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Paul E, Brown GW, Ridde V, Sturmberg JP. Who is "anti-science"? PUBLIC HEALTH IN PRACTICE 2024; 7:100493. [PMID: 38601178 PMCID: PMC11004618 DOI: 10.1016/j.puhip.2024.100493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024] Open
Abstract
Objectives "Anti-science" accusations are common in medicine and public health, sometimes to discredit scientists who hold opposing views. However, there is no such thing as "one science". Epistemology recognizes that any "science" is sociologically embedded, and therefore contextual and intersubjective. In this paper, we reflect on how "science" needs to adopt various perspectives to give a comprehensive and nuanced understanding of a phenomenon. Study design Opinion paper. Methods Based on a targeted literature survey, we first clarify the known limits of traditional scientific methods and then reflect on how the scientific reporting about Covid-19 mRNA vaccines has evolved. Results The first reports of the Covid-19 mRNA vaccines randomised controlled trial results showed impressive efficacy. Nevertheless, an abundant literature has since depicted a far more nuanced picture of the effectiveness and safety of those vaccines over the medium-term. We organise them around five themes: (i) differentiating between relative and absolute reduction; (ii) taking account of time in reporting effectiveness; (iii) taking account of all outcomes, including adverse effects; (iv) stratifying effectiveness and considering other decision criteria (efficiency, equity, and acceptance); (v) changing the outcome of concern and assessing vaccines' effectiveness on mortality. Conclusions Science offers a wide range of perspectives on a given study object. Only the process of deliberation amongst scientists and other stakeholders can result in accepted new knowledge useful to support decision-making. Unfortunately, by trying to reduce "science" to simple messages set in stone, scientists can become the worse enemies of science.
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Affiliation(s)
- Elisabeth Paul
- Université Libre de Bruxelles, School of Public Health, Campus Erasme, Route de Lennik 808, CP 591, 1070, Brussels, Belgium
| | - Garrett W. Brown
- University of Leeds, School of Politics and International Studies (POLIS), Leeds, United Kingdom
| | - Valéry Ridde
- Université Paris Cité, Institut de recherche pour le développement (IRD), INSERM, CEPED, Paris, France
| | - Joachim P. Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Australia
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Sié A, Fofana H, Kagoné M, Ouédraogo M, Onwujekwe OE, Mbachu CO, Chokshi M, Chilgod L, Mokashi T, Nair AB, Muriuki P, Taddese A, Ewald L, Handigol A. Understanding evidence ecosystems: What influences the production, translation, and use of modeled evidence in Burkina Faso, Nigeria, India, and Kenya? Gates Open Res 2023; 7:135. [PMID: 39165698 PMCID: PMC11333661 DOI: 10.12688/gatesopenres.14973.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 08/22/2024] Open
Abstract
Background This study sought to document and understand facilitators and barriers to producing, translating, and using modeled evidence in decision-making in Burkina Faso, Nigeria, India, and Kenya. We explored researcher-decision-maker engagement mechanisms as key facilitators of evidence use, with a focus on knowledge brokers and boundary organizations. Methods The study used mixed methods drawing on analysis from key informant interviews and surveys, complemented by a rapid desk review to map modeling activities and actors. The survey was conducted online while the qualitative research entailed in-depth interviews with modelers, knowledge brokers, and decision-makers working in a representative variety of health fields, organizations, and levels of government. This study was approved by Health Media Lab IRB (Institutional Review Board) in the United States and a local IRB in each study country and conducted between September 2021 and June 2022. Results Informants interviewed for this study described a range of factors that facilitate and inhibit the use of modeled evidence in public health decision-making at the individual, organizational, and environmental levels. Key themes included the capacity to produce, translate, and use modeled evidence; the timing and relevance of modeling outputs; the existence of communications channels between modelers and decision-makers; the strength of underlying data systems; the role of sustained funding; and the impact of global crises. Conclusion This study highlights the importance of taking an ecosystem approach to supporting modeling activities, considering individual, organizational, and environmental factors and how different actors and interact to inform the production, translation, and use of modeled evidence. Structured interaction that promotes dialogue, debate, and joint sense making between the producers and users of evidence is critical to informing and influencing the use of evidence in decision-making.
