The World Health Report 2000: World Health Organization health policy steering off course-changed values, poor evidence, and lack of accountability

Evidence uptake is only part of the process: Stakeholders' insights on WHO treatment guideline recommendation processes for radical cure of P. vivax malaria

Health policy processes should be evidence-informed, transparent and timely, but these processes are often unclear to stakeholders outside the immediate policymaking environment. We spoke to 36 international malaria stakeholders to gain insights on the processes involved in the World Health Organization's Global Malaria Programme's recommendations for their treatment guidelines of P. vivax malaria. Four key themes which drew on the 3i policy framework and Shiffman's four factors that influence global and national policymaking were identified to understand these processes. Triggers for policy change and change prioritisation, evidence types that inform policy, effects of funding on decision-making processes, and transparency and communication of these processes to external stakeholders. Results indicate that more clarity is needed on what triggers global malaria policy change processes, a clearer justification of evidence types used to inform policymaking, better understanding of the impact of the WHO's funding model on policymaking and further transparency and improved communication of these processes to external stakeholders is also needed. We suggest that global malaria policymaking could be improved by using the following strategies: ensuring that identified triggers actually initiate the policy change process, expediting decision-making timelines by developing a priority framework for assessing new evidence, adopting suitable frameworks to assess contextual evidence, and increasing the transparency of the role of non-state funders in policy decision-making processes and when publishing new recommendations.

Assessing the interactions of people and policy-makers in social participation for health: an inventory of participatory governance measures from a rapid systematic literature review

Social participation, also termed stakeholder voice, is an important component of health system governance. Increased interactions between the community and policy makers could facilitate a more responsive health system that targets the needs of the community better. Recently, the World Health Organization (WHO) published a handbook on social participation that identified five key themes for ministries of health to consider when engaging the input of the community. In this rapid systematic literature review, we aimed to identify quantitative and qualitative measures that have been used to assess aspects of social participation involving people and policy makers. We identified 172 measures from 48 studies from countries in all six WHO regions. These measures were categorized by all five themes from the handbook on social participation and these measures are linked to 27 concepts. This rapid review found that the focus of measures is largely on the existence of participation-be it by the general population or specific vulnerable groups-rather than on the quality of their participation. The measures in this inventory may be useful for ministries of health and other key stakeholders to use when developing methods to assess and encourage social participation in their context.

Health in All Policies: from rhetoric to action

AIMS

The fact that health is largely constructed outside the remits of the health sector has been known for a long time. However, implementing intersectoral health policies is difficult. The aim of this article is to study possibilities for strengthening the implementation of Health in All Policies (HiAP) approach.

METHODS

The article analyses earlier efforts in intersectoral health policy-making and adapts Kingdon's theory on policy change for exploring opportunities and challenges for strengthening HiAP approach.

RESULTS

Opportunities for HiAP can be identified by analysing possibilities for amending health determinants on the one hand, and by analysing policy trends, proposals, and actors, especially in fields other than health, on the other. Four basic strategies for HiAP are identified, namely: health strategy, win-win strategy, cooperation strategy, and damage limitation strategy. Their strengths in various situations are explored. Using an adaptation of Kingdon's framework, possibilities for creating opportunities for HiAP by raising health issues on the agenda, developing appropriate tools and by creating conducive momentums are discussed.

CONCLUSIONS

It is concluded that systematic efforts of experts in public health, health policy, and international health are important in identifying and prioritising the needs for HiAP, in analysing health implications of policies and policy proposals and making these understood by the policy-makers, as well as in suggesting feasible solutions. Improving health literacy of the public, the policy-makers, and the media is key for improved understanding on health implications of policies. Participatory and transparent approaches to policy-making are prerequisites for strengthening HiAP.

Revolution or evolution: the challenges of conceptualizing patient and public involvement in a consumerist world

BACKGROUND

Changing the relationship between citizens and the state is at the heart of current policy reforms. Across England and the developed world, from Oslo to Ontario, Newcastle to Newquay, giving the public a more direct say in shaping the organization and delivery of healthcare services is central to the current health reform agenda. Realigning public services around those they serve, based on evidence from service user's experiences, and designed with and by the people rather than simply on their behalf, is challenging the dominance of managerialism, marketization and bureaucratic expertise. Despite this attention there is limited conceptual and theoretical work to underpin policy and practice.

OBJECTIVE

This article proposes a conceptual framework for patient and public involvement (PPI) and goes on to explore the different justifications for involvement and the implications of a rights-based rather than a regulatory approach. These issues are highlighted through exploring the particular evolution of English health policy in relation to PPI on the one hand and patient choice on the other before turning to similar patterns apparent in the United States and more broadly.

CONCLUSIONS

A framework for conceptualizing PPI is presented that differentiates between the different types and aims of involvement and their potential impact. Approaches to involvement are different in those countries that adopt a rights-based rather than a regulatory approach. I conclude with a discussion of the tension and interaction apparent in the globalization of both involvement and patient choice in both policy and practice.