Faculty of Medicine, Heidelberg Institute for Global Health, University of Heidelberg, Heidelberg, Germany.
Int J Health Plann Manage. 2020 Nov;35(6):1571-1592. doi: 10.1002/hpm.3055. Epub 2020 Oct 8.
Health sector strategic plans are health policies outlining health service delivery in low- and middle- income countries, guiding health sectors to meet health needs while maximizing resources. However, little research has explored the formulation of these plans. This study utilized qualitative methods to explore the formulation of Malawi's Health Sector Strategic Plan II, including processes utilized, actors involved, important contextual factors and the use of evidence-based decision-making. Thirteen semi-structured key informant interviews with health policy actors were conducted to explore perceptions and experiences of formulating the policy. Data analysis used an inductive-deductive approach and interpretation of the data was guided by an adapted version of the Walt and Gilson Health Policy Triangle. Our results indicate that HSSP II formulation was complex and inclusive but that the Ministry of Health may have given up ownership of the formulation process to development partners to ensure their continued involvement. Disagreements between actors centered around inclusion of critical services in the Essential Health Package and selection of performance-based financing as purchasing strategy. Resource constraints and the Cashgate Scandal are critical contextual elements influencing the formulation and content of the policy. Evidence-based decision-making contributed to the plan's development despite respondents' divergent opinions regarding evidence availability, quality and the weight that evidence carried. The study raises questions regarding the roles of policy actors during health policy formulation, the inclusivity of health policy processes and their potential influence on government ownership of health policy, as well as the use of evidence in developing health sector strategic plans.
卫生部门战略计划是为中低收入国家制定的卫生服务提供蓝图，旨在指导卫生部门在最大限度利用资源的同时满足卫生需求。然而，很少有研究探讨这些计划的制定过程。本研究采用定性方法探讨了马拉维卫生部门战略计划 II 的制定过程，包括所采用的流程、涉及的行动者、重要的背景因素以及循证决策的应用。对 13 名卫生政策制定者进行了半结构化的关键知情人访谈，以探讨制定政策的看法和经验。数据分析采用了归纳演绎法，数据解释遵循经过改编的 Walt 和 Gilson 卫生政策三角模型。研究结果表明，HSSP II 的制定过程复杂而全面，但卫生部可能已经将制定过程的所有权让渡给发展伙伴，以确保他们的持续参与。行动者之间的分歧集中在基本卫生包中纳入关键服务以及选择绩效融资作为采购策略上。资源限制和现金门丑闻是影响政策制定和内容的关键背景因素。尽管受访者对证据的可用性、质量和证据的权重存在不同意见，但循证决策为计划的制定做出了贡献。本研究提出了一些问题，涉及卫生政策制定过程中政策制定者的角色、卫生政策制定过程的包容性以及它们对政府对卫生政策的所有权的潜在影响，以及在制定卫生部门战略计划中证据的应用。
