1
|
Ansah EW, Maneen S, Ephraim A, Ocloo JEY, Barnes MN, Botha NN. Politics-evidence conflict in national health policy making in Africa: a scoping review. Health Res Policy Syst 2024; 22:47. [PMID: 38622666 PMCID: PMC11017532 DOI: 10.1186/s12961-024-01129-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/05/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Generally, public health policy-making is hardly a linear process and is characterized by interactions among politicians, institutions, researchers, technocrats and practitioners from diverse fields, as well as brokers, interest groups, financiers and a gamut of other actors. Meanwhile, most public health policies and systems in Africa appear to be built loosely on technical and scientific evidence, but with high political systems and ideologies. While studies on national health policies in Africa are growing, there seems to be inadequate evidence mapping on common themes and concepts across existing literature. PURPOSE The study seeks to explore the extent and type of evidence that exist on the conflict between politics and scientific evidence in the national health policy-making processes in Africa. METHODS A thorough literature search was done in PubMed, Cochrane Library, ScienceDirect, Dimensions, Taylor and Francis, Chicago Journals, Emerald Insight, JSTOR and Google Scholar. In total, 43 peer-reviewed articles were eligible and used for this review. RESULT We found that the conflicts to evidence usage in policy-making include competing interests and lack of commitment; global policy goals, interest/influence, power imbalance and funding, morals; and evidence-based approaches, self-sufficiency, collaboration among actors, policy priorities and existing structures. Barriers to the health policy process include fragmentation among actors, poor advocacy, lack of clarity on the agenda, inadequate evidence, inadequate consultation and corruption. The impact of the politics-evidence conflict includes policy agenda abrogation, suboptimal policy development success and policy implementation inadequacies. CONCLUSIONS We report that political interests in most cases influence policy-makers and other stakeholders to prioritize financial gains over the use of research evidence to policy goals and targets. This situation has the tendency for inadequate health policies with poor implementation gaps. Addressing these issues requires incorporating relevant evidence into health policies, making strong leadership, effective governance and a commitment to public health.
Collapse
Affiliation(s)
- Edward W Ansah
- Department of Health, Physical Education and Recreation (HPER), University of Cape Coast, Cape Coast, Ghana
| | - Samuel Maneen
- Department of Health, Physical Education and Recreation (HPER), University of Cape Coast, Cape Coast, Ghana
| | - Anastasia Ephraim
- Department of Health, Physical Education and Recreation (HPER), University of Cape Coast, Cape Coast, Ghana
| | - Janet E Y Ocloo
- Department of Health, Physical Education and Recreation (HPER), University of Cape Coast, Cape Coast, Ghana
| | - Mabel N Barnes
- Department of Health, Physical Education and Recreation (HPER), University of Cape Coast, Cape Coast, Ghana
| | - Nkosi N Botha
- Department of Health, Physical Education and Recreation (HPER), University of Cape Coast, Cape Coast, Ghana.
| |
Collapse
|
2
|
Dalglish SL, Sanuade OA, Topp SM. Medical Dominance in Global Health Institutions as an Obstacle to Equity and Effectiveness Comment on "Power Dynamics Among Health Professionals in Nigeria: A Case Study of the Global Fund Policy Process". Int J Health Policy Manag 2023; 12:7734. [PMID: 37579487 PMCID: PMC10125140 DOI: 10.34172/ijhpm.2022.7734] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/04/2022] [Indexed: 08/16/2023] Open
Abstract
Medical professionals exercised structural and productive power in the Global Fund's Country Coordinating Mechanism (CCM) in Nigeria, directly impacting the selection of approaches to HIV/AIDS care, as described in a case study by Lassa and colleagues. This research contributes to a robust scholarship on how biomedical power inhibits a holistic understanding of health and prevents the adoption of solutions that are socially grounded, multi-disciplinary, and co-created with communities. We highlight Lassa and colleagues' findings demonstrating the 'long arm' of global health institutions in country-level health policy choices, and reflect on how medical dominance within global institutions serves as a tool of control in ways that pervert incentives and undermine equity and effectiveness. We call for increased research and advocacy to surface these conduits of power and begin to loosen their hold in the global health policy agenda.
