UNDERSTANDING THE DYNAMICS OF THE UPTAKE OF MATERNAL HEALTH SERVICES IN KEBBI STATE USING A SYSTEMS THINKING APPROACH
DOI:
https://doi.org/10.29121/granthaalayah.v8.i7.2020.589Keywords:
System Dynamics, Causal, Effect, Maternal, Loop, Health, Model, StockAbstract [English]
This study focused on the dynamics of Maternal Health Services utilization in Kebbi State using a Systems Thinking approach. The broad objective was to understand the effect of interventions intended to promote utilization of Maternal Health Services. The study evolved a model to represent the causal interrelationship, interdependencies and feedback influences of the multifactorial and multisectoral public health approach on utilization of public maternal health services using a Systems Thinking approach. This enabled us draw inferences on the effect on the mother, the intended end-beneficiary from these interventions. Using a Causal Loop Diagram, we were able to identify reinforcing and balancing feedback loops that could explain the behavior or outcomes being observed. The findings revealed that the feedback in the system is driven by limited resources at the household levels, technical quality of health care services, and knowledgeableness of women on maternal health services. From this, we were able to recommend that policy-makers should try to effectively address socio-economic inadequacies at the household level including socio-cultural practices leading to low level of girl-child school enrolment, and several factors affecting motivation of health care workers. While efforts to ensure quality of care and community awareness should be maintained, emphasis and priority needs to be given to interventions that target economic improvements of households.
Downloads
References
Achoki, T. and Lesego, A. (2017). The imperative for Systems Thinking to promote access to medicines, efficient delivery, and cost-effectiveness when implementing health financing reforms: a qualitative study. International Journal for Equity in Health, 16(53). DOI: https://doi.org/10.1186/s12939-017-0550-x
Basole, R.C. and Rouse, W.B. (2008) Complexity of Service Value Networks Conceptualization and Empirical Investigation. IBM Systems Journal, 47, 53-68. DOI: https://doi.org/10.1147/sj.471.0053
Bishai, D., Paina, L., Li, Q., Peters, H.D., Hyder, A. (2014). Advancing the application of Systems Thinking in health: why cure crowds out prevention. Health Research Policy and Systems, 12(28) DOI: https://doi.org/10.1186/1478-4505-12-28
Blomqvist, J. (2007). Towards better addiction care? Prerequisites and consequences of the quest for evidence-based care. Social Services of Stockhom, County council of Stockholm, and others
Cameron D. Norman, C.D., Charnaw-Burger, J., Yip, A.L., Saad, S., & Lombardo, C. (2010). Designing health innovation networks using complexity science and Systems Thinking: the CoNEKTR model. Journal of Evaluation in Clinical Practice, Vol.16 DOI: https://doi.org/10.1111/j.1365-2753.2010.01534.x
Carey, G., Malbon, E., Carey, N., Joyce, A., Crammond, B., & Carey, A. (2015). Systems science and Systems Thinking for public health: a systematic review of the field. BMJ Open 2015;5: e009002. doi:10.1136/bmjopen-2015009002
Durham, J., Schubert, L., Vaughan, L., & Willis, C.D. (2018). Using Systems Thinking and the Intervention Level Framework to analyze public health planning for complex problems: Otitis media in Aboriginal and Torres Strait Islander children. PLoS ONE 13(3): e0194275.https://doi.org/ 10.1371/journal.pone.0194275 DOI: https://doi.org/10.1371/journal.pone.0194275
https://www.who.int/health-topics/primary-health-care#tab=tab_1.
Hernández, A., Ruano, L.A., Marchal, B., Sebastián, S.M. & Flores, W. (2017). Engaging with complexity to improve the health of indigenous people: a call for the use of Systems Thinking to tackle health inequity. International Journal for Equity in Health, 16(26). DOI: https://doi.org/10.1186/s12939-017-0521-2
Homer, J.B & Hirsch, B.G. (2006). System Dynamics Modeling for Public Health: Background and Opportunities. American Journal of Public Health, 96(3). DOI: https://doi.org/10.2105/AJPH.2005.062059
Martinez- Garcia, M.A. (2013). Effect of CPAP on blood pressure in patients with obstructive sleep apnea and resistant hypertension: the HIPARCO randomized clinical trial. US National Library of Medicine. DOI: https://doi.org/10.1001/jama.2013.281250
Mutale, W., Ayles, H., Bond, V., Chintu, N., Chilengi, R., Mwanamwenge, M.T., Taylor, A., Spicer, N., & Balabanova, D. (2015). Application of Systems Thinking: 12-month postintervention evaluation of a complex health system intervention in Zambia: the case of the BHOMA. Journal of Evaluation in Clinical Practice DOI: https://doi.org/10.1111/jep.12354
National Bureau of Statistics (NBS) and United Nations children’s Fund (UNICEF). 2017 Multiple Indicator Cluster Survey 2016-17, Survey Findings Report. Abuja, Nigeria: National Bureau of Statistics and United Nations children’s Fund.
National Population Commission (NPC) (Nigeria) and ICF International. 2014. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF International.
Peters, H.D. (2014). The application of Systems Thinking in health: why use Systems Thinking. Health Research Policy and Systems, 12(51). DOI: https://doi.org/10.1186/1478-4505-12-51
Roux, A.V. (2011). Complex Systems Thinking and Current Impasses in Health Disparities Research. American Journal of Public Health, 101(9) DOI: https://doi.org/10.2105/AJPH.2011.300149
Rwashana, A.S., Nakubulwa, S., Nakakeeto-Kijjambu, M., & Adam, T. (2014). Advancing the application of Systems Thinking in health: Understanding the dynamics of neonatal mortality in Uganda. Health research policy and systems, 12(36). DOI: https://doi.org/10.1186/1478-4505-12-36
Sarriot, G.E., Kauletio, M., Jahan, S., Rasul, I., & Musha, A. (2014). Advancing the application of Systems Thinking in health: sustainability evaluation as learning and sense-making in a complex urban health system in Northern Bangladesh. Health Research Policy and Systems, 12(45). DOI: https://doi.org/10.1186/1478-4505-12-45
Senge, P. (1990). The Fifth Discipline: The Art and Practice of the Learning Organization
Sharma, S.R & Matheson, A. (2016). Systems Thinking in 21st century: a call to health promoters. Journal of public health, 15(2). DOI: https://doi.org/10.3126/hprospect.v15i2.15810
Varghese, J., Kutty, R.V., Paina, L. & Adam, T. (2014). Advancing the application of Systems Thinking in health: understanding the growing complexity governing immunization services in Kerala, India. Health Research Policy and Systems, 12(47). DOI: https://doi.org/10.1186/1478-4505-12-47
WHO Fact Sheet (2019). Retrieved from https://www.who.int. on Ftriday, 8th March 2019: 14:21pm
WHO Health topic on Health system (2019). Retrieved from www.google.com on Friday, 8th March 2019.
Zaidi, S., Riaz, A. & Memon, Z. (2015). Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions from Rural Pakistan. Health research policy and systems, 4(9).
Published
How to Cite
Issue
Section
License
With the licence CC-BY, authors retain the copyright, allowing anyone to download, reuse, re-print, modify, distribute, and/or copy their contribution. The work must be properly attributed to its author.
It is not necessary to ask for further permission from the author or journal board.
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.