جستجوی مقالات مرتبط با کلیدواژه "policy analysis" در نشریات گروه "پزشکی"

 In 2018, Kenya’s Ministry of Health (MoH) gazetted the Health Benefits Package Advisory Panel (HBPAP) to develop a benefits package for its universal health coverage (UHC) programme. In this study, we examine the political process that led to the gazettement of the HBPAP.

We conducted a case study based on semi-structured interviews with 20 national-level participants and, reviews of documents such as organizational and media reports. We analyzed data from the interviews and documents thematically using the Braun and Clarke’s six step approach. We identified codes and themes deductively using Kingdon’s Multiple Streams Theory which postulates that the successful emergence of a policy follows coupling of three streams: the problem, policy, and politics streams.

 We found that the problem stream was characterized by fragmented and implicit healthcare priority-setting processes that led to unaffordable, unsustainable, and wasteful benefits packages. A potential policy solution for these problems was the creation of an independent expert panel that would use an explicit and evidence-based healthcare priority-setting process to develop an affordable and sustainable benefits package. The political stream was characterized by the re-election of the government and the appointment of a new Cabinet Secretary for Health. Coupling of the problem, policy, and political streams occurred during a policy window that was created by the political prioritization of UHC by the newly re-elected government. Policy entrepreneurs who included health economists, health financing experts, health policy analysts, and health systems experts leveraged this policy window to push for the establishment of an independent expert panel as a solution for the issues identified in the problem stream. They employed strategies such as forming networks, framing, marshalling evidence, and utilizing political connections.

Applying Kingdon’s theory in this study was valuable in explaining why the HBPAP policy idea was gazetted. It demonstrated the crucial role of policy entrepreneurs and the strategies they employed to couple the three streams during a favourable policy window. This study contributes to the body of literature on healthcare priority-setting processes with an unusual analysis focused on a key procedural policy for such processes.

The National Mental Health Services (N-MHSs) in Iran was integrated with Primary Health Care (PHC) in 1988. This study aimeds to analyze the policy of integrating N-MHSs in PHC, focusing on the analysis of the current situation, pathology, and the existing challenge.

This qualitative research was conducted in 2020 using a case study approach. This study used the policy triangle model to analyze the policy. The required data were collected via interviews, literature review, and document analysis. The interviews were conducted with 23 experts, stakeholders across the country who were selected through purposive sampling, and the data were analyzed using the content-analysis method.

The main goals of this policy were to raise mental health literacy among the people and eliminate its stigma in the society, while implementing the referral system for N-MHSs. Twenty weaknesses were extracted in eight areas, including negative views of mental health, weaknesses in human resource training, compensation for the service of psychologists, unfavorable working conditions of the workforce, inappropriate service delivery facilities, lack of meaningful communication between different levels of service delivery, poor inter-sectorial communication, and the challenging nature of mental health care. De-stigmatizing psychological disorders in the society and identifying hidden patients are some of the most significant achievements of this policy.

Despite the successful implementation and significant achievements in integrating N-MHSs in PHC, the results of the present study indicate that there are many challenges in this field that require serious planning and attention from relevant authorities.

The joint operational plan was introduced by Iran’s Ministry of Health and Medical Education in 2015 as a way to improve the quality and efficiency of healthcare services by promoting collaboration and coordination among medical sciences universities. The plan aimed to address issues related to overlapping responsibilities, duplication of efforts, and resource constraints among universities.

This study was conducted to analyze this policy intervention and explore its challenges and opportunities.

Using a qualitative policy analysis approach, this study collected data through documentary analysisandsemi-structured interviews with stakeholders at various health system levels. Research participants were selected using purposive and snowball sampling methods. The collected data were analyzed using the framework analysis approach, supported by the policy triangle framework and heuristic model.

