Session 3.3 – Involving the Public in Prioritization decisions

Thursday October 30 8:30-10:00

Community Voice and Health Planning at a District Level: A Comparison Between Health Planners and Lay People Priorities in Tanzania

(Abstract 0136)

Emmanuel Makundi3, Aziza Mwisongo1, Stephen Magesa1, Willium Tubet4, Andrew Kitua1, Ole Frijorf Norheim2
1National Institute for Medical Research, Tanzania, United Republic of, 2Department of Public Health and Primary Health Care, Norway, 3Centre for International Health, University of Bergen, Norway, 4Regional Medical Office- Kagera, Tanzania, United Republic of

Background: The burden of disease and health problems are perceived differently among those affected by priority setting. Tools for involving the public in priority setting and health planning are called for.

Objectives: To compare health problems as identified by district managers and those defined by the community. Secondly, to explore the potential for using Nominal Group Technique (NGT) participatory methodology as a tool for priority setting and planning at a district level.

Methodology: The study population included purposefully sampled set of community members (n =117) and District Health Management Team (DHMT) members (n = 36). The Nominal Group Technique was used to identify major health problems. The study site included five districts of Kagera region in North-western Tanzania.

Results: Our findings show a great variation between district health managers’ priorities and those identified by lay people. Whereas health managers considered lack of skilled personnel, low salaries and limited motivation as priority problems, lay people at community level considered harsh language from health workers and inadequate health education as the leading problem. In addition lack of water, hunger and poverty were high on their list.

Policy Implications: Priority setting should be sensitive to the voices of community voice, which represent the largest share of the disease burden in poor nations. The Nominal Group Technique is being proposed as an important research tool for involving the ‘non-experts’ in priority setting. The tool is useful for district health planers in identifying and prioritising community problems as necessary input in developing health plans.

Is it feasible to evaluate the impact of public involvement in health and social research?

(Abstract 0064)

Rosemary Barber1, Jonathan Boote1, Glenys Parry1, Cindy Cooper1, Sarah Cook2, Philippa Yeeles3
1University of Sheffield, United Kingdom, 2Sheffield Hallam University, United Kingdom, 3UKCRC, United Kingdom

Background: Increasingly, members of the public are involved at all stages of the research process and in different ways. Yet little is known about the impact of public involvement.

Objective: We wanted to know if agreement could be reached by service users, researchers, research managers, policy makers and research commissioners on whether there are feasible ways of evaluating the impact of public involvement in research.

Methods: There were three stages to our study:

• An Expert Workshop to generate ideas about the topic.
• A Delphi process, to ask people to rate the feasibility of evaluating the impact of public involvement on specific aspects of research.
• Telephone interviews with a diverse sample of Delphi participants to gain a better understanding of evaluating the impacts considered measurable by the Delphi participants.

Results: We found strong agreement that the impact of public involvement could be evaluated for some research activities, but not others. These will be presented and discussed. This study benefited enormously from two advisors: One person giving advice from a public perspective and another providing advice as someone who works in the field of public involvement in research. They assisted in developing the questionnaires, interview guide and study documents. They also helped to interpret the findings.

Policy implications: Should future evaluations of the impact of public involvement in research focus on the specific impacts highlighted as measurable in this study?

Public Involvement in a Wait Time Management Initiative

(Abstract 0008)

Rebecca Bruni1, Andreas Laupacis2, Wendy Levinson1, Douglas K Martin1
1University of Toronto, Canada, 2Li Ka Shing Knowledge Institute of St. Michael's Hospital, Canada

Background: Wait list management is a particular form of the priority setting (ps) problem that plagues every health system around the world. In Ontario, Canada the provincial government has been aiming to improve access and reduce wait times in five key areas of the health system, in an effort known as the Ontario Wait Time Strategy (OWTS). The public have not been involved in the ps activities of the OWTS and leaders of the strategy do not know what the public thinks about their activities.

Objective: To describe the views of members of the public about a wait time initiative.
Methods: Two studies were conducted:1) telephone interviews with a population of Ontarians to describe views on the OWTS; 2) synthesis and analysis of emails sent to the OWTS web-email address.

Results: Members of the public want to be involved in the OWTS. Although
participants expressed support for the OWTS, they were disappointed with the strategy’s communication efforts, and desired more openness and honesty. Members of the public thought they could be involved in: 1) Identifying criteria that will guide OWTS priority setting, and selection of future target service areas; and 2) the communication strategy of the OWTS.

Policy Implications: There is ample opportunity to involve the public in a wait time strategy. Leaders of wait list management strategies can involve the public through 1) shared decision-making; 2) feedback and appeals mechanisms; and 3) the strategy’s communication efforts.

Can Involving the Community in the Development of Health Policy Lead to More Rational Priority Setting?

(Abstract 0060)

Kylie Mayo
Department of Human Services, Australia

Background: Birth rates continue to rise and our current workforce projections indicate that we cannot continue to organise services in the same way if we are to provide a quality maternity service in the future.

Objective: To develop a policy framework that draws together the evidence in regards to best practice, community expectations and aspirations, as well as the needs of the workforce.

Method: The maternity care consultation was a three-stage process escalating from highly targeted consultation in stage one through to a comprehensive public consultation in stage 3. Policy development methods included: Commissioning an independent review of the research literature on models of maternity care; development of draft policy released publicly for comment; a comprehensive state-wide consultation through focus groups with health professionals, community forums, Aboriginal community forums and bush meetings, one on one meetings with key stakeholders, a state-wide computer assisted telephone (CATI) survey, a telephone hotline, teleconferences and videoconferences.

Results: The policy identifies fundamental changes to the current structure and culture of maternity services. From first draft to public release, the policy priorities changed from the needs and desires for individuals to have choice in the services they received to being more focused on improving the outcomes for the most vulnerable in our community.

Policy Implications: This process demonstrated that given the right resources, including adequate development time, the community can take an active role in setting health policy with startling results in terms of equity outcomes.