Supporting policy dialogue for health planning and health financing

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Presentation transcript:

Supporting policy dialogue for health planning and health financing Brisbane, October 25th 2017 Supporting policy dialogue for health planning and health financing A realist intervention theory of the Universal Health Coverage Partnership E. Robert, D. Porignon, D. Rajan, V. Ridde Les questions qui servent de fil conducteur : In what respects and why have realist methods been useful?

Objectives of the presentation To present the intervention theory as the first output of the research To reflect on the value of the intervention theory and the research process

Context Universal health coverage (UHC) as a blueprint to strengthen health systems in developing countries Policy dialogue as a promising governance tool: process targeting both the technical and policy aspects of the problem being discussed, involving evidence and sensitive policy discussions, in which a wide range of stakeholders participate, with a concrete objective, such as the development of a plan or strategy UHC-Partnership to support policy dialogue for health planning and health financing in about 30 countries Typical soft intervention: how to account for outcomes in different settings with major contextual influences?

Method 1st round: 2nd round : 3rd round : For the realist evaluation For the intervention theory Objective: to better understand if the UHC- Partnership can contribute to strengthen policy dialogue, how and in what contexts Multiple case study (Togo, Liberia, Burkina Faso, Niger, DRC, Cape Verde) Qualitative research 1st round: Documentation Formal discussions with implementers 2nd round : Observations Interviews with key informants Literature review 3rd round : Discussions with implementers

UHC-P realist intervention theory Approach (SOFT) On-going support Training Capacity building of MoH Knowledge and resources production Components of support (HARD) Results MoH ownership of the process Mutual understanding of values, agendas, and needs of stakeholders Stakeholders’ buy-in of decisions Mécanismes Trust in a structured and transparent process Outcomes Formulation of robust and comprehensive health policies, strategies and plans Alignment of stakeholders Strengthened leadership of MoH Goal MAKE IT HAPPEN Support to policy dialogue M (?) Flexibility Fed by knowledge Inclusive and participatory Led by MoH Contribution Ad hoc technical expertise Policy dialogue TRIGGERS Responsiveness Support to institutionalisation of policy dialogue for health planning and financing Strengthening of governance towards Universal Health Coverage M (?) MAKE IT HAPPEN Proactiveness UHC-P realist intervention theory

The researchers’ perspective (1) For the research team Provides a common understanding of the intervention Becomes a framework to look at national experiences Exposes the two level analysis of the research Challenges: The IT does not depicts reality. It is a way to look at reality. How to move away from this “typical” representation? Social sciences and anthropology researchers unfamiliar with IT

The researchers’ perspective (2) For commissioners & implementers A way to send out messages : Ensure a common understanding of the intervention Demonstrate the complexity of the analysis Illustrate the multiple causal pathways and far-reaching and long term expected outcomes Lower expectations

The implementers’ perspective (Feedback from the field) The process The intervention theory Allowed for clarifications about both the intervention and their role Provoked discussions and triggers a reflective process among implementers on their role Raised awareness about the research process Provided - in a structured and synthesized manner - an illustration of their role Gave a sense to action Why? No time to step back when in the job Loss of sight of the objectives Possible confusion on role in the UHC-P vs. traditional role / way of doing thing (technical support to MoH)

The commissioner’s perspective Complex intervention on policy dialogue at country level The "million lives saved" syndrome The bureaucratic approach of donors to evaluation The attribution nightmare Confirm the perceptions of policy-makers Demonstrate actual outcomes of the intervention: WHO's role and mandate as an institution The real life of the process over time Identification of the mechanisms

Several ways at looking at policy dialogue & UHC-Partnership Normative evaluation SOM (EU) Research on policy dialogue Realist research Mandate Results/Objectives Results/objectives Perceptions of policy dialogue in the field Context & mechanisms Added value Valued by donors/stakeholders Responds to donor requirements Set the scene of policy dialogue in SSA Flexible Key actionable factors Limits Mechanistic attribution "Governed by numbers" No expertise in health systems « A côté de la plaque » Not about the UHC-P No attribution Does it work? Too sensitive to contexts?

Lessons learnt The intervention theory as an efficient tool to: Reflect on the intervention Structure the research process Building the intervention theory as a necessary step to : Ensure a shared understanding among researchers, implementers and commissioners about the research object, the intervention, and the research process Challenges of collaboration: symbolic vs. instrumental use of research findings?

Emilie Robert is a postdoctoral researcher at the Research Institute of McGill University Health Centre (Montreal, Canada). She holds a scholarship from the Canadian Institute of Health Research. Contact: emilie.robert2@mail.mcgill.ca Twitter: @emilie_robert_ Denis Porignon is a health policy specialist at the Department of Health Systems Governance and Financing at WHO (Geneva, Switzerland). Contact: porignond@who.int Twitter: @DenisPorignon Dheepa Rajan is a health policy specialist at the Department of Health Systems Governance and Financing at WHO (Geneva, Switzerland). Contact: rajand@who.int Twitter: @Dheepa_Rajan Valéry Ridde is a professor at the School of Public Health at Montreal University (Canada). Contact: valery.ridde@umontreal.ca Twitter: @ValeryRidde