Browsing by Person "Blanchet, Karl"

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Health Service Resilience in the Context of Adversity: Case Studies from Three African Countries
(MIT Press, 2025) Lembani, Martina; de Pinho, Helen; Delobelle, Peter; Zarowsky, Christina; Ager, Alastair; Blanchet, Karl
1. A group model building (GMB) approach to systems mapping can assist stakeholders in identifying key factors influencing specific health challenges and the dynamics of their interconnection. 2. GMB has proved a useful process to identify leverage points to mobilize and coordinate resources to address public health challenges in the process of engagements among key stakeholders. 3. Systems modeling provides a mechanism to enable stakeholders to articulate a vivid picture of the interplay of key factors seen to influence response to a crisis. 4. The GMB methodology appears promising in adapting it to use in analyzing different health systems issues and in different contexts for consolidating insights from multiple stakeholders regarding factors supporting—or undermining—health systems resilience.
Health system resilience: a critical review and reconceptualisation
(Elsevier, 2023-08-15) Witter, Sophie; Thomas, Steve; Topp, Stephanie M; Barasa, Edwine; Chopra, Mickey; Cobos, Daniel; Blanchet, Karl; Teddy, Gina; Atun, Rifat; Ager, Alastair
This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neglect of equity and of who is bearing the costs of resilience strategies. Resilience depends crucially on relationships between system actors and components, and—as amply shown during the COVID-19 pandemic—relationships with wider systems (eg, economic, political, and global governance structures). Resilience is therefore connected to power imbalances, which need to be addressed to enact the transformative strategies that are important in dealing with more persistent shocks and stressors, such as climate change. We discourage the framing of resilience as an outcome that can be measured; instead, we see it emerge from systemic resources and interactions, which have effects that can be measured. We propose a more complex categorisation of shocks than the common binary one of acute versus chronic, and outline some of the implications of this for resilience strategies. We encourage a shift in thinking from capacities towards capabilities—what actors could do in future with the necessary transformative strategies, which will need to encompass global, national, and local change. Finally, we highlight lessons emerging in relation to preparing for the next crisis, particularly in clarifying roles and avoiding fragmented governance.
Identifying vulnerabilities in essential health services: Analysing the effects of system shocks on childhood vaccination delivery in Lebanon
(Elsevier, 2024-08-28) Ismail, Sharif A.; Tomoaia-Cotisel, Andrada; Noubani, Aya; Fouad, Fouad M.; Trogrlić, Robert Šakić; Bell, Sadie; Blanchet, Karl; Borghi, Josephine
Shocks effects are under-theorised in the growing literature on health system resilience. Existing work has focused on the effects of single shocks on discrete elements within the health system, typically at national level. Using qualitative system dynamics, we explored how effects of multiple shocks interacted across system levels and combined with existing vulnerabilities to produce effects on essential health services delivery, through the prism of a case study on childhood vaccination in Lebanon. Lebanon has experienced a series of shocks in recent years, including large-scale refugee arrivals from neighbouring Syria, the COVID-19 pandemic and a political-economic crisis. We developed a causal loop diagram (CLD) to explore the effects of each shock individually, and in combination. The CLD was developed and validated using qualitative data from interviews with 38 stakeholders working in Lebanon's vaccination delivery system, in roles ranging from national level policy to facility-level service delivery, conducted between February 2020 and January 2022. We found that each of the shocks had different effects on service demand- and supply-side dynamics. These effects cascaded from national through to local levels. Both Syrian refugee movement and the COVID-19 pandemic primarily exposed vulnerabilities in service demand, mainly through slowly emerging knock-on effects on vaccination uptake behaviour among host communities, and fear of contracting infection in crowded health facilities respectively. The economic crisis exposed wider system vulnerabilities, including demand for vaccination as household income collapsed, and supply-side effects such as reduced clinic time for vaccination, declining workforce retention, and reduced availability of viable vaccine doses, among others. Finally, important pathways of interaction between shocks were identified, particularly affecting the balance between demand for vaccination through publicly supported facilities and private clinics. Future research should incorporate dynamic approaches to identifying within-system vulnerabilities and their potential impacts under different scenarios, as a precursor to improved resilience measurement, system preparedness, and intervention targeting.
