umu.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Publications (2 of 2) Show all publications
Schneider, H., Zulu, J. M., Mathias, K., Cloete, K. & Hurtig, A.-K. (2019). The governance of local health systems in the era of Sustainable Development Goals: reflections on collaborative action to address complex health needs in four country contexts. BMJ Global Health, 4(3), Article ID e001645.
Open this publication in new window or tab >>The governance of local health systems in the era of Sustainable Development Goals: reflections on collaborative action to address complex health needs in four country contexts
Show others...
2019 (English)In: BMJ Global Health, ISSN 2059-7908, Vol. 4, no 3, article id e001645Article in journal (Refereed) Published
Abstract [en]

This analysis reflects on experiences and lessons from four country settings-Zambia, India, Sweden and South Africa-on building collaborations in local health systems in order to respond to complex health needs. These collaborations ranged in scope and formality, from coordinating action in the community health system (Zambia), to a partnership between governmental, nongovernmental and academic actors (India), to joint planning and delivery across political and sectoral boundaries (Sweden and South Africa). The four cases are presented and analysed using a common framework of collaborative governance, focusing on the dynamics of the collaboration itself, with respect to principled engagement, shared motivation and joint capacity. The four cases, despite their differences, illustrate the considerable challenges and the specific dynamics involved in developing collaborative action in local health systems. These include the coconstruction of solutions (and in some instances the problem itself) through engagement, the importance of trust, both interpersonal and institutional, as a condition for collaborative arrangements, and the role of openly accessible information in building shared understanding. Ultimately, collaborative action takes time and difficulty needs to be anticipated. If discovery, joint learning and developing shared perspectives are presented as goals in themselves, this may offset internal and external expectations that collaborations deliver results in the short term.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-161544 (URN)10.1136/bmjgh-2019-001645 (DOI)000471834400038 ()31263592 (PubMedID)
Available from: 2019-07-10 Created: 2019-07-10 Last updated: 2019-07-10Bibliographically approved
Mathias, K., Mathias, J., Goicolea, I. & Kermode, M. (2018). Strengthening community mental health competence: A realist informed case study from Dehradun, North India. Health & Social Care in the Community, 26(1), E179-E190
Open this publication in new window or tab >>Strengthening community mental health competence: A realist informed case study from Dehradun, North India
2018 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 26, no 1, p. E179-E190Article in journal (Refereed) Published
Abstract [en]

Few accounts exist of programmes in low- and middle-income countries seeking to strengthen community knowledge and skills in mental health. This case study uses a realist lens to explore how a mental health project in a context with few mental health services, strengthened community mental health competence by increasing community knowledge, creating safer social spaces and engaging partnerships for action. We used predominantly qualitative methods to explore relationships between context, interventions, mechanisms and outcomes in the natural setting of a community-based mental health project in Dehradun district, Uttarakhand, North India. Qualitative data came from focus group discussions, participant observation and document reviews of community teams' monthly reports on changes in behaviour, attitudes and relationships among stakeholder groups. Data analysis initially involved thematic analysis of three domains: knowledge, safe social spaces and partnerships for action. By exploring patterns within the identified themes for each domain, we were able to infer the mechanisms and contextual elements contributing to observed outcomes. Community knowledge was effectively increased by allowing communities to absorb new understanding into pre-existing social and cultural constructs. Non-hierarchical informal community conversations allowed organic integration of unfamiliar biomedical knowledge into local explanatory frameworks. People with psycho-social disability and caregivers found increased social support and inclusion by participating in groups. Building skills in respectful communication through role plays and reflexive discussion increased the receptivity of social environments to people with psycho-social disabilities participation, thereby creating safe social spaces. Facilitating social networks through groups increases women's capacity for collective action to promote mental health. In summary, locally appropriate methods contribute most to learning, stigma reduction and help-seeking. The complex social change progress was patchy and often slow. This study demonstrates a participatory, iterative, reflexive project design which is generating evidence indicating substantial improvements in community mental health competence.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
community participation, evaluation and community-based research, global mental health, India, mental health promotion, social care
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-143627 (URN)10.1111/hsc.12498 (DOI)000418264900019 ()28891109 (PubMedID)
Available from: 2018-01-29 Created: 2018-01-29 Last updated: 2018-06-09Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-9607-9459

Search in DiVA

Show all publications