CHP participated in a five-year collaborative research programme which ended in 2010 known as the Consortium for Research on Equitable Health Systems (CREHS) to increase knowledge on strengthening health systems policies and interventions which will benefit the poorest. There is widespread evidence of significant gaps between health policies as laid down on paper by governments or ministries of health, and their implementation in practice.
Various factors enable or constrain the implementation of health policies. These include the content of the policy itself; the actors involved in implementation, and their interests and incentives; the context within which the policies are located; and, the process of policy implementation. Introducing and sustaining equity-orientated health policies, such as increasing access to primary care services or targeting vulnerable groups, has been particularly difficult in many countries. This is because such policies often challenge the conventional ways of working within health systems, including the existing professional practices which influence both who can access health services, and the treatment and nature of care offered to different groups.
Despite the evidence of problems, there has been only limited international investigation of the factors which may explain the poor achievements of new policies intended to promote equity. The Consortium for Research on Equitable Health Systems has investigated these factors by examining the experiences of actors involved in implementing policy at different levels of the health system.
CHP is continuing to develop expertise in innovative research methods such as experimental economics and stated preference studies. Experimental economics is the use of controlled, scientifically designed experiments to test economic theories and investigate decision processes under laboratory conditions. We developed a new experimental game to evaluate the impact of different reimbursement mechanisms on provider effort and performance quality. An example of instructions for an experimental economics game is availablehere.
Stated preference discrete choice experiments (DCEs) are a quantitative methodology for evaluating the relative importance of different product attributes on consumer choice. For an example of a DCE questionnaire, click here.
Click here for more information on this project and to read the full reports.
Publications related to the CREHS project:
Lagarde M, Blaauw D, Cairns J Cost-effectiveness analysis of human resources policy interventions to address the shortage of nurses in rural South Africa. Social Science & Medicine. 2012 doi:10.1016/j.socscimed.2012.05.005:1-6.
Mullei K, Mudhune S, Wafula J, Masamo E, English M, Goodman C, Lagarde M, Blaauw D Attracting and retaining health workers in rural areas: investigating nurses' views on rural posts and policy interventions. BMC Health Serv Res. 2010 Jul 2;10 Suppl 1:S1
Blaauw D, Erasmus E, Pagaiya N, Tangcharoensathein V, Mullei K, Mudhune S, Goodman C, English M, Lagarde M Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment. Bull World Health Organ. 2010 May;88(5):350-6