CHAT SA: Modification of a Public Engagement Tool for Priority Setting for a South African Rural Context

Background: Globally, as countries move towards universal health coverage (UHC), public participation in decisionmaking is particularly valuable to inform difficult decisions about priority setting and resource allocation. In South Africa (SA), which is moving towards UHC, public participation in decision-making is entrenched in policy documents yet practical applications are lacking. Engagement methods that are deliberative could be useful in ensuring the public participates in the priority setting process that is evidence-based, ethical, legitimate, sustainable and inclusive. Methods modified for the country context may be more relevant and effective. To prepare for such a deliberative process in SA, we aimed to modify a specific deliberative engagement tool – the CHAT (Choosing All Together) tool for use in a rural setting. Methods: Desktop review of published literature and policy documents, as well as 3 focus groups and modified Delphi method were conducted to identify health topics/issues and related interventions appropriate for a rural setting in SA. Our approach involved a high degree of community and policy-maker/expert participation. Qualitative data were analysed thematically. Cost information was drawn from various national sources and an existing actuarial model used in previous CHAT exercises was employed to create the board. Results: Based on the outcomes, 7 health topics/issues and related interventions specific for a rural context were identified and costed for inclusion. These include maternal, new-born and reproductive health; child health; woman and child abuse; HIV/AIDS and tuberculosis (TB); lifestyle diseases; access; and malaria. There were variations in priorities between the 3 stakeholder groups, with community-based groups emphasizing issues of access. Violence against women and children and malaria were considered important in the rural context. Conclusion: The CHAT SA board reflects health topics/issues specific for a rural setting in SA and demonstrates some of the context-specific coverage decisions that will need to be made. Methodologies that include participatory principles are useful for the modification of engagement tools like CHAT and can be applied in different country contexts in order to ensure these tools are relevant and acceptable. This could in turn impact the success of the implementation, ultimately ensuring more effective priority setting approaches.

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Global Health Priority-Setting

10.1093/oso/9780190912765.001.0001 ◽

2019 ◽

Cited By ~ 1

Keyword(s):

Global Health ◽

Priority Setting ◽

Health Resources ◽

Decision Makers ◽

Health Priorities ◽

Health Coverage ◽

Household Finances ◽

Health Gains ◽

Global Priority ◽

Financing Gap

Global health is at a crossroads. The 2030 Agenda for Sustainable Development has come with ambitious targets for health and health services worldwide. To reach these targets, many more billions of dollars need to be spent on health. However, development assistance for health has plateaued and domestic funding on health in most countries is growing at rates too low to close the financing gap. National and international decision-makers face tough choices about how scarce health care resources should be spent. Should additional funds be spent on primary prevention of stroke, treating childhood cancer, or expanding treatment for HIV/AIDS? Should health coverage decisions take into account the effects of illness on productivity, household finances, and children’s educational attainment, or should they just focus on health outcomes? Does age matter for priority-setting or should it be ignored? Are health gains far in the future less important than gains in the present? Should higher priority be given to people who are sicker or poorer? This book provides a framework for how to think about evidence-based priority-setting in health. Over 18 chapters, ethicists, philosophers, economists, policymakers, and clinicians from around the world assess the state of current practice in national and global priority-setting, describe new tools and methodologies to address establishing global health priorities, and tackle the most important ethical questions that decision-makers must consider in allocating health resources.

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Public participation in health care priority setting: A scoping review

Health Policy ◽

10.1016/j.healthpol.2009.01.005 ◽

2009 ◽

Vol 91 (3) ◽

pp. 219-228 ◽

Cited By ~ 187

Author(s):

Craig Mitton ◽

Neale Smith ◽

Stuart Peacock ◽

Brian Evoy ◽

Julia Abelson

Keyword(s):

Health Care ◽

Public Participation ◽

Scoping Review ◽

Priority Setting ◽

Health Care Priority Setting

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Research-to-Resource: Developing a Culturally Responsive Mind-Set in Elementary General Music

Update Applications of Research in Music Education ◽

10.1177/8755123318810111 ◽

2018 ◽

Vol 37 (2) ◽

pp. 11-14 ◽

Cited By ~ 2

Author(s):

Jacqueline Kelly-McHale

Keyword(s):

Culturally Responsive ◽

Community Context ◽

General Music ◽

Practical Applications ◽

Music Classroom ◽

School Teaching ◽

Elementary General Music ◽

Cultural Responsivity ◽

Mind Set ◽

Context Specific

The terms culturally responsive teaching and culturally responsive pedagogy have become more common in the vernacular of public-school teaching. However, practical applications of cultural responsivity are not often clearly presented due to the nature of being responsive. Responsivity requires knowledge of students and community (context) specific to each teaching context. Content and materials should then be derived from the development of the contextual understanding. This is why presenting a tool box of culturally responsive practices is not possible when seeking to become more culturally responsive in the classroom. This article seeks to situate cultural responsivity as a mind-set as opposed to an approach or method within the elementary general music classroom. Practical steps that can be taken toward the development of this mind-set are then presented with a focus on context and content.

