Policy researchers have used various categories of variables to explain why policies change, including those related to institutions, interests and ideas. Recent research has paid growing attention ...to the role of policy networks—the actors involved in policy-making, their relationships with each other, and the structure formed by those relationships—in policy reform across settings and issues; however, this literature has largely ignored the theoretical integration of networks with other policy theories, including the ‘3Is’ of institutions, interests and ideas. This article proposes a conceptual framework integrating these variables and tests it on three cases of policy change in Burkina Faso, addressing the need for theoretical integration with networks as well as the broader aim of theory-driven health policy analysis research in low- and middle-income countries. We use historical process tracing, a type of comparative case study, to interpret and compare documents and in-depth interview data within and between cases. We found that while network changes were indeed associated with policy reform, this relationship was mediated by one or more of institutions, interests and ideas. In a context of high donor dependency, new donor rules affected the composition and structure of actors in the networks, which enabled the entry and dissemination of new ideas and shifts in the overall balance of interest power ultimately leading to policy change. The case of strategic networking occurred in only one case, by civil society actors, suggesting that network change is rarely the spark that initiates the process towards policy change. This analysis highlights the important role of changes in institutions and ideas to drive policymaking, but hints that network change is a necessary intermediate step in these processes.
Les chercheurs en stratégies politiques ont utilisé diverses catégories de variables pour expliquer pourquoi les stratégies changent, notamment celles ayant un lien avec des institutions, des intérêts et des idées. Des recherches récentes ont accordé une attention croissante au rôle des réseaux politiques - les acteurs impliqués dans l’élaboration des politiques, leurs relations les uns avec les autres, et la structure formée par ces relations - dans la réforme des stratégies politiques dans tous les contextes et enjeux; cependant, cette littérature a largement ignoré l’intégration théorique des réseaux avec d’autres théories politiques, y compris les « 31 », à savoir, les institutions, les intérêts et les idées. Le présent article propose un cadre conceptuel intégrant ces variables et le teste sur trois cas de changement de stratégie politique au Burkina Faso, répondant à la nécessité de l’intégration théorique avec les réseaux ainsi qu’à l’objectif plus large d’analyse de la politique de recherche en santé fondée sur la théorie dans les pays à revenu faible et intermédiaire. Nous utilisons le répérage du processus historique, un type d’étude comparative de cas, afin d’interpréter et de comparer les documents et les données des entretiens en profondeur dans et entre les limites des cas. Nous avons constaté que les modifications du réseau ont en effet été associées à la réforme de la stratégie politique, et que cette relation a été modifiée par une ou plusieurs institutions, intérêts et idées. Dans un contexte de forte dépendance des bailleurs de fonds, les nouvelles règles des donateurs ont affecté la composition et la structure des acteurs dans les réseaux, ce qui a permis l’entrée et la diffusion de nouvelles idées et des modifications dans l’équilibre global du pouvoir de l’intérêt, qui en définitive aboutit à un changement de politique. La mise en réseau stratégique est survenue dans un seul cas, par le biais des acteurs de la société civile, ce qui laisse supposer que la modification du réseau produit rarement l’étincelle qui déclenche le processus menant au changement de stratégie politique. Cette analyse met en évidence l’important rôle de l’évolution des institutions et des idées devant aboutir à l’élaboration des politiques, mais laisse supposer que le changement de réseau est une étape intermédiaire nécessaire dans ces processus.