Resilience in childhood vaccination: analysing delivery system responses to shocks in Lebanon.
(2023-11-01) Ismail, Sharif A; Tomoaia-Cotisel, Andrada; Noubani, Aya; Fouad, Fouad M; Bell, Sadie; Borghi, Josephine; Blanchet, Karl
IntroductionDespite rapidly growing academic and policy interest in health system resilience, the empirical literature on this topic remains small and focused on macrolevel effects arising from single shocks. To better understand health system responses to multiple shocks, we conducted an in-depth case study using qualitative system dynamics. We focused on routine childhood vaccination delivery in Lebanon in the context of at least three shocks overlapping to varying degrees in space and time: large-scale refugee arrivals from neighbouring Syria; COVID-19; and an economic crisis.MethodsSemistructured interviews were performed with 38 stakeholders working at different levels in the system. Interview transcripts were analysed using purposive text analysis to generate individual stakeholder causal loop diagrams (CLDs) mapping out relationships between system variables contributing to changes in coverage for routine antigens over time. These were then combined using a stepwise process to produce an aggregated CLD. The aggregated CLD was validated using a reserve set of interview transcripts.ResultsVarious system responses to shocks were identified, including demand promotion measures such as scaling-up community engagement activities and policy changes to reduce the cost of vaccination to service users, and supply side responses including donor funding mobilisation, diversification of service delivery models and cold chain strengthening. Some systemic changes were introduced-particularly in response to refugee arrivals-including task-shifting to nurse-led vaccine administration. Potentially transformative change was seen in the integration of private sector clinics to support vaccination delivery and depended on both demand side and supply side changes. Some resilience-promoting measures introduced following earlier shocks paradoxically increased vulnerability to later ones.ConclusionFlexibility in financing and human resource allocation appear key for system resilience regardless of the shock. System dynamics offers a promising method for ex ante modelling of ostensibly resilience-strengthening interventions under different shock scenarios, to identify-and safeguard against-unintended consequences.
Understanding Resilience in UNRWA Health Response to the Syrian Crisis: Lessons from Causal Loop Analysis
(MIT Press, 2025) Ager, Alastair; Diaconu, Karin; Jamal, Zeina; Alameddine, Mohamad; Fouad, Fouad M.; Witter, Sophie; Blanchet, Karl
1. Group model building gathers key stakeholders together to develop causal loop analysis of health system responses to experienced shocks. 2. Causal loop analysis can identify important resources and strategies supporting health system resilience. 3. Evidence of absorptive, adaptive, and transformative resilience capacities was demonstrated in UNRWA health response to the Syria crisis across Jordan, Lebanon, and Syria. 4. Analysis highlights the importance of collateral pathways and redundancy; flexible governance and leadership practices; and an organizational culture that sees challenge as an opportunity for learning and innovation. 5. Such evidence has implications for other health systems seeking to integrate provision of services to refugee populations, as well as for UNRWA itself operating in a context of political instability.
Understanding the health needs of internally displaced persons: A scoping review
(Elsevier, 2021-10-29) Cantor, David James; Swartz, Jina; Bayard, Roberts; Abbara, Aula; Ager, Alastair; Bhutta, Zulfiqar A.; Blanchet, Karl; Bunte, Derebe Madoro; Chukwuorji, JohnBosco Chika; Daoud, Nihaya; Ekezie, Winifred; Jimenez-Damary, Cecilia; Jobanputra, Kiran; Makhashvili, Nino; Rayes, Diana; Restrepo-Espinosa, Maria Helena; Rodriguez-Morales, Alfonso J.; Bukola, Salami; Smith, James
We seek to strengthen understanding of the health needs of internally displaced persons (IDPs) in contexts of conflict or violence. Based upon a scoping review, our paper identified limited evidence on IDPs health, but nevertheless indicates that IDPs tend to experience worse health outcomes than other conflict-affected populations across a range of health issues; and this is due to the particularly vulnerable situation of IDPs relative to these other populations, including reduced access to health services. Further research is required to better understand these needs and the interventions that can most effectively address these needs.
