Abstract
BackgroundThe Kingdon model, based on the convergence of three streams (problem, policy, and politics) and the opening of a policy window, analyses the process by which a health issue is placed on the political agenda. We used this model to document the political agenda-setting process of the newborn hearing screening programme in Belgium.MethodsA qualitative study based on a document review and on semi-directed interviews was carried out. The interviews were conducted with nine people who had played a role in putting the issue in question on the political agenda, and the documents reviewed included scientific literature and internal reports and publications from the newborn hearing screening programme. The thematic analysis of the data collected was carried out on the basis of the Kingdon model’s three streams.ResultsThe political agenda-setting of this screening programme was based on many factors. The problem stream included factors external to the context under study, such as the technological developments and the contribution of the scientific literature which led to the recommendation to provide newborn hearing screening. The two other streams (policy and politics) covered factors internal to the Belgian context. The fact that it was locally feasible with financial support, the network of doctors convinced of the need for newborn hearing screening, the drafting of various proposals, and the search for financing were all part of the policy stream. The Belgian political context and the policy opportunities concerning preventive medicine were identified as significant factors in the third stream. When these three streams converged, a policy window opened, allowing newborn hearing screening onto the political agenda and enabling the policy decision for its introduction.ConclusionsThe advantage of applying the Kingdon model in our approach was the ability to demonstrate the political agenda-setting process, using the three streams. This made it possible to identify the many factors involved in the process. However, the roles of the stakeholders and of the context were somewhat inexplicit in this model.
Highlights
The Kingdon model, based on the convergence of three streams and the opening of a policy window, analyses the process by which a health issue is placed on the political agenda
The participants were from the medical and political communities, from healthcare organisation services, or were patient representatives: they were ENT specialists working in university (n = 3) and non-university (n = 1) hospitals, a paediatrician from the Office de la Naissance et de l’Enfance (ONE – the Fédération Wallonie-Bruxelles (FWB)’s Mother and Child Welfare Agency), a health insurance fund representative, and two representatives of the minister responsible for health prevention policy at the time of the decision to introduce the newborn hearing screening programme
Analysis of the problem stream The problem stream centred around the fact that there was no universal hearing screening programme in the FWB, the aim of which is the early treatment of hearingimpaired children in order to allow them to develop to their full potential
Summary
The Kingdon model, based on the convergence of three streams (problem, policy, and politics) and the opening of a policy window, analyses the process by which a health issue is placed on the political agenda. It often considers that there is some linearity between political agenda-setting, policy formulation, and its implementation and evaluation, implying that there is a clear demarcation between these stages, which in reality is not the case [2,3] These approaches often present health policy analysis models that focus on content, but which overlook the stakeholders, the context, and the political process. A more dynamic model explaining political agendasetting for a specific health issue was developed by Kingdon [4,5] This explains how certain problems become sufficiently significant to get on the political agenda while others do not. These three streams may uncouple, temporarily or permanently closing the policy window [1,3,4,5]
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