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


  • Jeremy Shiffman


  • Stephanie Smith


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.

Suggested Citation

  • Jeremy Shiffman & Stephanie Smith, 2007. "Generation of Political Priority for Global Health Initiatives: A Framework and Case Study of Maternal Mortality," Working Papers 129, Center for Global Development.
  • Handle: RePEc:cgd:wpaper:129

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    1. Baker, Phillip & Gill, Timothy & Friel, Sharon & Carey, Gemma & Kay, Adrian, 2017. "Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study," Social Science & Medicine, Elsevier, vol. 177(C), pages 141-149.
    2. International Food Policy Research Institute, 2015. "Global Nutrition Report 2015: Actions and accountability to advance nutrition and sustainable development," IFPRI books, International Food Policy Research Institute (IFPRI), number 978-0-89629-883-5, September.
    3. Nisbett, Nicholas & Gillespie, Stuart & Haddad, Lawrence & Harris, Jody, 2014. "Why Worry About the Politics of Childhood Undernutrition?," World Development, Elsevier, vol. 64(C), pages 420-433.
    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.
    5. Smith, Stephanie L. & Shiffman, Jeremy, 2016. "Setting the global health agenda: The influence of advocates and ideas on political priority for maternal and newborn survival," Social Science & Medicine, Elsevier, vol. 166(C), pages 86-93.
    6. Bernstein, Alissa, 2017. "Personal and political histories in the designing of health reform policy in Bolivia," Social Science & Medicine, Elsevier, vol. 177(C), pages 231-238.
    7. Walls, Helen L. & Cornelsen, Laura & Lock, Karen & Smith, Richard D., 2016. "How much priority is given to nutrition and health in the EU Common Agricultural Policy?," Food Policy, Elsevier, vol. 59(C), pages 12-23.
    8. Koduah, Augustina & Agyepong, Irene Akua & van Dijk, Han, 2016. "‘The one with the purse makes policy’: Power, problem definition, framing and maternal health policies and programmes evolution in national level institutionalised policy making processes in Ghana," Social Science & Medicine, Elsevier, vol. 167(C), pages 79-87.
    9. Smith, Stephanie L. & Neupane, Shailes, 2011. "Factors in health initiative success: Learning from Nepal's newborn survival initiative," Social Science & Medicine, Elsevier, vol. 72(4), pages 568-575, February.
    10. Akpalu, Wisdom & Dasmani, Isaac & Normanyo, Ametefee K., 2013. "Optimum Fisheries Management Under Climate Variability: Evidence from Artisanal Marine Fishing in Ghana," WIDER Working Paper Series 052, World Institute for Development Economic Research (UNU-WIDER).
    11. Ha, Bui Thi Thu & Green, Andrew & Gerein, Nancy & Danielsen, Katrine, 2010. "Health policy processes in Vietnam: A comparison of three maternal health case studies," Health Policy, Elsevier, vol. 98(2-3), pages 178-185, December.
    12. Stuart Gillespie & Mara van den Bold, 2016. "Stories of Change in Nutrition: A Tool Pool," Working Papers id:8225, eSocialSciences.
    13. Sandberg, Kristin Ingstad & Andresen, Steinar & Bjune, Gunnar, 2010. "A new approach to global health institutions? A case study of new vaccine introduction and the formation of the GAVI Alliance," Social Science & Medicine, Elsevier, vol. 71(7), pages 1349-1356, October.
    14. Harris, Patrick & Kent, Jennifer & Sainsbury, Peter & Thow, Anne Marie, 2016. "Framing health for land-use planning legislation: A qualitative descriptive content analysis," Social Science & Medicine, Elsevier, vol. 148(C), pages 42-51.
    15. 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.
    16. 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.
    17. 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.
    18. Gillespie, Stuart & van den Bold, Mara, 2015. "Stories of change in nutrition: A tool pool:," IFPRI discussion papers 1494, International Food Policy Research Institute (IFPRI).
    19. te Lintelo, Dolf J.H. & Lakshman, Rajith W.D., 2015. "Equate and Conflate: Political Commitment to Hunger and Undernutrition Reduction in Five High-Burden Countries," World Development, Elsevier, vol. 76(C), pages 280-292.
    20. Balarajan, Yarlini & Reich, Michael R., 2016. "Political economy of child nutrition policy: A qualitative study of India’s Integrated Child Development Services (ICDS) scheme," Food Policy, Elsevier, vol. 62(C), pages 88-98.
    21. Mogues, Tewodaj & Billings, Lucy, 2015. "The making of public investments: Champions, coordination, and characteristics of nutrition interventions:," IFPRI discussion papers 1479, International Food Policy Research Institute (IFPRI).
    22. Nisbett, Nicholas & Wach, Elise & Haddad, Lawrence & El Arifeen, Shams, 2015. "What drives and constrains effective leadership in tackling child undernutrition? Findings from Bangladesh, Ethiopia, India and Kenya," Food Policy, Elsevier, vol. 53(C), pages 33-45.

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    global health; maternal mortality;

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