When 'solutions of yesterday become problems of today': crisis-ridden decision making in a complex adaptive system (CAS)--the Additional Duty Hours Allowance in Ghana.

Abstract:

:Implementation of policies (decisions) in the health sector is sometimes defeated by the system's response to the policy itself. This can lead to counter-intuitive, unanticipated, or more modest effects than expected by those who designed the policy. The health sector fits the characteristics of complex adaptive systems (CAS) and complexity is at the heart of this phenomenon. Anticipating both positive and negative effects of policy decisions, understanding the interests, power and interaction between multiple actors; and planning for the delayed and distal impact of policy decisions are essential for effective decision making in CAS. Failure to appreciate these elements often leads to a series of reductionist approach interventions or 'fixes'. This in turn can initiate a series of negative feedback loops that further complicates the situation over time. In this paper we use a case study of the Additional Duty Hours Allowance (ADHA) policy in Ghana to illustrate these points. Using causal loop diagrams, we unpack the intended and unintended effects of the policy and how these effects evolved over time. The overall goal is to advance our understanding of decision making in complex adaptive systems; and through this process identify some essential elements in formulating, updating and implementing health policy that can help to improve attainment of desired outcomes and minimize negative unintended effects.

journal_name

Health Policy Plan

authors

Agyepong IA,Kodua A,Adjei S,Adam T

doi

10.1093/heapol/czs083

subject

Has Abstract

pub_date

2012-10-01 00:00:00

pages

iv20-31

eissn

0268-1080

issn

1460-2237

pii

czs083

journal_volume

27 Suppl 4

pub_type

杂志文章
  • Bypassing birth centres for childbirth: an analysis of data from a community-based prospective cohort study in Nepal.

    abstract:BACKGROUND:In Nepal, women residing in rural areas tend to bypass local birth centres and deliver at urban hospitals, despite the availability of obstetric care in these centres. This study investigated the incidence of bypassing, characteristics of bypassers and their reasons for bypassing the birth centres. METHODS:...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czt090

    authors: Karkee R,Lee AH,Binns CW

    更新日期:2015-02-01 00:00:00

  • Do essential service packages benefit the poor? Preliminary evidence from Bangladesh.

    abstract::In 1998 Bangladesh began a sector wide approach (SWAp) to the extension of health care to vulnerable groups in the country. The central feature of this approach is the funding of an essential service package (ESP) emphasizing maternal care, certain communicable diseases and child health. This study examines the way in...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/17.3.247

    authors: Ensor T,Dave-Sen P,Ali L,Hossain A,Begum SA,Moral H

    更新日期:2002-09-01 00:00:00

  • Measuring family planning quality and its link with contraceptive use in public facilities in Burkina Faso, Ethiopia, Kenya and Uganda.

    abstract::The individual impacts of several components of family planning service quality on contraceptive use have been studied, but the influence of a composite measure synthesizing these components has not been often investigated. We (1) develop a composite score for family planning service quality based on health facility d...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czy058

    authors: Fruhauf T,Zimmerman L,Kibira SPS,Makumbi F,Gichangi P,Shiferaw S,Seme A,Guiella G,Tsui A

    更新日期:2018-09-01 00:00:00

  • Treatment as insurance: HIV antiretroviral therapy offers financial risk protection in Malawi.

    abstract::Many countries have expanded insurance programmes in an effort to achieve universal health coverage (UHC). We assess a complementary path toward financial risk protection: increased access to technologies that improve health and reduce the risk of large health expenditures. Malawi has provided free HIV treatment since...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czaa023

    authors: Dickerson S,Baranov V,Bor J,Barofsky J

    更新日期:2020-07-01 00:00:00

  • Supervision of community health nurses in Ghana: a mixed-methods study on experiences and mentorship needs.

    abstract::Adequate supervision is critical to maintain the performance of health workers who provide essential maternal and child health services in low-resource areas. Supportive supervision emphasizing problem-solving, skill development and mentorship has been shown to improve the motivation and effectiveness of health worker...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czaa167

    authors: Bellerose M,Alva S,Magalona S,Awoonor-Williams K,Sacks E

    更新日期:2020-12-22 00:00:00

  • Health and economic benefits of scaling up a home-based neonatal care package in rural India: a modelling analysis.

