Browsing by Person "Parkhurst, Justin"

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Complexity and evidence in health sector decision-making: lessons from tuberculosis infection prevention in South Africa
(Oxford University Press (OUP), 2022-07-29) Perera, Shehani; Parkhurst, Justin; Diaconu, Karin; Bozzani, Fiammetta; Vassall, Anna; Grant, Alison; Kielmann, Karina
Abstract 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.
Improving maternal health : getting what works to happen
(Elsevier, 2007-11) Penn-Kekana, Loveday; McPake, Barbara; Parkhurst, Justin
Maternal mortality reduction in many countries is unlikely despite the availability of inexpensive, efficacious interventions that are part of official policy. This article explores the reasons why, based on research on maternity services in Bangladesh, Russia, South Africa and Uganda. A simple dynamic responses model shows that the key to understanding challenges in implementation lies in the reflexive, complex and dynamic responses of health workers and community members to policies and programmes. These responses are dynamic- in that they arise due to forces from within and outside the system, and in turn exert forces of their own. They result in the difference between the health system that is envisaged in policy, and what is implemented by health workers and experienced by users. Programmes aiming to improve maternal health are not only technical but also social interventions that need to be evaluated as such, using methodologies that have been developed for evaluating complex social interventions whose aim is to bring about change. The components of effective programmes have been defined globally. However, in getting what works to happen, context matters. Thus, technical advisors need to give advice- more circumspectly, local programme managers must be capacitated to make programme-improving adjustments continuously, and the detail related to process, not just outcomes, must be documented in evaluations.