Resistance and Change: A Multiple Streams Approach to Understanding Health Policy Making in Ghana

Kusi-Ampofo, Owuraku; Church, John; Conteh, Charles; Heinmiller, B. Timothy

doi:10.1215/03616878-2854711

Cited by 29 publications

(22 citation statements)

References 19 publications

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“…Data collection included semi-structured in-depth interviews, focus group discussions, participant observation, and documentation review. When provided by the authors, analytical design was mostly stakeholders’ analysis ( N = 4) [ 115 – 118 ], specific theory-based frameworks [ 106 , 108 , 119 ], or self-constructed frameworks [ 120 ]. Two quantitative papers were case-control studies using descriptive statistics with data obtained from questionnaire-based surveys [ 121 , 122 ].…”

Section: Resultsmentioning

confidence: 99%

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Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes

Gautier

Ridde

2017

glob health res policy

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BackgroundThe rise on the international scene of advocacy for universal health coverage (UHC) was accompanied by the promotion of a variety of health financing policies. Major donors presented health insurance, user fee exemption, and results-based financing policies as relevant instruments for achieving UHC in Sub-Saharan Africa. The “donor-driven” push for policies aiming at UHC raises concerns about governments’ effective buy-in of such policies. Because the latter has implications on the success of such policies, we searched for evidence of government ownership of the policymaking process.MethodsWe conducted a scoping review of the English and French literature from January 2001 to December 2015 on government ownership of decision-making on policies aiming at UHC in Sub-Saharan Africa. Thirty-five (35) results were retrieved. We extracted, synthesized and analyzed data in order to provide insights on ownership at five stages of the policymaking process: emergence, formulation, funding, implementation, and evaluation.ResultsThe majority of articles (24/35) showed mixed results (i.e. ownership was identified at one or more levels of policymaking process but not all) in terms of government ownership. Authors of only five papers provided evidence of ownership at all reviewed policymaking stages. When results demonstrated some lack of government ownership at any of the five stages, we noticed that donors did not necessarily play a role: other actors’ involvement was contributing to undermining government-owned decision-making, such as the private sector. We also found evidence that both government ownership and donors’ influence can successfully coexist.DiscussionFuture research should look beyond indicators of government ownership, by analyzing historical factors behind the imbalance of power between the different actors during policy negotiations. There is a need to investigate how some national actors become policy champions and thereby influence policy formulation. In order to effectively achieve government ownership of financing policies aiming at UHC, we recommend strengthening the State’s coordination and domestic funding mobilization roles, together with securing a higher involvement of governmental (both political and technical) actors by donors.Electronic supplementary materialThe online version of this article (doi:10.1186/s41256-017-0043-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…A third paper reviewed quantitative outcome records without using statistical analysis [ 123 ]. Despite their low methodological quality (i.e., very few details given about data collection and analysis), we included a couple of papers because they still provided useful information for our review [ 106 , 111 ].…”

Section: Resultsmentioning

confidence: 99%

Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes

Gautier

Ridde

2017

glob health res policy

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“…By using Kingdon's framework, we may run the risk of a US-based explanation of how a government agenda's is set; however, this framework has been widely used in other international settings to explain agenda setting and legislative passage. [23][24][25]57 There also is the possibility of bias in the selection of interviewees, if those who were against the tax were less likely to agree to be interviewed. In addition, there is the danger of bias, since passage of the tax may affect how participants view past events.…”

Section: Discussionmentioning

confidence: 99%

“…14 Agenda setting is an important stage in the development of government policies as it restricts the set of problems being addressed and the set of policy alternatives under consideration. Kingdon's theory has been used frequently to explain health policy processes in many situations, [23][24][25] including an analysis of how some US state legislatures passed SSB taxes. 26 We use the theory to explain agenda setting for the SSB tax in Mexico: how the SSB tax went from a policy idea without much support to its adoption as part of Mexico's 2013 fiscal reform.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

The Politics of Taxes for Health: An Analysis of the Passage of the Sugar-Sweetened Beverage Tax in Mexico

