Kingdon's Model Research Articles

National Politics' Role in Developing Primary Health Care Policy for Maternal Health in Papua New Guinea: A Qualitative Document Analysis.

Politics is one of the critical factors that influence health policy agendas. However, scholarly efforts, especially in low- and middle-income countries, rarely focus on how politics influence health policy agenda-setting. We conducted a qualitative document review to examine the factors that led to developing the free primary health care policy for maternal health in Papua New Guinea. We also discuss mechanisms through which national politics, as an overriding factor, influenced the development of the policy. The review draws on Kingdon's multiple-stream model for agenda-setting and incorporates theoretical insights from Fox and Reich's framework for analyzing the politics of health reform for universal health coverage in low- and middle-income countries.

Kingdon의 다중흐름모형을 활용한 다문화교육 정책변동 분석

The study applied Kingdon's multiple stream framework model to analyze the process of change in multicultural education support policies promoted from the Park Geun Hyen government to the Moon Jae Inn government, clarifying policy issues, policy alternatives, the flow of politics, the opportunity to open the window of politics, and the identity of policy leaders in the process of change. To achieve this research purpose, 2013-2022 was set as a timely range, and various data such as statistical data, press releases from the Ministry of Education, presidential election pledges, and government press releases were collected and analyzed. The main analysis results are as follows, the flow of policy problems consisted of statistical indicators such as the ratio of multicultural students and the enrollment rate, holding multicultural education forums, prejudice against multicultural children, and collective feedback through forums. Also, the flow of policy alternatives mainly consisted of presidential election pledges and proposals from lawmakers. In the flow of politics, the national atmosphere of the need for support for multicultural students and the changes of the administration were included. The window of multicultural education support policy opened twice, while the Park Geun Hyen government and the Moon Jae Inn government were playing the role of policy leaders who led the policy change.

Vitamin D deficiency prevention policies in Iran: a retrospective policy analysis.

Iran has a higher prevalence of vitamin D deficiency (VDD) than the global level. This study aimed to assess VDD prevention policies in Iran through a policy analysis of agenda setting using the multiple streams framework (MSF). Using Kingdon's MSF model, this qualitative analytical study performed a policy analysis on vitamin D-related policies in Iran. The policy documents were reviewed, and in-depth interviews were conducted with stakeholders (n = 27) using the framework analysis method. To categorize data and extract the related themes, MAXQDA version 10 was used. According to Kingdon's MSF theory, the problem stream included the high prevalence of VDD among Iranian infants (23.3%), adolescents (76%), and adults (59.1%). The policy stream was identified to focus on preventing programs for non-communicable diseases in the health sector. The political stream indicated that national and international support could provide a political climate for this issue. According to our results, a window of opportunity for policymaking on VDD prevention has opened. However, there are some challenges related to the implementation of these policies. These include the dominance of a treatment-based view rather than a prevention-based approach in the health sector, economic problems, and restricted access to health services due to the outbreak of coronavirus disease 2019 (COVID-19). To strengthen and implement VDD prevention policies, the stakeholders need support from high-level policymakers.

Health Workforce Development Policies in Iran: A Study of In-service Training Policies

Background: In-service training is one of the requirements for developing health workforce skills and providing quality services to patients. Objectives: This study aimed to determine the policy formulation of in-service training for the health workforce in Iran. Methods: In this qualitative policy analysis study, semi-structured interviews with key informant persons and document analysis were used to gather data. Interviews were conducted with 12 informed people about health system policies, experts, and managers of in-service training centers of medical universities and the Ministry of Health and Medical Education (MOHME) selected purposively. Targeted and snowball sampling was used to identify the participants. Data analysis was performed using the MAXQDA10 software, and framework analysis was run using the Kingdon model. Results: Centralized planning, lack of access in rural and remote areas, and the inability to use the potential of universities in staff training were the most frequent problems in in-service training of the health workforce. Establishing the Board of Trustees for universities affected the opening of the opportunity window to policy-making, and political entrepreneurs in MOHME took advantage of it and developed policies for in-service training. Conclusions: The development of policies has created a suitable platform for medical universities to increase the number of training hours and develop the skills of the health workforce. It also seems that policymakers' attention can lead to improving processes and using new approaches in the continuous development of health professions.