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Affiliation(s)
- Ali Sié
- Centre de recherche en santé de Nouna, Ouagadougou, Burkina Faso
| | - Habibou Fofana
- Centre de recherche en santé de Nouna, Ouagadougou, Burkina Faso
| | | | - Moussa Ouédraogo
- Centre de recherche en santé de Nouna, Ouagadougou, Burkina Faso
| | | | | | | | | | | | | | | | - Abeba Taddese
- Results for Development Institute, Washington, District of Columbia, USA
| | - Leah Ewald
- Results for Development Institute, Washington, District of Columbia, USA
| | - Apoorva Handigol
- Results for Development Institute, Washington, District of Columbia, USA
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Martens M, van Olmen J, Wouters E, Boateng D, Van Damme W, Van Belle S. Using the multiple streams model to elicit an initial programme theory: from policy dialogues to a roadmap for scaling up integrated care. BMJ Glob Health 2023; 8:e012637. [PMID: 37730245 PMCID: PMC10510919 DOI: 10.1136/bmjgh-2023-012637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/02/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION The 'SCale-Up diaBetes and hYpertension care' Project aims to support the scale-up of integrated care for diabetes and hypertension in Cambodia, Slovenia and Belgium through the co-creation, implementation and evaluation of contextualised roadmaps. These roadmaps offer avenues for action and are built on evidence as well as stakeholder engagement in policy dialogues. Roadmaps and policy dialogues are very much intertwined and considered to be key elements for successful stakeholder-supported scale-up in integrated chronic care. Yet, little is known about how, why and under which conditions policy dialogue leads to successful roadmap implementation and scale-up of integrated care. Therefore, this study aims to use a realist approach to elicit an initial programme theory (IPT), using political science theories on the policy process. METHODS To develop the IPT, information from different sources was collected. First, an exploratory literature review on policy dialogue and scale-up definitions and success factors was performed, identifying theoretical frameworks, empirical (case) studies and realist studies (information gleaning). Second, research workshops on applying theory to the roadmap for scale-up (theory gleaning) were conducted with a multidisciplinary expert team. We used the intervention-context-actors-mechanism-outcome configuration to synthesise information from the sources into a configurational map. RESULTS The information and theory gleaning resulted into an IPT, hypothesising how policy dialogues can contribute to roadmap success in different policy stages. The IPT draws on political science theory of the multiple streams model adapted by Howlett et al to include five streams (problem, solution, politics, process and programme) that can emerge, converge and diverge across all five policy stages. CONCLUSION This paper aims to extend the knowledge base on the use of policy dialogues to build a roadmap for scale-up. The IPT describes how (dynamics) and why (theories) co-created roadmaps are expected to work in different policy stages.
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Affiliation(s)
- Monika Martens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Josefien van Olmen
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family & Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Mitchell P, Reinap M, Moat K, Kuchenmüller T. An ethical analysis of policy dialogues. Health Res Policy Syst 2023; 21:13. [PMID: 36707839 PMCID: PMC9881302 DOI: 10.1186/s12961-023-00962-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/13/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND A policy dialogue is a tool which promotes evidence-informed policy-making. It involves deliberation about a high-priority issue, informed by a synthesis of the best-available evidence, where potential policy interventions are discussed by stakeholders. We offer an ethical analysis of policy dialogues - an argument about how policy dialogues ought to be conceived and executed - to guide those organizing and participating in policy dialogues. Our analysis focuses on the deliberative dialogues themselves, rather than ethical issues in the broader policy context within which they are situated. METHODS We conduct a philosophical conceptual analysis of policy dialogues, informed by a formal and an interpretative literature review. RESULTS We identify the objectives of policy dialogues, and consider the procedural and substantive values that should govern them. As knowledge translation tools, the chief objective of policy dialogues is to ensure that prospective evidence-informed health policies are appropriate for and likely to support evidence-informed decision-making in a particular context. We identify five core characteristics which serve this objective: policy dialogues are (i) focused on a high-priority issue, (ii) evidence-informed, (iii) deliberative, (iv) participatory and (v) action-oriented. In contrast to dominant ethical frameworks for policy-making, we argue that transparency and accountability are not central procedural values for policy dialogues, as they are liable to inhibit the open deliberation that is necessary for successful policy dialogues. Instead, policy dialogues are legitimate insofar as they pursue the objectives and embody the core characteristics identified above. Finally, we argue that good policy dialogues need to actively consider a range of substantive values other than health benefit and equity. CONCLUSIONS Policy dialogues should recognize the limits of effectiveness as a guiding value for policy-making, and operate with an expansive conception of successful outcomes. We offer a set of questions to support those organizing and participating in policy dialogues.
