Article type
Abstract
Background
Leveraging evidence from civil society organizations (CSOs) for primary health care (PHC) decision-making can promote social justice principles of inclusiveness, responsiveness, and accountability. However, little attention has been placed on how CSOs generate evidence for PHC delivery, and the factors affecting the use of this evidence. Our study, set in Ghana, explored the nature and scope of evidence use from CSOs and how this evidence contributed to contextualizing evidence use in PHC decision-making at subnational levels in 2 selected regions: Ashanti and Greater Accra.
Methods
The study used a qualitative research design approach. Data were elicited from 32 publicly available health policy documents from the Ministry of Health and the Ghana Health Service websites developed between 1999 and 2023, 2 deliberation sessions, 4 observations of health policy decision-making processes, and 20 semistructured interviews with CSOs-in-Health. Data were managed and analyzed thematically (deductive-inductive) using Atlas-ti software.
Results
The documents reviewed focus on national rather than subnational processes, and how CSOs generate evidence was unclear. Interviewees described that most CSOs gather evidence from the routine health system data and reports from facilities and subdistrict and district levels and through community engagements using varied mechanisms such as citizens’ advice bureaus. The scope of evidence was generally local in nature, with some transcending the subnational to the global level like World Health Organization (WHO) and United Nations (UN) documents. Key facilitators are strong collaborations with stakeholders such as health management teams and local authorities, and the presence of CSOs in communities based on visible activities promotes the use of knowledge CSOs generate in PHC decision-making. Barriers such as the perceived absence of scientific rigor in the knowledge CSOs produce, and the noninstitutionalization of CSOs in mainstream governance resulting from the rigidity of health systems structures, inhibit the use of the evidence CSOs produce in PHC decision-making at subnational levels.
Conclusions
We identified examples of CSOs’ knowledge generation in Ghana despite barriers to the use of this knowledge in PHC decision-making. The need to acknowledge CSOs' participation in mainstream structures of governance with supportive law is pivotal. Strengthening CSOs’ capacity to gather evidence can help empower citizens and support the production of high-quality and responsive knowledge.
Leveraging evidence from civil society organizations (CSOs) for primary health care (PHC) decision-making can promote social justice principles of inclusiveness, responsiveness, and accountability. However, little attention has been placed on how CSOs generate evidence for PHC delivery, and the factors affecting the use of this evidence. Our study, set in Ghana, explored the nature and scope of evidence use from CSOs and how this evidence contributed to contextualizing evidence use in PHC decision-making at subnational levels in 2 selected regions: Ashanti and Greater Accra.
Methods
The study used a qualitative research design approach. Data were elicited from 32 publicly available health policy documents from the Ministry of Health and the Ghana Health Service websites developed between 1999 and 2023, 2 deliberation sessions, 4 observations of health policy decision-making processes, and 20 semistructured interviews with CSOs-in-Health. Data were managed and analyzed thematically (deductive-inductive) using Atlas-ti software.
Results
The documents reviewed focus on national rather than subnational processes, and how CSOs generate evidence was unclear. Interviewees described that most CSOs gather evidence from the routine health system data and reports from facilities and subdistrict and district levels and through community engagements using varied mechanisms such as citizens’ advice bureaus. The scope of evidence was generally local in nature, with some transcending the subnational to the global level like World Health Organization (WHO) and United Nations (UN) documents. Key facilitators are strong collaborations with stakeholders such as health management teams and local authorities, and the presence of CSOs in communities based on visible activities promotes the use of knowledge CSOs generate in PHC decision-making. Barriers such as the perceived absence of scientific rigor in the knowledge CSOs produce, and the noninstitutionalization of CSOs in mainstream governance resulting from the rigidity of health systems structures, inhibit the use of the evidence CSOs produce in PHC decision-making at subnational levels.
Conclusions
We identified examples of CSOs’ knowledge generation in Ghana despite barriers to the use of this knowledge in PHC decision-making. The need to acknowledge CSOs' participation in mainstream structures of governance with supportive law is pivotal. Strengthening CSOs’ capacity to gather evidence can help empower citizens and support the production of high-quality and responsive knowledge.