How to work with intangible software in public health systems: some experiences from India.

Autor: Ramani S; Oxford Policy Management, New Delhi, India. sudha_ramani@yahoo.com., Parashar R; Evidence Action, New Delhi, India., Roy N; CARE India, New Delhi, India., Kullu A; Oxford Policy Management, New Delhi, India., Gaitonde R; Achutha Menon Centre for Health Science Studies, Thiruvananthapuram, Kerala, 695011, India., Ananthakrishnan R; Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India., Arora S; Center for Enquiry into Health and Allied Themes, Santacruz East, Mumbai, 400055, India., Mishra S; Oxford Policy Management, New Delhi, India., Pitre A; Gender Justice, Oxfam India, New Delhi, India., Saluja D; Women in Global Health, New Delhi, India., Srinivasan A; Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India., Uppal A; Vikalp Kriya, Panaji, Goa, India., Bose P; Vikalp Kriya, Panaji, Goa, India., Yellappa V; NITI Aayog, New Delhi, India., Kumar S; Health Systems Transformation Platform, New Delhi, India.
Jazyk: angličtina
Zdroj: Health research policy and systems [Health Res Policy Syst] 2022 May 07; Vol. 20 (1), pp. 52. Date of Electronic Publication: 2022 May 07.
DOI: 10.1186/s12961-022-00848-9
Abstrakt: This commentary focuses on "intangible software", defined as the range of ideas, norms, values and issues of power or trust that affect the performance of health systems. While the need to work with intangible software within health systems is increasingly being recognized, the practical hows of doing so have been given less attention. In this commentary, we, a team of researchers and implementers from India, have tried to deliberate on these hows through a practice lens. We engage with four questions of current relevance to intangible software in the field of health policy and systems research (HPSR): (1) Is it possible to rewire intangible software in health systems? (2) What approaches have been attempted in the Indian public health system to rewire intangibles? (3) Have such approaches been evaluated? (4) What practical lessons can we offer from our experience on rewiring intangibles? From our perspective, approaches to rewiring intangible software recognize that people in health systems are capable of visioning, thinking, adapting to and leading change. These approaches attempt to challenge the often-unchallenged power hierarchies in health systems by allowing people to engage deeply with widely accepted norms and routinized actions. In this commentary, we have reported on such approaches from India under six categories: approaches intended to enable visioning and leading; approaches targeted at engaging with evidence better; approaches intended to help health workers navigate contextual complexities; approaches intended to build the cultural competence; approaches that recognize and reward performance; and approaches targeted at enabling collaborative work and breaking power hierarchies. Our collective experiences suggest that intangible software interventions work best when they are codesigned with various stakeholders, are contextually adapted in an iterative manner and are implemented in conjunction with structural improvements. Also, such interventions require long-term investments. Based on our experiences, we highlight the need for the following: (1) fostering more dialogue on this category of interventions among all stakeholders for cross-learning; (2) evaluating and publishing evidence on such interventions in nonconventional ways, with a focus on participatory learning; and (3) building ecosystems that allow experiential learnings on such interventions to be shared.
(© 2022. The Author(s).)
Databáze: MEDLINE
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