Question

Waht are the problems caused

Answer 1

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Answer 2

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The identification and selection of appropriate options for addressing a problem should be guided by an understanding of its cause. Such insights may also lead to the original framing choice being changed. Often the causes of health systems problems are complex and uncertain and it may be more appropriate to consider underlying factors without attributing causation. The process of clarifying the cause or underlying factors is unlikely to be simple or linear. And although it may be possible to reduce uncertainty about the cause, it may be equally or more important to clarify uncertainty about the cause. Strategies for clarifying the cause of health system problems include using either broader or more specific frameworks, brainstorming, reviewing relevant research evidence, and interviews with key informants.

Broad frameworks for health system problems that could be used include the extent to which the problem is due to delivery, financial and governance arrangements (see Table 3.2),3,4 or to the implementation of existing policies (see SURE Guide 5. Identifying and addressing barriers to implementing the options). Although, for example, the problem may be described initially as a problem with delivery arrangements (e.g. a shortage of health workers in rural areas), the cause of this shortage instead may actually have to do with financial arrangements (e.g. how health workers are remunerated) or governance arrangements (e.g. the licensing of different types of health workers to perform specific tasks).

More specific frameworks may facilitate a more detailed consideration of the potential causes of some types of problems. For example, a framework for addressing problems with human resources for health might be used to think systematically through the potential causes of problems such as a shortage of health workers, their distribution, their performance, or their cost and efficient use, and to consider the solutions to these.5 Similarly, a framework for healthcare financing may help with thinking through the problems with health care financing systematically (Figure 1).6  Other examples of frameworks are shown in Table 3.3. Searching for frameworks such as these can be done easily using Google Scholar or PubMed by combining the word ‘framework’ with key words describing the problem. Often the most efficient way of finding frameworks is to talk to people with expertise in the specific area of interest. Other sources of such frameworks include other policy briefs on the same or closely related issues, policy analyses, and systematic reviews or overviews of systematic reviews.

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