scholarly journals "The Actor Is Policy": Application of Elite Theory to Explore Actors’ Interests and Power Underlying Maternal Health Policies in Uganda, 2000-2015

2020 ◽  
Author(s):  
Moses Mukuru ◽  
Suzanne N. Kiwanuka ◽  
Lucy Gilson ◽  
Maylene Shung-King ◽  
Freddie Ssengooba
Keyword(s):  
Maternal Health ◽  
Maternal Mortality ◽  
Policy Process ◽  
Policy Making ◽  
National Policy ◽  
Health Policies ◽  
Mortality Reduction ◽  
Elite Theory ◽  
The Government ◽  
Personal Interests

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.

scholarly journals Patients as equal partners in decision-making: The global reality

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Anubha Taneja Mukherjee
Keyword(s):  
Decision Making ◽  
Decision Maker ◽  
Policy Making ◽  
Medical Science ◽  
National Policy ◽  
Decision Makers ◽  
Developed Country ◽  
The World ◽  
The Government ◽  
To Come

Decision making is an inherently complicated procedure, which by its very nature requires the decision-maker to co-opt all the stakeholders concerned. The procedure of decision-making may vary from country to country, depending on its size, culture, history and special demographic circumstances. Around the world, key decision-makers include the executive, the legislature and the judiciary. While the distribution of powers between these three may vary in tandem with their relation to each other, their roles remain the same. While the legislature enacts laws for its citizens, the executive, popularly known as the government, implements these laws and while doing so promulgates policies that are in alignment with the said laws. Mostly, the executive is also authorised to promulgate some laws of its own. The judiciary, on the other hand, comes into the picture when there is a dispute with regard to such laws. It also steps in on its own at times. While settling such disputes, the judiciary also ends up setting what we know as precedents, which also become a part of the legal fabric of a society. In a nutshell, these three are the key decision makers in any country. As mentioned above, while making decisions, these authorities are mostly required to co-opt all the stakeholders concerned, thereby making decision making a consultative process. These stakeholders include think tanks, research bodies, media and most importantly the affected party. The reason for having such a consultative procedure in place is that the decision makers are not experts in every subject or issue that comes their way. For instance, when a need to promulgate a national policy on thalassemia presents itself to a certain government, whether it be owing to media reportage or representations from the civil society, the decision makers will look towards people considered to be the experts in the subject to come forward and be a part of the policy making. One could say that this sounds like an ideal situation where the government actually invites people concerned with thalassemia to come forward and share views about it for the purpose of policy making. It is, however, true! It is as true for India as it is for any developed country. What we must ensure then is that the government or the decision maker considers us, the patients, as the experts. While it does sound obvious that those impacted with the disorder would be the ones with the first-hand knowledge about the disorder, the very fact that there is a topic in this conference on the role of patients in decision making speaks volumes about the distance that remains to be covered by the patients of thalassemia as far as participation in decision-making is concerned. With the massive strides in the field of medical science and the unflinching support of organisations like Thalassemia International Federation (TIF), we have now reached the stage where we must step out of the victim mode and represent ourselves before the decision-makers, whether by forming Patients Advocacy Groups or otherwise. One may take cue from various associations around the world. Global HD Organisations are a good example. They are known to have got together to give patients a voice in clinical research. The most popular strategy for reaching out to the decision makers is to unite, engage, and partner both in private meetings and consultative fora like events, task forces and projects. “Unite, Engage & Partner” can therefore be the most successful mantra for engaging with the decision makers. Talking of examples of advocacy and participation by patients, while there are numerous examples in Europe and North America of the power of patient advocacy so much so that patients are on the same level as doctors when it comes to voicing opinions in policy making, TIF on an international level has created since 2009 the Expert Patients Programme, and is now moving forward in giving patients a voice through its educational platform. Recently, India also launched its first Thalassemia Patients Advocacy Group (PAG) in the august presence of the Deputy Chief Minister of the capital of the country. The India PAG has seven patients from the fields of law, psychology, education and IT. The Group is already involved with the government on the formulation of the National Thalassemia Policy. This is a great start and this should give enough and more encouragement to thalassemics across the world to UNITE, ENGAGE AND PARTNER in the process that impacts them the most – decision-making!

Exploring Maternal Health in Ethiopia Using Indigenous Approaches: Policy and Practice Implications

2021 ◽  
pp. 104973152098482
Author(s):  
Aissetu Barry Ibrahima
Keyword(s):  
Maternal Health ◽  
Maternal Mortality ◽  
Maternal Mortality Ratio ◽  
Home Birth ◽  
Sub Saharan Africa ◽  
Health Policies ◽  
Maternal Health Service ◽  
World Health ◽  
Average Risk ◽  
Policy And Practice

The World Health Organization reports reveal that the average risk of dying from pregnancy-related causes in sub-Saharan Africa is about 1 in 45 compared to 1 in 5,400 in high-income countries. In Ethiopia, maternal mortality remains a tremendous problem. Several studies associate the high maternal mortality ratio to the widespread practice of home birth, household income, and lack of transportation. Absent from the findings of these studies is any discussion of the sociocultural contexts that might influence maternal health service utilization. Birthing bears cultural significance accompanied by rituals. Thus, any solution to maternal health problems must consider the sociocultural and grassroots context. It is important to learn the needs and priorities of the mothers who are targets of maternal health policies. Using Indigenous approaches, this study examines the gaps in Ethiopian maternal health policies and programs. The study also identifies culturally relevant solutions that address the needs of communities.

