Participatory policy analysis in health policy and systems research: reflections from a study in Nepal.
Health policy and systems research
Nepal
Participatory policy analysis
Qualitative evidence
Journal
Health research policy and systems
ISSN: 1478-4505
Titre abrégé: Health Res Policy Syst
Pays: England
ID NLM: 101170481
Informations de publication
Date de publication:
09 Jan 2024
09 Jan 2024
Historique:
received:
15
03
2023
accepted:
11
12
2023
medline:
10
1
2024
pubmed:
10
1
2024
entrez:
9
1
2024
Statut:
epublish
Résumé
Participatory policy analysis (PPA) as a method in health policy and system research remains underexplored. Using our experiences of conducting PPA workshops in Nepal to explore the impact of the country's move to federalism on its health system, we reflect on the method's strengths and challenges. We provide an account of the study context, the design and implementation of the workshops, and our reflections on the approach's strengths and challenges. Findings on the impact of federalism on the health system are beyond the scope of this manuscript. We conducted PPA workshops with a wide range of health system stakeholders (political, administrative and service-level workforce) at the local and provincial levels in Nepal. The workshops consisted of three activities: river of life, brainstorming and prioritization, and problem-tree analysis. Our experiences show that PPA workshops can be a valuable approach to explore health policy and system issues - especially in a context of widespread systemic change which impacts all stakeholders within the health system. Effective engagement of stakeholders and activities that encourage both individual- and system-level reflections and discussions not only help in generating rich qualitative data, but can also address gaps in participants' understanding of practical, technical and political aspects of the health system, aid policy dissemination of research findings, and assist in identifying short- and long-term practice and policy issues that need to be addressed for better health system performance and outcomes. Conducting PPA workshops is, however, challenging for a number of reasons, including the influence of gatekeepers and power dynamics between stakeholders/participants. The role and skills of researchers/facilitators in navigating such challenges are vital for success. Although the long-term impact of such workshops needs further research, our study shows the usefulness of PPA workshops for researchers, for participants and for the wider health system. PPA workshops can effectively generate and synthesize health policy and system evidence through collaborative engagement of health system stakeholders with varied roles. When designed with careful consideration for context and stakeholders' needs, it has great potential as a method in health policy and systems research.
Sections du résumé
BACKGROUND
BACKGROUND
Participatory policy analysis (PPA) as a method in health policy and system research remains underexplored. Using our experiences of conducting PPA workshops in Nepal to explore the impact of the country's move to federalism on its health system, we reflect on the method's strengths and challenges. We provide an account of the study context, the design and implementation of the workshops, and our reflections on the approach's strengths and challenges. Findings on the impact of federalism on the health system are beyond the scope of this manuscript.
MAIN BODY
METHODS
We conducted PPA workshops with a wide range of health system stakeholders (political, administrative and service-level workforce) at the local and provincial levels in Nepal. The workshops consisted of three activities: river of life, brainstorming and prioritization, and problem-tree analysis. Our experiences show that PPA workshops can be a valuable approach to explore health policy and system issues - especially in a context of widespread systemic change which impacts all stakeholders within the health system. Effective engagement of stakeholders and activities that encourage both individual- and system-level reflections and discussions not only help in generating rich qualitative data, but can also address gaps in participants' understanding of practical, technical and political aspects of the health system, aid policy dissemination of research findings, and assist in identifying short- and long-term practice and policy issues that need to be addressed for better health system performance and outcomes. Conducting PPA workshops is, however, challenging for a number of reasons, including the influence of gatekeepers and power dynamics between stakeholders/participants. The role and skills of researchers/facilitators in navigating such challenges are vital for success. Although the long-term impact of such workshops needs further research, our study shows the usefulness of PPA workshops for researchers, for participants and for the wider health system.
CONCLUSIONS
CONCLUSIONS
PPA workshops can effectively generate and synthesize health policy and system evidence through collaborative engagement of health system stakeholders with varied roles. When designed with careful consideration for context and stakeholders' needs, it has great potential as a method in health policy and systems research.
Identifiants
pubmed: 38195539
doi: 10.1186/s12961-023-01092-5
pii: 10.1186/s12961-023-01092-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7Subventions
Organisme : Medical Research Council, Economic and Social Research Council, Foreign Commonwealth and Development Office, and Wellcome Trust under the Health System Research Initiative Round 6
ID : MR/T023554/1
Informations de copyright
© 2024. The Author(s).
Références
Langlois ÉV, Daniels K, Akl EA, World Health Organization. Evidence synthesis for health policy and systems: a methods guide. Geneva: World Health Organization; 2018.
