Poster Abstract Book Fourth Global Symposium on Health Systems Research November 14th – 18th, 2016 Vancouver, Canada Poster Abstracts Matilda Aberese Ako, Navrongo Health Research Centre, Ghana Abstract ID: 3053 ‘Even me, sometimes I get sick’: Governance arrangements, challenges and frontline health worker motivation: A case study of two public hospitals in Ghana Co‐authors: Matilda Aberese Ako, Han Van Dijk, Irene Akua Agyepong, Navrongo Health Research Centre; Wageningen University; Ghana Health Service Background and Objective: How hospital managers exercise power to make decisions that respond to frontline health workers’ personal and organisational needs is an important part of institutional governance that indirectly affects the quality of health care through its effects on worker motivation. This study sought to understand facilitating and constraining factors in hospital managers’ decision making and their effects on frontline health worker motivation and performance. Methods: Ethnographic study methods including participant observation, conversations and in‐depth interviews were conducted over 20 months, with health workers and hospital managers in two public hospitals in Ghana. Qualitative analysis software Nvivo 8 was used to facilitate coding, and common patterns emerging from the codes were further grouped into relevant themes, which formed the basis for interpreting and reporting study findings. Ethical approval and consent were obtained from relevant authorities and study participants. Results and discussion: Hospital managers operated in a complex and dynamic environment, but they had limited decision making power, and faced high levels of resource and environmental uncertainty. Consequently managers devised various coping strategies to overcome uncertainties in order to respond to frontline health workers’ personal and organisational needs. Yet, sometimes managers got overwhelmed as they could not find coping strategies to deal with some of the uncertainties. Resultantly hospital managers felt ‘sick’‐ as they felt a sense of disempowerment and frustration in their efforts to meet frontline health workers and organisational needs. Conclusion: National and health policies should aim at giving hospital managers more power to make decisions in response to frontline health workers’ personal and organisational needs. This could facilitate timely planning and coordination of activities required for quality maternal and neonatal health delivery. Poster Abstracts Seye Abimbola, University of Sydney School of Public Health, Abstract ID: 2004 Information, regulation and coordination: Realist analysis of efforts of community health committees to limit informal health care providers in Nigeria Co‐authors: Seye Abimbola, Kemi Ogunsina, Augustina Charles‐Okoli, Joel Negin, Alexandra Martiniuk, Stephen Jan, University of Sydney School of Public Health; University of Alabama at Birmingham; University of Nigeria Teaching Hospital; The George Institute for Global Health One of the consequences of ineffective governments is that they leave space for informal providers to deliver a large proportion of health services. Patients navigate health care markets from one inappropriate provider to another, receiving sub‐optimal care, before they find appropriate providers, incurring personal transaction costs in the process. Interventions to address these barriers to accessing services have been hampered by weak governments and because informal providers are well embedded. We therefore sought to understand how and under what circumstances communities may confer resilience on governance by performing the role of governments to limit informal providers within health care markets. We adopted a qualitative approach, and therefore conducted in‐depth interviews with primary health care workers and managers, and group discussions with members of community health committees. We analysed the data obtained using a realist framework to identify the context (circumstances) and mechanisms (modes of reasoning) influencing community response (outcomes strategies). This was informed by the transaction costs theory of the firm by Ronald Coase – that production comes to be organised within firms when the transaction costs of coordinating production through the market is greater than in a firm. We identified three outcome strategies used by the committees to limit informal providers: 1) Information to encourage the use of the health facility to which the committee is linked, and to discourage the use of informal providers; 2) Regulation to ensure the credibility of the health facility to which the committee is linked, and to keep the activities of informal providers within safe limits; and 3) Coordination of resources to improve the accessibility of health care services at the health facility to which the committee is linked, and to facilitate referral from informal to formal health care providers. The committees operate within and through the context of existing socio‐economic, traditional and religious structures of their community, and with the support of NGOs. Five modes of reasoning inform their functioning – through meetings (as “village square”), reaching out within their community (as “community connectors”), lobbying governments for support (as “government botherers”), inducing and augmenting government support (as “back‐up government”) and taking control of health care in their community (as “general overseers”). Depending on the context, some communities become co‐producers of health services, akin to coordinating production through a firm. Where governments are weak, supporting community‐level collective action can be an alternative governance intervention for limiting informal providers in local health care markets. Poster Abstracts AYAT ABU‐AGLA, CENTER FOR GLOBAL HEALTH‐TRINITY COLLEGE, UNIVERSITY OF DUBLIN, Ireland Abstract ID: 2242 Training Sudanese Clinicians to support South Sudanese refugees living in border regions in the delivery of primary health care interventions. Co‐authors: AYAT ABU‐AGLA, FREDERIQUE VALLIERES, ELSHEIKH BADR, CENTER FOR GLOBAL HEALTH‐ TRINITY COLLEGE, UNIVERSITY OF DUBLIN; CENTER FOR GLOBAL HEALTH‐ TRINITY COLLEGE, UNIVERSITY OF DUBLIN; SUDAN MEDICAL SPECIALIZATION BOARD Purpose: Since its secession from Sudan in 2011, South Sudan has faced escalating internal conflict that has resulted in the displacement of over 2 million people. Included in this figure are 101,440 South Sudanese seeking refuge in the Sudan, mostly in the border regions. This figure is forecasted to increase substantially over the coming year, given the recent opening of the Sudanese border to the South. The first of its kind in the Sudan, the purpose of the proposed training programme is to train Sudanese clinicians to train South Sudanese refugees living in the Sudan in the delivery of primary health care interventions. As an initial proof of concept, this project is being conducted at Kosti Hosptial, one of five Sudanese Medical Specialisation Board’s (SMSB) training sites located on the border. Focus: The world faces an estimated shortage of 40‐50 million new health workers to overcome within the next 20 years. The shortage of human resources for health in low and middle‐income countries is especially critical in fragile and post‐conflict states. Conflict not only results in the destruction of health facilities and infrastructure, but also in the frequent and prolonged shortages in drugs and equipment; the death, injury and exodus of qualified health staff; and restricted access to healthcare. Significance of the sub‐theme area: Working with the SMSB, we address three key problems. First, we aim to alleviate the burden on Sudanese hospitals, currently struggling to care for a growing number of South Sudanese refugees. While the Sudanese have accepted South Sudanese as citizens in their hospitals, making services available to them free‐of‐charge, this has severely increased the burden on hosting states and on existing health staff. Second, this project increases human resources for community health among South Sudanese refugees, in the hopes that this will contribute to strengthening the South Sudanese health system upon their return. Third, it aims to ease renewed tensions between the Sudanese and South Sudanese in border states, the former of which are increasingly discontented with having to care for individuals outside of their catchment areas. Target audience: Policy makers, researchers and non‐governmental organisations enlisting the help of community health workers (CHWs) to mitigate the dearth of human resources for health in post‐conflict and conflict settings. Poster Abstracts Olatunji Adetokunboh, Stellenbosch University, South Africa Abstract ID: 2891 Coverage and Geographical disparities of Expanded Programme on Immunisation in sub‐Saharan Africa: Results from Demographic Health Surveys in 28 countries Co‐authors: Olatunji O Adetokunboh, Stellenbosch University Background: Vaccination has proven to be a cost‐effective and beneficial public health intervention to protect both children and adults from vaccine‐preventable diseases. Studies from many sub‐Saharan African countries showed that the coverage of routine vaccinations is low and grossly inadequate and could not meet the targets of at least 90% vaccination coverage set by the World Health Organization and United Nations Children Fund in achieving as at the end of 2015. Africa and South‐East Asia account for more than 70% of global vaccine preventable disease burden,