Doctoral Dissertation Research: Changing Social Policies and Healthcare Implementation

SES-1436010加州大学洛杉矶分校的艾米·周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，为全球政策扩散研究做出了贡献。此外，通过在州和地方两级运作，该项目展示了国家政策是如何在执行过程中临时制定和重新解释的。本论文项目追溯了全球卫生优先事项对国家政策和实施的不均衡扩散。国际组织和国家在影响发展中国家的决策方面发挥作用。然而，发展中国家对全球政策处方的反应各不相同。在什么情况下，发展中国家会偏离政策处方？如何在资源受限的环境中实施和即兴制定新策略？该项目侧重于撒哈拉以南非洲最贫穷的国家之一马拉维的一个独特的政策分歧案例。2011年，马拉维违反了世卫组织的指导方针，成为第一个通过名为“备选方案B+”的艾滋病毒政策的国家。这项政策极大地扩大了艾滋病毒治疗的机会，使孕妇和哺乳妇女在检测呈阳性后立即和终身获得治疗。该项目调查马拉维为何偏离世卫组织的指导方针而采用B+方案，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对其采取行动。该项目的数据来自人种学观察和对国家和地方一级行为者的采访。在州一级，与参与备选方案B+讨论的国家机构和国际组织成员的面谈具体说明了国家和非国家行为者在制定政策方面所发挥的独特作用。在地方一级，卫生保健中心的采访和观察突出了提供者和患者是否以及何时偏离治疗程序，以及支撑他们决定的逻辑。更广泛的影响：自从马拉维采用备选方案B+以来，世卫组织在2012年修订了他们的建议，将备选方案B+列为有利的第三个备选方案，该地区的几个国家正在考虑这一政策变化。由于这项政策是新的和未经检验的，人们对护理障碍、坚持治疗以及合作伙伴和社区成员之间可能存在的紧张关系感到担忧。这个项目可以创造跨学科的对话。社会学的洞察力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想不到的后果，以及增加对艾滋病毒药物的吸收和遵守的可能方法。

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.