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Investigating the mechanisms that influence healthcare outcomes in sub-Saharan African countries

dc.contributor.advisorBam, Wouteren_ZA
dc.contributor.advisorDe Kock, Imkeen_ZA
dc.contributor.authorConway, Jenna-Dawnen_ZA
dc.contributor.otherStellenbosch University. Faculty of Engineering. Dept. of Industrial Engineering.en_ZA
dc.date.accessioned2019-02-18T13:18:20Z
dc.date.accessioned2019-04-17T08:30:24Z
dc.date.available2019-02-18T13:18:20Z
dc.date.available2019-04-17T08:30:24Z
dc.date.issued2019-04
dc.identifier.urihttp://hdl.handle.net/10019.1/106134
dc.descriptionThesis (MEng)--Stellenbosch University, 2019.en_ZA
dc.description.abstractENGLISH ABSTRACT: Sub-Saharan Africa experiences some of the poorest health care outcomes in the world. With the combination of a high burden of disease and a severe lack of resources, the health systems in SSA face immense pressure to perform under difficult circumstances. The need to drive efficiency and gain an in depth understanding of health systems in SSA is thus clear. In order to make improvements to health systems, an understanding of the way in which health systems function and the components which they are made up of and influenced by is required. The complexity of health systems is not only due to the number of components which make up a health system but due to the interactions with factors which extend beyond the health system. The significant impact of contextual impacts on the health care outcomes of an area must be recognised along with the way in which these interact and influence a health system. The ability to therefore map the way in which mechanisms influence health care outcomes over an area as large as SSA is found to be an inexhaustible task, therefore an approach is developed in order to facilitate the identification of health care outcome bottlenecks in a specific area. In order to gain an in depth understanding of factors that make up a health system, an analysis of existing conceptual frameworks of health systems is carried out. This analysis results in the emergence of nine over arching areas to consider when analysing a health system; along with five performance measure categories. A systematic literature review is carried out in order to populate the understanding of health systems in relation to the components identified in terms of a SSA setting. The review considers an extensive array of literature in order to gain a broad understanding of the factors attributed to influencing health care outcomes in SSA. From the analysis of the conceptual frameworks along with the results from the systematic literature review, a series of challenges and complexities within health systems are highlighted. In order to address these a number of tools are investigated to develop a method by which to identify bottlenecks found in health systems. The recognition of the complexity of health systems and the emphasis placed on contextual factors is reiterated as the recognition of over arching health system factors such as lack of resources is found to be well researched and recorded. Thus the contribution of over arching health system factors is less valuable than the ability to recognise specific factors. In order to facilitate health care outcome improvements and identify mechanisms which influence these outcomes, an approach to identify bottlenecks in district health systems emerges. The approach consists of the following stages: (i) Select a physical area or location; (ii) Select a health care outcome; (iii) Identify the population at risk; (iv) Interpret available data to identify bottlenecks; (v) Discuss process of care identified as the bottleneck; (vi) Discuss factors relating to the bottleneck identified; and (vii) Identify stakeholders and roleplayers to be involved in planning and change management. The approach is seen to contribute to the initiation of interventions as it hopes to identify a point in the health system which needs improvement. Extensive literature on planning and implementing interventions exists, therefore this approach makes no effort to contribute hereto but is a decision making tool as to where effort in health systems can be directed toward. An illustrative case study is carried out in order to demonstrate the way in which the approach can be populated and to facilitate the study validation. Subject matter experts are consulted in order to improve upon and approve the results of the study and the emergent approach. This study makes a contribution by illustrating the complexity of health systems and suggests an approach which may be followed in order to facilitate the identification of mechanisms affecting health care outcomes in specific settings.