{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:07:02Z","timestamp":1777248422790,"version":"3.51.4"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,4,8]],"date-time":"2016-04-08T00:00:00Z","timestamp":1460073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and methods<\/jats:title><jats:p>Health systems are complex and constantly adapt to changing demands. These complex\u2010adaptive characteristics are rarely considered in the current bureaucratic top\u2010down approaches to health system reforms aimed to constrain demand and expenditure growth. The economic focus fails to address the <jats:italic>needs<\/jats:italic> of patients, providers and communities, and ultimately results in declining effectiveness and efficiency of the health care system as well as the health of the wider community. A <jats:italic>needs\u2010focused complex\u2010adaptive health system<\/jats:italic> can be represented by the \u2018healthcare vortex\u2019 model; how to build a <jats:italic>needs\u2010focused complex\u2010adaptive health system<\/jats:italic> is illustrated by Eastern Deanery AIDS Relief Program approaches in the poor neighbourhoods of Nairobi, Kenya.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings and conclusions<\/jats:title><jats:p>A small group of nurses and community health workers focused on the care of terminally ill HIV\/AIDS patients. This work identified additional problems: tuberculosis (TB) was underdiagnosed and undertreated, a local TB\u2010technician was trained to run a local lab, a courier services helped to reach all at need, collaboration with the Ministry of Health established local TB and HIV treatment programmes and philanthropists helped to supplement treatment with nutrition support. Maternal\u2010to\u2010child HIV\u2010prevention and adolescent counselling services addressed additional needs.<\/jats:p><jats:p>The \u2018theory of the healthcare vortex\u2019 indeed matches the \u2018empery of the real world experiences\u2019. Locally developed and delivered <jats:italic>adaptive, people\u2010centred health systems,<\/jats:italic> a bottom\u2010up community and provider initiated approach, deliver highly effective and sustainable health care despite significant resource constraints.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.12540","type":"journal-article","created":{"date-parts":[[2016,4,10]],"date-time":"2016-04-10T17:55:10Z","timestamp":1460310910000},"page":"467-473","source":"Crossref","is-referenced-by-count":25,"title":["People\u2010centred health systems, a bottom\u2010up approach: where theory meets empery"],"prefix":"10.1111","volume":"23","author":[{"given":"Joachim P","family":"Sturmberg","sequence":"first","affiliation":[{"name":"Department of General Practice The University of Newcastle  Wamberal Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Njoroge","sequence":"additional","affiliation":[{"name":"Eastern Deanery AIDS Program  Nairobi Kenya"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,4,8]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"GawandeA.The cost conundrum. 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