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Affiliation(s)
- Polly Mitchell
- Centre for Public Policy Research, King's College London, London, United Kingdom.
- World Health Organization Regional Office for Europe, Copenhagen, Denmark.
- School of Education, Communication & Society, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Road, London, SE1 9NH, United Kingdom.
| | - Marge Reinap
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Kaelan Moat
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
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Lugten E, Marcus R, Bright R, Maruf F, Kureshy N. From fragility to resilience: A systems approach to strengthen primary health care. Front Public Health 2023; 10:1073617. [PMID: 36699864 PMCID: PMC9868809 DOI: 10.3389/fpubh.2022.1073617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Elizabeth Lugten
- Credence Management Solutions, Vienna, VA, United States,*Correspondence: Elizabeth Lugten ✉
| | - Rachel Marcus
- USAID Bureau for Global Health, Office of Health Systems, United States Agency for International Development, Washington, DC, United States
| | - Rhea Bright
- Social Solutions International, North Bethesda, MD, United States
| | - Farzana Maruf
- Global Health Technical Assistance and Mission Support Project, Washington, DC, United States
| | - Nazo Kureshy
- USAID Bureau for Global Health, Office of Health Systems, United States Agency for International Development, Washington, DC, United States
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Contributing to collaborative health governance in Africa: a realist evaluation of the Universal Health Coverage Partnership. BMC Health Serv Res 2022; 22:753. [PMID: 35668410 PMCID: PMC9172044 DOI: 10.1186/s12913-022-08120-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background Policy dialogue, a collaborative governance mechanism, has raised interest among international stakeholders. They see it as a means to strengthen health systems governance and to participate in the development of health policies that support universal health coverage. In this context, WHO has set up the Universal Health Coverage Partnership. This Partnership aims to support health ministries in establishing inclusive, participatory, and evidence-informed policy dialogue. The general purpose of our study is to understand how and in what contexts the Partnership may support policy dialogue and with what outcomes. More specifically, our study aims to answer two questions: 1) How and in what contexts may the Partnership initiate and nurture policy dialogue? 2) How do collaboration dynamics unfold within policy dialogue supported by the Partnership? Methods We conducted a multiple-case study realist evaluation based on Emerson’s integrative framework for collaborative governance to investigate the role of the Partnership in policy dialogue on three policy issues in six sub-Saharan African countries: health financing (Burkina Faso and Democratic Republic of Congo), health planning (Cabo Verde, Niger, and Togo), and aid coordination for health (Liberia). We interviewed 121 key informants, analyzed policy documents, and observed policy dialogue events. Results The Partnership may facilitate the initiation of policy dialogue when: 1) stakeholders feel uncertain about health sector issues and acknowledge their interdependence in responding to such issues, and 2) policy dialogue coincides with their needs and interests. In this context, policy dialogue enables stakeholders to build a shared understanding of issues and of the need for action and encourages collective leadership. However, ministries’ weak ownership of policy dialogue and stakeholders’ lack of confidence in their capacity for joint action hinder their engagement and curb the institutionalization of policy dialogue. Conclusions Development aid actors wishing to support policy dialogue must do so over the long term so that collaborative governance becomes routine and a culture of collaboration has time to grow. Public administrations should develop collaborative governance mechanisms that are transparent and intelligible in order to facilitate stakeholder engagement.