scholarly journals GROUPING OF PROVINCES IN INDONESIA BASED ON MATERNAL HEALTH INDICATORS USING VARIABLE WEIGHTING K-MEANS AND FUZZY C-MEANS

2020 ◽  
Vol 9 (1) ◽  
pp. 44
Author(s):  
Elvira Mustikawati Putri Hermanto
Keyword(s):  
Maternal Health ◽  
Maternal Mortality ◽  
Health Workers ◽  
Post Partum ◽  
Immunization Coverage ◽  
Health Indicators ◽  
Fuzzy C Means ◽  
Variable Weighting ◽  
The Government ◽  
Very High

Maternal Mortality Rate (MMR) is an indicator used to assess maternal health as well as the health status of a country. MMR is a target that must be achieved by Indonesian Government in Sustainable Development Goals (SDGs) in 2030. The Government of Indonesia has made various efforts to reduce MMR. This study aims to determine the distribution pattern of indicators for improving maternal health by grouping provinces in Indonesia based on the characteristics of maternal health indicators. The variables used are indicators that affect maternal mortality, namely K4 coverage (x1), Td2+ immunization coverage (x2), maternity assisted by health workers in health facilities coverage (x3), post-partum check up coverage (x4), Puskesmas implementing pregnant classes (x5), Puskesmas implementing P4K (x6), participant of KB coverage (x7) in Indonesia in 2017. The grouping methods are Variable Weighting K-Means (VWKM) and Fuzzy C-Means (FCM). The selection of the best grouping results uses the Internal Cluster Dispersion Rate (icdrate). Based on the analysis results, the best grouping is generated by the FCM method. The icdrate value generated by FCM is 0.325 while the icdrate value generated by VWKM is 0.552. FCM produces five groups which can be categorized as groups with maternal health indicator characteristics with very low, low, medium, high, and very high scores. Provinces in a group tend to be geographically close. East Java and Bali are provinces included in the indicator group of very high maternal health. Papua and West Papua fall into the group for maternal health which is very low.

scholarly journals The sources for orthodox and heterodox trade and industrial policies in Brazil

2016 ◽  
Vol 36 (3) ◽  
pp. 580-602 ◽  
Author(s):  
JAN-ULRICH ROTHACHER
Keyword(s):  
Policy Process ◽  
Policy Making ◽  
Car Industry ◽  
Industrial Policies ◽  
The Past ◽  
Private Interests ◽  
Brazilian Government ◽  
Policy Making Process ◽  
The Government ◽  
Private Actors

ABSTRACT: The Brazilian government has over the past years promulgated a mix of orthodox and heterodox policies for Brazil's economic development. This paper seeks to test whether the existing economic ideas have been prescriptive in formulating the policies, or whether they have been the outcome of the "infusion of private interests" (Katzenstein, 1978) in the policy making process. To this end, the paper charts the origins of the unilateral opening for trade in the agribusiness and contrasts them with the policy process in the car industry, where trade barriers have been erected. The article will identify the channels through which private actors informed the government's interventions and show that the industry bodies have largely prodded the government. The resulting policy maze has left both the representatives of the orthodox as well those of the heterodox approach unsatisfied and has failed to halt Brazil's dwindling manufacturing capabilities.

scholarly journals On Zero-Inflated Hierarchical Poisson Models with Application to Maternal Mortality Data

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Kassim Tawiah ◽  
Samuel Iddi ◽  
Anani Lotsi
Keyword(s):  
Maternal Health ◽  
Maternal Mortality ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Health Planning ◽  
Health Sector ◽  
Generalized Linear Mixed Model ◽  
Mortality Data ◽  
Model Framework ◽  
The Government

Count outcomes are commonly encountered in health sector data. The occurrence of count outcomes that exhibit many zeros has necessitated the extension of the ubiquitous Poisson regression model to accommodate the zero inflation and overdispersion as a result of the extra dispersion. We explored different extensions of the Poisson model including mixed models within the generalized linear mixed model framework to account for the repeated measurement of outcomes. These models are applied to maternal mortality data from fifty-six health facilities in four regions of Ghana. The objective is to identify factors associated with maternal mortality. The best-fitting model, the zero-inflated Poisson generalized linear mixed model, revealed that maternal mortality in hospital facilities is influenced by the number of referrals (into and out) of the hospital facility, number of antenatal visits exceeding four, number of midwives, and number of medical doctors at the facility. To be able to achieve targeted results in reducing maternal mortality and achieve the Sustainable Development Goal 3, the government, together with the ministry of health, should provide adequate maternal health services, especially at the district and community level. Additionally, there is a need for increased investment in Community Health Planning Services and related healthcare infrastructure and systems within the context of the Ouagadougou Declaration, that is, improve the training of skilled birth workers (midwives and doctors) and employ them at clinics to deal with labour complications without referring them to major hospitals. Furthermore, a well-structured awareness campaign is needed with importance given to avoiding adolescent pregnancy and improving antenatal care attendance to, at least, four, the gold standard, before delivery. Also, we recommend quality assessment form an essential part of all services that are directed towards improving maternal health and that more emphasis is needed to be given on research with multiple allied partners.

