What's in a policy context?

Abstract

y aa; E C ENT LY independent and torn by war, Mozambique, with a medical workforce one could hardly 1II 2 call a system, was able to make remarkable progress in policy development and become a crucible for global policy. Cliff et al. highlight the role Mozambique and other African countries played in developing DOTS and syndromic management. They demonstrate for health policies how local context has influenced global development. Transfer must be acknowledged in both directions-from global to local and local to global. The case study of Mozambique demands an answer to the question: How did a "policy context," constrained by war and scarcity, manage to make a global contribution to health policy? What can we learn about the prospects of policy development and transfer in other apparently unfavorable situations? When international agencies want to test a concept or develop a new principle, they usually avoid difficult situations. Yet the very constraints that make a situation difficult may reveal underlying problems and help focus energies and leadership. Were the war and medical system collapse in Mozambique such factors? Did they help enable a test of new policy principles, focus action, and develop useful lessons? When research capacity is lacking, international donors and agencies tend to set the agenda themselves. By contrast, with a more vibrant research community, middle income countries have been in a better position to engage in a dialogue with donors (i). Research donors try to respond to poor country needs, but they are influenced by their own perceptions. As local capacity grows, local health researchers can and should play a more prominent role than zo years ago. Researcher engagement in policy development requires the kind of local leaders and commitment found in Mozambique zo years ago.