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Table 2 Example of content analysis process for the study

From: Uptake of evidence in policy development: the case of user fees for health care in public health facilities in Uganda

  Meaning unit Category Theme
  Yes evidence has been used. We use evidence available at the time to compute how much was being collected and we compared this with the sector budget at the time. Operational research like the Uganda poverty participatory assessment undertaken by MoFPED, the Apuuli study on user fees that was commissioned by MoH were all used. Evidence was used to inform budget discussions Role of evidence in the policy process
  Although abolition of user fees was a political decision, at least there was some fury from the public that user fee had became politically unsustainable. Politicians considered evidence
  In the poverty participatory assessment study one of the biggest issues was the issue of user fees and access to services; so when this report came, it also caused worry among the politicians and we were asked to work out in financial terms, the cost of abolishing user fees. So we worked it out (......) we made recommendation to the minister and it was actually taken to cabinet and cabinet approved. Evidence informed cabinet discussions
  We used routine M & E data, a study undertaken by WHO and MoH (operational research). These sources of evidence showed increases in utilisation, drug stock-outs. We used this to lobby for increases in budget allocation. Districts also did some operational research whose results we used to lobby for more funding. The subsequent year, we had more money in the MTE. Evidence was used in lobbying for resources
  The truth of the matter is that this issue gets to be politicized because it was during campaigns that the president pronounced the abolition of user fees, but he actually used evidence from the district. Politicians considered evidence
  Regarding international evidence, this was mixed; some studies showed that user fees had some positive effects while others showed negative results. So there was lack of a firm position. Contradictory findings Characteristics of available evidence
  There were a number of discussion either on the benefits on chargers of user fees. But many of those studies were small based at the district level its after abolition that we were looking at levels of catastrophic expenditure; we were looking at the out of pocket expenditure in totality. evidence was from small scale studies
  Most of the studies on user fees in Uganda took place after its abolition. Timeliness of the evidence
  There was evidence but was that evidence properly synthesized? Was it properly shared by the different fora? Was it agreed that this was credible evidence for a decision to be made? Questionable quality of available evidence
  Influence of stakeholders   
  These were strong but their positions were mixed. The (X) were opposed to user fees. The (Z) from capitalist background were supportive of user fees. The (Y) had invested a lot in Bamako initiative so were supportive of the user fee policy. Actually in HPAC, there was no consensus. Strong with mixed positions due to different reasons Strong and divided
Donors Donor (X) was in favor of abolition of user fees, they were even generating some evidence to show that user fees were a burden. Strong and supportive of abolition of user fees
  Some donors were for the abolition because the climate then was for poverty eradication and one of the things they needed to do was to help the poor to access health services. So they were saying that if now you have got the HPIC (debt relief), why are you complaining? Strong and supportive of abolition of user fees
  The big financial players like (X) were against provision of free services and they were bringing in all sorts of evidence some of which was good and some bad. Some donors led by (X) were just pushing it and they used whatever evidence they liked. Strong, opposed and influential
Health workers They were opposed to abolition of user fees because they were beneficiaries. were opposed because of the benefits Strong and opposed
The health workers were using the money initially to get themselves some extra income so how can they support that such an option is stopped? Were opposed due to potential loss of benefits
Health workers were opposed to abolition of user fee because of the benefits. It was a steady reading available income, small as it may have been but it was there all the time. Now the challenge was, we were relying on them to implement the new free care policy. Were against user fee abolition yet they were the ones to implement free care