The policy analysis results yielded 14 categories and 29 sub-categories grouped into four overarching themes: Content, context, process, and actors/stakeholders. The content theme included categories such as the plan’s goals, the linkage between the plan’s goals and upstream policy documents, and the consistency between the plan’s goals and the visions and missions of medical universities. The context theme included structural characteristics, economic and financial factors, and social and cultural situations. The process theme included the issue’s priority, service delivery, policy design and formulation, implementation approach, and assessment and evaluation. The actors/stakeholders theme included categories such as the owner and leader of the policy, political support, and ambiguity in assigning responsibilities.

While enforcing a joint operational plan in medical universities can boost performanceandfoster competition, itmay also hinder universities’ ability to pursue innovative interventionsandactivities outside the plan. Toaddress this issue, stakeholders from various health system levels should work together to modify the plan’s development and implementation process. Effective use of planning tools is crucial for ensuring that medical universities and the health system achieve their goals.

 In-service training is one of the requirements for developing health workforce skills and providing quality services to patients.

 This study aimed to determine the policy formulation of in-service training for the health workforce in Iran.

 In this qualitative policy analysis study, semi-structured interviews with key informant persons and document analysis were used to gather data. Interviews were conducted with 12 informed people about health system policies, experts, and managers of in-service training centers of medical universities and the Ministry of Health and Medical Education (MOHME) selected purposively. Targeted and snowball sampling was used to identify the participants. Data analysis was performed using the MAXQDA10 software, and framework analysis was run using the Kingdon model.

 Centralized planning, lack of access in rural and remote areas, and the inability to use the potential of universities in staff training were the most frequent problems in in-service training of the health workforce. Establishing the Board of Trustees for universities affected the opening of the opportunity window to policy-making, and political entrepreneurs in MOHME took advantage of it and developed policies for in-service training.

 The development of policies has created a suitable platform for medical universities to increase the number of training hours and develop the skills of the health workforce. It also seems that policymakers' attention can lead to improving processes and using new approaches in the continuous development of health professions.

The retention of physicians' policy is recommended by the World Health Organization (WHO) to achieve the goals of the health system and justice in access to health services. The aim of this study was policy analysis of retention of physicians in deprived areas and providing some recommendations for improvement of this plan.

This was a qualitative study regarding policy which used Walt and Gilson's triangle framework and Kingdon's multiple streams. Data were collected using a deep semi-structured interview with 30 participants and a review of upstream laws and regulations. After that, all the interviews were recorded, transcribed, and reviewed. Then, data were analyzed through MAXQDA/12 and content analysis.

The findings of this study were categorized according to the policy context, content, and process, and actors who played a significant role in designing and implementing this policy.

The policy of retaining physicians in rural areas requires the support of the majority of the country's political and health authorities, and providing infrastructure for health providers. This policy not only increases the quality of services, but also is effective in increasing the patients' access to healthcare services in deprived areas.

As part of a global policy response for addressing malnutrition, food system actions have been proposed. Within food system interventions, policies directed to supply chains have the potential to increase the availability and affordability of a healthy diet. This qualitative study aimed to identify opportunities to integrate nutrition as a priority into the food supply policy space in Mexico.

Data were collected through analysis of 19 policy documents and 20 semi-structured stakeholder interviews. As an analytical framework, we used policy space analysis and embedded the Advocacy Coalition Framework (ACF) and the steps of the food chain of the conceptual framework of food systems for diets and nutrition.

Policy issues relevant to nutrition were viewed differently in the economic and agricultural sectors versus the health sector. Overall, the main policy objective related to nutrition within the economic and agricultural sectors was to contribute to food security in terms of food quantity. Nutrition was an objective in itself only in the health sector, with a focus on food quality. Our policy space analysis reveals an opportunity to promote a new integrated vision with the recent creation of an intersectoral group working on the public agenda for a food system transformation. This newer integrative narrative on food systems presents an opportunity to shift the existing food security narrative from quantity towards considerations of diet quality.

