How actors, processes, context and evidence influenced the development of Malawi's Health Sector Strategic Plan <scp>II</scp>

Walsh, Caitlin M.; Mwase, Takondwa; Allegri, Manuela De

doi:10.1002/hpm.3055

Cited by 8 publications

(15 citation statements)

References 86 publications

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“…Those consulted included CSOs, NGOs and local government, namely the DHOs. The stakeholder engagement strategy sounded thorough and an analysis of the policy development process assessed it as 'complex and inclusive', with DHOs involved in most and CSOs in all stages of the process (12). However, the individuals or names of the organisations engaged, the method and extent to which each was involved, and the impact of their input is not reported.…”

Section: Discussionmentioning

confidence: 99%

“…Many of the calls for inclusive and meaningful stakeholder engagement have come from donors such as the WHO and the United Nations who were partners in the development of the HSSP II (7,36). Walsh et al (12) found that to ensure the continued involvement of donors, the MoH may have given up ownership of the HSSP II development process to them. However, despite the signi cant in uence and likely leadership of donors in the NHP II and HSSP II process, the local level stakeholders still perceived their engagement as tokenistic, with rushed consultation which prevented deeper engagement, and limited ways of contributing such as alternatives to attending a public consultation event (9,23,25,36).…”

Section: Meaningful Engagementmentioning

confidence: 99%

“…A stakeholder analysis of the actors that in uenced the development of the HSSP II, identi ed 23 different stakeholders (12). These included District Health O cials, (unspeci ed) CSOs, and donors (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…Interviews were conducted with 13 members of the MoH and donors to explore how the policy was formulated, by whom, through which processes and in what context. Walsh et al (12) make the assumption that the involvement of donors in health policy development in Malawi ensures a degree of CSO in uence -though it is should be noted that consultation does not imply in uence (4,13). Nevertheless, it was reported that CSOs were involved in all areas of the policy formulation (over-arching agenda, essential health package, strategy, health nancing, monitoring and evaluation) and also included in the Health Sector Working Group (which has the nal decision on policy content) and technical working groups (12).…”

Section: Introductionmentioning

confidence: 99%

“…Walsh et al (12) make the assumption that the involvement of donors in health policy development in Malawi ensures a degree of CSO in uence -though it is should be noted that consultation does not imply in uence (4,13). Nevertheless, it was reported that CSOs were involved in all areas of the policy formulation (over-arching agenda, essential health package, strategy, health nancing, monitoring and evaluation) and also included in the Health Sector Working Group (which has the nal decision on policy content) and technical working groups (12). However, as Walsh et al did not conduct interviews with any CSOs, we do not know their experience of the consultation exercise and the extent to which they felt able to in uence the development of the strategic framework.…”

Section: Introductionmentioning

confidence: 99%

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Stakeholder engagement in the health policy process in a low income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi

Masefield

Msosa

Chinguwo

et al. 2021

Preprint

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Background: Inclusive engagement in healthcare policies and decision-making, including with patients, non-government organisations and local government, is essential to address the needs of patients and communities, reducing health inequities and increasing the accountability of the government. In low income countries such as Malawi, with significant health challenges, stakeholder inclusion is particularly important to improve performance and service delivery. The 2017 National Health Plan II (NHP II) and accompanying Health Sector Strategic Plan II (HSSP II) aimed to improve the functioning of the healthcare system. The Ministry of Health for Malawi intended to involve all key health sector stakeholders in their development. This study explores the extent of stakeholder engagement in the health policy process through the perceptions of local level stakeholders of their engagement in the NHP II and HSSP II.Methods: A qualitative study design was used. Interviews were conducted with 19 representatives of organisations operating at the local level, such as civil society organisations and local government. Open questions were asked about experiences and perceptions of the development of the NHP II and HSSP II. Inductive content analysis was performed.Results: Stakeholders perceived barriers to inclusive and meaningful engagement in the health policy process. Three categories were identified: power (tokenistic involvement; stakeholder hierarchy; mutual distrust); representation (preferred stakeholders; open versus invited engagement); stakeholder-driven engagement. Conclusions: Local level stakeholders identified serious challenges to the meaningful and equitable engagement of stakeholder groups in the health policy process. Issues of trust, accountability and hierarchy in donor-citizen-government relations must be addressed to support stakeholder engagement. Engagement must go beyond tokenism to embed a range of stakeholders in the process with feedback mechanisms to ensure impact from their contributions. Local level stakeholders can be empowered to advocate for and participate in both invited and open stakeholder engagement exercises, and policy literacy increased but greater top-down efforts to engage stakeholders via diverse and inclusive methods are also required. These issues are not unique to Malawi or to health policy-making.

