Influences on policy-formulation, decision-making, organisation and management for maternal, newborn and child health in Bangladesh, Ethiopia, Malawi and Uganda: The roles and legitimacy of a multi-country network.
Influences on policy-formulation, decision-making, organisation and management for maternal, newborn and child health in Bangladesh, Ethiopia, Malawi and Uganda: The roles and legitimacy of a multi-country network.
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DOI：
10.1371/journal.pgph.0001742
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发表时间：
2023
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提高孕产妇、新生儿和儿童保健质量网络旨在促进成员国在提高保健质量方面的学习、行动、领导和问责。这需要合法性——网络在国家背景下行使权力的权利。例如，这反映在政府对网络工作的购买和感知所有权上。在2019-2022年期间，我们在孟加拉国、埃塞俄比亚、马拉维、乌干达和全球一级进行了几轮利益攸关方访谈、会议观察、文件审查和医院观察。我们根据三个模型开发了一个框架：Tallberg和Zurn根据国际组织的特征、合法化过程和受众的信仰来概念化国际组织的合法性；Nasiritousi和Faber，从问题、目的、程序和制度绩效的角度来研究合法性；Sanderink和Nasiritousi，从政治，规范和认知互动的角度来描述网络。我们使用主题分析来描述、比较和对比跨案例综合中的制度互动，以确定显著特征。国家内部和国家之间以及全球层面的政治和规范互动是有利的，因为所有层面都观察到集体决策、合作努力和对QCN目标的承诺。网络国家之间的资源共享和共同原则并不普遍，这表明网络的局限性。认知互动——那些与信息共享和思想转移有关的互动——更具挑战性，概念和方法的双向转移、综合和协调在国家之间和国家内部基本缺失。这些可能需要增加政府对QCN工作的所有权，网络的嵌入性及其合法性。虽然我们从国家政府的角度找到了支持QCN合法性的证据，但政府需要进一步的工作和时间来拥有QCN并将其纳入日常护理中。
The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) is intended to facilitate learning, action, leadership and accountability for improving quality of care in member countries. This requires legitimacy—a network’s right to exert power within national contexts. This is reflected, for example, in a government’s buy-in and perceived ownership of the work of the network. During 2019–2022 we conducted iterative rounds of stakeholder interviews, observations of meetings, document review, and hospital observations in Bangladesh, Ethiopia, Malawi, Uganda and at the global level. We developed a framework drawing on three models: Tallberg and Zurn which conceptualizes legitimacy of international organisations dependent on their features, the legitimation process and beliefs of audiences; Nasiritousi and Faber, which looks at legitimacy in terms of problem, purpose, procedure, and performance of institutions; Sanderink and Nasiritousi, to characterize networks in terms of political, normative and cognitive interactions. We used thematic analysis to characterize, compare and contrast institutional interactions in a cross-case synthesis to determine salient features. Political and normative interactions were favourable within and between countries and at global level since collective decisions, collaborative efforts, and commitment to QCN goals were observed at all levels. Sharing resources and common principles were not common between network countries, indicating limits of the network. Cognitive interactions—those related to information sharing and transfer of ideas—were more challenging, with the bi-directional transfer, synthesis and harmonization of concepts and methods, being largely absent among and within countries. These may be required for increasing government ownership of QCN work, the embeddedness of the network, and its legitimacy. While we find evidence supporting the legitimacy of QCN from the perspective of country governments, further work and time are required for governments to own and embed the work of QCN in routine care.