A scoping review of researchers' involvement in health policy dialogue in Africa.

BACKGROUND: Improving evidence-informed policy dialogue to support the development and implementation of national health policies is vital, but there is limited evidence on researchers' roles in policy dialogue processes in Africa. The objective of this study is to examine researchers' involvement in health policy dialogue in Africa. METHODS: The database search of this scoping review was conducted from inception to January 24, 2021, by an expert searcher/librarian to determine the extent of evidence, barriers, and facilitators of researchers' involvement in health policy dialogues in Africa. PROSPERO, Wiley Cochrane Library, OVID Medline, OVID EMBASE, OVID PsycINFO, OVID Global Health, EBSCO CINAHL, BASE (Bielefeld Academic Search Engine), and Google/Google Scholar were searched using key words representing the concepts "policy dialogue", "health", and "Africa". No limits were applied. A narrative summary of results was presented. RESULTS: There were 26 eligible studies representing 21 African countries. Significant discrepancies in researchers' involvement existed across countries. In 62% of the countries, there was suboptimal involvement of researchers in policy dialogues due to no or partial participation in policy dialogues. Major barriers included limited funding, lack of evidence in the public health field of interest, and skepticism of policymakers. The presence of an interface for exchange, demand for scientific evidence, and donors' funding were the most reported facilitators. CONCLUSIONS: To improve the uptake of evidence in health policy-making processes, an environment of trust and communication between policymakers and researchers must be established. Policymakers need to demonstrate that they value research, by providing adequate funding, promoting knowledge translation activities, and supporting personal and professional development opportunities for researchers.

Priority-setting to integrate sexual and reproductive health into universal health coverage: the case of Malaysia.

Despite increasing calls to integrate and prioritise sexual and reproductive health (SRH) services in universal health coverage (UHC) processes, several SRH services have remained a low priority in countries' UHC plans. This study aims to understand the priority-setting process of SRH interventions in the context of UHC, drawing on the Malaysian experience. A realist evaluation framework was adopted to examine the priority-setting process for three SRH tracer interventions: pregnancy, safe delivery and post-natal care; gender-based violence (GBV) services; and abortion-related services. The study used a qualitative multi-method design, including a literature and document review, and 20 in-depth key informant interviews, to explore the context-mechanism-outcome configurations that influenced and explained the priority-setting process. Four key advocacy strategies were identified for the effective prioritisation of SRH services, namely: (1) generating public demand and social support, (2) linking SRH issues with public agendas or international commitments, (3) engaging champions that are internal and external to the public health sector, and (4) reframing SRH issues as public health issues. While these strategies successfully triggered mechanisms, such as mutual understanding and increased buy-in of policymakers to prioritise SRH services, the level and extent of prioritisation was affected by both inner and outer contextual factors, in particular the socio-cultural and political context. Priority-setting is a political decision-making process that reflects societal values and norms. Efforts to integrate SRH services in UHC processes need both to make technical arguments and to find strategies to overcome barriers related to societal values (including certain socio-cultural and religious norms). This is particularly important for sensitive SRH services, like GBV and safe abortion, and for certain populations.

Challenges and facilitators to the provision of sexual, reproductive health and rights services in Ghana.

Expanding access to sexual and reproductive health (SRH) services is one of the key targets of the Sustainable Development Goals. The extent to which sexual and reproductive health and rights (SRHR) targets will be achieved largely depends on how well they are integrated within Universal Health Coverage (UHC) initiatives. This paper examines challenges and facilitators to the effective provision of three SRHR services (maternal health, gender-based violence (GBV) and safe abortion/post-abortion care) in Ghana. The analysis triangulates evidence from document review with in-depth qualitative stakeholder interviews and adopts the Donabedian framework in evaluating provision of these services. Critical among the challenges identified are inadequate funding, non-inclusion of some SRHR services including family planning and abortion/post-abortion services within the health benefits package and hidden charges for maternal services. Other issues are poor supervision, maldistribution of logistics and health personnel, fragmentation of support services for GBV victims across agencies, and socio-cultural and religious beliefs and practices affecting service delivery and utilisation. Facilitators that hold promise for effective SRH service delivery include stakeholder collaboration and support, health system structure that supports continuum of care, availability of data for monitoring progress and setting priorities, and an effective process for sharing lessons and accountability through frequent review meetings. We propose the development of a national master plan for SRHR integration within UHC initiatives in the country. Addressing the financial, logistical and health worker shortages and maldistribution will go a long way to propel Ghana's efforts to expand population coverage, service coverage and financial risk protection in accessing essential SRH services.

What happens during antenatal visits? An ethnographic study of pregnant women's experiences with midwives in Benin.

