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Majiwa H, Bukachi SA, Omia D, Fèvre EM. Knowledge, perceptions, and practices around zoonotic diseases among actors in the livestock trade in the Lake Victoria crescent ecosystem in East Africa. Front Public Health 2024; 11:1199664. [PMID: 38264255 PMCID: PMC10805025 DOI: 10.3389/fpubh.2023.1199664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024] Open
Abstract
Background Zoonotic diseases such as anthrax, rabies, brucellosis, and Rift Valley fever pose a direct threat to health and undercut livelihoods in the communities in which they occur. A combination of anthropogenic and animal activities like migration and interaction with wildlife and their respective parasites and vectors drives the emergence and re-emergence of zoonotic diseases. Consequently, One Health interdisciplinary approaches that incorporate social scientists can provide key insights into complex local perceptions. The approach calls for collaboration between the human and animal health sectors, including the sharing of disease surveillance data necessary to alleviate disease impacts. Livestock traders interact closely with livestock, which puts them at elevated risk of infection and creates conditions by which they may spread zoonotic disease. It is thus essential to examine practices among actors involved in the livestock trade to understand the most appropriate ways to mitigate these risks. Methods A qualitative study was conducted among the actors in the livestock trade in Busia County on their knowledge and perceptions of zoonotic diseases and practices that may contribute to the spread, control, and prevention of zoonotic disease transmission. A thematic analysis framework was used to categorize and synthesize data from in-depth interviews (IDIs), key informant interviews (KIIs), and structured observations. Results Whereas participants could list livestock diseases, they could not identify which ones were zoonoses, demonstrating insufficient knowledge of zoonosis. They identify sick animals by checking for dropped ears, excess mucus production, diarrhea, bloody urinal discharge, and general animal activity levels. To prevent the spread of these diseases, they wash their animals, isolate sick animals from the rest of the stock, and vaccinate their animals. They seek help from animal health professionals for sick animals as part of curative practices. This shows that they perceive the diseases as serious and that they need to be attended to by professionals. The results also show that they perceive animals from outside the region to be more vulnerable to diseases compared to those from within. The actors in the livestock trade engage in practices like skinning dead animals before burying them; to them, this is a normal practice. Some also consume dead carcasses. These increase the risk of zoonotic disease transmission. Conclusion The actors involved in the livestock trade are critical in the prevention and elimination of zoonotic diseases; hence, they need to be involved when developing intervention programs and policies for animal health extension services. Training them as a continuum of animal health workers blends lay and professional knowledge, which, alongside their intense contact with large numbers of animals, becomes a critical disease surveillance tool. Increasing awareness of zoonoses by using multi-disciplinary teams with social scientists is urgently needed so that practices like skinning dead animals before disposing of them and consumption of dead carcasses can be minimized.
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Affiliation(s)
- Hamilton Majiwa
- Institute of Anthropology Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Salome A. Bukachi
- Institute of Anthropology Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Dalmas Omia
- Institute of Anthropology Gender and African Studies, University of Nairobi, Nairobi, Kenya
| | - Eric M. Fèvre
- International Livestock Research Institute, Nairobi, Kenya
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
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Saric J, Aerts A, Anne M, Barboza J, Boch J, Dashdorj N, McGhie DV, Santana A, Shellaby JT, Rollemberg SMS, Silveira M, Steinmann P, Cobos D. Assessing the contributions of an urban population health initiative to shift political priority towards cardiovascular health: three case studies from Brazil, Mongolia and Senegal. BMC Health Serv Res 2024; 24:16. [PMID: 38178108 PMCID: PMC10768224 DOI: 10.1186/s12913-023-10432-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The urban population health initiative was designed as a multidisciplinary, multisector programme to address cardiovascular (CV) disease, specifically hypertension and its underlying causes in the cities of Ulaanbaatar, Mongolia; Dakar, Senegal; and São Paulo, Brazil. This article aims to provide an overview of the history and dynamics of CV disease policy making in the three countries, to present the policy reform contributions of the initiative and its role in the policy agenda-setting framework/process in each country and to identify