CHAT SA: Modification of a Public Engagement Tool for Priority Setting for a South African Rural Context

Abstract

Background: Globally, as countries move towards universal health coverage (UHC), public participation in decisionmaking is particularly valuable to inform difficult decisions about priority setting and resource allocation. In South Africa (SA), which is moving towards UHC, public participation in decision-making is entrenched in policy documents yet practical applications are lacking. Engagement methods that are deliberative could be useful in ensuring the public participates in the priority setting process that is evidence-based, ethical, legitimate, sustainable and inclusive. Methods modified for the country context may be more relevant and effective. To prepare for such a deliberative process in SA, we aimed to modify a specific deliberative engagement tool – the CHAT (Choosing All Together) tool for use in a rural setting. Methods: Desktop review of published literature and policy documents, as well as 3 focus groups and modified Delphi method were conducted to identify health topics/issues and related interventions appropriate for a rural setting in SA. Our approach involved a high degree of community and policy-maker/expert participation. Qualitative data were analysed thematically. Cost information was drawn from various national sources and an existing actuarial model used in previous CHAT exercises was employed to create the board. Results: Based on the outcomes, 7 health topics/issues and related interventions specific for a rural context were identified and costed for inclusion. These include maternal, new-born and reproductive health; child health; woman and child abuse; HIV/AIDS and tuberculosis (TB); lifestyle diseases; access; and malaria. There were variations in priorities between the 3 stakeholder groups, with community-based groups emphasizing issues of access. Violence against women and children and malaria were considered important in the rural context. Conclusion: The CHAT SA board reflects health topics/issues specific for a rural setting in SA and demonstrates some of the context-specific coverage decisions that will need to be made. Methodologies that include participatory principles are useful for the modification of engagement tools like CHAT and can be applied in different country contexts in order to ensure these tools are relevant and acceptable. This could in turn impact the success of the implementation, ultimately ensuring more effective priority setting approaches.

Moving towards social inclusion: Engaging rural voices in priority setting for health

“…We used a modified priority setting tool called Choosing All Together (CHAT) SA that enables individuals and groups to make trade‐offs using a limited budget to demonstrate the type of health services packages that may be acceptable to a rural population 27,28 . The tool was originally developed by the US National Institutes for Health and Michigan University as a priority‐setting simulation exercise 29 .…”

“…The tool was modified for use in Bushbuckridge and described elsewhere. 27 In brief, this modification process included an iterative participatory approach that relied on policy analysis and engagement (3), and palliative care (4). 30 The access slice included five unique represented the funds they had available to allocate and that were able to cover 52% of the options on the board.…”

Double-duty solutions for optimising maternal and child nutrition in urban South Africa: a qualitative study

“…Participants included men and women aged ≥18 years. Women's FGD were held in three age groups to cover the different stages of the reproductive life course and to potentially avoid older women inhibiting younger women's (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) and >40 years) expressions.…”

“…Engaging the public in this agenda is, therefore, imperative. Recent innovative approaches in the field include the modification and implementation of a public engagement tool, CHAT (Choosing All Together), in a rural setting in South Africa (Tugendhaft et al 2020 (40) ). Similar approaches are needed to improve current practices in priority setting for nutrition.…”

Engaging the public in priority setting for nutrition in Sub-Saharan Africa

“…As part of INPreP, a cross-country study on optimizing nutrition during preconception, pregnancy and infancy in Sub-Saharan Africa, researchers used a participatory approach (1) to modify CHAT for the first time for nutrition interventions in Ghana, Burkina Faso and South Africa. The aim was to identify a package of nutrition interventions with local communities.…”