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.
Highlights
Given that health systems face shocks and chronic structural, governance and leadership problems, as well as multiple community and staff demands, Gilson et al (2017) and Barasa et al (2017a,b) argue for the exploration of health system resilience using an ‘everyday resilience’ lens (Gilson et al, 2017; Barasa et al, 2017a, 2018)
We investigate the strategies adopted by health managers, and through our analysis, we seek to strengthen the understanding of everyday resilience and the capacities required to build everyday resilience, an important endeavour given the wide recognition of resilience as a legitimate health system objective (Abimbola et al, 2019; Kieny et al, 2017)
We begin by describing the stressors experienced by health managers at different levels of the health system and, we present the strategies in response to these stressors
Summary
Given that health systems face shocks and chronic structural, governance and leadership problems, as well as multiple community and staff demands, Gilson et al (2017) and Barasa et al (2017a,b) argue for the exploration of health system resilience using an ‘everyday resilience’ lens (Gilson et al, 2017; Barasa et al, 2017a, 2018). Gilson and colleagues define everyday resilience as ‘the maintenance of positive adjustment under challenging conditions such that the organisation emerges from those conditions strengthened and more resourceful’ They provide some insights on how ‘everyday resilience’ might be nurtured drawing on concepts from vulnerability reduction programmes and organizational theory (Gilson et al, 2017; Lengnick-Hall and Beck, 2005; Lengnick-Hall et al, 2011; Bene et al, 2012). Peripheral facility arranged different clinics to run on different days maximizing use of the available space due to infrastructure challenges These responses as explained by a peripheral facility manager and hospital manager seemed to be motivated by a sense of community with the patients:. Hospital managers attempted to balance between the nurses’ concerns and the need to continue service delivery by listening to the nurses’ grievances, with the promise of taking the matter forward to decision-makers, but the managers appealed to the nurses’ sense of duty to continue working despite the challenges with understaffing
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