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Breast Cancer: Reimbursement Policies and Adoption of New Therapeutic Agents by National Health Systems

Breast Care ◽

10.1159/000502637 ◽

2019 ◽

Vol 14 (6) ◽

pp. 373-381 ◽

Cited By ~ 1

Author(s):

Dario Trapani ◽

Giuseppe Curigliano ◽

Alexandru Eniu

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Priority Setting ◽

Financial Distress ◽

Quality Care ◽

Premature Death ◽

Health Coverage ◽

Breast Cancer Patients ◽

Middle Income ◽

Timely Access

Background: Breast cancer is a cause of morbidity for more than half a million of patients in Europe, resulting in broad societal impacts that affect patients, families, and societies from a human, emotional, economic, and financial perspective. Expenditure for cancer medicines represents one of the principal driving costs of healthcare. The aim of this review is to describe the European policy and regulatory landscape of innovation uptake in breast oncology – with emphasis on value in cancer healthcare. Summary: In Europe, several reimbursement models or policy tools have been developed by countries to compose their benefit packages. The most commonly applied scheme is the product-specific eligibility model, prioritizing selected medicines and their indications. Mixed models are commonly developed, addressing the protection of more vulnerable people, ensuring protection from impoverishment caused by cancer and containing disparities. However, the risk to incur significant out-of-pocket expenses for essential or newer medicines for cancer is still substantial in Europe, especially in low- and middle-income countries, determining greater financial distress and poorer outcome for patients. Value-based priority setting is an essential mechanism to ensure timely access to the most valuable medicines for breast cancer patients. Estimations of the value of medicines can be provided within health technology assessment services and networks and informed by benefit scales and tools. Key Messages: There is ample room for reciprocal support across the diverse cultural and legal realities in Europe. The aim is common: save cancer patients from premature death by ensuring the timely access to the best care, protecting from financial hardships and distress to leave no cancer patient behind in poverty. Steps are to be taken to promote value-based priority setting, paving the way toward universal health coverage in Europe, where health of people is protected, and affordable best quality care is the only standard pursued and acceptable.

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Selecting topic areas for developing quality standards in a resource-limited setting

BMJ Open Quality ◽

10.1136/bmjoq-2018-000491 ◽

2019 ◽

Vol 8 (1) ◽

pp. e000491

Author(s):

Roongnapa Khampang ◽

Sarayuth Khuntha ◽

Phorntida Hadnorntun ◽

Suthasinee Kumluang ◽

Thunyarat Anothaisintawee ◽

...

Keyword(s):

Priority Setting ◽

Quality Standards ◽

Healthcare Services ◽

Priority Setting Process ◽

Deliberative Process ◽

Mortality And Morbidity ◽

Stakeholder Consultation ◽

Healthcare Settings ◽

Resource Limited ◽

Setting Process

Variation in practices of and access to health promotion and disease prevention (P&P) across geographical areas have been studied in Thailand as well as other healthcare settings. The implementation of quality standards (QS)—a concise set of evidence-informed quality statements designed to drive and measure priority quality improvements—can be an option to solve the problem. This paper aims to provide an overview of the priority setting process of topic areas for developing QS and describes the criteria used. Topic selection consisted of an iterative process involving several steps and relevant stakeholders. Review of existing documents on the principles and criteria used for prioritising health technology assessment topics were performed. Problems with healthcare services were reviewed, and stakeholder consultation meetings were conducted to discuss current problems and comment on the proposed prioritisation criteria. Topics were then prioritised based on both empirical evidence derived from literature review and stakeholders’ experiences through a deliberative process. Preterm birth, pre-eclampsia and postpartum haemorrhage were selected. The three health problems had significant disease burden; were prevalent among pregnant women in Thailand; led to high mortality and morbidity in mothers and children and caused variation in the practices and service uptake at health facilities. Having agreed-on criteria is one of the important elements of the priority setting process. The criteria should be discussed and refined with various stakeholders. Moreover, key stakeholders, especially the implementers of QS initiative, should be engaged in a constructive way and should be encouraged to actively participate and contribute significantly in the process.

