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Ferreira Umpiérrez A, Pérez M, Valli C, Gómez Garbero L, Olivera C, Moreno Dias B, De Bortoli Cassiani SH. [Health policy dialogue to strengthen nursing in UruguayDiálogo político-sanitário para o fortalecimento da enfermagem no Uruguai]. Rev Panam Salud Publica 2023; 47:e147. [PMID: 37881799 PMCID: PMC10597393 DOI: 10.26633/rpsp.2023.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/25/2023] [Indexed: 10/27/2023] Open
Abstract
This article presents the experience of the health policy dialogue on nursing held in Uruguay in 2021, based on the theory of change. Four working groups were held, with the participation of 725 people. The points discussed included: the shortage of registered nurses to implement programs and cover functions at all levels of health care; the poor visibility of the healthcare impact of the activities carried out; insufficient financial resources for undergraduate and postgraduate training; and poor integration of nurses in management teams and policy decision-making spaces in the country. Participants expressed the need to implement the national nursing development plan so that the country can: reduce the shortage of professionals; invest in job creation to meet the demand for professional care; improve staffing of services at all levels of care; improve working conditions; create new spaces for nurses by expanding their role through postgraduate training, while continuously improving the quality of training. Participants emphasized the need to increase intersectoral coordination in the areas of governance, regulation, and management, and to step up efforts to increase investment in health professionals in Uruguay.
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Affiliation(s)
| | - Mercedes Pérez
- Universidad de la RepúblicaMontevideoUruguayUniversidad de la República, Montevideo, Uruguay.
| | - Carlos Valli
- Ministerio de Salud PúblicaUruguayMinisterio de Salud Pública, Uruguay.
| | - Lucía Gómez Garbero
- Universidad Católica del UruguayMontevideoUruguayUniversidad Católica del Uruguay, Montevideo, Uruguay.
| | - Camila Olivera
- Universidad de la RepúblicaMontevideoUruguayUniversidad de la República, Montevideo, Uruguay.
| | - Bruna Moreno Dias
- Organización Panamericana de la Salud/Organización Mundial de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud/Organización Mundial de la Salud, Washington, D.C., Estados Unidos de América
| | - Silvia Helena De Bortoli Cassiani
- Organización Panamericana de la Salud/Organización Mundial de la SaludWashington, D.C.Estados Unidos de AméricaOrganización Panamericana de la Salud/Organización Mundial de la Salud, Washington, D.C., Estados Unidos de América
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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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Cheong Chi Mo J, Shah A, Downey C, Genay-Diliautas S, Saikat S, Mustafa S, Meru N, Dalil S, Schmets G, Porignon D. Developing technical support and strategic dialogue at the country level to achieve Primary Health Care-based health systems beyond the COVID-19 era. Front Public Health 2023; 11:1102325. [PMID: 37113176 PMCID: PMC10126771 DOI: 10.3389/fpubh.2023.1102325] [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] [Received: 11/18/2022] [Accepted: 03/03/2023] [Indexed: 04/29/2023] Open
Abstract
This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Pursuing the objectives of the Declaration of Alma-Ata for Primary Health Care (PHC), the World Health Organization (WHO) and global health partners are supporting national authorities to improve governance to build resilient and integrated health systems, including recovery from public health stressors, through the long-term deployment of WHO country senior health policy advisers under the Universal Health Coverage Partnership (UHC Partnership). For over a decade, the UHC Partnership has progressively reinforced, via a flexible and bottom-up approach, the WHO's strategic and technical leadership on Universal Health Coverage, with more than 130 health policy advisers deployed in WHO Country and Regional Offices. This workforce has been described as a crucial asset by WHO Regional and Country Offices in the integration of health systems to enhance their resilience, enabling the WHO offices to strengthen their support of PHC and Universal Health Coverage to Ministries of Health and other national authorities as well as global health partners. Health policy advisers aim to build the technical capacities of national authorities, in order to lead health policy cycles and generate political commitment, evidence, and dialogue for policy-making processes, while creating synergies and harmonization between stakeholders. The policy dialogue at the country level has been instrumental in ensuring a whole-of-society and whole-of-government approach, beyond the health sector, through community engagement and multisectoral actions. Relying on the lessons learned during the 2014-2016 Ebola outbreak in West Africa and in fragile, conflict-affected, and vulnerable settings, health policy advisers played a key role during the COVID-19 pandemic to support countries in health systems response and early recovery. They brought together technical resources to contribute to the COVID-19 response and to ensure the continuity of essential health services, through a PHC approach in health emergencies. This policy and practice review, including from the following country experiences: Colombia, Islamic Republic of Iran, Lao PDR, South Sudan, Timor-Leste, and Ukraine, provides operational and inner perspectives on strategic and technical leadership provided by WHO to assist Member States in strengthening PHC and essential public health functions for resilient health systems. It aims to demonstrate and advise lessons and good practices for other countries in strengthening their health systems.
