Abstract:
Health systems are faced with a wide variety of challenges. As complex adaptive systems,
they respond differently and sometimes in unexpected ways to these challenges. We set
out to examine the challenges experienced by the health system at a sub-national level in
Kenya, a country that has recently undergone rapid devolution, using an 'everyday
resilience' lens. We focussed on chronic stressors, rather than acute shocks in examining
the responses and organizational capacities underpinning those responses, with a view to
contributing to the understanding of health system resilience. We drew on learning and
experiences gained through working with managers using a learning site approach over
the years. We also collected in-depth qualitative data through informal observations,
reflective meetings and in-depth interviews with middle-level managers (sub-county and
hospital) and peripheral facility managers (n = 29). We analysed the data using a
framework approach. Health managers reported a wide range of health system stressors
related to resource scarcity, lack of clarity in roles and political interference, reduced
autonomy and human resource management. The health managers adopted absorptive,
adaptive and transformative strategies but with mixed effects on system functioning.
Everyday resilience seemed to emerge from strategies enacted by managers drawing on a
varying combination of organizational capacities depending on the stressor and context.