通过分析印度社区卫生工作者如何推动政策变革来扩展金登的多源流政策框架
Extending Kingdon's Multiple Streams Policy Framework Through an Analysis of How Community Health Workers in India Are Driving Policy Changes.
作者信息
Santosh Sanjana, Kane Sumit
机构信息
Centre for Health Policy and Systems, Gokhale Institute of Politics and Economics, Pune, India.
Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
出版信息
Community Health Equity Res Policy. 2025 Apr;45(3):245-260. doi: 10.1177/2752535X231222654. Epub 2023 Dec 17.
In this paper we develop and provide a novel account of the process through which the Accredited Social Health Activists (ASHAs), a cadre of seemingly powerless community health workers in India, are navigating a complex policy process to incrementally achieve their goals. ASHAs have been demanding better working conditions, better compensation, and regularisation as public service employees through protests and strikes and have managed to gain concessions from both the Central and various State governments. We observed two important aspects that emerged: (a) ASHAs achieved incremental increases in their wages despite being the lowest in the health system hierarchy, and, (b) major gains were made during the 2 years of the pandemic. We examine and analyse ASHAs' engagement and strategies used, both overt and covert, sometimes with the government, and the role of other actors in determining these policy outcomes. We do so by drawing on academic literature and news media reports; we trace the changes in ASHAs' wages by tying together key events, 'windows of opportunity', and actions of 'policy entrepreneurs' involved in the process.In doing so, we further develop and propose an extension to Kingdon's multiple streams policy framework through the addition of a 'narrative stream'.
在本文中,我们阐述并提供了一种全新的描述,关于印度一批看似无权的社区卫生工作者——经认证的社会健康活动家(ASHAs)——如何在复杂的政策进程中逐步实现其目标。ASHAs通过抗议和罢工,一直要求改善工作条件、提高薪酬,并作为公共服务雇员实现正规化,且已成功从中央政府和各邦政府那里获得了让步。我们观察到出现了两个重要方面:(a)尽管ASHAs处于卫生系统层级的最底层,但他们的工资还是逐步得到了提高;(b)在疫情的两年期间取得了重大成果。我们研究并分析了ASHAs所采用的公开和隐蔽的参与方式及策略,这些方式有时涉及与政府的互动,以及其他行为体在决定这些政策结果中所起的作用。我们通过借鉴学术文献和新闻媒体报道来做到这一点;我们通过将关键事件、“机会之窗”以及参与该进程的“政策企业家”的行动联系起来,追踪ASHAs工资的变化。在此过程中,我们通过增加一个“叙事流”,进一步发展并提出了对金登多元流政策框架的扩展。
相似文献
Community Health Equity Res Policy. 2025-4
本文引用的文献
Clin Epidemiol Glob Health. 2022
Health Res Policy Syst. 2021-10-12
Indian J Psychiatry. 2021
Int J Health Policy Manag. 2021-8-1