The political context and public agenda are favorable to pursue a food system transformation to deliver sustainable healthy diets. Mexico can provide a case study for other low- and middle-income countries (LMICs) for putting nutrition at the center of food policy, despite the ongoing constraints on achieving this.

The development and implementation of health policy have become more overt in the era of Sustainable Development Goals, with expectations for greater inclusivity and comprehensiveness in addressing health holistically. Such challenges are more marked in low- and middle-income countries (LMICs), where policy contexts, actor interests and participation mechanisms are not always well-researched. In this analysis of a multisectoral policy, the Tobacco Control Program in India, our objective was to understand the processes involved in policy formulation and adoption, describing context, enablers, and key drivers, as well as highlight the challenges of policy.

We used a qualitative case study methodology, drawing on the health policy triangle, and a deliberative policy analysis approach. We conducted document review and in-depth interviews with diverse stakeholders (n = 17) and anlayzed the data thematically.

The policy context was framed by national law in India, the signing of a global treaty, and the adoption of a dedicated national program. Key actors included the national Ministry of Health and Family Welfare (MoHFW), State Health Departments, technical support organizations, research organizations, non-governmental bodies, citizenry and media, engaged in collaborative and, at times, overlapping roles. Lobbying groups, in particular the tobacco industry, were strong opponents with negative implications for policy adoption. The state-level implementation relied on creating an enabling politico-administrative framework and providing institutional structure and resources to take concrete action.

Key drivers in this collaborative governance process were institutional mechanisms for collaboration, multi-level and effective cross-sectoral leadership, as well as political prioritization and social mobilization. A stronger legal framework, continued engagement, and action to address policy incoherence issues can lead to better uptake of multisectoral policies. As the impetus for multisectoral policy grows, research needs to map, understand stakeholders’ incentives and interests to engage with policy, and inform systems design for joint action.

Squires et al note that too many people use terms like ‘context’ imprecisely. The result (to avoid) is a catch-all term that lacks explanatory value and hinders the efforts of policy designers. Their list of 66 factors is a useful exercise to unpack what people mean when describing context. However, some problems will arise when the authors seek to move from research to practice. First, the list is too long to serve its purpose. Second, in many cases, it categorises rather than operationalises key terms. The result is the replacement of one vague term with a collection of others. Third, many categories describe what policy designers might need, rather than what they can reasonably expect to happen. In that context, wider studies of implementation and complex systems provide cautionary tales in which the outcomes of research become overwhelming rather than practical.

Food systems affect nutritional and other health outcomes. Recent literature from India has described policy aspects addressing nutritional implications of specific foods (eg, fruits, vegetables, and trans-fats), and identified opportunities to tackle the double burden of malnutrition. This paper attempts to deepen the understanding on how health concerns and the role of the health sector are addressed across food systems policies in India.

This qualitative study used two approaches; namely (i) the framework method and (ii) manifest content analysis, to investigate national-level policy documents from relevant sectors (ie, food security, agriculture, biodiversity, food processing, trade, and waste management, besides health and nutrition). The documents were selected purposively. The textual data were coded and compared, from which themes were identified, described, and interpreted. Additionally, mentions of various health concerns and of the health ministry in the included documents were recorded and collated.

A total of 35 policy documents were included in the analysis. A variety of health concerns spanning nutritional, communicable and non-communicable diseases (NCDs) were mentioned. Undernutrition received specific attention even beyond nutrition policies. Only few policies mentioned NCDs, infectious diseases, and injuries. Governing and advisory bodies were instituted by 17 of the analysed policies (eg, food safety, agriculture, and food processing), and often included representation from the health ministry (9 of the 17 identified inter-ministerial bodies).

We found some evidence of concern for health, and inclusion of health ministry in food policy documents in India. The ongoing and planned intersectoral coordination to tackle undernutrition could inform actions to address other relevant but currently underappreciated concerns such as NCDs. Our study demonstrated a method for analysis of health consideration and intersectoral coordination in food policy documents, which could be applied to studies in other settings and policy domains.

