Exploring Politics and Contestation in the Policy Process: The Case of Zambia's Contested Community Health Strategy

Area of Science:

• Public Health
• Health Policy
• Health Systems Strengthening

Background:

• Growing demand for community health systems (CHS) policies in low- and middle-income countries.
• Global guidance often overlooks the complexities of national policy development.
• Zambia's experience with its Community Health Strategy (CH Strategy) highlights these challenges.

Purpose of the Study:

• To examine the political dynamics and contextual factors influencing the development and abrupt revision of Zambia's CH Strategy.
• To analyze the interplay of events, actors, and contexts in health policy formulation.
• To understand the challenges in developing effective community health systems policies.

Main Methods:

• Documentary analysis of policy development processes.
• Qualitative interviews with 21 key stakeholders involved in Zambia's CH Strategy.
• Case study approach focusing on Zambia's CH Strategy formulation and revision.

Main Results:

• Zambia's CH Strategy faced significant contestation due to international partner involvement and shifting responsibilities within the Ministry of Health (MoH).
• Despite stated intentions, healthcare providers and communities were excluded from the policy process.
• These factors led to the strategy's withdrawal and reissuance with minimal changes.

Conclusions:

• Health policy development, particularly for community health systems, is inherently political and influenced by external actors and internal dynamics.
• Understanding the process, including the interaction of events, actors, and contexts, is crucial for successful CHS policy implementation.
• Future efforts should prioritize inclusive policy-making processes to ensure relevance and sustainability.