‘The one with the purse makes policy’: Power, problem definition, framing and maternal health policies and programmes evolution in national level institutionalised policy making processes in Ghana

2016 ◽  
Vol 167 ◽  
pp. 79-87 ◽  
Author(s):  
Augustina Koduah ◽  
Irene Akua Agyepong ◽  
Han van Dijk
Author(s):  
Moses Mukuru ◽  
Suzanne N. Kiwanuka ◽  
Lucy Gilson ◽  
Maylene Shung-King ◽  
Freddie Ssengooba

Background: The persistence of high maternal mortality and consistent failure in low- and middle-income countries to achieve global targets such as Millennium Development Goal five (MDG 5) is usually explained from epidemiological, interventional and health systems perspectives. The role of policy elites and their interests remains inadequately explored in this debate. This study examined elites and how their interests drove maternal health policies and actions in ways that could explain policy failure for MDG 5 in Uganda. Methods: We conducted a retrospective qualitative study of Uganda’s maternal health policies from 2000 to 2015 (MDG period). Thirty key informant interviews and 2 focus group discussions (FGDs) were conducted with national policy-makers, who directly participated in the formulation of Uganda’s maternal health policies during the MDG period. We reviewed 9 National Maternal Health Policy documents. Data were analysed inductively using elite theory. Results: Maternal health policies were mainly driven by a small elite group comprised of Senior Ministry of Health (MoH) officials, some members of cabinet and health development partners (HDPs) who wielded more power than other actors. The resulting policies often appeared to be skewed towards elites’ personal political and economic interests, rather than maternal mortality reduction. For a few, however, interests aligned with reducing maternal mortality. Since complying with the government policy-making processes would have exposed elites’ personal interests, they mainly drafted policies as service standards and programme documents to bypass the formal policy process. Conclusion: Uganda’s maternal health policies were mainly influenced by the elites’ personal interests rather than by the goal of reducing maternal mortality. This was enabled by the formal guidance for policy-making which gives elites control over the policy process. Accelerating maternal mortality reduction will require re-engineering the policy process to prevent public officials from infusing policies with their interests, and enable percolation of ideas from the public and frontline.


2020 ◽  
Vol 36 (S1) ◽  
pp. 37-37
Author(s):  
Americo Cicchetti ◽  
Rossella Di Bidino ◽  
Entela Xoxi ◽  
Irene Luccarini ◽  
Alessia Brigido

IntroductionDifferent value frameworks (VFs) have been proposed in order to translate available evidence on risk-benefit profiles of new treatments into Pricing & Reimbursement (P&R) decisions. However limited evidence is available on the impact of their implementation. It's relevant to distinguish among VFs proposed by scientific societies and providers, which usually are applicable to all treatments, and VFs elaborated by regulatory agencies and health technology assessment (HTA), which focused on specific therapeutic areas. Such heterogeneity in VFs has significant implications in terms of value dimension considered and criteria adopted to define or support a price decision.MethodsA literature research was conducted to identify already proposed or adopted VF for onco-hematology treatments. Both scientific and grey literature were investigated. Then, an ad hoc data collection was conducted for multiple myeloma; breast, prostate and urothelial cancer; and Non Small Cell Lung Cancer (NSCLC) therapies. Pharmaceutical products authorized by European Medicines Agency from January 2014 till December 2019 were identified. Primary sources of data were European Public Assessment Reports and P&R decision taken by the Italian Medicines Agency (AIFA) till September 2019.ResultsThe analysis allowed to define a taxonomy to distinguish categories of VF relevant to onco-hematological treatments. We identified the “real-world” VF that emerged given past P&R decisions taken at the Italian level. Data was collected both for clinical and economical outcomes/indicators, as well as decisions taken on innovativeness of therapies. Relevant differences emerge between the real world value framework and the one that should be applied given the normative framework of the Italian Health System.ConclusionsThe value framework that emerged from the analysis addressed issues of specific aspects of onco-hematological treatments which emerged during an ad hoc analysis conducted on treatment authorized in the last 5 years. The perspective adopted to elaborate the VF was the one of an HTA agency responsible for P&R decisions at a national level. Furthermore, comparing a real-world value framework with the one based on the general criteria defined by the national legislation, our analysis allowed identification of the most critical point of the current national P&R process in terms ofsustainability of current and future therapies as advance therapies and agnostic-tumor therapies.


