Champagne Sarah N, Koon Adam D, Ulitin Allan R, Valverde Haidee A, Ashraf Lamisa, Zarsuelo Ma-Ann M, Hoe Connie, Lam Hilton Y, Bachani Abdulgafoor M
Johns Hopkins International Injury Research Unit, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Global Health, School of Health, Georgetown University, Washington, DC, USA.
Int J Health Policy Manag. 2025;14:8585. doi: 10.34172/ijhpm.8585. Epub 2025 Jul 21.
Child restraint systems (CRS) can lead to a 60% reduction in child deaths, yet few low- and middle-income countries (LMICs) have comprehensive policies to enforce best practice standards. In 2019, the Philippines established such a policy: the Child Safety in Motor Vehicles (CSMV) Act.
Drawing on framing theory, this study aims to understand the social dimensions of policy change to identify the Act's origins, design, and implementation. Three sources of data - 25 articles, 27 key-informant interviews, and field notes - were collected and thematically analysed.
We present the findings according to two features of the framing process: storytelling and naming. The policy process can be sharply distinguished into two sections: the Act's passage into law (which was swift and successful) and its implementation (which to date has not been). The Act's implementation was stymied by three overarching frames - that it is "anti-poor," "unnecessary," and a "strategic political distraction." A media backlash at the time of implementation solidified these frames, leading President Duterte to indefinitely defer enforcement of the Act.
The CSMV Act emphasises that passing a law is insufficient. The trajectory of the act highlights the combined importance of (a) the framing of policy, (b) framing processes operate throughout a policy's lifecycle, and (c) the media in creating a narrative. Our findings offer valuable insights for other LMICs implementing evidence-based road safety measures, suggesting that successful implementation requires not only strong legislation but also strategic communication and frame management throughout the policy process. Understanding framing dynamics can help policy-makers anticipate and address potential resistance to life-saving public health interventions.
儿童约束系统可使儿童死亡人数减少60%，然而很少有低收入和中等收入国家（LMICs）制定全面政策来执行最佳实践标准。2019年，菲律宾制定了这样一项政策：《机动车儿童安全（CSMV）法案》。
本研究运用框架理论，旨在了解政策变化的社会层面，以确定该法案的起源、设计和实施情况。收集了三类数据来源——25篇文章、27次关键 informant 访谈和实地记录，并进行了主题分析。
我们根据框架构建过程的两个特征——讲故事和命名来呈现研究结果。政策过程可明显分为两个阶段：该法案成为法律的过程（迅速且成功）及其实施过程（迄今为止尚未实施）。该法案的实施受到三个总体框架的阻碍——即它是“反贫困的”、“不必要的”以及“战略性政治干扰”。实施时的媒体强烈反对强化了这些框架，导致杜特尔特总统无限期推迟该法案的执行。
《CSMV法案》强调通过一项法律是不够的。该法案的发展轨迹凸显了以下几点的综合重要性：（a）政策的框架构建，（b）框架构建过程贯穿政策的整个生命周期，以及（c）媒体在构建叙事方面的作用。我们的研究结果为其他实施基于证据的道路安全措施的低收入和中等收入国家提供了宝贵的见解，表明成功实施不仅需要强有力的立法，还需要在整个政策过程中进行战略沟通和框架管理。理解框架动态可以帮助政策制定者预测并应对对挽救生命的公共卫生干预措施的潜在阻力。
