Modélisation systémique des déterminants et processus de mise à l'échelle et de pérennisation d'innovations en santé : une étude qualitative de cas multiples au Burkina Faso et au Mali

Authors: Niang, Marietou
Advisor: Gagnon, Marie-PierreDupéré, Sophie
Abstract: In sub-Saharan Africa, many innovations in maternal, newborn, and child health (MNCH) are faced with environmental, social, political, economic, physical, and institutional vulnerabilities and often evolve on a small scale. Consequently, they are not sustainably integrated into these countries' systems and organizations. Furthermore, a techno-economic perspective prioritizes vertical and cost-effective approaches rather than the qualitative improvement of practices and equitable distribution of the impacts of innovations in society. Few studies focus on the processes of scaling up or sustainability of innovations and their determinants of success and failure. Based on systemic and complexity theory and the perspective of social innovation, this thesis proposes to model the determinants and processes of scaling up and sustainability based on empirical research on three innovations in MNCH: Seasonal malaria chemoprevention (SMC) initiated by the Burkinabe State, the Village health solidarity funds (CVSS) and Women's committees of health care services users (CFU) initiated by the National Federation of Community Health Associations (FENASCOM) in Mali. An initial conceptual model was developed based on the literature review and systemic theory. We adopted a qualitative multiple case study methodology, with each innovation constituting a case. A data set was collected using different sources of information. We conducted a documentary analysis (secondary interviews, reports, organizational notes, and more) from August 2017 to June 2018. From February to May 2018, individual (n=45) and group (n=34) interviews were conducted with stakeholders involved in each innovation in both countries while collecting documents, engaging in non-participant observation, and keeping a logbook. We completed a contextualization analysis with NVivo 11 software to understand the temporal and spatial evolution of the events studied and specific trends developed. The purpose was to conceptualize patterns that emerge from the studied phenomena. For each case, we observed interdependent determinants: values, leadership and governance, resources (financial, human, material, and knowledge), funding, simplification, and the adaptation of innovations. These determinants vary depending on whether innovation is supported by an external funder or by the community. They evolve according to the internal and external dynamics of the innovation. These results suggest a systemic understanding of these determinants by considering their interactions and treating them as a whole to understand the conditions for the success or failure of the processes studied. From these results, we were able to specify that the relationships between the different processes of innovation (conception/adoption, implementation, scaling up, and sustainability) and the environment in which the innovation evolves are recursive and complex. Then, we proposed a conceptual model integrating scaling up and sustainability. It encompasses a continuum of two critical events: (1) stabilization corresponding to the maintenance of resources, the structure of the innovation and its components, the purposes of the processes, and the institutional/community anchoring the innovation, and (2) resilience, or the capacity of the innovation's adaptation, transformation, learning, and appropriation. This thesis proposes new theoretical avenues and recommendations for practices that recognize the contextual particularities of resource-poor countries such as Burkina Faso and Mali. Specifically, it suggests that scaling up and sustainability should be imperative in innovation processes to address growing social inequalities in African countries. This approach could improve sustainable systems, policies, people's living conditions, and society. To this end, decision-makers should value certain principles in innovation processes, such as the participation of all stakeholders, the dynamic and recursive nature of processes and practices, and the implementation of inclusive practices focused on equity, quality, and power balance.
Document Type: Thèse de doctorat
Issue Date: 2022
Open Access Date: 16 May 2022
Grantor: Université Laval
Collection:Thèses et mémoires

Files in this item:
Description SizeFormat 
37746.pdf3.54 MBAdobe PDFThumbnail
All documents in CorpusUL are protected by Copyright Act of Canada.