Doctoral Dissertation Research: Changing Social Policies and Healthcare Implementation

SES-1436010 Stefan TimmermansAmy Zhou加州洛杉矶大学该项目通过研究发展中国家如何以及何时挑战全球政策处方，为全球政策传播研究做出了贡献。此外，通过在州和地方两级开展活动，该项目显示了国家政策在执行过程中是如何即兴发挥和重新解释的。 本论文项目跟踪全球卫生优先事项的国家政策和实施的不均衡扩散。国际组织和国家对发展中国家的政策决定施加影响。然而，发展中国家对全球政策处方的反应各不相同。发展中国家在什么条件下偏离政策处方？在资源有限的环境中，新政策是如何实施和即兴发挥的？该项目的重点是来自马拉维的政策分歧的一个独特案例，马拉维是撒哈拉以南非洲最贫穷的国家之一。2011年，马拉维违反了世卫组织的指导方针，成为第一个采取艾滋病毒政策的国家，名为？选项B+？。该政策大大扩大了获得艾滋病毒治疗的机会，为检测呈阳性的孕妇和哺乳期妇女提供立即和终身治疗的机会。该项目研究了马拉维为何偏离世卫组织的指导方针而采用方案B+，以及马拉维的医疗保健提供者和患者如何理解这一新政策并采取行动。在州一级，与参与选项B+讨论的国家机构和国际组织成员的访谈具体说明了国家和非国家行为者在制定政策方面的独特作用。在地方一级，在卫生保健中心进行的访谈和观察突出了提供者和患者是否以及何时偏离治疗程序以及支撑其决定的逻辑。更广泛的影响：自马拉维采用方案B+以来，世卫组织于2012年修订了其建议，将方案B+列为有利的第三种方案，该地区的几个国家正在考虑政策变化。由于该政策是新的，未经测试，有关于照顾的障碍，坚持治疗，以及合作伙伴和社区成员之间可能的紧张关系的关键问题。这个项目可以创造跨学科的对话。社会学的见解和丰富的定性数据可以告知公共卫生专业人员该政策的意外后果，以及增加艾滋病毒药物的使用和坚持的可能方法。

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.