Everyday resilience in district health systems

Emerging insights from the front lines in Kenya and South Africa

Bibliographic Data

ID23349040
AuthorsLucy Gilson (0000-0002-2775-7703, University of Cape Town, corresponding author), Edwine Barasa (0000-0001-5793-7177, Kenya Medical Research Institute), Nonhlanhla Nxumalo (0000-0002-1935-2204, University of the Witwatersrand), Susan Cleary (0000-0002-9071-7958, University of Cape Town), Jane Goudge (0000-0001-6555-7510, University of the Witwatersrand), Sassy Molyneux (0000-0001-9522-416X, Kenya Medical Research Institute), Benjamin Tsofa (0000-0003-1000-1771, Kenya Medical Research Institute), Uta Lehmann (0000-0002-2627-8954, University of the Western Cape)
Year2017
Volume2
Issue2
Pagese000224
Publication date2017-07-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2016-000224
PMID29081995
OpenAlexW2621024432
LanguageEN
Citations received75
References cited26

Recent global crises have brought into sharp relief the absolute necessity of resilient health systems that can recognise and react to societal crises. While such crises focus the global mind, the real work lies, however, in being resilient in the face of routine, multiple challenges. But what are these challenges and what is the work of nurturing everyday resilience in health systems? This paper considers these questions, drawing on long-term, primarily qualitative research conducted in three different district health system settings in Kenya and South Africa, and adopting principles from case study research methodology and meta-synthesis in its analytic approach. The paper presents evidence of the instability and daily disruptions managed at the front lines of the district health system. These include patient complaints, unpredictable staff, compliance demands, organisational instability linked to decentralisation processes and frequently changing, and sometimes unclear, policy imperatives. The paper also identifies managerial responses to these challenges and assesses whether or not they indicate everyday resilience, using two conceptual lenses. From this analysis, we suggest that such resilience seems to arise from the leadership offered by multiple managers, through a combination of strategies that become embedded in relationships and managerial routines, drawing on wider organisational capacities and resources. While stable governance structures and adequate resources do influence everyday resilience, they are not enough to sustain it. Instead, it appears important to nurture the power of leaders across every system to reframe challenges, strengthen their routine practices in ways that encourage mindful staff engagement, and develop social networks within and outside organisations. Further research can build on these insights to deepen understanding.

Cognitive reframing · Corporate governance · Economics · Management · Political science · Psychological resilience · Public relations · Resilience (materials science) · Sociology · Disaster Response and Management · Global Maternal and Child Health · Healthcare Systems and Reforms · Psychology · Social Psychology