Mapping of health system functions to strengthen priority programs. The case of maternal health in Mexico

BMC Public Health

Research Article

Paola Sesia¹  Victor Becerril²  Miguel A González-Block²  Mariel Rouvier² 

[1] Centro de Investigaciones y Estudios Superiores en Antropología Social, Oaxaca, Mexico;National Institute of Public Health, Av. Universidad 655 Col. Santa María Ahuacatitlán., 62100, Cuernavaca, Morelos, Mexico;

关键词: Maternal Health;    Maternal Mortality;    Tacit Knowledge;    Health System Strengthen;    Capacity Strengthen;   

DOI  :  10.1186/1471-2458-11-164

 received in 2010-08-27, accepted in 2011-03-15,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundHealth system strengthening is critical to ensure the integration and scaling-up of priority health promotion, disease prevention and control programs. Normative guidelines are available to address health system function imbalances while strategic and analytical frameworks address critical functions in complex systems. Tacit knowledge-based health system constructs can help identify actors' perspectives, contributing to improve strengthening strategies. Using maternal health as an example, this paper maps and analyses the health system functions that critical actors charged with formulating and delivering priority health programs consider important for their success.MethodsUsing concept mapping qualitative and statistical methods, health system functions were mapped for different categories of actors in high maternal mortality states of Mexico and at the federal level. Functions within and across maps were analyzed for degree of classification, importance, feasibility and coding.ResultsHospital infrastructure and human resource training are the most prominent functions in the maternal health system, associated to federal efforts to support emergency obstetric care. Health policy is a highly diffuse function while program development, intercultural and community participation and social networks are clearly stated although less focused and with lower perceived importance. The importance of functions is less correlated between federal and state decision makers, between federal decision makers and reproductive health/local health area program officers and between state decision makers and system-wide support officers. Two sets of oppositions can be observed in coding across functions: health sector vs. social context; and given structures vs. manageable processes.ConclusionsConcept mapping enabled the identification of critical functions constituting adaptive maternal health systems, including aspects of actor perspectives that are seldom included in normative and analytical frameworks. Important areas of divergence across actors' perceptions were identified to target capacity strengthening efforts towards better integrated, performing health systems.

【 授权许可】

CC BY   
© González-Block et al; licensee BioMed Central Ltd. 2011