Bennett Sara, Dalglish Sarah L, Juma Pamela A, Rodríguez Daniela C
Health Systems Program,
Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA and.
Health Policy Plan. 2015 Dec;30 Suppl 2:ii26-ii35. doi: 10.1093/heapol/czv071.
Policy transfer theories explain how policy ideas move across time and geography and offer an approach to understanding waves of policy change, a common phenomenon in global health. Four primary mechanisms for the transfer of policies from global to national levels are posited: learning, coercion, socialization and competition.
We used six concurrent country case studies of policy change for child survival followed by a global study to analyse (1) mechanisms for policy transfer and (2) the roles of international organizations in promoting policy transfer. Our six country cases drew upon early adopters of integrated Community Case Management of Childhood Illness policy (Malawi, Niger), as well as countries that were slower to adopt due either to practical implementation challenges (Mozambique, Mali) and/or policy resistance (Burkina Faso, Kenya). In total, 145 semi-structured interviews and 283 document reviews were conducted across the six country cases, and 25 semi-structured interviews and 72 document reviews for the global study.
Three of the four diffusion mechanisms (learning, coercion and socialization) were important in these cases, but not competition. Multiple strategies were employed by multilateral organizations to support policy transfer, such as regional meetings or academic publications, frequently serving multiple diffusion mechanisms simultaneously (e.g. both learning and socialization). In just one country case, funding conditionalities were used to press for policy change. The emphasis of policy transfer mechanisms varied between early and later adopters. Early adopters, for example, were more likely to engage in learning. International multilateral organizations were active policy transfer agents, and national policy-makers perception of them as "trusted partners" made them well suited for this role. However, on occasion their role became more that of advocates than neutral facilitators.
International actors use multiple synergistic channels to promote uptake of global health policies in low- and middle-income countries, and tailor strategies employed to country contexts.
政策转移理论解释了政策理念如何跨越时间和地域传播，并提供了一种理解政策变革浪潮的方法，这是全球卫生领域的常见现象。提出了政策从全球层面转移到国家层面的四种主要机制：学习、强制、社会化和竞争。
我们对六个国家同时进行了儿童生存政策变革的案例研究，随后进行了一项全球研究，以分析（1）政策转移机制，以及（2）国际组织在促进政策转移中的作用。我们的六个国家案例选取了儿童疾病综合社区病例管理政策的早期采用者（马拉维、尼日尔），以及因实际实施挑战（莫桑比克、马里）和/或政策抵制（布基纳法索、肯尼亚）而采用较慢的国家。在六个国家案例中总共进行了145次半结构化访谈和283次文件审查，在全球研究中进行了25次半结构化访谈和72次文件审查。
四种传播机制中的三种（学习、强制和社会化）在这些案例中很重要，但竞争机制不重要。多边组织采用了多种策略来支持政策转移，如区域会议或学术出版物，这些策略经常同时服务于多种传播机制（如学习和社会化）。仅在一个国家案例中，资金条件被用来推动政策变革。政策转移机制的重点在早期采用者和后期采用者之间有所不同。例如，早期采用者更有可能参与学习。国际多边组织是积极的政策转移推动者，国家政策制定者将它们视为“可信赖的伙伴”，这使它们非常适合这一角色。然而，有时它们的角色更多地是倡导者而非中立的促进者。
国际行为体利用多种协同渠道来促进低收入和中等收入国家采用全球卫生政策，并根据国家情况调整所采用的策略。
