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

2020 ◽  
Vol 35 (7) ◽  
pp. 799-809 ◽  
Author(s):  
Meghan Bruce Kumar ◽  
Miriam Taegtmeyer ◽  
Jason Madan ◽  
Sozinho Ndima ◽  
Kingsley Chikaphupha ◽  
...  

Abstract 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.

2021 ◽  
pp. 1-25
Author(s):  
Simon Turner ◽  
Danielle D´Lima ◽  
Jessica Sheringham ◽  
Nick Swart ◽  
Emma Hudson ◽  
...  

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e68-e68
Author(s):  
Malema Ahrari ◽  
Samina Ali ◽  
Michele Dyson ◽  
Lisa Hartling

Abstract Primary Subject area Emergency Medicine - Paediatric Background Healthcare visits, hospitalizations, and deaths due to opioid-related harms continue to rise for children, despite an overall decline in opioid prescriptions. Decision-makers (including patients and families, clinicians, and policy-makers) require high quality syntheses to inform decisions regarding opioid use. Previous research has found that how systematic review (SR) results are presented may influence uptake by decision-makers. Evidence summaries are appealing to decision-makers as they provide key messages in a succinct manner. Objectives 1) To conduct an SR examining the association between short-term therapeutic exposure to opioids in children and development of opioid use disorder, and 2) To gain perspectives from policy decision-makers on the usability and presentation of results through the form of an evidence summary. Design/Methods We conducted an SR following methods recommended by Cochrane. A medical librarian conducted a comprehensive search and two authors were involved in study selection, data extraction and quality assessment. Studies were eligible if they reported primary research in English or French, and study participants had therapeutic exposure to opioids before age 18 years. Results were described narratively. Decision makers were recruited through purposive and snowball sampling methods, and they participated in interviews to discuss an evidence summary based on the SR. Interviews were transcribed and data were analyzed using content analysis. Ethics approval was obtained for the qualitative study. Results Nineteen American studies involving 47,191,990 participants were included. One study demonstrated that short-term therapeutic exposure may be associated with opioid abuse. Four others showed an association without specifying duration of exposure. Fourteen studies provided information on prevalence or incidence of opioid misuse following therapeutic exposure, median 27.8% [interquartile range 21.4% – 30.7%]; notably, 12 of them did not specify duration of therapeutic exposure. Identified risk factors were contradictory and remain unclear. Decision makers had mixed preferences for the presentation of evidence, depending on their degree of involvement in research versus practice. A majority preferred having methods and key characteristics of studies included in the first page of the evidence summary. They noted that the summary should not be text-heavy and details should be appended. Conclusion A number of studies suggest there is an association between lifetime therapeutic opioid use (unknown duration) and future nonmedical opioid use; however, there is limited evidence to determine whether short-term exposure is specifically associated with these outcomes. Policy and decision-makers prefer a succinct evidence summary for this SR, with study-specific details provided as an appendix. PROSPERO Registration: 122681.


F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 1356
Author(s):  
Yossi Maaravi ◽  
Ben Heller

The novel coronavirus disease 2019 (COVID-19) has brought with it crucial policy- and decision-making situations, especially when making judgments between financial and health concerns. One particularly relevant decision-making phenomenon is the prominence effect, where decision-makers base their decisions on the most prominent attribute of the object at hand (e.g., health concerns) rather than weigh all the attributes together. This bias diminishes when the decision-making mode inhibits heuristic processes. In this study, we tested the prominence of health vs. financial concerns across two decision-making modes - choice (prone to heuristics) and matching (mitigates heuristics) - during the peak of the COVID-19 in the UK using Tversky et al.’s classic experimental paradigm. We added to the classic experimental design a priming condition. Participants were presented with two casualty-minimization programs, differing in lives saved and costs: program X would save 100 lives at the cost of 55-million-pound sterling, whereas program Y would save 30 lives at the cost of 12-million-pound sterling. Half of the participants were required to choose between the programs (choice condition). The other half were not given the cost of program X and were asked to determine what the cost should be to make it as equally attractive as the program Y. Participants in both groups were primed for either: a) financial concerns; b) health concerns; or c) control (no priming). Results showed that in the choice condition, unless primed for financial concerns, health concerns are more prominent. In the matching condition, on the other hand, the prominence of health concerns did not affect decision-makers, as they all “preferred” the cheaper option. These results add further support to the practical relevance of using the proper decision-making modes in times of consequential crises where multiple concerns, interests, and parties are involved.


