Unlocking policy synergies, challenges and contradictions influencing implementation of the Comprehensive Sexuality Education Framework in Zambia: a policy analysis

Chavula, Malizgani Paul; Zulu, Joseph Mumba; Goicolea, Isabel; Hurtig, Anna-Karin

doi:10.1186/s12961-023-01037-y

Cited by 6 publications

(1 citation statement)

References 39 publications

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“…SDG 17: creating partnerships for sustainable development: The intersection of CSE with SDG-17 emphasizes the critical role of partnerships and cooperation in achieving sustainable development. CSE is pivotal in advancing SDG 17 by fostering collaborative efforts among diverse stakeholders to promote inclusive, evidence-based sexual education programs [ 67 , 68 ]. Partnerships and cooperation are essential for the effective implementation of CSE initiatives.…”

Section: Reviewmentioning

confidence: 99%

Empowering Futures: Intersecting Comprehensive Sexual Education for Children and Adolescents With Sustainable Development Goals

Mohammed Tohit,

Haque

2024

Cureus

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Section: Reviewmentioning

confidence: 99%

Empowering Futures: Intersecting Comprehensive Sexual Education for Children and Adolescents With Sustainable Development Goals

Mohammed Tohit,

Haque

2024

Cureus

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Halting and re-issuing of the Zambia community health strategy (2017–2021): a retrospective analysis of the policy process and implications for community health systems

Chavula,

Silumbwe,

Munakampe

et al. 2024

BMC Health Serv Res

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Background Over the years, low-and middle-income countries have adopted several policy initiatives to strengthen community health systems as means to attain Universal Health Coverage (UHC). In this regard, Zambia passed a Community Health Strategy in 2017 that was later halted in 2019. This paper explores the processes that led to the halting and re-issuing of this strategy with the view of drawing lessons to inform the development of such strategies in Zambia and other similar settings. Methods We employed a qualitative case study comprising 20 semi-structured interviews with key stakeholders who had participated in either the development, halting, or re-issuing of the two strategies, respectively. These stakeholders represented the Ministry of Health, cooperating partners and other non-government organizations. Inductive thematic analysis approach was used for analysis. Results The major reasons for halting and re-issuing the community health strategy included the need to realign it with the national development framework such as the 7th National Development Plan, lack of policy ownership, political influence, and the need to streamline the coordination of community health interventions. The policy process inadequately addressed the key tenets of community health systems such as complexity, adaptation, resilience and engagement of community actors resulting in shortcomings in the policy content. Furthermore, the short implementation period, lack of dedicated staff, and inadequate engagement of stakeholders from other sectors threatened the sustainability of the re-issued strategy. Conclusion This study underscores the complexity of community health systems and highlights the challenges these complexities pose to health policymaking efforts. Countries that embark on health policymaking for community health systems must reflect on issues such as persistent fragmentation, which threaten the policy development process. It is crucial to ensure that these complexities are considered within similar policy engagement processes.

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Collaboration for implementation of decentralisation policy of multi drug-resistant tuberculosis services in Zambia

Chavula,

Matenga,

Maritim

et al. 2024

Health Res Policy Sys

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Background Multi-drug-resistant tuberculosis (MDR-TB) infections are a public health concern. Since 2017, the Ministry of Health (MoH) in Zambia, in collaboration with its partners, has been implementing decentralised MDR-TB services to address the limited community access to treatment. This study sought to explore the role of collaboration in the implementation of decentralised multi drug-resistant tuberculosis services in Zambia. Methods A qualitative case study design was conducted in selected provinces in Zambia using in-depth and key informant interviews as data collection methods. We conducted a total of 112 interviews involving 18 healthcare workers, 17 community health workers, 32 patients and 21 caregivers in healthcare facilities located in 10 selected districts. Additionally, 24 key informant interviews were conducted with healthcare workers managers at facility, district, provincial, and national-levels. Thematic analysis was employed guided by the Integrative Framework for Collaborative Governance. Findings The principled engagement was shaped by the global health agenda/summit meeting influence on the decentralisation of TB, engagement of stakeholders to initiate decentralisation, a supportive policy environment for the decentralisation process and guidelines and quarterly clinical expert committee meetings. The factors that influenced the shared motivation for the introduction of MDR-TB decentralisation included actors having a common understanding, limited access to health facilities and emergency transport services, a shared understanding of challenges in providing optimal patient monitoring and review and their appreciation of the value of evidence-based decision-making in the implementation of MDR- TB decentralisation. The capacity for joint action strategies included MoH initiating strategic partnerships in enhancing MDR-TB decentralisation, the role of leadership in organising training of healthcare workers and of multidisciplinary teams, inadequate coordination, supervision and monitoring of laboratory services and joint action in health infrastructural rehabilitation. Conclusions Principled engagement facilitated the involvement of various stakeholders, the dissemination of relevant policies and guidelines and regular quarterly meetings of clinical expert committees to ensure ongoing support and guidance. A shared motivation among actors was underpinned by a common understanding of the barriers faced while implementing decentralisation efforts. The capacity for joint action was demonstrated through several key strategies, however, challenges such as inadequate coordination, supervision and monitoring of laboratory services, as well as the need for collaborative efforts in health infrastructural rehabilitation were observed. Overall, collaboration has facilitated the creation of a more responsive and comprehensive TB care system, addressing the critical needs of patients and improving health outcomes.

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Unlocking policy synergies, challenges and contradictions influencing implementation of the Comprehensive Sexuality Education Framework in Zambia: a policy analysis

Cited by 6 publications

References 39 publications

Empowering Futures: Intersecting Comprehensive Sexual Education for Children and Adolescents With Sustainable Development Goals

Empowering Futures: Intersecting Comprehensive Sexual Education for Children and Adolescents With Sustainable Development Goals

Halting and re-issuing of the Zambia community health strategy (2017–2021): a retrospective analysis of the policy process and implications for community health systems

Collaboration for implementation of decentralisation policy of multi drug-resistant tuberculosis services in Zambia

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