Generating Political Priority: A lesson from Bangladesh. Helen Oko (hoo205)
For any country to set up a health plan there are no set down rules and regulation to guide the policy making process. This is illustrated by the study done by Shiffman and Sultana as they studied how neonatal care became a national priority in Bangladesh and the process that it took to make this a reality (J. P. Shiffman & Sultana, 2013). In developing countries there are many competing needs for the limited resources that are available. It is not often that the countries have a process to follow for a health issue to become a national priority. The availability of national data, Inventory of resources available, literature review on proposals and the contribution of experts all play significant roles in setting the agenda with list of priorities for guidance and deliberation by the politicians. The statistics are great advocacy tools.
Allocating resources to all sectors of the government is something that is complex and requires the determination and commitment of some people who are ready to work hard to make this a reality. The World Health Organization (WHO) have recommended that countries set aside a least 5% of the national budget for health but this is not the case in many countries of the world especially the developing countries. The allocation to health will then be shared to all the different units and segments.
Making health a national priority as described by Shiffman has three major influences. The role of the international community and donor agencies is very important. The activities of local advocacy groups cannot be underestimated, and the political climate of the country at the time will contribute to making health or health program a national priority. The WHO sets out agenda that is recommended to the member nations to be followed (Jody R. Lori & Starke, 2012). This carries a lot of weight and influence. International donors have their projects and priorities and if the country wants to benefit from these agencies they would have to have the same priorities as the donor agencies who come not only with donations but with expertise that is most needed in most places. This is illustrated by the HIV/AIDS programs designed by the USA government and Bill and Melinda Gates Foundation along with other international bodies (J. Shiffman, 2008). AIDS program has become the priority of the nations that would want to benefit from them. The agenda is presented with ethical appeal on why a particular issue is just the right thing to be done at this time. These agencies have the money, the knowledge and expertise and the political cloud.
Individuals with political power and influence can take up a project and become the spokesperson for that project, create awareness and put pressure on the government to take up that particular issue. An example is cited by Shiffman of the former Director of UNICEF (James Grant) who took up child survival and he got it on the agenda (J. P. Shiffman & Sultana, 2013). He had such political influence that Bangladesh took it up immediately. The role of local health indicators is very important as well as high profile meetings in the city to call attention to particular issues. Influential policy makers could affect the decision making process from within.
Many factors come to play in generation political priority for health (J. R. Lori, Amable, Mertz, & Moriarty, 2012). The most important contribution comes from the International community and aid agencies and the political will of the politicians. There are pressures from all interested parties and sometimes the real need is given up for political gains.
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Lori, J. R., & Starke, A. E. (2012). A critical analysis of maternal morbidity and mortality in Liberia, West Africa. Midwifery, 28(1), 67-72.
Shiffman, J. (2008). Has donor prioritization of HIV/AIDS displaced aid for other health issues? Health Policy Plan, 23(2), 95-100. doi: 10.1093/heapol/czm045
Shiffman, J. P., & Sultana, S. M. B. A. M. (2013). Generating Political Priority for Neonatal Mortality Reduction in Bangladesh. Am J Public Health, 103(4), 623-631.