Los investigadores de políticas han utilizado diversas categorías de variables para explicar por qué las políticas cambian, incluyendo aquellas relacionadas con las instituciones, los intereses y las ideas. La investigación reciente ha prestado cada vez más atención al papel de las redes de políticas -los actores involucrados en la formulación de políticas, sus relaciones entre sí, y la estructura formada por aquellas relaciones- en la reforma de políticas en todos los entornos y los problemas; sin embargo, esta literatura ha ignorado en gran parte la integración teórica de las redes con otras teorías políticas, incluyendo las ‘3Is’ de las instituciones, intereses e ideas. Este artículo propone un marco conceptual integrando estas variables probándolas en tres casos de cambio de políticas en Burkina Faso, abordando la necesidad de una integración teórica con las redes, así como con el objetivo más amplio de investigación de análisis de políticas de salud basada en la teoría en los países de ingresos bajos y medios. Utilizamos el rastreo de un proceso histórico, un tipo de estudio comparativo de casos, para interpretar y comparar los documentos y los datos de entrevistas en profundidad dentro y entre los casos. Se encontró que mientras los cambios de la red estuvieron vinculados a una reforma de la política, esta relación estaba mediada por una o más de las instituciones, los intereses y las ideas. En un contexto de elevada dependencia de los donantes, los nuevos reglamentos de los donantes afectaron la composición y la estructura de los actores en las redes, lo que permitió la entrada y difusión de nuevas ideas y cambios en el equilibrio total del poder de los intereses conduciendo finalmente a un cambio de política. El caso de interconexiones estratégicas ocurrió sólo en un caso, por los actores de la sociedad civil, lo que sugiere que el cambio de la red rara vez es el factor desencadenante que inicia el proceso hacia el cambio de política. Este análisis destaca el importante papel de los cambios en las instituciones y en las ideas para impulsar la formulación de políticas, pero insinúa que el cambio de red es un paso intermedio necesario en estos procesos.
政策研究者使用不同类别下的变量来解释政策变化, 包括与制 度、利益和想法的政策变化。最近的研究增加了对政策改革 中政策网络的关注——政策制定过程中的参与者, 他们之间的 关系, 这些关系构成的结构。然而, 这忽略了与其他政策理论 的理论整合, 包括制度、利益和想法的 “3LS” 。本文提出一 种整合这些变量的概念框架, 并在布基纳法索的三个政策变革 的例子中试验, 旨在提出对理论整合的需要以及在低收入和中 等收入国家以理论为导向的医疗政策分析研究的需要。我们 使用历史过程回溯, 一种案例比较研究, 解释和比较案例中的 文件和深度访谈得到的数据。我们发现随着政策变革网络确 实有所变化, 这种关系被制度、利益和想法中的一个中和了。 在高度依赖捐赠者的情境下, 新的捐赠规则影响网络中参与者 的组成和结构, 这样使新的想法能够进入或者渗透进来, 影响 利益力量的平衡, 最终引起政策变化。策略社交只在一个例子 中出现, 通过公民社会参与者, 这表明网络的变化很少是促进 政策变化的动因。本分析强调了制度和想法在政策制定中的 重要促进角色, 但是网络也是这些过程中必需的中间步骤。
The analysis of health policy processes in low- and middle-income countries (LMICs) emerged as a research area in the early 1990s. In their recent editorial Powell and Mannion argue that such ...research can be deepened by applying public policy theory. In response, we raise three questions to consider: are public policy models fit for purpose in today's world in LMICs (and what other theory can be used)? Is using theory the most important factor in deepening such research? Why do we, as researchers, do this work? Ultimately, we argue that the value of simple models, such as those already used in health policy analysis, lies in their enduring relevance and widespread use. They are supporting the development of the shared understandings that can, in turn, provide the basis for collective action addressing inequities in health and well-being.
This paper reviews country-level evidence about the impact of global health initiatives (GHIs), which have had profound effects on recipient country health systems in middle and low income countries. ...We have selected three initiatives that account for an estimated two-thirds of external funding earmarked for HIV/AIDS control in resource-poor countries: the Global Fund to Fight AIDS, TB and Malaria, the World Bank Multi-country AIDS Program (MAP) and the US President's Emergency Plan for AIDS Relief (PEPFAR). This paper draws on 31 original country-specific and cross-country articles and reports, based on country-level fieldwork conducted between 2002 and 2007. Positive effects have included a rapid scale-up in HIV/AIDS service delivery, greater stakeholder participation, and channelling of funds to non-governmental stakeholders, mainly NGOs and faith-based bodies. Negative effects include distortion of recipient countries’ national policies, notably through distracting governments from coordinated efforts to strengthen health systems and re-verticalization of planning, management and monitoring and evaluation systems. Sub-national and district studies are needed to assess the degree to which GHIs are learning to align with and build the capacities of countries to respond to HIV/AIDS; whether marginalized populations access and benefit from GHI-funded programmes; and about the cost-effectiveness and long-term sustainability of the HIV and AIDS programmes funded by the GHIs. Three multi-country sets of evaluations, which will be reporting in 2009, will answer some of these questions.