2021 ◽  
Vol 17 (2) ◽  
pp. 186-203
Author(s):  
Nathan Genicot

AbstractThe COVID-19 pandemic has given rise to the massive development and use of health indicators. Drawing on the history of international public health and of the management of infectious disease, this paper attempts to show that the normative power acquired by metrics during the pandemic can be understood in light of two rationales: epidemiological surveillance and performance assessment. On the one hand, indicators are established to evaluate and rank countries’ responses to the outbreak; on the other, the evolution of indicators has a direct influence on the content of public health policies. Although quantitative data are an absolute necessity for coping with such disasters, it is critical to bear in mind the inherent partiality and precarity of the information provided by health indicators. Given the growing importance of normative quantitative devices during the pandemic, and assuming that their influence is unlikely to decrease in the future, they call for close scrutiny.


Human Affairs ◽  
2013 ◽  
Vol 23 (1) ◽  
Author(s):  
Mishel Pavlovski

AbstractBy questioning the ways in which a supra-national European identity can be created in an environment of globalization, this article starts with the thesis that this concept faces problems which must be resolved first and foremost at the national level. By problematizing multiculturalism as a “utopian theory” which does not solve any problems at the practical level, and by viewing interculturalism as a potential danger to “smaller” cultures, this article identifies what it is that hinders the possible acceptance of the idea of a Europe without borders by analyzing plays by Goran Stefanovski. In four of his plays, Euralien, Hotel Europa, Ex-Yu, and Goce, Stefanovski criticizes Western Europe, on the one hand, for constructing a problematic Other, imposing a visa regime, and contributing to its marginalization, and the Balkans on the other, for mythologizing its nationally-romanticized narrative. The paper sheds light on the fact that the acceptance of a common (shared) European identity, a necessity which propagates itself amidst conditions of globalization, is dependent on the ways in which Europe will resolve its problems, such as the marginalization of the Other, way of thinking in binary oppositions, like old/new Europe, rich/poor Europe, and especially (talking about Balkan countries) the phrase South-East Balkan.


2018 ◽  
Vol 10 (11) ◽  
pp. 4042 ◽  
Author(s):  
Wei Wei ◽  
Yuanjun Zhu ◽  
Hao Li ◽  
Kebin Zhang ◽  
Baitian Wang ◽  
...  

The abandonment and cultivation of croplands in the Eurasian Steppe has become the focus of global and regional food security and agricultural policy-making. A large area of cropland in some post-Soviet countries has proven to be abandoned with the disintegration of the Soviet Union; however, it is unclear as to whether Kazakhstan also experienced a similar change as one of the main food providers for the former Soviet Union. In this study, we used the annual land cover dataset (1992–2015) from the European Space Agency, Climate Change Initiative (ESA-CCI) to detect spatio-temporal characteristics of rainfed and irrigated cropland changes in Kazakhstan. The Mann–Kendall test and regime shift analysis showed that rainfed and irrigated cropland at national level had a significant increasing trend with a significant rising up to 1999 and stagnation during 2000–2015, which was further confirmed with analysis at 14 regions. The greatest contributor to rainfed and irrigated croplands was steppes, followed by shrinkage of water bodies since 2005 to a great extent, rapid urbanization process resulted in losses of a part of irrigated oases. The trend surface analysis indicated that reorganized stable pattern characterized by rainfed cropland in north and irrigated cropland in south was driven by the strategy of the gradual agricultural development of oases. The nonexistence of cycle between the abandonment and recultivation proved that newly-gained cropland from steppe may be less degraded and more productive for sustainable land use in Kazakhstan. In conclusion, this study can provide strong evidence for sustainable land use and a basis for food security policy-making in Kazakhstan, and even all of the Central Asian countries in the future.


2017 ◽  
pp. 95-99
Author(s):  
Tamás Köpeczi-Bócz ◽  
Mónika Lőrincz

Both at European and national level tertiary and quaternary sectors are concentrated in the metropolitan centre. In the rural areas only the sites of such sectors can be found the premises of which temporarily transform the sectoral structure of these areas, but from the regional development aspect they did not prove to be an effective strategy.The European Commission is now focusing on growth from innovation, which could become the driving force behind productivity growth and the economy’s long-term trend. The innovation-oriented economic development’s key players are on the one hand the knowledge-intensive enterprises, on the other hand the universities. Tertiary education can play a role – among others – in shaping and creating the development of knowledge intensive business environment and conditions, on the other hand it can assist the development of network contacts – another precondition of employment growth.