2021 ◽  
Author(s):  
◽  
Edward Johnson

<p><b>The gold mining industry in Ghana is characterised by complexity in terms of its extended/sequential operations, its system-wide reach, its multiple stakeholders, and the variety of formal and informal organisations that constitute the industry. Perceptions of the industry differ considerably amongst stakeholders, depending on their stakes and interests, knowledge, understanding, involvement and agency within or without the sector. Studies of the industry to date have overlooked these diverse viewpoints and used limited-scope, single-frame analyses. However, they have highlighted wide-ranging industry issues that impact the diversity of stakeholders, which could benefit from a fuller and more comprehensive analysis.</b></p> <p>This study addresses this need by adopting a multi-framing systems-based approach. Data was examined and analysed through a variety of systems-based lenses and frames, including a stakeholder analysis (SA) frame, a causal loop modelling (CLM) frame, supply chain analysis (SCA) frame and the Theory of Constraints (TOC) Thinking Processes analytical frames lenses. First the Current Reality Tree (CRT) tool of the Theory of Constraints (TOC) was used to synthesise information from the literature examined, providing an initial provisional CRT model. Interview data was collected by sharing and seeking feedback to the CRT model at multiple levels of the industry, giving voice to stakeholders throughout the sector. Subsequent analysis used all the modelling frameworks mentioned above in a multi-framing analysis.</p> <p>In particular, the evaporating cloud (EC) tool from TOC was used to structure and develop potential solutions to conflict highlighted by the literature review, the SA, SCA and CLM. Building on this, a final CRT was developed, and a goal tree (GT) used to design the desired future whilst employing the future reality tree (FRT) to test the plausibility of solutions from the EC to deliver the desired future. The prerequisite tree (PRT) was then used to identify obstacles and intermediate objectives that must be overcome for successful transition to the desired future.</p> <p>Insights from the research shows a desire by multi-national large scale-gold mining companies and government alike to minimise adverse impacts and maximise the sector’s outcomes for key stakeholders, including those at the community level. However, the research has documented many instances of actions taken to address issues and improve outcomes that have instead resulted in unresolved dilemmas and paradoxes, failing to achieve desired outcomes.</p> <p>A number of factors have been identified as being responsible for these situations. Key amongst them is a limited understanding to deliver desired outcome for stakeholders without compromises, a focus on short-term goals, no collective effort, and arms-length/win-lose relationships amongst the Ghanaian stakeholders of the industry.</p> <p>The study’s concluding findings and results allow decision makers to benefit significantly from the study through its recommendations and showcasing of tools that may allow them to make sound decisions and address endogenous and exogenous cause-effect relationships limiting desirable outcomes from actions taken.</p> <p>Theoretical and knowledge-based contributions are made by conceptualising and offering evidence for three key factors or dimensions that can explain a significant number of issues limiting desirable outcomes for stakeholders of the gold mining industry. These include difficulty to transition from theory (espoused aims) to practice, a relative focus on local optima (silo thinking), poor monitoring (lack of evaluation), and a control culture. Methodological contributions are made by demonstrating the application of a multi-framing approach in a more organic and iterative manner as opposed to its use in a designed sequence, working down through layers of various systemic levels of an industry (in this case, the gold mining industry in Ghana). By so doing, the study builds on and extends the practicality of the multi-framing approach and stimulates further research in the field.</p> <p>In terms of its contribution to practice, the study provides Government, political and mining sector policy decision makers, and other interested actors, with a platform for understanding the sector in order to support their decision making about the industry to ultimately improve outcomes for key stakeholders. In particular, the study allows mining sector policy decision makers and other stakeholders to recognise complexity, uncertainty and conflicts that are embedded in the mining system and in their everyday decision-making activities about the industry. It also allows these stakeholders to become more aware that such issues can be addressed and improved by identifying and focusing on one or few underlying causes.</p> <p>This thesis draws on systems-based frameworks drawn both from functional management, for example, the supply chain and value chain frameworks of operations management and the stakeholder framework of strategic management, and from the broad domain of systems thinking (ST) and systems-based methodologies; and then focuses on the intersection of these frameworks in relation to the gold mining sector in Ghana. Due to the wide range of techniques applied, none are over-explored, creating potential for further research. On the other hand, with regard to explanations, depending on background, practitioners, and researchers familiar with some techniques may consider those sections over-explained. The researcher has sought a balance for the purpose of this study. Whilst limiting the scope of this work has been necessary in the context of doctoral study, topics ripe for future research are set out in the conclusion.</p>


