Health Systems and Health Policy Research Group, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium.
Health Systems and Health Policy Research Group, Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
BMJ Open. 2021 Jun 29;11(6):e047948. doi: 10.1136/bmjopen-2020-047948.
This paper presents the iterative process of participatory multistakeholder engagement that informed the development of a new national tuberculosis (TB) policy in Georgia, and the lessons learnt.
Guided by realist evaluation methods, a multistakeholder dialogue was organised to elicit stakeholders' assumptions on challenges and possible solutions for better TB control. Two participatory workshops were conducted with key actors, interspersed by reflection meetings within the research team and discussions with policymakers. Using concept mapping and causal mapping techniques, and drawing causal loop diagrams, we visualised how actors understood TB service provision challenges and the potential means by which a results-based financing (RBF) policy could address these.
The study was conducted in Tbilisi, Georgia.
A total of 64 key actors from the Ministry of Labour, Health and Social Affairs, staff of the Global Fund to Fight AIDS, TB and Malaria Georgia Project, the National Centre for Disease Control and Public Health, the National TB programme, TB service providers and members of the research team were involved in the workshops.
Findings showed that beyond provider incentives, additional policy components were necessary. These included broadening the incentive package to include institutional and organisational incentives, retraining service providers, clear redistribution of roles to support an integrated care model, and refinement of monitoring tools. Health system elements, such as effective referral systems and health information systems were highlighted as necessary for service improvement.
Developing policies that address complex issues requires methods that facilitate linkages between multiple stakeholders and between theory and practice. Such participatory approaches can be informed by realist evaluation principles and visually facilitated by causal loop diagrams. This approach allowed us leverage stakeholders' knowledge and expertise on TB service delivery and RBF to codesign a new policy.
本文介绍了参与式多方利益相关者参与的迭代过程，该过程为格鲁吉亚制定新的国家结核病（TB）政策提供了信息，并总结了经验教训。
在现实主义评价方法的指导下，组织了一次多方利益相关者对话，以了解利益相关者对改善结核病控制所面临的挑战和可能的解决方案的假设。与主要行为者进行了两次参与式研讨会，其间研究小组内部进行了反思会议，并与政策制定者进行了讨论。使用概念映射和因果映射技术，并绘制因果循环图，我们直观地展示了行为者如何理解结核病服务提供方面的挑战，以及基于成果的融资（RBF）政策如何解决这些问题的潜在手段。
该研究在格鲁吉亚第比利斯进行。
来自劳动、卫生和社会事务部、全球抗击艾滋病、结核病和疟疾基金格鲁吉亚项目工作人员、国家疾病控制和公共卫生中心、国家结核病规划、结核病服务提供者和研究团队成员的共 64 名主要行为者参加了研讨会。
研究结果表明，除了提供者激励措施外，还需要其他政策组成部分。这些组成部分包括扩大激励计划，纳入机构和组织激励措施、重新培训服务提供者、明确重新分配角色以支持综合护理模式，以及改进监测工具。卫生系统要素，如有效的转诊系统和卫生信息系统，被强调为改善服务所必需的。
制定解决复杂问题的政策需要方法，这些方法可以促进多方利益相关者之间以及理论与实践之间的联系。这种参与式方法可以通过现实主义评价原则来指导，并通过因果循环图来直观呈现。这种方法使我们能够利用利益相关者在结核病服务提供和 RBF 方面的知识和专业知识，共同设计一项新政策。