The global food system is not delivering affordable, healthy, diverse diets, which are needed to address malnutrition in all its forms for sustainable development. This will require policy change across the economic sectors that govern food systems, including agriculture, trade, finance, commerce and industry – a goal that has been beset by political challenges. These sectors have been strongly influenced by entrenched policy agendas and paradigms supported by influential global actors such as the World Bank and International Monetary Fund (IMF). 

This study draws on the concept of path dependency to examine how historical economic policy agendas and paradigms have influenced current food and nutrition policy and politics in Ghana. Qualitative data were collected through interviews with 29 relevant policy actors, and documentary data were collected from current policies, academic and grey literature, historical budget statements and World Bank Group Archives (1950-present). 

Despite increased political priority for nutrition in Ghana, its integration into food policy remains limited. Food policy agendas are strongly focused on production, employment and economic returns, and existing market-based incentives do not support a nutrition-sensitive food supply. This policy focus appears to be rooted in a liberal economic approach to food policy arising from structural adjustment in the 1980s and trade liberalization in the 1990s, combined with historical experience of ‘failure’ of food policy intervention and an entrenched narrowly economic conception of food security. 

This study suggests that attention to policy paradigms, in addition to specific points of policy change, will be essential for improving the outcomes of food systems for nutrition. An historical perspective can provide food and health policy-makers with insights to foster the revisioning of food policy to address multiple national policy objectives, including nutrition.

Achieving healthy food systems will require regulation across the supply chain; however, binding international economic agreements may be constraining policy space for regulatory intervention in a way that limits uptake of ‘best-practice’ nutrition policy. A deeper understanding of the mechanisms through which this occurs, and under which conditions, can inform public health engagement with the economic policy sector. 

We conducted a realist review of nutrition, policy and legal literature to identify mechanisms through which international trade and investment agreements (TIAs) constrain policy space for priority food environment regulations to prevent non-communicable diseases (NCDs). Recommended regulations explored include fiscal policies, product bans, nutrition labelling, advertising restrictions, nutrient composition regulations, and procurement policies. The process involved 5 steps: initial conceptual framework development; search for relevant empirical literature; study selection and appraisal; data extraction; analysis and synthesis, and framework revision. 

Twenty-six studies and 30 institutional records of formal trade/investment disputes or specific trade concerns (STCs) raised were included. We identified 13 cases in which TIA constraints on nutrition policy space could be observed. Significant constraints on nutrition policy space were documented with respect to fiscal policies, product bans, and labelling policies in 4 middle-income country jurisdictions, via 3 different TIAs. In 7 cases, trade-related concerns were raised but policies were ultimately preserved. Two of the included cases were ongoing at the time of analysis.TIAs constrained policy space through 1) TIA rules and principles (non- discrimination, necessity, international standards, transparency, intellectual property rights, expropriation, and fair and equitable treatment), and 2) interaction with policy design (objectives framed, products/services affected, nutrient thresholds chosen, formats, and time given to comment or implement). Contextual factors of importance included: actors/institutions, and political/regulatory context. 

Available evidence suggests that there are potential TIA contributors to policy inertia on nutrition. Strategic policy design can avoid most substantive constraints. However, process constraints in the name of good regulatory practice (investor-state dispute settlement (ISDS), transparency, regulatory coherence, and harmonisation) pose a more serious threat of reducing government policy space to enact healthy food policies.

In 1985, the Iranian parliament approved the integration of Medical Education and Health Services and the establishment of the Ministry of Health and Medical Education, which has since been the policymaker of Health Higher Education in Iran. The policies are not based on a codified framework and many were abolished at some point. Some critical issues are not addressed and some activities overlap. The purpose of the present study was to identify the content themes of core policies in the Iranian Health Higher Education system and provide a detailed policy orientation taxonomy.