the enablers and challenges to the initiative for doing so. METHODS A qualitative case study was conducted for each setting from November 2020 to January 2021, comprised of a document review, semi-structured in-depth interviews and unstructured interviews with stakeholders involved in the initiative. The literature review included documents from the initiative and the peer-reviewed and grey literature with a total of 188 documents screened. Interviews were conducted with 21 stakeholders. Data collection and thematic analysis was guided by (i) the Kingdon multiple streams conceptual framework with the main themes being CV disease problems, policy, politics and the role of policy entrepreneurs; and (ii) the study question inquiring on the role of the urban population health initiative at the CV disease policy level and enabling and challenging factors to advancing CV disease policy. Data were thematically analysed using the Framework Method. RESULTS Each setting was characterized by a high hypertension and CV disease burden combined with an aware and proactive political environment. Policy outcomes attributed to the initiative were updating the guidelines and/or algorithms of care for hypertension and including revised physical and nutritional education in school curricula, in each city. Overall, the urban health initiative's effects in the policy arena, were most prominent in Mongolia and Senegal, where the team effectively acted as policy entrepreneur, promoting the solutions/policies in alignment with the most pressing local problems and in strong involvement with the political actors. The initiative was also involved in improving access to CV disease drugs at primary health levels. Its success was influenced by the local governance structures, the proximity of the initiative to the policy makers and the local needs. In Brazil, needs were expressed predominantly in the clinical practice. CONCLUSIONS This multi-country experience shows that, although the policy and political environment plays its role in shaping initiatives, often the local priority needs are the driving force behind wider change.
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Affiliation(s)
- Jasmina Saric
- Swiss Tropical and Public Health Institute, 4123, Allschwil, Switzerland.
- University of Basel, 4003, Basel, Switzerland.
| | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - Malick Anne
- Division de la Lutte contre les Maladies non transmissible Ministère de la Santé et de l'Action Sociale, Dakar, Sénégal
| | | | | | | | | | | | | | | | | | - Peter Steinmann
- Swiss Tropical and Public Health Institute, 4123, Allschwil, Switzerland
- University of Basel, 4003, Basel, Switzerland
| | - Daniel Cobos
- Swiss Tropical and Public Health Institute, 4123, Allschwil, Switzerland
- University of Basel, 4003, Basel, Switzerland
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Essis EML, Yaméogo WME, Sossa OG, Doukouré D, Compaoré R, Kpebo DOD, Agbré-Yacé ML, Aka J, Tiembré I, Sondo B, Kouanda S. Development of Monitoring and Evaluation Systems in Four National Programs Addressing Mother and Child Health in Cote d'Ivoire: Qualitative Analysis of the Emergence and Formulation Process. Risk Manag Healthc Policy 2023; 16:699-709. [PMID: 37073282 PMCID: PMC10106087 DOI: 10.2147/rmhp.s377617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 03/24/2023] [Indexed: 04/20/2023] Open
Abstract
Background Monitoring and evaluation were introduced into the management of national health programs to ensure that results were attained, and that donors' funds were used transparently. This study aims to describe the process of the emergence and formulation of monitoring and evaluation (M&E) systems in national programs addressing maternal and child health in Cote d'Ivoire. Methods We conducted a multilevel case study combining a qualitative investigation and a literature review. This study took place in the city of Abidjan, where in-depth interviews were conducted with twenty-four (24) former officials who served at the central level of the health system and with six (06) employees from the technical and financial partners' agencies. A total of 31 interviews were conducted from January 10 to April 20, 2020. Data analysis was conducted according to the Kingdon conceptual framework modified by Lemieux and adapted by Ridde. Results The introduction of M&E in national health programs was due to the will of the technical and financial partners and the political and technical decision-makers at the central level of the national health system, who were concerned with accountability and convincing results in these programs. However, its formulation through a top-down approach was sketchy and lacked content to guide its implementation and future evaluation in the absence of national expertise in M&E. Conclusion The emergence of M&E systems in national health programs was originally endogenous and exogenous but strongly recommended by donors. Its formulation in the context of limited national expertise was marked by the absence of standards and guidelines that could codify the development of robust M&E systems.
