building block, health outcomes. In addition, two cross-cutting principles associated with all these building blocks and influencing factors are included.ConclusionsA new framework for assessing prison health system performance is now available, crucial to support informed decision-making for policy design and implementation for prisons and other places of detention.

Women with disabilities face higher risks of maternal morbidity and mortality, particularly in low- and middle-income countries like sub-Saharan Africa (SSA). Barriers such as socio-cultural stigma, health facility inaccessibility, and lack of supportive healthcare contribute to their limited access to maternity services, exacerbating their vulnerability. Despite significant research on maternal health in SSA, studies focusing on women with disabilities remain scarce, and current healthcare services often fail to accommodate their needs. This scoping review explores barriers to maternity care accessibility among women with disabilities in SSA, highlighting gaps in research necessary for developing interventions that align with global health goals, such as reducing maternal mortality by 2030. This current scoping review was informed by the methodological framework proposed by Arksey and O'Malley. Exploratory searches were conducted in JSTOR, PubMed, PsycINFO, African Journals Online, and Web of Science, etc., to identify studies conducted in SSA that focused on access, utilisation, and barriers to maternity services such as antenatal care (ANC) visits, facility delivery, and postnatal care visits among women with disabilities in SSA since the introduction of the sustainable development goals (SDGs). Twenty-two studies were included, spanning from June 1st 2016 to 30th May 2024. Of the 22 eligible studies out of 416 identified studies published between 2016 and 2024, 20 were conducted across eight countries in SSA. Eight studies employed quantitative methods, 12 used qualitative approaches, and two used mixed-methods analysis. These studies focused on all or either of the maternal health services measured in this study, which include antenatal care (ANC), facility delivery, and postnatal care (PNC) among women with disabilities. Findings indicate that, despite a strong desire for ANC, physical impairments, mobility issues, and unsupportive infrastructure hinder access. Although facility deliveries were high, support gaps and negative provider attitudes were common. The WHO health system framework categorisation shows that more barriers are within the service delivery and health workforce domains. The review found limited studies on access to and utilisation of ANC, facility delivery, and PNC for women with disabilities in SSA. This gap restricts understanding of the issue and hampers interventions, increasing risks to maternal and child health. Urgent research and interventions are needed to address equity challenges in these services for disabled women in SSA.

Despite high health expenditures, Lesotho had some of the world's worst health indicators between 2000 and 2014. Official development assistance tripled from $37 to $107 million. PEPFAR funding rose from $3.8 to $32.4 million. Yet, deaths from TB, HIV, infant mortality, and maternal mortality remained unchanged. Lesotho had declining health outcomes amidst increased disease-focused financing and several large infrastructure projects. A World Bank loan financed the state-of-the-art Mamohato Hospital, and the U.S.-supported $362.5 million Millennium Challenge Corporation Project supported primary and secondary health infrastructure. This analysis uses the WHO Health Systems Framework to explore the unintended consequences of health financing on Lesotho's health outcomes. The WHO Health Systems Framework can be used to optimize health financing through investments in health service delivery, health workforce, health information, essential medicines, leadership, and equitable financial strategies. This approach can support governments to achieve universal health coverage and develop comprehensive health systems.

Radiotherapy, a critical component of cancer treatment, faces significant challenges in Gauteng, South Africa. These disparities hinder the achievement of Sustainable Development Goal 3, primarily due to systemic issues, socioeconomic barriers, and limitations within the health system. This article presents the House framework, designed to enhance access to radiotherapy services by integrating the WHO Health Systems framework with the dimensions of access proposed by Penchansky and Thomas. The framework is visually represented as a house, with Policy & Governance as the foundation, WHO building blocks as pillars, and Equitable Cancer Care and Improved Outcomes as the roof. A mixed-methods approach was utilized, combining quantitative data from radiotherapy facilities and qualitative insights from healthcare professionals to identify barriers and potential solutions. Findings indicate significant disparities in resource distribution and accessibility between public and private institutions, compounded by socioeconomic factors like transport costs and lack of awareness. The article discusses innovative proposed framework using the 5As of access as potential solutions. The House framework serves as a valuable tool for policymakers and healthcare providers aiming to improve radiotherapy access and promote equitable cancer care in Gauteng, ultimately working towards reducing disparities in cancer outcomes.

