Table 4 Summary assessment of the AFR implementation
What worked well | Challenges |
|---|---|
AFR was regarded as a concrete and workable approach to strengthen the influence of values and context on decision making | AFR principles of legitimacy and fairness as supported by the conditionschange ways of thinking and acting which is only consolidated after a relatively long joint practice |
The AFR conditions were accepted as process guidance for use of criteria for priority setting | Stakeholders, including communities, were used to be included in decision-making processes on an ad hoc basis, and had some trouble seeing AFR as a change from ‘business as usual’ |
AFR increased the stakeholder and public understanding of their opportunities to influence local health action | Action research methods were not well recognized by all involved researchers and their institutions to be as valid as other research |
The AFR process guidance facilitated the coordination between current decision makers and expanded their inclusion of others in support of the implementation of national policies in local contexts | |
AFR conditions influenced priority setting and other decisions in some of the sites | |
Elements facilitating the application of AFR | Elements constraining the application of AFR |
Fairness and other AFR-related values of transparency, accountability, and equity were already recognized as desirable aims by respondents | Concerns for managerial consequences and risks to existing agendas and power relations were likely to be the reason for a limited national and donor interest in the approach |
AFR principles of inclusiveness and accountability corresponded well with existing policy guidelines and planning aims | The lack of focus on predetermined outcomes may not have been seen as a procedural support, but rather as a challenge to the strong international and national priority setting and programming |
Formal structures in place for boards and committees | Limited organizational, leadership, communication, and advocacy skills may have been among reasons for poor stakeholder and public awareness of options for health action |
The action research approach with continuous researcher support bridged the research into practice gap for AFR from the onset |