Halting and re-issuing of the Zambia community health strategy (2017-2021): a retrospective analysis of the policy process and implications for community health systems.

Autor: Chavula MP; Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.; Department of Epidemiology and Global Health, Umeå University, Umeå, Umeå, 901 87, Sweden., Silumbwe A; Department of Epidemiology and Global Health, Umeå University, Umeå, Umeå, 901 87, Sweden. adamsilumbwe@gmail.com.; Department of Health Policy and Management, School of Public Health, University of Zambia, P.O Box 50110, Lusaka, Cell, +260976085894, Zambia. adamsilumbwe@gmail.com., Munakampe MN; Department of Health Policy and Management, School of Public Health, University of Zambia, P.O Box 50110, Lusaka, Cell, +260976085894, Zambia., Zulu JM; Department of Health Policy and Management, School of Public Health, University of Zambia, P.O Box 50110, Lusaka, Cell, +260976085894, Zambia., Zulu W; Department of Public Health, National TB and Leprosy programme, Ministry of Health, Lusaka, Zambia., Michelo C; Strategic Centre for Health Systems Metrics (SCHEME), Global Health Institute, Nkwazi Research University, PO Box 50650, Lusaka, Zambia., Mulubwa C; Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2024 Aug 22; Vol. 24 (1), pp. 971. Date of Electronic Publication: 2024 Aug 22.
DOI: 10.1186/s12913-024-11419-9
Abstrakt: Background: Over the years, low-and middle-income countries have adopted several policy initiatives to strengthen community health systems as means to attain Universal Health Coverage (UHC). In this regard, Zambia passed a Community Health Strategy in 2017 that was later halted in 2019. This paper explores the processes that led to the halting and re-issuing of this strategy with the view of drawing lessons to inform the development of such strategies in Zambia and other similar settings.
Methods: We employed a qualitative case study comprising 20 semi-structured interviews with key stakeholders who had participated in either the development, halting, or re-issuing of the two strategies, respectively. These stakeholders represented the Ministry of Health, cooperating partners and other non-government organizations. Inductive thematic analysis approach was used for analysis.
Results: The major reasons for halting and re-issuing the community health strategy included the need to realign it with the national development framework such as the 7th National Development Plan, lack of policy ownership, political influence, and the need to streamline the coordination of community health interventions. The policy process inadequately addressed the key tenets of community health systems such as complexity, adaptation, resilience and engagement of community actors resulting in shortcomings in the policy content. Furthermore, the short implementation period, lack of dedicated staff, and inadequate engagement of stakeholders from other sectors threatened the sustainability of the re-issued strategy.
Conclusion: This study underscores the complexity of community health systems and highlights the challenges these complexities pose to health policymaking efforts. Countries that embark on health policymaking for community health systems must reflect on issues such as persistent fragmentation, which threaten the policy development process. It is crucial to ensure that these complexities are considered within similar policy engagement processes.
(© 2024. The Author(s).)
Databáze: MEDLINE
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