Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program [version 3; peer review: 1 approved, 2 approved with reservations]
Faced with declining donor funding for HIV, low- and middle-income countries must identify efficient and cost-effective ways to integrate HIV prevention programs into public health systems for long-term sustainability. In Zambia, donor support to the voluntary medical male circumcision (VMMC) progra...
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| Format: | Article |
| Language: | English |
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F1000 Research Ltd
2024-11-01
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| Series: | Gates Open Research |
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| Online Access: | https://gatesopenresearch.org/articles/8-18/v3 |
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| _version_ | 1846160672200589312 |
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| author | Rasi Surana Saransh Sharma Stephen Goetschius Nishan Gantayat Steve Kretschmer James Baer Ram Prasad Njekwa Mukamba Alick Samona Tina Chinsenga Alok Gangaramany Bright Jere |
| author_facet | Rasi Surana Saransh Sharma Stephen Goetschius Nishan Gantayat Steve Kretschmer James Baer Ram Prasad Njekwa Mukamba Alick Samona Tina Chinsenga Alok Gangaramany Bright Jere |
| author_sort | Rasi Surana |
| collection | DOAJ |
| description | Faced with declining donor funding for HIV, low- and middle-income countries must identify efficient and cost-effective ways to integrate HIV prevention programs into public health systems for long-term sustainability. In Zambia, donor support to the voluntary medical male circumcision (VMMC) program, which previously funded non-governmental organizations as implementing partners, is increasingly being directed through government structures instead. We developed a framework to understand how the behaviors of individual decision-makers within the government could be barriers to this transition. We interviewed key stakeholders from the national, provincial, and district levels of the Ministry of Health, and from donors and partners funding and implementing Zambia’s VMMC program, exploring the decisions required to attain a sustainable VMMC program and the behavioral dynamics involved at personal and institutional levels. Using pattern identification and theme matching to analyze the content of the responses, we derived three core decision-making phases in the transition to a sustainable VMMC program: 1) developing an alternative funding strategy, 2) developing a policy for early-infant (0–2 months) and early-adolescent (15–17 years) male circumcision, which is crucial to sustainable HIV prevention; and 3) identifying integrated and efficient implementation models. We formulated a framework showing how, in each phase, a range of behavioral dynamics can form barriers that hinder effective decision-making among stakeholders at the same level (e.g., national ministries and donors) or across levels (e.g., national, provincial and district). Our research methodology and the resulting framework offer a systematic approach for in-depth investigations into organizational decision-making in public health programs, as well as development programs beyond VMMC and HIV prevention. It provides the insights necessary to map organizational development and policy-making transition plans to sustainability, by explaining tangible factors such as organizational processes and systems, as well as intangibles such as the behaviors of policymakers and institutional actors. |
| format | Article |
| id | doaj-art-355843f54350470c9c47ef3faa4f0f95 |
| institution | Kabale University |
| issn | 2572-4754 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | F1000 Research Ltd |
| record_format | Article |
| series | Gates Open Research |
| spelling | doaj-art-355843f54350470c9c47ef3faa4f0f952024-11-22T01:00:00ZengF1000 Research LtdGates Open Research2572-47542024-11-01817697Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program [version 3; peer review: 1 approved, 2 approved with reservations]Rasi Surana0Saransh Sharma1Stephen Goetschius2Nishan Gantayat3https://orcid.org/0000-0003-3258-6643Steve Kretschmer4https://orcid.org/0000-0002-4839-2213James Baer5Ram Prasad6Njekwa Mukamba7Alick Samona8Tina Chinsenga9Alok Gangaramany10https://orcid.org/0000-0002-3908-8463Bright Jere11Final Mile Consulting, New York, New York, 10007, USAFinal Mile Consulting, New York, New York, 10007, USAFinal Mile Consulting, New York, New York, 10007, USAFinal Mile Consulting, New York, New York, 10007, USADesireLine, Istanbul, TurkeyDesireLine, Istanbul, TurkeyFinal Mile Consulting, New York, New York, 10007, USACenter for Infectious Disease Research in Zambia, Lusaka, Lusaka Province, ZambiaDesireLine, Istanbul, TurkeyMinistry of Health, Zambia, Lusaka, ZambiaFinal Mile Consulting, New York, New York, 10007, USACenter for Infectious Disease Research in Zambia, Lusaka, Lusaka Province, ZambiaFaced with declining donor funding for HIV, low- and middle-income countries must identify efficient and cost-effective ways to integrate HIV prevention programs into public health systems for long-term sustainability. In Zambia, donor support to the voluntary medical male circumcision (VMMC) program, which previously funded non-governmental organizations as implementing partners, is increasingly being directed through government structures instead. We developed a framework to understand how the behaviors of individual decision-makers within the government could be barriers to this transition. We interviewed key stakeholders from the national, provincial, and district levels of the Ministry of Health, and from donors and partners funding and implementing Zambia’s VMMC program, exploring the decisions required to attain a sustainable VMMC program and the behavioral dynamics involved at personal and institutional levels. Using pattern identification and theme matching to analyze the content of the responses, we derived three core decision-making phases in the transition to a sustainable VMMC program: 1) developing an alternative funding strategy, 2) developing a policy for early-infant (0–2 months) and early-adolescent (15–17 years) male circumcision, which is crucial to sustainable HIV prevention; and 3) identifying integrated and efficient implementation models. We formulated a framework showing how, in each phase, a range of behavioral dynamics can form barriers that hinder effective decision-making among stakeholders at the same level (e.g., national ministries and donors) or across levels (e.g., national, provincial and district). Our research methodology and the resulting framework offer a systematic approach for in-depth investigations into organizational decision-making in public health programs, as well as development programs beyond VMMC and HIV prevention. It provides the insights necessary to map organizational development and policy-making transition plans to sustainability, by explaining tangible factors such as organizational processes and systems, as well as intangibles such as the behaviors of policymakers and institutional actors.https://gatesopenresearch.org/articles/8-18/v3decision-making policy-making organisational behavior policy implementation public health zambiaeng |
| spellingShingle | Rasi Surana Saransh Sharma Stephen Goetschius Nishan Gantayat Steve Kretschmer James Baer Ram Prasad Njekwa Mukamba Alick Samona Tina Chinsenga Alok Gangaramany Bright Jere Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program [version 3; peer review: 1 approved, 2 approved with reservations] Gates Open Research decision-making policy-making organisational behavior policy implementation public health zambia eng |
| title | Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program [version 3; peer review: 1 approved, 2 approved with reservations] |
| title_full | Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program [version 3; peer review: 1 approved, 2 approved with reservations] |
| title_fullStr | Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program [version 3; peer review: 1 approved, 2 approved with reservations] |
| title_full_unstemmed | Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program [version 3; peer review: 1 approved, 2 approved with reservations] |
| title_short | Developing a framework for understanding policy decision-making behaviors in the transition of an HIV prevention program towards sustainability: a case study from Zambia’s voluntary medical male circumcision program [version 3; peer review: 1 approved, 2 approved with reservations] |
| title_sort | developing a framework for understanding policy decision making behaviors in the transition of an hiv prevention program towards sustainability a case study from zambia s voluntary medical male circumcision program version 3 peer review 1 approved 2 approved with reservations |
| topic | decision-making policy-making organisational behavior policy implementation public health zambia eng |
| url | https://gatesopenresearch.org/articles/8-18/v3 |
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