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Affiliation(s)
- Esme Marie Laure Essis
- National Institute of Public Health, Abidjan, Cote d’Ivoire
- Reproductive Health Research Unit of Cote d’Ivoire, Abidjan, Cote d'Ivoire
- Doctoral School in Science, Health, and Technology, Saint Thomas Aquinas University, Ouagadougou, Burkina Faso
- Correspondence: Esme Marie Laure Essis, National Institute of Public Health, Abidjan, BP V 47, Cote d’Ivoire, Tel +225 07 07 88 72 13, Fax +225 20 22 44 02, Email
| | | | - Olivier Gbènamblo Sossa
- Department of Economics and Management, Thomas Sankara University, Ouagadougou, Burkina Faso
| | - Daouda Doukouré
- National Institute of Public Health, Abidjan, Cote d’Ivoire
- Reproductive Health Research Unit of Cote d’Ivoire, Abidjan, Cote d'Ivoire
| | - Rachidatou Compaoré
- African Institute of Public Health, Saint Thomas Aquinas University, Saaba, Burkina Faso
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Djoukou Olga Denise Kpebo
- National Institute of Public Health, Abidjan, Cote d’Ivoire
- Reproductive Health Research Unit of Cote d’Ivoire, Abidjan, Cote d'Ivoire
- Department of Public Health, Felix Houphouët Boigny University, Abidjan, Cote d’Ivoire
| | - Marie Laurette Agbré-Yacé
- National Institute of Public Health, Abidjan, Cote d’Ivoire
- Reproductive Health Research Unit of Cote d’Ivoire, Abidjan, Cote d'Ivoire
| | - Joseph Aka
- National Institute of Public Health, Abidjan, Cote d’Ivoire
- Department of Public Health, Felix Houphouët Boigny University, Abidjan, Cote d’Ivoire
| | - Issiaka Tiembré
- Department of Public Health, Felix Houphouët Boigny University, Abidjan, Cote d’Ivoire
- National Institute of Public Hygiene, Abidjan, Cote d’Ivoire
| | - Blaise Sondo
- African Institute of Public Health, Saint Thomas Aquinas University, Saaba, Burkina Faso
| | - Seni Kouanda
- African Institute of Public Health, Saint Thomas Aquinas University, Saaba, Burkina Faso
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso
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Trowbridge J, Tan JY, Hussain S, Osman AEB, Di Ruggiero E. Examining Intersectoral Action as an Approach to Implementing Multistakeholder Collaborations to Achieve the Sustainable Development Goals. Int J Public Health 2022; 67:1604351. [PMID: 35652124 PMCID: PMC9149775 DOI: 10.3389/ijph.2022.1604351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: The Sustainable Development Goals (SDGs) re-orient action towards improving the social and ecological determinants of health and equity. SDG 17 calls for enhanced policy and institutional coherence and strong multi-stakeholder partnerships. Intersectoral action (IA) has a promising history in public health, including health promotion and global health. Some experts see IA as crucial to the SDGs. Yet less is known about how IA is conceptualized and what promising models exist with relevance to the SDGs. We sought to investigate how IA is understood conceptually and empirically. Methods: We conducted a narrative review of global public health and political science literatures and grey literature on the SDGs to identify theoretical models, case studies and reviews of IA research. Results: Multiple competing conceptualizations of IA exist. Research has focused on case studies in high-income countries. More conceptual clarity, analyses of applications in LMICs, and explorations of political and institutional factors affecting IA are needed, as is attention to power dynamics between sectors. Conclusion: IA is required to collaborate on the SDGs and address equity. New models for successful implementation merit exploration.
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Affiliation(s)
- Joslyn Trowbridge
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Julia Y. Tan
- Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Sameera Hussain
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ahmed Esawi Babiker Osman
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- *Correspondence: Erica Di Ruggiero,
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Cairney P, St Denny E, Mitchell H. The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies. OPEN RESEARCH EUROPE 2021; 1:23. [PMID: 37645203 PMCID: PMC10445916 DOI: 10.12688/openreseurope.13178.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 08/31/2023]
Abstract
Background: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways. Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.