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Priority setting and personal health responsibility: an analysis of Norwegian key policy documents

Journal of Medical Ethics ◽

10.1136/medethics-2019-105612 ◽

2020 ◽

pp. medethics-2019-105612 ◽

Cited By ~ 1

Author(s):

Gloria Traina ◽

Eli Feiring

Keyword(s):

Priority Setting ◽

Behavioural Change ◽

Personal Health ◽

Policy Documents ◽

Care Services ◽

Health Responsibility ◽

Key Policy ◽

The Subject ◽

The Individual ◽

Responsibility Criterion

BackgroundThe idea that individuals are responsible for their health has been the focus of debate in the theoretical literature and in its concrete application to healthcare policy in many countries. Controversies persist regarding the form, substance and fairness of allocating health responsibility to the individual, particularly in universal, need-based healthcare systems.ObjectiveTo examine how personal health responsibility has been framed and rationalised in Norwegian key policy documents on priority setting.MethodsDocuments issued or published by the Ministry of Health and Care Services between 1987 and 2018 were thematically analysed (n=14). We developed a predefined conceptual framework that guided the analysis. The framework included: (1) the subject and object of responsibility, (2) the level of conceptual abstraction, (3) temporality, (4) normative justificatory arguments and (5) objections to the application of personal health responsibility.ResultsAs an additional criterion, personal health responsibility has been interpreted as relevant if: (A) the patient’s harmful behaviour is repeated after receiving treatment (retrospectively), and if (B) the success of the treatment is conditional on the patient’s behavioural change (prospectively). When discussed as a retrospective criterion, considerations of reciprocal fairness have been dominant. When discussed as a prospective criterion, the expected benefit of treatment justified its relevance.ConclusionPersonal health responsibility appears to challenge core values of equality, inclusion and solidarity in the Norwegian context and has been repeatedly rejected as a necessary criterion for priority setting. However, the responsibility criterion seems to have some relevance in particular priority setting decisions.

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Choosing Public Participation Methods for Natural Resources: A Context-Specific Guide

Society & Natural Resources ◽

10.1080/089419201753242779 ◽

2001 ◽

Vol 14 (10) ◽

pp. 857-872 ◽

Cited By ~ 39

Author(s):

Rick L. Lawrence, Debbie A. Deagen

Keyword(s):

Natural Resources ◽

Public Participation ◽

Context Specific

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Tracking health sector priority setting processes and outcomes for human resources for health, five-years after political devolution: a county-level case study in Kenya

International Journal for Equity in Health ◽

10.1186/s12939-020-01284-3 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Joshua Munywoki ◽

Nancy Kagwanja ◽

Jane Chuma ◽

Jacinta Nzinga ◽

Edwine Barasa ◽

...

Keyword(s):

Service Delivery ◽

Human Resources ◽

Priority Setting ◽

Human Resources For Health ◽

Health Sector ◽

Health Service Delivery ◽

County Level ◽

Health Coverage ◽

Middle Income

Abstract Background Health sector priority setting in Low and Middle-Income Countries (LMICs) entails balancing between a high demand and low supply of scarce resources. Human Resources for Health (HRH) consume the largest allocation of health sector resources in LMICs. Health sector decentralization continues to be promoted for its perceived ability to improve efficiency, relevance and participation in health sector priority setting. Following the 2013 devolution in Kenya, both health service delivery and human resource management were decentralized to county level. Little is known about priority setting practices and outcomes of HRH within decentralized health systems in LMICs. Our study sought to examine if and how the Kenyan devolution has improved health sector priority setting practices and outcomes for HRH. Methods We used a mixed methods case study design to examine health sector priority setting practices and outcomes at county level in Kenya. We used three sources of data. First, we reviewed all relevant national and county level policy and guidelines documents relating to HRH management. We then accessed and reviewed county records of HRH recruitment and distribution between 2013 and 2018. We finally conducted eight key informant interviews with various stakeholder involved in HRH priority setting within our study county. Results We found that HRH numbers in the county increased by almost two-fold since devolution. The county had two forms of HRH recruitment: one led by the County Public Services Board as outlined by policy and guidelines and a parallel, politically-driven recruitment done directly by the County Department of Health. Though there were clear guidelines on HRH recruitment, there were no similar guidelines on allocation and distribution of HRH. Since devolution, the county has preferentially staffed higher level hospitals over primary care facilities. Additionally, there has been local county level innovations to address some HRH management challenges, including recruiting doctors and other highly specialized staff on fixed term contract as opposed to permanent basis; and implementation of local incentives to attract and retain HRH to remote areas within the county. Conclusion Devolution has significantly increased county level decision-space for HRH priority setting in Kenya. However, HRH management and accountability challenges still exist at the county level. There is need for interventions to strengthen county level HRH management capacity and accountability mechanisms beyond additional resources allocation. This will boost the realization of the country’s efforts for promoting service delivery equity as a key goal – both for the devolution and the country’s quest towards Universal Health Coverage (UHC).

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