Examining the Link between Equity-Centered Health Policies, Autonomy and Decision-Making Process in Low and Middle Income Countries

Abstract Background In 2017, a survey-based women's empowerment index (SWPER) was proposed for African countries, including three domains: social independence, decision making and attitude to violence. We explored the applicability of the SWPER in national health surveys from countries in other world regions. Methods We used data from the latest Demographic and Health Survey for 62 low- and middle-income countries (LMICs) since 2000, and adapted the indicator so that it could be used for any LMIC. Adaptations included the exclusion of women's working status and recategorization of the household decision-making related items. We compared the loading patterns obtained from principal components analysis for each country separately with those obtained in a pooled dataset with all countries combined. Country rankings based on the score of each SWPER domain were correlated with their rankings in the Gender Development Index (GDI) and the Gender Inequality Index (GII). Results Most countries presented similar patterns regarding item loadings for the three SWPER empowerment domains. Correlations between the country-specific and global individual-level scores were 0.89 or higher for all countries. Correlations between the country rankings according to SWPER and GDI were, respectively, 0.74, 0.71 and 0.67 for social independence, decision-making, and attitude to violence domains. The correlations were equal to 0.82, 0.67, and 0.44, respectively, with GDI. Conclusions The SWPER global is a suitable common measure of women's empowerment for LMICs, addressing the need for a single consistent survey-based indicator of women's empowerment and allowing wider comparisons across countries and world regions.

Download Full-text

The Achilles heel of international health policies in low- and middle-income countries

International Health and Aid Policies ◽

10.1017/cbo9780511902512.007 ◽

2011 ◽

pp. 16-34

Author(s):

Jean-Pierre Unger ◽

Pierre De Paepe ◽

Kasturi Sen ◽

Werner Soors

Keyword(s):

International Health ◽

Health Policies ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Download Full-text

New vaccine adoption: qualitative study of national decision-making processes in seven low- and middle-income countries

Health Policy and Planning ◽

10.1093/heapol/czs035 ◽

2012 ◽

Vol 27 (suppl 2) ◽

pp. ii5-ii16 ◽

Cited By ~ 17

Author(s):

H. E. D. Burchett ◽

S. Mounier-Jack ◽

U. K. Griffiths ◽

R. Biellik ◽

P. Ongolo-Zogo ◽

...

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Middle Income ◽

Middle Income Countries ◽

Decision Making Processes ◽

Low And Middle Income

Download Full-text

Data Equity to Advance Health and Health Equity in Low- and Middle-Income Countries: A Scoping Review

Digital Health ◽

10.1177/20552076211061922 ◽

2021 ◽

Vol 7 ◽

pp. 205520762110619

Author(s):

So O‘Neil ◽

Sydney Taylor ◽

Anitha Sivasankaran

Keyword(s):

Decision Making ◽

Health Outcomes ◽

Health Equity ◽

Scoping Review ◽

Data Use ◽

Data Access ◽

Middle Income ◽

Middle Income Countries ◽

Improve Health ◽

Low And Middle Income

Objective To assess a common hypothesis that data serve as a mechanism to improve health and health equity in low-and middle-income countries (LMICs), we conducted a synthesis of the evidence about the linkage between data capabilities in LMICs and health outcomes. Methods We searched and reviewed peer-reviewed and grey literature published in the past decade that focused on at least one aspect of health data or health equity or provided insights on the relationship between data use and improved health outcomes, decision-making, or both. We supplemented this with expert interviews and convenience-sampled literature. Results Of the 50 included articles, 33 discussed data collection, with 23 stating that poor accuracy, reliability, and completeness hindered data-informed decision-making. Of 27 articles discussing data access, 18 described how lack of interoperability between data systems hampered governments’ and other organizations’ ability to leverage the full value of data available. Of 19 articles discussing data use, 13 discussed how data were not getting to those doing work on the ground. Although key informants postulated a virtuous cycle between data and improved health outcomes, evidence did not support this connection. Conclusions Findings indicate better data might improve health service delivery. However, more work is needed to examine whether improvements in data yield improvements in health outcomes in LMICs. Our conceptual framework of data equity for health and health equity developed through this scoping review helps identify the key components along which to assess improvements in LMICs’ data capabilities.

Download Full-text

Implementation and Evaluation of Nonclinical Interventions for Appropriate Use of Cesarean Section in Low- and Middle-income Countries: Protocol for a Multisite Hybrid Effectiveness-implementation Type III Trial

10.21203/rs.3.rs-35564/v1 ◽

2020 ◽

Author(s):

Alexandre Dumont ◽

Ana Pilar Betrán ◽

Charles Kabore ◽

Myriam De Loenzien ◽

Pisake Lumbiganon ◽

...

Keyword(s):

