Health Systems and Economics

Executive Summary of Health Systems and Economics

This work represents the failure of implementation of systems thinking for the public health issue of malaria in Rwanda. It aims to deliver the statistical data on the prevalence of malaria followed by the identification of certain obstacles in the implementation systems thinking in Rwanda. The major obstacles identified in this report are the lack of awareness and promotion and the lack of funding for such programs that acts as a potential barrier. This report also highlights few recommendations that are important to be implemented to curb the barriers and to facilitate the successful implementation of the systems thinking for malaria in Rwanda.

Introduction to Health Systems and Economics

Systems thinking is a holistic approach that is a conceptual orientation concerned with the interconnectedness between constituent parts of a complex system (Reid & Dold, 2020). It focuses on the emergent behavior of the complex system and addresses multiple dynamic interactions of the whole system. The systems thinking is applied in the public health issue that assists in predicting and mitigating the possible unintended consequences of failed chronic policies or the actions taken for the eradication of a chronic disease or a public health issue (Atkins, Kilbourne & Shulkin, 2017). This is an intellectual endeavor that is being incorporated at rapid scale speed into the contemporary public health.

Public Health Issue

The selected public health issue is malaria because it is highly prevalent in the country of Rwanda. Malaria is a life threatening disease caused by parasite and is transmitted through the bite of an infected mosquito to the healthy human being. The high prevalence of malaria in Rwanda is evidenced by the statistical data that shows approximately 1000 increased incidences every year (USAID, 2018). From 2012- 2016, Rwanda has witnessed 8 folds increase in the incidences of Malaria in all thirty districts (USAID, 2018). The overall case fatality rate depleted but the malaria- related deaths doubled in the years 2013- 2016. This is a major burden on Rwanda and despite of many programs that have been implemented by the president, it has significantly failed to address this public health issue. The Rwanda Health System initiated a mission “to provide leadership of the health sector to ensure universal access to affordable preventive, curative, and rehabilitative health services of the highest attainable quality” (Omolade et al., 2018).

Key Stakeholders

The progress in the battle against malaria in Rwanda is contributed to the stakeholder’s degree of involvement and their relevant response and sustainable gain in disease control programs is significant. The potential stakeholders that are important in addressing increasing incidences of malaria in Rwanda includes the stakeholders from both health sectors and non- health sectors like political sector and educational sector. The participatory actions from the stakeholders of health sector can be gained from public health nurses and other health care staff members that are a part of local, national and regional health care system. Their participatory actions will have the major impact in addressing this issue and the second major group of stakeholders that will have a prominent part to play are local, national and regional governmental organizations (Ingabire et al., 2016).

The stakeholders from the education sector, administrative sector and business sector will also play an important role in addressing the drastically increasing rates of malaria cases in Rwanda. The partnering agency that will fund the malaria programs like NGOs and international development organization will also be considered as an important stakeholders for the funding purpose (Alexis et al., 2016). Other important stakeholders in this list will be manufacturers of malaria drugs and vaccines that have a direct major role in addressing this issue. The stakeholders that will also play a significant role in funding malaria programs are privately owned businesses that would come under business sector. All of these sectors together that sums up the list of stakeholders have most important roles to play in addressing this issue.

Obstacles Into Implementation of Systems Thinking

Systems thinking application has not been implemented in addressing this public health issue of malaria in Rwanda. There are numerous drawbacks that have resulted in the failure of implementation of systems thinking in Rwanda. Systems thinking as an application in the filed of public health is a important mean of mitigating implicit assumptions and it also facilitates ethics debate with the identified key stakeholders. The practical challenges to the implementation of systems thinking in public health is the lack of funding for transdisciplinary and interagency collaborative project with a system focus (Knai et al., 2018). Rwandan has this major problem of non- collaborative work motive because of the lack of potential sources of funding. In contemporary times, there were many programs implemented for the eradication of malaria but they somehow failed in being successful in mitigating this issue due to the lack of funding. The funding to these programs were initiated by the Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM) (English, 2016). There is a lack of promotion and awareness because the last attempt was neglected as it was assumed that the uniform and rapid spraying operations would diminish the prevalence of this disease. These issues lead to the failure of implementation of systems thinking in Rwanda for addressing the issue of malaria.

Recommendations on Health Systems and Economics

The suggestions for the implementation of systems thinking approach includes the measures that will be taken by new governance arrangements. The policy making process should be strengthened so as to adopt the modern ethics thinking to the nonlinear problems that would also make people aware on the need of research for this public health issue in Rwanda. One of the major suggestions in this field is identification of the cross- sectoral and sociopolitical level so that appropriate interventions can be implemented to operate this public health issues at multiple levels. This can be done at both private and public levels that requires major support from the mass and the key stakeholders that were identified above. It is suggested to explore the systems paradigms and perspectives such as ecological, participatory, constructivist and non linear frameworks. It is also suggested that the limitations of dominant paradigm are well identified in public health like disease focused frameworks.

Conclusion on Health Systems and Economics

The conclusion drawn is that the prevalence of public health issue that is malaria in Rwanda is very high that has led to this research on the failure of implementation of systems thinking approach in this public health domain. There are many reasons behind this failure like the lack of funds and awareness by the people that requires the efforts from the key stakeholders. These key stakeholders belong to health sector, administrative sector, business sector and educational sector. The suggestions are made to overcome the potential obstacles in the implementation of systems thinking that will facilitate the implementation of this approach for addressing this public health issue of malaria in Rwanda.

References for Health Systems and Economics

Alexis Rulisa, M. P. H., Muvunyi, C., & Msc, C. J. (2016). Stakeholder engagement in community-based malaria studies in a defined setting in the eastern province, Rwanda. Determinants Of Malaria Control In A Rural Community In Eastern Rwanda7, 179.

Atkins, D., Kilbourne, A. M., & Shulkin, D. (2017). Moving from discovery to system-wide change: the role of research in a learning health care system: experience from three decades of health systems research in the Veterans Health Administration. Annual Review Of Public Health38, 467-487.

English, E. (2016). The Global Fund to Fight Aids, Tuberculosis and Malaria: Assessing Compliance from Global Health Donors.

Ingabire, C. M., Kateera, F., Hakizimana, E., Rulisa, A., Borne, B., Muvunyi, C. M., ... & Alaii, J. (2016). Stakeholder engagement in community-based malaria studies in a defined setting in the eastern province, Rwanda.

Knai, C., Petticrew, M., Mays, N., Capewell, S., Cassidy, R., Cummins, S., ... & Katikireddi, S. V. (2018). Systems thinking as a framework for analyzing commercial determinants of health. The Milbank Quarterly96(3), 472-498.

Omolade, I. O., Ingabire, C. M., van Vugt, M., Mutesa, L., van den Borne, B., & Busari, J. O. (2018). Qualitative analysis of the health system effects of a community-based malaria elimination program in Rwanda.

Reid, W. M., & Dold, C. J. (2020). Systems Thinking for the Middle Manager and Aspiring Leader in Public Health. Open Journal of Leadership9(01), 84.

USAID. (2018). President’s malaria initiative Rwanda. Retrieved from https://www.pmi.gov/docs/default-source/default-document-library/malaria-operational-plans/fy-2018/fy-2018-rwanda-malaria-operational-plan.pdf?sfvrsn=6#:~:text=Over%2095%25%20of%20total%20reported,2012%20to%204%2C794%2C778%20in%202016.

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