Systems Responsiveness Research Articles

Rethinking Health Systems Responsiveness in Low- and Middle-Income Countries: Validation Study.

Health systems responsiveness (HSR) is the ability of systems to respond to legitimate non-health expectations of the population. The concept of HSR by the World Health Organization (WHO) includes respect for dignity, individual autonomy, confidentiality, prompt attention to care, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. The WHO tool is applied globally to assess HSR in low, middle, and high-income countries. We have revised the conceptual framework of HSR following a rigorous systematic review and made it specific for low- and middle-income countries (L&MICs). This study is designed to (1) run the Delphi technique to validate the upgraded conceptual framework of HSR, (2) modify and upgrade the WHO measurement tool for assessing HSR in the context of L&MICs, and (3) determine the validity of the upgraded HSR measurement tool by pilot testing it in Pakistan. The Delphi technique will be run by inviting global public health experts to provide suggestions on the domains and subdomains of HSR specific to L&MICs. Cronbach ɑ will be calculated to determine internal consistency among the participants. The upgraded HSR conceptual framework will serve as a beacon to modify the measurement tool by the research team, which will be reviewed by subject experts for refinement. The modified tool will be pilot-tested by administering it to 1128 participants from primary, secondary, and tertiary care hospitals in Rawalpindi district, Pakistan. Additionally, an "observation checklist" of HSR domains and subdomains will be completed to objectively measure the state of HSR across health care facilities. HSR assessment will be further strengthened by incorporating the perspective of hospital managers, service providers, and policy makers (ie, the supply side) as well as community leaders and representatives (ie, the demand side) through qualitative interviews. The study was started in January 2024 and will continue until February 2025. A multidimensional approach will yield significant quantifiable information on HSR from the demand and supply sides of L&MICs. This study will provide a conceptual understanding of HSR and a corresponding measurement tool specific to L&MICs. It will contribute to global public health literature and provide a snapshot of HSR in Rawalpindi district, Pakistan, with concrete action points for policy makers. DERR1-10.2196/59836.

Exploring how non-clinical factors in childbirth care shape users’ experiences in public health facilities in rural Chiapas, Mexico: a qualitative study using the WHO health systems responsiveness framework

IntroductionMany Mexicans face barriers to receive delivery care from qualified professionals, especially indigenous and poor sectors of the population, which represent most of the population in the state of Chiapas. When access to institutional delivery care is an option, experiences with childbirth care are often poor. This underscores the need for evidence to improve the quality of services from the user’s perspective. The present study was conceived with the objective of understanding how non-clinical aspects of care shape women’s birthing experiences in public health institutions in Chiapas.MethodsWe conducted an exploratory qualitative study. Data collection consisted in 20 semi-structured interviews to women who had delivered in a public health facility in Chiapas during the last six months prior to the interview. For the design of the interview guide we used the WHO health system responsiveness framework, which focus on the performance of the health system in terms of the extent to which it delivers services according to the “universally legitimate expectations of individuals” and focuses on the non-financial and non-clinical qualities of care. The resulting data were analyzed using thematic analysis methodology.ResultsWe identified a total of 16 themes from the data, framed in eight categories which followed the eight domains of the WHO health systems responsiveness framework: Choice of the provider and the facility, prompt attention, quality of basic amenities, access to social support, respectful treatment, privacy, involvement in decisions, and communication. We shed light on the barriers women face in receiving prompt care, aspects of health facilities that impact women’s comfort, the relevance of being provided with adequate food and drink during institutional delivery, how accompaniment contributes positively to the birthing experience, the aspects of childbirth that women find important to decide on, and how providers’ interpersonal behaviors affect the birthing experience.ConclusionsWe have identified non-clinical aspects of childbirth care that are important to the user experience and that are not being satisfactorily addressed by public health institutions in Chiapas. This evidence constitutes a necessary first step towards the design of strategies to improve the responsiveness of the Chiapas health system in childbirth care.

