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Towards systemic and contextual priority setting for implementing the 2030 Agenda.

ABSTRACT: How the sustainable development goals (SDGs) interact with each other has emerged as a key question in the implementation of the 2030 Agenda, as it has potentially strong implications for prioritization of actions and their effectiveness. So far, analysis of interactions has been very basic, typically starting from one SDG, counting the number of interactions, and discussing synergies and trade-offs from the perspective of that issue area. This paper pushes the frontier of how interactions amongst SDG targets can be understood and taken into account in policy and planning. It presents an approach to assessing systemic and contextual interactions of SDG targets, using a typology for scoring interactions in a cross-impact matrix and using network analysis techniques to explore the data. By considering how a target interacts with another target and how that target in turn interacts with other targets, results provide a more robust basis for priority setting of SDG efforts. The analysis identifies which targets have the most and least positive influence on the network and thus guides, where efforts may be directed (and not); where strong positive and negative links sit, raising warning flags to areas requiring extra attention; and how targets that reinforce each others' progress cluster, suggesting where important cross-sectoral collaboration between actors is merited. How interactions play out is context specific and the approach is tested on the case of Sweden to illustrate how priority setting, with the objective to enhance progress across all 17 SDGs, might change if systemic impacts are taken into consideration.

SUBMITTER: Weitz N

PROVIDER: S-EPMC6086277 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Competing priorities in health systems necessitate difficult choices on which health actions and investments to fund: decisions that are complex, value-based, and highly political. In light of the centrality of universal health coverage (UHC) in driving current health policy, we sought to examine the value interests that influence agenda setting in the country's health financing space. Given the plurality of Kenya's health policy levers, we aimed to examine how the perspectives of stakeholders involved in policy decision-making and implementation shape discussions on health financing within the UHC framework. METHODS:A series of in-depth key informant interviews were conducted at national and county level (n?=?13) between April and May 2018. Final thematic analysis using the Framework Method was conducted to identify similarities and differences amongst stakeholders on the challenges hindering Kenya's achievement of UHC in terms of its the optimisation of health service coverage; expansion of the population that benefits from essential healthcare services; and the minimisation of out-of-pocket costs associated with health-seeking behaviour. RESULTS:Our findings indicate that the perceived lack of strategic leadership from Kenya's national government has led to a lack of agreement on stakeholders' interpretation of what is to be understood by UHC, its contextual values and priorities. We observe material differences between and within policy networks on the country's priorities for population coverage, healthcare service provision, and cost-sharing under the UHC dispensation. In spite of this, we note that progressive universalism is considered as the preferred approach towards UHC in Kenya, with most interviewees prioritising an equity-based approach that prioritises better access to healthcare services and financial risk protection. However, the conflicting priorities of key stakeholders risk derailing progress towards the expansion of access to health services and financial risk protection. CONCLUSIONS:This study adds to existing knowledge of UHC in Kenya by contextualising the competing and evolving priorities that should be taken into consideration as the country strategises over its UHC process. We suggest that clear policy action is required from national government and county governments in order to develop a logical and consistent approach towards UHC in Kenya.

Project description:Background:Safety net hospitals, which serve vulnerable and underserved populations and often operate on smaller budgets than non-safety net hospitals, may experience unique implementation challenges. We sought to describe common barriers and facilitators that affect the implementation of improvement initiatives in a safety net hospital, and identify potentially transferable lessons to enhance implementation efforts in similar settings. Methods:We interviewed leaders within five inpatient departments and asked them to identify the priority inpatient improvement initiative from the last year. We then conducted individual, semi-structured interviews with 25 stakeholders across the five settings. Interviewees included individuals serving in implementation oversight, champion, and frontline implementer roles. The Consolidated Framework for Implementation Research informed the discussion guide and a priori codes for directed content analysis. Results:Despite pursuing diverse initiatives in different clinical departments, safety net hospital improvement stakeholders described common barriers and facilitators related to inner and outer setting dynamics, characteristics of individuals involved, and implementation processes. Implementation barriers included (1) limited staffing resources, (2) organizational recognition without financial investment, and (3) the use of implementation strategies that did not adequately address patients' biopsychosocial complexities. Facilitators included (1) implementation approaches that combined passive and active communication styles, (2) knowledge of patient needs and competitive pressure to perform well against non-SNHs, (3) stakeholders' personal commitment to reduce health inequities, and (4) the use of multidisciplinary task forces to drive implementation activities. Conclusion:Inner and outer setting dynamics, individual's characteristics, and process factors served as implementation barriers and facilitators within the safety net. Future work should seek to leverage findings from this study toward efforts to enact positive change within safety net hospitals.

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Towards systemic and contextual priority setting for implementing the 2030 Agenda.

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