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Is there life beyond Kingdon? A plea for an innovative health policy agenda

By Sara Van Belle
on June 9, 2017

In this short piece, I’ll try to critically self-reflect on my own practice as lecturer health policy analysis at the Institute of Tropical Medicine. (No worries, I’m a social scientist: we do self-reflection and meta-analysis for a living 🙂 )

For some time now, something in the back of my mind has been nagging me: the feeling that it cannot be sufficient to teach health policy analysis of the UK and US in the 70s, 80s & 90s to students from LMIC, in the year 2017, without a certain (wry?) sense of irony; maybe the same sense of irony that you are displaying when wearing orange 70s bell-bottoms now. True, Lipsky (the one from the “street level bureaucrats”), Kingdon (“window of opportunity”) and Lindblom (“muddling through”) are, what you call, universal theories on implementation, agenda-setting and decision-making. As they are (pretty much) universal, they can be successfully applied anywhere and have thus also been applied to LMIC, with good results in many cases. However, since Gill Walt’s seminal work, Health Policy -An introduction to process and power (1994), there has been (virtually) no successful conceptual translation of good political science theories into health policy. Yes, governance was introduced, and neo-institutionalism also made a few inroads (e.g. political economy, the work of Elinor Ostrom), but that’s about it.

In global health policy research, political science concepts are more widely used, mainly through International Relations scholars who are increasingly interested in global health governance. In environmental studies, political science seems to have found easier inroads as well, see for example the journals Global Environmental Change and Global Environmental Politics. But at national level? Where are the political scientists in national (multi-level) health policy development? In this world of half- (and often half-baked) truths (see Nichols’ book “The death of expertise” (2017)), increasing complexity and acceleration, some recent concepts, methods and tools could actually serve health policy development well, as they explicitly try to manage uncertainty. National LMIC health policies are hardly insulated from the uncertainty and unpredictability we witness in other sectors and  all over the world. This is what causes most of the nagging in the back of mind – many of the theories and concepts currently used were tailored for far more predictable and slower times. Those times are gone, as far as I can tell.

In addition, the role of health policy makers (and the MOH) is also changing rapidly. In the SDG era and far beyond, they will have to seek a more collaborative and interactive role (facilitating networks) e.g. under the umbrella of UHC, embracing new financing arrangements, engaging in inter-sector coordination, negotiating with local governments,…

So this is a call to those policy makers, political scientists and sub-regional practitioner networks out there, interested in LMIC governance, to join forces and consider new tools, fitting the changed role of health policy makers and new policy realities. Anticipatory governance, scenario-planning, realist policy analysis, to name just a few… There is a whole plethora of new tools out there for the benefit of policy makers in LMIC!

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