Aluminum particle ignition behavior in open atmosphere rocket propellants fires is of particular interest for preventing accidents for rockets carrying high-value payloads. For nominal motor ...pressures, aluminum particles oxidize to aluminum oxide in the gas phase and release significant combustion energy while minimizing motor instability. During rocket abort or launch pad malfunction which occur under atmospheric or low pressure, behavior of aluminum particle combustion becomes complex and aluminum appears to melt, agglomerate or form a skeletal structure. Furthermore, an oxide shell of alumina instantly forms on any fresh aluminum surface which is exposed to an oxidizing environment. Aluminum combustion then strongly depends on the oxide layer growth, which is influenced by causative factors, including particle size, environmental gas composition, and heating rate. This work focuses on the effect of the oxide barrier which forms on the surface of aluminum that is recognized to impede combustion of aluminum in solid rocket propellants. Understanding the mechanism for breach of this barrier is deemed to be an important consideration in the overall process. In this discussion, results of various experiments will be discussed which have a bearing on this process. Basically, a recognized criterion is the melting of the oxide layer at 2350 K is sufficient. However, in other situations, depending on the mechanism of oxide formation, there will occur defects in the oxide shell which provide for aluminum ignition at lower temperatures. For slow heating in an oxidizing environment, where the oxide layer can grow thick, then ignition is more difficult. Because there is no uniform model to establish an ignition criterion due to the unknown history of an aluminum particle, this paper reports experimental findings involving oxyacetylene torch, thermogravimetric analysis with differential scanning calorimeter, aluminum particle heating, electric ignition and aluminum powder heating, to address the influence of the oxide layer on the aluminum particle ignition.
Summary
Increased attention is being paid to networks in public administration and development policy, yet there is limited understanding of how voluntary global networks form and why some of these ...networks cohere and emerge faster than others. Comparisons between the global networks for tuberculosis (TB) and pneumonia reveal processes of network formation relevant to other contexts. Though selected as most similar paired cases, their trajectories of network emergence diverged and TB's formed far earlier and more easily. By using a theoretic framework allowing for networks to be considered as outcomes of a policy process, this study reveals an iterative process of network emergence corresponding to the three streams model of issue attention. Successful emergence is based on building shared identities among policy entrepreneurs, agreeing on issue frames, creating institutions, developing relationships, sustaining latent networks during issue neglect, and linking to opportunities in the policy environment. Further, this study reveals that once formed, network structures enable access to political opportunities and more effective development policymaking and governance. Additionally, for networks struggling to take shape, we identify deliberate efforts that can overcome earlier iterations of failed attempts at network formation.
Researchers are increasingly required to describe the impact of their work, e.g. in grant proposals, project reports, press releases and research assessment exercises. Specialised impact assessment ...studies can be difficult to replicate and may require resources and skills not available to individual researchers. Researchers are often hard-pressed to identify and describe research impacts and ad hoc accounts do not facilitate comparison across time or projects.
The Research Impact Framework was developed by identifying potential areas of health research impact from the research impact assessment literature and based on research assessment criteria, for example, as set out by the UK Research Assessment Exercise panels. A prototype of the framework was used to guide an analysis of the impact of selected research projects at the London School of Hygiene and Tropical Medicine. Additional areas of impact were identified in the process and researchers also provided feedback on which descriptive categories they thought were useful and valid vis-à-vis the nature and impact of their work.
We identified four broad areas of impact: I. Research-related impacts; II. Policy impacts; III. Service impacts: health and intersectoral and IV. Societal impacts. Within each of these areas, further descriptive categories were identified. For example, the nature of research impact on policy can be described using the following categorisation, put forward by Weiss: Instrumental use where research findings drive policy-making; Mobilisation of support where research provides support for policy proposals; Conceptual use where research influences the concepts and language of policy deliberations and Redefining/wider influence where research leads to rethinking and changing established practices and beliefs.
Researchers, while initially sceptical, found that the Research Impact Framework provided prompts and descriptive categories that helped them systematically identify a range of specific and verifiable impacts related to their work (compared to ad hoc approaches they had previously used). The framework could also help researchers think through implementation strategies and identify unintended or harmful effects. The standardised structure of the framework facilitates comparison of research impacts across projects and time, which is useful from analytical, management and assessment perspectives.