The role of governance models in the development of transport infrastructure megaprojects in Greater Montreal: The case of the Réseau express métropolitain

This article focuses on mobility issues in Montreal, whose metropolitan transportation policies are presented as one of the major ambitions of large North American metropolitan areas. Empirically, we are interested in a recent transportation megaproject: the Réseau express métropolitain (REM) in Montreal, an electric light-rail transit network spanning 67 kilometers in the Greater Metropolitan Area. These types of megaprojects involve significant governance challenges and certain criticisms due to the involvement of several actors from different backgrounds and defending different interests, which places. This is why we believe that it is important to address this issue from the point of view of metropolitan governance through the agenda-setting of urban megaprojects. The originality of this article is that it demonstrates how presenting the REM project as a public-public partnership, between the Caisse de dépôt et placement du Québec (CDPQ) and the Government of Québec, opened the door to favoritism for the Caisse which influenced the choice of a political solution in Greater Montreal. By mobilizing Kingdon's model, we conclude that windows of opportunity cannot open without choosing a governance model during the agenda-setting phase.

카자흐스탄 의무의료보험제도 도입 과정 연구

In November 2015, Kazakhstan introduced the “Compulsory Social Health Insurance System (the System) in the social insurance format,” first among the Central Asian countries, including Russia. By introducing the system, the country shifted from the previous government-led medical insurance system that had originated from the era of the former Soviet Union to that in the “social insurance format.” Under the new system, every citizen pays health insurance premiums and bears the collective responsibility for public health. The process of introducing the System was quite abrupt, which was possible because Kazakhstan is an authoritative nation where the president of the country exerts enormous power. In this regard, this study alters and modifies Kingdon's multiple streams framework model, which is useful for analyzing such an abrupt process of policy change by period, and applies the revised version as the analysis framework. The analysis period was classified into three periods based on the national mood, the presence and direction of policies, etc. In addition, the intensity of the three streams(problems, politics and policies), and the extent of the policy entrepreneur’s role were set as the specific components of the analytical framework. As a result of the analysis, the policy change succeeds in the third period(Jan. 2014-Jan.2020). The results confirmed that when the aforementioned model is applied, policy entrepreneurs played the most important role in the policy change process in Kazakhstan for the introduction of the compulsory social health insurance system. Nazarbayev, a policy entrepreneur, first recognized the necessity of improving the public health budget indicators, which had been deteriorating since 2010, from the perspective of the flow of policy problems. Based on his realization, Nazarbayev tried to strengthen the country's financial soundness by resolving the identified policy problems and further, he intended to achieve the advancement and modernization of the country. Aggressive and enthusiastic efforts and firm and decisive willingness of the policy entrepreneur finally led to the successful policy change. Consequently, the System was established and implemented nationwide in Kazakhstan from January 2020, starting with partial implementation in July 2017.

Environmental Issues in Post-Conflict States and the Multiple Streams Model

In post-conflict states, environmental problems are often neglected regardless of their severity. According to UN data, Bosnia and Herzegovina (BiH) is one of the countries with the worst air pollution in the world, which has serious consequences for people's health and the economy. Given the importance of this issue, the paper investigates why it is not on the agenda of policymakers, by applying Kingdon's multiple streams model. The analysis leads to the conclusion that of the three streams (problem, policy, and politics), the politics stream remains the most problematic one. However, the author argues that Kingdon's original model is deficient in explaining why this problem is off the agenda, since it only includes domestic actors, while in the case of post-conflict BiH, as well as some other post-conflict countries, international actors play a significant role. In order to overcome this shortcoming, the model itself is enhanced by an insight into the role that international actors played in relation to this problem. It is concluded that the problems of environmental protection were largely ignored by international actors as well, primarily due to the nature of the liberal model of peacebuilding, that predominantly focused on building democratic institutions.

다중흐름모형을 이용한 국가균형발전의 정책변동 분석

This study attempted to explore the factors affecting the change in the national balanced development policy based on Kingdon's MSF model and suggest a plan for effective balanced development policy in the future. Methodologically, big data analysis was used along with literature analysis. The analysis results show that the factors affecting the change in the national balanced development policy were influenced by policy problems and policy alternatives at the time, but the most affected was the flow of politics. It should be noted that during the MB Administration and Moon Jae-in Administration, the policy window opened in accordance with the big political trend of "regime change," and the name, degree of implementation, and content of the national balanced development policy changed accordingly. It also supports that the policy output would be influenced by the president's national philosophy following the launch of the new government.

