Making consultation meaningful: Insights from a case study of the South African mental health policy consultation process
Making consultation meaningful: Insights from a case study of the South African mental health policy consultation process
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DOI：
10.1371/journal.pone.0228281
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发表时间：
2020-01-29
期刊：
影响因子：
3.7
通讯作者：
Petersen, Inge
中科院分区：
文献类型：
--
作者：
Marais, Debra Leigh;Quayle, Michael;Petersen, Inge
背景：人们普遍认识到，制定精神卫生政策时应与负责执行政策的人以及受政策影响的使用者协商。在南非的立法环境中，公众参与决策是假定的，但很少指导如何进行协商过程，也没有指导如何在决策中使用协商的投入。方法经过广泛磋商，2013年通过了《南非精神卫生政策框架和战略计划》。本案例研究以2012年的省级和国家级咨询峰会为中心，通过对关键信息提供者的访谈和文献分析，探讨了咨询意见被或未被转化为政策信息的过程。在2013年至2016年期间，进行了7次采访，分析了11份文件（政策草案和峰会成果）和23次国家峰会的录音记录。结果调查结果显示，磋商首脑会议后，精神卫生政策没有实质性变化。似乎没有系统的程序来促进和获取知识投入，或在省和国家一级之间转移这些投入。在政策最后确定之前，也没有就确定的执行优先事项进行进一步协商，因此与会者强调了对地方一级政策执行的关切。这意味着失去了让服务使用者更多地参与政策制定的机会。再加上服务用户代表性差，咨询过程的形式限制了参与者的互动，以及参与或吸收更多经验形式知识的可能性。发现有几个程序因素限制了征求和转移协商贡献以纳入政策。对今后政策协商的建议包括调整参与性进程的形式，以便最佳地利用参与性知识，并加强服务使用者的参与。
BackgroundIt is widely recognised that mental health policies should be developed in consultation with those tasked with their implementation and the users affected by them. In the South African legislative context public participation in policymaking is assumed, with little guidance on how to conduct consultation processes, nor how to use consultation inputs in policy decisions.MethodsThe South African Mental Health Policy Framework and Strategic Plan was adopted in 2013 after an extensive consultation process. Focussing on the 2012 provincial and national consultation summit, this case-study conducted key informant interviews and undertook documentary analysis to explore the process through which consultation inputs were-or were not-transferred to inform this policy. Between 2013 and 2016 seven interviews were conducted, and 11 documents (policy drafts and summit outputs) and transcripts of 23 audio-recorded sessions from the national summit were analysed.ResultsFindings revealed that no substantive changes were made to the mental health policy following the consultation summits. There do not seem to have been systematic processes for facilitating and capturing knowledge inputs, or for transferring these inputs between provincial and national levels. There was also no further consultation regarding priorities identified for implementation prior to finalisation of the policy, with participants highlighting concerns about policy implementation at local levels as a result. This represents a lost opportunity for greater involvement of service users in policy development.ConclusionsTogether with poor service-user representation, the format of the consultation process limited participant interaction and the possibility for engagement with, or uptake of, more experiential forms of knowledge. Several procedural elements were found to limit the elicitation and transference of consultation contributions for uptake into policy. Recommendations for future policy consultations include adapting the format of participatory processes to enable optimal use of participant knowledge, as well as greater service-user participation.