Browsing by Author "Conway, Jenna-Dawn"

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    Investigating the mechanisms that influence healthcare outcomes in sub-Saharan African countries
    (Stellenbosch : Stellenbosch University, 2019-04) Conway, Jenna-Dawn; Bam, Wouter; De Kock, Imke; Stellenbosch University. Faculty of Engineering. Dept. of Industrial Engineering.
    ENGLISH 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.