Health systems responsiveness at a leading private hospital in Sri Lanka

Responsiveness is identified as a key goal of the health systems by the World Health Organization. There are eight elements in responsiveness namely, Dignity, Confidentiality, Autonomy, Communication, Prompt attention, Basic amenities, Access to social support, and choice of provider. The objective of this report was to assess the responsiveness of healthcare delivery in a leading private hospital in Colombo, Sri Lanka. Observations (participant and non-participant) and informal discussions were used to collect the data. Indicators were developed to assess the responsiveness and a 04-point Likert Scale was used as the scoring system. According to the result, all eight elements of responsiveness were in the range of 79% to 80% and can be considered “excellent”. Recommendations were given for further improvement of selected elements of responsiveness.

Governance in Crises: Ideologies, Political Systems, and Pandemic Responsiveness

Why are some governments more active in responding to the COVID-19 pandemic than others? Based on ample literature on the political determinants of pandemic responses, this paper seeks to understand the question with an interactive framework of ideology strategies and their political conditions. Resorting to a dataset of 155 countries and their COVID responses in the year of 2020 (before the world enters into the vaccination phase in 2021), we find that government COVID responsiveness is associated with the interactions between the specific character of ideological legitimation strategy (socialist or conservative) invoked by the government and the political system (democratic or decentralized) where it operates. Overall, this research contributes to a multifactor understanding of the political explanations for government responses to crises. It also provides insight for policy choices and designs that are more suitable for the leadership and political contexts.

Responsiveness of the healthcare system in the Kingdom of Saudi Arabia: evidence from a nationally representative survey

BackgroundResponsiveness is one of the widely used metrics in assessing the performance of healthcare systems. An analysis of the determinants of health care demand and supply and how the Saudi health system responds to the needs of patients (inpatient and outpatient) is needed; hence the need for this study.MethodsWe analysed data from the Saudi Health Systems Responsiveness survey – a nationally representative survey of 10,000 households interviewed in 2017. Using this dataset, we descriptively analysed the level of responsiveness of inpatient and outpatient services (using the standard World Health Organization (WHO) responsiveness dimensions). Based on a logit modelling approach, the relationship between responsiveness and its key determinants was analysed in terms of healthcare demand and supply.ResultsOver four fifths of respondents are satisfied with the level of inpatient and outpatient responsiveness. Furthermore, we find that those in bad health tend to show lower levels of satisfaction with inpatient and outpatient care. We also find some evidence that age, gender, and to some extent nationality act as correlates of health system responsiveness. Specifically, we find evidence that Saudi nationals are less satisfied with health services compared to foreign nationals.ConclusionBased on these findings improving the responsiveness of public healthcare facilities would need to be prioritized. Focusing on patients in worse health and lower socio-economic status should also be one of the main priorities.

Health systems responsiveness towards the Mentor Mother Program for preventing mother-to-child transmission of HIV in military hospitals.

This study explored health systems responsiveness towards the Mentor Mother Program for PMTCT in the Nigeria Department of Defence hospitals. Factors affecting quality service were also highlighted, which gave helpful insights into the strategies employed by stakeholders to ensure that health systems responsiveness was propagated responsibly. An exploratory qualitative interview study. Six semistructured interviews were conducted with six key informants (three doctors and three nurses) and one focus group session with six Mentor Mothers. Open coding of data was done to formulate themes and subthemes. Thematic analysis was adopted for analysis. Four themes emerged-Service Quality, Basic Amenities, Patient-oriented Strategies and Factors affecting service Quality. These showcased the nonmedical components of health systems responsiveness and accentuated how well they were utilized to achieve health systems responsiveness.

Inequity in the Distribution of Non-Communicable Disease Multimorbidity in Adults in South Africa: An Analysis of Prevalence and Patterns.

Objectives: The present study examined the prevalence and patterns of non-communicable disease multimorbidity by wealth quintile among adults in South Africa. Methods: The South African National Income Dynamics Study Wave 5 was conducted in 2017 to examine the livelihoods of individuals and households. We analysed data in people aged 15 years and older (N = 27,042), including self-reported diagnosis of diabetes, stroke, heart disease and anthropometric measurements. Logistic regression and latent class analysis were used to analyse factors associated with multimorbidity and common disease patterns. Results: Multimorbidity was present in 2.7% of participants. Multimorbidity was associated with increasing age, belonging to the wealthiest quintile group, increasing body mass index and being a current smoker. Having secondary education was protective against multimorbidity. Three disease classes of multimorbidity were identified: Diabetes and Hypertension; Heart Disease and Hypertension; and Stroke and Hypertension. Conclusion: Urgent reforms are required to improve health systems responsiveness to mitigate inequity in multimorbidity patterns in the adult population of South Africa as a result of income inequality.

