Browsing by Person "Delobelle, Peter"

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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 service resilience in Yobe state, Nigeria in the context of the Boko Haram insurgency: a systems dynamics analysis using group model building
(BioMed Central, 2015-10) Ager, Alastair; Lembani, Martina; Mohammed, Abdulaziz; Mohammed Ashir, Garba; Abdulwahab, Ahmad; de Pinho, Helen; Delobelle, Peter; Zarowsky, Christina
Background: Yobe State has faced severe disruption of its health service as a result of the Boko Haram insurgency. A systems dynamics analysis was conducted to identify key pathways of threat to provision and emerging pathways of response and adaptation. Methods: Structured interviews were conducted with 39 stakeholders from three local government areas selected to represent the diversity of conflict experience across the state: Damaturu, Fune and Nguru, and with four officers of the PRRINN-MNCH program providing technical assistance for primary care development in the state. A group model building session was convened with 11 senior stakeholders, which used participatory scripts to review thematic analysis of interviews and develop a preliminary systems model linking identified variables. Results: Population migration and transport restrictions have substantially impacted access to health provision. The human resource for health capability of the state has been severely diminished through the outward migration of (especially non-indigenous) health workers and the suspension of programmes providing external technical assistance. The political will of the Yobe State government to strengthen health provision - through lifting a moratorium on recruitment and providing incentives for retention and support of staff - has supported a recovery of health systems functioning. Policies of free-drug provision and decentralized drug supply appear to have been protective of the operation of the health system. Community resources and cohesion have been significant assets in combatting the impacts of the insurgency on service utilization and quality. Staff commitment and motivation - particularly amongst staff indigenous to the state - has protected health care quality and enabled flexibility of human resource deployment. Conclusions: A systems analysis using participatory group model building provided a mechanism to identify key pathways of threat and adaptation with regard to health service functioning. Generalizable systems characteristics supportive of resilience are suggested, and linked to wider discussion of the role of factors such as diversity, self-regulation and integration. 2015 Ager et al.
Understanding key drivers of performance in the provision of maternal health services in Eastern Cape, South Africa: A systems analysis using group model building
(BioMed Central, 2018-11-29) Lembani, Martina; de Pinho, Helen; Delobelle, Peter; Zarowsky, Christina; Mathole, Thubelihle; Ager, Alastair
Background: The Eastern Cape Province reports among the poorest health service indicators in South Africa with some of its districts standing out as worst performing as regards maternal health indicators. To understand key drivers and outcomes of this underperformance and to explore whether a participatory analysis could deepen action-oriented understanding among stakeholders, a study was conducted in one of the chronically poorly performing districts. Methods: The study used a systems analysis approach to understand the drivers and outcomes affecting maternal health in the district in order to identify key leverage points for addressing the situation. The approach included semistructured interviews with a total of 24 individuals consisting health system managers at various levels, health facility staff and patients. This was followed by a participatory group model building exercise with 23 key stakeholders to analyze system factors and their interrelationships affecting maternal health in the district using rich pictures and interrelationship diagraphs (IRDs) and finally the development of causal loop diagrams (CLDs). Results: The stakeholders were able to unpack the complex ways in which factors were interrelated in contributing to poor maternal health performance and identified the feedback loops which resulted in the situation being intractable, suggesting strategies for sustainable improvement. Quality of leadership was shown to have a pervasive influence on overall system performance by linking to numerous factors and feedback loops, including staff motivation and capacity building. Staff motivation was linked to quality of care in turn influencing patient attendance and feeding back into staff motivation through its impact on workload. Without attention to workload, patient waiting times and satisfaction, the impact of improved leadership and staff support on staff competence and attitudes would be diminished. Conclusion: Understanding the complex interrelationships of factors in the health system is key to identifying workable solutions especially in the context of chronic health systems challenges. Systems modelling using group model building methods can be an efficient means of supporting stakeholders to recognize valuable resources within the context of a dysfunctional system to strengthen systems performance.