Article Text
Abstract
Objectives This paper presents the iterative process of participatory multistakeholder engagement that informed the development of a new national tuberculosis (TB) policy in Georgia, and the lessons learnt.
Methods Guided by realist evaluation methods, a multistakeholder dialogue was organised to elicit stakeholders’ assumptions on challenges and possible solutions for better TB control. Two participatory workshops were conducted with key actors, interspersed by reflection meetings within the research team and discussions with policymakers. Using concept mapping and causal mapping techniques, and drawing causal loop diagrams, we visualised how actors understood TB service provision challenges and the potential means by which a results-based financing (RBF) policy could address these.
Setting The study was conducted in Tbilisi, Georgia.
Participants A total of 64 key actors from the Ministry of Labour, Health and Social Affairs, staff of the Global Fund to Fight AIDS, TB and Malaria Georgia Project, the National Centre for Disease Control and Public Health, the National TB programme, TB service providers and members of the research team were involved in the workshops.
Results Findings showed that beyond provider incentives, additional policy components were necessary. These included broadening the incentive package to include institutional and organisational incentives, retraining service providers, clear redistribution of roles to support an integrated care model, and refinement of monitoring tools. Health system elements, such as effective referral systems and health information systems were highlighted as necessary for service improvement.
Conclusions Developing policies that address complex issues requires methods that facilitate linkages between multiple stakeholders and between theory and practice. Such participatory approaches can be informed by realist evaluation principles and visually facilitated by causal loop diagrams. This approach allowed us leverage stakeholders’ knowledge and expertise on TB service delivery and RBF to codesign a new policy.
- health policy
- tuberculosis
- qualitative research
Data availability statement
All data relevant to the study are included in the article or uploaded as supplemental information.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplemental information.
Supplementary materials
Supplementary Data
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Footnotes
Twitter @lade_abeji, @sophie_witter
Contributors BM, LS and IC conceptualised the manuscript with input from I-OOA, MU, NS, KD, AV, AZ, ANG and SW, who collectively designed and executed the research study as members of the Results4TB research consortium. The participatory workshops were mainly facilitated by the research consortium and the CIF team (LS, IC, MU, NS and AZ) in particular. I-OOA and BM prepared the drafts of the article with additional contribution from the other authors (LS, IC, MU, NS, KD, AV, AZ, ANG and SW). All authors contributed to and agreed on the final manuscript.
Funding The Results4TB study is a 4-year (2017-2021) project funded under the Health Systems Research Initiative call 3 of the MRC/ESRC/DfID/Wellcome Trust consortium (Grant Ref: MR/P015018/1).
Competing interests AZ being the project PI, is both a member of the Results4TB research team and a member of parliament in Georgia.
Provenance and peer review Not commissioned; externally peer reviewed.
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