Nancy Gerein

Health policy processes in maternal health: A comparison of Vietnam, India and China

This article reports on a comparative analysis to assess and explain the strengths and weaknesses of policy processes based on 9 case-studies of maternal health in Vietnam, India and China. Policy processes are often slow, inadequately coordinated and opaque to outsiders. Use of evidence is variable and, in particular, could be more actively used to assess different policy options. Whilst an increasing range of actors are involved, there is scope for further opening up of the policy processes. This is likely, if appropriately managed with due regard to issues such as accountability of advocacy organisations, to lead to stronger policy development and greater subsequent ownership; it may however be a more messy process to co-ordinate. Coordination is critical where policy issues span conventional sectoral boundaries, but is also essential to ensure development of policy considers critical health system and resource issues. This, and other features related to the nature of a specific policy issue, suggests the need both to adapt processes for each particular policy issue and to monitor the progress of the policy processes themselves. The article concludes with specific questions to be considered by actors keen to enhance policy processes.

HIV/AIDS and TB: contextual issues and policy choice in programme relationships

Tuberculosis (TB) and HIV/AIDS affect each other closely. Given the rapid spread of the HIV‐driven TB epidemic worldwide, the case for establishing some form of relationship between control activities for HIV/AIDS and TB is clear. However, the question ‘how’ has not been resolved satisfactorily. TB and HIV/AIDS programmes have traditionally maintained their own management, supervision, funding flows and specialist boundaries. This article explores opportunities and challenges for collaboration between the two, through drawing on the expertise in organization and management, policy analysis and disease control of both TB and HIV/AIDS. Based on an extensive literature review, the article investigates how contextual issues affect the design of a collaboration; what the organizational options are; and what impact a collaboration would have. A universal model for organizational change is unlikely and changes may present as both solutions and contradictions. Careful planning and consultation are required before implementing the changes, in order to avoid jeopardizing the function and effectiveness of both disease control programmes and the health service system.

Exclusion, inequity and health system development: the critical emphases for maternal, neonatal and child health

The World health report 2005 provides a powerful analysis of the global scandal of mothers’ and children’s ill-health (1). Every year over half a million women die from pregnancy-related causes and over 10 million children die under five years of age. These deaths are largely preventable. The report correctly identifies the causes as lying primarily in failures within health systems to provide appropriate frameworks and resources to deliver the technical interventions and in broader social and cultural factors. Evidence on technical interventions is well covered. Midwifery-led care at the first level of services with accessible back-up in hospitals is essential for reducing maternal and neonatal mortality. The report is crystal clear on this acknowledging past failures of training traditional birth attendants and problems of over-medicalization of childbirth. Universal access both financial and geographical to care by skilled attendants is emphasized although a description of the requirements of referral systems to ensure timely access to obstetric care would have been helpful. Issues too often ignored are included: violence discrimination and marginalization during pregnancy sex selection and the need for evidence to develop policy on postpartum care. (excerpt)

Health policy processes in Vietnam: A comparison of three maternal health case studies

OBJECTIVES To describe and analyse the policy processes related to maternal health in Vietnam. METHODS A multi-method, retrospective comparative study of three case studies of maternal health policy processes-skilled birth attendance, adolescent reproductive health and domestic violence. It drew on primary qualitative data and secondary data. The underpinning conceptual framework of the study with key elements of policy processes is described. RESULTS The study identified significant differences between the policy processes related to the different case studies. Various factors affect these processes. Critical amongst these are the nature of the policy, the involvement of different actors and the wider context both nationally and internationally. The changing national context is opening up increasing opportunities for civil society to interact with policy processes. CONCLUSIONS Understanding the nature of policy processes is critical to strengthen them, particularly in a changing environment. There is potential for a review of government policy processes which were developed in the period prior to Doi Moi to reflect the changing composition of civil society.

Public-Private Partnership for TB Control in Bangladesh: Role of Private Medical Practitioners in the Management of TB patients

Background: Despite enormous efforts, Bangladesh has one of the highest burdens of tuberculosis (TB) in the world. Treatment in the private sector is common and popular among TB patients in South Asian countries, including Bangladesh, even though the quality of diagnosis and treatment of TB patients has been shown to be poor in several such countries. The Bangladesh National Tuberculosis Programme (NTP) has recently shown considerable interest in exploring policy options to address this problem. Consequently, the NTP and non-governmental organization (NGO) partners planned to develop a public-private partnership (PPP) model for effective involvement of private medical practitioners (PMPs) in TB control. However, there was a lack of solid data on TB case management practice by PMPs, which was needed to appraise the potential role and contribution of PMPs in TB control. The purpose of the study is therefore to assess the knowledge, attitudes, and practices of PMPs on TB control in an urban setting in Bangladesh in order to inform development of a public-private collaboration model.