Collapse
Affiliation(s)
- Sarah L. Dalglish
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Institute for Global Health, University College London, London, UK
| | - Olutobi A. Sanuade
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, USA
| | - Stephanie M. Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| |
Collapse
|
3
|
Elliott LM, Dalglish SL, Topp SM. Health Taxes on Tobacco, Alcohol, Food and Drinks in Low- and Middle-Income Countries: A Scoping Review of Policy Content, Actors, Process and Context. Int J Health Policy Manag 2022; 11:414-428. [PMID: 32945639 PMCID: PMC9309941 DOI: 10.34172/ijhpm.2020.170] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/25/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Taxation of tobacco, food, alcohol and other beverages has gained renewed attention in responding to non-communicable diseases (NCDs). While largely built on evidence from high-income countries (HICs), the projected economic and health benefits of these measures have increased calls for their use in price-sensitive low- and middle-income countries (LMICs). However, uptake has been sporadic and there remains little research on why and how LMICs utilise fiscal measures in response to NCDs. METHODS This scoping review analyses factors influencing the design and implementation of health-related fiscal measures in LMICs. Utilising Arksey and O'Malley's scoping review methodology and Walt and Gilson's policy triangle, we considered the contextual, procedural, content and stakeholder-related factors that influenced measures. RESULTS We identified 75 papers focussing on health-related fiscal measures, with 47 (63%) focused on tobacco, 5 on alcohol, 6 on soft drink and 4 studies on food-related fiscal regulation. Thirteen papers analysed multiple measures and most papers (n = 66, 88%) were less than a decade old. Key factors enabling the design and implementation of measures included localised health and economic evidence, policy championing, inter-ministerial support, and global or regional momentum. Impeding factors encompassed negative framing and retaliation by industry, vested interests and governmental policy disjuncture. Aligning with theoretic insights from the policy triangle, findings consistently demonstrated that the interplay between factors - rather than the presence or absence of particular factors - has the most profound impact on policy implementation. CONCLUSION Given the growing urgency to address NCDs in LMICs, this review highlights the need for recognition and rigorous exploration of political economy factors influencing the design and implementation of fiscal measures. Broader LMIC-specific empirical research is needed to overcome an implication noted in much of the literature: that mechanisms used to enact tobacco taxation are universally applicable to measures targeting foods, alcohol and other beverages.
Collapse
Affiliation(s)
- Lana M. Elliott
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Sarah L. Dalglish
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Institute for Global Health, University College London, London, UK
| | - Stephanie M. Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| |
Collapse
|
4
|
Occupational Health and Safety Statistics as an Indicator of Worker Physical Health in South African Industry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031690. [PMID: 35162712 PMCID: PMC8835012 DOI: 10.3390/ijerph19031690] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 02/04/2023]
Abstract
Operations in general industry, including manufacturing, expose employees to a myriad of occupational health hazards. To prevent exposure, occupational health and safety regulations were enacted, with both employers and workers instituting various risk reduction measures. The analysis of available occupational disease and injury statistics (indicators of worker physical health) can be used to infer the effectiveness of risk reduction measures and regulations in preventing exposure. Thus, using the READ approach, analyses of occupational disease and injury statistics from South African industry, derived from annual reports of the Compensation Fund, were conducted. The publicly available database of occupational disease and injury statistics from the South African general industry is unstructured, and the data are inconsistently reported. This data scarcity, symptomatic of an absence of a functional occupational disease surveillance system, complicates judgement making regarding the effectiveness of implemented risk reduction measures, enacted occupational health and safety regulations and the status of worker physical health from exposure to workplace hazards. The statistics, where available, indicate that workers continue to be exposed to occupational health impacts within general industry, notwithstanding risk reduction measures and enacted regulations. In particular, worker physical health continues to be impacted by occupational injuries and noise-induced hearing loss. This is suggestive of shortcomings and inefficiencies in industry-implemented preventive measures and the regulatory state. A robust national occupational disease surveillance system is a regulatory tool that should detect and direct policy responses to identified occupational health hazards.
