Agenda setting analysis for maternal mortality reduction: exploring influential factors using Kingdon's Stream Model.

Abstract

Maternal mortality is considered as unacceptable death. This study aimed to analyse the agenda setting process for maternal mortality reduction policies in nine successful countries in achieving Millennium Development Goal 5 (MDG 5) using the Kingdon's multiple streams theory. This comparative study analysed the agenda setting process in nine successful countries which achieved MDG 5. The agenda setting analysed the use of the Kingdon's multiple streams model. To extract similarities and differences in the agenda setting process, the content analysis method, available documents and reports, and the comparative table were used. The initial attention to the problem of high rate of maternal mortality was different in the studied countries, but MDGs and the countries' official reports were the main driver. Political stability, political will, key person's contribution and legislation were considered influential factors strengthening political stream. International technical or financial support, regional and international conferences, national plans and enabling factors, which provide technical feasibility, were the most important factors influencing the policy stream. Enabling factors included approving regulations and legislation, increased quantity and quality of human resources, organizational structure, service delivery enhancement, infrastructure development, providing medicines and equipment, and strengthening health information system. The three streams: problem, policy and politics are not separate from each other. Political stability and commitment, having a national plan and benefiting from technical or financial support of international entities was a common feature among almost all the studied countries. The key actions leading to the opening of the window of opportunity were those actions that led to highlighting the problem.