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Generation of Political Priority for Global Health Initiatives: A Framework and Case Study of Maternal Mortality


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  • Jeremy Shiffman


  • Stephanie Smith
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    Why do some global health initiatives receive priority from international and national political leaders while others receive minimal attention? We propose a framework for analyzing this question consisting of four categories of factors: the strength of the actors involved in the initiative, the power of the ideas they use to frame 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, launched in 1987. Using a process-tracing methodology commonly employed in qualitative research, we conducted archival research and interviewed actors involved in the initiative. We find 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 twentieth anniversary 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 that convinces political leaders to act. We draw on the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, a subject that has attracted much speculation but little scholarship.

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    Bibliographic Info

    Paper provided by Center for Global Development in its series Working Papers with number 129.

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    Length: 32 pages
    Date of creation: Oct 2007
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    Handle: RePEc:cgd:wpaper:129

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    Keywords: global health; maternal mortality;

    This paper has been announced in the following NEP Reports:


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    Cited by:
    1. Mark Tomlinson & Crick Lund, 2012. "Why Does Mental Health Not Get the Attention It Deserves? An Application of the Shiffman and Smith Framework," Working Papers id:4819, eSocialSciences.
    2. Green, Andrew & Gerein, Nancy & Mirzoev, Tolib & Bird, Philippa & Pearson, Stephen & Anh, Le Vu & Martineau, Tim & Mukhopadhyay, Maitrayee & Qian, Xu & Ramani, K.V. & Soors, Werner, 2011. "Health policy processes in maternal health: A comparison of Vietnam, India and China," Health Policy, Elsevier, vol. 100(2), pages 167-173.
    3. Smith, Stephanie L., 2014. "Political contexts and maternal health policy: Insights from a comparison of south Indian states," Social Science & Medicine, Elsevier, vol. 100(C), pages 46-53.
    4. Spicer, Neil & Harmer, Andrew & Aleshkina, Julia & Bogdan, Daryna & Chkhatarashvili, Ketevan & Murzalieva, Gulgun & Rukhadze, Natia & Samiev, Arnol & Walt, Gill, 2011. "Circus monkeys or change agents? Civil society advocacy for HIV/AIDS in adverse policy environments," Social Science & Medicine, Elsevier, vol. 73(12), pages 1748-1755.


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