Closing the gap between research and policy-making to better enable effective educational practice: a proposed framework

Although there is increased need for closing the gap between educational research and policy to better enable effective practice, addressing the problem remains a challenge. A review of current literature reveals a lack of systematic guidelines which clarify how collaboration between researchers and policy-makers can actually be achieved. Therefore, this study aims to articulate a framework which satisfies these needs. We used Lasswell’s stages heuristic model, integrated with perspectives from Kingdon's model, as a basis for building this framework, and conducted semi-structured interviews with nine experts in educational research and policy-making to gain understanding for how to effectuate their collaboration. The study identified six main stages for achieving effective collaboration, and the resulting framework could prove useful to future applications.

Getting closure? Mining rehabilitation reform in Queensland and Western Australia

Orphaned, abandoned and inadequately rehabilitated mines have left of legacy of social, economic, and environmental risk. The failure of mine rehabilitation in Australia has become a policy issue in the last decade, with the two major mining states, Western Australia and Queensland, introducing reforms to their regulatory and financial assurance regimes in order to reduce the financial risk to the state. While similar reforms were introduced in both states, Queensland's regime was more stringent in terms of reducing the risk to the state. This paper, which is based on analysis of government documents and legislation, as well as interviews with government, industry, and environmental group representatives in the two states, evaluates the two states' regulatory changes through the lens of law and economics, and explains the reasons for the different policy decisions using Kingdon's streams model. It argues that Queensland's reform was more stringent because of the focusing events driving the reform; the political orientation of the government in power; and the organization responsible for developing policy options.

Views on smoking free premise 2007, England; the gains so far

Smoking is one of the most avoidable cause of death and disability. Smoking not only affects smokers but also nonsmokers who are involuntarily exposed to smoke raising a serious concern for public health, safety, and welfare. Concerns regarding secondhand smoking came to the ground after various medical scientific researches and publications quantified and confirmed the health risk of passive smoking after exposure with it, which drew the public attention. The turning point for the government to introduce a ban of smoking at public and workplaces to protect the right of nonsmokers to enjoy fresh air, came as a 2006 Health Act in UK after it was strongly backed by the recommendation given by SCOTH regarding SHS. Through this policy, the government also supports internationally recognized comprehensive tobacco control standard. UK was first among the FCTC parties to introduce comprehensive smoke free legislation. The major objective of this policy is to limit the preventable epidemic of smoking. This policy is based on the Health Policy Triangle which considers the interaction of all four elements (Content, Context, Process and Actors) to structure policymaking. For agenda setting Kingdon model was used and for implementation phase of the policy Top-down approach was used. The major stakeholders that supported 2006 Health Act were Labour party, The Royal College of physicians (RCP), Action on smoking and Health (ASH) and research and evidence-based news while Tobacco industry and hospital trade was against the Act. The evidence suggested that risks of heart disease in secondhand smoker was double than what was known before. SHS became an agenda when in 2003, around 11,000 adults exposed in home and 617 people exposed in workplace died in UK because of exposure to SHS. People want to quit smoking and wanted help from government to make favorable environment. Following the public consultation white paper was published, Choosing Health: Making Healthy Choices Easier, in November 2004. It set the target that by 2008 all enclosed public places and workplace would be smoke free with some exceptions. Act was supported by labour party and department of Health Economist was of the view that ban would not have any immediate benefits on passive smoker instead it will discourage the young from starting. After publishing the white paper in 2004 there was the consultation period till 2005. There was a voting in parliament and majority of voted for ban on smoking in public places. As a result, Health Act 2006 was introduced on 1st July 2007. Smokers were against the ban, but the purpose of the ban was to focus on protecting health of people from SHS not make smokers quit. Reports disseminated after inspection from local bodies confirmed high levels of compliance with smoke free legislation. The data showed there were 2.4% reduction in hospital admission in a year for heart attack and almost 7000 fewer admission due to childhood asthma. Thus, Smoking ban policies have shown effective public health interventions for the prevention of cardiovascular, cerebrovascular, and respiratory mortality and preserve the health of children.

