Technical analysis, contestation and politics in policy agenda setting and implementation: the rise and fall of primary care maternal services from Ghana's capitation policy.
Technical analysis, contestation and politics in policy agenda setting and implementation: the rise and fall of primary care maternal services from Ghana's capitation policy.
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DOI：
10.1186/s12913-016-1576-2
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发表时间：
2016-07-29
影响因子：
2.8
通讯作者：
Agyepong IA
中科院分区：
文献类型：
--
作者：
Koduah A;van Dijk H;Agyepong IA
为什么问题出现在政策议程上，进入政策制定和执行过程，而其他问题却在这个过程中被遗漏，这是一个重要的调查领域，为公共社会政策的制定和执行提供信息。本文试图通过探索如何以及为什么在全国推广之前在不到三个月的时间内实施试点；初级保健孕产妇服务作为人均初级保健国家国家医疗保险计划提供者支付系统中的一篮子服务的一部分，来促进我们对加纳卫生政策议程的制定、制定和实施过程的理解。我们使用案例研究设计，系统地重建了初级保健孕产妇保健服务的决定和行动，这些决定和行动围绕着初级保健孕产妇保健服务的兴衰。数据是从2012年7月和2014年8月通过深入访谈、观察和文件审查收集的。利用政策阻力、权力和冲突领域的概念对数据进行了分析。在议程制定和政策制定阶段，主要是官僚机构内的技术政策行为者利用他们的专门知识和建立共识的权威，将产前、正常分娩和产后服务纳入初级保健人均支付制度。一旦政策执行开始，政策制定者就面临着意想不到的阻力。服务提供者，特别是私营自筹资金的人，利用他们的专业知识和技能、获得政治和社会权力以及街道一级的官僚权力，对政策及其执行安排的各个方面--包括纳入初级保健--产妇保健服务--提出异议和抵制。在选举年激烈的公共舞台冲突和争议的背景下，增加了竞选产生的高度政治焦虑。总统和卫生部长作出回应，将产前、正常分娩和产后护理从人均一揽子计划中删除。技术考虑与政治以及官僚与公共冲突之间的紧张关系和复杂关系，是可能导致政策议程上的项目起起落落的重要影响。
Why issues get on the policy agenda, move into policy formulation and implementation while others drop off in the process is an important field of enquiry to inform public social policy development and implementation. This paper seeks to advance our understanding of health policy agenda setting, formulation and implementation processes in Ghana, a lower middle income country by exploring how and why less than three months into the implementation of a pilot prior to national scale up; primary care maternal services that were part of the basket of services in a primary care per capita national health insurance scheme provider payment system dropped off the agenda. We used a case study design to systematically reconstruct the decisions and actions surrounding the rise and fall of primary care maternal health services from the capitation policy. Data was collected from July 2012 and August 2014 through in-depth interviews, observations and document review. The data was analysed drawing on concepts of policy resistance, power and arenas of conflict. During the agenda setting and policy formulation stages; predominantly technical policy actors within the bureaucratic arena used their expertise and authority for consensus building to get antenatal, normal delivery and postnatal services included in the primary care per capita payment system. Once policy implementation started, policy makers were faced with unanticipated resistance. Service providers, especially the private self-financing used their professional knowledge and skills, access to political and social power and street level bureaucrat power to contest and resist various aspects of the policy and its implementation arrangements – including the inclusion of primary care maternal health services. The context of intense public arena conflicts and controversy in an election year added to the high level political anxiety generated by the contestation. The President and Minister of Health responded and removed antenatal, normal delivery and postnatal care from the per capita package. The tensions and complicated relationships between technical considerations and politics and bureaucratic versus public arenas of conflict are important influences that can cause items to rise and fall on policy agendas.