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Section: Discussionmentioning

confidence: 99%

Section: Meaningful Engagementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Stakeholder engagement in the health policy process in a low income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi

Masefield

Msosa

Chinguwo

et al. 2021

Preprint

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Strategic planning in public organizations: reviewing 35 years of research

Vandersmissen,

George

2023

International Public Management Journal

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The human right to health, inclusion and essential health care packages in low income countries: “health for all” in Malawi

Grugel

Masefield²,

Msosa³

2022

IJHRH

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Purpose Health in low-income countries has become associated with the provision of minimum guaranteed public health services though Essential Health Packages (EHPs). How far do EHPs deliver the human right to health for all? This study addresses this question through qualitative research into access to health care for vulnerable communities, using Malawi as a case study. This study shows that there are significant accountability gaps and perceptions of weak service provision in Malawi’s EHP in relation to some particularly marginalised (and stigmatised) groups that limit the right to health and the promise of “health for all”. Design/methodology/approach This study extends the body of qualitative work on EHPs in general and on Malawi in particular by exploring the perceptions of key stakeholders in relation to inclusivity and the delivery of health policies to particularly vulnerable groups. To do so, this study adopted an approach based on interpretive epistemologies (Scott, 2014). This study conducted largely unstructured interviews with a range of health stakeholders, speaking to stakeholders individually, rather than through focus groups due to the potentially sensitive nature of the topic. Findings The findings of this study are as follows: limited inclusion of civil society actors and local communities; local communities and local policymakers feel frustration with the gap between the promises of consultation in the EHP and the reality, and the difficulties of not having effective channels of communication; and exclusionary health practices for particularly vulnerable groups. Research limitations/implications There are limitations based on the qualitative methodology, and in terms of the particularly vulnerable groups – the authors studied two such groups (people with disabilities and those who identify as LBTQ) but a wider survey of vulnerable groups is needed to extend and confirm the findings. Practical implications Greater attention to the health rights of vulnerable groups would improve access and services, even in the context of resource restrictions. This study suggests that a deeper engagement with human rights-based approaches would pay dividends in terms of increasing access to health in Malawi, even within the constraints of the EHP process. Furthermore, without this, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised. Social implications Without addressing these issues, there is the risk that discrimination and exclusion will become more embedded in health policies, rather than progressively minimised. Originality/value This paper makes an important contribution to the growing literatures on EHP in sub-Saharan Africa and Malawi in particular and to the importance of listening to stakeholder perceptions. It provides original data on stakeholder perspectives of the challenges associated with universalising health care in resource-constrained countries. To the best of the authors’ knowledge, it is one of the first papers to focus on the rights of disabled and LBTQ people in relation to EHPs.

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How actors, processes, context and evidence influenced the development of Malawi's Health Sector Strategic Plan II

Abstract: Health sector strategic plans are health policies outlining health service delivery in low-and middle-income coun

Cited by 8 publications

References 86 publications

Stakeholder engagement in the health policy process in a low income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi

Stakeholder engagement in the health policy process in a low income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi

Strategic planning in public organizations: reviewing 35 years of research

The human right to health, inclusion and essential health care packages in low income countries: “health for all” in Malawi

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