The predictors of COVID-19 mortality among health systems parameters: an ecological study across 203 countries

BackgroundHealth systems responsiveness is the key to addressing infectious disease threats such as pandemics. The paper outlines an assessment of health systems resilience by exploring the association of health systems and Global Health Security (GHS) parameters with case load and mortality resulting from COVID-19 across 203 countries using an ecological design.MethodologyCorrelation analysis was performed to assess the relationship of each of the indicators with COVID 19 cases and deaths per million population. Stepwise multiple regression models were developed to determine the predictors of COVID-19 cumulative cases and deaths per million population separately.ResultsGlobal health security indicators seemed to have a strong association when analyzed individually but those did not necessarily translate into less burden of cases or deaths in the multivariable analysis. The predictors of cumulative deaths per million population included general government expenditure on health as a proportion of general government expenditure, responsiveness of the system to prevent the emergence and release of pathogens and governance related voice and accountability.ConclusionTo conclude, health financing parameters and preventive activities with regard to emergence of pathogens were better predictors of cumulative COVID-19 cases and deaths per million population compared to other health systems and global health security indicators.

Health system responsiveness and associated factors among outpatients in primary health care facilities in Ethiopia

BackgroundHealth system responsiveness is defined as the outcome of designing health facility relationships so that they are familiar and responsive to patients’ universally legitimate expectations. Even though different strategies have been implemented to measure responsiveness, only limited evidence exists in Sub-Saharan Africa. In Ethiopia, information about health system responsiveness among outpatients is limited. Assessing responsiveness could help facilities in improving service delivery based on patient expectations.ObjectiveThe study aimed to assess health system responsiveness and associated factors among outpatients in primary health care facilities, Asagirt District, Ethiopia, 2021.MethodsFacility-based cross-sectional quantitative study was implemented between March 30 and April 30/2021. A systematic random sampling technique was employed to select 423 participants, and interviewer-administered data were collected using structured and pretested questionnaires. Both bivariable and multivariable logistic regressions were employed to identify factors associated with health system responsiveness. Adjusted Odds Ratio with their corresponding 95% CI was used to declare factors associated with health system responsiveness. A p-value less than 0.05 was used to declare significant statistical variables.ResultsThe overall health system responsiveness performance was 66.2% (95% CI: 61.4—70.7). Confidentiality and dignity were the highest responsive domains. Health system responsiveness was higher among satisfied patients (AOR: 9.9, 95% CI: 5.11–19.46), utilized private clinics (AOR: 8.8, 95% CI: 4.32–18.25), and no transport payment (AOR: 1.7, 95% CI: 1.03–2.92) in the study setting.ConclusionOverall, health system responsiveness performance was higher than a case-specific study in Ethiopia. To improve the health systems responsiveness and potentially fulfil patients’ legitimate expectations, we need to facilitate informed treatment choice, provide reasonable care within a reasonable time frame, and give patients the option of consulting a specialist. Aside from that, enhancing patient satisfaction, using input from service users, Collaboration, and exchanging experiences between public and private facilities will be important interventions to improve HSR performance.

Evaluation of primary care responsiveness by people with mental illness in Spain

BackgroundThe health system responsiveness is a concept developed by the World Health Organization that measures patients’ expectations for the non-medical care they receive. The aim of this study is to assess primary care responsiveness as seen by people with mental illness and to analyse the factors associated with poor responsiveness.MethodsCross-sectional descriptive study on 426 people with mental illness who had attended primary care consultations at least once in the previous 12 months. The responsiveness of the health system was determined through the short questionnaire “Multi-country Survey Study on Health and Health Systems Responsiveness”. Differences in responsiveness by sociodemographic characteristics were compared through the Chi-squared test. Logistic regression identified the factors associated with poor responsiveness.ResultsOverall responsiveness was measured as good by 77.4% of patients, being this probability higher in the domains: dignity, confidentiality, and communication. The most valued domains by people with mental illness were prompt attention (42.4%), dignity (30.1%), and communication (17%). Only prompt attention scored high importance and poor responsiveness. In patients with an income lower than 900 euros per month and low level of studies, the probability of poor confidentiality responsiveness was multiplied by 3 and 2.7 respectively.ConclusionsPeople with mental illness perceive good responsiveness from primary care in terms of dignity, confidentiality, and communication. Prompt attention, as the domain of greatest importance and worst valuation, should be prioritised through the implementation of organisational measures in health centres to reduce waiting times, especially in urban areas.