Pregnancy and childbirth place women at risk of morbidity and mortality, particularly in Benin where the health system is fragile. This study aimed to understand women's experiences concerning their interactions with midwives during antenatal visits and to explore contextual factors influencing these interactions and the quality of care received. A qualitative study was conducted from June to August 2015 in two primary health facilities in So-Ava, Benin. One hundred seven individual in-depth interviews with 100 pregnant women, five midwives, and two physicians and one focus group discussion with seven government decision-makers were conducted. Despite midwives' good intentions, most pregnant women reported absenteeism, delays, cold attitudes, fear-based communication, and arbitrary and non-consensual interventions during antenatal visits and believed midwives would interfere with their family relationships. The suboptimal quality of care provided by midwives was interpreted as due to several factors, including lack of accountability of midwives in health facilities. The communication of midwives with pregnant women needs improvement. Results of this study highlight the importance of understanding the problem from the perspective of the political economy of the Benin health system to address its structural and systemic failures with open dialogue, including implementation of accountability measures.

Provision of consumer health information in Alberta's Rural Public Libraries.

BACKGROUND: Access to health services is a major challenge in many rural communities within Canada. Rural public libraries can serve as centres for health resources. OBJECTIVE: The aim of this exploratory study was to analyse the manner in which Alberta's rural libraries provide health information to their patrons. METHODS: A questionnaire including closed ended and open ended questions was sent to the 285 rural libraries across the Canadian province of Alberta. Descriptive statistics and thematic analysis techniques were used for the data analysis. RESULTS: The findings indicate that in three quarters of Alberta's rural libraries, about 10% of requests for assistance were related to health issues. The provision of health information in these libraries is hampered by the lack of Internet, private space for reference interviews, and staff and volunteer training. Library staff members were inexperienced in conducting reference transactions and reported lacking confidence in meeting patrons' needs and ethical standards. DISCUSSION: Addressing these challenges will require the recruitment of more qualified librarians in rural library systems, possibly through incentive measures, and a comprehensive education and training programme for both staff and volunteers combined with the necessary resource support for the rural libraries. CONCLUSION: When human and material resources are adequate, rural libraries can contribute to improving the health literacy of their communities.

Improving social accountability processes in the health sector in sub-Saharan Africa: a systematic review.

BACKGROUND: Social accountability is a participatory process in which citizens are engaged to hold politicians, policy makers and public officials accountable for the services that they provide. In the Fifteenth Ordinary Session of the Assembly of the African Union, African leaders recognized the need for strong, decentralized health programs with linkages to civil society and private sector entities, full community participation in program design and implementation, and adaptive approaches to local political, socio-cultural and administrative environments. Despite the increasing use of social accountability, there is limited evidence on how it has been used in the health sector. The objective of this systematic review was to identify the conditions that facilitate effective social accountability in sub-Saharan Africa. METHODS: Electronic databases (MEDLINE, PsycINFO, Sociological Abstracts, Social Sciences Abstracts) were searched for relevant articles published between 2000 and August 2017. Studies were eligible for inclusion if they were peer-reviewed English language publications describing a social accountability intervention in sub-Saharan Africa. Qualitative and quantitative study designs were eligible. RESULTS: Fourteen relevant studies were included in the review. The findings indicate that effective social accountability interventions involve leveraging partnerships and building coalitions; being context-appropriate; integrating data and information collection and analysis; clearly defined roles, standards, and responsibilities of leaders; and meaningful citizen engagement. Health system barriers, corruption, fear of reprisal, and limited funding appear to be major challenges to effective social accountability interventions. CONCLUSION: Although global accountability standards play an important guiding role, the successful implementation of global health initiatives depend on national contexts.

Determinants of bed net policy implementation: A case study of Southern Benin.

BACKGROUND: Malaria is a major global health challenge. This study aims to clarify the manner in which contextual factors determine the use and maintenance of bed nets and the extent to which malaria prevention policy is responsive to them in Southern Benin. METHODS: Semi-structured interviews and direct observations were undertaken with 30 pregnant women in the municipality of So-Ava from June to August 2015. Key informants in the Ministry of Health and local community health workers were also interviewed regarding malaria prevention policy formation, and the monitoring and evaluation of bed net interventions, respectively. Data were analyzed through categorical content analysis and grouped into themes. RESULTS: The majority of pregnant women participants (80%) declared non-adherence to instructions for hanging and maintaining insecticide-treated nets (ITNs). The distributed bed nets were washed like clothes, which affected their bio-efficacy, and were in poor condition (ie, torn or had holes). Multiple factors contributed to the poor condition of ITNs: Pregnant women's limited understanding of risk including their inability to connect the key environmental factors to personal risk, gendered responsibility for installing bed nets, and lack of public measures that would enable women to re-treat or access new bed nets as needed. Poverty that determined structural aspects of housing such as the size and quality of homes and access to bed nets exacerbated the challenges. CONCLUSION: Institutionalizing an iterative process of monitoring, review, and responsive adaptation throughout the entire policymaking cycle would better support malaria preventive policy implementation in Benin.