Collapse
|
5
|
Topp SM, Schaaf M, Sriram V, Scott K, Dalglish SL, Nelson EM, Sr R, Mishra A, Asthana S, Parashar R, Marten R, Costa JGQ, Sacks E, Br R, Reyes KAV, Singh S. Power analysis in health policy and systems research: a guide to research conceptualisation. BMJ Glob Health 2021; 6:bmjgh-2021-007268. [PMID: 34740915 PMCID: PMC8573637 DOI: 10.1136/bmjgh-2021-007268] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/12/2021] [Indexed: 12/30/2022] Open
Abstract
Power is a growing area of study for researchers and practitioners working in the field of health policy and systems research (HPSR). Theoretical development and empirical research on power are crucial for providing deeper, more nuanced understandings of the mechanisms and structures leading to social inequities and health disparities; placing contemporary policy concerns in a wider historical, political and social context; and for contributing to the (re)design or reform of health systems to drive progress towards improved health outcomes. Nonetheless, explicit analyses of power in HPSR remain relatively infrequent, and there are no comprehensive resources that serve as theoretical and methodological starting points. This paper aims to fill this gap by providing a consolidated guide to researchers wishing to consider, design and conduct power analyses of health policies or systems. This practice article presents a synthesis of theoretical and conceptual understandings of power; describes methodologies and approaches for conducting power analyses; discusses how they might be appropriately combined; and throughout reflects on the importance of engaging with positionality through reflexive praxis. Expanding research on power in health policy and systems will generate key insights needed to address underlying drivers of health disparities and strengthen health systems for all.
Collapse
Affiliation(s)
- Stephanie M Topp
- College of Public Health Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia .,Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Veena Sriram
- School of Public Policy and Global Affairs and School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry Scott
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Independent Consultant, Toronto, Ontario, Canada
| | - Sarah L Dalglish
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,Institute for Global Health, University College London, London, UK
| | - Erica Marie Nelson
- Health and Nutrition Cluster, Institute of Development Studies, Brighton, UK
| | - Rajasulochana Sr
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
| | - Arima Mishra
- Azim Premji University, Bangalore, Karnataka, India
| | | | | | - Robert Marten
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | | | - Emma Sacks
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rajeev Br
- Society for Community Health Awareness Research and Action, Bangalore, Karnataka, India
| | | | | |
Collapse
|
6
|
Conroy M, Malik AY, Hale C, Weir C, Brockie A, Turner C. Using practical wisdom to facilitate ethical decision-making: a major empirical study of phronesis in the decision narratives of doctors. BMC Med Ethics 2021; 22:16. [PMID: 33602193 PMCID: PMC7890840 DOI: 10.1186/s12910-021-00581-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/31/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Medical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an 'executive virtue', offers a way to navigate the practice virtues for any given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians. METHODS The primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process. RESULTS We found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants' 'collective practical wisdom', including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua. CONCLUSION Given the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well.
Collapse
Affiliation(s)
- Mervyn Conroy
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Aisha Y. Malik
- Warwick Medical School, University of Warwick, Coventry, UK
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Catherine Hale
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Catherine Weir
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Alan Brockie
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Chris Turner
- Emergency Medicine, University Hospitals Coventry and Warwickshire, Coventry, UK
| |
Collapse
|
7
|
Dalglish SL, Khalid H, McMahon SA. Document analysis in health policy research: the READ approach. Health Policy Plan 2021; 35:1424-1431. [PMID: 33175972 PMCID: PMC7886435 DOI: 10.1093/heapol/czaa064] [Citation(s) in RCA: 112] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2020] [Indexed: 11/25/2022] Open
Abstract
Document analysis is one of the most commonly used and powerful methods in health policy research. While existing qualitative research manuals offer direction for conducting document analysis, there has been little specific discussion about how to use this method to understand and analyse health policy. Drawing on guidance from other disciplines and our own research experience, we present a systematic approach for document analysis in health policy research called the READ approach: (1) ready your materials, (2) extract data, (3) analyse data and (4) distil your findings. We provide practical advice on each step, with consideration of epistemological and theoretical issues such as the socially constructed nature of documents and their role in modern bureaucracies. We provide examples of document analysis from two case studies from our work in Pakistan and Niger in which documents provided critical insight and advanced empirical and theoretical understanding of a health policy issue. Coding tools for each case study are included as Supplementary Files to inspire and guide future research. These case studies illustrate the value of rigorous document analysis to understand policy content and processes and discourse around policy, in ways that are either not possible using other methods, or greatly enrich other methods such as in-depth interviews and observation. Given the central nature of documents to health policy research and importance of reading them critically, the READ approach provides practical guidance on gaining the most out of documents and ensuring rigour in document analysis.
