Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
Department of Epidemiology and Global Health, Umeå University, Umeå 901 87, Sweden.
Health Policy Plan. 2024 Nov 18;39(Supplement_2):i19-i28. doi: 10.1093/heapol/czae042.
In Zambia, efforts to produce a tobacco control policy have stalled for over a decade, and the country is not yet close to developing one. Limited studies have explored the dynamics in this policy process and how they affect the attainment of policy goals and outcomes. This study explored how collaborative dynamics within tobacco control policy development shaped shared motivation among stakeholders in Zambia. The study used a qualitative case study design that adopted a collaborative governance lens, comprising an in-depth exploration of the tobacco control policy working group meetings and their internal collaborative dynamics. The integrative framework for collaborative governance, which identifies mutual trust, mutual understanding, internal legitimacy and shared commitment as key elements of shared motivation, was adapted for this study. Data were collected from 27 key informants and analysed using thematic analysis. Several collaborative dynamics thwarted mutual trust among tobacco control stakeholders, including concerns about associated loyalties, fear of a ban on tobacco production, silo-mentality and lack of comprehensive dialogue. All stakeholders agreed that the limited sharing of information on tobacco control and the lack of reliable local evidence on the tobacco burden hindered mutual understanding. Diverse factors hampered internal legitimacy, including sector representatives' lack of authority and the perceived lack of contextualization of the proposed policy content. Acknowledgement of the need for multisectoral action, lack of political will from other sectors and limited local allocation of funds to the process were some of the factors that shaped shared commitment. To accelerate the development of tobacco control policies in Zambia and elsewhere, policymakers must adopt strategies founded on shared motivation that deliberately create opportunities for open discourse and respectful interactions, promote a cultural shift towards collaborative information sharing and address unequal power relations to enable shaping of appropriate tobacco control actions in respective sectors.
在赞比亚，制定烟草控制政策的努力已经停滞了十多年，而该国还远未制定出这样的政策。有限的研究探讨了这一政策进程中的动态及其如何影响政策目标和结果的实现。本研究探讨了烟草控制政策制定过程中的协作动态如何影响赞比亚利益相关者之间的共同动机。该研究采用了定性案例研究设计，采用了协作治理视角，深入探讨了烟草控制政策工作组会议及其内部协作动态。适应于本研究的协作治理综合框架确定了相互信任、相互理解、内部合法性和共同承诺是共同动机的关键要素。数据来自 27 名关键信息提供者，使用主题分析进行分析。几种协作动态破坏了烟草控制利益相关者之间的相互信任，包括对相关忠诚度的担忧、对烟草生产禁令的恐惧、筒仓思维和缺乏全面对话。所有利益相关者都认为，关于烟草控制的信息共享有限，以及缺乏关于烟草负担的可靠本地证据，阻碍了相互理解。内部合法性受到多种因素的阻碍，包括部门代表缺乏权威，以及所提出的政策内容缺乏对背景的理解。承认需要多部门行动、其他部门缺乏政治意愿以及对该过程的本地资金有限分配，是形成共同承诺的一些因素。为了加速赞比亚和其他地方的烟草控制政策的制定，政策制定者必须采取基于共同动机的策略，刻意为公开对话和相互尊重的互动创造机会，促进向协作信息共享的文化转变，并解决权力不平等的问题，以便在各自部门中制定适当的烟草控制行动。
