Country Technical Lead, Better Health Programme Malaysia, RTI International Malaysia, Kuala Lumpur, Malaysia/Post-doctoral Fellow, International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia.
Research Intern, International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia.
Sex Reprod Health Matters. 2020 Dec;28(2):1842153. doi: 10.1080/26410397.2020.1842153.
Despite increasing calls to integrate and prioritise sexual and reproductive health (SRH) services in universal health coverage (UHC) processes, several SRH services have remained a low priority in countries' UHC plans. This study aims to understand the priority-setting process of SRH interventions in the context of UHC, drawing on the Malaysian experience. A realist evaluation framework was adopted to examine the priority-setting process for three SRH tracer interventions: pregnancy, safe delivery and post-natal care; gender-based violence (GBV) services; and abortion-related services. The study used a qualitative multi-method design, including a literature and document review, and 20 in-depth key informant interviews, to explore the context-mechanism-outcome configurations that influenced and explained the priority-setting process. Four key advocacy strategies were identified for the effective prioritisation of SRH services, namely: (1) generating public demand and social support, (2) linking SRH issues with public agendas or international commitments, (3) engaging champions that are internal and external to the public health sector, and (4) reframing SRH issues as public health issues. While these strategies successfully triggered mechanisms, such as mutual understanding and increased buy-in of policymakers to prioritise SRH services, the level and extent of prioritisation was affected by both inner and outer contextual factors, in particular the socio-cultural and political context. Priority-setting is a political decision-making process that reflects societal values and norms. Efforts to integrate SRH services in UHC processes need both to make technical arguments and to find strategies to overcome barriers related to societal values (including certain socio-cultural and religious norms). This is particularly important for sensitive SRH services, like GBV and safe abortion, and for certain populations.
尽管人们越来越呼吁将性健康和生殖健康（SRH）服务纳入全民健康覆盖（UHC）进程，并将其作为优先事项，但在各国的 UHC 计划中，一些 SRH 服务仍然是低优先级。本研究旨在借鉴马来西亚的经验，了解在 UHC 背景下 SRH 干预措施的优先排序过程。采用现实主义评价框架，考察了三种 SRH 追踪干预措施（妊娠、安全分娩和产后护理、基于性别的暴力（GBV）服务和与堕胎相关的服务）的优先排序过程。本研究采用定性多方法设计，包括文献和文件审查以及 20 次深入的关键知情人访谈，以探讨影响和解释优先排序过程的背景-机制-结果配置。为有效优先考虑 SRH 服务，确定了四项主要的宣传策略，即：（1） 产生公众需求和社会支持；（2） 将 SRH 问题与公共议程或国际承诺联系起来；（3） 争取公共卫生部门内外的拥护者；（4） 将 SRH 问题重新定义为公共卫生问题。虽然这些策略成功地触发了机制，如相互理解和决策者更多地认同优先考虑 SRH 服务，但优先排序的程度和范围受到内部和外部环境因素的影响，特别是社会文化和政治背景。优先排序是一个政治决策过程，反映了社会价值观和规范。将 SRH 服务纳入 UHC 进程的努力需要提出技术论点，并找到克服与社会价值观相关的障碍的策略（包括某些社会文化和宗教规范）。这对于敏感的 SRH 服务（如 GBV 和安全堕胎）和某些人群尤为重要。