Background/Objectives: This study identifies barriers to maternal and child healthcare access in Afghanistan under the Taliban and proposes solutions using the WHO Health System Building Blocks Framework. Methods: Midwives and mothers were recruited via chain-referral sampling. After obtaining IRB and the participants' informed consent, in-depth virtual interviews, guided by Social Cognitive Theory, were recorded, transcribed, and analyzed using content analysis in MAXQDA 2020. Results: Data analysis revealed four primary consequences of the political unrest in Afghanistan that have exacerbated barriers to accessing maternal and child healthcare: (a) Taliban-imposed restrictions on women's education and mobility, reducing female healthcare providers and limiting mothers' access to care; (b) increased poverty, preventing women from attending perinatal visits due to out-of-pocket costs; (c) the deterioration of healthcare services, including medicine shortages, weakened health financing due to donor withdrawals, lack of insurance, and poor governance; and (d) the increased perpetuation of misinformation and harmful practices, such as the use of clergymen for medical advice instead of doctors. Using the WHO Health Systems Framework, we recommend solutions that address issues in service delivery, health workforce, health information systems, access to essential medicines, financing, and governance. Conclusions: This is the first qualitative study capturing Afghan mothers' and healthcare providers' experiences under Taliban rule. Our findings can inform international efforts to advocate for women's healthcare and education rights and guide global aid programs in strengthening Afghanistan's healthcare system in alignment with Sustainable Development Goal 5.

ObjectiveThe COVID-19 pandemic exposed significant gaps in Iran’s and other health systems’ risk communication. The accompanying infodemic undermined policy responses, amplified distrust in government and reduced adherence to public health...

BackgroundThe use of herbal medicines in developing countries has been increasing over the years. In Ghana, since 2011, the government has been piloting the integration of herbal medicine in 17 public hospitals. However, the strengths and the weaknesses of the integration have not been fully explored. The current study sought to examine the strengths and weaknesses of the integration using the WHO health systems framework.MethodsThis study used qualitative, exploratory study design involving interviews of 25 key informants. The respondents had experience in conducting herbal medicine research. Two key informants were medical herbalists practising in hospitals piloting the integration in Ghana. We used Framework analysis to identify the perspectives of key informants in regards to the integration. ResultsKey informants mostly support the integration although some noted that the government needs to support scale-up in other public hospitals. Among the strengths cited were the employment of medical herbalists, utilization of traditional knowledge, research opportunities, and efficient service delivery by restricting the prescription and use of fake herbal medicine. The weaknesses were the lack of government policies on implementing the integration, financial challenges because the National Health Insurance Scheme does not cover herbal medicine, poor advocacy and research opportunities, and lack of training of conventional health practitioners in herbal medicine.ConclusionsResearchers view the integration of the two healthcare systems–biomedicine, and herbal medicine– positively but it has challenges that need to be addressed. The integration could offer more opportunities for researching into herbal medicine. More training for conventional health professionals in herbal medicine could increase the chances of better coordination between the two units. Additionally, strong advocacy and publicity is needed to educate more people on the integration and the utilization of the services.

The aim of this chapter is to provide an overview of the Qatari health system’s transformation and to assess its performance using the World Health Organization’s (WHO) Health Systems Framework (WHO 2007). As shown in Fig. 7.1, in the WHO Framework a health system is conceptualized as six building blocks that include governance; financing; workforce; service delivery; health information systems; and medical products, vaccines, and technologies. In a well-functioning health system, these components are effectively built to produce universal healthcare coverage that provides access to high quality and safe services to produce improved population health outcomes, financial protection against the costs of ill-health, satisfactory responsiveness to the legitimate expectations of the population, and improved efficiency throughout the health system. This chapter discusses Qatar’s health system using the WHO Health Systems Framework and assesses achievements in relation to the six building blocks and system outputs.

Strategies for enhancing vaccine uptake among children under two years of age in low and middle-income countries (LMICs): A scoping review.