Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia
Introduction Resilient health systems have the capacity to continue providing health services to meet the community’s diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system’s joined capacities for resilien...
Main Authors: | , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMJ Publishing Group
2020-04-01
|
Series: | BMJ Global Health |
Online Access: | https://gh.bmj.com/content/5/4/e002272.full |
id |
doaj-22d56810c4ab437daf852f353e68c0d3 |
---|---|
record_format |
Article |
spelling |
doaj-22d56810c4ab437daf852f353e68c0d32021-04-25T09:30:22ZengBMJ Publishing GroupBMJ Global Health2059-79082020-04-015410.1136/bmjgh-2019-002272Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in CambodiaHelle Mölsted Alvesson0Johan Von Schreeb1Dell D SaulnierHom HeanDawin Thol2 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden 1 Centre for Research on Health Care in Disasters, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Introduction Resilient health systems have the capacity to continue providing health services to meet the community’s diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system’s joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how community management of pregnancy and childbirth care during floods is contributing to the system’s capacity to absorb, adapt or transform as viewed through a framework on health systems resilience.Methods Eight focus group discussions and 17 semi-structured interviews were conducted with community members and leaders who experienced pregnancy or childbirth during recent flooding in rural Cambodia. The data were analysed by thematic analysis and discussed in relation to the resilience framework.Results The theme ‘Responsible for the status quo’ reflected the community’s responsibility to find ways to manage pregnancy and childbirth care, when neither the expectations of the health system nor the available benefits changed during floods. The theme was informed by notions on: i) developmental changes, the unpredictable nature of floods and limited support for managing care, ii) how information promoted by the public health system led to a limited decision-making space for pregnancy and childbirth care, iii) a desire for security during floods that outweighed mistrust in the public health system and iv) the limits to the coping strategies that the community prepared in case of flooding.Conclusions The community mainly employed absorptive strategies to manage their care during floods, relieving the burden on the health system, yet restricted support and decision-making may risk their capacity. Further involvement in decision-making for care could help improve the health system’s resilience by creating room for the community to adapt and transform when experiencing floods.https://gh.bmj.com/content/5/4/e002272.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Helle Mölsted Alvesson Johan Von Schreeb Dell D Saulnier Hom Hean Dawin Thol |
spellingShingle |
Helle Mölsted Alvesson Johan Von Schreeb Dell D Saulnier Hom Hean Dawin Thol Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia BMJ Global Health |
author_facet |
Helle Mölsted Alvesson Johan Von Schreeb Dell D Saulnier Hom Hean Dawin Thol |
author_sort |
Helle Mölsted Alvesson |
title |
Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia |
title_short |
Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia |
title_full |
Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia |
title_fullStr |
Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia |
title_full_unstemmed |
Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia |
title_sort |
staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in cambodia |
publisher |
BMJ Publishing Group |
series |
BMJ Global Health |
issn |
2059-7908 |
publishDate |
2020-04-01 |
description |
Introduction Resilient health systems have the capacity to continue providing health services to meet the community’s diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system’s joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how community management of pregnancy and childbirth care during floods is contributing to the system’s capacity to absorb, adapt or transform as viewed through a framework on health systems resilience.Methods Eight focus group discussions and 17 semi-structured interviews were conducted with community members and leaders who experienced pregnancy or childbirth during recent flooding in rural Cambodia. The data were analysed by thematic analysis and discussed in relation to the resilience framework.Results The theme ‘Responsible for the status quo’ reflected the community’s responsibility to find ways to manage pregnancy and childbirth care, when neither the expectations of the health system nor the available benefits changed during floods. The theme was informed by notions on: i) developmental changes, the unpredictable nature of floods and limited support for managing care, ii) how information promoted by the public health system led to a limited decision-making space for pregnancy and childbirth care, iii) a desire for security during floods that outweighed mistrust in the public health system and iv) the limits to the coping strategies that the community prepared in case of flooding.Conclusions The community mainly employed absorptive strategies to manage their care during floods, relieving the burden on the health system, yet restricted support and decision-making may risk their capacity. Further involvement in decision-making for care could help improve the health system’s resilience by creating room for the community to adapt and transform when experiencing floods. |
url |
https://gh.bmj.com/content/5/4/e002272.full |
work_keys_str_mv |
AT hellemolstedalvesson stayingafloatcommunityperspectivesonhealthsystemresilienceinthemanagementofpregnancyandchildbirthcareduringfloodsincambodia AT johanvonschreeb stayingafloatcommunityperspectivesonhealthsystemresilienceinthemanagementofpregnancyandchildbirthcareduringfloodsincambodia AT delldsaulnier stayingafloatcommunityperspectivesonhealthsystemresilienceinthemanagementofpregnancyandchildbirthcareduringfloodsincambodia AT homhean stayingafloatcommunityperspectivesonhealthsystemresilienceinthemanagementofpregnancyandchildbirthcareduringfloodsincambodia AT dawinthol stayingafloatcommunityperspectivesonhealthsystemresilienceinthemanagementofpregnancyandchildbirthcareduringfloodsincambodia |
_version_ |
1721510084833443840 |