Can decision-making processes for health systems strengthening and universal health coverage (UHC) be made more inclusive, responsive and accountable? This project will explore this question, focusing on the extent to which actively involving civil society voices and other stakeholders can humanise decision-making processes for UHC and promote equity. How countries pursue UHC depends on their approaches to strengthening health systems. However, this should ideally include using evidence to inform decisions about health systems interventions, and involving stakeholders in these processes. Our research therefore focuses on two key areas: evidence-informed health systems decisions and inclusive and accountable decision-making. We will explore national and subnational decision-making processes in Ghana and Kenya—two low- and middle-income countries (LMICs) with a political commitment to UHC, and focused on implementing decentralization as a key strategy for health sector reform and more inclusive governance.
The project has three objectives: 1) to identify factors affecting the participation and agency of civil society during national and subnational evidence-informed health policy processes; 2) to explore how policymakers in Ghana and Kenya engage with, value and use different types of evidence, particularly qualitative evidence on stakeholder views and experiences, when making health systems decisions on service delivery reforms and; 3) to develop new tools to support inclusive and accountable health systems decisions at national and subnational levels. Project partners include the University of Ghana, the Kenyan Medical Research Institute (KEMRI), the University of Oslo and the Norwegian Institute of Public Health. Our findings will provide key insights on how citizen voices, including research evidence on citizen perspectives, can be included in health decision making in LMICs and how this can contribute to more inclusive, accountable and equitable health systems.
The overall goal of this project is to explore how decision-making processes for health systems strengthening and universal health coverage (UHC) can be made more inclusive, responsive and accountable. We will focus on the extent to which giving greater prominence to the voices of civil society groups and other stakeholders, both directly and through the wider use of qualitative and local evidence, can humanise decision-making processes and promote equity. As a major sub-goal of United Nations (UN) Sustainable Development Goal (SDG) 3 on ‘Good health and well-being’, UHC is now a global political priority. How countries pursue UHC depend on their approaches to strengthening health systems. But for all countries, this should ideally include the use of evidence to inform decisions about the financing, governance and delivery of health services, and the inclusive involvement of stakeholders in these processes.The ongoing COVID-19 pandemic has reinforced the value of assessing a wide range of evidence and listening to a wide range of stakeholders when health systems decisions are made. Our proposal will advance a research agenda at the intersection of two key ambitions: evidence-informed health systems decisions and inclusive and accountable decision-making. We will explore and compare national and subnational decision-making processes in Ghana and Kenya—two low- and middle-income countries (LMICs) with a political commitment to UHC. As these countries strive to deliver health care services for their populations, we will examine how they are using evidence to, firstly, help policymakers contextualize global guidance by integrating local stakeholder views and, secondly, foster agency among civil society stakeholders.