SAMRC/Wits Centre for Health Economics and Decision Science - PRICELESS, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Department of Bioethics, National Institutes of Health, Bethesda, MD, USA.
Int J Health Policy Manag. 2022 Feb 1;11(2):197-209. doi: 10.34172/ijhpm.2020.110.
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.
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.
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.
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.
在全球范围内，随着各国迈向全民医保（UHC），公众参与决策对于为优先排序和资源分配做出艰难决策提供信息尤为有价值。在南非（SA），正在迈向 UHC，公众参与决策已纳入政策文件，但实际应用却缺乏。参与式的协商方法可能有助于确保公众参与到基于证据、合乎道德、合法、可持续和包容的优先排序过程中。为国家背景修改的方法可能更相关和有效。为了在南非为这样的协商过程做准备，我们旨在修改一个特定的协商参与工具 - 用于农村环境的 CHAT（一起选择）工具。
对已发表的文献和政策文件进行桌面审查，以及进行 3 个焦点小组和修改德尔菲法，以确定适合南非农村环境的卫生主题/问题和相关干预措施。我们的方法涉及高度的社区和政策制定者/专家参与。对定性数据进行主题分析。成本信息来自各种国家来源，并且使用了以前 CHAT 练习中使用的现有精算模型来创建董事会。
基于结果，确定了 7 个特定于农村背景的卫生主题/问题和相关干预措施，并对其进行了成本核算。这些措施包括母婴、新生儿和生殖健康；儿童健康；妇女和儿童虐待；艾滋病毒/艾滋病和结核病（TB）；生活方式疾病；获取；和疟疾。3 个利益相关者群体之间存在优先级差异，基于社区的群体强调获取问题。针对妇女和儿童的暴力行为以及疟疾在农村环境中被认为是重要的。
CHAT SA 董事会反映了南非农村环境特有的卫生主题/问题，并展示了一些需要做出的特定于上下文的覆盖决策。包括参与性原则的方法对于修改像 CHAT 这样的参与工具很有用，并且可以在不同的国家背景下应用，以确保这些工具是相关和可接受的。这反过来又会影响实施的成功，最终确保更有效的优先排序方法。
