University of New Mexico, Social Sciences Bldg 3008 - MSC05-3100, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
French National Center for Scientific Research (CNRS), France.
Soc Sci Med. 2019 Apr;226:135-142. doi: 10.1016/j.socscimed.2019.02.049. Epub 2019 Mar 2.
High-level political support for the United Nations Millennium Development Goals (MDGs) drew international attention to included causes at the turn of the century. Influences of this normative framework on national-level health agenda setting remain little investigated. This study investigates the agenda status of maternal survival against the backdrop of the MDGs in two countries in sub-Saharan Africa. Informed by replicative case studies conducted in Ghana and Tanzania, the study finds the MDGs played a significant role in the issue's increasing status in both countries by helping to align several factors that facilitate the agenda setting process, including: ideas concerning the severity of the problem and expectations for its redress; institutions that shape policies, programs and monitoring; and economic and political interests. The agenda setting process was similar in the countries but for two dynamics. HIV/AIDS dominated Tanzania's health policy agenda in the early 2000s, crowding out attention to maternal and other health issues. A network of concerned actors that expanded to form a broad political coalition later facilitated agenda setting in Tanzania, including securing some budgetary commitments. By contrast, Ghana's core maternal health network remained technically oriented and closed to broader political and civil society engagement, limiting its capacity to expand issue attention and budgetary commitments beyond the health sector.
高层政治支持联合国千年发展目标（MDGs）在世纪之交引起了国际社会对所包含事业的关注。这一规范框架对国家一级卫生议程设定的影响仍鲜有研究。本研究在两个撒哈拉以南非洲国家的背景下调查了孕产妇生存问题在千年发展目标中的议程地位。本研究通过复制性案例研究加纳和坦桑尼亚进行，发现千年发展目标通过帮助协调促进议程设定过程的几个因素，在这两个国家使该问题的地位不断提高方面发挥了重要作用，这些因素包括：对问题严重性的认识以及对问题解决的期望；影响政策、方案和监测的机构；以及经济和政治利益。这两个国家的议程设定过程相似，但有两个动态不同。艾滋病毒/艾滋病在 21 世纪初主导了坦桑尼亚的卫生政策议程，使人们对孕产妇和其他健康问题的关注减少。一个关注的行为者网络扩大形成了一个广泛的政治联盟，后来在坦桑尼亚促进了议程设定，包括确保一些预算承诺。相比之下，加纳的核心孕产妇健康网络仍然以技术为导向，对更广泛的政治和民间社会参与持封闭态度，限制了其扩大问题关注和预算承诺的能力，使其无法超越卫生部门。
