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Using frameworks to set priorities for health policy
Round Up: Knowledge, evidence, practice and power. Reproductive Health Matters 2015;23(45):164–171
Using frameworks to set priorities for health policy
Financing adolescent health care for universal health coverage
This article systematically reviewed a set of health policy papers on agenda setting and tests them against a specific priority-setting framework. The authors applied a commonly used Shiffman and Smith framework, which identified four conditions which would facilitate a priority issue being integrated into national policies and then acted on. The four conditions are actor power (the strength of the individuals and networks concerned with the issue), ideas (the ways in which those involved with the issue understand and portray it), context (environment in which actors operate) and issue characteristics. The framework was used to analyse 22 papers that analysed health agenda or priority-setting in low- and middle-income countries between 2000 and 2007. Over half of the papers analysed dealt with reproductive or maternal health or HIV and AIDS. Papers were analysed to identify the extent to which the four conditions were applied, in order to identify whether using such a theoretical approach would be useful when prospectively planning programmes that seek to set health policies or priorities. The framework was found to offer huge value in guiding crossnational as well as cross-policy research and analysis in a field that has been neglected and under-developed. The analysis demonstrated that comparative qualitative studies would be more rigorous if such frameworks were utilised prospectively. A few adjustments and conceptual refinements are proposed: using consideration of contestability or conflict as one of the characteristics of the problem being considered; and dividing the notion of ‘guiding institutions’ into two concepts - guiding organisations and the formal and informal norms and rules that make up judicial and legal institutions under political context. Framework synthesis offers a feasible, deductive approach to qualitative synthesis for health policy analysis research.1
This article assesses how far health care financing approaches that seek to provide universal coverage work for adolescents, by asking (and suggesting answers for) some important questions. Are adolescents adequately covered by a pooled financing arrangement (insurance- or tax-based)? If not, there may need to be a focus on increasing overall coverage and/or on measures that particularly target adolescents, including older adolescents. Do adolescents have to pay fees to use essential services, and if so, what is the impact of fees on their use of services? If this is a problem, exemptions could be a short-term measure. Are the services that are appropriate for adolescents covered by pooled financing arrangements? Decisions about services for adolescents are made by the agencies responsible for allocating the money in pooled health funds. Financing may not happen if adolescents are not seen as a priority in a contest for resources; if there is little awareness or information available about adolescents’ health needs; or if there is not a strong commitment to providing services related to potentially sensitive issues such as pre-marital sex, substance abuse or mental health.1
1. Walt G, Gilson L. Can frameworks inform knowledge about health policy processes? Reviewing health policy papers on agenda setting and testing them against a specific priority-setting framework. Health Policy & Planning 2014;29 (Suppl 3):iii6-iii22. http://dx.doi.org/10.1093/heapol/czu081.
1. Waddington C, Sambo C. Financing health care for adolescents: a necessary part of universal health coverage. Bulletin of the World Health Organization 2015;93:57-9. http://dx.doi.org/10.2471/BLT.14.139741.
Sexual and reproductive health and rights in changing health systems This paper explores what introduction of concepts of universal health coverage and care mean for sexual and reproductive health and rights, and for gender equity in health. Health system reform that does not address the core elements of the sexual and reproductive health and rights agenda will fail to meet important criteria of equality of access and affordability and will fail to meet the need for acceptability and quality in health services. Such reform could also remain weak on accountability. Although many elements in the concept of universal health coverage (such as its core principle of universality and its recognition of critical systemic factors) have value for sexual and reproductive health, there are missing or 165
Using frameworks to set priorities for health policy
Financing adolescent health care for universal health coverage
This article systematically reviewed a set of health policy papers on agenda setting and tests them against a specific priority-setting framework. The authors applied a commonly used Shiffman and Smith framework, which identified four conditions which would facilitate a priority issue being integrated into national policies and then acted on. The four conditions are actor power (the strength of the individuals and networks concerned with the issue), ideas (the ways in which those involved with the issue understand and portray it), context (environment in which actors operate) and issue characteristics. The framework was used to analyse 22 papers that analysed health agenda or priority-setting in low- and middle-income countries between 2000 and 2007. Over half of the papers analysed dealt with reproductive or maternal health or HIV and AIDS. Papers were analysed to identify the extent to which the four conditions were applied, in order to identify whether using such a theoretical approach would be useful when prospectively planning programmes that seek to set health policies or priorities. The framework was found to offer huge value in guiding crossnational as well as cross-policy research and analysis in a field that has been neglected and under-developed. The analysis demonstrated that comparative qualitative studies would be more rigorous if such frameworks were utilised prospectively. A few adjustments and conceptual refinements are proposed: using consideration of contestability or conflict as one of the characteristics of the problem being considered; and dividing the notion of ‘guiding institutions’ into two concepts - guiding organisations and the formal and informal norms and rules that make up judicial and legal institutions under political context. Framework synthesis offers a feasible, deductive approach to qualitative synthesis for health policy analysis research.1
This article assesses how far health care financing approaches that seek to provide universal coverage work for adolescents, by asking (and suggesting answers for) some important questions. Are adolescents adequately covered by a pooled financing arrangement (insurance- or tax-based)? If not, there may need to be a focus on increasing overall coverage and/or on measures that particularly target adolescents, including older adolescents. Do adolescents have to pay fees to use essential services, and if so, what is the impact of fees on their use of services? If this is a problem, exemptions could be a short-term measure. Are the services that are appropriate for adolescents covered by pooled financing arrangements? Decisions about services for adolescents are made by the agencies responsible for allocating the money in pooled health funds. Financing may not happen if adolescents are not seen as a priority in a contest for resources; if there is little awareness or information available about adolescents’ health needs; or if there is not a strong commitment to providing services related to potentially sensitive issues such as pre-marital sex, substance abuse or mental health.1
1. Walt G, Gilson L. Can frameworks inform knowledge about health policy processes? Reviewing health policy papers on agenda setting and testing them against a specific priority-setting framework. Health Policy & Planning 2014;29 (Suppl 3):iii6-iii22. http://dx.doi.org/10.1093/heapol/czu081.
1. Waddington C, Sambo C. Financing health care for adolescents: a necessary part of universal health coverage. Bulletin of the World Health Organization 2015;93:57-9. http://dx.doi.org/10.2471/BLT.14.139741.
Sexual and reproductive health and rights in changing health systems This paper explores what introduction of concepts of universal health coverage and care mean for sexual and reproductive health and rights, and for gender equity in health. Health system reform that does not address the core elements of the sexual and reproductive health and rights agenda will fail to meet important criteria of equality of access and affordability and will fail to meet the need for acceptability and quality in health services. Such reform could also remain weak on accountability. Although many elements in the concept of universal health coverage (such as its core principle of universality and its recognition of critical systemic factors) have value for sexual and reproductive health, there are missing or 165