Complexity and evidence in health sector decision-making: lessons from tuberculosis infection prevention in South Africa.
Complexity and evidence in health sector decision-making: lessons from tuberculosis infection prevention in South Africa.
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DOI：
10.1093/heapol/czac059
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发表时间：
2022-10-12
影响因子：
3.2
通讯作者：
Kielmann, Karina
中科院分区：
文献类型：
--
作者：
Perera, Shehani;Parkhurst, Justin;Diaconu, Karin;Bozzani, Fiammetta;Vassall, Anna;Grant, Alison;Kielmann, Karina
为了更好地理解和规划具有多层次和复杂因果因素的卫生系统，人们越来越多地尝试将复杂性科学产生的工具纳入决策中。新规划方法的利用可能会对为卫生决策提供信息的证据类型及其制定机制产生重要影响。本文对南非结核病控制规划中此类工具——系统动力学模型（SDM）的应用进行了实证分析，以探讨如何利用 SDM，并反思对循证卫生决策的影响。我们观察了用于开发 SDM 流程的小组模型构建研讨会，并对参加这些研讨会的政策制定者和从业者进行了 19 次定性访谈。我们通过四个概念视角分析了 SDM 过程与政策制定证据使用之间的关系：（1）理性主义知识转化观点，考虑如何将先前产生的研究纳入政策； (2) 一种计划性方法，考虑决策者的现有目标和任务，以及证据如何解决这些问题； (3) 社会建构主义视角，探索使用 SDM 等证据规划工具的过程如何塑造对问题及其解决方案的理解； (4) 规范性视角，承认利益相关者可能有不同的优先事项，从而考虑哪些群体被纳入流程并得到代表。每个视角都可以为 SDM 流程和证据使用的政治性质提供有用的见解。特别是，SDM 可以提供解决问题的技术信息，可能会忽略其他问题，并通过形式化政策问题的边界和描绘特定的解决方案集来影响问题的概念化。进行这一过程还涉及对利益相关者纳入的选择，这些利益相关者的利益可以作为决策的证据。
To better understand and plan health systems featuring multiple levels and complex causal elements, there have been increasing attempts to incorporate tools arising from complexity science to inform decisions. The utilization of new planning approaches can have important implications for the types of evidence that inform health policymaking and the mechanisms through which they do so. This paper presents an empirical analysis of the application of one such tool—system dynamics modelling (SDM)—within a tuberculosis control programme in South Africa in order to explore how SDM was utilized, and to reflect on the implications for evidence-informed health policymaking. We observed group model building workshops that served to develop the SDM process and undertook 19 qualitative interviews with policymakers and practitioners who partook in these workshops. We analysed the relationship between the SDM process and the use of evidence for policymaking through four conceptual perspectives: (1) a rationalist knowledge-translation view that considers how previously-generated research can be taken up into policy; (2) a programmatic approach that considers existing goals and tasks of decision-makers, and how evidence might address them; (3) a social constructivist lens exploring how the process of using an evidentiary planning tool like SDM can shape the understanding of problems and their solutions; and (4) a normative perspective that recognizes that stakeholders may have different priorities, and thus considers which groups are included and represented in the process. Each perspective can provide useful insights into the SDM process and the political nature of evidence use. In particular, SDM can provide technical information to solve problems, potentially leave out other concerns and influence how problems are conceptualized by formalizing the boundaries of the policy problem and delineating particular solution sets. Undertaking the process further involves choices on stakeholder inclusion affecting whose interests may be served as evidence to inform decisions.
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