Health Systems Performance in Circumpolar Regions: Can Regional Comparisons Support Policy and Stimulate Improvement?
Principal Investigator: Chatwood, Susan (4)
Licence Number: 15219
Organization: Institute for Circumpolar Health Research
Licensed Year(s): 2013
Issued: Mar 13, 2013

Objective(s): To inform how circumpolar ministries might best fulfil their obligations to steer their health systems and compile, disseminate, and use appropriate evidence with an aim to understand and improve health systems performance in their northern regions.

Project Description: This thesis aims to explore the mechanisms that influence health system performance through a stewardship lens that provides insight as to how ministries, affiliated health sectors and regions not only carry out performance measures, but also hold accountability and make improvements.

Understandings around the performance of health systems in circumpolar regions will be addressed through a case study approach using country comparisons to study health systems stewardship and performance. Insights will be gained on the capacity for good health systems stewardship and the operation of existing performance mechanisms as they currently exist in the circumpolar nations and regions. Findings will inform strategic directions for the oversight and improvement of health systems performance in circumpolar regions.

Overall, this body of research will aim to inform how circumpolar ministries might best fulfill their obligations to steer their health systems and compile, disseminate, and use appropriate evidence with an aim to understand and improve health systems performance in their northern regions. National, subnational (circumpolar), and indigenous groups/governments obligations and capacity will be highlighted. In addition to circumpolar regions, findings will have applications in other jurisdictions where health systems performance may be impacted by extreme geographic settings, health disparities, and vulnerabilities due to climate changes, and due to human rights and equity issues experienced by Indigenous peoples.

Methods will entail a multiple case study approach that will allow for the study of health systems stewardship and performance through multiple bounded systems (nation states). The approach for case study research is built on the theory and processes for case study research presented by Eisenhardt and Yin. The work will be conceptually guided by existing theory and Veillard’s frameworks on health systems performance and stewardship. The case study approach will involve detailed data collection from a variety of sources, including key informant interviews, literature review, quantitative analysis of data and community based participatory methods.

The procedures for collecting each type of data will be expanded and standardized. It is not expected that all sources will elicit the same data within a case. However, multiple sources of data will be used within and across case studies and, when possible, multiple data points will be utilized to validate findings. The data compilation will create a rich case study database that will support data triangulation and cross case analysis. The process of data collection will be iterative and responsive to emerging themes and questions.

Key informants will play an important role in this study. Both as a source of data as interview subjects, and through additional input where they will validate and inform study conclusions. The validation and informing study conclusions will occur concurrently during data collection and through a face to face meeting of selected key informants and community based participants. Key informant roles and responsibilities will be highlighted through the consent process.

This study will involve a literature review and interviews that explore the scope of health systems stewardship. Community based organizations and leaders involved in health services and government staff may be contacted.

Study findings will be shared in the peer review literature in open access journals. Findings will be presented to territorial ministry leaders and to indigenous leadership.

The fieldwork for this study will be conducted from March 13, 2013 to December 31, 2013.