How do external donors influence national health policy processes? Experiences of domestic policy actors in Cambodia and Pakistan.
How do external donors influence national health policy processes? Experiences of domestic policy actors in Cambodia and Pakistan.
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DOI：
10.1093/heapol/czx145
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发表时间：
2018-03-01
影响因子：
3.2
通讯作者：
Parkhurst J
中科院分区：
文献类型：
--
作者：
Khan MS;Meghani A;Liverani M;Roychowdhury I;Parkhurst J
虽然人们历来关注外部捐助者对受援国卫生政策进程的影响，但很少有研究调查国内决策者和顾问的观点和经验。本研究审查了捐助者在柬埔寨和巴基斯坦这两个依赖援助的低收入国家卫生政策进程的不同阶段（确定优先事项、政策制定、政策执行以及监测和评价）的影响。它确定了捐助者和国内政策行为者之间出现影响力不对称的机制。我们进行了24个关键的线人访谈-14个在巴基斯坦，10个在巴基斯坦-与高级别决策者谁通知或授权卫生优先事项的设置，分配资源和/或负责政策的实施，确定三个影响力的途径：财政资源，技术专长和间接的财政和政治激励。我们用归纳法和演绎法分析数据。我们的研究结果表明，不同的路线的影响出现了取决于政策过程的阶段。控制财政资源是捐助者影响优先事项确定和政策执行的最常见途径。更多的（被认为的）技术专门知识在捐助者在政策制定阶段的影响力方面发挥了重要作用。捐助者影响决策的权力，特别是在政策进程的最后阶段（监测和评价），取决于它们控制间接的财政和政治奖励以及直接控制财政资源的能力。因此，这项研究有助于揭示捐助方在这些背景下对卫生政策制定的影响的细微差别，并有可能指出需要注意的领域，以增加国内行为者对本国卫生政策进程的自主权。
Although concerns have historically been raised about the influence of external donors on health policy process in recipient countries, remarkably few studies have investigated perspectives and experiences of domestic policymakers and advisers. This study examines donor influence at different stages of the health policy process (priority setting, policy formulation, policy implementation and monitoring and evaluation) in two aid-dependent LMICs, Cambodia and Pakistan. It identifies mechanisms through which asymmetries in influence between donors and domestic policy actors emerge. We conducted 24 key informant interviews—14 in Pakistan and 10 in Cambodia—with high-level decision-makers who inform or authorize health priority setting, allocate resources and/or are responsible for policy implementation, identifying three routes of influence: financial resources, technical expertise and indirect financial and political incentives. We used both inductive and deductive approaches to analyse the data. Our findings indicate that different routes of influence emerged depending on the stage of the policy process. Control of financial resources was the most commonly identified route by which donors influenced priority setting and policy implementation. Greater (perceived) technical expertise played an important role in donor influence at the policy formulation stage. Donors’ power in influencing decisions, particularly during the final (monitoring and evaluation) stage of the policy process, was mediated by their ability to control indirect financial and political incentives as well as direct control of financial resources. This study thus helps unpack the nuances of donor influence over health policymaking in these settings, and can potentially indicate areas that require attention to increase the ownership of domestic actors of their countries’ health policy processes.
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影响因子：
168.9
作者：
Lu, Chunling;Schneider, Matthew T.;Murray, Christopher J. L.
通讯作者：
Murray, Christopher J. L.
影响因子：
7.8
作者：
Goldsmith, AA
通讯作者：
Goldsmith, AA
影响因子：
5.2
作者：
Khan, M. M.;Van den Heuvel, W.
通讯作者：
Van den Heuvel, W.
影响因子：
3.2
作者：
Hafner, Tamara;Shiffman, Jeremy
通讯作者：
Shiffman, Jeremy
影响因子：
3
作者：
Harrison, G
通讯作者：
Harrison, G