Advancing the application of systems thinking in health: analysing the contextual and social network factors influencing the use of sustainability indicators in a health system – a comparative study in Nepal and Somaliland

Health Research Policy and Systems

Susan Girois³  Ali Jama²  Dorothy Boggs⁴  Raju Palanchowke⁵  Jennifer Palmer¹  Karl Blanchet¹ 

[1] International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK;Disability Action Network, Hargeisa, Somaliland;Norfolk Community Services Board, 6401 Tidewater Dr, Norfolk, VA 23509, USA;Handicap International, 9 Rushworth Street, London SE1, UK;Handicap International, Narayan Gopal Chowk Sallaghari, PO Box 10179, Kathmandu, Nepal

关键词: Systems thinking;    Sustainability;    Somaliland;    Social network analysis;    Physical rehabilitation;    Nepal;    Health systems;    Disability;   

Others  :  1177329
DOI  :  10.1186/1478-4505-12-46

 received in 2013-12-05, accepted in 2014-06-10,  发布年份 2014

【 摘 要 】

Background

Health systems strengthening is becoming a key component of development agendas for low-income countries worldwide. Systems thinking emphasizes the role of diverse stakeholders in designing solutions to system problems, including sustainability. The objective of this paper is to compare the definition and use of sustainability indicators developed through the Sustainability Analysis Process in two rehabilitation sectors, one in Nepal and one in Somaliland, and analyse the contextual factors (including the characteristics of system stakeholder networks) influencing the use of sustainability data.

Methods

Using the Sustainability Analysis Process, participants collectively clarified the boundaries of their respective systems, defined sustainability, and identified sustainability indicators. Baseline indicator data was gathered, where possible, and then researched again 2 years later. As part of the exercise, system stakeholder networks were mapped at baseline and at the 2-year follow-up. We compared stakeholder networks and interrelationships with baseline and 2-year progress toward self-defined sustainability goals. Using in-depth interviews and observations, additional contextual factors affecting the use of sustainability data were identified.

Results

Differences in the selection of sustainability indicators selected by local stakeholders from Nepal and Somaliland reflected differences in the governance and structure of the present rehabilitation system. At 2 years, differences in the structure of social networks were more marked. In Nepal, the system stakeholder network had become more dense and decentralized. Financial support by an international organization facilitated advancement toward self-identified sustainability goals. In Somaliland, the small, centralised stakeholder network suffered a critical rupture between the system’s two main information brokers due to competing priorities and withdrawal of international support to one of these. Progress toward self-defined sustainability was nil.

Conclusions

The structure of the rehabilitation system stakeholder network characteristics in Nepal and Somaliland evolved over time and helped understand the changing nature of relationships between actors and their capacity to work as a system rather than a sum of actors. Creating consensus on a common vision of sustainability requires additional system-level interventions such as identification of and support to stakeholders who promote systems thinking above individual interests.

【 授权许可】

   
2014 Blanchet et al.; licensee BioMed Central Ltd.

【 图 表 】

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