There is a growing body of literature about public participation in health-system priority setting in different contexts and levels of governance, however, explicit focus on vulnerable populations’ participation is lacking. This dissertation incorporated a mix of methodological approaches to address this gap. First, a scoping review was used to synthesize the literature on priority-setting frameworks to understand whether and how applications of the frameworks involve the public and vulnerable populations in different contexts. Second, an interpretive description study was used to examine stakeholder participation at the district level in a low-income country, Uganda. Third, a qualitative description study design was used to qualitatively assess vulnerable women’s participation in health-system priority setting within a district in Uganda, from the perspectives of both vulnerable women and decision-makers. The research chapters complement and build on one another to make substantive, methodological, and theoretical contributions. Specifically, insights gained from the scoping review demonstrate that while priority-setting frameworks may require participation of all stakeholders, in practice certain stakeholder groups, namely the public and especially vulnerable populations, are not consistently integrated into priority-setting processes. The empirical research provides a rich understanding of the roles of different stakeholders in the priority-setting process and provides explanations about why vulnerable women, as a subset of the public, are not participating. This adds to the evidence base that policy-makers can access to guide future attempts to engage publics in health-system priority setting. These studies collectively contribute to a wider understanding of public’s and vulnerable populations’ participation in health-system priority setting in low-income contexts where health disparities are pronounced, and health resources are especially scarce. Policy-makers should aim to support vulnerable populations’ participation in health-system priority setting. Clear articulation of which vulnerable populations should participate and how they should participate can facilitate priority-setting processes. Co-developing participatory methods, frameworks, and guides with vulnerable populations can reinforce their participation and lead to mechanisms of participation that are more responsive to their needs. / Thesis / Doctor of Philosophy (PhD) / Public participation is often considered a cornerstone of fair and legitimate priority setting. Yet, little is known about whether and how the participation of vulnerable populations is operationalized in the field of health-system priority setting. An in-depth understanding of who participates and who does not, and how participation is enabled and/or hindered is essential to ensure that policy-makers can support participation. This dissertation addresses gaps in knowledge through: 1) a literature synthesis examining the operationalization of stakeholder participation within priority-setting frameworks, with specific attention to the publics’ and vulnerable populations’ participation, in cases where the frameworks have been applied to health-system priority setting; 2) supportive qualitative evidence on the roles, leverages, and challenges of different stakeholders’ participation in district-level health-system priority setting in Uganda; and 3) examining vulnerable women’s participation within one Ugandan district, specifically outlining barriers to their participation, and solutions to address these barriers and support vulnerable women’s participation in health-system priority setting. Collectively these studies can inform policy-making and development of public participation strategies that specifically target vulnerable populations for participation in health-system priority setting.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/24950 |
| Date | January 2019 |
| Creators | Razavi, Shaghayegh Donya |
| Contributors | Kapiriri, Lydia, Abelson, Julia, Wilson, Michael, Health Policy |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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