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, Sarah; Msosa, Alan; Chinguwo, Florence Kasende; Grugel, Jean

doi:10.1186/s12913-021-07016-9

Cited by 20 publications

(26 citation statements)

References 45 publications

(64 reference statements)

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“…It is imperative that each program is tailored to the context of the country/region where it will be implemented, with careful consideration of context during development, implementation, and evaluation (53). Lastly, the joint involvement and ownership of government authorities from all relevant sectors, local stakeholders, and the community is essential for the effective development and adoption of IBCM protocols (68,69).…”

Section: Discussionmentioning

confidence: 99%

Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management

et al. 2022

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As part of the ‘Zero by 30’ strategy to end human deaths from dog-mediated rabies by 2030, international organizations recommend a One Health framework that includes Integrated Bite Case Management (IBCM). However, little is understood about the implementation of IBCM in practice. This study aims to understand how IBCM is conceptualized, exploring how IBCM has been operationalized in different contexts, as well as barriers and facilitators to implementation. Semi-structured interviews were conducted with seventeen practitioners and researchers with international, national, and local expertise across Africa, Asia, and the Americas. Thematic analysis was undertaken using both inductive and deductive approaches. Four main themes were identified: 1) stakeholders’ and practitioners’ conceptualization of IBCM and its role in rabies elimination; 2) variation in how IBCM operates across different contexts; 3) barriers and facilitators of IBCM implementation in relation to risk assessment, PEP provisioning, animal investigation, One Health collaboration, and data reporting; and 4) the impact of the COVID-19 pandemic on IBCM programs. This study highlights the diversity within experts’ conceptualization of IBCM, and its operationalization. The range of perspectives revealed that there are different ways of organizing IBCM within health systems and it is not a one-size-fits-all approach. The issue of sustainability remains the greatest challenge to implementation. Contextual features of each location influenced the delivery and the potential impact of IBCM. Programs spanned from highly endemic settings with limited access to PEP charged to the patient, to low endemicity settings with a large patient load associated with free PEP policies and sensitization. In practice, IBCM was tailored to meet the demands of the local context and level of rabies control. Thus, experts’ experiences did not necessarily translate across contexts, affecting perceptions about the function, motivation for, and implementation of IBCM. To design and implement future and current programs, guidance should be provided for health workers receiving patients on assessing the history and signs of rabies in the biting animal. The study findings provide insights in relation to implementation of IBCM and how it can support programs aiming to reach the Zero by 30 goal.

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Section: Discussionmentioning

confidence: 99%

Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management

et al. 2022

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“…• input on situational analysis of hard-to-reach areas where they deliver services Assessing Malawi's recent development of a National Oral Health Policy -learning for the future played: policy experts, health practitioners, dental practitioners, academics, international development partners, and Civil Society Organisations. 12,13,15,19 What is unusual about the Malawi actors is that other categories emerged which are not included in the above list. This is exemplified by the category of consultancies, where several organizations were consulted, such as the Ministry of Forestry and Natural Resources and Strathclyde University on water and fluoride content, the Ministry of Education on child oral health and the NGO Partners in Health regarding the incorporation of oral health into the broader Non-Communicable Disease agenda in Malawi.…”

Section: Non-governmental Organizationsmentioning

confidence: 99%

Assessing Malawi’s recent development of a National Oral Health Policy – learning for the future

