By guest contributor Dr Soumya Swaminathan Women and girls account for 50% of the population. Despite this, health systems are ill-equipped to…
We Need Better Service Experience to Build Resilient Health Systems
A village headman conducts a door-to-door visit with a family. Engaging community members in the monitoring of services can build not only trust and effective communication but also foster greater linkages and accountability with the health system. Image credit
Matthew Baek, John Snow, Inc. (JSI)
By guest contributors Samantha Noshin Noor and Hannah Hausi
When it comes to seeking health services, the ability to access high-quality care remains a privilege for many. In 2017, the World Bank and WHO found that at least half of the world’s population lacks access to essential health services. Since 2020, circumstances have only worsened due to the COVID-19 pandemic. Health systems have been stretched to the limit, with services facing continued disruptions.
While health service availability and access challenges preceded the pandemic, the last few years have underscored the importance of the way in which services are delivered and received. As improved and sustained health outcomes rely on the decisions of people to seek and continue care, restoring trust in health systems is critical. Improving the service experience (SE) can help chart a path to building resilient health systems for the future.
What is Service Experience?
Imagine you need a blood panel test and have the option of choosing between two clinics to receive care. What would draw you to one instead of the other? There are a number of questions you might ask, such as:
- Which is easier to schedule with or has shorter wait times?
- Which has friendly, skilled staff or a clean and safe environment?
- Has one been recommended by family and friends?
SE touches on such considerations. It includes the quality of interactions experienced along the journey to health – all points of contact before, during, and after service delivery – and beyond these interactions to include other factors, such as community voice, advocacy, health worker empowerment, and more, which may ultimately influence the delivery and experience of care. A key benefit of improved SE is establishing trust and confidence in the health system, influencing a person’s decision to seek care and keep coming back.
A negative SE can be traumatizing, resulting in disengagement from seeking care from a provider, facility, or even the entire health system. For decades, person-centered care models have championed dignified, relevant, and empowering approaches to improve care. SE complements these models through a systems approach, examining the design of health systems through intersections between the individual, community, and broader institutional levels.
Service Experience in Action: Insights from Immunization
One way to enhance SE is through fostering positive client-provider relationships. In Nepal, qualitative interviews conducted by the Kathmandu University-led Behavioral Science Center revealed that the decision to vaccinate a child often happened before they were even born: expecting mothers’ treatment (e.g., scolding by health workers) during antenatal care visits was so poor that it influenced their decision to never return to health facilities. Conversely, those who had favorable interactions with their providers felt encouraged to return to vaccinate their child and seek other health services. Furthermore, providers with adequate resources, capacity-building, and mentorship felt empowered to provide high-quality care to their clients.
SE can also be improved outside of healthcare settings, by engaging directly with communities. In six countries, the Maternal and Child Survival Program (MCSP) deployed My Village My Home (MVMH), a tool to measure vaccination coverage. In Malawi, immunization was typically monitored by government entities and external actors. MVMH put power into the hands of the community, pairing village heads with volunteers to go door-to-door encouraging vaccination and tracking coverage themselves. Following the visits, community members confessed that when familiar faces appeared at doorsteps, it evoked a sense of reliability and trust in a way that wasn’t possible before. By the end of the 2-year program, vaccination rates rose from 68 to 91 percent across 130 villages – a clear sign that improving SE was working.
What Next?
It’s important to improve SE wherever possible, as the decision to seek and continue care is fragile. SE allows us to consider the various socio-ecological components that impact the health system and can be used as a lens for continuous improvement at all levels of care. Ultimately, good SE means adjusting the experience and not the client.
Though SE considers many components, a complete re-design of health systems isn’t necessary to achieve improved outcomes. Depending on the country or context, some elements related to SE may be more pressing to address than others – and some improvements may already be underway. If you are looking for ways to improve SE, some great ways to engage include:
- Exploring resources related to SE, and complementary tools and concepts to help understand areas of improvement (e.g., human-centered design, trauma-informed care; social and behavior change)
- Building an evidence base and identifying gaps to advocate for SE improvement within your community or networks
- Planning, implementing, and evaluating healthcare services with a SE perspective
Together, we can work towards a future with better SE, and ensure resilient health systems in the years to come.
About the authors:
Samantha Noshin Noor supports the design and implementation of global health programs for donors, governments, and businesses. Based in Washington, DC, with John Snow, Inc. (JSI), she brings an innovative and systems-thinking approach to improve health outcomes around the world. In her free time, she can be found jamming out to new tunes, mountaineering, or exploring local eats.
Hannah Hausi is a public health specialist, holding a Master’s degree in Public Health from Kamuzu University of Health Sciences (KUHES). She has worked for over 20 years on several preventive health interventions. Hannah has worked with JSI in Malawi as an Immunization Technical Advisor for 10 years, and prior to this, she was with the Ministry of Health for 17 years. She is currently providing Technical Assistance to the Ministry of Health’s Expanded Program on Immunization (EPI) for routine immunization and new vaccine introductions, including COVID-19 vaccination.
Very informative manuscript. The problem also resides in the racial and economic status of ppl. The health staff get the influenced by appearance, reference and work load. In countries like Pakistan where health service is provided in crammed rooms and wards. The service experience becomes more chaotic and a nightmare at times. These burdened workers often make and execute wrong or untimely decisions. Service experience is a significant factor in follow up and vaccines. The world needs to collaborate more often in improving health care.