Case 6: health systems resillience & decentralisation Flashcards
What are the effects of a health system centralisation?
- better resource allocation
- implementation of large-scale preventative measures
- standardised responses.
- can lead to one-size-fits-all approach that doesn’t account for location variations in HC
What are the effects of a decentralised health system?
- respond more flexibly & specifically to local needs
- promote stronger community engagement & ownership
What is health system resilience?
ability to:
- prepare for
- manage (absorb, adapt, transform)
- learn from shocks to a system
what is shock?
sudden and extreme change which impact a health system → unpredictable
What are the 4 stages of shock?
- preparedness
- shock onset and alert
- shock impact and management,
- recovery and learning
Why is resilience important?
Key to coping with catastrophic events e.g. economic crisis or pandemic → need to define resilience clearly for operationalism/assessment
What are strategies to enhance resilience?
- Governance
- Financing
- Resources
- Service delivery
How can governance enhance resilience?
- Effective & participatory leadership
- Coordination of activities
- Organisational learning responsive to crises
- Effective information systems & flows
- Surveillance enabling timely detection of shocks & impact
How does financing enhance resilience?
- Ensuring sufficient monetary resources in system & flexibility to reallocate and inject extra funds
- Ensuring stability of health system funding through countercyclical health financing mechanisms and reserves
- Purchasing flexibility and reallocation of funding to meet changing needs
- Comprehensive health coverage
How do resources enhance resilience?
Appropriate level/distribution of resources with ability to increase capacity to cope with a sudden surge in demand and a well-supported workforce
How does service delivery enhance resilience?
Alternative and flexible approaches to delivery care
*How do we assess resilience?
idk if this is correct
Resilience assessment: crisis- and context-specific and important to employ a range of
quantitative and qualitative metrics for meaningful analysis → important to look at aftermath
*WHat is the impact of decentralisation?
idk if correct
Decentralisation in the health sector: rarely implemented in the health sector only → typically decentralisation may be implemented to stimulate economic growth, reduce rural poverty, deepen democracy and delegate responsibilities onto lower-level governments
What are the effects of decentralisation?
equity in population health outcomes, system efficiency and system resilience → stakeholders need to understand and be equipped with strategies to maximise the positive and minimise the negative impacts of decentralisation reforms
How is decentralisation defined?
- As an intervention - arrangement in which power/resources/responsibilities are transferred from central to peripheral actors in a top-down approach
- As a phenomenon - power, resources & responsibilities are widely distributed in society and consolidated in a top-down process or bottom-up process
What are 3 mechanisms of decentralisation?
- Voting with feet
- close to the ground
- Watching the watchers
Explain voting with feet
People “vote with their feet” when respond to varying levels of public goods (e.g. police, army, levies) and the varying prices at which they are offered (e.g. taxes)
Explain close to the ground as a mechanism for decentralisation
Having governance closer to the people “allows for better use of local initiative, information, feedback, input and control”
Explain watching the watchers as a mechanism for decentralisation
mutual accountability between levels of governance that are multiplied by decentralisation (more decentralised = more levels of governance)
What are the problems involved in decentralisation?
Incoherencies in achieving homogenous implementation of COVID rules → could be mitigated by the federal government creating a document on criteria for the implementation of public event bans etc.