    abstract::Approximately 900 000 newborn children die every year in India, accounting for 28% of neonatal deaths globally. In 2011, India introduced a home-based newborn care (HBNC) package to be delivered by community health workers across rural areas. We estimate the disease and economic burden that could be averted by scaling...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czv113

    authors: Nandi A,Colson AR,Verma A,Megiddo I,Ashok A,Laxminarayan R

    更新日期:2016-06-01 00:00:00

  • Private payers of health care in Brazil: characteristics, costs and coverage.

    abstract::The private sector is the predominant provider of health care in Brazil, particularly for inpatient services, and financing is a mix of public (through a prospective reimbursement system) and private. Roughly a quarter of the population has private insurance coverage, reflecting rapid growth in the past decade fuelled...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/10.4.362

    authors: Lewis MA,Medici AC

    更新日期:1995-12-01 00:00:00

  • Patterns of informal patient payments in Bulgaria, Hungary and Ukraine: a comparison across countries, years and type of services.

    abstract::Informal payments for health care are a well-known phenomenon in many health care systems around the world. While informal payments could be an important source of health care financing, they have an adverse impact on efficiency and access to care, and are a major impediment to ongoing health care reforms. This paper ...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czw147

    authors: Stepurko T,Pavlova M,Gryga I,Gaál P,Groot W

    更新日期:2017-05-01 00:00:00

  • Donor funding for health reform in Africa: is non-project assistance the right prescription?

    abstract::During the past 10 years, donors have recognized the need for major reforms to achieve sustainable development. Using non-project assistance they have attempted to leverage reforms by offering financing conditioned on the enactment of reform. The experience of USAID's health reform programmes in Niger and Nigeria sugg...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/9.4.371

    authors: Foltz AM

    更新日期:1994-12-01 00:00:00

  • Did contracting effect the use of primary health care units in Pakistan?

    abstract::For many years, Pakistan has had a wide network of Basic Health Units spread across the country, but their utilization by the population in rural and peri-urban areas has remained low. As of 2004, in an attempt to improve the utilization and performance of these public primary healthcare facilities, the government has...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czx040

    authors: Malik MA,Van de Poel E,Van Doorslaer E

    更新日期:2017-09-01 00:00:00

  • Willingness to pay for community-based health insurance in Nigeria: do economic status and place of residence matter?

    abstract:OBJECTIVE:We examine socio-economic status (SES) and geographic differences in willingness of respondents to pay for community-based health insurance (CBHI). METHODS:The study took place in Anambra and Enugu states, south-east Nigeria. It involved a rural, an urban and a semi-urban community in each of the two states....

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czp046

    authors: Onwujekwe O,Okereke E,Onoka C,Uzochukwu B,Kirigia J,Petu A

    更新日期:2010-03-01 00:00:00

  • Ability to pay for health care: concepts and evidence.

    abstract::In many developing countries people are expected to contribute to the cost of health care from their own pockets. As a result, people's ability to pay (ATP) for health care, or the affordability of health care, has become a critical policy issue in developing countries, and a particularly urgent issue where households...

    journal_title:Health policy and planning

    pub_type: 杂志文章,评审

    doi:10.1093/heapol/11.3.219

    authors: Russell S

    更新日期:1996-09-01 00:00:00

  • Financing mental health services in low- and middle-income countries.

    abstract::Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries und...

    journal_title:Health policy and planning

    pub_type: 杂志文章,评审

    doi:10.1093/heapol/czl004

    authors: Dixon A,McDaid D,Knapp M,Curran C

    更新日期:2006-05-01 00:00:00

  • The impact of Ghana's R3M programme on the provision of safe abortions and postabortion care.

