An innovative approach to participatory health policy development in Bulgaria: The conception and first achievements of the Partnership for Health

Abstract

The Bulgarian Partnership for Health was established in 2015 as a new forum for health policy formulation and discussion. The Partnership presents a new approach of structured and sustained stakeholder involvement to overcome the lack of public participation in health policy development and implementation. Constituted as a permanent consultative body to the Council of Ministers, the Partnership engages a wide variety of stakeholders and professionals to shape and improve health policies. The shared governance of the Partnership between the Minister of Health and a patient organisation supports the elaboration of legislative acts based on the stakeholders' collaboration in priority areas. The governance and organisational structure of the Partnership assures capacity building, fast mobilisation of experts, continuity of stakeholder involvement, and increased responsibility in health policy development and implementation. This type of participatory approach may help reconcile initially opposing positions and foster reforms often impeded by political antagonism. Persisting challenges are a rather slow process of policy development and different perceptions of key concepts among the stakeholders. As policy-making in many countries in Eastern Europe suffers from political distrust, the Partnership's approach of involving experts - and not only politicians - could provide inspiration also to other countries, which have struggled with inconsistency of health policies pursued by different governments.

Taking stock of Roma health policies in Spain: Lessons for health governance

“…Successful public policies on education, sanitation, social services and discrimination are likely to have a positive impact on the social determinants of health with spillover effects to Roma health outcomes [1,44,51]. Roma health policies thus need to be developed from a systems-thinking perspective and foster multilevel partnerships between representatives of the various policy, professional and civil society sectors to jointly devise and implement intersectoral strategies to address Roma health inequities [52]. This requires building stakeholders' capacity to frame and communicate the problems at hand, procure resources and engage in participatory decision-making processes directed at improving Roma health [52,53].…”

“…academics, professionals) to work together with both national and foreign Roma communities to identify legitimate representatives, discuss their problems and establish priorities for action, and foster the skills necessary to advocate for their needs and influence decisionmaking (e.g. argumentation skills) [52,57]. Acting in this way, will require the creation of participatory mechanisms specifically designed to foster Roma participation in policy formulation, implementation and assessment, i.e.…”

A Community-Based Participatory Action Research for Roma Health Justice in a Deprived District in Spain

“…An RHJ approach aims to develop alliances in order to promote collaboration between different sectors and encourage systemic agreements and strategies [44]. This builds a sustainable and shared decision-making platform of overarching health priorities at the local level that can quickly mobilize stakeholders and resources [55]. Following community development strategies, HJA creates opportunities for dialogue between multiple stakeholders, promotes the leadership of Roma neighbors, and develops social solidarity through shared critical knowledge [56].…”

Health care provider payment schemes across nine Central and Eastern European countries – a comparative analysis

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