Leveraging public engagement to improve healthcare quality: The role of community and stakeholder engagement in Colombia's National Quality of Care Strategy.

Public engagement, also referred to as community and stakeholder engagement (CSE), and high-quality care are core components of strategies to achieve universal health coverage (UHC), one of the United Nations Sustainable Development Goals. As part of the movement toward achieving UHC, Colombia has developed one of the first national quality of care strategies in the Latin America and Caribbean region. However, the degree to which public engagement was considered in the development and implementation of Colombia's National Quality of Care Strategy (the Strategy) is not clearly understood. With a growing global consensus on the importance of public engagement in health systems and policy, we use a qualitative case study comprising a document analysis followed by qualitative interviews, to explore how CSE has been considered in the design and implementation of the Strategy. In an analysis guided by the Lavery framework for CSE, we address the following three research objectives: 1) describe how community and stakeholder engagement is reflected in the Strategy; 2) explore approaches undertaken to engage community and stakeholders in the development and implementation of the Strategy and their perceived effectiveness; and 3) report on strengths and opportunities for improving CSE in health policymaking in Colombia. Our findings demonstrate a strong written commitment to CSE. However, the implementation of engagement strategies fell short in including community (i.e., patients and citizens), particularly those from structurally marginalized communities, due in part to inconsistent political and financial support and the absence of evaluation mechanisms. These findings have important implications for Colombia and other comparable jurisdictions aiming to enhance public engagement in health policy making. Our study highlights the need to move beyond symbolic participation toward inclusive, well-resourced, and systematically evaluated engagement strategies.