Ideas matter: An analysis of the effects of framing on health system strengthening in Zimbabwe.

IF 3.2 2区 医学 Q1 HEALTH POLICY & SERVICES
Alison T Mhazo, Charles C Maponga
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引用次数: 0

Abstract

Background: Health system strengthening (HSS) has been a well-endorsed concept globally since the 2000s. However, few studies have utilized theory to examine its evolution at the country level and potential implications for policy. This study used framing theory to examine changes in the portrayal of HSS in Zimbabwe from the mid-2000s to the period post-2020.

Methods: We employed a framing analysis methodology encompassing documentary review and key informant interviews.

Results: Four main frames were identified, namely HSS as (i) a donor imperative, (ii) a pathway to resolve crisis, (iii) a strategy for achieving long-term stability and (iv) a foundational investment for a resilient health system. HSS as a remedy for a crisis frame has been the most influential, but the greater involvement of donors in crisis response may have entrenched the mis-framings of HSS as a donor imperative. Donors have shifted from outlining strategies to assigning responsibility for HSS, with framing for more governmental funding. The government's response to those framing shifts has been more symbolic rather than substantive, undermining health system performance. Recently, donors have started to reduce their funding to align with framing towards more governmental responsibility, resulting in health system shocks in critical areas such as human resources.

Conclusions: The vulnerability and emotional frames that attracted donor funding during peak crisis have lost potency over time. Shifts in framing require proactive action, as policy underreaction can lead to exacerbated problems, missed opportunities for improvement and a loss of public trust in government effectiveness and responsiveness. Nascent, overly futuristic framings such as "resilience" need to be interpreted with caution, as they may cloud the reality that HSS is simply sufficient investment in basic functions. HSS needs to be reframed as a routine, country-owned strategy aimed at improving health system performance rather than a crisis response shaped by donor interventions. Zimbabwe has a rich history of effectively framing events to design and implement pragmatic, domestic -led policies towards HSS, and such latent potential should be tapped into to steer progressive reforms.

Abstract Image

想法很重要:分析津巴布韦框架对加强卫生系统的影响。
背景:自2000年代以来,加强卫生系统(HSS)已成为全球广泛认可的概念。然而,很少有研究利用理论来审查其在国家一级的演变及其对政策的潜在影响。本研究使用框架理论研究了从2000年代中期到2020年后津巴布韦HSS描述的变化。方法:我们采用框架分析方法,包括文献回顾和关键线人访谈。结果:确定了四个主要框架,即HSS作为(i)捐助者的当务之急,(ii)解决危机的途径,(iii)实现长期稳定的战略,以及(iv)对具有复原力的卫生系统的基础投资。HSS作为危机框架的补救措施一直是最具影响力的,但捐助者更多地参与危机应对可能巩固了HSS作为捐助者必须采取的措施的错误框架。捐助者已经从概述战略转向分配HSS的责任,并制定了更多政府资助的框架。政府对这些框架转变的反应更多是象征性的,而不是实质性的,这削弱了卫生系统的绩效。最近,捐助者已开始减少供资,以配合政府承担更多责任的框架,导致卫生系统在人力资源等关键领域受到冲击。结论:在危机高峰时期吸引捐助资金的脆弱性和情感框架随着时间的推移失去了效力。框架的转变需要采取积极主动的行动,因为政策反应不足可能导致问题加剧,错失改善的机会,并使公众对政府的效率和反应能力失去信任。新兴的、过于未来主义的框架,如“弹性”,需要谨慎解读,因为它们可能会掩盖HSS只是对基本功能进行足够投资的现实。HSS需要重新定义为一项常规的、国家所有的战略,旨在改善卫生系统绩效,而不是由捐助者干预措施形成的危机应对。津巴布韦在设计和实施务实的、以国内为主导的HSS政策方面有着丰富的历史,应该利用这种潜在的潜力来引导渐进式改革。
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来源期刊
Health Research Policy and Systems
Health Research Policy and Systems HEALTH POLICY & SERVICES-
CiteScore
7.50
自引率
7.50%
发文量
124
审稿时长
27 weeks
期刊介绍: Health Research Policy and Systems is an Open Access, peer-reviewed, online journal that aims to provide a platform for the global research community to share their views, findings, insights and successes. Health Research Policy and Systems considers manuscripts that investigate the role of evidence-based health policy and health research systems in ensuring the efficient utilization and application of knowledge to improve health and health equity, especially in developing countries. Research is the foundation for improvements in public health. The problem is that people involved in different areas of research, together with managers and administrators in charge of research entities, do not communicate sufficiently with each other.
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