Department of Community Medicine, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.
School of Sociology and Social Policy, University of Leeds, Leeds, United Kingdom.
Health Res Policy Syst. 2021 Mar 1;19(1):26. doi: 10.1186/s12961-020-00660-3.
The unacceptably high rate of maternal and child mortality in Nigeria prompted the government to introduce a free maternal and child health (MCH) programme, which was stopped abruptly following a change in government. This triggered increased advocacy for sustaining MCH as a political priority in the country and led to the formation of advocacy coalitions. This study set out to explain the process involved in the formation of advocacy coalition groups and how they work to bring about sustained political prioritization for MCH in Nigeria. It will contribute to the understanding of the Nigerian MCH sector subsystem and will be beneficial to health policy advocates and public health researchers in Nigeria.
This study employed a qualitative case study approach. Data were collected using a pretested interview guide to conduct 22 in-depth interviews, while advocacy events were reviewed pro forma. The document review was analysed using the manual content analysis method, while qualitative data audiotapes were transcribed verbatim, anonymized, double-coded in MS Word using colour-coded highlights and analysed using manual thematic and framework analysis guided by the advocacy coalition framework (ACF). The ACF was used to identify the policy subsystem including the actors, their belief, coordination and resources, as well as the effects of advocacy groups on policy change. Ethics and consent approval were obtained for the study.
The policy subsystem identified the actors and characterized the coalitions, and described their group formation processes and resources/strategies for engagement. The perceived deep core belief driving the MCH agenda is the right of an individual to health. The effects of advocacy groups on policy change were identified, along with the factors that enabled effectiveness, as well as constraints to coalition formation. External factors and triggers of coalition formation were identified to include high maternal mortality and withdrawal of the free MCH programme, while the contextual issues were the health system issues and the socioeconomic factors affecting the country.
Our findings add to an increasing body of evidence that the use of ACF is beneficial in exploring how advocacy coalitions are formed and in identifying the effects of advocacy groups on policy change.
尼日利亚母婴死亡率居高不下，政府因此推出了免费母婴健康（MCH）计划，但该计划在政府更迭后突然停止。这引发了人们对将 MCH 作为国家政治优先事项持续推进的强烈呼吁，并促成了倡导联盟的形成。本研究旨在解释倡导联盟团体形成的过程，以及它们如何努力使 MCH 在尼日利亚得到持续的政治重视。这将有助于理解尼日利亚的母婴健康部门子系统，并将有益于尼日利亚的卫生政策倡导者和公共卫生研究人员。
本研究采用定性案例研究方法。使用经过预测试的访谈指南收集数据，进行了 22 次深入访谈，同时对倡导活动进行了形式审查。使用手动内容分析方法分析文件审查，将定性数据录音带逐字转录、匿名化，在 MS Word 中使用彩色突出显示进行双重编码，并使用倡导联盟框架（ACF）指导的手动主题和框架分析进行分析。ACF 用于识别政策子系统，包括行为者、他们的信仰、协调和资源，以及倡导团体对政策变化的影响。本研究获得了伦理和同意批准。
确定了政策子系统中的行为者并描述了联盟，描述了他们的团体形成过程和参与的资源/策略。推动 MCH 议程的深层核心信念是个人享有健康的权利。确定了倡导团体对政策变化的影响，以及使联盟形成有效的因素以及对联盟形成的限制。确定了外部因素和联盟形成的触发因素，包括高孕产妇死亡率和免费 MCH 计划的撤销，而背景问题是影响该国的卫生系统问题和社会经济因素。
我们的研究结果增加了越来越多的证据，即使用 ACF 有助于探索倡导联盟是如何形成的，以及倡导团体对政策变化的影响。
