Synergies and Fragmentation in Country Level Policy and Program Agenda Setting, Formulation and Implementation for Global Health Agendas: A Case Study of Health Security, Universal Health Coverage, and Health Promotion in Ghana and Sierra Leone
| Autor: | Irene Akua Agyepong, Wallace Odiko-Ollennu, Hannah Brown Amoakoh, Theresa Ethel Darkwa, Abigail Nyarko Codjoe Derkyi-Kwarteng, Fredline A. O. M’Cormack-Hale |
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| Rok vydání: | 2020 |
| Předmět: |
Low and middle income countries (LMIC)
medicine.medical_specialty Economic growth Health Promotion Population health Global Health Ghana Health informatics Sierra Leone Sierra leone Health administration 03 medical and health sciences 0302 clinical medicine Universal Health Insurance Fragmentation medicine Global health Humans 030212 general & internal medicine Global agendas Universal health coverage (UHC) Policy Making business.industry 030503 health policy & services Health Policy Public health Stakeholder Context Health security (HS) Health promotion (HP) Health promotion Synergies Agency Power Public aspects of medicine RA1-1270 0305 other medical science business Research Article |
| Zdroj: | BMC Health Services Research, Vol 21, Iss 1, Pp 1-15 (2021) BMC Health Services Research |
| Popis: | Background Global health agendas have in common the goal of contributing to population health outcome improvement. In theory therefore, whenever possible, country level policy and program agenda setting, formulation and implementation towards their attainment should be synergistic such that efforts towards one agenda promote efforts towards the other agendas. Observation suggests that this is not what happens in practice. Potential synergies are often unrealized and fragmentation is not uncommon. In this paper we present findings from an exploration of how and why synergies and fragmentation occur in country level policy and program agenda setting, formulation and implementation for the global health agendas of Universal Health Coverage (UHC), Health Security (HS) and Health Promotion (HP) in Ghana and Sierra Leone. Our study design was a two country case study. Data collection involved document reviews and Key Informant interviews with national and sub-national level decision makers in both countries between July and December 2019. Additionally, in Ghana a stakeholder workshop in December 2019 was used to validate the draft analysis and conclusions. Results National and global context, country health systems leadership and structure including resources were drivers of synergies and fragmentation. How global as well as country level actors mobilized power and exercised agency in policy and program agenda setting and implementation processes within country were also important drivers. Conclusions There is potential in both countries to pull towards synergies and push against fragmentation in agenda setting, formulation and implementation of global health agendas despite the resource and other structural constraints. It however requires political and bureaucratic prioritization of synergies, as well as skilled leadership. It also requires considerable mobilization of country level actor exercise of agency to counter sometimes daunting contextual, systems and structural constraints. |
| Databáze: | OpenAIRE |
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