Health Systems Responsiveness in Addressing Indigenous Residents' Health and Mental Health Needs Following the 2016 Horse River Wildfire in Northern Alberta, Canada: Perspectives From Health Service Providers.

Following the 2016 Horse River Wildfire in northern Alberta, the provincial health authority, the ministry of health, non-profit and charitable organizations, and regional community-based service agencies mobilized to address the growing health and mental health concerns among Indigenous residents and communities through the provision of services and supports. Among the communities and residents that experienced significant devastation and loss were First Nation and Métis residents in the region. Provincial and local funding was allocated to new recovery positions and to support pre-existing health and social programs. The objective of this research was to qualitatively describe the health systems response to the health impacts following the wildfire from the perspective of service providers who were directly responsible for delivering or organizing health and mental wellness services and supports to Indigenous residents. Semi-structured qualitative interviews were conducted with 15 Indigenous and 10 non-Indigenous service providers from the Regional Municipality of Wood Buffalo (RMWB). Interviews were transcribed verbatim and a constant comparative analysis method was used to identify themes. Following service provider interviews, a supplemental document review was completed to provide background and context for the qualitative findings from interviews. The document review allowed for a better understanding of the health systems response at a systems level following the wildfire. Triangulation of semi-structured interviews and organization report documents confirmed our findings. The conceptual framework by Mirzoev and Kane for understanding health systems responsiveness guided our data interpretation. Our findings were divided into three themes (1) service provision in response to Indigenous mental health concerns (2) gaps in Indigenous health-related services post-wildfire and (3) adopting a health equity lens in post-disaster recovery. The knowledge gained from this research can help inform future emergency management and assist policy and decision makers with culturally safe and responsive recovery planning. Future recovery and response efforts should consider identifying and addressing underlying health, mental health, and emotional concerns in order to be more effective in assisting with healing for Indigenous communities following a public health emergency such as a wildfire disaster.

Lived Experiences and Perceptions of Childbirth among Pastoralist Women in North-Eastern Ethiopia: A Multimethod Qualitative Analysis to the WHO Health Systems Responsiveness Framework.

Maternity should be a time of hope and joy. However, for women in pastoralist communities in Ethiopia, the reality of motherhood is often grim. This problem is creating striking disparities of skilled birth uptake among the agrarian and pastoral communities in Ethiopia. So far, the depth and effects of the problem are not well understood. This study is intended to fill this research gap by exploring mothers’ lived experiences and perceptions during skilled birthing care in hard-to-reach communities of Ethiopia. An Interpretive Phenomenological approach was employed to analyse the exploratory data. Four key informant interviews, six in-depth interviews, six focus group discussions, and twelve focused observations were held. WHO responsiveness domains formed the basis for coding and analysis: dignity, autonomy, choice of provider, prompt attention, communication, social support, confidentiality, and quality of basic amenities. The skilled birthing experience of nomadic mothers is permeated by a deep-rooted and hidden perceived neglect, which constitutes serious challenges to the health system. Mothers’ experiences reflect not only the poor skilled delivery uptake, but also how health system practitioners are ignorant of Afar women’s way of life, their living contexts, and their values and beliefs regarding giving birth. Three major themes emerged from data analysis: bad staff attitude, lack of culturally acceptable care, and absence of social support. Nomadic mothers require health systems that are responsive and adaptable to their needs, beliefs, and values. The abuse and disrespect they experience from providers deter nomadic women from seeking skilled birthing care. Women’s right to dignified, respectful, skilled delivery care requires the promotion of woman-centred care in a culturally appropriate manner. Skilled birthing care providers should be cognizant of the WHO responsiveness domains to ensure the provision of culturally sensitive birthing care.