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Affiliation(s)
- Paul Cairney
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
| | - Emily St Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - Heather Mitchell
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
- Faculty of Health Sciences, University of Stirling, Stirling, FK94LA, UK
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6
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Cairney P, St Denny E, Mitchell H. The future of public health policymaking after COVID-19: a qualitative systematic review of lessons from Health in All Policies. OPEN RESEARCH EUROPE 2021; 1:23. [PMID: 37645203 PMCID: PMC10445916 DOI: 10.12688/openreseurope.13178.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 08/31/2023]
Abstract
Background: 'Health in All Policies' (HiAP) describes the pursuit of health equity. It has five main elements: treat health as a human right; identify evidence of the 'social determinants' of health inequalities, recognise that most powers to affect health are not held by health departments, promote intersectoral policymaking and collaboration inside and outside of government, and generate political will. Studies describe its potential but bemoan a major implementation gap. Some HiAP scholars learn from policymaking research how to understand this gap, but the use of policy theories is patchy. In that context, our guiding research question is: How does HiAP research use policy theory to understand policymaking? It allows us to zoom-out to survey the field and zoom-in to identify: the assumed and actual causes of policy change, and transferable lessons to HiAP scholars and advocates. Methods: Our qualitative systematic review (two phases, 2018 and 2020) identified 4972 HiAP articles. Of these, 113 journal articles (research and commentary) provide a non-trivial reference to policymaking (at least one reference to a policymaking concept). We use the 113 articles to produce a general HiAP narrative and explore how the relatively theory-informed articles enhance it. Results: Most articles focus on policy analysis (identifying policy problems and solutions) rather than policy theory (explaining policymaking dynamics). They report a disappointing gap between HiAP expectations and policy outcomes. Theory-informed articles contribute to a HiAP playbook to close that gap or a programme theory to design and evaluate HiAP in new ways. Conclusions: Few HiAP articles use policy theories for their intended purpose. Policy theories provide lessons to aid critical reflection on power, political dilemmas, and policymaking context. HiAP scholars seek more instrumental lessons, potentially at the cost of effective advocacy and research.
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Affiliation(s)
- Paul Cairney
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
| | - Emily St Denny
- Department of Political Science, University of Copenhagen, Copenhagen, DK-1353, Denmark
| | - Heather Mitchell
- History, Heritage, and Politics, University of Stirling, Stirling, FK94LA, UK
- Faculty of Health Sciences, University of Stirling, Stirling, FK94LA, UK
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7
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Ssennyonjo A, Van Belle S, Titeca K, Criel B, Ssengooba F. Multisectoral action for health in low-income and middle-income settings: how can insights from social science theories inform intragovernmental coordination efforts? BMJ Glob Health 2021; 6:bmjgh-2020-004064. [PMID: 34039586 PMCID: PMC8160194 DOI: 10.1136/bmjgh-2020-004064] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022] Open
Abstract
There is consensus in global health on the need for multisectoral action (MSA) to address many contemporary development challenges, but there is limited action. Examples of issues that require coordinated MSA include the determinants of health conditions such as nutrition (malnutrition and obesity) and chronic non-communicable diseases. Nutrition, tobacco control and such public health issues are regulated separately by health, trade and treasury ministries. Those issues need to be coordinated around the same ends to avoid conflicting policies. Despite the need for MSA, why do we see little progress? We investigate the obstacles to and opportunities for MSA by providing a government perspective. This paper draws on four theoretical perspectives, namely (1) the political economy perspective, (2) principal–agent theory, (3) resource dependence theory and (4) transaction cost economics theory. The theoretical framework provides complementary propositions to understand, anticipate and prepare for the emergence and structuring of coordination arrangements between government organisations at the same or different hierarchical levels. The research on MSA for health in low/middle-income countries needs to be interested in a multitheory approach that considers several theoretical perspectives and the contextual factors underlying coordination practices.
