Understanding the health policy formulation process over the years has focused on the content of policy to the neglect of context. This had led to several policy initiatives having a still birth or ineffective policy choices with sub-optimal outcomes when implemented. Sometimes, the difficulty has been finding congruence between different values and interests of the various stakeholders. This paper attempts to conceptualise the levers of policy formulation using a qualitative participant observation case study based on retrospective recollection of the policy process and political levers involved in developing the Ghana National Health Insurance Scheme. The study finds that technical experts, civil society, academics and politicians all had significant influence on setting the health insurance agenda. Each of these various stakeholders carefully engaged in ways that preserved their constituency interests through explicit manoeuvres and subtle engagements. Where proposals lend themselves to various interpretations, stakeholders were quick to latch on the contentious issues to preserve their constituency. The paper provides lessons which suggest that in understanding the policy process, it is important that actors engage with the content as well as the context to understand viewpoints that may be expressed by interest groups.
Values, Policies and Rights
The World Health Organisation's Commission on Social Determinants of Health has stated that health inequities result from inequities in power, money, and resources, which in turn are based on a combination of unfair economic arrangements, poor policies and programmes and bad governance. In other words, a focus on health equity should shift to the causes of the causes. According to this article, putting health equity at the heart of policy making is a perfectly feasible goal. While there is fierce debate over economic policy in the face of huge debts faced by rich countries, with some economists calling for economic growth and others calling for reduced deficit spending, the criterion of success seeming to be a return to growth of gross domestic product (GDP). The author argues here that what is actually required are broader measures of social and economic progress than simply GDP. He calls for examination of the effects of economic policy choices on the lives people are able to lead, and hence the likely effect on health equity. When governments cut social expenditures, the effect is greatest on those at the lower end of the social hierarchy, namely those who are most dependent on cash and in-kind government expenditures. It should be of the highest priority to ensure that government policies do not unfairly increase avoidable health inequalities.
This abbreviated version of the Policy on Quality in Health Care for South Africa follows on the original that became national policy in 2001. It comes at a time when the public health care system is in dire need of again refocusing its collective efforts towards improving the quality of care provided in public health facilities and communities. Knowing that quality is never an accident, always the result of high intention, sincere effort, intelligent direction and skilfull execution, and that it represents the wise choice of many alternatives, this abbreviated version attempts to provide to all public health officials in a nutshell and in a more reader friendly language, the strategic direction health facilities and officials need to follow to assure quality in health care and continuous improvement in the care that is being provided. Health care personnel are encouraged to use this copy of the Policy to focus their intentions and guide their efforts.
This review identified health policies related to the role of CHWs in the management of pre-eclampsia and eclampsia in Mozambique. It used three methods - policy document review, key informant interview and literature review. Three main themes were identified from the qualitative review as establishment of the community health worker programme and early challenges, revitalization of the community health workers programme and the integration of maternal health in the community health tasks. In 1978, following the Alma Alta Declaration, the Mozambique government brought in legislation establishing primary health care and the community health worker programme. Between the late 1980s and early 1990s, this programme was scaled down due to several factors including a prolonged civil war; however, the decision to revitalise the programme was made in 1995. In 2010, a revitalised programme was re-launched and expanded to include the management of common childhood illnesses, detection of warning signs of pregnancy complications, referrals for maternal health and basic health promotion. The study observe that the role of community health workers has evolved over the last 40 years to include care of childhood diseases and basic maternal health counselling, but do not yet include some possible areas, like management of emergency conditions of pregnancy including pre-eclampsia and eclampsia.
The United Nations General Assembly adopted by consensus the resolution titled "Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases" (document A/66/L.1). The declaration calls for the development of multisectoral public policies that create equitable health-promoting environments that empower individuals, families and communities to make healthy choices and lead healthy lives. It commits governments to accelerate implementation of the WHO Framework Convention on Tobacco Control (FCTC) and encourages countries, which have not yet done so, to consider acceding to the FCTC. In addition to price and tax measures to reduce tobacco consumption, governments committed to steps that include curbing the extensive marketing to children of foods and beverages that are high in saturated fats, trans-fatty acids, sugars, or salt. Other measures seek to cut the harmful consumption of alcohol, promote overall healthy diets and increase physical activity. It calls for countries to promote, establish or strengthen by 2013, and to implement multisectoral national policies and plans for the prevention and control of NCDs, taking into account, as appropriate, the 2008-2013 WHO Action Plan for the Global Strategy for the Prevention and Control of NCDs.
