The influence of crisis on policy formulation: the case of alcohol regulation in South Africa during COVID-19 (2020-21).

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Mumta Hargovan, Leslie London, Marsha Orgill
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引用次数: 0

Abstract

This study contributes to a neglected aspect of health policy analysis: policy formulation processes. Context is central to the policy cycle, yet the influence of crises on policy formulation is underrepresented in the health policy literature in low- and middle-income countries (LMICs). This paper analyses a detailed case study of how the COVID-19 crisis influenced policy formulation processes for the regulation of alcohol in South Africa, as part of COVID-19 control measures, in 2020 and 2021. It provides a picture of the policy context, specifically considering the extent to which the crisis influenced the position and power of actors, and policy content. Qualitative data were collected from nine key informant interviews and 127 documents. Data were analysed using thematic content analysis. A policy formulation conceptual framework was applied as a lens to describe complex policy formulation processes. The study revealed that the perceived urgency of the pandemic prompted a heightened sense of awareness of alcohol-related trauma as a known, preventable threat to public health system capacity. This enabled a high degree of innovation among decision-makers in the generation of alternative alcohol policy content. Within the context of uncertainty, epistemic and experiential policy learning drove rapid, adaptive cycles of policy formulation, demonstrating the importance of historical and emerging public health evidence in crisis-driven decision-making. Within the context of centralization and limited opportunities for stakeholder participation, non-state actors mobilized to influence policy through the public arena. The paper concludes that crisis-driven policy formulation processes are shaped by abrupt redistributions of power among policy actors and the dynamic interplay of evolving economic, political and public health priorities. Understanding the complexity of the local policy context may allow actors to navigate opportunities for public health-oriented alcohol policy reforms in South Africa and other LMICs.

危机对政策制定的影响:COVID-19 期间(2020-2021 年)南非酒精管制的案例。
本研究对卫生政策分析中被忽视的一个方面--政策制定过程--有所贡献。环境是政策周期的核心,然而危机对政策制定的影响在中低收入国家(LMIC)的卫生政策文献中却没有得到充分的体现。本文分析了 COVID-19 危机如何影响南非 2020 年和 2021 年酒精监管政策制定过程的详细案例研究,作为 COVID-19 控制措施的一部分。本文介绍了政策背景,特别考虑了危机对参与者的地位和权力以及政策内容的影响程度。定性数据收集自 9 次关键信息提供者访谈和 127 份文件。数据采用专题内容分析法进行分析。研究采用 Berlan 等人(2014 年)的框架作为透镜来描述复杂的政策制定过程。研究结果表明,大流行病的紧迫性促使人们进一步认识到与酒精相关的创伤是对公共卫生系统能力的一种已知的、可预防的威胁。这使得决策者在制定替代性酒精政策内容时能够高度创新。在不确定的背景下,认识论和经验政策学习推动了快速、适应性的政策制定周期,证明了历史和新出现的公共卫生证据在危机驱动决策中的重要性。在中央集权和利益相关者参与机会有限的背景下,非国家行为者动员起来,通过公共领域影响政策。本文的结论是,危机驱动的政策制定过程是由政策参与者之间突然的权力再分配以及不断变化的经济、政治和公共卫生优先事项的动态相互作用所决定的。了解当地政策背景的复杂性,可以使政策参与者把握机会,在南非和其他低收入和中等收入国家进行以公共卫生为导向的酒精政策改革。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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