scholarly journals Synergies and Fragmentation in Country Level Policy and Program Agenda Setting, Formulation and Implementation for Global Health Agendas: A Case Study of Health Security, Universal Health Coverage, and Health Promotion in Ghana and Sierra Leone

2020 ◽  
Author(s):  
Irene Akua Agyepong ◽  
Fredline A.O. M’Cormack-Hale ◽  
Hannah Brown-Amoakoh ◽  
Abigail N.C. Derkyi-Kwarteng ◽  
Theresa Ethel Darkwa ◽  
...  
Keyword(s):  
Health Promotion ◽  
Global Health ◽  
Sierra Leone ◽  
Agenda Setting ◽  
Structural Constraints ◽  
Health Coverage ◽  
Health Security ◽  
Country Level ◽  
Universal Health

Abstract Background: Global health agendas have in common the goal of contributing to population health outcome improvement. In theory therefore, whenever possible, country level policy and program agenda setting, formulation and implementation towards their attainment should be synergistic such that efforts towards one agenda promote efforts towards the other agendas. Observation suggests that this is not what happens in practice. Potential synergies are often unrealized and fragmentation is not uncommon. In this paper we present findings from an exploration of how and why synergies and fragmentation occur in country level policy and program agenda setting, formulation and implementation for the global health agendas of Universal Health Coverage (UHC), Health Security (HS) and Health Promotion (HP) in Ghana and Sierra Leone. Our study design was a two country case study. Data collection involved document reviews and Key Informant interviews with national and sub-national level decision makers in both countries between July and December 2019. Additionally, in Ghana a stakeholder workshop in December 2019 was used to validate the draft analysis and conclusions. This study is part of a series of country case studies to inform the Lancet Commission on synergies between UHC, HS and HP.Results: National and global context, country health systems leadership and structure including resources were drivers of synergies and fragmentation. How global as well as country level actors mobilized power and exercised agency in policy and program agenda setting and implementation processes within country were also important drivers. Conclusions: There is potential in both countries to pull towards synergies and push against fragmentation in agenda setting, formulation and implementation of global health agendas despite the resource and other structural constraints. It however requires political and bureaucratic prioritization of synergies, as well as skilled leadership. It also requires considerable mobilization of country level actor exercise of agency to counter sometimes daunting contextual, systems and structural constraints.

scholarly journals Synergies and fragmentation in country level policy and program agenda setting, formulation and implementation for Global Health agendas: a case study of health security, universal health coverage, and health promotion in Ghana and Sierra Leone

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Irene Akua Agyepong ◽  
Fredline A. O. M’Cormack-Hale ◽  
Hannah Brown Amoakoh ◽  
Abigail N. C. Derkyi-Kwarteng ◽  
Theresa Ethel Darkwa ◽  
...  
Keyword(s):  
Health Promotion ◽  
Global Health ◽  
Sierra Leone ◽  
Agenda Setting ◽  
Structural Constraints ◽  
Health Coverage ◽  
Health Security ◽  
Country Level ◽  
Universal Health

Abstract Background Global health agendas have in common the goal of contributing to population health outcome improvement. In theory therefore, whenever possible, country level policy and program agenda setting, formulation and implementation towards their attainment should be synergistic such that efforts towards one agenda promote efforts towards the other agendas. Observation suggests that this is not what happens in practice. Potential synergies are often unrealized and fragmentation is not uncommon. In this paper we present findings from an exploration of how and why synergies and fragmentation occur in country level policy and program agenda setting, formulation and implementation for the global health agendas of Universal Health Coverage (UHC), Health Security (HS) and Health Promotion (HP) in Ghana and Sierra Leone. Our study design was a two country case study. Data collection involved document reviews and Key Informant interviews with national and sub-national level decision makers in both countries between July and December 2019. Additionally, in Ghana a stakeholder workshop in December 2019 was used to validate the draft analysis and conclusions. Results National and global context, country health systems leadership and structure including resources were drivers of synergies and fragmentation. How global as well as country level actors mobilized power and exercised agency in policy and program agenda setting and implementation processes within country were also important drivers. Conclusions There is potential in both countries to pull towards synergies and push against fragmentation in agenda setting, formulation and implementation of global health agendas despite the resource and other structural constraints. It however requires political and bureaucratic prioritization of synergies, as well as skilled leadership. It also requires considerable mobilization of country level actor exercise of agency to counter sometimes daunting contextual, systems and structural constraints.