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BEHZADIFAR MASOUD, GHANBARI MAHBOUBEHKHATON, RAVAGHI HAMID, BAKHTIARI AHAD, SHAHABI SAEED, DOSHMANGIR LEILA, ALIDOOST SAEIDE, AZARI SAMAD, MARTINI MARIANO, EHSANZADEH SEYEDJAFAR, BRAGAZZI NICOLALUIGI. Health policy analysis in Eastern Mediterranean region using a health policy triangle framework: Historical and ethical insights from a systematic review. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E351-E373. [PMID: 35968073 PMCID: PMC9351417 DOI: 10.15167/2421-4248/jpmh2022.63.2.2450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/07/2022] [Indexed: 11/16/2022]
Abstract
Background Health policy can be defined as an agreement and consensus on a health-related program and set of actions taken to achieve the goals expected by programs in the area of policy. Policy analysis involves a wide range of methods, techniques, and tools in a way to reach awareness of the impacts of the developed and implemented policies. Whereas policy analysis in developed countries has a long history, in developing countries, it is instead in its first developing stages. Our paper aimed to collect systematically the studies using health policy triangle framework in doing analysis in one of the health policy issues in the Eastern Mediterranean region organization. Methods To conduct our literature search, ISI/Web of Science, PubMed/MEDLINE, Embase, The Cochrane Library, Global Health Database, Scopus, as well as Google Scholar from 2003 up to June 2020 were systematically mined. To evaluate the methodological quality of the included studies, the Critical Appraisal Skills Program checklist was used. Results We selected 30 studies, conducted between 2011 and 2020. According to the findings of these studies, in the Eastern Mediterranean region, organization region, and the role of evidence-based research in policy-making has been repeatedly emphasized, but its use in health program decision-making has been limited, and health research systems in Eastern Mediterranean region organization are still under scrutiny. There is still a gap between evidence-based research in health systems and its use in policy-making. Discussion Based on the present systematic review, studies based on policy analysis should focus on all the elements of health policies and provide evidence to inform decisions that can strengthen health systems, improve health and improve existing inequalities.
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Affiliation(s)
- MASOUD BEHZADIFAR
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - HAMID RAVAGHI
- School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - AHAD BAKHTIARI
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - SAEED SHAHABI
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - LEILA DOSHMANGIR
- Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - SAEIDE ALIDOOST
- School of Health Management & Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - SAMAD AZARI
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - MARIANO MARTINI
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - SEYED JAFAR EHSANZADEH
- English Language Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - NICOLA LUIGI BRAGAZZI
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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Ogbonnaya LU, Okedo-Alex IN, Akamike IC, Azuogu B, Urochukwu H, Ogbu O, Uneke CJ. Assessing the usefulness of policy brief and policy dialogue as knowledge translation tools towards contextualizing the accountability framework for routine immunization at a subnational level in Nigeria. Health Res Policy Syst 2021; 19:154. [PMID: 34969398 PMCID: PMC8717671 DOI: 10.1186/s12961-021-00804-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Evidence suggests that implementing an accountability mechanism such as the accountability framework for routine immunization in Nigeria (AFRIN) will improve routine immunization (RI) performance. The fact that the AFRIN, which was developed in 2012, still had not been operationalized at the subnational level (Ebonyi State) by 2018 may in part account for the poor RI coverage (33%) in 2017. Knowledge translation (KT) is defined as the methods for closing the gaps from knowledge to practice. Policy briefs (useful in communicating research findings to policy-makers) and policy dialogues (that enable stakeholders to understand research evidence and create context-resonant implementation plans) are two KT tools. This study evaluated their usefulness in enabling policy-makers to contextualize AFRIN in Ebonyi State, Nigeria. Methods The study design was cross-sectional descriptive with mixed-methods data collection. A policy brief developed from AFRIN guided deliberations in a 1-day multi-stakeholder policy dialogue by 30 policy actors. The usefulness of the KT tools in contextualizing policy recommendations in the AFRIN was assessed using validated questionnaires developed at McMaster University, Canada. Results At the end of the policy dialogue, the policy options in the policy brief were accepted but their implementation strategies were altered to suit the local context. The respondents’ mean ratings (MNR) of the overall usefulness of the policy brief and the policy dialogue in contextualizing the implementation strategies were 6.39 and 6.67, respectively, on a seven-point Likert scale (very useful). The MNR of the different dimensions of the policy brief and policy dialogue ranged from 6.17 to 6.60 and from 6.10 to 6.83, respectively (i.e. moderately helpful to very helpful). Conclusion The participants perceived the KT tools (policy brief and policy dialogue) as being very useful in contextualizing policy recommendations in a national policy document into state context-resonant implementable recommendations. We recommend the use of these KT tools in operationalizing AFRIN at the subnational level in Nigeria.
