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Public social policy development and implementation: a case study of the Ghana National Health Insurance scheme.

机译：公共社会政策的制定和实施：以加纳国家健康保险计划为例。

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The public social policy and programme decisions that are made in low-income countries have critical effects on human social and development outcomes. Unfortunately, it would appear that inadequate attention is paid to analysing, understanding and factoring into attempts to reshape or change policy, the complex historical, social, cultural, economic, political, organizational and institutional context; actor interests, experiences, positions and agendas; and policy development processes that influence policy and programme choices. Yet these can be just as critical as the availability of research or other evidence in influencing decision making on policies and their accompanying programmes and the resulting degree of success or failure in achieving the original objectives. Ghana, a low-income developing country in sub-Saharan Africa, embarked on a national policy process of replacing out-of-pocket fees at point of service use with national health insurance in 2001. This paper uses a case study approach to describe and reflect on the complex interactions of context with actors and processes including political power play; and the effects on agenda setting, decision making and policy and programme content. This case study supports observations from the literature that although availability of evidence is critical, major public social policy and programme content can be heavily influenced by factors other than the availability or non-availability of evidence to inform content decision making. In the low-income developing country context there can be imbalances of policy decision-making power related to strong and dominant political actors combined with weak civil society engagement, accountability systems and technical analyst power and position. Efforts at major reform need to consider and address these issues alongside efforts to provide evidence for content decision-making. Without an analysis and understanding of the politics of reform and how to work within it, researchers and other technical actors may find their information to support reform is not applied effectively. Similarly, without an appreciation of the need for critical technical analysis to support decision making rather than an indiscriminate use of political approaches, political actors may find that even with the best of intentions, desired policy objectives may not be attained.
机译：低收入国家制定的公共社会政策和方案决定对人类社会和发展成果具有关键影响。不幸的是，似乎没有充分注意分析，理解和考虑重塑或改变政策，复杂的历史，社会，文化，经济，政治，组织和体制背景的企图;演员的兴趣，经验，职位和议程;影响政策和计划选择的政策制定流程。然而，对于影响政策及其配套计划的决策以及最终实现目标的成败程度，研究或其他证据的可用性同样至关重要。加纳是撒哈拉以南非洲地区的低收入发展中国家，于2001年开始了一项国家政策程序，即以国民健康保险代替服务使用点的自付费用。本文采用案例研究的方法来描述和描述反思环境与参与者和包括政治权力游戏在内的各种过程之间的复杂互动;以及对议程设置，决策，政策和计划内容的影响。该案例研究支持了来自文献的观察，即尽管证据的可用性至关重要，但是主要的公共社会政策和计划内容可能会受到除证据的可用性或不可用性以外的其他因素影响，从而可以为内容决策提供依据。在低收入发展中国家，与强大而占主导地位的政治行为者相关的政策决策权可能会不平衡，再加上民间社会参与度，问责制和技术分析人员的权能和地位薄弱。进行重大改革的努力需要考虑并解决这些问题，同时还要努力为内容决策提供依据。如果不分析和理解改革的政治以及如何进行改革，研究人员和其他技术参与者可能会发现他们的信息无法有效地应用改革。同样，在没有意识到需要关键的技术分析来支持决策而不是不加选择地使用政治方法的情况下，政治行为者可能会发现，即使有最好的意图，也无法实现预期的政策目标。

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