Doctoral Dissertation Research: Changing Social Policies and Healthcare Implementation

博士论文研究：不断变化的社会政策和医疗保健实施

• 批准号: 1436010
• 负责人: Stefan Timmermans
• 金额: $ 1.2万
• 依托单位: University of California-Los Angeles
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1436010&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Research; Changing; Social

SES-1436010Stefan TimmermansAmy ZhouUniversity of California Los AngelesThe project contributes to research on global policy diffusion by examining how and when developing countries challenge global policy prescriptions. In addition, by operating at both the state and local levels, the project shows how national policies are improvised and re-interpreted in their implementation. This dissertation project traces the uneven diffusion of global health priorities to national policy and implementation. International organizations and states exert influence in shaping the policy decisions of developing countries. Yet developing countries vary in their responses to global policy prescriptions. Under what conditions do developing states diverge from policy prescriptions? How are new policies implemented and improvised upon in resource-constrained settings? This project focuses on a unique case of policy divergence from Malawi, one of the poorest countries in sub-Saharan Africa. In 2011, Malawi went against WHO guidelines and became the first country to adopt an HIV policy called ?Option B+?. The policy significantly expanded access to HIV treatment by providing pregnant and breastfeeding women immediate and lifelong access to treatment upon testing positive. This project examines why Malawi diverged from WHO guidelines to adopt Option B+, and how Malawian healthcare providers and patients understand and act upon this new policy.Data for the project comes from ethnographic observations and interviews with actors at both the state and local level. At the state level, interviews with members of state agencies and international organizations involved in the Option B+ discussion specifies the unique roles that state and non-state actors have in developing policy. At the local level, interviews and observations at health care centers highlights if and when providers and patients deviate from treatment procedures and the logic that underpins their decisions. Broader Impacts:Since Malawi's adoption of Option B+, the WHO revised their recommendation in 2012 to include Option B+ as an advantageous third option and several countries in the region are considering the policy change. Because the policy is new and untested, there are key concerns regarding barriers to care, adherence to treatment, and possible tensions between partners and community members. This project can create interdisciplinary dialogue. Sociological insights and the richness of qualitative data can inform public health professionals on the unintended consequences of the policy and possible ways to increase uptake and adherence to HIV medication.

SES-1436010Stefan TimmermansAmy Zhou 加州大学洛杉矶分校该项目通过研究发展中国家如何以及何时挑战全球政策规定，为全球政策扩散研究做出贡献。此外，通过在州和地方层面的运作，该项目展示了国家政策在实施过程中如何即兴发挥和重新解释。 本论文项目追溯了全球卫生优先事项向国家政策和实施的不均衡扩散。国际组织和国家在制定发展中国家的政策决定方面发挥影响力。然而，发展中国家对全球政策规定的反应各不相同。发展中国家在什么情况下会偏离政策规定？在资源有限的环境中如何实施和临时制定新政策？该项目重点关注马拉维政策分歧的独特案例，马拉维是撒哈拉以南非洲最贫穷的国家之一。 2011年，马拉维违反世界卫生组织的指导方针，成为第一个采用名为“选项B+”的艾滋病毒政策的国家。该政策显着扩大了艾滋病毒治疗的可及性，为孕妇和哺乳期妇女提供检测呈阳性后立即和终身接受治疗的机会。该项目探讨了马拉维为何偏离世卫组织指南而采用选项 B+，以及马拉维医疗保健提供者和患者如何理解这一新政策并采取行动。该项目的数据来自人种学观察以及对州和地方一级行动者的采访。在国家层面，对参与选项 B+ 讨论的国家机构和国际组织成员的采访明确了国家和非国家行为者在制定政策中的独特作用。在地方一级，对医疗保健中心的采访和观察突显了医疗服务提供者和患者是否以及何时偏离治疗程序以及支撑他们决定的逻辑。更广泛的影响：自马拉维采用选项 B+ 以来，世界卫生组织在 2012 年修改了建议，将选项 B+ 作为有利的第三个选项，该地区的一些国家正在考虑政策改变。由于该政策是新的且未经测试的，因此人们对护理障碍、治疗依从性以及合作伙伴和社区成员之间可能存在的紧张关系存在主要担忧。该项目可以创造跨学科对话。社会学见解和丰富的定性数据可以让公共卫生专业人员了解该政策的意外后果以及提高艾滋病毒药物使用和依从性的可能方法。