Speaker
Description
Background: Research on health system capacity for non-communicable diseases has largely focused on ‘hardware’ components such as infrastructure and commodities. However, this overlooks the complex adaptive nature of health systems and the critical role of ‘software’ elements such as relationships and power, which also shape health system capacity. This study aims to explore how hardware and software elements interact to shape the capacity of a rural health system in Kenya to deliver hypertension care.
Methods: We conducted a cross-sectional qualitative study and collected data using in-depth- interviews with front-line health workers (FLHWs) at five health facilities and health managers at county and national levels (n=37). We applied a framework approach to data analysis, utilizing complex adaptive systems (CAS) theory as our analytic framework.
Results: Complex interactions of hardware and software elements across different health system levels constrained the provision of hypertension care. Frequent unavailability of antihypertensive medicines (hardware) stemmed from budgetary gaps, procurement delays, regulatory restrictions, and weak quantification practices (software). To mitigate medication shortages, facilities employed adaptive responses such as inter-facility borrowing, while hospitals with financial autonomy sourced from alternative suppliers (software). Access and continuity of care were enabled by organizational norms like dedicated hypertension clinic days (software), but undermined by hardware deficits (e.g., inadequate consultation rooms, staff shortages) and limited training and support supervision (software). FLHWs’ ideas to improve medication adherence were undermined by staff shortages (hardware) and inadequate support from facility managers (software), weakening service delivery.
Conclusion: The application of CAS theory unpacked the hitherto unseen aspects of capacity. System ‘software’, including organizational norms, procedures and leadership, plays a central role in shaping health system capacity for hypertension care. Strengthening health system capacity requires coordinated investment in both hardware (e.g., financing, infrastructure) and software (e.g., FLHW training, leadership) to enable access and patient-centred service delivery for NCDs.
| Country | Kenya |
|---|---|
| Organization | Research Institution |
| Position | PhD Fellow |
| Received a Grant? | Yes |
| If yes, give grant details | This project is funded by the National Institute for Health and Care Research (NIHR) under its ‘Global Health Research Units and Groups Programme’ (Grant Reference Number NIHR134544). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscrip |
