‘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

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Study Justification:
– The study aims to enhance our understanding of health policy agenda setting and formulation processes in a lower middle income country, specifically Ghana.
– By exploring how and why maternal health policies and programs appeared and evolved on the health sector program of work agenda between 2002 and 2012, the study provides valuable insights into the decision-making processes that shape health policies.
– The study highlights the importance of power dynamics, problem definition, and framing in shaping maternal health policies and programs.
– Understanding these factors is crucial for achieving transformative change and sustained improvement in health systems in low- and middle-income countries.
Highlights:
– The study examines the influence of national level decision makers’ power sources on the appearance and fate of maternal health policies and programs.
– Power sources identified include legal and structural authority, political influence, control over resources (especially financial), access to evidence such as health sector performance reviews and demographic health surveys, and knowledge of national plans.
– The study emphasizes the significance of power sources as negotiation tools in policy development.
– Findings suggest that power dynamics, problem definition, and framing play a crucial role in shaping maternal health policies and programs in Ghana.
Recommendations:
– Policymakers should be aware of the influence of power dynamics in policy development and take steps to ensure a more inclusive and equitable decision-making process.
– Efforts should be made to improve access to evidence, such as health sector performance reviews and demographic health surveys, to inform policy development.
– Greater collaboration and coordination among stakeholders, including government agencies, civil society organizations, and international partners, is needed to address maternal health challenges effectively.
– Policymakers should consider the findings of this study when designing and implementing maternal health policies and programs.
Key Role Players:
– National level decision makers, including government officials and policymakers.
– Health sector professionals, including doctors, nurses, and public health experts.
– Civil society organizations working on maternal health issues.
– International partners and donor agencies providing support for maternal health programs.
– Researchers and academics studying health policy and maternal health.
Cost Items for Planning Recommendations:
– Funding for research and data collection on maternal health issues.
– Resources for improving access to evidence, such as health sector performance reviews and demographic health surveys.
– Budget allocation for implementing maternal health policies and programs.
– Investment in capacity building for health sector professionals.
– Support for civil society organizations working on maternal health issues.
– Collaboration and coordination costs among stakeholders, including government agencies and international partners.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides a clear description of the research objectives and methodology. However, it does not explicitly mention the specific evidence or data sources used in the study. To improve the evidence, the abstract could include information on the specific data sources, research methods, and sample size used in the study.

This paper seeks to advance our understanding of health policy agenda setting and formulation processes in a lower middle income country, Ghana, by exploring how and why maternal health policies and programmes appeared and evolved on the health sector programme of work agenda between 2002 and 2012. We theorized that the appearance of a policy or programme on the agenda and its fate within the programme of work is predominately influenced by how national level decision makers use their sources of power to define maternal health problems and frame their policy narratives. National level decision makers used their power sources as negotiation tools to frame maternal health issues and design maternal health policies and programmes within the framework of the national health sector programme of work. The power sources identified included legal and structural authority; access to authority by way of political influence; control over and access to resources (mainly financial); access to evidence in the form of health sector performance reviews and demographic health surveys; and knowledge of national plans such as Ghana Poverty Reduction Strategy. Understanding of power sources and their use as negotiation tools in policy development should not be ignored in the pursuit of transformative change and sustained improvement in health systems in low- and middle income countries (LMIC).

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Based on the provided description, it seems that the paper focuses on understanding the policy agenda setting and formulation processes related to maternal health in Ghana. While the specific innovations are not described, here are some potential recommendations that could be used to improve access to maternal health:

1. Mobile health (mHealth) solutions: Develop and implement mobile applications or text messaging services to provide pregnant women with important health information, appointment reminders, and access to healthcare providers.

2. Telemedicine: Establish telemedicine services to enable remote consultations between pregnant women and healthcare professionals, particularly in rural areas where access to healthcare facilities may be limited.

3. Community health workers: Train and deploy community health workers to provide maternal health education, prenatal care, and postnatal support in underserved communities.

4. Transportation solutions: Improve transportation infrastructure and services to ensure pregnant women can easily access healthcare facilities, especially in remote areas.

5. Maternal health vouchers: Implement voucher programs that provide pregnant women with financial assistance to cover the costs of maternal healthcare services, including prenatal care, delivery, and postnatal care.

6. Public-private partnerships: Foster collaborations between the government, private sector, and non-profit organizations to improve the availability and quality of maternal healthcare services.

7. Quality improvement initiatives: Implement strategies to enhance the quality of maternal healthcare services, including training healthcare providers, improving facility infrastructure, and ensuring the availability of essential medical supplies.

8. Maternal health awareness campaigns: Launch public awareness campaigns to educate communities about the importance of maternal health, encouraging early prenatal care, and promoting healthy behaviors during pregnancy.

These are just a few potential innovations that could be considered to improve access to maternal health. The specific recommendations would depend on the context and resources available in Ghana.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health in Ghana would be to prioritize the following actions:

1. Enhance the involvement of national decision makers: It is crucial to engage decision makers at the national level in the process of defining maternal health problems and designing policies and programs. This can be achieved through regular consultations, workshops, and forums where decision makers can contribute their perspectives and insights.

2. Strengthen the use of evidence: Decision makers should have access to reliable and up-to-date evidence, such as health sector performance reviews and demographic health surveys. This will enable them to make informed decisions and develop evidence-based policies and programs to address maternal health challenges.

3. Allocate sufficient resources: Adequate financial resources should be allocated to maternal health programs to ensure their effective implementation. Decision makers should prioritize maternal health within the national health sector program of work and allocate funds accordingly.

4. Align policies with national plans: Maternal health policies and programs should be designed within the framework of national plans, such as the Ghana Poverty Reduction Strategy. This alignment will ensure that maternal health is integrated into broader development goals and strategies.

5. Promote collaboration and coordination: Decision makers should foster collaboration and coordination among relevant stakeholders, including government agencies, healthcare providers, civil society organizations, and international partners. This will facilitate the implementation of comprehensive and integrated maternal health interventions.

By implementing these recommendations, Ghana can improve access to maternal health services and contribute to the overall well-being of women and children in the country.
AI Innovations Methodology
Based on the provided description, it seems that you are looking for innovations and a methodology to improve access to maternal health in Ghana. Here are some potential recommendations for innovations:

1. Mobile Health (mHealth) Solutions: Develop and implement mobile applications or SMS-based systems that provide pregnant women with information, reminders for prenatal care appointments, and access to teleconsultations with healthcare providers.

2. Community Health Workers (CHWs): Expand the role of CHWs in maternal health by training them to provide basic antenatal and postnatal care, conduct health education sessions, and facilitate referrals to healthcare facilities.

3. Telemedicine: Establish telemedicine networks to connect remote areas with healthcare professionals, enabling pregnant women to receive virtual consultations, advice, and monitoring during pregnancy.

4. Maternal Health Vouchers: Introduce a voucher system that provides pregnant women with subsidized or free access to essential maternal health services, including antenatal care, delivery, and postnatal care.

5. Transportation Solutions: Improve transportation infrastructure and services in rural areas to ensure that pregnant women can easily access healthcare facilities for antenatal care, delivery, and emergency obstetric care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Data Collection: Gather relevant data on the current state of maternal health access in Ghana, including information on healthcare facilities, maternal mortality rates, distance to facilities, and utilization rates.

2. Modeling: Develop a simulation model that incorporates the recommended innovations and their potential effects on improving access to maternal health. This model should consider factors such as population distribution, healthcare facility capacity, transportation infrastructure, and the availability of resources.

3. Scenario Analysis: Run simulations using different scenarios to assess the potential impact of each innovation on improving access to maternal health. This could involve varying parameters such as the coverage of mHealth solutions, the number of trained CHWs, the extent of telemedicine network coverage, the distribution of maternal health vouchers, or the improvement in transportation services.

4. Impact Assessment: Analyze the simulation results to determine the projected impact of each innovation on key indicators, such as the increase in antenatal care coverage, the reduction in maternal mortality rates, or the improvement in timely access to emergency obstetric care.

5. Policy Recommendations: Based on the simulation findings, provide evidence-based policy recommendations on the implementation and scaling up of the most effective innovations to improve access to maternal health in Ghana.

It is important to note that the methodology described above is a general framework, and the specific details and data requirements may vary depending on the context and available resources.

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