This qualitative study was conducted in 2019 using the thematic content analysis of documents relevant to Higher Education and Health Higher Education, including upstream documents, and documents and enactments of the Deputy Minister of Education and its policy centers.

From 586 policy documents, six main themes or six core policy orientations in the Health Higher Education System were identified, including Development of Medical Education System Policies; Ensuring the Alignment of Operations with Policies; Policies Related to Medical Education Development; Value‑orientation; Networking and Development of Medical Education System Interactions; and the Development of Research, Management, and Translation of Medical Education knowledge.

Developing a taxonomy of Health Higher Education policy orientations helps policymakers identify the neglected and overstressed areas. It can provide education policymakers with categorized and comprehensive information to quickly access accurate information, make informed decisions, avoid mistakes, and increase productivity.

There is a growing interest in implementing intersectoral approaches to address social determinants especially within the Sustainable Development Goals (SDGs) era. However, there is limited research that uses policy analysis approaches to understand the barriers to adoption and implementation of intersectoral approaches. In this paper we apply a policy analysis lens in examining implementation of the first thousand days (FTD) of childhood initiative in the Western Cape province of South Africa. This initiative aims to improve child outcomes through a holistic intersectoral approach, referred to as nurturing care.

The case of the FTD initiative was constructed through a triangulated analysis of document reviews (34), in depth interviews (22) and observations. The analysis drew on Hall’s ‘ideas, interests and institutions’ framework to understand the shift from political agendas to the implementation of the FTD.

In the Western Cape province, the FTD agenda setting process was catalysed by the increasing global evidence on the life-long impacts of brain development during the early childhood years. This created a window of opportunity for active lobbying by policy entrepreneurs and a favourable provincial context for a holistic focus on children. However, during implementation, the intersectoral goal of the FTD got lost, with limited bureaucratic support from service-delivery actors and minimal cross-sector involvement. Challenges facing the health sector, such as overburdened facilities, competing policies and the limited consideration of implementation realities (such as health providers’ capacity), were perceived by implementing actors as the key constraints to intersectoral action. As a result, FTD actors, whose decision-making power largely resided in health services, reformulated FTD as a traditional maternal-child health mandate. Ambiguity and contestation between key actors regarding FTD interventions contributed to this narrowing of focus.

This study highlights conditions that should be considered for the effective implementation of intersectoral action - including engaging cross-sector players in agenda setting processes and creating spaces that allow the consideration of actors’ interests especially those at service-delivery level. Networks that prioritise relationship building and trust can be valuable in allowing the emergence of common goals that further embrace collective interests.

  Health apps are a booming, yet under-regulated market, with potential consumer harms in privacy and health safety. Regulation of the health app market tends to be siloed, with no single sector holding comprehensive oversight. We sought to explore this phenomenon by critically analysing how the problem of health app regulation is being presented and addressed in the policy arena.

We conducted a critical, qualitative case study of regulation of the Australian mental health app market. We purposively sampled influential policies from government, industry and non-profit organisations that provided oversight of app development, distribution or selection for use. We used Bacchi’s critical, theoretical approach to policy analysis, analysing policy solutions in relation to the ways the underlying problem was presented and discussed. We analysed the ways that policies characterised key stakeholder groups and the rationale policy authors provided for various mechanisms of health app oversight.

We identified and analysed 29 policies from Australia and beyond, spanning 5 sectors: medical device, privacy, advertising, finance, and digital content. Policy authors predominantly framed the problem as potential loss of commercial reputations and profits, rather than consumer protection. Policy solutions assigned main responsibility for app oversight to the public, with a heavy onus on consumers to select safe and high-quality apps. Commercial actors, including powerful app distributors and commercial third parties were rarely subjects of policy initiatives, despite having considerable power to affect app user outcomes.

A stronger regulatory focus on app distributors and commercial partners may improve consumer privacy and safety. Policy-makers in different sectors should work together to develop an overarching regulatory framework for health apps, with a focus on consumer protection.