Exploring Politics and Contestation in the Policy Process: The Case of Zambia's Contested Community Health Strategy.

Autor: Zulu JM; Department of Health Promotion and Education, School of Public Health, The University of Zambia, Lusaka, Zambia.; Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia., Chavula MP; Department of Health Promotion and Education, School of Public Health, The University of Zambia, Lusaka, Zambia.; Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia., Silumbwe A; Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia., Munakampe MN; Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia., Mulubwa C; Department of Health Promotion and Education, School of Public Health, The University of Zambia, Lusaka, Zambia.; Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia., Zulu W; The Ministry of Health, Lusaka, Zambia.; Department of Epidemiology and Biostatistics, School of Public Health, The University of Zambia, Lusaka, Zambia., Michelo C; Department of Epidemiology and Biostatistics, School of Public Health, The University of Zambia, Lusaka, Zambia., Schneider H; School of Public Health, University of the Western Cape, Cape Town, South Africa.; South African Medical Research Council Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa., Lehmann U; School of Public Health, University of the Western Cape, Cape Town, South Africa.; South African Medical Research Council Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa.
Jazyk: angličtina
Zdroj: International journal of health policy and management [Int J Health Policy Manag] 2022 Jan 01; Vol. 11 (1), pp. 24-30. Date of Electronic Publication: 2022 Jan 01.
DOI: 10.34172/ijhpm.2021.145
Abstrakt: There have been increased calls for low- and middle-income countries to develop community health systems (CHS) policies or strategies. However, emerging global guidance brackets the inherent complexity and contestation of policy development at the country level. This is explored through the case of Zambia's 5-year Community Health Strategy (CH Strategy), formulated in 2017 and then summarily withdrawn and reissued two years later, with largely similar content. This paper examines the events, actors, and contexts behind this abrupt change in the Strategy, through an analysis of documentary sources and interviews with 21 stakeholders involved in the policy process. We describe an environment of contestation, characterised by numerous international partners weighing in on the CH Strategy, interfacing with shifting loci of responsibility for the CHS in the Ministry of Health (MoH). Despite the rhetoric of participation, providers and communities played no part in the policy process. These dynamics created the conditions for the abrupt change in strategy, illustrating the inherently fraught and political nature of policy development on the CHS in many countries. Going forward, we conclude that paying attention to processes of CHS policy development, and in particular the interaction between events, actors, and contexts, is as important as ensuring meaningful policy content.
(© 2022 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)
Databáze: MEDLINE
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