The application of EquiFrame in the analysis of sexual and reproductive health policies by Ivanova et al to a new thematic area, their selection of only some of the Core Concepts of human rights in health service provision and the addition of new vulnerable groups relevant to the purpose of their analysis, are all very welcome developments. We also applaud their application of EquiFrame to policies in countries where it has not previously been used, along with their use of interviews with policy-makers to produce a deeper understanding of policy processes. We argue that clear justification for the inclusion of additional, or replacement of some exiting vulnerable groups within EquiFrame should be accompanied by clear definitions of such groups, along with the evidence-base that justifies their classification as a vulnerable or marginalised group. To illustrate the versatility of EquiFrame, we summarise a range of ways in which it has been used across a number of regions; including a brief Case Study of its use to develop the National Health Policy of Malawi. While EquiFrame focuses on policy content, we preview a new policy analysis tool -Equity and Inclusion in Policy Processes (EquIPP) -which assesses the extent of equity and inclusion in broader policy processes. Together, EquiFrame and EquIPP can be used to help governments and civil society ensure that policies are addressing the much stronger emphasis on social inclusion, now apparent in the Sustainable Development Goals (SDGs).
Background: Equity and social inclusion for vulnerable groups in policy development processes and resulting documents remain a challenge globally. Most often, the marginalization of vulnerable groups is overlooked in both the planning and practice of health service delivery. Such marginalization may occur because authorities deem the targeting of those who already have better access to healthcare a cheaper and easier way to achieve short-term health gains. The Government of Malawi wishes to achieve an equitable and inclusive HIV and AIDS Policy. The aim of this study is to assess the extent to which the Malawi Policy review process addressed regional and international health priorities of equity and social inclusion for vulnerable groups in the policy content and policy revision process.
Methods: This research design comprised two phases. First, the content of the Malawi HIV and AIDS Policy was assessed using EquiFrame regarding its coverage of 21 Core Concepts of human rights and inclusion of 12 Vulnerable Groups. Second, the engagement of vulnerable groups in the policy process was assessed using the EquIPP matrix. For the latter, 10 interviews were conducted with a purposive sample of representatives of public sector, civil society organizations and development partners who participated in the policy revision process. Data was also collected from documented information of the policy processes.
Results: Our analyses indicated that the Malawi HIV and AIDS Policy had a relatively high coverage of Core Concepts of human rights and Vulnerable Groups; although with some notable omissions. The analyses also found that reasonable steps were taken to engage and promote participation of vulnerable groups in the planning, development, implementation, monitoring and evaluation processes of the HIV and AIDS Policy, although again, with some notable exceptions. This is the first study to use both EquiFrame and EquIPP as complimentary tools to assess the content and process of policy.
Conclusion: While the findings indicate inclusive processes, commitment to Core Concepts of human rights and inclusion of Vulnerable Groups in relation to the Malawi HIV and AIDS Policy, the results also point to areas in which social inclusion and equity could be further strengthened.
To promote and protect social inclusion meaningfully, interventions must be holistic in their scope, seeking to encourage inclusion between different social groups just as much as addressing examples of exclusion. Understanding the growing demand for policy approaches to promote social inclusion, this chapter seeks to develop practicable insights of the relevance and contribution of systems thinking to policy-making and programming for social inclusion. This chapter beings by briefly outlining the history of social inclusion/exclusion, the evolution of the concept, and its predominance within the current international development agenda. It argues that social inclusion/exclusion is best described as a “wicked” social problem and bears many characteristics of a complex adaptive system (CAS). The chapter discusses some applications of systems thinking to social inclusion/exclusion and argues that systems thinking is a useful heuristic to understand social exclusion and to analyze and design effective interventions to promote social inclusion. Finally, the chapter illustrates how systems thinking can provide innovative entry points for policy interventions aimed at promoting social inclusion for vulnerable groups with complex needs.
Discussion Combining nutrition education and system-level dietary modification is an effective approach for promoting healthy eating at work. The FCW intervention is a sustainable cost-effective model and wide-scale implementation is underway at local, national and international workplaces. Specific elements will be digitally automated to increase the reach of the FCW intervention. The purpose of our next related study is to develop, implement and assess the effectiveness of digitalising the FCW intervention. The results of this study will determine the effectiveness and user engagement of a theorybased, multidimensional, web platform and smartphone nutrition intervention to support healthier food choices and better health status for employees in their workplaces.
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