Challenges to fair decision-making processes in the context of health care services: a qualitative assessment from Tanzania

Shayo, Elizabeth H.; Norheim, Ole Frithjof; Mboera, Leonard E. G.; Byskov, Jens; Maluka, Stephen; Kamuzora, Peter; Blystad, Astrid

doi:10.1186/1475-9276-11-30

Cited by 34 publications

(44 citation statements)

References 23 publications

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“…Successful participation by women either hinged upon the support of the male members of their households [72, 73] or was observed in roles that were coherent with their culturally prescribed responsibilities such as input on maternal and child health [22, 24, 27]. In a study of decision making processes related to health services in Tanzania, Shayo, Norheim, et al [65] found that women’s voices were particularly valued during decision-making around maternal health, but were not given the same consideration when discussing other health priorities. However, in some instances, women were mobilized to actively participate as the intervention was seen as an opportunity to build one’s self-confidence and extend beyond their traditional role as housewives [19, 22, 39, 55].…”

Section: Resultsmentioning

confidence: 99%

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Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review

George

Scott

Mehra

et al. 2016

BMC Health Serv Res

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BackgroundCommunity capability is the combined influence of a community’s social systems and collective resources that can address community problems and broaden community opportunities. We frame it as consisting of three domains that together support community empowerment: what communities have; how communities act; and for whom communities act. We sought to further understand these domains through a secondary analysis of a previous systematic review on community participation in health systems interventions in low and middle income countries (LMICs).MethodsWe searched for journal articles published between 2000 and 2012 related to the concepts of “community”, “capability/participation”, “health systems research” and “LMIC.” We identified 64 with rich accounts of community participation involving service delivery and governance in health systems research for thematic analysis following the three domains framing community capability.ResultsWhen considering what communities have, articles reported external linkages as the most frequently gained resource, especially when partnerships resulted in more community power over the intervention. In contrast, financial assets were the least mentioned, despite their importance for sustainability. With how communities act, articles discussed challenges of ensuring inclusive participation and detailed strategies to improve inclusiveness. Very little was reported about strengthening community cohesiveness and collective efficacy despite their importance in community initiatives. When reviewing for whom communities act, the importance of strong local leadership was mentioned frequently, while conflict resolution strategies and skills were rarely discussed.Synergies were found across these elements of community capability, with tangible success in one area leading to positive changes in another. Access to information and opportunities to develop skills were crucial to community participation, critical thinking, problem solving and ownership. Although there are many quantitative scales measuring community capability, health systems research engaged with community participation has rarely made use of these tools or the concepts informing them. Overall, the amount of information related to elements of community capability reported by these articles was low and often of poor quality.ConclusionsStrengthening community capability is critical to ensuring that community participation leads to genuine empowerment. Our simpler framework to define community capability may help researchers better recognize, support and assess it.

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Section: Resultsmentioning

confidence: 99%

“…For instance, with regards to community health planning, regardless of education status, women felt that they were undermined by men during decision-making due to their sex [65]. Traditionally, the social and legal systems in Ugandan communities restrict women from individually providing services beyond their families.…”

Section: Resultsmentioning

confidence: 99%

Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review

George

Scott

Mehra

et al. 2016

BMC Health Serv Res

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“…For example, in Tanzania, similar to most other settings, effective participation of the public in priority setting decisions was influenced by gender, wealth, ethnicity and education. 42 Members of the public who were male, more educated, and wealthier or shared ethnicity with decisionmakers were more empowered in decision-making spaces.…”

Section: Argumentmentioning

confidence: 99%

Setting Healthcare Priorities at the Macro and Meso Levels: A Framework for Evaluation

Barasa

Molyneux

English

et al. 2015

Int J Health Policy Manag

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Background: Priority setting in healthcare is a key determinant of health system performance. However, there is no widely accepted priority setting evaluation framework. We reviewed literature with the aim of developing and proposing a framework for the evaluation of macro and meso level healthcare priority setting practices. Methods: We systematically searched Econlit, PubMed, CINAHL, and EBSCOhost databases and supplemented this with searches in Google Scholar, relevant websites and reference lists of relevant papers. A total of 31 papers on evaluation of priority setting were identified. These were supplemented by broader theoretical literature related to evaluation of priority setting. A conceptual review of selected papers was undertaken. Results: Based on a synthesis of the selected literature, we propose an evaluative framework that requires that priority setting practices at the macro and meso levels of the health system meet the following conditions: (1) Priority setting decisions should incorporate both efficiency and equity considerations as well as the following outcomes; (a) Stakeholder satisfaction, (b) Stakeholder understanding, (c) Shifted priorities (reallocation of resources), and (d) Implementation of decisions. (2) Priority setting processes should also meet the procedural conditions of (a) Stakeholder engagement, (b) Stakeholder empowerment, (c) Transparency, (d) Use of evidence, (e) Revisions, (f) Enforcement, and (g) Being grounded on community values. Conclusion: Available frameworks for the evaluation of priority setting are mostly grounded on procedural requirements, while few have included outcome requirements. There is, however, increasing recognition of the need to incorporate both consequential and procedural considerations in priority setting practices. In this review, we adapt an integrative approach to develop and propose a framework for the evaluation of priority setting practices at the macro and meso levels that draws from these complementary schools of thought. Background Despite recognition of the importance of priority setting in healthcare, priority setting exercises in most settings are ad hoc rather than systematic. 1,2 This has led to calls for strategies to improve priority setting practices in healthcare.

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“…Participation to decision making by diabetic patients is highly encouraged and widely practiced in industrialized countries like the USA and UK as compared to less developed countries (4,5). In sub-Saharan Africa, participation of patients in making decision regarding their treatment is reported to be minimal although there are limited studies focusing on this aspect of care in the region (4,6).…”

Section: Introductionmentioning

confidence: 99%

Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

Vedasto

Morris

Fredrick

2020

Preprint

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Background Patients’ participation in decision making regarding their treatment play an important role in treatment outcome through improvement in self-care and adherence to treatment. There is scarcity of information regarding shared decision making in sub-Saharan Africa. This study was conducted to assess participation of patients and health care providers in decision-making process in the diabetic clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania.Methods This study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working in the diabetic clinic at Muhimbili National Hospital. Data was collected using interview guide with open ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding with assistance by Nvivo 12 software. Results Several themes were identified in this study including some form of participation in decision making of patients, use of decision aids in the clinic and belief and values regarding patients’ engagement in decision making. Several factors were identified as barriers to shared decision making as noted from participants interview, these included lack of time, literacy level, beliefs and values. Decision aids were reported to be important for improving patient’s knowledge and subsequently their involvement in decisions that were made although it was also noted that these were not prepared by the health care providers in the clinic and they were not adequately provided.Conclusion Some form of participation in decision making was observed in the diabetic clinic at Muhimbili national Hospital, and barriers identified for shared decision-making included time, literacy, beliefs and values.

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Challenges to fair decision-making processes in the context of health care services: a qualitative assessment from Tanzania

Cited by 34 publications

References 23 publications

Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review

Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review

Setting Healthcare Priorities at the Macro and Meso Levels: A Framework for Evaluation

Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

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