Does the Narrative About the Use of Evidence in Priority Setting Vary Across Health Programs Within the Health Sector: A Case Study of 6 Programs in a Low-Income National Healthcare System

Background: There is a growing body of literature on evidence-informed priority setting. However, the literature on the use of evidence when setting healthcare priorities in low-income countries (LICs), tends to treat the healthcare system (HCS) as a single unit, despite the existence of multiple programs within the HCS, some of which are donor supported. Objectives: (i) To examine how Ugandan health policy-makers define and attribute value to the different types of evidence; (ii) Based on 6 health programs (HIV, maternal, newborn and child health [MNCH], vaccines, emergencies, health systems, and non- communicable diseases [NCDs]) to discuss the policy-makers’ reported access to and use of evidence in priority setting across the 6 health programs in Uganda; and (iii) To identify the challenges related to the access to and use of evidence. Methods: This was a qualitative study based on in-depth key informant interviews with 60 national level (working in 6 different health programs) and 27 sub-national (district) level policy-makers. Data were analysed used a modified thematic approach. Results: While all respondents recognized and endeavored to use evidence when setting healthcare priorities across the 6 programs and in the districts; more national level respondents tended to value quantitative evidence, while more district level respondents tended to value qualitative evidence from the community. Challenges to the use of evidence included access, quality, and competing values. Respondents from highly politicized and donor supported programs such as vaccines, HIV and maternal neonatal and child health were more likely to report that they had access to, and consistently used evidence in priority setting. Conclusion: This study highlighted differences in the perceptions, access to, and use of evidence in priority setting in the different programs within a single HCS. The strong infrastructure in place to support for the access to and use of evidence in the politicized and donor supported programs should be leveraged to support the availability and use of evidence in the relatively under-resourced programs. Further research could explore the impact of unequal availability of evidence on priority setting between health programs within the HCS.

From papers to practices: district level priority setting processes and criteria for family planning, maternal, newborn and child health interventions in Tanzania

BMC Women s Health ◽

10.1186/1472-6874-11-46 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 10

Author(s):

Dereck Chitama ◽

Rob Baltussen ◽

Evert Ketting ◽

Switbert Kamazima ◽

Anna Nswilla ◽

...

Keyword(s):

Family Planning ◽

Child Health ◽

Priority Setting ◽

District Level ◽

Health Interventions ◽

Newborn And Child Health ◽

Addressing inequities in child health and development: towards social justice

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000503 ◽

2019 ◽

Vol 3 (1) ◽

pp. e000503 ◽

Cited By ~ 9

Author(s):

Nick Spencer ◽

Shanti Raman ◽

Bernadette O'Hare ◽

Giorgio Tamburlini

Keyword(s):

Child Health ◽

Life Course ◽

National Level ◽

Health Inequities ◽

Well Being ◽

Health Determinants ◽

Health And Development ◽

The Life Course ◽

The Impact ◽

Inequities have a profound impact on the health and development of children globally. While inequities are greatest in the world’s poorest countries, even in rich nations poorer children have poorer health and developmental outcomes. From birth through childhood to adolescence, morbidity, mortality, growth and development are socially determined, resulting in the most disadvantaged having the highest risk of poor health outcomes. Inequities in childhood impact across the life course. We consider four categories of actions to promote equity: strengthening individuals, strengthening communities, improving living and working conditions, and promoting healthy macropolicies. Inequities can be reduced but action to reduce inequities requires political will. The International Society for Social Paediatrics and Child Health (ISSOP) calls on governments, policy makers, paediatricians and professionals working with children and their organisations to act to reduce child health inequity as a priority. ISSOP recommends the following: governments act to reduce child poverty; ensure rights of all children to healthcare, education and welfare are protected; basic health determinants such as adequate nutrition, clean water and sanitation are available to all children. Paediatric and child health organisations ensure that their members are informed of the impact of inequities on children’s well-being and across the life course; include child health inequities in curricula for professionals in training; publish policy statements relevant to their country on child health inequities; advocate for evidence-based pro-equity interventions using a child rights perspective; advocate for affordable, accessible and quality healthcare for all children; promote research to monitor inequity as well as results of interventions in their child populations. Paediatricians and child health professionals be aware of the impact of social determinants of health on children under their care; ensure their clinical services are accessible and acceptable to all children and families within the constraints of their country’s health services; engage in advocacy at community and national level.

The Impact of Surveillance Method and Record Source on Autism Prevalence: Collaboration with Utah Maternal and Child Health Programs

Maternal and Child Health Journal ◽

10.1007/s10995-009-0472-3 ◽

2009 ◽

Vol 14 (3) ◽

pp. 392-400 ◽

Cited By ~ 11

Author(s):

Judith Pinborough-Zimmerman ◽

Deborah Bilder ◽

Robert Satterfield ◽

Shaheen Hossain ◽

William McMahon

Keyword(s):

Child Health ◽

Health Programs ◽

Surveillance Method ◽

Child Health Programs ◽

The Impact ◽

And Child Health ◽

Autism Prevalence

Building on momentum from the global campaigns: an exploration of factors that influenced prioritization of stillbirth prevention at the national level in Uganda

Globalization and Health ◽

10.1186/s12992-021-00724-1 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Eric Ssegujja ◽

Michelle Andipatin

Keyword(s):