Epidemiological transition and the dual burden of communicable and noncommunicable diseases in Zimbabwe

Background: The epidemiological transition model, coined by Abdel Omran in 1971, building on the demographic transition theory developed by Frank Notestein in 1945, has been largely credited for describing epidemiological situations both globally and nationally in many parts of the world. However, owing to its origins in the United States of America (USA), scholars critique the model's applicability to various geographical, socioeconomic, and epidemiological contexts, which are diversely different from the USA and vary from region to region. It was imperative to test the applicability of this model in sub-Saharan Africa (SSA), particularly Zimbabwe to ascertain versatility in describing epidemiological transitions, predicting population health status and whether the assumption of a shift from communicable diseases (CDs) to noncommunicable diseases (NCDs) could be confirmed in a low-income developing nation focusing on Zimbabwe. Methods: The study was a retrospective document review case study, using the existing framework of the epidemiological transition model, as a guiding principle, applying the model to describe the demographic and epidemiological circumstances prevailing within Zimbabwe. The researcher reviewed, compared, analyzed, and described the existing literature on population dynamics and epidemiological profile of the country for the period 1990–2020. Results: The epidemiological transition model attempts to describe the changes in epidemiological circumstances both at national and global scales. The model presumes a shift in CDs to NCDs. However, many scholars question the applicability of the model to diverse contexts, particularly within the SSA context. The Zimbabwean case was considered in light to its rising population growth, dual burden characterized by a high burden of communicable and rising NCDs. Findings from this study indicate that NCDs are on the rise in Zimbabwe. However, owing to a high burden of CDs, a dual disease burden model is the best fit to explain the epidemiological transition currently obtaining within Zimbabwe. Conclusions: Consequentially, funding streams targeting CDs should take heed of the currently obtaining epidemiological situation in the country and respond by challenging funding to public health interventions with a view to address the rising NCDs. Further, public health authorities should craft Public health policies that create supporting environments conducive for the populace to fight NCDs. Informed by the Ottawa charter, reorientation of health services to ensure more health systems responsiveness in the face of emerging NCDs is imperative. In addition, developing interpersonal skills for individuals to be able to act against NCD's risk behaviors and factors is key; at the same time, strengthening community action by capacitating community health workers to address risk behaviors and factors associated with NCDs at community level is imperative. Finally, the inadequacy of the epidemiological transition model inadvertently challenges epidemiologists to step up efforts to review, refine, and extend the model to suit SSA countries like Zimbabwe and elsewhere countries in similar circumstances.

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.

Background: Despite governments striving for responsive health systems and the implementation of mechanisms to foster better citizen feedback and strengthen accountability and stewardship, these mechanisms do not always function in effective, equitable, or efficient ways. There is also limited evidence that maps the diverse array of responsiveness mechanisms coherently across a particular health system, especially in low- and middle-income country (LMIC) contexts. Methods: This scoping review presents a cross-sectional ‘map’ of types of health system responsiveness mechanisms; the regulatory environment; and evidence available about these; and assesses what is known about their functionality in a particular local South African health system; the Western Cape (WC) province. Multiple forms of indexed and grey literature were synthesized to provide a contextualized understanding of current ‘formal’ responsiveness mechanisms mandated in national and provincial policies and guidelines (n = 379). Various forms of secondary analysis were applied across quantitative and qualitative data, including thematic and time-series analyses. An expert checking process was conducted, with three local field experts, as a final step to check the veracity of the analytics and conclusions made. Results: National, provincial and district policies make provision for health system responsiveness, including varied mechanisms intended to foster public feedback. However, while some are shown to be functioning and effective, there are major barriers faced by all, such as resource and capacity constraints, and a lack of clarity about roles and responsibilities. Most mechanisms exist in isolation, failing to feed into an overarching strategy for improved responsiveness. Conclusion: The lack of synergy between mechanisms or analysis of varied forms of feedback is a missed opportunity. Decision-makers are unable to see trends or gaps in the flow of feedback, check whether all voices are heard or fully understand whether/how systemic response occurs. Urgent health system work lies in the research of macro ‘whole’ systems responsiveness (levels, development, trends).

Protocol for a realist synthesis of health systems responsiveness in low-income and middle-income countries

IntroductionHealth systems responsiveness is a key objective of any health system, yet it is the least studied of all objectives particularly in low-income and middle-income countries. Research on health systems...

