TY - JOUR
T1 - Generation of political priority for global health initiatives
T2 - a framework and case study of maternal mortality
AU - Shiffman, Jeremy
AU - Smith, Stephanie
N1 - Funding Information:
Whether the maternal health MDG, efforts by advocates to take advantage of the MDG, and continual efforts by global safe motherhood advocates have had substantial effect on political support and resources is uncertain. A weak global governance structure for health (including absence of leadership on the issue of safe motherhood within the UN system) has hampered the capacity of the initiative to create and take advantage of opportunities. On the positive side, the UK Department for International Development (DFID), influenced by the MDGs, has increased maternal and newborn health funding from GB£0·9 million in 2001–02 to £16·2 million in 2005–06. 48 Other donors also increased funding for maternal survival during this time. 48 Furthermore, the MDG commitment stood behind several substantial global calls for action, including a declaration in 2005 in New Delhi, India, from UN agency heads and many developing country governments calling for global progress on maternal, newborn, and child health. 49 Additionally, the leaders of the countries that rank number one and two in terms of numbers of maternal death, India's Prime Minister Manmohan Singh and Nigeria's former President Olusegun Obasanjo, commented publicly on the maternal health MDG. They expressed concern about their countries' high levels of maternal death, and demanded that their governments act to address the issue. 35–36
Funding Information:
We thank the MacArthur Foundation for funding this study; the Center for Global Development for providing a visiting fellow position during which research was undertaken and results written up; the many individuals who agreed to be interviewed for this research, who were generous and candid with their insights, information, and time, and without whose openness this study would not have been possible; and Ben Elberger for his thoughtful comments on drafts, and his research support for this work. The views presented represent those of the authors alone, who take responsibility for all errors.
PY - 2007/10/13
Y1 - 2007/10/13
N2 - Why do some global health initiatives receive priority from international and national political leaders whereas others receive little attention? To analyse this question we propose a framework consisting of four categories: the strength of the actors involved in the initiative, the power of the ideas they use to portray the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself. We apply this framework to the case of a global initiative to reduce maternal mortality, which was launched in 1987. We undertook archival research and interviewed people connected with the initiative, using a process-tracing method that is commonly employed in qualitative research. We report that despite two decades of effort the initiative remains in an early phase of development, hampered by difficulties in all these categories. However, the initiative's 20th year, 2007, presents opportunities to build political momentum. To generate political priority, advocates will need to address several challenges, including the creation of effective institutions to guide the initiative and the development of a public positioning of the issue to convince political leaders to act. We use the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, which is a subject that has attracted much speculation but little scholarship.
AB - Why do some global health initiatives receive priority from international and national political leaders whereas others receive little attention? To analyse this question we propose a framework consisting of four categories: the strength of the actors involved in the initiative, the power of the ideas they use to portray the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself. We apply this framework to the case of a global initiative to reduce maternal mortality, which was launched in 1987. We undertook archival research and interviewed people connected with the initiative, using a process-tracing method that is commonly employed in qualitative research. We report that despite two decades of effort the initiative remains in an early phase of development, hampered by difficulties in all these categories. However, the initiative's 20th year, 2007, presents opportunities to build political momentum. To generate political priority, advocates will need to address several challenges, including the creation of effective institutions to guide the initiative and the development of a public positioning of the issue to convince political leaders to act. We use the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, which is a subject that has attracted much speculation but little scholarship.
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U2 - 10.1016/S0140-6736(07)61579-7
DO - 10.1016/S0140-6736(07)61579-7
M3 - Comment/debate
C2 - 17933652
AN - SCOPUS:35148831175
SN - 0140-6736
VL - 370
SP - 1370
EP - 1379
JO - Lancet
JF - Lancet
IS - 9595
ER -