Shocks, stress and everyday health system resilience

Experiences from the Kenyan coast

Bibliographic Data

ID11490434
AuthorsNancy Kagwanja (0000-0002-4411-4961, KEMRI Wellcome Trust Research Programme, Health Systems and Ethics Research Unit, Bofa Road, Kilifi, Kenya, corresponding author), Dennis Waithaka (0000-0002-2879-5226, KEMRI Wellcome Trust Research Programme, Health Systems and Ethics Research Unit, Bofa Road, Kilifi, Kenya), Jacinta Nzinga (0000-0001-8394-8857, KEMRI Wellcome Trust Research Programme, Health Systems and Ethics Research Unit, Bofa Road, Kilifi, Kenya), Benjamin Tsofa (0000-0003-1000-1771, KEMRI Wellcome Trust Research Programme, Health Systems and Ethics Research Unit, Bofa Road, Kilifi, Kenya), Mwanamvua Boga (0000-0002-9647-9567, KEMRI Wellcome Trust Research Programme, Health Systems and Ethics Research Unit, Bofa Road, Kilifi, Kenya), Hassan Leli (Kilifi County Department of Health, P.O BOX 9-80108, Bofa Road, Kilifi, Kenya), Christine Mataza (Kilifi County Department of Health, P.O BOX 9-80108, Bofa Road, Kilifi, Kenya), Lucy Gilson (0000-0002-2775-7703, University of Cape Town), Sassy Molyneux (0000-0001-9522-416X, KEMRI Wellcome Trust Research Programme, Health Systems and Ethics Research Unit, Bofa Road, Kilifi, Kenya), Edwine Barasa (0000-0001-5793-7177, KEMRI Wellcome Trust Research Programme, Health Systems and Ethics Research Unit, Bofa Road, Kilifi, Kenya)
Year2020
Volume35
Issue5
Pages522-535
Publication date2020-06-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czaa002
PMID32101609
OpenAlexW3007483772
LanguageEN
Citations received25
References cited32

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

Business · Context (archaeology) · Economics · Environmental resource management · Geography · Political science · Preparedness · Psychological resilience · Public relations · Sociology · Stressor · Disaster Response and Management · Global Maternal and Child Health · Healthcare Systems and Reforms · Psychology · Social Psychology