Browsing by Author "Gilson, Lucy"

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    “The Actor Is Policy”: Application of Elite Theory to Explore Actors’ Interests and Power Underlying Maternal Health Policies in Uganda, 2000-2015
    (International journal of health policy and management, 2021) Mukuru, Moses; Kiwanuka, Suzanne N.; Gilson, Lucy; Shung-King, Maylene; Ssengooba, Freddie
    The persistence of high maternal mortality and consistent failure in low- and middle-income countries to achieve global targets such as Millennium Development Goal five (MDG 5) is usually explained from epidemiological, intervention and health systems perspectives. The role of policy elites and their interests remains inadequately explored in this debate. This study examined elites and how their interests drove maternal health policies and actions in ways that could explain policy failure for MDG 5 in Uganda. Methods: We conducted a retrospective qualitative study of Uganda’s maternal health policies from 2000 to 2015 (MDG period). Thirty key informant interviews and 2 focus group discussions (FGDs) were conducted with national policy-makers, who directly participated in the formulation of Uganda’s maternal health policies during the MDG period. We reviewed 9 National Maternal Health Policy documents. Data were analysed inductively using elite theory. Results: Maternal health policies were mainly driven by a small elite group comprised of Senior Ministry of Health (MoH) officials, some members of cabinet and health development partners (HDPs) who wielded more power than other actors. The resulting policies often appeared to be skewed towards elites’ personal political and economic interests, rather than maternal mortality reduction. For a few, however, interests aligned with reducing maternal mortality. Since complying with the government policy-making processes would have exposed elites’ personal interests, they mainly drafted policies as service standards and programme documents to bypass the formal policy process. Conclusion: Uganda’s maternal health policies were mainly influenced by the elites’ personal interests rather than by the goal of reducing maternal mortality. This was enabled by the formal guidance for policy-making which gives elites control over the policy process. Accelerating maternal mortality reduction will require re-engineering the policy process to prevent public officials from infusing policies with their interests, and enable percolation of ideas from the public and frontline.
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    Building the Field of Health Policy and Systems Research: Social Science Matters
    (PLoS medicine, 2011) Gilson, Lucy; Hanson, Kara; Sheikh, Kabir; Akua Agyepong, Irene; Ssengooba, Freddie; Bennett, Sara
    The first paper in this series on building mthe field of Health Policy and Systems Research (HPSR) in low- and middle income countries (LMICs) [1] outlined the scope and questions of the field and highlighted the key challenges and opportunities it is currently facing. This paper examines more closely one key challenge, the risk of disciplinary capture the imposition of a particular knowledge frame on the field, privileging some questions and methodologies above others. In HPSR the risk of disciplinary capture can be seen in the current methodological critique of the field, with consequences for its status and development (especially when expressed by research leaders). The main criticisms are reported to be: that the context specificity of the research makes generalisation from its findings difficult; lack of sufficiently clear conclusions for policy makers; and questionable quality and rigour [2].