Collapse
Affiliation(s)
- Sarah L Dalglish
- Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
- Institute for Global Health, University College London, Institute for Global Health 3rd floor, 30 Guilford Street, London WC1N 1EH, UK
| | - Hina Khalid
- School of Humanities and Social Sciences, Information Technology University, Arfa Software Technology Park, Ferozepur Road, Lahore 54000, Pakistan
| | - Shannon A McMahon
- Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130/3, 69120 Heidelberg, Germany
| |
Collapse
|
8
|
Uneke CJ, Sombie I, Johnson E, Uneke BI. Lessons Learned from Strategies for Promotion of Evidence-to-Policy Process in Health Interventions in the ECOWAS Region: A Rapid Review. Niger Med J 2021; 61:227-236. [PMID: 33487844 PMCID: PMC7808283 DOI: 10.4103/nmj.nmj_188_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/04/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022] Open
Abstract
Context: The West African Health Organization (WAHO) is vigorously supporting evidence-informed policymaking (EIPM) in the countries of West Africa. EIPM is increasingly recognized as one of the key strategies that can contribute to health systems strengthening and the improvement of health outcomes. The purpose of this rapid review is to examine two key examples of evidence-based strategies used to successfully implement health interventions in each of the West African countries and to highlight the lessons learned. Methods: A rapid review technique, defined as a type of knowledge synthesis in which systematic review processes are accelerated and methods are streamlined to complete the review more quickly, was used. A PubMed search was conducted using the combination of the following keywords: Health, policy making, evidence, plus name of each of the 15 countries to identify studies that described the process of use of evidence in policymaking in health interventions. Two examples of the publications that fulfilled the study inclusion criteria were selected. Results: Among the key processes used by the countries to promote EIPM in health interventions include policy cycle mechanism and political prioritization, rapid response services, technical advisory group and steering committees (SCs), policy dialog, capacity-strengthening mechanisms, local context evidence and operational guidelines, multisectoral action and consultative process. Conclusion: Various degrees of success have been achieved in by West African countries in the promotion of EIPM. As the science of EIPM continues to evolve and better understanding of the process is gained among policymakers, more studies on effective strategies to improve the evidence-to-policy process are advocated.
Collapse
Affiliation(s)
- Chigozie Jesse Uneke
- Department of Health Policy/Systems, African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, Nigeria
| | - Issiaka Sombie
- Department of Public Health and Research, West African Health Organisation, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso 01 01 BP 153, Burkina Faso
| | - Ermel Johnson
- Department of Public Health and Research, West African Health Organisation, 175, Avenue Ouezzin Coulibaly, Bobo Dioulasso 01 01 BP 153, Burkina Faso
| | - Bilikis Iyabo Uneke
- Department of Health Policy/Systems, African Institute for Health Policy and Health Systems, Ebonyi State University, CAS Campus, Abakaliki, Nigeria
| |
Collapse
|
9
|
Sacks E, Schleiff M, Were M, Chowdhury AM, Perry HB. Communities, universal health coverage and primary health care. Bull World Health Organ 2020; 98:773-780. [PMID: 33177774 PMCID: PMC7607457 DOI: 10.2471/blt.20.252445] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022] Open
Abstract
Universal health coverage (UHC) depends on a strong primary health-care system. To be successful, primary health care must be expanded at community and household levels as much of the world's population still lacks access to health facilities for basic services. Abundant evidence shows that community-based interventions are effective for improving health-care utilization and outcomes when integrated with facility-based services. Community involvement is the cornerstone of local, equitable and integrated primary health care. Policies and actions to improve primary health care must regard community members as more than passive recipients of health care. Instead, they should be leaders with a substantive role in planning, decision-making, implementation and evaluation. Advancing the science of primary health care requires improved conceptual and analytical frameworks and research questions. Metrics used for evaluating primary health care and UHC largely focus on clinical health outcomes and the inputs and activities for achieving them. Little attention is paid to indicators of equitable coverage or measures of overall well-being, ownership, control or priority-setting, or to the extent to which communities have agency. In the future, communities must become more involved in evaluating the success of efforts to expand primary health care. Much of primary health care has taken place, and will continue to take place, outside health facilities. Involving community members in decisions about health priorities and in community-based service delivery is key to improving systems that promote access to care. Neither UHC nor the Health for All movement will be achieved without the substantial contribution of communities.
