Holy grail or convenient excuse? Stakeholder perspectives on the role of health system strengthening evaluation in global health resource allocation.

IF 5.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Veena Sriram, Natasha Palmer, Shreya Pereira, Sara Bennett
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引用次数: 0

Abstract

Background: The role of evaluation evidence in guiding health systems strengthening (HSS) investments at the global-level remains contested. A lack of rigorous impact evaluations is viewed by some as an obstacle to scaling resources. However, others suggest that power dynamics and knowledge hierarchies continue to shape perceptions of rigor and acceptability in HSS evaluations. This debate has had major implications on HSS resource allocation in global-level funding decisions. Yet, few studies have examined the relationship between HSS evaluation evidence and prioritization of HSS. In this paper, we explore the perspectives of key global health stakeholders, specifically around the nature of evidence sought regarding HSS and its potential impact on prioritization, the challenges in securing such evidence, and the drivers of intra- and inter-organizational divergences. We conducted a stakeholder analysis, drawing on 25 interviews with senior representatives of major global health organizations, and utilized inductive approaches to data analysis to develop themes.

Results: Our analysis suggests an intractable challenge at the heart of the relationship between HSS evaluations and prioritization. A lack of evidence was used as a reason for limited investments by some respondents, citing their belief that HSS was an unproven and potentially risky investment which is driven by the philosophy of HSS advocates rather than evidence. The same respondents also noted that the 'holy grail' of evaluation evidence that they sought would be rigorous studies that assess the impact of investments on health outcomes and financial accountability, and believed that methodological innovations to deliver this have not occurred. Conversely, others held HSS as a cross-cutting principle across global health investment decisions, and felt that the type of evidence sought by some funders is unachievable and not necessary - an 'elusive quest' - given methodological challenges in establishing causality and attribution. In their view, evidence would not change perspectives in favor of HSS investments, and evidence gaps were used as a 'convenient excuse'. Respondents raised additional concerns regarding the design, dissemination and translation of HSS evaluation evidence.

Conclusions: Ongoing debates about the need for stronger evidence on HSS are often conducted at cross-purposes. Acknowledging and navigating these differing perspectives on HSS evaluation may help break the gridlock and find a more productive way forward.

圣杯还是方便的借口?利益相关者对卫生系统强化评估在全球卫生资源分配中的作用的看法。
背景:评估证据在指导全球卫生系统强化(HSS)投资方面的作用仍然存在争议。一些人认为,缺乏严格的影响评估是扩大资源规模的障碍。然而,另一些人则认为,权力动态和知识等级继续左右着人们对卫生系统强化评估的严谨性和可接受性的看法。这一争论对全球一级筹资决策中的人文社科资源分配产生了重大影响。然而,很少有研究探讨人文社科评估证据与人文社科优先次序之间的关系。在本文中,我们探讨了全球卫生领域主要利益相关者的观点,特别是围绕所寻求的人文社科证据的性质及其对确定优先次序的潜在影响、获得此类证据的挑战以及组织内部和组织之间分歧的驱动因素。我们对利益相关者进行了分析,对主要全球卫生组织的高级代表进行了 25 次访谈,并采用归纳法进行数据分析,以确定主题:结果:我们的分析表明,人的安全系统评估与优先次序的确定之间的核心问题是一个棘手的挑战。一些受访者将缺乏证据作为限制投资的理由,他们认为人文社科是一项未经证实的、具有潜在风险的投资,其驱动因素是人文社科倡导者的理念而非证据。这些答复者还指出,他们所寻求的评价证据的 "圣杯 "是严格的研究,评估投资对保健成果和财务责任的影响,并认为实现这一点的方法创新尚未出现。与此相反,另一些人则认为,人文社 会科学是贯穿全球卫生投资决策的原则,并认为,鉴于在确定因果关系和归因方面的方法学 挑战,一些资助者所寻求的证据类型是无法实现的,也是不必要的,是一种 "难以实现的 追求"。他们认为,证据不会改变支持人文社 会保障系统投资的观点,证据差距被用作 "方便的借口"。受访者还对人文社 会保障系统评价证据的设计、传播和转化提出了其他关切:关于是否需要加强人文社科证据的持续辩论往往是在相互矛盾的情况下进行的。承认并驾驭这些关于人文社 会科学评价的不同观点,可能有助于打破僵局,找到更有成效的前进道路。
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来源期刊
Globalization and Health
Globalization and Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
18.40
自引率
1.90%
发文量
93
期刊介绍: "Globalization and Health" is a pioneering transdisciplinary journal dedicated to situating public health and well-being within the dynamic forces of global development. The journal is committed to publishing high-quality, original research that explores the impact of globalization processes on global public health. This includes examining how globalization influences health systems and the social, economic, commercial, and political determinants of health. The journal welcomes contributions from various disciplines, including policy, health systems, political economy, international relations, and community perspectives. While single-country studies are accepted, they must emphasize global/globalization mechanisms and their relevance to global-level policy discourse and decision-making.
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