Power and the Policy Machine: The Development of Child Survival Policy at the Global Level and in Niger

health policy;political economy;West Africa;international affairs;Social & Behavioral Interventions

Dalglish, Sarah LorraineLawrence, Robert ;

Johns Hopkins University

关键词: health policy;    political economy;    West Africa;    international affairs;    Social & Behavioral Interventions;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/60554/DALGLISH-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Despite reductions in worldwide child mortality rates, 6.3 million children still die each year, the vast majority of them in low- and middle-income countries (LMICs), often from easily preventable and treatable diseases.This dissertation explores how a child survival strategy called integrated community case management of childhood illness (iCCM) was developed at the global level and adopted and implemented in Niger, drawing upon qualitative methods (in-depth interviews, document analysis), quantitative methods (citation network analysis), and contextual analysis of historical, political, economic and social trends.The results show that the development of effective policies depends on far more that synthesizing relevant research evidence – particularly when ;;evidence” is narrowly defined as the scientific literature.Policy processes at both the global and national (Nigerien) levels were determined by (geo-) political factors, power structures, distributions of resources and economic and financial incentives, which influenced policy decisions of individuals and groups of actors.At the global level (Chapter 4), an ;;epistemic community” of mid- to upper-level technical officers in global health norm-setting bodies, implementing agencies, funders and academic groups used sophisticated scientific analyses to develop and promote iCCM; however, their narrow technical focus created blind spots, for example about service delivery implications in countries with weak health systems.In Niger, political economy factors and internal power relationships were crucial determinants of key policy decisions underlying iCCM, such as the President’s creation of the policy’s underlying health infrastructure (the ;;health huts”) as a way to distribute rents to client networks (Chapter 5).In terms of the use of evidence in the development of iCCM in Niger (Chapter 6), technical expertise was concentrated among actors from multi-lateral and bilateral agencies who packaged and delivered scientific arguments supportive of iCCM to Nigerien policymakers, whose input was limited mainly to operational decisions.This dissertation sheds light on determinants of policy-making processes that have been less frequently examined in the scholarly literature, notably how contextual factors shape policy content and determine whether policies are adopted and implemented at the country level.These issues merit further research, for while policy development processes remain as yet largely opaque, their consequences are far-reaching.