Evaluating a traditional medicine policy in South Africa: phase 1 development of a policy assessment tool

Background: Policies that empower individuals and communities may be appropriate for public health, and more broadly. Simple, transparent and acceptable tools are therefore required to evaluate policies from an empowerment perspective. In 2008, the South African Department of Health (DOHSA) drafted a policy to endorse the integration of African Traditional Medicine (ATM) into the public health sector, following the World Health Organization's (WHO) long-standing directives. Objective: The purpose of this study is to critically analyze this policy using a novel evaluation tool. Design: A 12-point ‘Policy Empowerment Index’ (PEI) is introduced, and used to classify and score the policy according to five theoretical policy types. The evaluation was based on a stepwise review and associated publications: policy drafts, policy statements and news announcements. Results: According to the assessment tool, the ATM policy was marginally ‘supportive’ of constituent empowerment, although several ‘directive’ features were also observed. The importance of ATM to SA's communities and the promotion of education, employment, entrepreneurship and peripheral resource mobilization were the main empowering elements. Centralised conception, planning and implementation, the absence of provisions for local adaptations and the authoritative legislation context were sub-optimal features. Conclusions: South Africa's ATM legislation may need to further involve communities in policy design and implementation to capitalise upon the broader benefits of community empowerment. However, the iterative nature of method and evaluation is important. Indeed, they are proposed as points to initiate participatory development, and improve policy evaluation . Such instruments can empower constituents in the political process

Community-Led Social Housing Regeneration: From Government-Led Programmes to Community Initiatives

Engaging communities in neighbourhood regeneration processes is vital for achieving inclusive cities, particularly when vulnerable groups belong to these communities. In the UK, different governments have implemented diverse strategies, funding schemes and approaches to social housing estates’ regeneration, which have implied various degrees of involvement of the residents in decision-making processes. This paper explores the approaches to community participation in the regeneration of social housing neighbourhoods since 1997—when the New Labour won the general elections—until today. Within this period, it identifies two models: the government-led regeneration scheme New Deal for Communities implemented by the New Labour Government, which provided funding for intervening in deprived areas and which included representatives of the community in the decision-making board; and the Big Society approach implemented by the Coalition Government in the context of austerity, which advocates for a state-enabling approach and has changed the planning system to involve communities in decision-making. The paper explores how these two models have addressed the participation of residents in social housing regeneration. For doing so, it looks at the policy context and case studies in these two periods. The paper concludes that community participation needs easier processes, which do not require such a strong effort from community groups. It also concludes that both funding and support is needed to promote community engagement in regeneration processes, which can, firstly, serve as an incentive to be more actively involved in the regeneration of their neighbourhood, and secondly, do not rely on private investment for the improvement of council estates

Reflections and Experiences of a Co-Researcher involved in a Renal Research Study

Background Patient and Public Involvement (PPI) is seen as a prerequisite for health research. However, current Patient and public involvement literature has noted a paucity of recording of patient and public involvement within research studies. There have been calls for more recordings and reflections, specifically on impact. Renal medicine has also had similar criticisms and any reflections on patient and public involvement has usually been from the viewpoint of the researcher. Roles of patient and public involvement can vary greatly from sitting on an Advisory Group to analysing data. Different PPI roles have been described within studies; one being a co-researcher. However, the role of the co-researcher is largely undefined and appears to vary from study to study. Methods The aims of this paper are to share one first time co-researcher's reflections on the impact of PPI within a mixed methods (non-clinical trial) renal research study. A retrospective, reflective approach was taken using data available to the co-researcher as part of the day-to-day research activity. Electronic correspondence and documents such as meeting notes, minutes, interview thematic analysis and comments on documents were re-examined. The co-researcher led on writing this paper. Results This paper offers a broad definition of the role of the co-researcher. The co-researcher reflects on undertaking and leading on the thematic analysis of interview transcripts, something she had not previously done before. The co-researcher identified a number of key themes; the differences in time and responsibility between being a coresearcher and an Advisory Group member; how the role evolved and involvement activities could match the co-researchers strengths (and the need for flexibility); the need for training and support and lastly, the time commitment. It was also noted that it is preferable that a co-researcher needs to be involved from the very beginning of the grant application. Conclusions The reflections, voices and views of those undertaking PPI has been largely underrepresented in the literature. The role of co-researcher was seen to be rewarding but demanding, requiring a large time commitment. It is hoped that the learning from sharing this experience will encourage others to undertake this role, and encourage researchers to reflect on the needs of those involved.Peer reviewedFinal Published versio