Collapse
Affiliation(s)
- Emma Sacks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E8011, Baltimore, Maryland, 21205, United States of America
| | - Meike Schleiff
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E8011, Baltimore, Maryland, 21205, United States of America
| | | | | | - Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E8011, Baltimore, Maryland, 21205, United States of America
| |
Collapse
|
10
|
Yourkavitch J, Davis LM, Hobson R, Arscott-Mills S, Anson D, Baugh G, Sadruddin S, Mantshumba JC, Sambou B, Bakukulu JT, Leya PN, Luhanga M, Mgalula L, Jenda G, Nsona H, Nassivila SA, de Carvalho E, Smith M, Absi M, Aboubakar F, Konate AT, Wahab M, Ufere J, Isiguzo C, Ozor L, Gimba PB, Ndaliman I. Integrated community case management: planning for sustainability in five African countries. J Glob Health 2019; 9:010802. [PMID: 31275567 PMCID: PMC6596361 DOI: 10.7189/jogh.09.010802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The World Health Organization (WHO) launched an initiative to plan for the sustainability of integrated community case management (iCCM) programmes supported by the Rapid Access Expansion (RAcE) Programme in five African countries in 2016. WHO contracted experts to facilitate sustainability planning among Ministries of Health, WHO, nongovernmental organisation grantees, and other stakeholders. Methods We designed an iterative and unique process for each RAcE project area which involved creating a sustainability framework to guide planning; convening meetings to identify and prioritise elements of the framework; forming technical working groups to build country ownership; and, ultimately, creating roadmaps to guide efforts to fully transfer ownership of the iCCM programmes to host countries. For this analysis, we compared priorities identified in roadmaps across RAcE project sites, examined progress against roadmaps via transition plans, and produced recommendations for short-term actions based on roadmap priorities that were unaddressed or needed further attention. Results This article describes the sustainability planning process, roadmap priorities, progress against roadmaps, and recommendations made for each project area. We found a few patterns among the prioritised roadmap elements. Overall, every project area identified priorities related to policy and coordination of external stakeholders including funders; supply chain management; service delivery and referral system; and communication and social mobilisation, indicating that these factors have persisted despite iCCM programme maturity, and are also of concern to new programmes. We also found that a facilitated process to identify and document programme priorities in roadmaps, along with deliberately planning for transition from an external implementer to a national system could support the sustainability of iCCM programmes by facilitating teams of stakeholders to accomplish explicit tasks related to transitioning the programme. Conclusions Certain common elements are of concern for sustaining iCCM programmes across countries, among them political leadership, supply chain management, data processes, human resources, and community engagement. Adapting and using a sustainability planning approach created an inclusive and comprehensive dialogue about systemic factors that influence the sustainability of iCCM services and facilitated changes to health systems in each country.