2008 ◽  
Vol 23 (S2) ◽  
pp. s70-s73 ◽  
Author(s):  
Dick Q.P. Fundter ◽  
Bas Jonkman ◽  
Steve Beerman ◽  
Corsmas L.P.M. Goemans ◽  
Rosanna Briggs ◽  
...  

AbstractDuring the 15th World Congress on Disaster and Emergency Medicine in Amsterdam, May 2007 (15WCDEM), a targeted agenda program (TAP) about the public health aspects of large-scale floods was organized. The main goal of the TAP was the establishment of an overview of issues that would help governmental decision-makers to develop policies to increase the resilience of the citizens during floods. During the meetings, it became clear that citizens have a natural resistance to evacuations. This results in death due to drowning and injuries. Recently, communication and education programs have been developed that may increase awareness that timely evacuation is important and can be life-saving. After a flood, health problems persist over prolonged periods, including increased death rates during the first year after a flood and a higher incidence of chronic illnesses that last for decades after the flood recedes. Population-based resilience (bottom-up) and governmental responsibility (top-down) must be combined to prepare regions for the health impact of evacuations and floods. More research data are needed to become better informed about the health impact and consequences of translocation of health infrastructures after evacuations. A better understanding of the consequences of floods will support governmental decision-making to mitigate the health impact. A top-10 priority action list was formulated.


Oryx ◽  
2017 ◽  
Vol 52 (2) ◽  
pp. 316-324 ◽  
Author(s):  
Ben Phalan ◽  
Genevieve Hayes ◽  
Sharon Brooks ◽  
David Marsh ◽  
Pippa Howard ◽  
...  

AbstractThe mitigation hierarchy is a decision-making framework designed to address impacts on biodiversity and ecosystem services through first seeking to avoid impacts wherever possible, then minimizing or restoring impacts, and finally by offsetting any unavoidable impacts. Avoiding impacts is seen by many as the most certain and effective way of managing harm to biodiversity, and its position as the first stage of the mitigation hierarchy indicates that it should be prioritized ahead of other stages. However, despite an abundance of legislative and voluntary requirements, there is often a failure to avoid impacts. We discuss reasons for this failure and outline some possible solutions. We highlight the key roles that can be played by conservation organizations in cultivating political will, holding decision makers accountable to the law, improving the processes of impact assessment and avoidance, building capacity, and providing technical knowledge. A renewed focus on impact avoidance as the foundation of the mitigation hierarchy could help to limit the impacts on biodiversity of large-scale developments in energy, infrastructure, agriculture and other sectors.


Author(s):  
James M. Goldgeier

Decision makers, acting singly or in groups, influence the field of international relations by shaping the interactions among nations. It is therefore important to understand how those decision makers are likely to behave. Some scholars have developed elegant formal theories of decision making to demonstrate the utility of rational choice approaches in the study of international relations, while others have chosen to explain the patterns of bias that exist when leaders face the difficult task of making decisions and formulating policy. Among them are Herbert Simon, who introduced “bounded rationality” to allow leaders to short-circuit the decision process, and Elizabeth Kier, who has shown how organizational cultures shaped the development of military doctrine during the interwar period. The literature on foreign policy decision making during the Cold War looked inside the black box to generate analyses of bureaucratic politics and individual mindsets. Because decision making involves consensus seeking among groups, leaders will often avoid making choices so that they will not antagonize key members of the bureaucracy. Scholars have also investigated the role of “policy entrepreneurs” in the decision-making process, bringing individual agents into organizational, diplomatic and political processes. Over time, the field of policy decision making has evolved to help us understand not only why leaders often calculate so poorly but even more importantly, why systematic patterns of behavior are more or less likely under certain conditions.