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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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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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Garchitorena A, Miller AC, Cordier LF, Randriamanambintsoa M, Razanadrakato HTR, Randriamihaja M, Razafinjato B, Finnegan KE, Haruna J, Rakotonirina L, Rakotozafy G, Raharimamonjy L, Atwood S, Murray MB, Rich M, Loyd T, Solofomalala GD, Bonds MH. District-level health system strengthening for universal health coverage: evidence from a longitudinal cohort study in rural Madagascar, 2014-2018. BMJ Glob Health 2021; 5:bmjgh-2020-003647. [PMID: 33272943 PMCID: PMC7716667 DOI: 10.1136/bmjgh-2020-003647] [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] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Despite renewed commitment to universal health coverage and health system strengthening (HSS) to improve access to primary care, there is insufficient evidence to guide their design and implementation. To address this, we conducted an impact evaluation of an ongoing HSS initiative in rural Madagascar, combining data from a longitudinal cohort and primary health centres. Methods We carried out a district representative household survey at the start of the HSS intervention in 2014 in over 1500 households in Ifanadiana district, and conducted follow-up surveys at 2 and 4 years. At each time point, we estimated maternal, newborn and child health coverage; economic and geographical inequalities in coverage; and child mortality rates; both in the HSS intervention and control catchments. We used logistic regression models to evaluate changes associated with exposure to the HSS intervention. We also estimated changes in health centre per capita utilisation during 2013 to 2018. Results Child mortality rates decreased faster in the HSS than in the control catchment. We observed significant improvements in care seeking for children under 5 years of age (OR 1.23; 95% CI 1.05 to 1.44) and individuals of all ages (OR 1.37, 95% CI 1.19 to 1.58), but no significant differences in maternal care coverage. Economic inequalities in most coverage indicators were reduced, while geographical inequalities worsened in nearly half of the indicators. Conclusion The results demonstrate improvements in care seeking and economic inequalities linked to the early stages of a HSS intervention in rural Madagascar. Additional improvements in this context of persistent geographical inequalities will require a stronger focus on community health.
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Affiliation(s)
- Andres Garchitorena
- MIVEGEC, Univ. Montpellier, CNRS, IRD, Montpellier, France .,PIVOT, Ifanadiana, Madagascar
| | - Ann C Miller
- PIVOT, Ifanadiana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Marius Randriamanambintsoa
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | - Hery-Tiana R Razanadrakato
- Direction de la Démographie et des Statistiques Sociales, Institut National de la Statistique, Antananarivo, Madagascar
| | | | | | - Karen E Finnegan
- PIVOT, Ifanadiana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Rich
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Matthew H Bonds
- PIVOT, Ifanadiana, Madagascar.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Robert E, Rajan D, Koch K, Muggleworth Weaver A, Porignon D, Ridde V. Policy dialogue as a collaborative tool for multistakeholder health governance: a scoping study. BMJ Glob Health 2021; 4:bmjgh-2019-002161. [PMID: 32816823 PMCID: PMC7437973 DOI: 10.1136/bmjgh-2019-002161] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/25/2020] [Accepted: 03/21/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Health system governance is the cornerstone of performant, equitable and sustainable health systems aiming towards universal health coverage. Global health actors have increasingly been using policy dialogue (PD) as a governance tool to engage with both state and non-state stakeholders. Despite attempts to frame PD practices, it remains a catch-all term for both health systems professionals and researchers. Method We conducted a scoping study on PD. We identified 25 articles published in English between 1985 and 2017 and 10 grey literature publications. The analysis was guided by the following questions: (1) How do the authors define PD? (2) What do we learn about PD practices and implementation factors? (3) What are the specificities of PD in low-income and middle-income countries? Results The analysis highlighted three definitions of policy dialogue: a knowledge exchange and translation platform, a mode of governance and an instrument for negotiating international development aid. Success factors include the participants’ continued and sustained engagement throughout all the relevant stages, their ability to make a constructive contribution to the discussions while being truly representative of their organisation and their high interest and stake in the subject. Prerequisites to ensuring that participants remained engaged were a clear process, a shared understanding of the goals at all levels of the PD and a PD approach consistent with the PD objective. In the context of development aid, the main challenges lie in the balance of power between stakeholders, the organisational or technical capacity of recipient country stakeholders to drive or contribute effectively to the PD processes and the increasingly technocratic nature of PD. Conclusion PD requires a high level of collaborative governance expertise and needs constant, although not necessarily high, financial support. These conditions are crucial to make it a real driver of health system reform in countries’ paths towards universal health coverage.