Global health partnerships: building multi-national collaborations to achieve lasting improvements in maternal and neonatal health

Abstract Background In response to health care challenges worldwide, extensive funding has been channeled to the world’s most vulnerable health systems. Funding alone is not sufficient to address the complex issues and challenges plaguing these health systems. To see lasting improvement in maternal and infant health outcomes in the developing world, a global commitment to the sharing of knowledge and resources through international partnerships is critical. But partnerships that merely introduce western medical techniques and protocols to low resource settings, without heeding the local contexts, are misguided and unsustainable. Forming partnerships with mutual respect, shared vision, and collaborative effort is needed to ensure that all parties, irrespective of whether they belong to resource rich or resource poor settings, learn from each other so that meaningful and sustained system strengthening can take place. Methods In this paper, we describe the partnership building model of an international NGO, Kybele, which is committed to achieving childbirth safety through sustained partnerships in low resource settings. The Kybele model adapts generic stages of successful partnerships documented in the literature to four principles relevant to Kybele’s work. A multiple-case study approach is used to demonstrate how the model is applied in different country settings. Results The four principle of Kybele’s partnership model are robust drivers of successful partnerships in diverse country settings. Conclusions Much has been written about the need for multi-country partnerships to achieve sustainable outcomes in global health, but few papers in the literature describe how this has been achieved in practice. A strong champion, support and engagement of stakeholders, co-creation of solutions with partners, and involvement of partners in the delivery of solutions are all requirements for successful and sustained partnerships

Students and academics working in partnership to embed cultural competence as a graduate quality

Since 2014, the University of Sydney has been experimenting with a new initiative motivated by the research on “students as partners”. In 2014, six students were selected as Ambassadors of the Sydney Teaching Colloquium (STC)-the University’s annual learning and teaching conference-as undergraduate researchers. In that year, the focus was on assessment standards

Performed and preferred participation in science and technology across Europe: Exploring an alternative idea of "democratic deficit"

Republican ideals of active scientific citizenship and extensive use of deliberative, democratic decision making have come to dominate the public participation agenda, and academic analyses have focused on the deficit of public involvement vis-à-vis these normative ideals. In this paper we use latent class models to explore what Eurobarometer survey data can tell us about the ways in which people participate in tacit or in policy-active ways with developments in science and technology, but instead of focusing on the distance between observed participation and the dominant, normative ideal of participation, we examine the distance between what people do, and what they themselves think is appropriate in terms of involvement. The typology of citizens emerging from the analyses entails an entirely different diagnosis of democratic deficit, one that stresses imbalance between performed and preferred participation

Power to the people: To what extent has public involvement in applied health research achieved this?

Public involvement in applied health research is a pre-requisite for funding from many funding bodies. In particular the National Institute of Health Research (NIHR) in the UK, clearly states that it values lay knowledge and there is an expectation that members of the public will participate as research partners in research. As a result a large public involvement infrastructure has emerged to facilitate this. However, there is concern that despite the flurry of activity in promoting public involvement, lay knowledge is marginalised and has limited impact on research decision-making. This article asks to what extent has power shifted from the scientific research community to the public? It discusses the meaning of power and models of public involvement and examines the development of public involvement in applied health research. It identifies public involvement in a range of decision-making: identifying priority areas for commissioning research; making decisions about which projects are funded; decisions about details of research design. Whilst there is evidence that the public voice is present in the composition of research proposals submitted to NIHR and in the decision-making about which projects are funded and how they are carried out, there is less evidence of a change in the power dynamic manifest in social relations between the scientific research community and the public. As a result the biomedical model remains dominant and largely unchallenged in research decision-making