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Guest article by Corinne Hinlopen, Global Health Advocate, Wemos

Many of us working in public health and aiming to reduce health inequalities know how complex our challenges can be. In the AHEAD project (Action for Health and Equity Addressing medical Deserts) we have extensively studied the different manifestations of medical deserts and medical desertification, medical deserts being areas with limited health services that result in unmet health needs of the local population and health inequalities. In doing so, we regularly marvelled at the differences in their characteristics and root causes across the project countries (Italy, Moldova, Netherlands, Romania, Serbia). 

Realising that policy-making for such complex challenges includes multiple decision-points, we set out to apply a participatory policy-making methodology, engaging all relevant stakeholders. In the traditional top-down model, policies are formulated at national, regional or international levels and to be accomplished by the implementers, with no or very limited involvement of those implementing the policies or affected by the policies. More bottom-up policy-making focuses rather on the involvement of stakeholders and their knowledge, expertise, experiences, values and ideas to develop or modify policies based on local context. Such extensive stakeholder involvement introduces values such as rights, justice, fairness and democracy, improves the transparency and legitimacy of decision-making, enhances accountability for decision-making, and inform, educate, and build capacity for all involved.

With these theoretical principles in mind, AHEAD partners have implemented and validated a contextualised consensus-building methodology, in three phases, in all countries. We started with homogeneous groups of stakeholders at local level, who identified feasible, acceptable policy options from their own unique perspectives. They then selected representatives to participate in multi-stakeholder sessions in their locality, to explore and reach consensus on the most pressing and feasible policy options for their particular challenges. Finally, the representatives of the multistakeholder session met with national level policy makers and experts to agree on the most important and appropriate policy solutions.

The AHEAD consortium has evaluated the consensus-building methodology throughout all three phases and used the findings to update its methodology. While not difficult to implement per se, implementation requires careful planning and preparation, to build good relations, trust and safe spaces for all to participate equitably. If you would like to know more about the methodology, there is an explainer slide show and a recording of our webinar on this topic. The full guidance document will soon be available here.

In all countries, the consensus-building sessions and policy dialogues resulted in a variety of policy options, with tasks and responsibilities for all stakeholders involved. These policy options can be found here. Or you can watch our webinar on the topic. The AHEAD project was DG Sante funded, kicked off on World Health Day, 7 April, 2021, and concluded at the end of May 2023.  

For more information, you can send an email to: 

Corinne Hinlopen, Wemos (AHEAD Project lead partner).
Corinne.Hinlopen@wemos.org