Framing ârural health equityâ and implications for governance: thematic analysis of 51 expert narratives from a global webinar series
Notice bibliographique
Résumé
INTRODUCTION: To respond to persisting gaps in health service coverage and health outcomes impacting rural populations globally, governance for rural health equity requires enhanced focus by policymakers, researchers and practitioners. During 2021-22, 51 experts from around the world contributed (as speakers, co-chairs and discussants) to an eight-part webinar series on rural health equity convened by WHO and Rural WONCA, with inputs from partners including the OECD and agencies in the UN Inequalities Task Team subgroup on rural inequalities. The aim of the webinar series was to share technical/operational know-how and lessons learnt for addressing rural health inequities. METHODS: A thematic analysis of all webinar expert narratives was completed by the authors during 2022-23, with the purpose of using the data to conceptually feed into multiple WHO technical and capacity-building products. Following transcription, this entailed familiarization with the data and reflexivity (including on the framework used to inform the series and the researchers' roles), generation of codes, combining codes in categories and themes, further analysis and reporting (alongside amendment of the original framework). The research question was 'What do the 51 expert narratives from the WHO Rural Health Equity eight-part webinar series convey about the framing of rural health equity and related governance approaches?' RESULTS: Expert narratives provided evidence suggesting that the framing of rural health equity needs to account for primary health care-oriented health systems strengthening issues in a way that highlights their indivisible, interrelated and synergistic nature, taking a system-wide approach. Expert narratives pointed to the health sector having an active role in rural development policy, as a platform to leverage action for rural health equity through working across sectors to address social and environmental determinants of health. In framing the equity dimension of rural health equity, there was a clear acknowledgement in expert narratives that the concept comprises inequitable differences both between urban and rural areas and within rural areas. Narratives underlined that a historical lens is required to understand the drivers of rural health inequities, as well as formulate or improve - through participatory approaches - the strategies to overcome them. The narratives shed light on governance issues such as inter- and intrasectorial policy and programming coherence, effective rural-proofing mechanisms, evidence-based decision-making drawing from strengthened equity-oriented information systems, ground-up participatory decision-making approaches, rights-based governance (including for self-determination), and greater accountability for redressing socio-spatial inequities and optimizing rural communities' assets. Findings suggest that unlocking rural health inequities will require the further study of government commitments, governance mechanisms, and capacities to effectively implement measures for territorially balanced development and area-based strategies for equity within and between territories. CONCLUSION: The findings have relevance for the further design of policies, programming, and monitoring and evaluation for rural health equity by national and subnational authorities, as well as for the activities of researchers, WHO, Rural WONCA and partners.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».