Power and Agenda-Setting in Tanzanian Health Policy: An Analysis of Stakeholder Perspectives
Power and Agenda-Setting in Tanzanian Health Policy: An Analysis of Stakeholder Perspectives
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DOI：
10.15171/ijhpm.2016.09
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发表时间：
2016-06-01
影响因子：
3.5
通讯作者：
Strandberg-Larsen, Martin
中科院分区：
文献类型：
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作者：
Fischer, Sara Elisa;Strandberg-Larsen, Martin
背景：全球卫生政策主要是通过发展机构和受援国政府之间的合作过程制定的，但目前尚不清楚各国政府是否保留对本国政策制定的所有权。因此，评估这种关系中的权力结构及其对议程制定的影响是了解发展政策制定方面仍需取得进展的第一步。 方法：本研究采用定性政策分析方法，以坦桑尼亚为案例研究，研究低收入国家如何采用与健康相关的政策议程。我们从议程制定过程及其参与者的角度对 11 名政策制定者进行了半结构化、深入的关键知情人访谈。选择金登的流理论作为解释数据分析的透镜。结果：这项研究表明，虽然每个利益相关者都有影响流程的方式，但可以根据三个主要因素来评估这样做的权力：财务激励、技术专长和影响力地位。由于捐助者往往同时拥有其中两个或全部要素，因此自然会出现权力失衡，捐助者的利益往往会压倒受援国政府在议程优先顺序方面的限制。调解这些不平衡的一种方法似乎是启动有意义的政策对话。 结论：在坦桑尼亚，议程设定过程是在一个复杂的因素网络中运作的，这些因素相互作用，直到“政策窗口”打开并做出决定。这一过程中的权力往往不在于坦桑尼亚政府，而在于捐助者，这种权力的潜在存在和故意使用之间的对比似乎是基于提供援助背后的捐助者意识形态（此处由资助方式定义）。使用集合资金（PF）模式的捐助者不太可能利用其固有权力，而那些更愿意对其提供的援助保持最大控制的捐助者（即非集合资助者）更容易利用其内在权力来推动自己的优先事项。
Background: Global health policy is created largely through a collaborative process between development agencies and aid-recipient governments, yet it remains unclear whether governments retain ownership over the creation of policy in their own countries. An assessment of the power structure in this relationship and its influence over agenda-setting is thus the first step towards understanding where progress is still needed in policy-making for development.Methods: This study employed qualitative policy analysis methodology to examine how health-related policy agendas are adopted in low-income countries, using Tanzania as a case study. Semi-structured, in-depth, key informant interviews with 11 policy-makers were conducted on perspectives of the agenda-setting process and its actors. Kingdon's stream theory was chosen as the lens through which to interpret the data analysis.Results: This study demonstrates that while stakeholders each have ways of influencing the process, the power to do so can be assessed based on three major factors: financial incentives, technical expertise, and influential position. Since donors often have two or all of these elements simultaneously a natural power imbalance ensues, whereby donor interests tend to prevail over recipient government limitations in prioritization of agendas. One way to mediate these imbalances seems to be the initiation of meaningful policy dialogue.Conclusion: In Tanzania, the agenda-setting process operates within a complex network of factors that interact until a "policy window" opens and a decision is made. Power in this process often lies not with the Tanzanian government but with the donors, and the contrast between latent presence and deliberate use of this power seems to be based on the donor ideology behind giving aid (defined here by funding modality). Donors who used pooled funding (PF) modalities were less likely to exploit their inherent power, whereas those who preferred to maintain maximum control over the aid they provided (ie, non-pooled funders) more readily wielded their intrinsic power to push their own priorities.