Uptake of evidence in policy development: the case of user fees for health care in public health facilities in Uganda
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Date
2014
Journal Title
Journal ISSN
Volume Title
Publisher
BMC health services research
Abstract
Several countries in Sub Saharan Africa have abolished user fees for health care but the extent to
which such a policy decision is guided by evidence needs further exploration. We explored the barriers and
facilitating factors to uptake of evidence in the process of user fee abolition in Uganda and how the context and
stakeholders involved shaped the uptake of evidence. This study builds on previous work in Uganda that led to the
development of a middle range theory (MRT) outlining the main facilitating factors for knowledge translation (KT).
Application of the MRT to the case of abolition of user fees contributes to its refining.
Methods: Employing a theory-driven inquiry and case study approach given the need for in-depth investigation,
we reviewed documents and conducted interviews with 32 purposefully selected key informants. We assessed
whether evidence was available, had or had not been considered in policy development and the reasons why and;
assessed how the actors and the context shaped the uptake of evidence.
Results: Symbolic, conceptual and instrumental uses of evidence were manifest. Different actors were influenced
by different types of evidence. While technocrats in the ministry of health (MoH) relied on formal research,
politicians relied on community complaints. The capacity of the MoH to lead the KT process was weak and the
partnerships for KT were informal. The political window and alignment of the evidence with overall government
discourse enhanced uptake of evidence. Stakeholders were divided, seemed to be polarized for various reasons and
had varying levels of support and influence impacting the uptake of evidence.
Description
Keywords
User fees, Health care, Public facilities, Policy development, Knowledge translation, Uganda
Citation
Nabyonga-Orem, J., Ssengooba, F., Mijumbi, R., Kirunga Tashobya, C., Marchal, B., & Criel, B. (2014). Uptake of evidence in policy development: the case of user fees for health care in public health facilities in Uganda. BMC health services research, 14(1), 1-19.10.1186/s12913-014-0639-5