Centre for Global Health, Trinity College Dublin, Dublin, Ireland.
Department of Nutrition, HIV and AIDS, Lilongwe, Malawi.
Int J Health Policy Manag. 2018 Apr 1;7(4):297-307. doi: 10.15171/ijhpm.2017.87.
Equity and social inclusion for vulnerable groups in policy development processes and resulting documents remain a challenge globally. Most often, the marginalization of vulnerable groups is overlooked in both the planning and practice of health service delivery. Such marginalization may occur because authorities deem the targeting of those who already have better access to healthcare a cheaper and easier way to achieve short-term health gains. The Government of Malawi wishes to achieve an equitable and inclusive HIV and AIDS Policy. The aim of this study is to assess the extent to which the Malawi Policy review process addressed regional and international health priorities of equity and social inclusion for vulnerable groups in the policy content and policy revision process.
This research design comprised two phases. First, the content of the Malawi HIV and AIDS Policy was assessed using EquiFrame regarding its coverage of 21 Core Concepts of human rights and inclusion of 12 Vulnerable Groups. Second, the engagement of vulnerable groups in the policy process was assessed using the EquIPP matrix. For the latter, 10 interviews were conducted with a purposive sample of representatives of public sector, civil society organizations and development partners who participated in the policy revision process. Data was also collected from documented information of the policy processes.
Our analyses indicated that the Malawi HIV and AIDS Policy had a relatively high coverage of Core Concepts of human rights and Vulnerable Groups; although with some notable omissions. The analyses also found that reasonable steps were taken to engage and promote participation of vulnerable groups in the planning, development, implementation, monitoring and evaluation processes of the HIV and AIDS Policy, although again, with some notable exceptions. This is the first study to use both EquiFrame and EquIPP as complimentary tools to assess the content and process of policy.
While the findings indicate inclusive processes, commitment to Core Concepts of human rights and inclusion of Vulnerable Groups in relation to the Malawi HIV and AIDS Policy, the results also point to areas in which social inclusion and equity could be further strengthened.
在政策制定过程中和由此产生的文件中，为弱势群体实现公平和社会包容仍然是一个全球性的挑战。在卫生服务提供的规划和实践中，弱势群体往往被边缘化。这种边缘化可能是因为当局认为，针对那些已经更容易获得医疗保健的人进行定向，是实现短期健康收益的更便宜、更容易的方式。马拉维政府希望制定一项公平和包容的艾滋病毒和艾滋病政策。本研究旨在评估马拉维政策审查过程在政策内容和政策修订过程中，在多大程度上解决了弱势群体的公平和社会包容等区域和国际卫生重点问题。
本研究设计包括两个阶段。首先，使用 EquiFrame 评估马拉维艾滋病毒和艾滋病政策的内容，评估其对人权和包容 12 个弱势群体的 21 个核心概念的涵盖情况。其次，使用 EquIPP 矩阵评估弱势群体在政策过程中的参与情况。为此，对参与政策修订过程的公共部门、民间社会组织和发展伙伴的代表进行了 10 次有针对性的访谈。还从政策过程的文件信息中收集了数据。
我们的分析表明，马拉维艾滋病毒和艾滋病政策在人权核心概念和弱势群体方面的覆盖面相对较高；尽管存在一些明显的遗漏。分析还发现，为了让弱势群体参与艾滋病毒和艾滋病政策的规划、制定、实施、监测和评估过程，已经采取了合理的步骤来促进参与，尽管再次有一些明显的例外。这是第一项使用 EquiFrame 和 EquIPP 作为补充工具来评估政策内容和过程的研究。
虽然调查结果表明存在包容性的过程、对人权核心概念的承诺以及在马拉维艾滋病毒和艾滋病政策中纳入弱势群体，但结果也指出了可以进一步加强社会包容和平等的领域。
