Table 3 Using local evidence to inform judgements about values and views regarding options

The importance of involving consumers and communities in decisions regarding their healthcare is recognised widely. In Australia, the Consumers' Health Forum undertook consultations with consumers and consumer organisations to explore their needs and expectations regarding general practice. This evidence was gathered to inform policy development for the delivery of general practice services and the improvement of relations between key stakeholders. The evidence was fed into a number of Australian policy processes, including the government's General Practice Reform Strategy, the General Practice Strategy Review, and the development of co-ordinated care as proposed by the Council of Australian Governments [37].

The local acceptability of community-based malaria control interventions provides another example of consumer and community involvement. Indoor residual spraying (IRS) and insecticide-treated nets - the two principal strategies for malaria prevention - are similar in cost and efficacy. The acceptability of these interventions varies across settings. In South Africa, both research and routine programme monitoring have highlighted community dissatisfaction with the IRS insecticide, DDT. This is due to the residue that DDT leaves on house walls and because it stimulates nuisance insects such as bedbugs. In certain areas of Mozambique, there are concerns that specific sleeping habits - for example, people sleeping outside due to the heat - might also negatively influence the uptake of nets [38, 39].