In 2009 the government of China identified an essential drugs policy as one of five priority areas for health system reform. Since then, a national essential drugs policy has been defined, along with plans to implement it. As a large scale social intervention, the policy will have a significant impact on various local health actors. This paper uses the lens of complex adaptive systems to examine how the policy has been implemented in three rural Chinese counties. Using material gathered from interviews with key actors in county health bureaus and township health centers, we illustrate how a single policy can lead to multiple unanticipated outcomes. The complexity lens applied to the material gathered in interviews helps to identify relevant actors, their different relationships and policy responses and a new framework to better understand heterogeneous pathways and outcomes. Decision-makers and policy implementers are advised to embrace the complex and dynamic realities of policy implementation. This involves developing mechanisms to monitor different behaviors of key actors as well as the intended outcomes and unintended consequences of the policy.
Entries in David Bishai (10)
Dr David Bishai gives an introduction complex adaptive systems and their application to health systems modelling and strengthening.
The presentation by Dr David Bishai was given at the First Complex Adaptive Systems Training Workshop for CNHDRC, which was held in Beijing, China, from 18-19 July. It outlines the origins of complex adaptive systems thinking in social sciences.
Comparing private sector family planning services to government and NGO services in Ethiopia and Pakistan: how do social franchises compare across quality, equity and cost?
Policy makers in developing countries need to assess how public health programmes function across both public and private sectors. We propose an evaluation framework to assist in simultaneously tracking performance on efficiency, quality and access by the poor in family planning services. We apply this framework to field data from family planning programmes in Ethiopia and Pakistan, comparing independent private sector providers; social franchises of private providers; non-government organization (NGO) providers; and government providers on these three factors.
WP13 - Engaging the private sector in maternal and neonatal health in low and middle income countries
We reviewed existing literature on private sector initiatives that have shown effectiveness in improving maternal and neonatal health. The private sector constitutes a significant proportion of delivery services for women in developing countries and it also plays a key role in family planning, abortion, nutrition, and antenatal care. We primarily address maternal health outcomes and include interventions that improve neonatal health outcomes where they are included in the study design or interventional strategy alongside maternal outcomes. We do not review evidence that addresses neonatal outcomes alone, as this would go beyond the scope of this paper.