Governance of malaria prevention: How decision-makers' and pregnant women's sensemaking contribute to unintended consequences.

Although malaria in pregnancy predisposes women to increased perinatal mortality and morbidity, complex issues underlie its persistence. To develop a better understanding of the factors affecting women's access to Intermittent Preventive Treatment in Benin, we used the theoretical lens of "sensemaking" to clarify policymakers', health professionals', and women's perspectives concerning preventive policies and barriers to access. Several assumptions were found to underlie Benin's malaria preventive policy that contribute to the unintended effect of deterring pregnant women in poverty from accessing preventive treatment. Health system dysfunctions including drug shortages and deficiencies in health care professionalism exacerbate the unintended effect.

Extent of Knowledge about HIV and Its Determinants among Men in Bangladesh.

BACKGROUND: Bangladesh is currently a low human immunodeficiency virus (HIV) prevalent country. However, the risk factors are widespread and the number of at-risk population is also rising, which warrants special policy attention. The risks of transmission were shown to be correlated with the level of HIV knowledge of individuals. In this study, we aimed to explore the level and influencing factors of HIV knowledge among adult men in Bangladesh. METHODOLOGY: Data for the present study were collected from the sixth round of Bangladesh Demographic and Health Survey. Participants were 3305 men between 15 and 54 years of age regardless of HIV status. The primary outcome variable was the HIV knowledge score, which was calculated by responses to questions regarding general concepts and the mode of transmission of HIV. Association between the HIV knowledge score and the explanatory variables were analyzed by binary logistic regression methods. RESULT: The mean HIV knowledge score was 7.2 (SD 1.3). Results indicate that being an urban resident [p < 0.001; odds ratios (OR) = 0.56, 95% confidence intervals (CI) = 0.48-0.64], having secondary/higher educational level (p < 0.001 OR = 0.56, 95%CI = 0.48-0.64), reading newspaper [p = 0.006; OR = 0.76, 95%CI = 0.62-0.92], and communication with community health workers (CHWs) (p = 0.05; OR = 0.77, 95%CI = 0.60-10.00) were significantly associated with a high (equal or above mean value) HIV knowledge level. CONCLUSION: The level of HIV knowledge among Bangladeshi men is low. Leveraging HIV awareness programs targeting adult men to prevent future expansion of the epidemic should be a high priority. Revitalization and restructuring of the education sector and strengthening CHW's engagement to improve knowledge about HIV transmission among men could generate beneficial returns for HIV prevention programs.

Trends and determinants of HIV/AIDS knowledge among women in Bangladesh.

BACKGROUND: Globally, women share an indiscriminate burden of the HIV epidemic and the associated socioeconomic consequences. Previous studies have demonstrated a positive correlation between levels of HIV knowledge with its prevalence. However, for Bangladesh such evidence is non-existent. In this study, we aimed to explore the extent of HIV knowledge in relation to the socio-demographic variables such as age, region, area of residence i.e., urban or rural, wealth index and education, and investigate the factors influencing the level of HIV knowledge among Bangladeshi women. METHODS: We used data from the Bangladesh Demographic and Health Survey (BDHS) survey conducted in 2011. In total 12,512 women ageing between 15 and 49 ever hearing about HIV regardless of HIV status were selected for this study. HIV knowledge level was estimated by analyzing respondents' answers to a set of 11 basic questions indicative of general awareness and mode of transmission. Descriptive statistics, cross-tabulation and multinominal logistic regression were performed for data analysis. RESULTS: Little over half the respondents had good knowledge regarding HIV transmission risks. The mean HIV knowledge score was -0.001 (SD 0.914). Average correct response rate about mode of transmission was higher than for general awareness. Educational level of women and sex of household head were found to be significantly associated with HIV knowledge in the high score group. Those with no education, primary education or secondary education were less likely to be in the high score group for HIV knowledge when compared with those with higher than secondary level of education. Similarly those with male as household head were less likely to be in the higher score group for HIV knowledge. CONCLUSIONS: Level of HIV knowledge among Bangladeshi women is quite low, and the limiting factors are rooted in various demographic and household characteristics. Education and sex of the household head have been found to be significantly correlated with the level of HIV knowledge and propound sound grounds for their incorporation in the future HIV prevention strategies. Education of women may also have wider ramifications allowing reduction in gender inequality, which in turn favors higher knowledge about HIV.