Matanhire-Zihanzu

Chambers

Bagg

et al. 2022

Journal of Global Health Reports

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Background Policymakers in many low- and middle-income countries do not prioritize oral health and are inadequately informed about the burden of oral and maxillofacial problems, their connection with systemic health and the possible threat to human life. In Africa, the absence of oral health policies is a key problem contributing to increased oral disease burden, health workforce shortage, and inadequate oral health service provision. Context-relevant policies and research to determine needs and monitor progress are key components in eradicating oral health inequalities. This paper focuses on the work of Malawi to follow the direction of travel outlined at the 2021 World Health Assembly by developing its first National Oral Health Strategy and Implementation Plan. Methods A case study approach examined the processes followed by Malawi to develop its National Oral Health Policy, launched in April 2022. The aim was to understand how oral health policy is being developed within the context of an African country. Specifically, the objectives were to identify how oral health policy was being developed in Malawi and the contributors to the development of that policy. Qualitative data were collected from semi-structured interviews (n=8) of purposively selected key informants from the Malawi National Oral Health Policy Taskforce team involved in the policy creation. Data were analyzed in the thematic areas within the Health Policy Triangle of actors, context, processes, and content. Results The policy development process was guided by Malawi’s Ministry of Health and involved a diverse group of actors, both local and international. The funding of the policy development process by the Scottish Government and Borrow Foundation provided critical support. Five groups of stakeholders have conducted the relevant background investigations and written the Oral Health Policy: international development partners, academics, policy experts, dental practitioners, and civil society organizations. The partnership skill-sharing and well-managed dynamics of the group, together with the reliable funding base, all contributed to a successful outcome. Conclusions A multisectoral approach was used. Malawi is uniquely placed in its oral health policy development, having a solid stakeholder base (local and international) and resources to support the policy development and, partly, its implementation.

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“…The leadership of grassroots civil society groups focused on gender issues in program design phases can improve the contextualization of issues that may be missed in standard gender assessments, and ensure that projects are relevant, responsive to the needs of participants, and sustainable 56 . Donors are called on to create opportunities for consultation and leadership of these groups, enabling them to exert influence on health programming 62 .…”

Section: Create Leadership and Funding Opportunities For Groups Most ...mentioning

confidence: 99%

“…Where they do not exist, donors can support civil society engagement mechanisms as a foundational step. Such mechanisms can reveal issues of unintended harm or opportunities for program modifications that improve effectiveness 62 . For example, the Global Fund to Fight HIV, TB, and Malaria established dialogues to optimize input and transparency at country level.…”

Section: Create Leadership and Funding Opportunities For Groups Most ...mentioning

confidence: 99%

Exploring system drivers of gender inequity in development assistance for health and opportunities for action

Bartel

Coile²,

Zou

et al. 2022

Gates Open Res

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Background: Deep-rooted and widespread gender-based bias and discrimination threaten achievement of the Sustainable Development Goals. Despite evidence that addressing gender inequities contributes to better health and development outcomes, the resources for, and effectiveness of, such efforts in development assistance for health (DAH) have been insufficient. This paper explores systemic challenges in DAH that perpetuate or contribute to gender inequities, with a particular focus on the role of external donors and funders. Methods: We applied a co-creation system design process to map and analyze interactions between donors and recipient countries, and articulate drivers of gender inequities within the landscape of DAH. We conducted qualitative primary data collection and analysis in 2021 via virtual facilitated discussions and visual mapping exercises among a diverse set of 41 stakeholders, including representatives from donor institutions, country governments, academia, and civil society. Results: Six systemic challenges emerged as perpetuating or contributing to gender inequities in DAH: 1) insufficient input and leadership from groups affected by gender bias and discrimination; 2) decision-maker blind spots inhibit capacity to address gender inequities; 3) imbalanced power dynamics contribute to insufficient resources and attention to gender priorities; 4) donor funding structures limit efforts to effectively address gender inequities; 5) fragmented programming impedes coordinated attention to the root causes of gender inequities; and 6) data bias contributes to insufficient understanding of and attention to gender inequities. Conclusions: Many of the drivers impeding progress on gender equity in DAH are embedded in power dynamics that distance and disempower people affected by gender inequities. Overcoming these dynamics will require more than technical solutions. Groups affected by gender inequities must be centered in leadership and decision-making at micro and macro levels, with practices and structures that enable co-creation and mutual accountability in the design, implementation, and evaluation of health programs.

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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

Cited by 20 publications

References 45 publications

Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management

Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management

Assessing Malawi’s recent development of a National Oral Health Policy – learning for the future

Exploring system drivers of gender inequity in development assistance for health and opportunities for action

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