The hepatitis C infection in Iran: a policy analysis of agenda-setting using Kingdon’s multiple streams framework

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Abstract

Background

Hepatitis C virus (HCV) infection causes a large number of deaths annually worldwide. Policies play an important role in regulating healthcare agendas and prioritising of health-related issues. Understanding these priorities is very important in health. The objective of this study was to investigate HCV-related issues and their influence on agenda-setting in Iran.

Methods

A qualitative design was used. Data were collected by carrying out a review of documents and interviews. A comprehensive search was conducted to identify documents related to HCV-related policies in Iran. Semi-structured interviews were conducted with both purposive and snowball sampling of 14 interviewees related to the HCV programme in Iran, including government officials, civil society, development partnership members and academicians. Documents and interview data were analysed manually and using MAXQDA Version 10 software. Kingdon’s multiple streams framework was used to guide data analysis.

Results

The factors which influenced HCV-related agenda-setting were lack of proper information of the HCV epidemiology before the 1990s, lack of diagnostic facilities, neighbouring countries with high HCV prevalence, the stigma of HCV, high prevalence in prisoners, international evidence and high costs generated by HCV. The factors related to policy were effective treatment methods, drug production inside Iran, Iran Hepatitis Network, support outside government group elites and academicians. The factors related to political will were international influence, changes in the government and parliament support.

Conclusion

The findings of this study showed that there are various national and international factors that play a role in shaping HCV-related policies. It seems that, if HCV is put into the agenda, it can be eliminated in Iran by 2030 by supporting and implementing appropriate programmes from decision- and policy-makers.

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Most cited references 55

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Generation of political priority for global health initiatives: a framework and case study of maternal mortality.

Jeremy Shiffman, Stephanie Smith (2007)

Why do some global health initiatives receive priority from international and national political leaders whereas others receive little attention? To analyse this question we propose a framework consisting of four categories: the strength of the actors involved in the initiative, the power of the ideas they use to portray 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, which was launched in 1987. We undertook archival research and interviewed people connected with the initiative, using a process-tracing method that is commonly employed in qualitative research. We report 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 20th 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 to convince political leaders to act. We use the framework and case study to suggest areas for future research on the determinants of political priority for global health initiatives, which is a subject that has attracted much speculation but little scholarship.

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The utilisation of health research in policy-making: concepts, examples and methods of assessment

Stephen R Hanney, Miguel A González-Block, Martin Buxton … (2003)

The importance of health research utilisation in policy-making, and of understanding the mechanisms involved, is increasingly recognised. Recent reports calling for more resources to improve health in developing countries, and global pressures for accountability, draw greater attention to research-informed policy-making. Key utilisation issues have been described for at least twenty years, but the growing focus on health research systems creates additional dimensions. The utilisation of health research in policy-making should contribute to policies that may eventually lead to desired outcomes, including health gains. In this article, exploration of these issues is combined with a review of various forms of policy-making. When this is linked to analysis of different types of health research, it assists in building a comprehensive account of the diverse meanings of research utilisation. Previous studies report methods and conceptual frameworks that have been applied, if with varying degrees of success, to record utilisation in policy-making. These studies reveal various examples of research impact within a general picture of underutilisation. Factors potentially enhancing utilisation can be identified by exploration of: priority setting; activities of the health research system at the interface between research and policy-making; and the role of the recipients, or 'receptors', of health research. An interfaces and receptors model provides a framework for analysis. Recommendations about possible methods for assessing health research utilisation follow identification of the purposes of such assessments. Our conclusion is that research utilisation can be better understood, and enhanced, by developing assessment methods informed by conceptual analysis and review of previous studies.

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The terrain of health policy analysis in low and middle income countries: a review of published literature 1994–2007

Lucy Gilson, Nika Raphaely (2008)

This article provides the first ever review of literature analysing the health policy processes of low and middle income countries (LMICs). Based on a systematic search of published literature using two leading international databases, the article maps the terrain of work published between 1994 and 2007, in terms of policy topics, lines of inquiry and geographical base, as well as critically evaluating its strengths and weaknesses. The overall objective of the review is to provide a platform for the further development of this field of work. From an initial set of several thousand articles, only 391 were identified as relevant to the focus of inquiry. Of these, 164 were selected for detailed review because they present empirical analyses of health policy change processes within LMIC settings. Examination of these articles clearly shows that LMIC health policy analysis is still in its infancy. There are only small numbers of such analyses, whilst the diversity of policy areas, topics and analytical issues that have been addressed across a large number of country settings results in a limited depth of coverage within this body of work. In addition, the majority of articles are largely descriptive in nature, limiting understanding of policy change processes within or across countries. Nonetheless, the broad features of experience that can be identified from these articles clearly confirm the importance of integrating concern for politics, process and power into the study of health policy. By generating understanding of the factors influencing the experience and results of policy change, such analysis can inform action to strengthen future policy development and implementation. This article, finally, outlines five key actions needed to strengthen the field of health policy analysis within LMICs, including capacity development and efforts to generate systematic and coherent bodies of work underpinned by both the intent to undertake rigorous analytical work and concern to support policy change.

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Author and article information

Contributors

Masoud Behzadifar: behzadifar.m@tak.iums.ac.ir

Hasan Abolghasem Gorji:

ORCID: http://orcid.org/0000-0002-6328-1925

gorjiha@yahoo.com

Aziz Rezapour: rezapoor_a57@yahoo.com

Nicola Luigi Bragazzi: robertobragazzi@gmail.com

Journal

Journal ID (nlm-ta): Health Res Policy Syst

Journal ID (iso-abbrev): Health Res Policy Syst

Title: Health Research Policy and Systems

Publisher: BioMed Central (London )

ISSN (Electronic): 1478-4505

Publication date (Electronic): 27 March 2019

Publication date PMC-release: 27 March 2019

Publication date Collection: 2019

Volume: 17

Electronic Location Identifier: 30

Affiliations

[1 ]ISNI 0000 0004 4911 7066, GRID grid.411746.1, Health Management and Economics Research Center, , Iran University of Medical Sciences, ; Tehran, Iran

[2 ]ISNI 0000 0001 2151 3065, GRID grid.5606.5, School of Public Health, Department of Health Sciences (DISSAL), , University of Genoa, ; Genoa, Italy

Author information

Hasan Abolghasem Gorji http://orcid.org/0000-0002-6328-1925

Article

Publisher ID: 436

DOI: 10.1186/s12961-019-0436-z

PMC ID: 6438031

PubMed ID: 30917837

SO-VID: 84a9881f-ccb7-4645-a533-faa4624dd8c9

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 12 September 2018

Date accepted : 10 March 2019

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ScienceOpen disciplines: Health & Social care

Keywords: hepatitis c,iran,agenda-setting,kingdon’s multiple streams framework,health policy

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ScienceOpen disciplines: Health & Social care

Keywords: hepatitis c, iran, agenda-setting, kingdon’s multiple streams framework, health policy

The hepatitis C infection in Iran: a policy analysis of agenda-setting using Kingdon’s multiple streams framework

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International Journal of Applied Technology in Medical Sciences

Most cited references 55

Generation of political priority for global health initiatives: a framework and case study of maternal mortality.

The utilisation of health research in policy-making: concepts, examples and methods of assessment

The terrain of health policy analysis in low and middle income countries: a review of published literature 1994–2007

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