Parashar Rakesh, Gawde Nilesh, Gupt Anadi, Gilson Lucy
School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai , India and Health Systems, Oxford Policy Management Limited, India.
School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India.
Health Policy Plan. 2020 Nov 1;35(Supplement_2):ii74-ii83. doi: 10.1093/heapol/czaa125.
Exploring the implementation blackbox from a perspective that considers embedded practices of power is critical to understand the policy process. However, the literature is scarce on this subject. To address the paucity of explicit analyses of everyday politics and power in health policy implementation, this article presents the experience of implementing a flagship health policy in India. Janani Shishu Suraksha Karyakram (JSSK), launched in the year 2011, has not been able to fully deliver its promises of providing free maternal and child health services in public hospitals. To examine how power practices, influence implementation, we undertook a qualitative analysis of JSSK implementation in one state of India. We drew on an actor-oriented perspective of development and used 'actor interface analysis' to guide the study design and analysis. Data collection included in-depth interviews of implementing actors and JSSK service recipients, document review and observations of actor interactions. A framework analysis method was used for analysing data, and the framework used was founded on the constructs of actor lifeworlds, which help understand the often neglected and lived realities of policy actors. The findings illustrate that implementation was both strengthened and constrained by practices of power at various interface encounters. The implementation decisions and actions were influenced by power struggles such as domination, control, resistance, contestation, facilitation and collaboration. Such practices were rooted in: Social and organizational power relationships like organizational hierarchies and social positions; personal concerns or characteristics like interests, attitudes and previous experiences and the worldviews of actors constructed by social and ideological paradigms like their values and beliefs. Application of 'actor interface analysis' and further nuancing of the concept of 'actor lifeworlds' to understand the origin of practices of power can be useful for understanding the influence of everyday power and politics on the policy process.
从考虑权力的内在实践的角度探索实施黑箱对于理解政策过程至关重要。然而，关于这个主题的文献很少。为了解决健康政策实施中日常政治和权力的明确分析匮乏的问题，本文介绍了在印度实施一项旗舰健康政策的经验。2011年推出的“母婴安全保障计划”（Janani Shishu Suraksha Karyakram，JSSK）未能完全兑现其在公立医院提供免费母婴健康服务的承诺。为了研究权力实践如何影响实施，我们对印度一个邦的JSSK实施情况进行了定性分析。我们采用了以行为体为导向的发展视角，并使用“行为体界面分析”来指导研究设计和分析。数据收集包括对实施行为体和JSSK服务接受者的深入访谈、文件审查以及对行为体互动的观察。采用框架分析方法进行数据分析，所使用的框架基于行为体生活世界的构建，这有助于理解政策行为体常常被忽视的生活现实。研究结果表明，在各种界面遭遇中，实施既受到权力实践的强化，也受到其制约。实施决策和行动受到诸如支配、控制、抵抗、竞争、促进和协作等权力斗争的影响。这些实践根源于：社会和组织权力关系，如组织层级和社会地位；个人关切或特征，如利益、态度和以往经历；以及由社会和意识形态范式构建的行为体世界观，如他们的价值观和信仰。应用“行为体界面分析”以及进一步细化“行为体生活世界”的概念以理解权力实践的起源，对于理解日常权力和政治对政策过程的影响可能是有用的。
