Staying afloat

Community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia

Bibliographic Data

ID21879075
AuthorsDell D Saulnier (0000-0001-7761-0737, Karolinska Institutet, corresponding author), Hom Hean (National Institute of Public Health), Dawin Thol (National Institute of Public Health), Por Ir (0000-0003-3493-2749, National Technical Training Institute), Claudia Hanson (0000-0001-8066-7873, Karolinska Institutet), Johan Von Schreeb (0000-0002-5331-3305, Karolinska Institutet), Helle Mølsted Alvesson (0000-0001-6109-7203, Karolinska Institutet)
Year2020
Volume5
Issue4
Pagese002272
Publication date2020-04-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2019-002272
PMID32332036
OpenAlexW3019056317
LanguageEN
Citations received15
References cited39

INTRODUCTION: Resilient health systems have the capacity to continue providing health services to meet the community's diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system's joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how community management of pregnancy and childbirth care during floods is contributing to the system's capacity to absorb, adapt or transform as viewed through a framework on health systems resilience. METHODS: Eight focus group discussions and 17 semi-structured interviews were conducted with community members and leaders who experienced pregnancy or childbirth during recent flooding in rural Cambodia. The data were analysed by thematic analysis and discussed in relation to the resilience framework. RESULTS: The theme 'Responsible for the status quo' reflected the community's responsibility to find ways to manage pregnancy and childbirth care, when neither the expectations of the health system nor the available benefits changed during floods. The theme was informed by notions on: i) developmental changes, the unpredictable nature of floods and limited support for managing care, ii) how information promoted by the public health system led to a limited decision-making space for pregnancy and childbirth care, iii) a desire for security during floods that outweighed mistrust in the public health system and iv) the limits to the coping strategies that the community prepared in case of flooding. CONCLUSIONS: The community mainly employed absorptive strategies to manage their care during floods, relieving the burden on the health system, yet restricted support and decision-making may risk their capacity. Further involvement in decision-making for care could help improve the health system's resilience by creating room for the community to adapt and transform when experiencing floods

Childbirth · Community health · Community resilience · Focus group · Health care · Political science · Pregnancy · Psychological resilience · Public health · Public relations · Qualitative research · Sociology · Thematic analysis · Disaster Response and Management · Global Health and Surgery · Global Maternal and Child Health · Medicine · Nursing · Psychology · Social Psychology