Understanding the political economy of reforming global health initiatives – insights from global and country levels
(Springer, 2025-07-09) Witter, Sophie; Palmer, Natasha; Jouhaud, Rosemary; Zaidi, Shehla; Carillon, Severine; English, Rene; Loffreda, Giulia; Venables, Emilie; Habib, Shifa Salman; Tan, Jeff; Hane, Fatouma; Bertone, Maria Paola; Hosseinalipour, Seyed-Moeen; Ridde, Valery; Shoaib, Asad; Faye, Adama; Dudley, Lilian; Daniels, Karen; Blanchet, Karl
Introduction Since 2000, the number and role of global health initiatives (GHIs) has been growing, with these platforms playing an increasingly important role in pooling and disbursing funds dedicated to specific global health priorities. While recognising their important contribution, there has also been a growth in concerns about distortions and inefficiencies linked to the GHIs and attempts to improve their alignment with country health systems. There is a growing momentum to adjust GHIs to the current broader range of global health threats, such as non-communicable diseases, humanitarian crises and climate change, and against the backdrop of the recent aid cuts. However, reform attempts are challenged by the political economy of the current structures. Methods In this article, we draw on research conducted as part of the Future of Global Health Initiatives process. The study adopted a cross-sectional, mixed-methods approach, drawing from a range of data sources and data collection methods, including a global and regional level analysis as well as three embedded country case studies in Pakistan, South Africa and Senegal. All data was collected from February to July 2023. 271 documents were analysed in the course of the study, along with data from 335 key informants and meeting participants in 66 countries and across a range of constituencies. For this paper, data were analysed using a political economy framework which focused on actors, context (especially governance and financing) and framing. Findings In relation to actors, the GHIs themselves have become increasingly complex (both internally and in their interrelations with other global health actors and one another). They have a large range of clients (including at national level and amongst multilateral agencies) which function as collaborators as well as competitors. Historically there have been few incentives for any of the actors to maximise collaboration given the competitive funding landscape. Power to exert pressure for reforms sits ultimately with bilateral and private funders, though single-issue northern non-governmental organisations (NGOs) are also cited as important influencers. Funders have not collaborated to enable reforms, despite concerns amongst a number of them, because of the helpful functional role of GHIs, which serves funder interests. Some key global boards are reported to be engineered for stasis, and there are widespread concerns about lack of transparency and over-claiming (by some GHIs) of their results. Framing of narratives about achievements and challenges is important to enable or block reforms and are vigorously contested, with stakeholders often selecting different outcomes to emphasise in justifying positions. Conclusion GHIs have played an important role in the global health ecosystem but despite formal accountability structures to include recipient governments, substantive accountability has been focused upwards to funders, with risk management strategies which prioritise tracking resources more than improved national health system performance. Achieving consensus on reforms will be challenging but current funding pressures and new threats are creating a sense of urgency, which may shift positions. Political economy analysis can model and influence these debates.
Understanding the resilience of health systems
(Springer, 2020-02-26) Blanchet, Karl; Diaconu, Karin; Witter, Sophie; Bozorgmehr, Kayvan; Roberts, Bayard; Razum, Oliver; Biddle, Louise
Globally, displacement is now at the highest level ever recorded with 68.5 million people being forcibly displaced due to violence, political instability or poor economic conditions. Migration towards neighbouring countries or more distant high-income settings in Europe is creating new challenges for national health systems. This chapter explores health systems resilience, i.e. the capacity of health systems to adapt and transform themselves in response to challenges. We offer reflections and a new conceptual framework on resilience based on systems thinking and complexity theories. The chapter also offers examples of migration-related challenges and resilience responses in health systems and policies in order to illustrate the utility and relevance of the developed conceptual framework for European and neighbouring health systems faced by population flows and conflict. Finally, we make recommendations for a new research agenda.
World Health Organization and emergency health: if not now, when?
(BMJ Publishing Group, 2016-01) Checchi, Francesco; Waldman, Ronald J.; Roberts, Leslie F.; Ager, Alastair; Asgary, Ramin; Benner, Marie T.; Blanchet, Karl; Burnham, Gilbert; d'Harcourt, Emmanuel; Leaning, Jennifer; Massaquoi, Moses B. F.; Mills, Edward J.; Moresky, Rachel T.; Patel, Preeti; Roberts, Bayard; Toole, Michael J.; Woodruff, Bradley; Zwi, Anthony B.