Abstract
Background: Globally, as countries move towards universal health coverage (UHC), public participation in decisionmaking is particularly valuable to inform difficult decisions about priority setting and resource allocation. In South Africa (SA), which is moving towards UHC, public participation in decision-making is entrenched in policy documents yet practical applications are lacking. Engagement methods that are deliberative could be useful in ensuring the public participates in the priority setting process that is evidence-based, ethical, legitimate, sustainable and inclusive. Methods modified for the country context may be more relevant and effective. To prepare for such a deliberative process in SA, we aimed to modify a specific deliberative engagement tool – the CHAT (Choosing All Together) tool for use in a rural setting. Methods: Desktop review of published literature and policy documents, as well as 3 focus groups and modified Delphi method were conducted to identify health topics/issues and related interventions appropriate for a rural setting in SA. Our approach involved a high degree of community and policy-maker/expert participation. Qualitative data were analysed thematically. Cost information was drawn from various national sources and an existing actuarial model used in previous CHAT exercises was employed to create the board. Results: Based on the outcomes, 7 health topics/issues and related interventions specific for a rural context were identified and costed for inclusion. These include maternal, new-born and reproductive health; child health; woman and child abuse; HIV/AIDS and tuberculosis (TB); lifestyle diseases; access; and malaria. There were variations in priorities between the 3 stakeholder groups, with community-based groups emphasizing issues of access. Violence against women and children and malaria were considered important in the rural context. Conclusion: The CHAT SA board reflects health topics/issues specific for a rural setting in SA and demonstrates some of the context-specific coverage decisions that will need to be made. Methodologies that include participatory principles are useful for the modification of engagement tools like CHAT and can be applied in different country contexts in order to ensure these tools are relevant and acceptable. This could in turn impact the success of the implementation, ultimately ensuring more effective priority setting approaches.
Highlights
Background Public engagement in priority setting for health is the practice of actively involving members of the public in the decisionmaking activities of health policy development, which can include health service design and planning.[1,2] The moral imperative of transparency and public engagement is widely recognized by health experts and ethicists.[3,4,5,6] These perspectives demonstrate that health priority-setting should reflect the values of the public, and the decision-making process, should include their involvement
Public engagement in decision-making is viewed as valuable to inform difficult decisions about priority setting and resource allocation as countries move towards universal health coverage (UHC).[9,10]
Focus Group Discussions Some common themes emerged across all focus group discussion (FGD), some of which overlapped with the topics/issues identified from the desktop review
Summary
Background Public engagement in priority setting for health is the practice of actively involving members of the public in the decisionmaking activities of health policy development, which can include health service design and planning.[1,2] The moral imperative of transparency and public engagement is widely recognized by health experts and ethicists.[3,4,5,6] These perspectives demonstrate that health priority-setting should reflect the values of the public, and the decision-making process, should include their involvement. Beyond improving the ability of the public to influence decisions on issues that affect their lives, public engagement has the potential to reinforce the legitimacy and the public acceptability of the decision-making process and its outcomes; increase the success rate of policy implementation; manage community expectations and improve public understanding of the issues considered.[7,8] Public engagement in decision-making is viewed as valuable to inform difficult decisions about priority setting and resource allocation as countries move towards universal health coverage (UHC).[9,10]. By bringing the voices of decision-makers and the public together the priority setting agenda can be set not just by experts and by the public. Including barriers to physical access, poverty, social exclusion, disconnect between local and national priorities, time constraints and lack of oversight among others.[2]
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