Investigating public values in health care priority – Chileans´ preference for national health care

Núñez, Alicia; Chi, Chunhuei

doi:10.1186/s12889-021-10455-y

Cited by 7 publications

(6 citation statements)

References 34 publications

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“…In this way, every community was able to determine its specific barriers that set the basis to evaluate the relative inaccessibility to the system. The second survey developed considers communities' willingness to overcome the barriers detected, considering people's values and preferences for priority, not only thinking about themselves as individuals but also as members of the society and, therefore, considering the entire Chilean population and society 27 . All these results should contribute to the on‐going debate and research for improving healthcare systems.…”

Section: Discussionmentioning

confidence: 99%

Identifying local barriers to access to healthcare services in Chile using a communitarian approach

Núñez

Manzano

2021

Health Expectations

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Introduction Previous research has used proxy variables or a unique construct to quantify healthcare access. However, there is a need for a different model that can handle this multivariable problem. This study seeks to develop a way to measure access to the local healthcare system with higher local resolution. Methods A new survey was developed based on communitarian claims, following a behavioural model and an ontological framework. The survey was used to identify local barriers to healthcare services and the local preferences for priority settings. The results were analysed using multiattribute utility functions and individual weights were assigned by a panel of experts. National and regional indexes of access to healthcare were developed. Results The survey contained seven modules and 104 questions. It was conducted on 1885 participants at 42 rural and 231 urban locations in three regions of Chile. The total disutility of the identified barriers to healthcare access at the national level was low (0.1448; values ranged between 0 and 1, with 1 representing a higher barrier) and was higher in the northern region (0.1467). The barriers associated with the health‐policy component showed the highest disutility value, and specific barriers for each community were identified. Conclusions These results have the potential to improve health decision‐making in Chile and can be used to assess the impacts of new health policy reforms. Although this model was tested in Chile, it can be adapted for use in any other country. Patient or Public Contribution Participants contributed to this study by completing a survey, participating in general talks and receiving brochures with the results obtained from this study.

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Section: Discussionmentioning

confidence: 99%

Identifying local barriers to access to healthcare services in Chile using a communitarian approach

Núñez

Manzano

2021

Health Expectations

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“…Tailand [8,11,20] Iran [8,[21][22][23][24][25][26] Chile [27][28][29][30][31][32][33][34][35][36][37][38][39] France [8,[40][41][42][43][44][45] Tunisia [8,[46][47][48][49][50][51][52][53][54] Origin of demand for participation Despite the fact that the model designed for Tunisia is based on the successful model of Tailand, the "Societal Dialogue for Health System Reform" program is still far from realization of its goals for reasons including lack of political and managerial stability, lack of trust, and tension between citizens and health professionals [54].…”

Section: Teme Subthemementioning

confidence: 99%

Cross-Country Study of Institutionalizing Social Participation in Health Policymaking: A Realist Analysis

Bonab

Majdzadeh

Rajabi

2023

Health & Social Care in the Community

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Strong evidence suggests that interventions based on community participation have a positive effect on a range of health outcomes in different settings. Community participation contributes significantly to the promotion of health at the local level, especially among the more disadvantaged groups of the society. The main goal of social participation mechanisms is to fill the gap between the views of the policymakers and the experiences and needs of the communities. An important point is that institutionalization of social participation in the development of health policies and its continuity over time are essential requirements. The question here is how participation should be institutionalized in the systems that have started this process. We conducted a realistic evaluation of a multicase study of public participation in health system policymaking. Countries including France, Chile, Iran, Thailand, and Tunisia were selected. The study objective was to determine interventions and mechanisms used by these countries for community participation in health policymaking and institutionalizing it. The data were extracted via a literature review for each country using a realistic approach analysis also known as context, intervention, mechanism, and outcome (CIMO) configurations. Thailand and France, which have applied a set of interventions such as supportive legislations, evidence production structures for informed decision making and interactions, accountability and transparency, and providing a context for development of civil society organizations, have succeeded in institutionalizing community participation in health policymaking. Iran, Tunisia, and Chile have been successful in this regard, but they are still far from institutionalizing community participation. Success in the institutionalization of participatory health governance requires a political will and commitment at the highest level in order to minimize the conflicts between economic and political interests of different stakeholders and to implement a set of interventions to maximize social participation in health policymaking.