Decision Making ◽

Burkina Faso ◽

Implementation Strategy ◽

Organizational Factors ◽

Multifaceted Intervention ◽

Appropriate Use ◽

Middle Income ◽

Middle Income Countries ◽

The Impact ◽

Low And Middle Income

Abstract Background: While cesarean sections (CSs) are a life-saving intervention, an increasing number are performed without medical reasons in low- and middle-income countries (LMICs). Unnecessary CS diverts scarce resources and thereby reduces access to healthcare for women in need. Argentina, Burkina Faso, Thailand and Vietnam are committed to reducing unnecessary CS, but many individual and organizational factors in healthcare facilities obstructthis aim. Nonclinical interventions can overcome these barriers by helping providers improve their practices and supporting women’s decision-making regarding childbirth. Existing evidence has shown only a modest effect of single interventions onreducing CS rates, arguably because of the failure to design multifaceted interventions effectively tailored to the context. The aim of this studyis to design, adapt and test a multifaceted intervention for the appropriate use of CS in Argentina, Burkina Faso, Thailand and Vietnam. Methods: We designed an intervention (QUALIty DECision-making - QUALI-DEC) with four components: (1) opinion leaders at heath care facilities to improve adherence to best practices among clinicians, (2) CS audits and feedback to help providers identify potentially avoidable CS, (3) a decisionanalysistool to helpwomen make an informed decision on the mode of birth, and (4) companionship to support women during labor.QUALI-DEC will be implemented and evaluated in 32 hospitals (8 sites per country) using a pragmatic hybrid effectiveness-implementation design to test our implementation strategy, and information regardingits impact on relevant maternal and perinatal outcomes will be gathered. The implementation strategy will involve the participation of women, healthcare professionals and organizations and account for the local environment, needs, resources and social factors in each country.Discussion:There is urgent need for interventions and implementation strategies to optimize the use of CS while improving health outcomes and satisfaction in LMICs. This can only be achieved by engaging all stakeholders involved in the decision-making process surroundingbirth and addressing their needs and concerns. The study will generate robust evidence about the effectiveness and the impact of this multifaceted intervention. It will also assess the acceptability and scalability of the intervention and the capacity for empowerment among women and providers alike. Trial registration: ISRCTN67214403

Download Full-text

Value and effectiveness of National Immunization Technical Advisory Groups in low- and middle-income countries: a qualitative study of global and national perspectives

Health Policy and Planning ◽

10.1093/heapol/czz027 ◽

2019 ◽

Vol 34 (4) ◽

pp. 271-281 ◽

Cited By ~ 5

Author(s):

Sadie Bell ◽

Laurence Blanchard ◽

Helen Walls ◽

Sandra Mounier-Jack ◽

Natasha Howard

Keyword(s):

Decision Making ◽

World Health ◽

Middle Income ◽

Middle Income Countries ◽

Immunization Programme ◽

National Immunization ◽

National Immunization Programme ◽

Management Procedures ◽

Decision Making Processes ◽

Low And Middle Income

Abstract The Global Vaccine Action Plan proposes that every country establish or have access to a National Immunization Technical Advisory Group (NITAG) by 2020. The NITAG role is to produce evidence-informed recommendations that incorporate local context, to guide national immunization policies and practice. This study aimed to explore the value and effectiveness of NITAGs in low- and middle-income countries (LMICs), identifying areas in which NITAGs may require further support to improve their functionality and potential barriers to global investment. A multi-methods study design was used, comprising 134 semi-structured interviews and 82 literature review sources that included 38 countries. Interviews were conducted with 53 global/regional and 81 country-level participants able to provide insight into NITAG effectiveness, including NITAG members, national immunization programme staff, and global agency representatives (e.g. the World Health Organisation, the Bill and Melinda Gates Foundation, Gavi the Vaccine Alliance). The review, including published and unpublished sources on NITAGs in LMICs, was conducted to supplement and corroborate interview findings. Data were analysed thematically. NITAGs were described as valuable in promoting evidence-informed vaccination decision-making, with NITAG involvement enhancing national immunization programme strength and sustainability. Challenges to NITAG effectiveness included: (1) unreliable funding; (2) insufficient diversity of member expertise; (3) inadequate conflicts of interest management procedures; (4) insufficient capacity to access and use evidence; (5) lack of transparency; and (6) limited integration with national decision-making processes that reduced the recognition and incorporation of NITAG recommendations. LMIC NITAGs have developed significantly in the past decade. Well-functioning NITAGs were trusted national resources that enhanced country ownership of immunization provision. However, many LMIC NITAGs require additional technical and funding support to strengthen quality and effectiveness, while maintaining impartiality and ensuring sufficient integration with national decision-making processes. Barriers to sustainable global support need to be addressed for LMIC NITAGs to both continue and develop further.

Download Full-text

Application of evidence-informed deliberative processes in health technology assessment in low- and middle-income countries

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462320000549 ◽

2020 ◽

Vol 36 (4) ◽

pp. 440-444

Author(s):

Wija Oortwijn ◽

Sanne van Oosterhout ◽

Lydia Kapiriri

Keyword(s):

Decision Making ◽

Health Technology Assessment ◽

Technology Assessment ◽

Contextual Factors ◽

Health Technology ◽

Appraisal Committee ◽

Middle Income ◽

Middle Income Countries ◽

Deliberative Processes ◽

Low And Middle Income

ObjectivesEvidence-informed deliberative processes (EDPs) were introduced to guide health technology assessment (HTA) agencies to improve their processes toward more legitimate decision making. A survey among members of the International Network of Agencies for HTA (INAHTA) showed that EDPs can also be relevant for countries that have not (yet) established such an agency. Therefore, we explored to what extent low- and middle-income countries (LMIC) applied the steps and elements stipulated in the EDP framework and their need for guidance.MethodsThe survey among INAHTA members was slightly adapted to address LMIC context and sent to 416 experts identified through several HTA sources. The questions focused on contextual factors and the EDP steps (installation of an appraisal committee, selecting technologies and criteria, assessment, appraisal, communication and appeal). Data collection took place between 21 May and 1 September 2019. Descriptive statistics and qualitative analyses were used to summarize the findings.ResultsWe received sixty-six meaningful responses from experts in thirty-two LMIC. We found that contextual factors to support HTA development are overall not present or only present to some extent. Respondents indicated that guidance was needed for specific elements related to selecting technologies and criteria, assessment, appraisal, as well as communication and appeal.ConclusionsEDPs have the potential to provide steps for improving HTA processes. The results of this study can serve as a baseline measurement for future monitoring and evaluation of EDP application in the responding LMIC. This could support the countries in improving their processes and enhancing legitimate decision making when using HTA.

Download Full-text