The inter-section of political history and health policy in Asia – The historical foundations for health policy analysis

Grundy, John; Hoban, Elizabeth; Allender, Steven; Annear, Peter Leslie

doi:10.1016/j.socscimed.2014.07.047

Cited by 9 publications

(12 citation statements)

References 29 publications

(41 reference statements)

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“…A recent study of five countries in Asia shows that political and social episodes in a country’s development do present key junctures in health system evolution ( Grundy et al. 2014 ), thus underlining the importance of this kind of analysis.…”

Section: Discussionmentioning

confidence: 99%

The path dependence of district manager decision-space in Ghana

Kwamie

Dijk

Ansah

et al. 2015

Health Policy Plan.

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The district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the influence of path-dependent administrative, fiscal and political decentralization processes on development of the district health system and district manager decision-space. Methods included a non-exhaustive literature review of democratic governance in Ghana, and key informant interviews with high-level health system officials integral to the development of the district health system. Through our analysis we identified four periods of district health system progression: (1) development of the district health system (1970–85); (2) Strengthening District Health Systems Initiative (1986–93); (3) health sector reform planning and creation of the Ghana Health Service (1994–96) and (4) health sector reform implementation (1997–2007). It was observed that district manager decision-space steadily widened during periods (1) and (2), due to increases in managerial profile, and concerted efforts at managerial capacity strengthening. Periods (3) and (4) saw initial augmentation of district health system financing, further widening managerial decision-space. However, the latter half of period 4 witnessed district manager decision-space contraction. Formalization of Ghana Health Service structures influenced by self-reinforcing tendencies towards centralized decision-making, national and donor shifts in health sector financing, and changes in key policy actors all worked to the detriment of the district health system, reversing early gains from bottom-up development of the district health system. Policy feedback mechanisms have been influenced by historical and contemporary sequencing of local government and health sector decentralization. An initial act of administrative decentralization, followed by incomplete political and fiscal decentralization has ensured that the balance of power has remained at national level, with strong vertical accountabilities and dependence of the district on national level. This study demonstrates that the rhetoric of decentralization does not always mirror actual implementation, nor always result in empowered local actors.

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Section: Discussionmentioning

confidence: 99%

The path dependence of district manager decision-space in Ghana

Kwamie

Dijk

Ansah

et al. 2015

Health Policy Plan.

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“…In researching these domains, attention was paid to the historical background, in keeping with a growing body of empirical works which have documented the important effects of the past on the subsequent development of domestic institutions, reform and capacities, in public health as in other sectors. 23 24 …”

Section: Methodsmentioning

confidence: 99%

The making of evidence-informed health policy in Cambodia: knowledge, institutions and processes

2018

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IntroductionIn global health discussions, there have been widespread calls for health policy and programme implementation to be informed by the best available evidence. However, recommendations in the literature on knowledge translation are often decontextualised, with little attention to the local systems of institutions, structures and practices which can direct the production of evidence and shape whether or how it informs health decisions. This article explores these issues in the country setting of Cambodia, where the Ministry of Health has explicitly championed the language of evidence-based approaches to policy and planning.MethodsResearch for this paper combined multiple sources and material, including in-depth interviews with key informants in Phnom Penh and the analysis of documentary material and publications. Data collection and analysis focused on two key domains in evidence advisory systems: domestic capacities to generate health policy-relevant evidence and institutional mechanisms to monitor, evaluate and incorporate evidence in the policy process.ResultsWe identified a number of structural arrangements that may increasingly work to facilitate the supply of health-related data and information, and their use to inform policy and planning. However, other trends and features appear to be more problematic, including gaps between research and public health priorities in the country, the fragmented nature of research activities and information systems, the lack of a national policy to support and guide the production and use of evidence for health policy, and challenges to the use of evidence for intersectoral policy-making.ConclusionsIn Cambodia, as in other low/middle-income countries, continued investments to increase the supply and quality of health data and information are needed, but greater attention should be paid to the enabling institutional environment to ensure relevance of health research products and effective knowledge management.

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“…The myriad of factors are bound by diverse institutions and must be accounted. An institutional reasoning behind these factors offer insights on the historical trajectories and its turning points (Grundy et al 2014) behind the spread of diseases for developing appropriate interventions. Institutions cut across the social and biophysical environment and between the proximal and distal determinants of health.…”

Section: Key Messagesmentioning

confidence: 99%

Urbanization and human health in urban India: institutional analysis of water-borne diseases in Ahmedabad

Saravanan

Idenal

Saiyed

et al. 2016

Health Policy Plan.

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Diseases are rapidly urbanizing. Ageing infrastructures, high levels of inequality, poor urban governance, rapidly growing economies and highly dense and mobile populations all create environments rife for water-borne diseases. This article analyzes the role of institutions as crosscutting entities among a myriad of factors that breed water-borne diseases in the city of Ahmedabad, India. It applies 'path dependency' and a 'rational choice' perspective to understand the factors facilitating the breeding of diseases. This study is based on household surveys of approximately 327 households in two case study wards and intermittent interviews with key informants over a period of 2 years. Principle component analysis is applied to reduce the data and convert a set of observations, which potentially correlate with each other, into components. Institutional analyses behind these components reveal the role of social actors in exploiting the deeply rooted inefficiencies affecting urban health. This has led to a vicious cycle; breaking this cycle requires understanding the political dynamics that underlie the exposure and prevalence of diseases to improve urban health.

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The inter-section of political history and health policy in Asia – The historical foundations for health policy analysis

Cited by 9 publications

References 29 publications

The path dependence of district manager decision-space in Ghana

The path dependence of district manager decision-space in Ghana

The making of evidence-informed health policy in Cambodia: knowledge, institutions and processes

Urbanization and human health in urban India: institutional analysis of water-borne diseases in Ahmedabad

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