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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] [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
- grid.420226.00000 0004 0639 2949World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Kaelan Moat
- grid.25073.330000 0004 1936 8227McMaster Health Forum, McMaster University, Hamilton, ON Canada
| | - Tanja Kuchenmüller
- grid.3575.40000000121633745World Health Organization, Geneva, Switzerland
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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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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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Koon AD, Windmeyer L, Bigdeli M, Charles J, El Jardali F, Uneke J, Bennett S. A scoping review of the uses and institutionalisation of knowledge for health policy in low- and middle-income countries. Health Res Policy Syst 2020; 18:7. [PMID: 31959208 PMCID: PMC6971874 DOI: 10.1186/s12961-019-0522-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/20/2019] [Indexed: 12/21/2022] Open
Abstract
There is growing interest in how different forms of knowledge can strengthen policy-making in low- and middle-income country (LMIC) health systems. Additionally, health policy and systems researchers are increasingly aware of the need to design effective institutions for supporting knowledge utilisation in LMICs. To address these interwoven agendas, this scoping review uses the Arskey and O’Malley framework to review the literature on knowledge utilisation in LMIC health systems, using eight public health and social science databases. Articles that described the process for how knowledge was used in policy-making, specified the type of knowledge used, identified actors involved (individual, organisation or professional), and were set in specific LMICs were included. A total of 53 articles, from 1999 to 2016 and representing 56 countries, were identified. The majority of articles in this review presented knowledge utilisation as utilisation of research findings, and to a lesser extent routine health system data, survey data and technical advice. Most of the articles centered on domestic public sector employees and their interactions with civil society representatives, international stakeholders or academics in utilising epistemic knowledge for policy-making in LMICs. Furthermore, nearly all of the articles identified normative dimensions of institutionalisation. While there is some evidence of how different uses and institutionalisation of knowledge can strengthen health systems, the evidence on how these processes can ultimately improve health outcomes remains unclear. Further research on the ways in which knowledge can be effectively utilised and institutionalised is needed to advance the collective understanding of health systems strengthening and enhance evidence-informed policy formulation.
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Affiliation(s)
- Adam D Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States of America. .,International Development Division, Abt Associates Inc, Rockville, MD, United States of America.
| | - Lauren Windmeyer
- Upstream USA, Oakland, CA, United States of America.,John F Kennedy School of Government, Harvard University, Cambridge, MA, United States of America
| | | | - Jodi Charles
- Office of Health Systems, United States Agency for International Development, Washington, D.C, United States of America
| | | | | | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States of America
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Kennedy C, O’Reilly P, O’Connell R, O’Leary D, Fealy G, Hegarty J, Brady A, Nicholson E, McNamara M, Casey M. Integrative review; identifying the evidence base for policymaking and analysis in health care. J Adv Nurs 2019; 75:3231-3245. [DOI: 10.1111/jan.14121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Catriona Kennedy
- School of Nursing and Midwifery Robert Gordon University Aberdeen Scotland
| | - Pauline O’Reilly
- Department of Nursing and Midwifery University of Limerick Limerick Ireland
| | - Rhona O’Connell
- Catherine McAuley School of Nursing and Midwifery University College Cork Cork Ireland
| | - Denise O’Leary
- School of Hospitality Management and Tourism Dublin Institute of Technology Dublin Ireland
| | - Gerard Fealy
- UCD School of Nursing, Midwifery & Health Systems University College Dublin Dublin Ireland
| | | | - Anne‐Marie Brady
- School of Nursing & Midwifery Trinity College Dublin Dublin Ireland
| | - Emma Nicholson
- UCD School of Nursing, Midwifery & Health Systems University College Dublin Dublin Ireland
| | - Martin McNamara
- UCD School of Nursing, Midwifery & Health Systems University College Dublin Dublin Ireland
| | - Mary Casey
- UCD School of Nursing, Midwifery & Health Systems University College Dublin Dublin Ireland
