How do decision-makers use evidence in community health policy and financing decisions? A qualitative study and conceptual framework in four African countries

Datos Bibliográficos

ID11490152
AutoresMeghan Bruce Kumar (0000-0002-4713-8328, Liverpool School of Tropical Medicine), Miriam Taegtmeyer (0000-0002-5377-2536, Liverpool School of Tropical Medicine, autor de correspondencia), Jason Madan (0000-0003-4316-1480, University of Warwick), Sozinho Ndima (0000-0003-4650-379X, Community Health Department, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique), Kingsley Chikaphupha (0000-0002-3534-3172, Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi), Aschenaki Zerihun Kea (0000-0002-0806-3503, Hawassa University), Aschenaki Kea (Hawassa University), Edwine Barasa (0000-0001-5793-7177, Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya)
Año2020
Volumen35
Número7
Páginas799-809
Fecha de publicación2020-08-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaHealth Policy and Planning (JOURNAL)
Identificadores de la revistaISSN: 0268-1080 • E-ISSN: 1460-2237
EditorialOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czaa027
PMID32516361
OpenAlexW3033915111
IdiomaEN
Citas recibidas7
Referencias citadas54

Various investments could help countries deliver on the universal health coverage (UHC) goals set by the global community; community health is a pillar of many national strategies towards UHC. Yet despite resource mobilization towards this end, little is known about the potential costs and value of these investments, as well as how evidence on the same would be used in related decisions. This qualitative study was conducted to understand the use of evidence in policy and financing decisions for large-scale community health programmes in low- and middle-income countries. Through key informant interviews with 43 respondents in countries with community health embedded in national UHC strategies (Ethiopia, Kenya, Malawi, Mozambique) and at global institutions, we investigated evidence use in community health financing and policy decision-making, as well as evidentiary needs related to community health data for decision-making. We found that evidence use is limited at all levels, in part due to a perceived lack of high-quality, relevant evidence. This perception stems from two main areas: first, desire for local evidence that reflects the context, and second, much existing economic evidence does not deal with what decision-makers value when it comes to community health systems—i.e. coverage and (to a lesser extent) quality. Beyond the evidence gap, there is limited capacity to assess and use the evidence. Elected officials also face political challenges to disinvestment as well as structural obstacles to evidence use, including the outsized influence of donor priorities. Evaluation data must to speak to decision-maker interests and constraints more directly, alongside financiers of community health providing explicit guidance and support on the role of evidence use in decision-making, empowering national decision-makers. Improved data quality, increased relevance of evidence and capacity for evidence use can drive improved efficiency of financing and evidence-based policymaking

Business · Context (archaeology) · Disinvestment · Economic growth · Economics · Health care · Incentive · Political science · Public economics · Public relations · Global Maternal and Child Health · Global Public Health Policies and Epidemiology · Healthcare Systems and Reforms · Health Policy