Political economy analysis of universal health coverage and health financing reforms in low- and middle-income countries: the role of stakeholder engagement in the research process

Background Progress towards universal health coverage (UHC) is an inherently political process. Political economy analysis (PEA) is gaining momentum as a tool to better understand the role of the political and economic dimensions in shaping and achieving UHC in different contexts. Despite the acknowledged importance of actors and stakeholders in political economy considerations, their role in the PEA research process beyond “study subjects” as potential cocreators of knowledge and knowledge users has been overlooked so far. We therefore aimed to review the approaches with reference to stakeholder engagement during the research process adopted in the current published research on the political economy of UHC and health financing reforms, and the factors favouring (or hindering) uptake and usability of PEA work. Methods We reviewed the literature to describe whether, when and how stakeholders were involved in the research process of studies looking at the political economy of UHC and health financing reforms, and to identify challenges and lessons learned on effective stakeholder engagement and research uptake. We used a standardized search strategy with key terms across several databases; we screened and included articles that focused on PEA and UHC. Additionally, we conducted a short survey of the authors of the included studies to complement the information retrieved. Results Fifty articles met the inclusion criteria and were included in the analysis. We found overall little evidence of systematic engagement of stakeholders in the research process, which focused mostly on the data collection phase of the research (i.e., key informant interviews). Our study identifies some reasons for the varying stakeholder engagement. Challenges include PEA requiring specific skills, a focus on sensitive issues, and the blurriness in researchers’ and stakeholders’ roles and the multiple roles of stakeholders as research participants, study subjects and research users. Among the approaches that might favour usability of PEA work, we identified early engagement, coproduction of research questions, local partners and personal contact, political willingness, and trust and use of prospective analysis. Conclusions Stakeholder engagement and research uptake are multifaceted concepts and complex processes, particularly when applied to PEA. As such, stakeholder engagement in the research process of PEA of UHC and health financing reforms is limited and underreported. Despite the challenges, however, stakeholder engagement remains key to ensuring relevance, usability and research uptake of PEA studies. More efforts are required to ensure engagement at different stages of the research process and better reporting in published articles.

Designing Research to Catalyse Climate Action

Climate action ahead of 2030 requires ambitious research that is fit for purpose: working across scale, creating synergy among cohorts of projects, and enabling capacity to pursue research uptake. Research needs to bridge local and national levels and provide evidence that informs decisions with decadal implications. To become more than the sum of its constituent activities, research programmes and consortia require learning frameworks and equitable partnership among participating organisations. Beyond scholarships and fellowships for training and independent study, exchanges and embedding in real-world settings practical experiences allow people to gain experience beyond academia in diverse host institutions. Greater emphasis needs to be given to the spectrum extending from research to its application, including co-production and knowledge brokering with local people and decision-makers.

Factors influencing uptake of schistosomiasis research findings in ingwavuma area, uMkhanyakude District, Kwazulu-Natal, South Africa

Background: Research uptake is concerned with spreading ideas across multiple levels of the community. Barriers such as poverty, lack of infrastructure, illiteracy and culture prevent information sharing in arid rural areas of sub-Saharan Africa. Objective: This study explores the factors influencing schistosomiasis research uptake and the available channels for the uptake of research findings from a transdisciplinary and eco-health research project on schistosomiasis in Ingwavuma area, uMkhanyakude district, KwaZulu-Natal province in South Africa. Methods: This case study conducted in 2017 involved 78 primary school children and 73 heads of household recruited through convenience and purposive sampling. Data were collected through focus group discussions, then transcribed and analysed by the researcher using thematic analysis. Results: Factors such as poor knowledge, water and sanitation problems, and lack of sufficient health workers hindered the uptake of schistosomiasis research findings. Participants recommended several platforms to share schistosomiasis research findings with the community, including: door to door visits; social gatherings such as sports events, talent shows, and religious gatherings; mass media platforms such as radio and television; social media platforms such as WhatsApp, Facebook and Twitter; and printed media such as posters, booklets and pamphlets. Conclusions: There is a need to train health workers and peer educators in this area of South Africa to educate people about schistosomiasis infection, screening and treatment through home visits or social events. Schistosomiasis research findings must be synthesised and packaged in different forms for dissemination via multimedia media-based communication channels.

A Model to Facilitate Research Uptake in Health Care Practice and Policy Development for Low-resource Countries

BACKGROUND: Despite the availability of numerous models for knowledge translation into health care practice and policy development, research uptake remains low in resource-limited countries. Recent reports have indicated that this trend of low research uptake is likely to continue for some time in low-resource countries unless initiatives to promote research uptake strategies consider challenges faced by these countries. This paper aimed to develop a tailored model to enable the optimal uptake of public health research findings for health care practice and policy development in a low-resource country. APPROACH: The study used a two-phase exploratory sequential approach. Qualitative data were collected through semi-structured interviews with 21 participants. Quantitative data were collected through an online cross-sectional survey administered to 212 respondents who conducted research studies in the study area between 2014 to 2019. HIGHLIGHTS: The findings indicated a lack of awareness of research results and champions to lead engagements among research stakeholders. Researchers also fail to align public health research projects to existing local contexts and available resources as well as establish and sustain beneficial collaboration between all research stakeholders. The survey indicated a total of 13 factors needed for research uptake, namely four individual factors (support, experience, motivation & time factor); four organisational factors (research agenda, funding, resources & partnerships), and five research characteristics factors (gatekeeping, local research committees, accessibility of evidence, quality of evidence and critical appraisal skills). The Spearman's correlation coefficient revealed that of the 13 factors, only six factors had a significant positive correlation with research uptake, namely: support, experience, motivation, time factor, resources, and critical appraisal skills. CONCLUSION: In the context of research uptake for healthcare practice and policy development, we consider this model unique and appropriate for low-resource countries in that it integrated the PARIHS framework with the logical framework to streamline the research uptake process. Keywords: Healthcare Policy, Healthcare Practice, Low-resource countries, Research Uptake, Model

Stakeholder Engagement for ARCH

For research uptake to be effective, there is need to involve relevant individuals, groups, organisations, and institutions. Stakeholder mapping enables one to identify these groups, as well their importance in research uptake, and how to engage with them. In this document, we highlight steps of stakeholder mapping in research uptake, as adapted from literature.

Stakeholder Mapping Tool for ARCH

This tool contains a step-by-step guide to stakeholder mapping in research uptake. This methodology has been adapted from several methodologies identified in a stakeholder mapping methodology scoping exercise.

Consulting the Community on Strategies to Strengthen Social Capital for Community Disease Control

Excluding communities in planning and implementing research maximizes internal risks that are otherwise visible and avoidable when there is adequate community consultation. Communities might not meaningfully use research results if majority of the researched people have minimal or no participation in information generation and dissemination. However, effective participation of researched communities in research is key to transferring knowledge to action. Using a qualitative approach, the study identified barriers to, and relevant strategies for improving health research uptake, particularly for schistosomiasis (commonly known as bilharzia) in the Ingwavuma area, uMkhanyakude District of KwaZulu-Natal. Data was collected through modified ethnography using participant observation, focus group discussions, unstructured in-depth interviews, and ethnographic conversational interviews. Results reveal that research uptake is inhibited by reduced opportunities for habitual interaction between residents, a paucity of innovative and inclusive health education activities and unsafe recreational facilities. The community’s strategies on strengthening social capital for disease control include using existing social systems and power hierarchies to mobilise and organise and using the performing arts to facilitate habitual interaction and knowledge sharing. The study recommends a community consultation flow which facilitates openness about the benefits and the community’s role in research, a pre-condition for community wide efforts in local disease prevention and control.