This activity explores Appreciative Inquiry as an approach to addressing health system challenges. Rather than focusing solely on problems, Appreciative Inquiry emphasizes identifying strengths, successes, and possibilities to build upon. This approach is particularly valuable in complex health systems where multiple stakeholders and factors are involved.
Appreciative Inquiry follows a structured approach often represented as a cycle with five key phases:
For the purposes of this activity, we will follow the 5D cycle and look at the Appreciative Inquiry approach in 3 phases:
Researchers for a campaign working to prevent medicines stock-outs, called Stop Stockouts, want to find out what strategies healthcare workers use when managing shortages of medicines. In line with the aim of the project, they want to see if the Stop Stockouts project has had a positive impact on service delivery.
Rather than point to the flaws in the system, which are well documented (Hodes, 2017; Hwang, 2019; Zuma 2022), they want to explore creative and innovative ways that health care workers address medicine shortages, especially in rural areas. According to Hodes et al., (2017: 738), "Stock-outs arise from an inability to manage medical supplies, report shortages, and act swiftly and effectively to prevent their recurrence". Additionally, stockouts are impacted by other health sector challenges, including healthcare worker shortages, inadequate training, weak oversight and management, and inadequate monitoring and evaluation of clinic data.
You are part of a team that want to run a series of interview with nursing staff in selected rural primary healthcare clinics. Instead of looking for problems and generating solutions, you and the team want to take an Appreciative Inquiry approach to finding out what works, why it works, and what could be done even better. Before you leave, you want to consider the 5Ds framework and plan an appropriate methodology.
Qualitative Research Design, (Appreciative Inquiry approach.) Medication shortages, and how they managed medication shortages in their respected clinics, by making use of a qualitative research design we are able to get the shared lived experiences of the nurses.
We focused on the shared and lived experiences of the nurses and questions like these helped us understand the issue at hand better:
After speaking to nurses in a number of rural clinics, you realise that there are a number of self-generated strategies that health workers apply to address the immediacy of medicines stockouts. These include informal networks between different facilities, where nurses talk to each other about what medicines they have in stock and what might be in short supply in one area.
Nurses explain that they mobilise personal resources to move stock from one clinic to another, where the need is greatest. This 'borrowing' strategy is not regulated and runs the risk that stock can be stolen or abused. It also takes time away from clinic staff in their own facility.
Through this network, however, nurses feel they can support each other and work towards the best outcomes from their patients, given limited resources. Nurses recognise that in an idea world, they would have more time to dedicate to patients if they did not have to constantly make plans to get medicines, drive long distances, and waste time doing someone else's job. At the same time, the recognise that other health workers on the supply side are equally constrained by funding and procurement issues that prevent them from supporting local health facilities.
Hodes et al (2017: 739) point out that the "government has recognised the urgency of stock-outs and committed to improving monitoring and accountability in the health sector". They note that many plans and circulars show attempts to improve procurement and oversight of medical supplies and improve reporting.
Some suggestions include a digital stock-monitoring but investments in technology and infrastructure at facility level are needed. Proposed initiatives must be accompanied by attendant investments in human resources, especially data capturers within facilities. This would free up nurses from completing paperwork and improve monitoring and evaluation.
The informal networks that nurses have established have improved communication and exchange of other health systems challenges, and for the time being have allowed front-line healthcare workers a level of agency in responding quickly and effectively to stockouts. This sense of belonging, caring, support and control has been very valuable for nurses who often feel isolated and unheard.
Digital stock managers and a division of duties.
By making use of AI implementation systems with logbooks, monitoring systems, and evaluation strategies.
This activity demonstrates the value of taking an appreciative approach when addressing health system challenges. Rather than focusing solely on what's going wrong, Appreciative Inquiry allows us to identify existing strengths and successful strategies that can be built upon.
In the case of medicine stockouts, this approach revealed that nurses have already developed informal networks and collaborative strategies to manage shortages. These self-generated solutions contain important insights that could inform more formal systems. By recognizing and valuing these existing practices, we can design interventions that complement rather than replace successful grassroots approaches.
The AI process also highlights the importance of engaging frontline workers in solution development. Nurses possess invaluable practical knowledge about what works in their specific contexts. Their insights about informal borrowing networks, communication channels, and resource mobilization strategies provide a foundation for more sustainable formal solutions.
Finally, this activity reinforces that effective health systems interventions must balance ideal solutions with practical realities. While digital stock monitoring and dedicated data capturers might be optimal, implementation must consider existing resources, infrastructure limitations, and the day-to-day realities of rural healthcare facilities.
Below is documentation that provides evidence of my work on this Appreciative Inquiry activity.