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Affiliation(s)
- Emilie Robert
- Institut universitaire SHERPA, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | | | - Kira Koch
- World Health Organization, Geneva, Switzerland
| | | | | | - Valery Ridde
- CEPED (French Centre for Population and Development), IRD (French Research Institute for Development) (IRD-Paris Descartes University), Paris, France
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Anjomshoa M, Akbari Sari A, Takian A. Assessing progress in the national health financing system towards universal health coverage in Iran: a mixed-method study protocol. Health Res Policy Syst 2021; 19:4. [PMID: 33435989 PMCID: PMC7805138 DOI: 10.1186/s12961-020-00610-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/28/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Health financing systems have a key role in achieving universal health coverage (UHC) across the globe. However, little is known about how best to monitor health financing system progress towards UHC, especially in low- and middle-income countries. This is a protocol of a study that will aim to assess health financing system progress towards achieving UHC in Iran. METHODS An explanatory mixed-method approach will be used in two phases. In the quantitative phase, the performance of the Iranian health financing system will be assessed using a well-established set of indicators to draw on progress over 5-year intervals starting in the year 2000 up to the present. Data will be extracted from the global health expenditure database using a specific form and will be classified in accordance with each indicator. A qualitative phase will then take place considering the Kutzin et al. framework and by using health financing progress matrices. The qualitative phase will consist of two successive stages; first, a descriptive overview on the major health coverage schemes along with key attributes of each scheme. This initial mapping will be the underlying background for the second stage. In the second stage, the matrices comprised of a series of questions and relevant to the core functions of health financing and cross-cutting options will be invested in enhancing the evaluation of the ongoing reforms or policies. In this phase, data will be collected by reviewing national policy documents and in-depth interviews with key informants who will be recruited using purposive sampling. Finally, a policy discussion with key stakeholders will be held in order to review and verify the consistency between the current health financing policy and UHC goals. DISCUSSION This study will provide a comprehensive image about the current status of the national health financing system progress towards achieving UHC in Iran. Such assessment will give detailed insight about the performance of the current financing system through identifying encountered challenges. Furthermore, some other defects in the design of the financing system are expected to appear. In all likelihood, the results will be fruitful enough to make informed decisions about interventions and policies in relation to UHC. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee for Research at Tehran University of Medical Sciences. Informed consent will be obtained from all key informants and the data will be collected and transcribed anonymously in order to maintain utmost confidentiality. The results will be disseminated in peer-reviewed journals and presented in national and international conferences and meetings.
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Affiliation(s)
- Mina Anjomshoa
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
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Bonnet E, Nikiéma A, Adoléhoume A, Ridde V. Better data for better action: rethinking road injury data in francophone West Africa. BMJ Glob Health 2020; 5:bmjgh-2020-002521. [PMID: 32371569 PMCID: PMC7223014 DOI: 10.1136/bmjgh-2020-002521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 01/23/2023] Open
Affiliation(s)
- Emmanuel Bonnet
- Résiliences, Institut de recherche pour le developpement, Bondy, Seine Saint Denis, France
| | | | | | - Valery Ridde
- CEPED, Institut de Recherche pour le Développement, Paris, France
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Ridde V, Pérez D, Robert E. Using implementation science theories and frameworks in global health. BMJ Glob Health 2020; 5:e002269. [PMID: 32377405 PMCID: PMC7199704 DOI: 10.1136/bmjgh-2019-002269] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 11/20/2022] Open
Abstract
In global health, researchers and decision makers, many of whom have medical, epidemiology or biostatistics background, are increasingly interested in evaluating the implementation of health interventions. Implementation science, particularly for the study of public policies, has existed since at least the 1930s. This science makes compelling use of explicit theories and analytic frameworks that ensure research quality and rigour. Our objective is to inform researchers and decision makers who are not familiar with this research branch about these theories and analytic frameworks. We define four models of causation used in implementation science: intervention theory, frameworks, middle-range theory and grand theory. We then explain how scientists apply these models for three main implementation studies: fidelity assessment, process evaluation and complex evaluation. For each study, we provide concrete examples from research in Cuba and Africa to better understand the implementation of health interventions in global health context. Global health researchers and decision makers with a quantitative background will not become implementation scientists after reading this article. However, we believe they will be more aware of the need for rigorous implementation evaluations of global health interventions, alongside impact evaluations, and in collaboration with social scientists.
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Affiliation(s)
- Valéry Ridde
- CEPED, IRD (French Institute for Research on sustainable Development), Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Dennis Pérez
- Epidemiology Division, Pedro Kouri Tropical Medicine Institute (IPK), Havana, Cuba
| | - Emilie Robert
- ICARES and Centre de recherche SHERPA (Institut Universitaire au regard des communautés ethnoculturelles, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal), Montreal, Quebec, Canada
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