Assessing policy dialogues and the role of context: Liberian case study before and during the Ebola outbreak

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Study Justification:
– The study aims to understand how the context influences policy dialogue, particularly the participation of stakeholders.
– Liberia’s post-war, donor-dependent, and Ebola-recovering context provides an opportunity to examine the influence of context on policy dialogue.
– The study contributes to the existing evidence on the quality of policy dialogue and its impact on policy-making processes.
Highlights:
– The policy dialogues in Liberia were considered successful and involved important stakeholders.
– Concerns were raised about the improper methodology and facilitation used in conducting the dialogues.
– The context, both before and during the Ebola outbreak, played a significant role in shaping the dialogues.
– Policy dialogues have become a platform for policy discussions and decisions in Liberia, contributing to the success of negotiations during the Ebola outbreak.
Recommendations:
– Proper information sharing through diverse forums and avenues is needed to sustain and strengthen policy dialogues.
– Stakeholders’ empowerment and competent facilitation should be prioritized to ensure the credibility and legitimacy of the dialogue process.
Key Role Players:
– Ministry of Health (MoH)
– Other relevant ministries
– Donors
– Non-governmental organizations (NGOs)
– Sub-national health management team members
Cost Items for Planning Recommendations:
– Information sharing platforms and resources
– Capacity-building programs for stakeholders
– Facilitation training and support

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on an exploratory study using qualitative methods. The study conducted key informant interviews and analyzed the data using thematic content analysis. The respondents felt that the policy dialogues were a success and involved important stakeholders. However, there were concerns about the methodology and facilitation used. The abstract provides some insights into the influence of context on policy dialogue in Liberia, particularly in the post-war and Ebola outbreak recovery context. To improve the strength of the evidence, the abstract could include more specific details about the methodology, such as the selection criteria for the respondents and the interview process. Additionally, it would be helpful to include specific examples or quotes from the respondents to support the findings. Overall, the abstract provides a good overview of the study, but more specific information and supporting evidence would enhance its strength.

Background: In the last decade participatory approaches have gained prominence in policy-making, becoming the focus of good policy-making processes. Policy dialogue is recognised as an important aspect of policy-making among several interactive and innovative policy-making models applied in different contexts and sectors. Recently there has been emphasis on the quality of policy dialogue in terms of how it should be conducted to attain participation and inclusiveness. However, there is paucity of evidence on how the context influences policy dialogue, particularly participation of stakeholders. Liberia’s context, which is characterised as post-war, highly donor dependent and in recovery from the recent catastrophic Ebola outbreak, provides an opportunity to understand the influence of context on policy dialogue. Methods: This was an exploratory study using qualitative methods. Key informant interviews were conducted using an interview guide. A total of 16 interviews were conducted, 12 at the national level and 4 at the sub national level. Data were analysed using inductive thematic content analysis. Results: The respondents felt that the dialogues were a success and involved important stakeholders; however, there were concerns about the improper methodology and facilitation used to conduct them. Opinions among the respondents about the process of generating and selecting the themes for the dialogues were extremely divergent. Both before and during the Ebola outbreak, the context was instrumental in shaping the dialogues according to the issue of focus, requirements for participation and the decisions to be made. Policy dialogues have become a platform for policy discussions and decisions in Liberia. It is a process that is well recognised and appreciated and is highly attributed to the success of the negotiations during the Ebola outbreak. Conclusions: To sustain and strengthen policy dialogues in future, there needs to be proper information sharing through diverse forums and avenues, stakeholders’ empowerment and competent facilitation. These will ensure that the process is credible and legitimate.