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van de Pas R, Kolie D, Delamou A, Van Damme W. Health workforce development and retention in Guinea: a policy analysis post-Ebola. HUMAN RESOURCES FOR HEALTH 2019; 17:63. [PMID: 31382972 PMCID: PMC6683560 DOI: 10.1186/s12960-019-0400-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 07/19/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND The state of the Guinean health workforce is one of the country's bottlenecks in advancing health outcomes. The impact of the 2014-2015 Ebola virus disease outbreak and resulting international attention has provided a policy window to invest in the workforce and reform the health system. This research constitutes a baseline study on the health workforce situation, professional education, and retention policies in Guinea. The study was conducted to inform capacity development as part of a scientific collaboration between Belgian and Guinean health institutes aiming to strengthen public health systems and health workforce development. It provides initial recommendations to the Guinean government and key actors. METHODOLOGY The conceptual framework for this study is inspired by Gilson and Walt's health policy triangle. The research consists of a mixed-methods approach with documents and data collected at the national, regional, and district levels between October 2016 and March 2017. Interviews were conducted with 57 resource persons from the Ministry of Health, other ministries, district health authorities, health centers and hospitals, health training institutions, health workers, community leaders, NGO representatives, and development partners. Quantitative data included figures obtained from seven health professionals' schools in each administrative region of Guinea. A quantitative analysis was conducted to determine the professional graduate trends by year and type of personnel. This provided for a picture of the pool of professional graduates available in the regions in relation to the actual employment possibilities in rural areas. The districts of Forecariah and Yomou were chosen as the main study sites. RESULTS Limited recruitment and a relative overproduction of medical doctors and nurse assistants have led to unemployment of health personnel. There was a mismatch between the number of civil servants administratively deployed and those actually present at their health posts. Participants argued for decentralization of health workforce management and financing. Collaboration between government actors and development partners is required to anticipate problems with the policy implementation of new health workers' deployment in rural areas. Further privatization of health education has to meet health needs and labor market dynamics.
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Affiliation(s)
- Remco van de Pas
- Department of Public Health, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium
- Department of Health Ethics and Society, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Delphin Kolie
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Ministère de la Santé, 2640 Forécariah, Guinea
| | - Alexandre Delamou
- Centre National de Formation et de Recherche en Santé Rurale de Maferinyah, Ministère de la Santé, 2640 Forécariah, Guinea
- Department of Public Health, Gamal Abdel Nasser University, Conakry, Guinea
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000 Antwerp, Belgium
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Robert E, Ridde V, Rajan D, Sam O, Dravé M, Porignon D. Realist evaluation of the role of the Universal Health Coverage Partnership in strengthening policy dialogue for health planning and financing: a protocol. BMJ Open 2019; 9:e022345. [PMID: 30782678 PMCID: PMC6340476 DOI: 10.1136/bmjopen-2018-022345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 10/08/2018] [Accepted: 10/19/2018] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION In 2011, WHO, the European Union and Luxembourg entered into a collaborative agreement to support policy dialogue for health planning and financing; these were acknowledged as core areas in need of targeted support in countries' quest towards universal health coverage (UHC). Entitled 'Universal Health Coverage Partnership', this intervention is intended to strengthen countries' capacity to develop, negotiate, implement, monitor and evaluate robust and integrated national health policies oriented towards UHC. It is a complex intervention involving a multitude of actors working on a significant number of remarkably diverse activities in different countries. METHODS AND ANALYSIS The researchers will conduct a realist evaluation to answer the following question: How, in what contexts, and triggering what mechanisms, does the Partnership support policy dialogue for health planning and financing towards UHC? A qualitative multiple case study will be undertaken in Togo, Liberia, Democratic Republic of Congo, Cape Verde, Burkina Faso and Niger. Three steps will be implemented: (1) formulating context-mechanism-outcome explanatory propositions to guide data collection, based on expert knowledge and theoretical literature; (2) collecting empirical data through semistructured interviews with key informants and observations of key events, and analysing data; (3) specifying the intervention theory. ETHICS AND DISSEMINATION The primary target audiences are WHO and its partner countries; international and national stakeholders involved in or supporting policy dialogues in the health sector, especially in low-income countries; and researchers with interest in UHC, policy dialogue, evaluation research and/or realist evaluation.
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Affiliation(s)
- Emilie Robert
- Training and Research Transcultural Team, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Valery Ridde
- Centre Population et Développement, Paris, Île-de-France, France
- Institut de recherche en santé publique, Université de Montréal, Montreal, Quebec, Canada
| | - Dheepa Rajan
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
| | - Omar Sam
- Inter-Country Support Team, World Health Organization, Ouagadougou, Burkina Faso
| | - Mamadou Dravé
- Country Office, World Health Organization, Lomé, Togo
| | - Denis Porignon
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland
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