In July 2015, Malawi’s Special Law Commission on the Review of the Law on Abortion released a draft Termination of Pregnancy bill. If approved by Parliament, it will liberalize Malawi’s strict abortion law, expanding the grounds for safe abortion and representing an important step toward safer abortion in Malawi. Drawing on prospective policy analysis (2013–2017), the authors identify factors that helped generate political will to address unsafe abortion. Notably, the authors show that transnational influences and domestic advocacy converged to make unsafe abortion a political issue in Malawi and to make abortion law reform a possibility. Since the 1980s, international actors have promoted global norms and provided financial and technical resources to advance ideas about women’s reproductive health and rights and to support research on unsafe abortion. Meanwhile, domestic coalitions of actors and policy champions have mobilized new national evidence on the magnitude, costs, and public health impacts of unsafe abortion, framing action on unsafe abortion as part of a broader imperative to address Malawi’s high level of maternal mortality. Although these efforts have generated substantial support for abortion law reform, an ongoing backlash from the international anti-choice movement has gained momentum by appealing to religious and nationalist values. Passage of the bill confronts, for example, the current United States’ government position prohibiting the funding of safe abortion.
This paper reviews the literature on the association between polygyny and women's health in sub-Saharan Africa. It argues that polygyny is an example of ‘co-operative conflict’ within households, with likely implications for the vulnerability of polygynous women to illness, and for their access to treatment. Polygyny is associated with an accelerated transmission of sexually transmitted infections, because it permits a multiplication of sexual partners and correlates with low rates of condom use, poor communication between spouses, and age and power imbalances, among other factors. The paper also examines areas that have so far received only cursory attention: mental health and a premature ‘social’ menopause. Although data is scarce, polygyny seems to be associated with higher levels of anxiety and depression. The examples reviewed here should help build a framework for mixed method quality research to inform policy makers better.
In this paper, the authors assess the evolution of African Union policies related to women's and children's health, and analyse how these policies are prioritised and framed. It used a document review of all African Union policies developed from 1963 to 2010, focusing specifically on policies that explicitly mention health. The findings were discussed with key actors to identify policy implications. With over 220 policies in total, peace and security was the most common AU policy topic. Social affairs and other development issues became more prominent in the 1990s. The number of policies that mentioned health rose steadily over the years (with 1 policy mentioning health in 1963 to 7 in 2010). This change was catalysed by factors such as: a favourable shift in AU priorities and systems towards development issues, spurred by the transition from the Organisation of African Unity to the African Union; the mandate of the African Commission on Human and People's Rights; health-related advocacy initiatives, such as the Campaign for the Accelerated Reduction of Maternal Mortality in Africa (CARMMA); action and accountability requirements arising from international human rights treaties, the Millennium Development Goals (MDGs), and new health-funding mechanisms, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Prioritisation of women's and children's health issues in AU policies has been framed primarily by human rights, advocacy and accountability considerations, more that by frameworks looking at their economic impact. The authors suggest that more effective prioritisation of women's and children's health in African Union policies could be supported by widening the policy framework to integrate their economic benefit and strengthening the evidence base of policies and strengthening multi-stakeholder advocacy for them.
2015 is a said to be pivotal year. The post–2015 sustainable development agenda currently being drafted is premised on the reality that the present model of development is not working, given worsening inequalities and straining planetary boundaries. All countries and peoples—and the planet –have the right to live with a better model, one that is inclusive and sustainable. The authors argue that an increasingly urgent imperative for change informs the two–track negotiations unfolding at the United Nations from now until September. One track involves the post–2015 sustainable development agenda; the second focuses on financing for development, an independent process that began at the 2002 Monterrey Conference. While the two talks are separate, the issues in each are observed to be deeply interlinked, and the success of any new model to depend on the outcomes of both. The political stakes are high, but so too the authors argue are the opportunities—perhaps once–in–a–generation—for genuine transformation. The article discusses the implications of these two tracks of negotiation.
The Co-facilitators of the Post-2015 Development Agenda talks have released what could be the near-final version of the Post-2015 Development Agenda. This will set the stage for the final round of hectic negotiations at the United Nations headquarters in New York in end July.
The “Outcome Document for the UN Summit to Adopt the Post 2015 Development Agenda: Draft for Adoption” attempts to resolve some of the still remaining thorny issues. However, whether and how quickly the Member States agree to the final document remains to be seen. The document is likely to undergo some changes as negotiations continue, and the final document will be adopted when there is consensus among member states.