Liberia is a post-civil war state, where the conflict, which ran between 1989 and 2002, devastated the country’s economy, human capacity, infrastructure and security [13]. Recovery efforts began in 2006 after President Johnson Sirleaf came to power [14, 15]. Despite the efforts and strides, Liberia still has a long way to go. It is estimated that it is one of the poorest countries in Africa, with an average per capita income of US$ 160 [16]. Likewise, the health indicators have suffered from the country’s plight. In 2010 life expectancy at birth was 59.3 and infant mortality rate per 1,000 live births was 91.3. In 2008 the maternal mortality rate per 1000,000 live births was 990 [14]. Several donors have come to assist Liberia rebuilt. However, the aid architecture has been rife with criticism, including its effect on harmonisation and alignment to Liberia’s needs [13, 15]. Recently, the Ebola outbreak weakened the already stressed systems, economy and performance, adding to the country’s predicaments [17]. There is one promising element, though: policy dialogues have been going on in the health sector to help strengthen policy-making. The main areas of focus have been the development, implementation and monitoring of the health sector strategic plan; integrated monitoring and evaluation; capacity building with a focus on planning and budgeting; and operationalization of health financing. This was an exploratory study using qualitative methods. The research was conducted primarily through key informant interviews with various stakeholders. The interviews were conducted using a guide and were carried out by a Liberian researcher conversant with qualitative research and the context. The interview guide was pretested with health systems technical officers in the WHO Regional office and adjusted accordingly prior to conducting interviews. The initial list of respondents was drawn with the officials responsible for the dialogues at the Ministry of Health (MoH). This was followed with snowballing to identify additional respondents until descriptive saturation [18]. Respondents included a range of stakeholders at the national level such as the MoH and other relevant ministries, donors and nongovernmental organisations (NGOs). The respondents at the subnational level included sub-national health management team members and NGO representatives. A total of 16 interviews were conducted with 12 national and 4 subnational level respondents. Table 1 presents details of the respondents and their organisations. Data were collected between June and August 2015 after the Ebola outbreak of 2014. Respondents’ organisations The national level stakeholders were interviewed in Monrovia, the capital city and where their various institutions were headquartered. Grand Bassa and Bong counties hosted the county level interviews. These counties were selected based on ease and convenience of access in consideration of the resource and time limitations and travel constraints due to the heavy rains and poor road infrastructure. Data collection focused on five broad areas and aimed to assess the effectiveness of the policy dialogue programme in Liberia. These areas were contextualisation and understanding of the dialogue, governance and management of the dialogues, policy dialogue processes, policy dialogue outcomes, and policy dialogues around the Ebola response. Table 2 lists the areas and parameters that were assessed. Data collection domains The transcripts, which were in English, were analysed by two coders both of whom are authors of this paper. As a first step to formal analysis, we read the interviews in detail looking for emerging issues in line with the study objectives and these were coded and categorised into themes. One of the coders created a start list of the themes that were in line with the objectives of the study. Both coders read through all the transcripts independently and coded them using QSR NVivo 10. The two coders then selected the quotations that best represented each theme and sub-theme. The quotations selected by both coders were included as representative of the others.

Based on the provided information, here are some potential innovations that could be recommended to improve access to maternal health in Liberia:

1. Mobile Health (mHealth) Solutions: Implementing mobile health technologies, such as SMS reminders for prenatal care appointments and educational messages about maternal health, can help reach women in remote areas and improve their access to essential healthcare services.

2. Community Health Workers (CHWs): Training and deploying community health workers who can provide basic maternal health services, including prenatal care, education, and referrals, can help bridge the gap between healthcare facilities and remote communities.

3. Telemedicine: Introducing telemedicine services, where healthcare providers can remotely consult and provide guidance to pregnant women and healthcare workers in underserved areas, can improve access to specialized maternal healthcare.

4. Maternal Waiting Homes: Establishing maternal waiting homes near healthcare facilities can provide a safe and comfortable place for pregnant women to stay before delivery, especially for those who live far away and may not have access to transportation.

5. Cash Transfer Programs: Implementing cash transfer programs that provide financial support to pregnant women can help alleviate financial barriers to accessing maternal healthcare, such as transportation costs and fees for services.

