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Engaging citizens for evidence-informed health policies in Lebanon

By , , and on March 5, 2019

Olivia Biermann is a PhD student, Department of Public Health Sciences, Karolinska Institutet, Sweden
Rana Saleh, LD, MPH, Advocacy and Evidence Lead Specialist at K2P Center at the Faculty of Health Sciences (FHS), AUB. Rana is leading the advocacy, citizen engagement and capacity building arm at K2P and involved in multiple Knowledge Translation initiatives
Rima Nakkash, MPH, DrPH, Associate Professor at the Department of Health Promotion and Community Health at FHS-AUB and the Associate Director of K2P Center. She is the coordinator of the AUB Tobacco Control research group and co-directs the WHO FCTC water pipe tobacco smoking knowledge hub
Fadi El Jardali, MPH, PhD, Professor of Health Policy and Systems Research and the Chairman at the Department of Health Management and Policy at FHS-AUB and the Founder and Director of K2P Center. He is also the Co-Director of the Center for Systematic Reviews in Health Policy and Systems Research (SPARK)

In evidence-informed policy-making, there has been an increasing focus on involving those who are potentially affected by policies in the policy-making process. While at the Knowledge to Policy Center (K2P) (American University of Beirut, Lebanon), I spoke to Rana Saleh (Advocacy and Evidence Lead Specialist at K2P) on her work on citizen engagement. She provided me with insights into why citizen engagement is important for health policy, what could be learned about the topic from the literature, and how K2P made citizen engagement a reality in Lebanon.

Why is citizen engagement important for health policies?
Citizen engagement is important to make health policies more inclusive and equitable. By engaging citizens, we ensure that their knowledge feeds into the policy-making process. What citizens know (e.g. what a teacher knows about the implementation issues linked to offering healthy food in schools) can be extremely valuable in identifying feasible policy options, understanding context and implementing policies. Citizens’ knowledge goes beyond what is written in the literature.

Besides, the benefit of citizen engagement extends beyond the improvement of policies; being engaged in policy-making processes can build capacity and empower citizens to speak up for their needs, and to hold policy-makers accountable.

What did you learn about citizen engagement from the literature? 
Firstly, most studies on citizen engagement that we identified had been conducted in high-income countries, and the methods used are thus not necessarily applicable in low- and middle-income settings. Contextualizing the modes of engagement is a must.

The political support, culture of engagement and established citizen engagement processes that exist in some countries are inspiring. Yet, in contexts where these factors are not a given (let alone in conflict-affected areas), introducing the concept of engagement might be the main challenge in itself.

Finally, although the published processes of engaging citizens do not necessarily apply in the Lebanese context, they helped us identify which components we should be looking at, e.g. in terms of levels of engagement and methods of recruitment.

How did you develop a context-specific approach for citizen engagement in Lebanon? 
We have gone through a learning process that included “trial and error” on citizen consultations, a qualitative study and close collaboration with a steering committee.

The study is entitled “Developing a contextual model for citizen engagement in health policy and decision-making in Lebanon”, and will be published later this year. It consists of 1) interviews with policy-makers, researchers and civil society on methods of citizen engagement, 2) focus group discussions with citizens on how they would like to be engaged, and 3) piloting these methods. We expect that the lessons we are able to draw will be useful for Lebanon and the Arab world.   

What are the barriers and facilitators for citizen engagement in Lebanon? 
Many factors influence citizen engagement – from the human and financial resources available to support such processes, to the citizens who are involved and able to contribute, to policy-makers; ideally, the latter are ready to listen to citizens, and act upon what citizens have to share.

While recruiting citizens for a consultation, some individuals were hesitant to get involved due to their lack of trust in both policy-makers and researchers. Even during consultations, we were repeatedly asked: “How will you use what we tell you?”

We increased citizens’ trust by being clear and transparent about the engagement process, and building on the perception of K2P as a neutral player. We keep individuals in the loop on a regular basis, e.g. by sharing updates via WhatsApp. Citizen engagement is a (learning) process, not a single event.  

How did K2P put citizen engagement into practice?
Citizen engagement is part of K2P’s strategy to empower citizens through the use of evidence, and for them to become an active pressure group for change. Dealing with the political and interest-charged issue of childhood obesity in Lebanon, we realized the potential of engaging citizens in policy-making. Citizen engagement would add depth to discussions that we would otherwise not be able to reach through a policy dialogue alone.

We organized four citizen consultations on the topic. The following steps have worked well for us so far: 1) recruiting citizens via municipalities, primary care centers and community health committees, 2) introducing the topic through advocacy and using infographics and videos, 3) starting discussions in homogenous groups (e.g. teachers among teachers) to harness feedback on the topic, policy options and implementation considerations, 4) continuing the discussion with all invited citizens, 5) summarizing citizens’ feedback and sharing it with them, and 6) including the feedback in the related policy brief.

The policy brief will be discussed during a policy dialogue in March. Knowing that the policy brief will include citizens’ views has already made policy-makers curious.

What are your lessons learned related to citizen engagement?
We know that we still have a lot to learn on how to engage citizens in Lebanon, while using innovative methods and being flexible. What we are sure of is that citizens’ views are necessary to develop inclusive and equitable health policies, and enhance accountability for policy implementation.  

The K2P Center is a World Health Organization Collaborating Center on evidence-informed policy and practice. It is a leader in the field of knowledge translation, working closely with the Ministry of Public Health and other key stakeholders in Lebanon, the Eastern Mediterranean Region and internationally.  The K2P Center is also co-hosting the Sixth Global Symposium on Health Systems Research in Dubai, United Arab Emirates, in 2020.

During a visit at the K2P Center, Olivia Biermann developed the idea for this blog, together with Rana Saleh. Fadi El-Jardali and Rima Nakkash provided input to the content of the blog. All authors approved the final version of the blog. 

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