James

Lajous

Reich

2020

Health Systems & Reform

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This article explores the politics of passage of the sugar-sweetened beverage (SSB) tax in Mexico, using published documents, media articles, and interviews with key stakeholders. The article examines first the period of agenda setting when the tax was included in the President's fiscal reform package; and second, the period of legislative passage, when the bill was introduced in Congress and was passed. The analysis uses Kingdon's three streams theory of agenda setting, to explain how the tax emerged on the agenda and how agenda setting shaped and enabled legislative passage. The article offers five lessons related to the politics of passing the SSB tax in Mexico. First, passing an SSB tax was difficult and required high-level organization, cooperation, planning, and effort. Second, supporters needed an understanding of how to manage the political and economic context, facilitated by a grant from Bloomberg Philanthropies. Third, framing the tax as generating revenue helped get the proposal onto the policy agenda and enabled buy-in from the powerful Ministry of Finance (Hacienda). Fourth, forming networks within the legislature early on allowed tax proponents to have a network of allies within Congress ready when the SSB tax was introduced as a bill. Finally, early public relations campaigns helped shape public perception that Mexico's obesity epidemic was driven in part by SSB consumption. This is the first paper that uses political science theory and primary data collection and interviews with a broad range of stakeholders, to explain how Mexico passed an SSB tax despite opposition from a strong national SSB industry.

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“…8 , 9 We chose the multiple streams framework (MSF) 22 as one that has been found useful in examining health policy agenda-setting, formulation and implementation in other settings, 23 - 25 including in LMIcs. 26 - 29 Our account of the MSF is largely based on those given by Zahariadis 30 and Cairney, 8 and we considered five main elements, summarised in Box 1. Briefly these five elements are: the problem – how the issue of NCDs is defined, discussed, and framed; the policies – that have been adopted, developed, and implemented; politics – how this influenced and was influenced by the problem of NCDs; policy windows – particular times/opportunities when problem, policies, and politics come together and enable change.…”

Section: Methodsmentioning

confidence: 99%

The Development of Public Policies to Address Non-communicable Diseases in the Caribbean Country of Barbados: The Importance of Problem Framing and Policy Entrepreneurs

Unwin

Samuels

Hassell³

et al. 2016

Int J Health Policy Manag

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Background: Government policy measures have a key role to play in the prevention and control of non-communicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control in Barbados, and to investigate factors promoting, and hindering, success. Methods: A qualitative case study design was used involving a structured policy document review and semi-structured interviews with key informants, identified through stakeholder analysis and ‘cascading.’ Documents were abstracted into a standard form. Interviews were recorded, transcribed verbatim and underwent framework analysis, guided by the multiple streams framework (MSF). There were 25 key informants, from the Ministry of Health (MoH), other government Ministries, civil society organisations, and the private sector. Results: A significant policy window opened between 2005 and 2007 in which new posts to address NCDs were created in the MoH, and a government supported multi-sectoral national NCD commission was established. Factors contributing to this government commitment and funding included a high level of awareness, throughout society, of the NCD burden, including media coverage of local research findings; the availability of policy recommendations by international bodies that could be adopted locally, notably the framework convention on tobacco control (FCTC); and the activities of local highly respected policy entrepreneurs with access to senior politicians, who were able to bring together political concern for the problem with potential policy solutions. However, factors were also identified that hindered multi-sectoral policy development in several areas, including around nutrition, physical activity, and alcohol. These included a lack of consensus (valence) on the nature of the problem, often framed as being predominantly one of individuals needing to take responsibility for their health rather than requiring government-led environmental changes; lack of appropriate detailed policy guidance for local adaptation; conflicts with other political priorities, such as production and export of alcohol, and political reluctance to use legislative and fiscal measures. Conclusion: The study’s findings indicate mechanisms to promote and support NCD policy development in the Caribbean and similar settings.

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Resistance and Change: A Multiple Streams Approach to Understanding Health Policy Making in Ghana

Cited by 29 publications

References 19 publications

Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes

Health financing policies in Sub-Saharan Africa: government ownership or donors’ influence? A scoping review of policymaking processes

The Politics of Taxes for Health: An Analysis of the Passage of the Sugar-Sweetened Beverage Tax in Mexico

The Development of Public Policies to Address Non-communicable Diseases in the Caribbean Country of Barbados: The Importance of Problem Framing and Policy Entrepreneurs

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