Collapse
Affiliation(s)
| | | | | | | | - Daniel Anson
- Independent Consultant, Silver Spring, Maryland, USA; formerly ICF, Rockville, Maryland, USA
| | | | | | | | - Bacary Sambou
- World Health Organization, Kinshasa, Democratic Republic of Congo
| | | | - Pascal Ngoy Leya
- Abt Associates; formerly International Rescue Committee, Kinshasa, Democratic Republic of Congo
| | | | | | | | | | | | | | | | | | | | | | | | - Joy Ufere
- World Health Organization, Abuja, Nigeria
| | | | - Lynda Ozor
- World Health Organization, Abuja, Nigeria
| | | | | |
Collapse
|
11
|
Wallace LJ, Kapiriri L. Priority setting for maternal, newborn and child health in Uganda: a qualitative study evaluating actual practice. BMC Health Serv Res 2019; 19:465. [PMID: 31286950 PMCID: PMC6615092 DOI: 10.1186/s12913-019-4170-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/20/2019] [Indexed: 11/30/2022] Open
Abstract
Background Despite continued investment, Maternal, Newborn and Child Health (MNCH) indicators in low and middle income countries have remained relatively poor. This could, in part, be explained by inadequate resources to adequately address these problems, inappropriate allocation of the available resources, or lack of implementation of the most effective interventions. Systematic priority setting and resource allocation could contribute to alleviating these limitations. There is a paucity of literature that follows through MNCH prioritization processes to implementation, making it difficult for policy makers to understand the impact of their decision-making on population health. The overall objective of this paper was to describe and evaluate priority setting for maternal, newborn and child health interventions in Uganda. Methods Fifty-four key informant interviews and a review of policies and media reports were used to describe priority setting for MNCH in Uganda. Kapiriri and Martin’s conceptual framework was used to evaluate priority setting for MNCH. Results There were three main prioritization exercises for maternal, newborn and child health in Uganda. The processes were participatory and were guided by explicit tools, evidence, and criteria, however, the public and the districts were insufficiently involved in the priority setting process. While there were conducive contextual factors including strong political support, implementation was constrained by the presence of competing actors, with varying priorities, an unequal allocation of resources between child health and maternal health interventions, limited financial and human resources, a weak health system and limited institutional capacity. Conclusions Stronger institutional capacity at the Ministry of Health and equitable engagement of key stakeholders in decision-making processes, especially the public, and implementers, would improve understanding, satisfaction and compliance with the priority setting process. Availability of financial and human resources that are appropriately allocated would facilitate the implementation of well-developed policies. Electronic supplementary material The online version of this article (10.1186/s12913-019-4170-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lauren J Wallace
- Department of Health, Aging and Society, McMaster University, KTH-236, Main Street West 1280, Hamilton, ON, Canada
| | - Lydia Kapiriri
- Department of Health, Aging and Society, McMaster University, KTH-236, Main Street West 1280, Hamilton, ON, Canada.
| |
Collapse
|
12
|
Dalglish SL, Sriram V, Scott K, Rodríguez DC. A framework for medical power in two case studies of health policymaking in India and Niger. Glob Public Health 2019; 14:542-554. [PMID: 29616876 DOI: 10.1080/17441692.2018.1457705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
Medical professionals influence health policymaking but the power they exercise is not well understood in low- and middle-income countries. We explore medical power in national health policymaking for child survival in Niger (late 1990s-2012) and emergency medicine specialisation in India (early 1990s-2015). Both case studies used document review, in-depth interviews and non-participant observation; combined analysis traced policy processes and established theoretical categories around power to build a conceptual framework of medical power in health policymaking. Medical doctors, mainly specialists, utilised their power to shape policy differently in each case. In Niger, a small, connected group of paediatricians pursued a policy of task-shifting after a powerful non-medical actor, the country's president, shifted the debate by enacting broad health systems improvements. In India, a more fragmented group of specialists prioritised tertiary-level healthcare policies likely to benefit only a small subset of the population. Compared to high-income settings, medical power in these cases was channelled and expressed with greater variability in the profession's ability to organise and influence policymaking. Taken together, both cases provide evidence that a concentration of medical power in health policymaking can result in the medicalisation of public health issues.
Collapse
Affiliation(s)
- Sarah L Dalglish
- a Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| | - Veena Sriram
- a Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| | - Kerry Scott
- a Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| | - Daniela C Rodríguez
- a Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
| |
Collapse
|