Browsing by Subject "Policy Research"

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    Open Access
    A new methodology for assessing health policy and systems research and analysis capacity in African universities
    (2014-10-08) Lê, Gillian; Mirzoev, Tolib; Orgill, Marsha; Erasmus, Ermin; Lehmann, Uta; Okeyo, Stephen; Goudge, Jane; Maluka, Stephen; Uzochukwu, Benjamin; Aikins, Moses; de Savigny, Don; Tomson, Goran; Gilson, Lucy
    Abstract Background The importance of health policy and systems research and analysis (HPSR + A) has been increasingly recognised, but it is still unclear how most effectively to strengthen the capacity of the different organisations involved in this field. Universities are particularly crucial but the expansive literature on capacity development has little to offer the unique needs of HPSR + A activity within universities, and often overlooks the pivotal contribution of capacity assessments to capacity strengthening. Methods The Consortium for Health Policy and Systems Analysis in Africa 2011–2015 designed and implemented a new framework for capacity assessment for HPSR + A within universities. The methodology is reported in detail. Results Our reflections on developing and conducting the assessment generated four lessons for colleagues in the field. Notably, there are currently no published capacity assessment methodologies for HPSR + A that focus solely on universities – we report a first for the field to initiate the dialogue and exchange of experiences with others. Second, in HPSR + A, the unit of assessment can be a challenge, because HPSR + A groups within universities tend to overlap between academic departments and are embedded in different networks. Third, capacity assessment experience can itself be capacity strengthening, even when taking into account that doing such assessments require capacity. Conclusions From our experience, we propose that future systematic assessments of HPSR + A capacity need to focus on both capacity assets and needs and assess capacity at individual, organisational, and systems levels, whilst taking into account the networked nature of HPSR + A activity. A genuine partnership process between evaluators and those participating in an assessment can improve the quality of assessment and uptake of results in capacity strengthening.
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    Health system's barriers hindering implementation of public-private partnership policy in the health sector at district level: A case study of partnership for improved reproductive and child health services provision in Bagamoyo district, Tanzania
    (2015) Kamugumya, Denice Cyprian; Olivier, Jill
    The role of the private sector in improving health systems performance in lower to middle income countries is increasingly gaining more recognition. Public-private partnership (PPP) has been suggested as a tool, to assist governments fulfil their responsibilities in the efficient delivery of health services. In Tanzania, although the idea of PPP has existed for many years in the health sector, there has been limited coordination, especially at a district level - which has contributed to limited health gains or systems strengthening obviously seen as a result of PPP. In 2009 a formal PPP policy was introduced in Tanzania, which directs the appropriate allocation of resources, and describes risk and rewards that can be achieved by building on the expertise of each partner. The Health Sector Strategic Plan III (2009-2015) further emphasises the need for service level agreements (SLAs), which are seen as an important indicator of improved PPP. This case study that draws on the decision-space framework, was conducted in the Bagamoyo district of Tanzania, and employed in-depth interviews, document reviews, and observations methods. The study findings reveal several forms of informal partnerships between the local government and non-state actors. The lack of SLAs for facilities that receive subsides from the government is argued to contribute to inappropriate distribution of risk and reward leading to moral hazards. This is evidenced by non-state actors who pursue their own interests, diverting from public social goals. Furthermore, findings highlight weak capacity of governing bodies to exercise oversights and sanctions, which is acerbated by weak accountability linkages and power differences. Moreover, restricted flexibility in spending is seen to deter prompt actions to address evolving population needs, given limited local fiscal space. It is concluded that effective PPP policy implementation at a local level depends on the capacity of local government officials to make choices that would embrace relational elements dynamics in strategic plans. Disempowered Council Health Services Board in relation to engaging non-state actors is shown to impede PPP initiatives that are conceptualized at local and national levels. This study highlights a need to consider initiatives that would foster new social contracts with non-state actors at the local level and in return build a people-centred district health system. This study is intended to improve knowledge on health systems policy interventions, strengthen future policy implementation at the sub-national level, and strengthen the district health systems as a result of PPP in a country with similar contextual elements.
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    Policy maker and health care provider perspectives on reproductive decision-making amongst HIV-infected individuals in South Africa
    (BioMed Central Ltd, 2007) Harries, Jane; Cooper, Diane; Myer, Landon; Bracken, Hillary; Zweigenthal, Virginia; Orner, Phyllis
    BACKGROUND:Worldwide there is growing attention paid to the reproductive decisions faced by HIV-infected individuals. Studies in both developed and developing countries have suggested that many HIV-infected women continue to desire children despite knowledge of their HIV status. Despite the increasing attention to the health care needs of HIV-infected individuals in low resource settings, little attention has been given to reproductive choice and intentions. Health care providers play a crucial role in determining access to reproductive health services and their influence is likely to be heightened in delivering services to HIV-infected women. We examined the attitudes of health care policy makers and providers towards reproductive decision-making among HIV-infected individuals. METHODS: In-depth interviews were conducted with 14 health care providers at two public sector health care facilities located in Cape Town, South Africa. In addition, 12 in-depth interviews with public sector policy makers and managers, and managers within HIV/AIDS and reproductive health NGOs were conducted. Data were analyzed using a grounded theory approach. RESULTS: Providers and policy makers approached the issues related to being HIV-infected and child bearing differently. Biomedical considerations were paramount in providers' approaches to HIV infection and reproductive decision-making, whereas, policy makers approached the issues more broadly recognizing the structural constraints that inform the provision of reproductive health care services and the possibility of "choice" for HIV-infected individuals. CONCLUSION: The findings highlight the diversity of perspectives among policy makers and providers regarding the reproductive decisions taken by HIV-infected people. There is a clear need for more explicit policies recognizing the reproductive rights and choices of HIV-infected individuals.