Shocks, stress and everyday health system resilience: experiences from the Kenyan coast

Nancy Kagwanja, Dennis Waithaka, Jacinta Nzinga, Benjamin Tsofa, Mwanamvua Boga, Hassan Leli, Christine Mataza, Lucy Gilson, Sassy Molyneux, Edwine Barasa

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

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.
Original languageEnglish
Pages (from-to)522-535
Number of pages14
JournalHealth Policy and Planning
Volume35
Issue number5
DOIs
Publication statusPublished - 1 Jun 2020
Externally publishedYes

Keywords

  • Coping strategies
  • Decentralization
  • Framework
  • Health systems
  • Organizational change

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