Author(s):  
Alina Mihaela Dima

Many times, in the attempt to win or to maintain an advantageous position on the market, the economic agent will use a whole arsenal of practices (inclusively and mostly from the marketing field), most of them anticompetitive, with a negative impact on the business environment, which also affects the well-being of the consumer. The policy in the field of competition is the one that defines these types of behaviour and penalizes them depending on the importance of their negative impact, by creating a complex and coherent legislative and institutional mechanism. The right enforcement of the competition policy at the national level is the key in this process, but this should be coordinated with the regional and international objectives and regulations in this field. Romania is facing a double challenge: on the one side, it had to set up a competition policy, which was almost ignored before the90s, on the other side, it had to comply, recently, with high standards in the field, as an EU candidate. Now, as a member state, the promotion of a competition culture becomes a must, along with the design of an adequate system of information and knowledge dissemination for all of those involved. The paper is based on a original and qualitative research and aims at emphasising the increased necessity of the promotion of a competition culture for the competitiveness of the Romanian business environment on the European level in the new context of accession. This will help Romanian business to face the competition challenges within a more extended single European market, as an essential issue of the free market economy status recently granted, and accordingly to the most important EU objectives set up at Lisabon to become the most competitive economy in the world up to 2010.


2021 ◽  
Author(s):  
Christian Selbach ◽  
Maarten P. M. Vanhove ◽  
Kim Nørgaard Mouritsen

The One Health concept offers an integrative approach to disease and health at the human-animal-environment interface. It has often been suggested to view the COVID-19 outbreak within this framework to better understand and mitigate this global crisis. Here, we discuss how the evolutionary ecology of host-pathogen systems can add a valuable additional perspective to the debate around SARS-CoV-2 and its implications for public health awareness and policy-making. In this context, it is especially important to highlight that changes in nature, such as zoonotic spillover events, are often irreversible, and that humans, while deeply embedded in ecosystems, are intricate ecosystems themselves. A better recognition of the complex biology and evolution of human-parasite interactions will assist our understanding of such zoonoses.


PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247935
Author(s):  
Prem Shankar Mishra ◽  
Karthick Veerapandian ◽  
Prashant Kumar Choudhary

Background Caste plays a significant role in Indian society and it influences women to health care access in the community. The implementation of the maternal health benefits scheme in India is biased due to caste identity. In this context, the paper investigates access to Janani Suraksha Yojana (JSY) among social groups to establish that caste still plays a pivotal role in Indian society. Also, this paper aims to quantify the discrimination against Scheduled Castes/Scheduled Tribes (SCs/STs) in accessing JSY. Methods This paper uses a national-level data set of both NFHS-3 (2005–06) and NFHS-4 (2015–16). Both descriptive statistics and the Fairlie decomposition econometric model have been used to measure the explained and unexplained differences in access to JSY between SCs/STs and non-SCs/STs groups. Results Overall, the total coverage of JSY in India is still, 36.4%. Further, it is found that 72% of access to JSY is explained by endowment variables. The remaining unexplained percentage (28%) indicates that there is caste discrimination (inequity associated social-discrimination) against SCs/STs in access to JSY. The highest difference (54%) between SCs/STs and non-SCs/STs in access to JSY comes from the wealth quintile, with the positive sign indicating that the gap between the two social groups is widening. Discussion and conclusion It is necessary for the government to implement a better way to counter the caste-based discrimination in access to maternal health benefits scheme. In this regard, ASHA and Anganwadi workers must be trained to reduce the influence of dominant caste groups as well as they must be recruited from the same community to identify the right beneficiaries of JSY and in order to reduce inequity associated with social-discrimination.


2021 ◽  
Vol 9 ◽  
Author(s):  
Enrico Michelini ◽  
Nico Bortoletto ◽  
Alessandro Porrovecchio

Introduction: Mandated restrictions on outdoor physical activity (PA) during the coronavirus pandemic disrupted the lifeworld of millions of people and led to a contradictory situation. On the one hand, PA was perceived as risky behaviour, as it might facilitate transmission of the virus. On the other hand, while taking precautions, regular PA was an important tool to promote the population's health during the lockdown.Methods: This paper examines the differences in government restrictions on PA in France, Germany, and Italy during the first wave of the COVID-19 pandemic. We draw on techniques of qualitative content analysis and apply a critical theoretical framework to assess the countries' restrictions on PA.Results: Our analysis shows that the restrictions on PA varied in the three countries, in all three countries. This variance is attributed both to differences in the timing and severity of the pandemic in the countries analysed, as well as to the divergence in the relationships between the countries' sport and health systems.Conclusion: At the national level, the variance in restrictions on PA reflect the differences in the spread of the coronavirus and in the health systems' understanding of and approach to PA. The global scientific discourse on the pandemic represents a further key influencing factor. The management of the coronavirus pandemic has demonstrated that the extreme complexity of societies in terms of public health, politics, and the economy pose challenges and unsolvable contradictions.


Sign in / Sign up

Export Citation Format

Share Document