    abstract::In 2006, in response to the high maternal mortality, driven largely by unsafe abortions, the government of Ghana, in partnership with other organizations, launched the reducing maternal mortality and morbidity (R3M) programme in seven districts in Greater Accra, Ashanti and Eastern, to improve comprehensive abortion c...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czu105

    authors: Sundaram A,Juarez F,Ahiadeke C,Bankole A,Blades N

    更新日期:2015-10-01 00:00:00

  • Exploring referral systems for injured patients in low-income countries: a case study from Cambodia.

    abstract::Injury is a growing public health concern worldwide. Since severe injuries require urgent treatment, involving smooth, timely patient referral between facilities, strengthening of the referral system would reduce injury mortality. Smooth referral consists of identification of severe cases, organization of transportati...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czp063

    authors: Nakahara S,Saint S,Sann S,Ichikawa M,Kimura A,Eng L,Yoshida K

    更新日期:2010-07-01 00:00:00

  • The progressivity of health-care financing in Kenya.

    abstract:BACKGROUND:Health-care financing should be equitable. In many developing countries such as Kenya, changes to health-care financing systems are being implemented as a means of providing equitable access to health care with the aim of attaining universal coverage. Vertical equity means that people of dissimilar ability t...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czt073

    authors: Munge K,Briggs AH

    更新日期:2014-10-01 00:00:00

  • The influence of gender and household headship on voluntary health insurance: the case of North-West Cameroon.

    abstract::Within the existing health financing literature, males are typically categorized as the household's decision-makers. While this view accurately reflects many local sociocultural realities, approximately a quarter of sub-Saharan African households are now headed by females. In light of various efforts to expand health ...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czx152

    authors: Oraro T,Ngube N,Atohmbom GY,Srivastava S,Wyss K

    更新日期:2018-03-01 00:00:00

  • Barriers to accessing benefits in a community-based insurance scheme: lessons learnt from SEWA Insurance, Gujarat.

    abstract::This paper seeks to examine barriers faced by members of a community-based insurance (CBI) scheme, which is targeted at poor women and their families, in accessing scheme benefits. CBI schemes have been developed and promoted as mechanisms to offer protection to poor families from the risks of ill-health, death and lo...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czj010

    authors: Sinha T,Ranson MK,Chatterjee M,Acharya A,Mills AJ

    更新日期:2006-03-01 00:00:00

  • National Health Accounts development: lessons from Thailand.

    abstract::National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns; policy instruments to re-orientate the pattern can then be further introduced. The National ...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/14.4.342

    authors: Tangcharoensathien V,Laixuthai A,Vasavit J,Tantigate NA,Prajuabmoh-Ruffolo W,Vimolkit D,Lertiendumrong J

    更新日期:1999-12-01 00:00:00

  • Factors influencing the burden of health care financing and the distribution of health care benefits in Ghana, Tanzania and South Africa.

    abstract::In Ghana, Tanzania and South Africa, health care financing is progressive overall. However, out-of-pocket payments and health insurance for the informal sector are regressive. The distribution of health care benefits is generally pro-rich. This paper explores the factors influencing these distributions in the three co...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czs024

    authors: Macha J,Harris B,Garshong B,Ataguba JE,Akazili J,Kuwawenaruwa A,Borghi J

    更新日期:2012-03-01 00:00:00

  • Does an expansion in private sector contraceptive supply increase inequality in modern contraceptive use?

    abstract:OBJECTIVE:To determine whether an expansion in private sector contraceptive supply is associated with increased socio-economic inequality in the modern contraceptive prevalence rate (MCPR inequality). METHODS:Multiple rounds of Demographic and Health Surveys data were analysed for five countries that experienced an in...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czn035

    authors: Agha S,Do M

    更新日期:2008-11-01 00:00:00

  • Delivering a primary-level non-communicable disease programme for Syrian refugees and the host population in Jordan: a descriptive costing study.

    abstract::The Syrian conflict has caused enormous displacement of a population with a high non-communicable disease (NCD) burden into surrounding countries, overwhelming health systems' NCD care capacity. Médecins sans Frontières (MSF) developed a primary-level NCD programme, serving Syrian refugees and the host population in I...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czaa050

    authors: Ansbro É,Garry S,Karir V,Reddy A,Jobanputra K,Fardous T,Sadique Z

    更新日期:2020-10-01 00:00:00

  • How linked are national HIV and SRHR strategies? A review of SRHR and HIV strategies in 60 countries.

