Limits...
Towards people-centred health systems: a multi-level framework for analysing primary health care governance in low- and middle-income countries.

Abimbola S, Negin J, Jan S, Martiniuk A - Health Policy Plan (2014)

Bottom Line: Although there is evidence that non-government health system actors can individually or collectively develop practical strategies to address primary health care (PHC) challenges in the community, existing frameworks for analysing health system governance largely focus on the role of governments, and do not sufficiently account for the broad range of contribution to PHC governance.We apply the framework to PHC because, like common-pool resources, PHC facilities in LMICs tend to be commonly owned by the community such that individual and collective action is often required to avoid the 'tragedy of the commons'-destruction and degradation of the resource resulting from lack of concern for its continuous supply.We demonstrate the potential impact of health system actors functioning at different levels of governance on PHC delivery, and how governance failure at one level can be assuaged by governance at another level.

View Article: PubMed Central - PubMed

Affiliation: National Primary Health Care Development Agency, Abuja, Nigeria, School of Public Health, University of Sydney, Australia, The George Institute for Global Health, University of Sydney, Australia and Dalla Lana School of Public Health, University of Toronto, Canada National Primary Health Care Development Agency, Abuja, Nigeria, School of Public Health, University of Sydney, Australia, The George Institute for Global Health, University of Sydney, Australia and Dalla Lana School of Public Health, University of Toronto, Canada National Primary Health Care Development Agency, Abuja, Nigeria, School of Public Health, University of Sydney, Australia, The George Institute for Global Health, University of Sydney, Australia and Dalla Lana School of Public Health, University of Toronto, Canada seyeabimbola@hotmail.com.

No MeSH data available.


Related in: MedlinePlus

Application of the multi-level governance framework to the Midwives Service Scheme in Nigeria shows a failure of polycentric governance due to weak collective governance
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czu069-F2: Application of the multi-level governance framework to the Midwives Service Scheme in Nigeria shows a failure of polycentric governance due to weak collective governance

Mentions: The Midwives Service Scheme in Nigeria illustrates the limits of the National PHC Development Agency. In order to expedite Nigeria’s achievement of the Millennium Development Goals, the national government in 2009 addressed a key driver of high maternal and child mortality in Nigeria: the failure of sub-national governments to provide human resources for skilled birth attendance (Abimbola et al. 2012). The Midwives Service Scheme was established as a collaborative effort among the three tiers of government, with the National PHC Development Agency representing the national government. The Midwives Service Scheme aims to reduce inequities in access to skilled birth attendance by redistributing midwives from urban to rural areas; however, persisting governance challenges limit the success of the scheme. These include varying levels of commitment by state and local governments across the country, such as failure by some local governments to keep a commitment to provide free accommodation to midwives. In addition many states and local governments fail to keep their commitment to share payment of the midwives among national, state and local governments in a ratio of 3:2:1 and to effectively monitor and supervise the midwives within their jurisdiction (Abimbola et al. 2012). Absenteeism and retention of midwives in the scheme is a major challenge. The National PHC Development Agency often relies on ineffective strategies to co-opt states and local governments to fulfil their statutory roles. Also, despite the availability of skilled birth attendants in participating communities, women are still more likely to deliver at home without skilled attendance (Abimbola et al. 2012), due in part to weak collective governance (Figure 2).Figure 2


Towards people-centred health systems: a multi-level framework for analysing primary health care governance in low- and middle-income countries.

Abimbola S, Negin J, Jan S, Martiniuk A - Health Policy Plan (2014)

Application of the multi-level governance framework to the Midwives Service Scheme in Nigeria shows a failure of polycentric governance due to weak collective governance
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4202919&req=5

czu069-F2: Application of the multi-level governance framework to the Midwives Service Scheme in Nigeria shows a failure of polycentric governance due to weak collective governance
Mentions: The Midwives Service Scheme in Nigeria illustrates the limits of the National PHC Development Agency. In order to expedite Nigeria’s achievement of the Millennium Development Goals, the national government in 2009 addressed a key driver of high maternal and child mortality in Nigeria: the failure of sub-national governments to provide human resources for skilled birth attendance (Abimbola et al. 2012). The Midwives Service Scheme was established as a collaborative effort among the three tiers of government, with the National PHC Development Agency representing the national government. The Midwives Service Scheme aims to reduce inequities in access to skilled birth attendance by redistributing midwives from urban to rural areas; however, persisting governance challenges limit the success of the scheme. These include varying levels of commitment by state and local governments across the country, such as failure by some local governments to keep a commitment to provide free accommodation to midwives. In addition many states and local governments fail to keep their commitment to share payment of the midwives among national, state and local governments in a ratio of 3:2:1 and to effectively monitor and supervise the midwives within their jurisdiction (Abimbola et al. 2012). Absenteeism and retention of midwives in the scheme is a major challenge. The National PHC Development Agency often relies on ineffective strategies to co-opt states and local governments to fulfil their statutory roles. Also, despite the availability of skilled birth attendants in participating communities, women are still more likely to deliver at home without skilled attendance (Abimbola et al. 2012), due in part to weak collective governance (Figure 2).Figure 2

Bottom Line: Although there is evidence that non-government health system actors can individually or collectively develop practical strategies to address primary health care (PHC) challenges in the community, existing frameworks for analysing health system governance largely focus on the role of governments, and do not sufficiently account for the broad range of contribution to PHC governance.We apply the framework to PHC because, like common-pool resources, PHC facilities in LMICs tend to be commonly owned by the community such that individual and collective action is often required to avoid the 'tragedy of the commons'-destruction and degradation of the resource resulting from lack of concern for its continuous supply.We demonstrate the potential impact of health system actors functioning at different levels of governance on PHC delivery, and how governance failure at one level can be assuaged by governance at another level.

View Article: PubMed Central - PubMed

Affiliation: National Primary Health Care Development Agency, Abuja, Nigeria, School of Public Health, University of Sydney, Australia, The George Institute for Global Health, University of Sydney, Australia and Dalla Lana School of Public Health, University of Toronto, Canada National Primary Health Care Development Agency, Abuja, Nigeria, School of Public Health, University of Sydney, Australia, The George Institute for Global Health, University of Sydney, Australia and Dalla Lana School of Public Health, University of Toronto, Canada National Primary Health Care Development Agency, Abuja, Nigeria, School of Public Health, University of Sydney, Australia, The George Institute for Global Health, University of Sydney, Australia and Dalla Lana School of Public Health, University of Toronto, Canada seyeabimbola@hotmail.com.

No MeSH data available.


Related in: MedlinePlus