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Sub-Sahara Afrika ondervind van die swakste gesondheidsorguitkomste in die wereld. Met die kombinasie van ’n hoe las van siekte en ’n ernstige gebrek aan hulpbronne, ondervind die gesondheidstelsels in SSA geweldige druk om onder moeilike omstandighede te presteer. Die behoefte om doeltreffendheid te bestuur en ’n grondige begrip van gesondheidstelsels in SSA te verkry, is dus duidelik. Ten einde verbeterings aan gesondheidstelsels te maak, word ’n begrip van die wyse waarop gesondheidstelsels funksioneer en die komponente waaruit hulle bestaan en beinvloed word benodig. Die kompleksiteit van gesondheidstelsels is nie net as gevolg van die aantal komponente wat ’n gesondheidstelsel vorm nie, maar as gevolg van die interaksies met faktore wat buite die gesondheidstelsel strek. Die wesenlike impak van die kontekstuele impak op die gesondheidsorguitkomste van ’n gebied moet erken word saam met die wyse waarop dit in wisselwerking is met die gesondheidstelsel, asook hoe hierdie stelsels beinvloed word. Die vermoe om die wyse waarop meganismes gesondheidsorguitkomste oor ’n gebied so groot soos SSA beinvloed, te bepaal, is dus onuitputlik. Daarom word ’n benadering ontwikkel om die identifisering van knelpunte vir gesondheidsorguitkomste in ’n spesifieke gebied te fasiliteer. Ten einde ’n deeglike begrip te verkry van faktore wat ’n gesondheidstelsel vorm, word ’n ontleding van bestaande konseptuele raamwerke van gesondheidstelsels uitgevoer. Hierdie analise lei tot die opkoms van nege oorkoepelende gebiede wat in ag geneem moet word wanneer ’n gesondheidstelsel geanaliseer word; saam met vyf prestasie-maatstaf kategoriee. ’n Sistematiese literatuuroorsig word uitgevoer om die begrip van gesondheidstelsels te vul met betrekking tot die komponente wat geidentifiseer is ingevolge ’n SSA-omgewing. Die hersiening oorweeg ’n uitgebreide verskeidenheid literatuur om ’n bree begrip te verkry van die faktore wat toegeskryf word aan die uitwerking van gesondheidsorguitkomste in SSA. Uit die ontleding van die konseptuele raamwerke, tesame met die resultate van die sistematiese literatuuroorsig, word ’n reeks uitdagings en kompleksiteite binne gesondheidstelsels beklemtoon. Om dit aan te spreek, word ’n aantal gereedskap ondersoek om ’n metode te ontwikkel om knelpunte in gesondheidstelsels te identifiseer. Die erkenning van die kompleksiteit van gesondheidstelsels en die klem wat op kontekstuele faktore geplaas word, word herhaal, aangesien die erkenning van oorkoepelende gesondheidstelselfaktore, soos die gebrek aan hulpbronne, goed ondersoek en aangeteken word. Die bydrae van oorkoepelende gesondheidstelselfaktore is dus minder waardevol as die vermoe om spesifieke faktore te herken. Ten einde verbeterings van gesondheidsorguitkomste te fasiliteer en meganismes te identifiseer wat hierdie uitkomste beinvloed, kom ’n benadering tot knelpunte in distriksgesondheidstelsels voor. Die benadering bestaan uit die volgende stadiums: (i) Kies ’n fisiese area of plek; (ii) Kies ’n gesondheidsorguitkoms; (iii) Identifiseer die bevolking in gevaar; (iv) Interpreteer beskikbare data om knelpunte te identifiseer; (v) Bespreek sorgproses wat as die knelpunt geidentifiseer word; (vi) Bespreek faktore wat verband hou met die knelpunt wat geidentifiseer is; en (vii) Identifiseer belanghebbendes en rolspelers wat betrokke sal te wees by beplanning en veranderingsbestuur. Die benadering word gesien om by te dra tot die inisiering van intervensies, aangesien dit hoop om ’n punt in die gesondheidstelsel te identifiseer wat verbeter moet word. Uitgebreide literatuur oor beplanning en implementering van intervensies bestaan, dus maak hierdie benadering nie deur die moeite om hierby by te dra nie, maar is eerder ’n besluitnemingsinstrument vir waar die poging in gesondheidstelsels gerig kan word. ’n Illustratiewe gevallestudie word uitgevoer om te demonstreer hoe die benadering ingevul kan word en om die studievalidering te fasiliteer. Onderwerpkenners word geraadpleeg om die resultate van die studie en die opkomende benadering te verbeter en goed te keur. Hierdie studie lewer ’n bydrae deur die kompleksiteit van gesondheidstelsels te illustreer en stel ’n benadering voor wat gevolg kan word om die identifisering van meganismes wat gesondheidsorguitkomste in spesifieke instellings beinvloed, te fasiliteer.af_ZA
dc.format.extentxv, 296 pagesen_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.subjectHealth care -- Africa, Sub-Saharanen_ZA
dc.subjectOutcome assessment (Medical care)en_ZA
dc.subjectHealth planning -- Africa, Sub-Saharanen_ZA
dc.subjectHealth care reform -- Africa, Sub-Saharanen_ZA
dc.subjectUCTD
dc.titleInvestigating the mechanisms that influence healthcare outcomes in sub-Saharan African countriesen_ZA
dc.typeThesisen_ZA
dc.rights.holderStellenbosch Universityen_ZA


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