Department of Family Medicine, McGill University, Montreal, QC, Canada.
Department of Public Health, Health Policy Unit, Institute of Tropical Medicine, Antwerp, Belgium.
Int J Health Policy Manag. 2022 Sep 1;11(9):1703-1714. doi: 10.34172/ijhpm.2021.66. Epub 2021 Jul 14.
The development and implementation of health policy have become more overt in the era of Sustainable Development Goals, with expectations for greater inclusivity and comprehensiveness in addressing health holistically. Such challenges are more marked in low- and middle-income countries (LMICs), where policy contexts, actor interests and participation mechanisms are not always well-researched. In this analysis of a multisectoral policy, the Tobacco Control Program in India, our objective was to understand the processes involved in policy formulation and adoption, describing context, enablers, and key drivers, as well as highlight the challenges of policy.
We used a qualitative case study methodology, drawing on the health policy triangle, and a deliberative policy analysis approach. We conducted document review and in-depth interviews with diverse stakeholders (n = 17) and anlayzed the data thematically.
The policy context was framed by national law in India, the signing of a global treaty, and the adoption of a dedicated national program. Key actors included the national Ministry of Health and Family Welfare (MoHFW), State Health Departments, technical support organizations, research organizations, non-governmental bodies, citizenry and media, engaged in collaborative and, at times, overlapping roles. Lobbying groups, in particular the tobacco industry, were strong opponents with negative implications for policy adoption. The state-level implementation relied on creating an enabling politico-administrative framework and providing institutional structure and resources to take concrete action.
Key drivers in this collaborative governance process were institutional mechanisms for collaboration, multi-level and effective cross-sectoral leadership, as well as political prioritization and social mobilization. A stronger legal framework, continued engagement, and action to address policy incoherence issues can lead to better uptake of multisectoral policies. As the impetus for multisectoral policy grows, research needs to map, understand stakeholders' incentives and interests to engage with policy, and inform systems design for joint action.
在可持续发展目标时代，卫生政策的制定和实施变得更加公开化，人们期望以更具包容性和全面性的方式综合解决卫生问题。在中低收入国家（LMICs），这些挑战更为明显，因为政策背景、利益相关者的利益和参与机制并不总是经过充分研究。在对印度多部门政策（即《烟草控制计划》）的这项分析中，我们的目标是了解政策制定和采用所涉及的过程，描述背景、促成因素和主要驱动因素，并强调政策面临的挑战。
我们使用了定性案例研究方法，借鉴了卫生政策三角和审议性政策分析方法。我们进行了文件审查，并对来自不同利益相关者的 17 名受访者进行了深入访谈，并对数据进行了主题分析。
政策背景受到印度国家法律、全球条约的签署以及专门国家计划的通过的影响。主要利益相关者包括国家卫生部和家庭福利部（MoHFW）、州卫生部门、技术支持组织、研究组织、非政府组织、公民和媒体，他们共同合作，有时还会重叠角色。游说团体，特别是烟草业，是强大的反对者，对政策采用产生了负面影响。在州一级，实施依赖于创建一个有利的政治行政框架，并提供体制结构和资源来采取具体行动。
在这种协作治理过程中，主要的驱动因素是协作的体制机制、多层次和有效的跨部门领导，以及政治优先事项和社会动员。一个更强有力的法律框架、持续的参与以及解决政策不一致性问题的行动可以导致更好地采用多部门政策。随着多部门政策的推动，研究需要映射、理解利益相关者的动机和利益，以参与政策，并为联合行动提供系统设计。