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“…Whether a community favours individualistic or communitarian values, there are methods developed to accommodate their philosophical preferences. As community participation gains more traction, there are more researchers investigating improvement of these methods, 29,33,34 and also policy makers basing their decisions on these methods. 35,36 This is a welcome development towards community ownership.…”

Section: Nities' Ability To "Elucidate[e] Cause-and-effect Relationsh...mentioning

confidence: 99%

“…48 In the last decade Chile has focussed on enhancing the active role of users in health management, involving them in consultative processes (such as in the development of the Health Objectives for the decade), and planning and evaluation processes (for example, participatory budgeting for health services). 49,50 Experiences of participatory work have been documented in case studies about citizen participation and co-management for health in Chile 51 and other peer-reviewed publications 34,52 :…”

Section: Brief Case: Chilementioning

confidence: 99%

“…In the last decade Chile has focussed on enhancing the active role of users in health management, involving them in consultative processes (such as in the development of the Health Objectives for the decade), and planning and evaluation processes (for example, participatory budgeting for health services) 49,50 . Experiences of participatory work have been documented in case studies about citizen participation and co‐management for health in Chile 51 and other peer‐reviewed publications 34,52 : The Adelaida in Biobío experience, which features empowered formal citizen councils, organised at local and provincial levels of the health system, capable of leveraging intersectoral and private sector resources for action on social determinants of health affecting people with disabilities. A primary health centre (CESFAM), Madre Teresa de Calcuta, was established in the Santiago metropolitan region, which addressed challenges in developing a citizen participation plan with community representatives in a neighbourhood with little social cohesion, weak public infrastructure and disperse community resources. In Santiago Sano, an adolescent committee of student leaders organised in 10 municipal high schools, which have decision‐making control in development and publication of a sexuality manual. Psircutopia, an initiative in a deprived neighbourhood of the northern city of Ovalle, engaged socially vulnerable youth in performance art, aiming to expand their self‐esteem and capacities to express needs and connect with available services. Another Santiago CESFAM, Juan Pablo II, developed a receptive environment for exercise of health rights by immigrants, through culturally appropriate information and support for inclusion in local health councils, public accounts, and citizen dialogs. Grupo Llareta, an autonomous community‐led work, generating resources and supportive networks over 30 years in a historically mobilised neighbourhood of Santiago, independent of government organisations. A population survey administrated in three regions of Chile that identified healthcare access barriers and explored an alternative method to solicit community preferences for priority setting. …”

Section: Brief Case: Chilementioning

confidence: 99%

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From sharing voices to making decisions: The case for centring community ownership in evaluation of health programme planning and management

Chi

Núñez

Tuepker

2022

Health Planning & Management

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Background Community participation in health programme planning has gained traction in public health in recent decades. When an idea enters the mainstream, it becomes vulnerable to overuse and dilution, and public health professionals claiming “community participation” may intentionally or unintentionally prevent more meaningful participatory action. The principle of community‐centred planning is seldom integrated into programme evaluation. We have previously argued that, to prevent ambiguity and abuse, a stronger and more explicit idea of community ownership is useful. Un‐like “participation”, “ownership” leaves little room for dilution. Method This perspective piece explores a framework to support evaluating community ownership in planning, by emphasising decision‐making power in health planning and management as a necessary element for evaluation alongside other outcomes. After defining the concept of community ownership, we identify and discuss challenges and research gaps related to implementing community ownership in health programme planning, management, and evaluation. Such issues include considering which communities have claims to programme ownership, alternative approaches to representation and participation that support ownership, gathering community values and preferences, and incorporating them into ongoing programme planning, management and evaluation. We consider methodological issues likely to arise when transitioning from gathering community voices ‐ which is valuable but incomplete work ‐ towards community decision making power in planning and evaluation. Results We use cases from recent policy and research in Chile as examples to consider through the lens of this framework. Finally, we discuss some current constraints in implementing community ownership in healthcare planning and evaluation. Conclusion We encourage exploring how to practice evaluation in ways that will further our ability to be helpful professional supporters of community self‐determination in finding their paths to health.

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Investigating public values in health care priority – Chileans´ preference for national health care

Cited by 7 publications

References 34 publications

Identifying local barriers to access to healthcare services in Chile using a communitarian approach

Identifying local barriers to access to healthcare services in Chile using a communitarian approach

Cross-Country Study of Institutionalizing Social Participation in Health Policymaking: A Realist Analysis

From sharing voices to making decisions: The case for centring community ownership in evaluation of health programme planning and management

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