Map Map


How has the problem been framed (described) and what are the consequences of this framing?

How a problem is framed or described can determine the kinds of options considered to address the problem, as well as stakeholders’ perceptions of its importance. Thinking about how a problem has been framed means viewing the problem from different perspectives and identifying ways in which the problem could be packaged. A problem with chronic care, for example, might be framed in a number of different ways: as one of coordination and communication between primary and secondary care providers; as a problem with inadequate primary care; as a quality–of-care problem (poor adherence to clinical practice guidelines); as a problem of rising costs; or as a problem of long waiting times or lack of access to care. Each of these would lead to different perceptions and different sets of solutions. It is important to ensure that a problem is framed in a way that resonates with stakeholders and leads to the identification of appropriate options for addressing the problem. Therefore to facilitate this, consideration should be given to the different ways to frame the problem in light of how it originally came to attention, the available indicators and comparisons, and an analysis of its cause.

Interviews or discussions with key stakeholders about how a problem has been framed (or could be framed) can lead to the identification of alternative framing ideas and information about their advantages and disadvantages. Discussions can also provide a better sense of which framing approach is likely to resonate most with stakeholders and result in the identification of appropriate options. Studies of the perceptions and attitudes of stakeholders may also help to clarify how best to frame a problem. A worksheet for clarifying a problem is provided in the ‘Additional resources’ section of this guide, as well as example of completed worksheets (in Uganda and in Zambia). Further guidance can be found in the SUPPORT tool on using evidence to clarify the problem. Workshop materials and a presentation on clarifying the problem are also provided in the ‘Additional resources’ section. Click here to listen to a member of the Zambian EVIPNet team describing the clarification of the problem for a policy brief on integrating mental health care into primary care. Box 3.1 shows an example of a clarifying the problem exercise.


Box 3.1 Example of a clarifying the problem exercise

  1. Write in two or three sentences what the problem is and why this problem is being addressed at this time.

  2. Make a table (see Table 3.1) listing different ways of framing the problem and then consider the advantages and disadvantages of each of these. This sometimes results in framing the problem differently. It helps to clarify problems and identify information that should be included in the background or in a section following the background.

  3. Consider what information would best characterise the size of the problem by identifying what indicators or measures are relevant (e.g. numbers of clinics or health workers) and the size of the consequences (e.g. utilisation/access, expenditures). For each indicator consider what comparisons would be relevant (e.g. with goals, changes over time, between different areas within the country, and with other countries).

  4. Consider what the causes or factors underlying the problem are in two ways: by brainstorming and by applying a framework.

  5. Then generate a list of potential solutions based on the underlying factors, and on what has been found in the literature and through brainstorming. This is helpful for the next step in preparing a policy brief: deciding on and describing policy options.

A useful way to consider whether a problem has been framed appropriately might be to create a table such as Table 3.1, and to add rows iteratively. 


Table 3.1 Example of alternative ways of framing a problem - task shifting

Ways of framing the problem

Advantages

Disadvantages

Task shifting

This was initially suggested as a topic by a senior policymaker and is a topic of interest that will resonate with other policymakers

Task shifting is a solution, not a problem, and the term may be unfamiliar to some stakeholders, or misleading and may generate unnecessary controversy

Expanding health worker roles  

Expanding the roles of health workers (e.g. community health workers, traditional birth attendants, nurses and midwives) may better describe the issue and be less likely to generate unnecessary controversy

Expanding health workers roles is also a solution and therefore  also leaves unclear the nature of the problem that this solution is intended to address

Supply of health workers  

This is a problem that is easily understood and for which there are many possible options, including expanding health worker roles 

Based on available information, there does not appear to be a shortage of health professionals

Inefficient use of health workers (i.e. paying highly trained professionals to do tasks that could be done by less costly health workers)  

This is another problem that is easily understood and for which there are many possible options, including task shifting

It is unclear if this is a problem (e.g. that physicians are performing tasks that other health workers could perform at a lower cost) or that task shifting would result in substantial savings

Distribution of health professionals  

There is evidence that this is a problem, particularly recruiting and retaining health professionals in rural areas. It is a problem that is easily understood and for which there are many possible options, including expanding health worker roles 

This may not resonate with policymakers or be sufficiently focussed

Inadequate provision of effective MCH care. Inadequate human resources and sub-optimal use of available human resources is a major contributing factor  

Upon further reflection this is the starting point and the underlying problem for which ‘task shifting’ was suggested as the focus for a policy brief. This is a problem that is likely to resonate with a wide range of stakeholders and policymakers. It is well focused, and expanding the roles of health workers is a promising strategy

It may be important to consider a broad range of other options, in addition to expanding the roles of health workers, in order to address this problem

A detailed analysis of different ways to frame a problem is unlikely to be helpful to stakeholders or decision makers. However, when relevant, the policy brief should include a description of the different ways of framing the problem, the reason for framing the problem in a particular way, and the consequences of doing so. This information can be provided in the background section, in a separate section after it, or at the end of the problem description. Providing this information could help to reassure stakeholders that alternative ways of framing the problem have been considered, and that the problem has been framed appropriately. It can also form the basis for a more informed discussion of the problem. 

An example of how a problem can be better clarified through a consideration of different ways to frame it is provided in the ‘Additional resources’ section of this guide. 


This page was last updated November 2011.