Child Health ◽

Low Income ◽

National Level ◽

Health Systems Strengthening ◽

Low Income Countries ◽

Health Programming ◽

Policy Community ◽

Document Review ◽

Abstract Background Of the close to 2.6 million stillbirths that happen annually, most are from low-income countries where until recently policies rarely paid special attention to addressing them. The global campaigns that followed called on countries to implement strategies addressing stillbirths and the adoption of recommendations varied according to contexts. This study explored factors that influenced the prioritization of stillbirth reduction in Uganda. Methods The study employed an exploratory qualitative design adopting Shiffman’s framework for political prioritization. Data collection methods included a document review and key informants’ interviews with a purposively selected sample of 20 participants from the policy community. Atlas. Ti software was used for data management while thematic analysis was conducted to analyze the findings. Findings Political prioritization of stillbirth interventions gained momentum following norm promotion from the global campaigns which peaked during the 2011 Lancet stillbirth series. This was followed by funding and technical support of various projects in Uganda. A combination of domestic advocacy factors such as a cohesive policy community converging around the Maternal and Child Health cluster accelerated the process by vetting the evidence and refining recommendations to support the adoption of the policy. The government’s health systems strengthening aspirations and integration of interventions to address stillbirths within the overall Maternal and Child Health programming resonated well. Conclusions The transnational influence played a key role during the initial stages of raising attention to the problem and provision of technical and financial support. The success and subsequent processes, however, relied heavily on domestic advocacy and the national political environment, and the cohesive policy community.

Association between adolescent motherhood and maternal and child health indices in Maiduguri, Nigeria: a community-based cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-024017 ◽

2019 ◽

Vol 9 (3) ◽

pp. e024017 ◽

Cited By ~ 1

Author(s):

Adewale L Oyeyemi ◽

Salamatu U Aliyu ◽

Fatima Sa’ad ◽

Adamu Ahmad Rufa’i ◽

Abdul Rahman M Jajere ◽

...

Keyword(s):

Child Health ◽

Adolescent Mothers ◽

National Level ◽

Normal Weight ◽

Cross Sectional ◽

Health Indices ◽

Adolescent Motherhood ◽

The Impact ◽

IntroductionAdolescent motherhood (childbearing below 18 years of age) is a major global health and social problem. Understanding the impact of early motherhood on maternal and child health indices is important to community and population health promotion in developing countries. This study examined the association between adolescent motherhood and maternal and child health indices in Maiduguri, Nigeria.MethodsA cross-sectional design method was used to recruit 220 mothers (age=14–25 years) from four communities in the city of Maiduguri, Northeastern Nigeria. Participants were surveyed using a self-developed interviewer-administered questionnaire that assesses maternal and child health indices and sociodemographic characteristics. Logistic regression analysis was used to compute adjusted OR and 95% CI of the associations between motherhood in adolescence (mothers below 18 years old) and maternal and child health indices.ResultsCompared to adult mothers, adolescent mothers were more likely to experience fistula (OR=5.01, 95% CI=3.01 to 14.27), to have postpartum haemorrhage (OR=6.83, 95% CI=2.93 to 15.92), to have sexually transmitted infections (OR=6.29, 95% CI=2.26 to 17.51) and to lose a child within 5 years of birth (OR=3.52, 95% CI=1.07 to 11.60). Children born to adolescent mothers were less likely to have normal weight at birth (OR=0.34, CI=0.15 to 0.73) than those born to adult mothers.ConclusionAdolescent motherhood was associated with negative maternal and child health indices. The findings can be used by public health professionals including physiotherapists in this role to inform effective primary healthcare practice and community health advocacy to improve maternal and child health indices among adolescent mothers in Maiduguri. Future studies are needed to confirm the evidence at the regional or national level including the rural population in Nigeria.

Impact of public health programs on maternal and child health services and health outcomes in India: A systematic review

Social Science & Medicine ◽

10.1016/j.socscimed.2021.113795 ◽

2021 ◽

Vol 274 ◽

pp. 113795

Author(s):

Abinash Singh ◽

Sukumar Vellakkal

Keyword(s):

Public Health ◽

Systematic Review ◽

Child Health ◽

Health Services ◽

Health Outcomes ◽

Health Programs ◽

Child Health Services ◽

Public Health Programs ◽

Understanding Affordability

10.1332/policypress/9781529211863.001.0001 ◽

2020 ◽

Author(s):

Geoffrey Meen ◽

Christine Whitehead

Keyword(s):

Low Income ◽

Structural Changes ◽

Home Ownership ◽

House Prices ◽

Household Formation ◽

Policy Makers ◽

Political Forces ◽

The Uk ◽

Developed World ◽

The Impact

Affordability is, perhaps, the greatest housing problem facing households today, both in the UK and internationally. Even though most households are now well housed, hardship is disproportionately concentrated among low-income and younger households. Our failure to deal with their problems is what makes housing so frustrating. But, to improve outcomes, we have to understand the complex economic and political forces which underlie their continued prevalence. There are no costless solutions, but there are new policy directions that can be explored in addition to those that have dominated in recent years. The first, analytic, part of the book considers the factors that determine house prices and rents, household formation and tenure, housing construction and the roles played by housing finance and taxation. The second part turns to examine the impact of past policy and the possibilities for improvement - discussing supply and the impact of planning regulation, supply subsidies, subsidies to low-income tenants and attempts to increase home ownership. Rather than advocating a particular set of policies, the aim is to consider the balance of policies; the constraints under which housing policy operates; what can realistically be achieved; the structural changes that would need to occur; and the significant sacrifices that would have to be made by some groups if there are to be improvements for others. Our emphasis is on the UK but throughout the book we also draw on international experience and our conclusions have relevance to analysts and policy makers across the developed world.