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Affiliation(s)
- Lawrence Ulu Ogbonnaya
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Faculty of Clinical Medicine College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria. .,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Benedict Azuogu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Faculty of Clinical Medicine College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Henry Urochukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Community Medicine, Faculty of Clinical Medicine College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria.,National Obstetric Fistula Centre (NOFIC), Abakaliki, Nigeria
| | - Ogbonnaya Ogbu
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Applied Microbiology, Faculty of Science, Ebonyi State University, Abakaliki, Nigeria
| | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Nigeria.,Department of Medical Microbiology, Faculty of Clinical Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
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Lewin S, Lehmann U, Perry HB. Community health workers at the dawn of a new era: 3. Programme governance. Health Res Policy Syst 2021; 19:129. [PMID: 34641914 PMCID: PMC8506073 DOI: 10.1186/s12961-021-00749-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Community health workers (CHWs) can play a critical role in primary healthcare and are seen widely as important to achieving the health-related Sustainable Development Goals (SDGs). The COVID-19 pandemic has emphasized the key role of CHWs. Improving how CHW programmes are governed is increasingly recognized as important for achieving universal access to healthcare and other health-related goals. This paper, the third in a series on "Community Health Workers at the Dawn of a New Era", aims to raise critical questions that decision-makers need to consider for governing CHW programmes, illustrate the options for governance using examples of national CHW programmes, and set out a research agenda for understanding how CHW programmes are governed and how this can be improved. METHODS We draw from a review of the literature as well as from the knowledge and experience of those involved in the planning and management of CHW programmes. RESULTS Governing comprises the processes and structures through which individuals, groups, programmes, and organizations exercise rights, resolve differences, and express interests. Because CHW programmes are located between the formal health system and communities, and because they involve a wide range of stakeholders, their governance is complex. In addition, these programmes frequently fall outside of the governance structures of the formal health system or are poorly integrated with it, making governing these programmes more challenging. We discuss the following important questions that decision-makers need to consider in relation to governing CHW programmes: (1) How and where within political structures are policies made for CHW programmes? (2) Who implements decisions regarding CHW programmes and at what levels of government? (3) What laws and regulations are needed to support the programme? (4) How should the programme be adapted across different settings or groups within the country or region? CONCLUSION The most appropriate and acceptable models for governing CHW programmes depend on communities, on local health systems, and on the political system in which the programme is located. Stakeholders in each setting need to consider what systems are currently in place and how they might be adapted to local needs and systems.