Poverty, Inequality and Health: An International Perspective raises new and critical issues about health inequalities. It is unique in that it provides the first truly international perspective on ...this problem, with contributions from the developed and developing world. The outcome of a Public Health Forum organised by the London School of Hygiene and Tropical Medicine, this book brings together material from internationally recognised contributors from a wide range of disciplines and countries. The chapters reflect this diversity, ranging from the micro- to the macro-level, from aetiology to intervention. Topics covered include: the over-arching concepts linking economic and social forces and health status the extent to which ethical concerns lie at the heart of the issue of inequalities in health and attempts to ameliorate them; macro-level features of inequalities in health within and between countries; an overview of the main body of work on inequalities in health in developed countries and those in transition within Europe; specific pathways and mechanisms at the individual level that link poverty and inequality to health status; the interaction of social and biological influences on health status throughout life; specific disease-specific links; and issues of policy and interventions aimed at reducing inequalities in health. The book brings together people from very varied disciplines to discuss an area of clear international interest and global importance. As such it will be of value to the broad public health audience as well as research epidemiologists, international policy analysts and policy makers and those concerned with economic development and health. Available in OSO: http://www.oxschol.com/oso/public/content/publichealthepidemiology/9780192631961/toc.html
Shiffman rightly raises questions about who exercises power in global health, suggesting power is a complex concept, and the way it is exercised is often opaque. Power that is not based on financial ...strength but on knowledge or experience, is difficult to estimate, and yet it may provide the legitimacy to make moral claims on what is, or ought to be, on global health agendas. Twenty years ago power was exercised in a much less complex health environment. The World Health Organization (WHO) was able to exert its authority as world health leader. The landscape today is very different. Financial resources for global health are being competed for by diverse organisations, and power is diffused and somewhat hidden in such a climate, where each organization has to establish and make its own moral claims loudly and publicly. We observe two ways which allow actors to capture moral authority in global health. One, through power based on scientific knowledge and two, through procedures in the policy process, most commonly associated with the notion of broad consultation and participation. We discuss these drawing on one particular framework provided by Bourdieu, who analyses the source of actor power by focusing on different sorts of capital. Different approaches or theories to understanding power will go some way to answering the challenge Shiffman throws to health policy analysts. We need to explore much more fully where power lies in global health, and how it is exercised in order to understand underlying health agendas and claims to legitimacy made by global health actors today.
Antiretroviral therapy (ART) is difficult in poor settings. In 2001, the Thai government adopted the policy to scale-up its treatment initiative to meet the needs of all its people. Employing ...qualitative approaches, including in-depth interviews, document review and direct observation, this study examines the processes by which the universal ART policy developed between 2001 and 2007, with the focus on the connections between actors who shared common interests—so-called policy networks. Research findings illustrate the crucial contributions of non-state networks in the policy process. The supportive roles of public-civic networks could be observed at every policy stage, and at different levels of the health sector. Although this particular health policy may be unique in case and setting, it does suggest clearly that while the state dominated the policy process initially, non-state actors played extremely important roles. Their contribution was not simply at agenda-setting stages—for example by lobbying government—but in the actual development and implementation of health policy. Further it illustrates that these processes were dynamic, took place over long periods and were not limited to national borders, but extended beyond, to include global actors and processes.
How and why policies are transferred between countries has attracted considerable interest from scholars of public policy over the last decade. This paper, based on a larger study, sets out to ...explore the processes involved in policy transfer between international and national levels. These processes are illustrated by looking at a particular public health policy—DOTS for the control and treatment of tuberculosis. The paper demonstrates how, after a long period of neglect, resources were mobilised to put tuberculosis back on international and national public policy agendas, and then how the policy was ‘branded’ and marketed as DOTS, and transferred to low and middle income countries. It focuses specifically on international agenda setting and policy formulation, and the role played by international organisations in those processes. It shows that policy communities, and particular individuals within them, may take political rather than technical positions in these processes, which can result in considerable contestation. The paper ends by suggesting that while it is possible to raise the profile of a policy dramatically through branding and marketing, success also depends on external events providing windows of opportunity for action. Second, it warns that simplifying policy approaches to ‘one-size-fits-all’ carries inherent risks, and can be perceived to harm locally appropriate programmes. Third, top-down internationally driven policy changes may lead to apparent policy transfer, but not necessarily to successfully implemented programmes.
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