Abstract
BackgroundTranslating research evidence from global guidance into policy can help strengthen health systems. A workbook was developed to support the contextualization of the WHO’s ‘Optimizing health worker roles to improve maternal and newborn health’ (OptimizeMNH) guidance. This study evaluated the use of the workbook for the development of evidence briefs in two countries — Peru and Uganda. Findings surrounding contextual factors, steps in the process and evaluation of the workbook are presented.MethodsA qualitative embedded case study was used. The case was the process of using the workbook to support the contextualization of global health systems guidance, with local evidence, to develop evidence briefs. Criterion sampling was used to select the countries, participants for interviews and documents included in the study. A template-organizing style and constant comparison were used for data analysis.ResultsA total of 19 participant-observation sessions and 8 interviews were conducted, and 50 documents were reviewed. Contextual factors, including the cadres, or groups, of health workers available in each country, the way the problem and its causes were framed, potential policy options to address the problem, and implementation considerations for these policy options, varied substantially between Peru and Uganda. However, many similarities were found in the process of using the workbook. Overall, the workbook was viewed positively and participants in both countries would use it again for other topics.ConclusionsOrganizations that produce global guidance, such as WHO, need to consider institutionalizing the application of the workbook into their guidance development processes to help users at the national/subnational level create actionable and context-relevant policies. Feedback mechanisms also need to be established so that the evidence briefs and health policies arising from global guidance are tracked and the findings coming out of such guideline contextualization processes can be taken into consideration during future guidance development and research priority-setting.
Highlights
Weak health systems hinder the delivery of and access to effective clinical and public health interventions to those most in need, especially in low- and middleincome countries, where these systems can be overburdened and under-resourced [1,2,3]
In turn, be used to (1) develop policies at the global level; (2) develop guidance at the national level (for example, Evidence-Informed Policy Network (EVIPNet) developing an evidence brief); and (3) develop policies at the national or subnational level [4]
The criteria included (1) commitment from policy-makers, the WHO country office, regional office and/or headquarters, or from the Ministry of Health to support the development of an evidence brief by using the workbook to contextualize the OptimizeMNH guidance, and (2) the prerequisite that the country had not conducted formal work on task shifting with regards to the OptimizeMNH guidance
Summary
Weak health systems hinder the delivery of and access to effective clinical and public health interventions to those most in need, especially in low- and middleincome countries, where these systems can be overburdened and under-resourced [1,2,3]. To our knowledge, there was no tool available to support users of health systems guidance in combining global recommendations with local assessments of the problem and its causes, existing health systems arrangements (delivery, financial and governance arrangements) and political system considerations (institutions, interests, ideas and external factors) in order to help with the contextualization process [4]. Considering these factors during policy development can ensure the policy options are designed to meet the needs and realities of a given setting, which can aid with implementation [4]. Steps in the process and evaluation of the workbook are presented
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