Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, UK.
Health Economics and Policy Unit, Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
BMC Health Serv Res. 2021 Sep 18;21(1):984. doi: 10.1186/s12913-021-07016-9.
Inclusive engagement in healthcare policies and decision-making is essential to address the needs of patients and communities, reduce health inequities and increase the accountability of the government. In low income countries such as Malawi, with significant health challenges, stakeholder inclusion is particularly important to improve performance and service delivery. The 2017 National Health Plan II (NHP II) and accompanying Health Sector Strategic Plan II (HSSP II) aimed to improve the functioning of the healthcare system. The Ministry of Health for Malawi intended to involve all key health sector stakeholders in their development. This study explores the extent of stakeholder engagement in the health policy process through local level stakeholders' perceptions of their involvement in the NHP II and HSSP II.
A qualitative study design was used. Interviews were conducted with 19 representatives of organisations operating at the local level, such as CSOs and local government. Open questions were asked about experiences and perceptions of the development of the NHP II and HSSP II. Inductive content analysis was performed.
Stakeholders perceived barriers to inclusive and meaningful engagement in the health policy process. Five categories were identified: tokenistic involvement; stakeholder hierarchy; mutual distrust; preferred stakeholders; no culture of engagement.
Serious challenges to the meaningful and equitable engagement of local level stakeholder groups in the health policy process were identified. Issues of trust, accountability and hierarchy in donor-citizen-government relations must be addressed to support stakeholder engagement. Engagement must go beyond tokenism to embed a range of stakeholders in the process with feedback mechanisms to ensure impact from their contributions. Local level stakeholders can be empowered to advocate for and participate in consultation exercises alongside greater top-down efforts to engage stakeholders via diverse and inclusive methods. These issues are not unique to Malawi or to health policy-making.
在医疗保健政策和决策中进行包容性参与对于满足患者和社区的需求、减少健康不平等以及增强政府的问责制至关重要。在马拉维等低收入国家，由于存在重大的健康挑战，利益相关者的参与对于改善绩效和服务提供尤为重要。2017 年国家卫生计划二（NHP II）和配套的卫生部门战略计划二（HSSP II）旨在改善医疗保健系统的运作。马拉维卫生部打算让所有关键的卫生部门利益攸关方参与其制定过程。本研究通过当地利益攸关方对参与 NHP II 和 HSSP II 的看法，探讨了利益攸关方在卫生政策过程中的参与程度。
采用定性研究设计。对在当地运作的组织（如民间社会组织和地方政府）的 19 名代表进行了访谈，询问了他们对 NHP II 和 HSSP II 制定过程的经验和看法。提出了关于参与 NHP II 和 HSSP II 的开发的开放性问题。采用了归纳内容分析。
利益攸关方认为在卫生政策过程中进行包容性和有意义的参与存在障碍。确定了五个类别：象征性参与；利益相关者层次结构；相互不信任；首选利益相关者；没有参与文化。
确定了在卫生政策过程中当地利益攸关方群体有意义和平等参与的重大挑战。在捐助者-公民-政府关系中，必须解决信任、问责制和层次结构问题，以支持利益攸关方的参与。参与必须超越象征性，让一系列利益攸关方参与该过程，并建立反馈机制，以确保他们的贡献产生影响。必须赋予地方利益攸关方权力，让他们参与倡导和协商，同时通过多样化和包容性的方法，加大自上而下的努力，让更多的利益攸关方参与进来。这些问题不仅在马拉维，而且在卫生政策制定中都不是独一无二的。