MacGregor H, Bloom G. Health systems research in a complex and rapidly changing context: ethical implications of major health systems change at scale. Dev World Bioeth. 2016;16(3):158–67.
doi: 10.1111/dewb.12115
pubmed: 26957047
pmcid: 5111606
Greenhalgh T, Papoutsi C. Studying complexity in health services research: desperately seeking an overdue paradigm shift. BMC Med. 2018;16(1):1–6.
doi: 10.1186/s12916-018-1089-4
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 Plan. 2014;29(suppl 3):iii6-22.
doi: 10.1093/heapol/czu081
pubmed: 25435537
Walt G, Shiffman J, Schneider H, Murray SF, Brugha R, Gilson L. ‘Doing’health policy analysis: methodological and conceptual reflections and challenges. Health Policy Plan. 2008;23(5):308–17.
doi: 10.1093/heapol/czn024
pubmed: 18701552
pmcid: 2515406
Ghaffar A, Gilson L, Tomson G, Viergever R, Røttingen JA. Where is the policy in health policy and systems research agenda? Bull World Health Organ. 2016;94(4):306.
doi: 10.2471/BLT.15.156281
pubmed: 27034524
Gilson L, Raphaely N. The terrain of health policy analysis in low- and middle-income countries: a review of published literature 1994–2007. Health Policy Plan. 2008;23(5):294–307.
doi: 10.1093/heapol/czn019
pubmed: 18650209
pmcid: 2515407
Majchrzak A. Focus of information inquiry. Methods Policy Res. 1984;24–32.
Masum JH. Rapid and Participatory Policy Analysis (RAPA)—a practical tool to analyze any policy at any time. Coastal Development Partnership (CDP); 2013.
Weimer DL, Vining AR. Policy analysis: concepts and practice. UK: Routledge; 2017.
doi: 10.4324/9781315442129
Kraft ME, Furlong SR. Public policy: politics, analysis, and alternatives. Thousand Oaks: Cq Press; 2019.
Shapiro S. Analysis and public policy: successes, failures and directions for reform. UK: Edward Elgar Publishing; 2016.
doi: 10.4337/9781784714765
Geurts JL, Joldersma C. Methodology for participatory policy analysis. Eur J Oper Res. 2001;128(2):300–10.
doi: 10.1016/S0377-2217(00)00073-4
Kunseler EM, Tuinstra W, Vasileiadou E, Petersen AC. The reflective futures practitioner: balancing salience, credibility and legitimacy in generating foresight knowledge with stakeholders. Futures. 2015;66:1–12.
doi: 10.1016/j.futures.2014.10.006
Loewenson R, Laurell AC, Hogstedt C, D’Ambruoso L, Shroff Z. Participatory action research in health systems: a methods reader. 2014.
Chambers R. Working Paper 286 PRA to PLA and Pluralism: Practice and Theory. Inst Dev Stud Httpsopendocs Ids Ac Ukopendocshandle20500 [Internet]. 2007. 12413. https://opendocs.ids.ac.uk/opendocs/bitstream/handle/20.500.12413/660/Wp286%20web.pdf?sequence=1&isAllowed=y . Accessed 7 Feb 2023.
DeLeon P. Participatory policy analysis: prescriptions and precautions. Asian J Public Adm. 1990;12(1):29–54.
Durning D. Participatory policy analysis in a social service agency: a case study. J Policy Anal Manage. 1993;12(2):297–322.
doi: 10.2307/3325237
Guba EG. What can happen as a result of a policy? Rev Policy Res. 1985;5(1):11–6.
doi: 10.1111/j.1541-1338.1985.tb00003.x
Baker S, Eckerberg K. A policy analysis perspective on ecological restoration. Ecol Soc. 2013;18(2).
Hommes S, Vinke-de Kruijf J, Otter HS, Bouma G. Knowledge and perceptions in participatory policy processes: lessons from the Delta-region in the Netherlands. Water Resour Manag. 2009;23(8):1641–63.
doi: 10.1007/s11269-008-9345-6
Kallis G, Videira N, Antunes P, Pereira ÂG, Spash CL, Coccossis H, et al. Participatory methods for water resources planning. Environ Plan C Gov Policy. 2006;24(2):215–34.
doi: 10.1068/c04102s
Sapkota S, Panday S, Wasti SP, Lee A, Balen J, van Teijlingen E, et al. Health system strengthening: the role of public health in Federal Nepal. J Nepal Public Health Assoc JNEPHA. 2022;7(1):36–42.
Secretariat CA, Durbar S. Constitution of Nepal 2015. Kathmandu Const Assem Secr. 2015.
Adhikari D. Nepal’s road to federalism. Kathmandu: RTI International; 2020.