Elderly Fall Detection With Vital Signs Monitoring Using CW Doppler Radar

Falling is the main cause of disability and fatality of elderly. In this work we used a 24 GHz continuous-wave Doppler radar to develop a low price and a highly accurate fall detection system aiming at observing indoor human activities and detecting fall accidents, thus limiting the consequences of undiscovered falls. A radar sensor was selected due to its capability of tracking human motions, passing through obstacles, and not being affected by light conditions. The sampled signals from the sensor were subjected to different feature engineering and machine learning techniques in order to determine the most characteristic features. Consequently, we were able to extract nontraditional radar features. Moreover, to improve the systems responsiveness and to lessen the hardware constraints, we added an additional pre-processing step to detect major physical activities with O(N) complexity. As part of fall detection, we also implemented vital signs monitoring to reduce false positives and to alert concerned authorities if necessary. Experimental results show that our proposed system has 90% recall rate for fall detection and 97.7% and 95.3% accuracy rates for respiration and heartbeat detection respectively.

Exploring patient-provider interactions and the health system\u2019s responsiveness to street-connected children and youth in Kenya: a qualitative study

BackgroundIn Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other.MethodsThis qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness.ResultsThrough three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness.ConclusionsThis study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY’s experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions.

‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa

IntroductionUniversal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that...

The effect of supply chain responsiveness on customer development

PurposeThe study examines how supply chain responsiveness (logistics process responsiveness, operations systems responsiveness and supplier network responsiveness) impacts the ability of firms to attract, satisfy and retain customers.Design/methodology/approachUsing a quantitative approach, a total of 250 questionnaires were distributed to firms in the Kumasi metropolis in the Ashanti Region of Ghana, with 100 useable responses retrieved. The effect of supply chain responsiveness on customer development was analysed using partial least squares structural equation modelling.FindingsThe findings showed that operations systems responsiveness and supplier network responsiveness drive the logistics systems responsiveness of firms as hypothesized. It was also revealed that operations systems responsiveness and logistics process responsiveness enhanced customer development, but supplier network responsiveness did not. Logistics process responsiveness additionally partially mediated the effect of operations systems responsiveness on customer development.Originality/valueTo the best of the researchers' knowledge, no previous studies have empirically examined interrelationships between the dimensions of supply chain responsiveness. Additionally, no previous study has examined the effect of supply chain responsiveness on customer development.

Realist evaluation to improve health systems responsiveness to neglected health needs of vulnerable groups in Ghana and Vietnam: Study protocol.

BackgroundSocio-economic growth in many low and middle-income countries has resulted in more available, though not equitably accessible, healthcare. Such growth has also increased demands from citizens for their health systems to be more responsive to their needs. This paper shares a protocol for the RESPONSE study which aims to understand, co-produce, implement and evaluate context-sensitive interventions to improve health systems responsiveness to health needs of vulnerable groups in Ghana and Vietnam.MethodsWe will use a realist mixed-methods theory-driven case study design, combining quantitative (household survey, secondary analysis of facility data) and qualitative (in-depth interviews, focus groups, observations and document and literature review) methods. Data will be analysed retroductively. The study will comprise three Phases. In Phase 1, we will understand actors’ expectations of responsive health systems, identify key priorities for interventions, and using evidence from a realist synthesis we will develop an initial theory and generate a baseline data. In Phase 2, we will co-produce jointly with key actors, the context-sensitive interventions to improve health systems responsiveness. The interventions will seek to improve internal (i.e. intra-system) and external (i.e. people-systems) interactions through participatory workshops. In Phase 3, we will implement and evaluate the interventions by testing and refining our initial theory through comparing the intended design to the interventions’ actual performance.DiscussionThe study’s key outcomes will be: (1) improved health systems responsiveness, contributing to improved health services and ultimately health outcomes in Ghana and Vietnam and (2) an empirically-grounded and theoretically-informed model of complex contexts-mechanisms-outcomes relations, together with transferable best practices for scalability and generalisability. Decision-makers across different levels will be engaged throughout. Capacity strengthening will be underpinned by in-depth understanding of capacity needs and assets of each partner team, and will aim to strengthen individual, organisational and system level capacities.