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Affiliation(s)
- Simon Lewin
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Uta Lehmann
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Henry B Perry
- Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
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Yimgang D, Danhoundo G, Kusi-Appiah E, Sunder V, Campbell S, Yaya S. A scoping review of researchers' involvement in health policy dialogue in Africa. Syst Rev 2021; 10:190. [PMID: 34174957 PMCID: PMC8236190 DOI: 10.1186/s13643-021-01745-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Improving evidence-informed policy dialogue to support the development and implementation of national health policies is vital, but there is limited evidence on researchers' roles in policy dialogue processes in Africa. The objective of this study is to examine researchers' involvement in health policy dialogue in Africa. METHODS The database search of this scoping review was conducted from inception to January 24, 2021, by an expert searcher/librarian to determine the extent of evidence, barriers, and facilitators of researchers' involvement in health policy dialogues in Africa. PROSPERO, Wiley Cochrane Library, OVID Medline, OVID EMBASE, OVID PsycINFO, OVID Global Health, EBSCO CINAHL, BASE (Bielefeld Academic Search Engine), and Google/Google Scholar were searched using key words representing the concepts "policy dialogue", "health", and "Africa". No limits were applied. A narrative summary of results was presented. RESULTS There were 26 eligible studies representing 21 African countries. Significant discrepancies in researchers' involvement existed across countries. In 62% of the countries, there was suboptimal involvement of researchers in policy dialogues due to no or partial participation in policy dialogues. Major barriers included limited funding, lack of evidence in the public health field of interest, and skepticism of policymakers. The presence of an interface for exchange, demand for scientific evidence, and donors' funding were the most reported facilitators. CONCLUSIONS To improve the uptake of evidence in health policy-making processes, an environment of trust and communication between policymakers and researchers must be established. Policymakers need to demonstrate that they value research, by providing adequate funding, promoting knowledge translation activities, and supporting personal and professional development opportunities for researchers.
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Affiliation(s)
| | | | | | | | | | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, Ontario, K1N 6 N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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Sienkiewicz D, Maassen A, Imaz-Iglesia I, Poses-Ferrer E, McAvoy H, Horgan R, de Arriaga MT, Barnfield A. Shaping Policy on Chronic Diseases through National Policy Dialogs in CHRODIS PLUS. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197113. [PMID: 32998399 PMCID: PMC7579029 DOI: 10.3390/ijerph17197113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 01/04/2023]
Abstract
Policy dialogs are deliberative dialogue that gather policy makers and relevant stakeholders from across disciplines to discuss a topic of mutual interest. They typically serve as a single element in a broader policymaking cycle, either informing the content of new policy or forming a component of policy evaluation and review. In the joint action CHRODIS PLUS, national policy dialogs were conducted in fourteen EU Member States. The aim of the dialogs was to identify new policies or changes to existing policies and legislation that are capable of tackling major risk factors for chronic disease, to strengthen health promotion and prevention programs and to ensure health systems are equipped to respond to priority issues within the chronic diseases field. In this paper, we present the CHRODIS PLUS policy dialog methodology, as well as results and lessons learnt from three national policy dialogs held in Ireland, Portugal and Spain. After discussion of the results, we conclude that the CHRODIS PLUS methodology is an effective mechanism to provoke deliberative discussion around chronic disease prevention and management in different countries. However, it is essential to ensure adequate human and financial resources—as well as political commitment—to accomplish objectives set out during the policy dialogs. We argue that priority-setting across sectors can improve the resilience of health systems and opportunities for investment in Health in All Policies (HiAP), both at European Union and Member State levels.
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Affiliation(s)
| | - Alison Maassen
- EuroHealthNet, 1000 Brussels, Belgium
- Correspondence: (D.S.); (A.M.)
| | - Iñaki Imaz-Iglesia
- Instituto de Salud Carlos III–“Carlos III” Institute for Health, 28029 Madrid, Spain;
| | - Elisa Poses-Ferrer
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Government of Catalonia, 08005 Barcelona, Spain;
| | - Helen McAvoy
- Institute of Public Health in Ireland, D08 NH90 Dublin, Ireland;
| | - Rita Horgan
- Directorate-General of Health of Portugal, 1049-005 Lisbon, Portugal; (R.H.); (M.T.d.A.)
| | - Miguel Telo de Arriaga
- Directorate-General of Health of Portugal, 1049-005 Lisbon, Portugal; (R.H.); (M.T.d.A.)
| | - Andrew Barnfield
- School for Policy Studies, University of Bristol, Bristol BS8 1TZ, UK;
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