scholarly journals Analyzing efforts to synergize the global health agenda of universal health coverage, health security and health promotion: a case-study from Ethiopia

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Amare Worku Tadesse ◽  
Kassu Ketema Gurmu ◽  
Selamawit Tesfaye Kebede ◽  
Mahlet Kifle Habtemariam
Keyword(s):  
Health Promotion ◽  
Global Health ◽  
Health System ◽  
Universal Health Coverage ◽  
World Health ◽  
Health Coverage ◽  
Health Security ◽  
Universal Health ◽  
Health Agenda

Abstract Background Evidence exists about synergies among universal health coverage, health security and health promotion. Uniting these three global agendas has brought success to the country’s health sector. This study aimed to document the efforts Ethiopia has made to apply nationally synergistic approaches uniting these three global health agendas. Our study is part of the Lancet Commission on synergies between these global agendas. Methods We employed a case study design to describe the synergistic process in the Ethiopian health system based on a review of national strategies and policy documents, and key informant interviews with current and former policymakers, and academics. We analyzed the “hardware” (using the World Health Organization’s building blocks) and the “software” (ideas, interests, and power relations) of the Ethiopian health system according to the aforementioned three global agendas. Results Fragmentation of health system primarily manifested as inequities in access to health services, low health workforce and limited capacity to implementation guidelines. Donor driven vertical programs, multiple modalities of health financing, and inadequate multisectoral collaborations were also found to be key features of fragmentation. Several approaches were found to be instrumental in fostering synergies within the global health agenda. These included strong political and technical leadership within the government, transparent coordination, and engagement of stakeholders in the process of priority setting and annual resource mapping. Furthermore, harmonization and alignment of the national strategic plan with international commitments, joint financial arrangements with stakeholders and standing partnership platforms facilitated efforts for synergy. Conclusions Ethiopia has implemented multiple approaches to overcome fragmentation. Such synergistic efforts of the primary global health agendas have made significant contributions to the improvement of the country’s health indicators and may promote sustained functionality of the health system.

scholarly journals Fragmented health systems in COVID-19: rectifying the misalignment between global health security and universal health coverage

The Lancet ◽  
2021 ◽  
Vol 397 (10268) ◽  
pp. 61-67
Author(s):  
Arush Lal ◽  
Ngozi A Erondu ◽  
David L Heymann ◽  
Githinji Gitahi ◽  
Robert Yates
Keyword(s):  
Global Health ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Health Coverage ◽  
Global Health Security ◽  
Health Security ◽  
Universal Health

scholarly journals The impact of the fragile health system on the implementation of health policies in Yemen

2020 ◽  
Author(s):  
Taha Hussein ◽  
Fekri Dureab ◽  
Raof Al-Waziza ◽  
Hanan Noman ◽  
Lisa Hennig ◽  
...  
Keyword(s):  
Health Promotion ◽  
Health System ◽  
Universal Health Coverage ◽  
Peace Building ◽  
Health Policies ◽  
Health Coverage ◽  
Health Security ◽  
The Public ◽  
The Impact ◽  
Universal Health

The on-going humanitarian crisis in Yemen is one of the worst in the world, with more than14 million people in acute need. The conflict in Yemen deteriorated the already fragile health system and lead to the collapse of more than half of the health facilities. Health system fragmentation is also a problem in Yemen, which is complicated by the existence of two health ministries with different strategies. The aim of this study is to evaluate the effect of health system fragmentation on the implementation of health policies in Yemen across the global agendas of Universal Health Coverage (UHC), Health Security (GHS) and Health Promotion (HP) in the context of WHO priorities achieving universal health coverage, addressing health emergencies and promoting healthier populations. Methods The study is qualitative research using key informant in-depth interviews and documents analysis. Results There are many health stakeholders in Yemen, including the public, private, and NGO sectors - each with different priorities and interests, which did not always align with national policies and strategies. The WHO and Ministry of Public Health and Population (MoPHP) are the main supporters to implement all policies related to the UHC, GHS and HP agendas. Interestingly, initiatives initially pursuing a health security approach to control the cholera epidemic realigned with the UHC concept and moved from an initial focus on health security, to propose a minimum health service package, a classical UHC intervention. Overall, Universal Health Coverage is the most adapted agenda, health security agendas were highly disrupted due to conflicts and health staffs were caught unprepared for emerging outbreaks. The health promotion agenda was largely ignored. Conclusion Restoring peace, building on synergies between the three health agendas through joint planning between the MoPHP and other health actors are highly recommended.

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