2009 ◽  
Vol 12 (2) ◽  
pp. 111-124
Author(s):  
Chulwon Lee

The future direction of China's approach to energy policy making is, of course, difficult to predict. This is due not only to the opaque and fragmented nature of Chinese energy policy decision-making, but also to the fact that energy policy is a new topic for China's leaders and the individuals they rely on for advice to master that impinges on the interests of actors throughout the Chinese bureaucracy. The wide range of participants in the energy policy debate indicates that more diversified views on it probably reach the top leadership. The impact of the multiplicity of opinions is two-fold. It can result in more informed decision-making, but it can also delay the process as decision makers must assess a larger number of competing and sometimes contradictory views.


F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1356
Author(s):  
Yossi Maaravi ◽  
Ben Heller

The novel coronavirus disease 2019 (COVID-19) has brought with it crucial policy- and decision-making situations, especially when making judgments between economic and health concerns. One particularly relevant decision-making phenomenon is the prominence effect, where decision-makers base their decisions on the most prominent attribute of the object at hand (e.g., health concerns) rather than weigh all the attributes together. This bias diminishes when the decision-making mode inhibits heuristic processes. In this study, we tested the prominence of health vs. economic concerns across two decision-making modes - choice (prone to heuristics) and matching (mitigates heuristics) - during the peak of the COVID-19 in the UK using Tversky et al.’s classic experimental paradigm. We added to the classic experimental design a priming condition. Participants were presented with two casualty-minimization programs, differing in lives saved and costs: program X would save 100 lives at the cost of 55-million-pound sterling, whereas program Y would save 30 lives at the cost of 12-million-pound sterling. Half of the participants were required to choose between the programs (choice condition). The other half were not given the cost of program X and were asked to determine what the cost should be to make it as equally attractive as the program Y. Participants in both groups were primed for either: a) economic concerns; b) health concerns; or c) control (no priming). Results showed that in the choice condition, unless primed for economic concerns, health concerns are more prominent. In the matching condition, on the other hand, the prominence of health concerns did not affect decision-makers, as they all “preferred” the cheaper option. These results add further support to the practical relevance of using the proper decision-making modes in times of consequential crises where multiple concerns, interests, and parties are involved.


PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242460
Author(s):  
Aparna John ◽  
Nicholas Nisbett ◽  
Inka Barnett ◽  
Rasmi Avula ◽  
Purnima Menon

Globally, there remain significant knowledge and evidence gaps around how to support Community Health Worker (CHW) programmes to achieve high coverage and quality of interventions. India’s Integrated Child Development Services scheme employs the largest CHW cadre in the world—Anganwadi Workers (AWWs). However, factors influencing the performance of these workers remain under researched. Lessons from it have potential to impact on other large scale global CHW programmes. A qualitative study of AWWs in the Indian state of Bihar was conducted to identify key drivers of performance in 2015. In-depth interviews were conducted with 30 AWWs; data was analysed using both inductive and deductive thematic analysis. The study adapted and contextualised existing frameworks on CHW performance, finding that factors affecting performance occur at the individual, community, programme and organisational levels, including factors not previously identified in the literature. Individual factors include initial financial motives and family support; programme factors include beneficiaries’ and AWWs’ service preferences and work environment; community factors include caste dynamics and community and seasonal migration; and organisational factors include corruption. The initial motives of the worker (the need to retain a job for family financial needs) and community expectations (for product-oriented services) ensure continued efforts even when her motivation is low. The main constraints to performance remain factors outside of her control, including limited availability of programme resources and challenging relationships shaped by caste dynamics, seasonal migration, and corruption. Programme efforts to improve performance (such as incentives, working conditions and supportive management) need to consider these complex, inter-related multiple determinants of performance. Our findings, including new factors, contribute to the global literature on factors affecting the performance of CHWs and have wide application.


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