Thapa R, Bam K, Tiwari P, Sinha TK, Dahal S. Implementing federalism in the health system of Nepal: opportunities and challenges. Int J Health Policy Manag. 2019;8(4):195.
doi: 10.15171/ijhpm.2018.121
pubmed: 31050964
Wasti SP, van Teijlingen E, Rushton S, Subedi M, Simkhada P, Balen J. Overcoming the challenges facing Nepal’s health system during federalisation: an analysis of health system building blocks. Health Res Policy and Syst. 2023;21:117.
doi: 10.1186/s12961-023-01033-2
Denov M, Shevell MC. An arts-based approach with youth born of genocidal rape in Rwanda: the river of life as an autobiographical mapping tool. Glob Stud Child. 2021;11(1):21–39.
doi: 10.1177/2043610621995830
pubmed: 33868636
pmcid: 8022799
Madu I, Adesope O, Ogueri E. Application of problem tree analysis in solving poverty related issues. Glob Approaches Ext Pr. 2018;13:62–9.
Niemeijer AR, Frederiks BJ, Depla MF, Legemaate J, Eefsting JA, Hertogh CM. The ideal application of surveillance technology in residential care for people with dementia. J Med Ethics. 2011;37(5):303–10.
doi: 10.1136/jme.2010.040774
pubmed: 21292695
Simon RW, Canacari EG. A practical guide to applying lean tools and management principles to health care improvement projects. AORN J. 2012;95(1):85–103.
doi: 10.1016/j.aorn.2011.05.021
pubmed: 22201573
Moussa Z. Tips for Trainers: Rivers of Life [Internet]. 2009 p. 183–6. https://pubs.iied.org/sites/default/files/pdfs/migrate/G02828.pdf . Accessed 14 Jul 2022.
Brainstorming: The Complete List of Tools and Techniques [Internet]. https://status.net/articles/brainstorming-tools-techniques/ . Accessed 14 Jul 2022.
Brainstorming 8 rules [Internet]. https://public-media.interaction-design.org/pdf/Brainstorm.pdf
Wilson C. Brainstorming and beyond: a user-centered design method. Newnes; 2013.
Ritter SM, Mostert NM. How to facilitate a brainstorming session: The effect of idea generation techniques and of group brainstorm after individual brainstorm. Creat Ind J. 2018;11(3):263–77.
Ammani A, Auta S, Aliyu J. Challenges to sustainability: Applying the problem tree analysis methodology to the ADP system in Nigeria. J Agric Ext. 2010;14(2):64122.
Problem Tree Analysis—Procedure and Example [Internet]. https://www.eawag.ch/fileadmin/Domain1/Abteilungen/sandec/schwerpunkte/sesp/CLUES/Toolbox/t8/D8_1_Problem_Tree_Analysis.pdf . Accessed 17 Jul 2022.
Slocum N. Participatory methods toolkit: a practitioner’s manual. Belgium: King Baudouin Foundation Brussels; 2003.
Ahmed S, Asraf RM. The workshop as a qualitative research approach: lessons learnt from a “critical thinking through writing” workshop. Turk Online J Des Art Commun. 2018;2018:1504–10.
Ørngreen R, Levinsen K. Workshops as a research methodology. Electron J E-Learn. 2017;15(1):70–81.
Khanal GN, Bharadwaj B, Upadhyay N, Bhattarai T, Dahal M, Khatri RB. Evaluation of the National Health Insurance Program of Nepal: are political promises translated into actions? Health Res Policy Syst. 2023;21(1):1–26.
doi: 10.1186/s12961-022-00952-w
Purtle J, Dodson EA, Brownson RC. Policy dissemination research. In: Dissemination and Implementation Research in Health: Translating Science to Practice, Second Edition. Oxford, Oxford University Press; 2017. p. 433–48.
Sween-Cadieux M, Dagenais C, Somé PA, Ridde V. Research dissemination workshops: observations and implications based on an experience in Burkina Faso. Health Res Policy Syst. 2017;15(1):1–12.
Brandt F, Josefsson J, Spierenburg M. Power and politics in stakeholder engagement. Ecol Soc. 2018;23(3).
O’Brien L, Marzano M, White RM. ‘Participatory interdisciplinarity’: towards the integration of disciplinary diversity with stakeholder engagement for new models of knowledge production. Sci Public Policy. 2013;40(1):51–61.
doi: 10.1093/scipol/scs120
Public Service International. Community-based health workers’ struggle in Nepal enters a new phase. 2018. https://www.world-psi.org/en/community-based-health-workers-struggle-nepal-enters-new-phase . Accessed 15 Jul 2022.
Nepal Federal Health System Team. Nepal Health Sector Strategic Plan 2022–30: Recommendations from the Nepal Federal Health System Project [Internet]. 2022. www.nepalfederalhealthsystem.com/publications/Policy-Briefs/MoPH-Policy-Brief-May2022