SUPPORT-SYSTEMS (32) Q2 Have you ever participated in health policy? (3) International Journal of Health Governance

17 May, 2022

Dear HIFA colleagues,

International Journal of Health Governance has recently published several papers that describe positive and negative experience of civil society participation in health policy processes on the national and sub-national level (from India, Malaysia, Iran, Australia). (Though they are not in open access, you can access full-text in the preprint repositories).

1. Sharma, S., Rawat, S., Akhtar, F., Singh, R.K. and Mehra, S. (2022), "Assessing community health governance for evidence-informed decision-making: a cross-sectional study across nine districts of India", International Journal of Health Governance, Vol. 27 No. 1, pp. 8-20.

The authors assessed the village health sanitation and nutrition committees (VHSNC) on six parameters, including their formation, composition, meeting frequencies, activities, supervisory mechanisms and funds receipt and expenditures across nine districts of the three states of India. VHSNCs are envisaged to ensure community participation in health planning, but their actions and performance are shaped by contextual factors, such as availability of funds and motivation, and willingness of its members to perform. The study sheds light on the irregular and delayed receipt of funds, lack of supervisory visits by medical officers or Integrated Child Development Service (ICDS) Scheme staff or their assessments of the accounts, nonperformance of the key activities, such as making a village health plan, monitoring services and organizing VHSND. They argue that the poor performance of VHSNC in some of the areas may be linked to multiple factors, including inadequate training of VHSNC members on their key roles and responsibilities. (Preprint

2. Ashraf, A. and Ong, S.C. (2021), "Drug price control in Malaysia: a stakeholder analysis", International Journal of Health Governance, Vol. 26 No. 4, pp. 333-347.

Recently, the Government of Malaysia has proposed for drug price control. The authors found that the drug price control regulation received mixed reactions from the stakeholders, with the public sector mainly supporting the proposal (Federation of Malaysian Consumers Associations), whereas the private sectors opposing it (Pharmaceutical Association of Malaysia, Association of Private Hospitals, Malaysian Organization of Pharmaceutical Industries, Federation of Private Medical Practitioners' Associations, Malaysian Medical Association). Malaysian Pharmaceutical Society (MPS), which represents the majority of pharmacists, supported the move, but the Malaysian Community Pharmacy Guild (MCPG) opposed it. Academicians also opposed it. Citizens and nongovernmental organizations (NGOs) overwhelmingly supported the policy. NGOs are the citizens' primary voice. For decades, they have advocated for more affordable and accessible healthcare. The involvement of various NGOs in supporting the issue through social media and newspaper campaigns has raised citizens' awareness of the need to regulate the pharmaceutical market.

3. Khodayari-Zarnaq, R., Kakemam, E., Arab-Zozani, M., Rasouli, J. and Sokhanvar, M. (2020), "Participation of Iranian non-governmental organizations in health policy-making; barriers and strategies for development", International Journal of Health Governance, Vol. 25 No. 1, pp. 46-56.

There were 30 active health-related NGOs working in Tabriz at the time of the study. These were working as charities (seven), with cancer patients (four), in the field of kidney disease (four) and with diabetic patients (three). Others sectors included cochlear implant, cardiovascular disease, liver disease, multiple sclerosis, autism, HIV, counseling services, addiction, physician-patient relationships and biosecurity. Most NGO activity has been in the area of providing services, whereas the least amount of activity has been in the domain of policy-making. Factors that were influential for NGO participation in policy-making were divided into three categories: those related to government, to civil society and within NGOs themselves. The primary barriers to participation in policy-making were related to government and the way that NGOs operated. Recommendations include the production of supportive law, financial aid to NGO and infrastructure that facilitates NGO participation.

4. Rendalls, S., Spigelman, A.D., Goodwin, C. and Daniel, N. (2019), "Health service engagement with consumers and community in Australia for issue: Engagement and accountability with your community", International Journal of Health Governance, Vol. 24 No. 4, pp. 274-283.

The purpose of this paper is to provide an overview of consumer and community engagement in health service planning, quality improvement and programme evaluation in Australia, and key components and importance of a strong suite of tools for achieving effective outcomes.

Consumer engagement is a recognised component of the Australian health system. It is reflected in the national and state health policy and is a mandatory requirement of hospital accreditation. The application of co-design principles is gaining increasing popularity in health service planning and programme evaluation. There has been an increasing focus on engagement moving beyond consultation and consumer experience to bring consumers to the table to actively engage in key decision making. At a governance level, consumer experience is increasingly sought for positions on Health Service Boards, quality and safety and clinical governance committees.

Practical example. PHNs ( primary health networks) are an Australian Government initiative to increase the effectiveness and efficiency of medical services for patients in the community. PHNs act as budget holders commissioning a range of primary care services. In 2017, a metropolitan PHN engaged an external consultant to undertake co-design workshops with people with lived experience (consumers) and local service providers to develop a recovery orientated and stepped care approach to support people experiencing severe mental illness in the community. The co-design process entailed two workshops with key stakeholders including people with lived experience and local service providers. The key themes identified in the workshops provided the foundation for the service specifications. The contract for service provision was awarded to a community-based service provider.

One-year post implementation the PHN engaged consultants to review the progress of the project. The review method entailed detailed data analysis; policy and document review; process mapping; consultations with consumers, direct service providers, service management and external clinical supervisors; and a clinical and operational risk assessment. The review found that while comprehensive activity measures were in place, there was limited information collected on service outputs or outcomes, as well as issues with consistency in the client information system. From the activity analysis and process mapping with consumers and staff, the review was able to make practical recommendations for service improvement, reveal positive service experiences, identify operational and clinical risks and develop a risk mitigation plan.


Irina Ibragimova, PhD

Co-editor, International Journal of Health Governance

HIFA profile: Irina Ibraghimova is an independent consultant with a PhD. in library sciences and more than 20 years’ international experience in ICT for health projects. She now serves as a Co-editor for the International Journal of Health Governance (Emerald Publishing). Professional interests: Information and health literacy, evidence-based practice, science communication and medical journals editing. She is a HIFA country representative for Croatia: