Understanding Global Health Policy

Brugha, Ruairı́; Bruen, Carlos; Tangcharoensathien, Viroj

doi:10.1002/9781118509623.ch1

Cited by 3 publications

(4 citation statements)

References 43 publications

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“…UNICEF’s values and pragmatism synchronised with the underpinnings of Option B+, and their engagement with the policy allowed them to regain prominence within a congested global policy space. The organisation, together with partners such as PEPFAR, WHO and the IATT more broadly, had served as ‘policy entrepreneurs’: the actors who take the lead in promoting a policy through a variety of channels and means, and ultimately are crucial to its success [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thereafter, the ‘policy triangle framework’ [ 30 , 31 ] is used to understand how political contexts influenced the direction and feasibility of policy-making at global and then country level. We aim to draw out the influence and interactions of various actors – specifically focusing on UNICEF – to map the process trajectories and identify how these shaped the policy content.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

UNICEF’s contribution to the adoption and implementation of option B+ for preventing mother-to-child transmission of HIV: a policy analysis

Chersich

Newbatt

Kondwani³

et al. 2018

Global Health

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BackgroundBetween 2011 and 2013, global and national guidelines for preventing mother-to-child transmission (PMTCT) of HIV shifted to recommend Option B+, the provision of lifelong antiretroviral treatment for all HIV-infected pregnant women.MethodsWe aimed to analyse how Option B+ reached the policy agenda, and unpack the processes, actors and politics that explain its adoption, with a focus on examining UNICEF’s contribution to these events. Analysis drew on published articles and other documentation, 30 key informants interviews with staff at UNICEF, partner organisations and government officials, and country case studies. Cameroon, India, South Africa and Zimbabwe were each visited for 5–8 days. Interview transcripts were analysed using Dedoose software, reviewed several times and then coded thematically.ResultsA national policy initiative in Malawi in 2011, in which the country adopted Option B+, rather than existing WHO recommended regimens, irrevocably placed the policy on the global agenda. UNICEF and other organisations recognised the policy’s potential impact and strategically crafted arguments to support it, framing these around operational considerations, cost-effectiveness and values. As ‘policy entrepreneurs’, these organisations vigorously promoted the policy through a variety of channels and means, overcoming concerted opposition. WHO, on the basis of scanty evidence, released a series of documents towards the policy’s endorsement, paving the way for its widespread adoption. National-level policy transformation was rapid and definitive, distinct from previous incremental policy processes. Many organisations, including UNICEF, facilitated these changes in country, acting individually, or in concert.ConclusionsThe adoption of the Option B+ policy marked a departure from established processes for PMTCT policy formulation which had been led by WHO with the support of technical experts, and in which recommendations were developed following shifts in evidence. Rather, changes were spurred by a country-level initiative, and a set of strategically framed arguments that resonated with funders and country-level actors. This bottom-up approach, supported by normative agencies, was transformative. For UNICEF, alignment between the organisation’s country focus and the policy’s underpinning values, enabled it to work with partners and accelerate widespread policy change.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

UNICEF’s contribution to the adoption and implementation of option B+ for preventing mother-to-child transmission of HIV: a policy analysis

Chersich

Newbatt

Kondwani³

et al. 2018

Global Health

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“…A wide range of frameworks, each contested in their own right, are available to policy researchers to assist in understanding the complexity of political processes in global health policy. Longstanding theories on institutional rational choice, multiple-streams, punctuated-equilibrium, and advocacy coalition frameworks have been supplemented by more recent understandings of the role of networks in political processes and how people make and bring about political change or act to stabilize existing hierarchical orders (22). Despite being viewed by some as beyond the remit of public health research, the political is an enduring feature of global health policy, and therefore of health policy analysis.…”

Section: Global Health Policy As Political Processmentioning

confidence: 99%

A Ghost in the Machine? Politics in Global Health Policy

Bruen

Brugha

2014

Int J Health Policy Manag

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“…Writing in his weekly column, The Lancet editor Richard Horton remarked that global health has experienced a recent revolution in accountability, with improved metrics increasingly linked to politics and decision-making in ways that seek to create “the right political conditions for data to have an impact on health and health policy” [ 1 ]. Substantial changes in the global health landscape since the late 1990s have served to intensify demands for greater accountability, including: increases in funding for specific diseases or interventions; a growth in the number of state and non-state actors involved in the making, financing and implementation of health policies; and more diverse channels for funding global health projects and programmes [ 2 ]. However, as both a concept and in practice, accountability is infused with different meanings, criteria and standards depending on who uses the term, whether managers, policy makers, researchers, advocates, or health professionals.…”

Section: Introductionmentioning

confidence: 99%

A concept in flux: questioning accountability in the context of global health cooperation

et al. 2014

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BackgroundAccountability in global health is a commonly invoked though less commonly questioned concept. Critically reflecting on the concept and how it is put into practice, this paper focuses on the who, what, how, and where of accountability, mapping its defining features and considering them with respect to real-world circumstances. Changing dynamics in global health cooperation - such as the emergence of new health public-private partnerships and the formal inclusion of non-state actors in policy making processes - provides the backdrop to this discussion.DiscussionAccountability is frequently reduced to one set of actors holding another to account. Changes in the global health landscape and in relations between actors have however made the practice of accountability more complex and contested. Currently undergoing a reframing process, participation and transparency have become core elements of a new accountability agenda alongside evaluation and redress or enforcement mechanisms. However, while accountability is about holding actors responsible for their actions, the mechanisms through which this might be done vary substantially and are far from politically neutral.Accountability in global health cooperation involves multipolar relationships between a large number of stakeholders with varying degrees of power and influence, where not all interests are realised in that relationship. Moreover, accountability differs across finance, programme and governance subfields, where each has its own set of policy processes, institutional structures, accountability relations and power asymmetries to contend with. With reference to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, this paper contributes to discussions on accountability by mapping out key elements of the concept and how it is put into practice, where different types of accountability battle for recognition and legitimacy.SummaryIn mapping some defining features, accountability in global health cooperation is shown to be a complex problem not necessarily reducible to one set of actors holding another to account. Clear tensions are observed between multi-stakeholder participatory models and more traditional vertical models that prioritise accountability upwards to donors, both of which are embodied in initiatives like the Global Fund. For multi-constituency organisations, this poses challenges not only for future financing but also for future legitimacy.

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Understanding Global Health Policy

Cited by 3 publications

References 43 publications

UNICEF’s contribution to the adoption and implementation of option B+ for preventing mother-to-child transmission of HIV: a policy analysis

UNICEF’s contribution to the adoption and implementation of option B+ for preventing mother-to-child transmission of HIV: a policy analysis

A Ghost in the Machine? Politics in Global Health Policy

A concept in flux: questioning accountability in the context of global health cooperation

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