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Affiliation(s)
- Aloysius Ssennyonjo
- School of Public Health, Department of Health Policy Planning and Management, Makerere University College of Health Sciences, Kampala, Uganda .,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Institute of Development Policy, University of Antwerp, Antwerp, Belgium
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristof Titeca
- Institute of Development Policy, University of Antwerp, Antwerp, Belgium
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Freddie Ssengooba
- School of Public Health, Department of Health Policy Planning and Management, Makerere University College of Health Sciences, Kampala, Uganda
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Shahabi S, Mojgani P, Shabaninejad H, Teymourlouy AA, Behzadifar M, Lankarani KB. Physical rehabilitation financing in Iran: a policy analysis using Kingdon's multiple streams. BMC Health Serv Res 2021; 21:413. [PMID: 33941180 PMCID: PMC8094566 DOI: 10.1186/s12913-021-06447-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/27/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Adequate financing is a crucial function, securing that physical rehabilitation services (i.e., physiotherapy, occupational therapy, prosthetics and orthotics) are available with no financial hardship. Like many other countries, despite the adoption of various policies and strategies in recent decades, Iran enjoys no desirable physical rehabilitation financing (PRF). Accordingly, this qualitative study aimed to explore the PRF-related strategies and issues as well as their impacts on relevant policies in Iran. METHODS An analysis of PRF-related policies was conducted in Iran using semi-structured interviews and policy documents review. Purposive and snowball sampling techniques were employed to select key informants, including health-policy makers, civil society, rehabilitation-policy makers, university professors, and practitioners. Thematic analysis was used to analyze the collected data. The analysis was framed within Kingdon's multiple streams. RESULTS The hindering factors for desirable financing were weak insurance coverage, lack of sustainable financial resources, fragmented financing, lack of split between provider and financer, high-cost of physical rehabilitation services, low engagement of relevant experts in policy-making processes, and corrupt activities. In the policy stream, the following factors were highlighted: involvement of sustainable financial resources, the use of external revenue sources, allocated resources' earmarking, the integration of the current funds to have better pooling, the use of incentive and timely payment mechanisms, the implementation of strategic purchasing principals, and the employment of effective rationing strategies. Moreover, parliament support, changes in administrations, international effects, pressures from interest campaigns and NGOs, and international sanctions were found as factors affecting the politics stream. CONCLUSION The study findings revealed that a variety of national and international factors affect PRF-related issues in Iran. The recently enacted laws indicate that the PRF policies have already been on the national health political agenda. The study reflected the multifaceted nature of barriers to optimal PRF in Iran.
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Affiliation(s)
- Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran
| | | | - Ahmad Ahmadi Teymourlouy
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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9
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Health Sector Reform Following COVID-19 Outbreak: Using Kingdon’s Multiple Streams. SHIRAZ E-MEDICAL JOURNAL 2020. [DOI: 10.5812/semj.106674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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10
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Behzadifar M, Gorji HA, Rezapour A, Bragazzi NL. The hepatitis C infection in Iran: a policy analysis of agenda-setting using Kingdon's multiple streams framework. Health Res Policy Syst 2019; 17:30. [PMID: 30917837 PMCID: PMC6438031 DOI: 10.1186/s12961-019-0436-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/10/2019] [Indexed: 01/08/2023] Open
Abstract
Background Hepatitis C virus (HCV) infection causes a large number of deaths annually worldwide. Policies play an important role in regulating healthcare agendas and prioritising of health-related issues. Understanding these priorities is very important in health. The objective of this study was to investigate HCV-related issues and their influence on agenda-setting in Iran. Methods A qualitative design was used. Data were collected by carrying out a review of documents and interviews. A comprehensive search was conducted to identify documents related to HCV-related policies in Iran. Semi-structured interviews were conducted with both purposive and snowball sampling of 14 interviewees related to the HCV programme in Iran, including government officials, civil society, development partnership members and academicians. Documents and interview data were analysed manually and using MAXQDA Version 10 software. Kingdon’s multiple streams framework was used to guide data analysis. Results The factors which influenced HCV-related agenda-setting were lack of proper information of the HCV epidemiology before the 1990s, lack of diagnostic facilities, neighbouring countries with high HCV prevalence, the stigma of HCV, high prevalence in prisoners, international evidence and high costs generated by HCV. The factors related to policy were effective treatment methods, drug production inside Iran, Iran Hepatitis Network, support outside government group elites and academicians. The factors related to political will were international influence, changes in the government and parliament support. Conclusion The findings of this study showed that there are various national and international factors that play a role in shaping HCV-related policies. It seems that, if HCV is put into the agenda, it can be eliminated in Iran by 2030 by supporting and implementing appropriate programmes from decision- and policy-makers.
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Affiliation(s)
- Masoud Behzadifar
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Abolghasem Gorji
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
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