Louisiana Lush

Family planning policies and programmes in eight low-income countries: A comparative policy analysis

The extent to which family planning programmes are successful at reducing fertility remains a major debate among population scholars. A comparative policy analysis of four pairs of low-income countries (Bangladesh/Pakistan, Thailand/Philippines, Tunisia/Algeria and Zimbabwe/Zambia) was carried out to understand why some countries develop appropriate and effective programmes, while other countries do not. The study found that the formation of coalitions among policy elites, spread of policy risk, and institutional and financial stability were factors which supported or inhibited the adoption of strong population policies and family planning programmes.

The emerging international policy agenda for reproductive health services in conflict settings.

Over the past 20 years, shifts in the nature of conflict and the sheer numbers of civilians affected have given rise to increasing concern about providing appropriate health services in unstable settings. Concurrently, international health policy attention has focused on sexual and reproductive health issues and finding effective methods of addressing them. This article reviews the background to the promotion and development of reproductive health services for conflict-affected populations. It employs qualitative methods to analyse the development of policy at international level. First we examine the extent to which reproductive health is on the policy agendas of organisations active in humanitarian contexts. We then discuss why and how this has come about, and whether the issue has sufficient support to ensure effective implementation. Our findings demonstrate that reproductive health is clearly on the agenda for agencies working in these settings, as measured by a range of established criteria including the amount of new resources being attracted to this area and the number of meetings and publications devoted to this issue. There are, however, barriers to the full and effective implementation of reproductive health services. These barriers include the hesitation of some field-workers to prioritise reproductive health and the number and diversity of the organisations involved in implementation. The reasons for these barriers are discussed in order to highlight areas for action before effective reproductive health service provision to these populations can be ensured.

The role of MCH and family planning services in HIV/STD control: is integration the answer?

During the mid 1990s, high HIV and sexually transmitted disease (STD) prevalence led to calls for the integration of effective services with maternal and child health and family planning (MCH/FP) programs. There are advantages and disadvantages to integration, but little evidence existed to assess the practicalities of implementing this policy. Analysis of policy development for integration was conducted in Ghana, Kenya, South Africa, and Zambia. Semi-structured interviews were conducted with policy-makers at national, provincial and district levels and a survey of facilities was undertaken to identify gaps between policy intent and implementation. Significant advances had been made at the national level to formulate policies to integrate reproductive health and primary health care. However, barriers to implementation included entrenched HIV/STD and MCH/FP vertical programs; diverse demands on district managers and providers, such as on-going institutional reform; and conflicting objectives of international donors. Policy-makers need to address conflicting objectives between the needs for vertical accountability and the reality of providing integrated services. More careful consideration of implementation is required at earlier stages of policy design. Increased consultation with those who are to implement and provide integrated services is recommended.

Planning reproductive health in conflict: a conceptual framework

A conceptual framework for planning reproductive health services for refugees is presented for use by those involved in planning field activities. Secondary sources of data are recommended to describe pre-existing patterns and trends in reproductive health status and likely determinants of any change in status, for populations which have been subsequently affected by conflict. The interaction between these patterns and the conflict itself is then analyzed, taking into account the shift in health status and service availability as the conflict progresses through various recognized phases. The potential impact of conflict is thus hypothesized in order to make initial plans for incorporating reproductive health services into standard relief packages. Two case studies are presented: Rwanda demonstrates the use of the framework in a relatively short but dramatic conflict, for which there was also substantial prior evidence on reproductive health status; Cambodia is used, in contrast, to demonstrate the use of the framework in a much more complex conflict which has been occurring over the last 20 years.

Health systems and the implementation of disease programmes: Case studies from South Africa.

Abstract This paper analyses the transfer and implementation of two internationally formulated infectious disease strategies in South Africa, namely, directly observed therapy (DOTS) for TB and syndromic management (SM) for sexually transmitted infections (STIs). Using the tools of policy analysis, this paper seeks to draw conclusions from contrasting experiences with the two strategies. DOTS and SM differ with respect to styles of engagement by World Health Organization (WHO), the international agency promoting the ideas, in the following ways: continuity and networking between policy makers, practitioners and researchers nationally; and approaches to sub-national implementation. We show how these factors may have been important to national uptake, and conclude on the need for a context sensitive approach to policy transfer and a balance between bottom-up and top-down implementation strategies. These insights may have relevance for the current global wave of treatment programmes for HIV and other infectious diseases.

Politics and fertility: a new approach to population policy analysis

This paper aims to explain why divergentpopulation policies and programs arise in otherwisesimilar countries and to clarify how such policiesrelate to fertility decline. An analysis wasundertaken of demographic and policy change over a 30year period in four pairs of developing countries: Algeria and Tunisia; Bangladesh and Pakistan; thePhilippines and Thailand; and Zambia and Zimbabwe. Insome countries, popular demand for family planningfacilitated changing policy. In others, independentfactors, such as economic crisis or internationalpressure, pushed policy makers into action onpopulation policy, often in the absence of populardemand. In these countries, governments whichidentified a coherent rationale, usually economic, forreducing population growth, tended to develop moresuccessful policies. Strong and financially securecoalitions of policy elites were important in sharingthe political risk associated with such policies. Analysis of these processes has lessons for policymakers and researchers interested in expeditingimplementation of new approaches to population andreproductive health.