    abstract::The connection between HIV and sexual and reproductive health and rights (SRHR) is widely recognised along with the benefits of linking them at the legal/policy, health systems, and service delivery levels. However, despite increased rhetoric about the need for this three-tiered approach, integrated service delivery h...

    journal_title:Health policy and planning

    pub_type: 杂志文章,评审

    doi:10.1093/heapol/czw119

    authors: Hopkins J,Collins L

    更新日期:2017-11-01 00:00:00

  • Income elasticity of health expenditures in Iran.

    abstract::Because of its policy implications, the income elasticity of health care expenditures is a subject of much debate. Governments may have an interest in subsidizing the care of those with low income. Using more than two decades of data from the Iran Household Expenditure and Income Survey, this article investigates the ...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czs106

    authors: Zare H,Trujillo AJ,Leidman E,Buttorff C

    更新日期:2013-09-01 00:00:00

  • Policymaking 'under the radar': a case study of pesticide regulation to prevent intentional poisoning in Sri Lanka.

    abstract:BACKGROUND:Suicide in Sri Lanka is a major public health problem and in 1995 the country had one of the highest rates of suicide worldwide. Since then reductions in overall suicide rates have been largely attributed to efforts to regulate a range of pesticides. The evolution, context, events and implementation of the k...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czt096

    authors: Pearson M,Zwi AB,Buckley NA,Manuweera G,Fernando R,Dawson AH,McDuie-Ra D

    更新日期:2015-02-01 00:00:00

  • Progress in reducing child mortality and stunting in India: an application of the Lives Saved Tool.

    abstract::The Lives Saved Tool (LiST) has been used to estimate the impact of scaling up intervention coverage on undernutrition and mortality. Evidence for the model is largely based on efficacy trials, raising concerns of applicability to large-scale contexts. We modelled the impact of scaling up health programs in India betw...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czz088

    authors: Alderman H,Nguyen PH,Menon P

    更新日期:2019-11-01 00:00:00

  • Pneumonia's second wind? A case study of the global health network for childhood pneumonia.

    abstract::Advocacy, policy, research and intervention efforts against childhood pneumonia have lagged behind other health issues, including malaria, measles and tuberculosis. Accelerating progress on the issue began in 2008, following decades of efforts by individuals and organizations to address the leading cause of childhood ...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czv070

    authors: Berlan D

    更新日期:2016-04-01 00:00:00

  • Distributional impact of the Malawian Essential Health Package.

    abstract::In low- and middle-income countries (LMICs), making the best use of scarce resources is essential to achieving universal health coverage. The design of health benefits packages creates the opportunity to select interventions on the basis of explicit objectives. Distributional cost-effectiveness analysis (DCEA) provide...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czaa015

    authors: Arnold M,Nkhoma D,Griffin S

    更新日期:2020-07-01 00:00:00

  • Developing a logic model for youth mental health: participatory research with a refugee community in Beirut.

    abstract::Although logic models are now touted as an important component of health promotion planning, implementation and evaluation, there are few published manuscripts that describe the process of logic model development, and fewer which do so with community involvement, despite the increasing emphasis on participatory resear...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czr001

    authors: Afifi RA,Makhoul J,El Hajj T,Nakkash RT

    更新日期:2011-11-01 00:00:00

  • Assessing the impact of budget controls on the prescribing behaviours of physicians treating dialysis-dependent patients.

    abstract:OBJECTIVES:This study examined whether outpatient haemodialysis providers changed their treatment practices with the establishment of an outpatient dialysis global budget (ODGB) through analysing the outpatient visits and medication received by those patients. METHODS:A sample of 4668 observations (patient year) of 13...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czu119

    authors: Chang RE,Tsai YH,Myrtle RC

    更新日期:2015-11-01 00:00:00