Research On Barriers And Strategies For "Post-abortion Family Planning Service" Policy Translation

Background: Abortion,especially repeated abortion,has been a serious public health as well as social issue since it can bring heavy burden on women's physiological and psychological health.In China,post-abortion family planning(PAFP)service,aimed at solving this issue,has been promoted and implemented.However,since PAFP hasn't been formulated into national policies,service coverage,depth and continuation are not satisfying.According to previous PAFP service implementation practices,translating PAFP service into policy and practice,namely PAFP service policy translation,faces many barriers.To better promote PAFP service policy translation,barriers should be scientifically analyzed first and corresponding strategies should be explored.Following on this,this study analyzes potential barriers to and possible strategies for PAFP service policy translation to promote PAFP policy formulation and implementation,to enrich related theories on health policy translation in China,and to provide theoretical framework for health policy translations in other researches.Method:(1)A literature review was applied to construct basic theory framework for PAFP service policy translation barriers and strategies,and to form basis for following studies.(2)Five in-depth interviews with two national and three provincial health policymakers and eleven semi-structured interviews with medical institution managers,health service providers,and health policy researchers in eleven provinces were conducted to sort PAFP service policy translation barriers and strategies out from the perspective of interviewees.(3)An electronic questionnaire survey was conducted on managers,health service providers in 90 medical institutions in 30 provinces(district,city)nationwide and relevant health policy researchers to analyze their suggestions for PAFP service policy translation strategies and to inspect whether there are differences and exact differences among suggestions from respondents of different kinds.Result: PAFP service policy translation barriers and strategies are analyzed from four major aspects: health policy agenda setting,health policy formulation,health policy implementation and health policy evaluation.PAFP service translation barriers:(1)In health policy agenda setting,barriers include: current medical health reform environment overemphasizes clinical medicine and underestimates public health;a top-down and relatively closed research-policy translation mode;PAFP service policy translation research is scarce;promotion for PAFP research outcomes is far from enough,etc.(2)In health policy formulation,barriers include: health policymakers haven't paid sufficient attention to PAFP;support and guidance for researchers on PAFP service policy translation are insufficient;there exists lack of close relationship and bidirectional communication among stakeholders,etc.(3)In health policy implementation,barriers include: PAFP service financial support is not adequate or continuous;human resource is insufficient for PAFP service provision;PAFP service information registration,file management and follow-up recording have yet not been standardized and electronic;relevant materials for PAFP service provision are in deficiency;the roles of different departments in PAFP service policy translation cooperation are not clearly defined;service providers do not perform or fully perform existing guidance;PAFP training and incentives are lacking;PAFP service is not widespread among general public;there is a lack of PAFP service specifications for medical institutions at different levels and of different types,etc.(4)In health policy evaluation,barriers include: PAFP service hasn't been involved in the evaluation system of all abortion service provision medical institutions,etc.PAFP service translation strategies:(1)In health policy agenda setting,strategies include: construct open,interactive policymaking process which is based on broad consultation and involves all PAFP stakeholders in and outside health system;researchers present PAFP research outcomes to health policymakers in an easily-understandable,inspiring,and practical way,etc.(2)In health policy formulation,strategies include: strengthen training for health policymakers;PAFP researchers take the initiative for translation;PAFP stakeholders keep stable relationship,ongoing communication and mutual trust in the long run,etc.(3)In health policy implementation,strategies include: guarantee enough funding for PAFP service policy translation;promote PAFP service translation in service providers;integrate PAFP service information into national health information statistical system;guarantee enough materials,equipment,facilities and space for PAFP service policy translation;enhance coordination and cooperation among PAFP service policy translation departments;establish PAFP service policy translation training and initiative system;promote PAFP service among general public via various promotion methods;involve PAFP service into specifications for abortion service,etc.(4)In health policy evaluation,strategies include: PAFP should be integrated into the evaluation system for individuals and departments,and the evaluation standard for medical institutions,etc.Discussion and policy recommendation: Based on theoretical and empirical research outcomes above,this study puts forward following policy recommendations on how to facilitate PAFP service translation into policies,promotion and implementation: integrate PAFP service into specifications for abortion service;increase funding for PAFP service;strengthen capacity building for PAFP service providers;integrate PAFP service information into current post-abortion care information system;pay close attention to long-acting contraceptive(LAC)promotion and utilization;lay much emphasis on abortion and repeated abortion prevention for unmarried child-bearing age population;involve PAFP service into performance assessment for health service providers in medical institutions.