A framework for explaining the role of values in health policy decision-making in Latin America: a critical interpretive
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(2020) 18:100
REVIEW
Open Access
A framework for explaining the role of values in health policy decision-making in Latin America: a critical interpretive synthesis C. Marcela Vélez1,2,3,4,5* , Michael G. Wilson1,2,3,4, John N. Lavis1,2,3,4,6,7, Julia Abelson2,3,4 and Ivan D. Florez2,5
Abstract Background: Although values underpin the goals pursued in health systems, including how health systems benefit the population, it is often not clear how values are incorporated into policy decision-making about health systems. The challenge is to encompass social/citizen values, health system goals, and financial realities and to incorporate them into the policy-making process. This is a challenge for all health systems and of particular importance for Latin American (LA) countries. Our objective was to understand how and under what conditions societal values inform decisions about health system financing in LA countries. Methods: A critical interpretive synthesis approach was utilised for this work. We searched 17 databases in December 2016 to identify articles written in English, Spanish or Portuguese that focus on values that inform the policy process for health system financing in LA countries at the macro and meso levels. Two reviewers independently screened records and assessed them for inclusion. One researcher conceptually mapped the included articles, created structured summaries of key findings from each, and selected a purposive sample of articles to thematically synthesise the results across the domains of agenda-setting/prioritisation, policy development and implementation. Results: We identified 5925 references, included 199 papers, and synthesised 68 papers. We identified 116 values and developed a framework to explain how values have been used to inform policy decisions about financing in LA countries. This framework has four categories – (1) goal-related values (i.e. guiding principles of the health system); (2) technical values (those incorporated into the instruments adopted by policy-makers to ensure a sustainable and efficient health system); (3) governance values (those applied in the policy process to ensure a transparent and accountable process of decision-making); and (4) situational values (a broad category of values that represent competing strategies to make decisions in the health systems, their influence varying according to the four factors). (Continued on next page)
* Correspondence: [email protected] 1 McMaster Health Forum, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L6, Canada 2 Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St. West, Hamilton, ON L8S 4K1, Canada Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the sourc
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