KEMRI Wellcome Trust Research Programme, Health Systems and Ethics Research Unit, Bofa Road, Kilifi, Kenya.
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
Health Policy Plan. 2020 Jun 1;35(5):522-535. doi: 10.1093/heapol/czaa002.
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.
卫生系统面临着各种各样的挑战。作为复杂适应系统，它们对这些挑战的反应不同，有时甚至出人意料。我们试图用“日常韧性”的视角来考察肯尼亚一个次国家级卫生系统所经历的挑战，肯尼亚最近经历了快速权力下放。我们专注于慢性压力源，而不是急性冲击，来考察支撑这些反应的反应和组织能力，以期增进对卫生系统韧性的理解。我们借鉴了多年来通过学习地点方法与管理人员合作获得的经验和知识。我们还通过非正式观察、反思性会议和对中层管理人员（县级和医院）和周边设施管理人员（n=29）的深入访谈收集了深入的定性数据。我们使用框架方法分析数据。卫生管理人员报告了与资源短缺、角色不明确和政治干预、自主权和人力资源管理减少相关的广泛的卫生系统压力源。卫生管理人员采取了吸收性、适应性和变革性策略，但对系统功能的影响不一。日常韧性似乎源自管理人员根据压力源和环境，利用组织能力的不同组合来实施策略。