6. Strengthening Health Systems: Investing in improving healthcare infrastructure, training healthcare workers, and ensuring the availability of essential medicines and supplies can enhance the overall quality and accessibility of maternal health services.

7. Public-Private Partnerships: Collaborating with private sector organizations, such as pharmaceutical companies and technology companies, can leverage their resources and expertise to improve access to maternal health services.

It is important to note that the specific recommendations for improving access to maternal health in Liberia would require further research and assessment of the local context and needs.
AI Innovations Description
Based on the provided information, the recommendation to improve access to maternal health in Liberia is to strengthen and sustain policy dialogues. This can be achieved through the following actions:

1. Proper information sharing: Ensure that information related to maternal health is shared through diverse forums and avenues. This can include workshops, conferences, and online platforms. By disseminating information widely, more stakeholders can be reached and engaged in the policy dialogue process.

2. Stakeholders’ empowerment: Empower stakeholders, including healthcare providers, community leaders, and women themselves, to actively participate in policy dialogues. This can be done through capacity building initiatives, such as training programs and workshops, that provide them with the necessary knowledge and skills to contribute effectively to the dialogue.

3. Competent facilitation: Ensure that policy dialogues are facilitated by individuals who have the necessary expertise and skills to guide the discussions in a productive and inclusive manner. Facilitators should be trained in facilitation techniques, conflict resolution, and consensus-building to create an environment that encourages open and constructive dialogue.

By implementing these recommendations, policy dialogues in Liberia can become more credible, legitimate, and effective in addressing the challenges and barriers to maternal health. This, in turn, can lead to the development of innovative solutions and policies that improve access to maternal health services and ultimately reduce maternal mortality rates.
AI Innovations Methodology
Based on the provided information, it seems that the focus is on assessing policy dialogues and the role of context in Liberia, particularly in relation to maternal health and the impact of the Ebola outbreak. The study used qualitative methods, including key informant interviews, to gather data and analyze the effectiveness of policy dialogues in Liberia.

To improve access to maternal health in Liberia, the following innovations could be considered:

1. Mobile Health (mHealth) Solutions: Implementing mobile health technologies, such as SMS reminders for prenatal care appointments, educational messages about maternal health, and access to telemedicine consultations, can help improve access to maternal health services, especially in remote areas.

2. Community Health Worker Programs: Training and deploying community health workers who can provide basic maternal health services, including prenatal care, health education, and referrals, can help bridge the gap between communities and formal healthcare facilities.

3. Telemedicine and Teleconsultation: Establishing telemedicine networks and teleconsultation services can enable pregnant women in remote areas to access specialized care and consultations with healthcare professionals without the need for travel.

4. Maternal Health Vouchers: Implementing voucher programs that provide financial assistance to pregnant women for accessing maternal health services can help reduce financial barriers and improve access to quality care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as the number of prenatal care visits, percentage of women receiving skilled birth attendance, and maternal mortality rates.

2. Collect baseline data: Gather existing data on the selected indicators to establish a baseline for comparison.

3. Define the simulation parameters: Determine the specific parameters for each recommendation, such as the number of community health workers to be trained and deployed, the coverage of mobile health interventions, or the number of telemedicine consultations to be provided.

4. Simulate the interventions: Use modeling techniques, such as mathematical models or computer simulations, to estimate the potential impact of the recommendations on the selected indicators. This could involve projecting the increase in prenatal care visits or the reduction in maternal mortality rates based on the defined parameters.

5. Analyze the results: Evaluate the simulated impact of the recommendations on improving access to maternal health by comparing the projected outcomes with the baseline data. Assess the feasibility, cost-effectiveness, and scalability of the interventions.

6. Refine and iterate: Based on the analysis, refine the simulation parameters and repeat the simulation to further optimize the recommendations and assess their potential long-term impact.

By following this methodology, policymakers and stakeholders can gain insights into the potential benefits and challenges of implementing the recommended innovations to improve access to maternal health in Liberia.

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