Examining the Link between Equity-Centered Health Policies, Autonomy and Decision-Making Process in Low and Middle Income Countries

Abstract

Objective: The purpose of this article is to examine the main underlying social values that define health policy decisions. We focus on LMICs, many of which are at an early stage of implementation of these evidence-based policy processes. This review aimed at analyzing the ethical and procedural principles that underlie these social values, their potential conflict and the challenges of implementing a decision-making process according to these values in LMIC. Methods: Broad scoping search of international literature (December 2012) in PubMed, Cinahl, ISI Web of knowledge, Cochrane Library, and ProQuest. Search terms were “social values”, “healthcare/ health” and “low and middle income countries” (terms adapted according to each database). There was no pre-defined limit of year or language. We excluded “grey literature” documents only. From a total of 252 hits, we finally selected and fully read 51 of them. Results: The translation of health policy decisions from high-income countries to LMICs is complex, as they have differences that might affect the expected outcomes. Decisions should primarily aim at improving population health. The measurement of socioeconomic status and social inequalities in health, which is also context-specific, it is another primary objective in decisions about healthcare policies. Autonomy and equity might conflict in scenarios of limited budget. However, individual autonomy should be limited when affects other´s individuals autonomy and social welfare. Evidence and transparency in the decision process is highly valued, and expenditure in information for decision-making should be promoted since it increases population health. Conclusion: High-quality research evidence is paramount to implement health policies consistent with social values and the resources needed to produce relevant evidence can be considered a good use of public resources. A framework for decision-making should be anchored at least in three first order social values, improvement of population health, improving equity (in access to healthcare and health) and transparency.