scholarly journals Maternal Mortality and Maternal Health Care in Nigeria: Implications for Socio-Economic Development

2019 ◽  
Vol 7 (5) ◽  
pp. 849-855 ◽  
Author(s):  
Olawale Olonade ◽  
Tomike I. Olawande ◽  
Oluwatobi Joseph Alabi ◽  
David Imhonopi
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Maternal Mortality ◽  
Health Care System ◽  
Socioeconomic Development ◽  
Maternal Health Care ◽  
African Countries ◽  
Sub Saharan ◽  
The Government ◽  
Care System

BACKGROUND: Even though maternal mortality, which is a pregnancy-related death is preventable, it has continued to increase in many nations of the world, especially in the African countries of the sub-Saharan regions caused by factors which include a low level of socioeconomic development. AIM: This paper focuses on cogent issues affecting maternal mortality by unpacking its precipitating factors and examining the maternal health care system in Nigeria. METHODS: Contemporary works of literature were reviewed, and the functionalist perspective served as a theoretical guide to examine the interrelated functions of several sectors of the society to the outcome of maternal mortality. RESULTS: It was noted that apart from the medical related causes (direct and indirect) of maternal mortality, certain socio-cultural and socioeconomic factors influence the outcome of pregnancy. Also, a poor health care system, which is a consequent of weak social structure, is a contributing factor. CONCLUSION: As a result, maternal mortality has debilitating effects on the socioeconomic development of any nation. It is therefore pertinent for the government to improve maternal health and eradicate poverty to ensure sustainable development.

Moral Theory and Policy Science: A New Look at the Gap Between Foreign and Domestic Affairs

1992 ◽  
Vol 6 ◽  
pp. 81-93 ◽  
Author(s):  
Irving Louis Horowitz
Keyword(s):  
Policy Process ◽  
Moral Theory ◽  
Policy Making ◽  
Information Technologies ◽  
National Policy ◽  
Policy Science ◽  
Direct Consequence ◽  
Ethical Theories ◽  
New Information ◽  
Domestic Affairs

This article examines the present bifurcation of policy-making into domestic and foreign components, and urges a theoretical effort aimed at unifying national policy by integrating its various components. Beyond such an urging, the article aims to show that the act of making policy invariably involves decisions about events that take place both within and outside of a nation. This is not a claim for the superiority of any one segment of policy making. What is important or trivial is determined within a means-ends continuum. In breaking down artificial barriers inherited from nationalist models, it is possible to institutionalize a policy process that takes into account “shrinkage” of the world that is a direct consequence of new information technologies, and at the same time, incorporates the wisdom of classical ethical theories on the nature of power.

scholarly journals The Absence of Democracy in Aboriginal Self-Governance Policy

1969 ◽  
Vol 6 (1) ◽  
Author(s):  
Gina van den Berg
Keyword(s):  
First Nations ◽  
Policy Process ◽  
Policy Making ◽  
Outcome Evaluation ◽  
Problem Definition ◽  
History Of ◽  
Effective Policy ◽  
The Government ◽  
New Policies ◽  
Paternalistic Attitude

The protracted history of Aboriginal governance policy is ripe with frustrations among First Nations peoples and Canadian governments, the most pronounced aggravation being the federal government. Substantial resistance from Aboriginals often marks each new policy the government introduces. New policies often maintain the paternalistic attitude inherent in government initiatives, which has been very difficult for Aboriginal organizations to eradicate. Although Aboriginal governance policy is currently progressing towards a quasi-cooperative form of policy-making on both sides, this particular policy area continues to encounter significant disparities between policy actors within the Canadian government and Aboriginal organizations. Differences throughout the entire policy process hinder effective policy-making from agenda-setting/problem definition to the outcome/evaluation

Coalition Government in Northern Ireland: Social Policy and the Lowest Common Denominator Thesis

2011 ◽  
Vol 11 (1) ◽  
pp. 15-25 ◽  
Author(s):  
Ann Marie Gray ◽  
Derek Birrell
Keyword(s):  
Social Policy ◽  
Northern Ireland ◽  
Policy Process ◽  
Policy Making ◽  
Policy Formulation ◽  
Coalition Government ◽  
Common Denominator ◽  
Social Policies ◽  
Complex Approach ◽  
The Government

In analysing governance and social policy in Northern Ireland in the period of devolution 1999–2002 Eithne McLaughlin described and predicted the dominance of a lowest common denominator approach to the formulation of social policies. This paper examines the period of restored devolution 2007–11 using this thesis. It identifies the trends in the development of social policies after 2007 and examines social policy-making by the government under five categories. Having established the reasons for this complex approach to social policy formulation, consideration is also given to the outcomes of the policy process.

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