An Analysis of the 'Kindergarten 3 Laws' Policy Based on Kingdon's Multiple Streams Framework Model

An Analysis of the 'Kindergarten 3 Laws' Policy Based on Kingdon's Multiple Streams Framework Model

The Pursuit of Nurse Practitioner Practice Legislation: A Case Study.

Across the United States, nursing practice acts (NPAs) have been revised to include provisions that promote full practice authority (FPA) for nurse practitioners (NPs). Such revisions provide a mechanism to better utilize the full scope of NP services to address growing demands for access to health care. Modernized NPAs that facilitate FPA for NPs are imperative, especially now with the unprecedented health care crisis that the world now faces: Coronavirus Disease 2019. This is the first known study to use an embedded single-case study design, guided by the Kingdon policy stream model, to provide a detailed account of how stakeholders for NP FPA determine the appropriate time to pursue legislative changes to NP scope of practice regulations. Qualitative data analysis revealed four themes which comprised the components considered by stakeholders during their decision-making processes related to NP FPA: participants, problem, policy development, and politics. Themes were further collapsed within concepts from the Kingdon model to form the case description. Study findings can be used to increase the competency among NP FPA stakeholders in determining the timing of legislative pursuits for regulatory change.

Addressing the challenges of implementing a Health Technology Assessment Policy Framework in South Africa.

South Africa's commitment to progressively achieve universal health coverage can lead to the effective and appropriate use of Health Technology Assessment (HTA) to strengthen the healthcare system. The study aimed to analyze the challenges faced in the formal implementation and utilization of HTA in the public health sector. Review and analysis of health technology policies and legislation introduced in South Africa since 1965 serves as the backbone of this study. Walt and Gilson's health policy triangle framework and Kingdon's model were used for data analysis. In addition, a semi-structured survey was conducted among key stakeholders, including those attending HTA workshops that were held in 2016 and 2017. The document review identified appropriate legislative and policy framework for informing healthcare decisions. Survey participants (n = 55) reported limited political support, local capacity, and awareness of HTA as barriers to implementing HTA. They noted that adequate financial resources and availability and sharing of quality data are primary drivers for HTA development. Effective governance, collaboration, and cooperation between key stakeholders of the healthcare system were suggested as possible ways forward for the institutionalization of HTA. The South African government's goal to introduce the national health insurance program provides an excellent opportunity to formally introduce the use of HTA in decision making. Individual capacity development supported by institutional and organizational environments is urgently needed to achieve its full potential.

Kingdon 모형을 적용한 국제과학비즈니스벨트 정책형성 과정 분석 : 기초과학연구원(IBS)을 중심으로

Kingdon 모형을 적용한 국제과학비즈니스벨트 정책형성 과정 분석 : 기초과학연구원(IBS)을 중심으로

Seizing the Moment: Policy Advocacy to End Mass Incarceration in the Time of COVID-19.

The mass human and economic casualties wrought by the COVID-19 pandemic laid bare the deep inequities at the base of the disproportionate losses and suffering experienced by diverse U.S. populations. But the urgency and enormity of unmet needs requiring bold policy action also provided a unique opportunity to learn from and partner with community-based organizations that often are at the frontlines of such work. Following a review of Kingdon's model of the policy-making process, we illustrate how a partnership in a large California county navigated the streams in the policy-making process and used the window of opportunity provided by the pandemic to address a major public health problem: the incarceration of over 2 million people, disproportionately African American and Latinx, in overcrowded, unsafe jails, prisons, and detention centers. We highlight tactics and strategies used, challenges faced, and implications for health educators as policy advocates during and beyond the pandemic.

Maritime doctors’ skills and competencies: A review for policy analysis

Maritime medicine deals with the health of seafarers, fishermen, and offshore employees and, more specifically, with their employment, working and living conditions, and their health and safety at sea. Maritime doctors should have the appropriate training and competencies to provide the equivalent service as would be found on land. This review discusses a) the required skills and competencies of maritime doctors and b) explores the associated ongoing discussions for the establishment of a global accredited Masters programme in maritime health. A literature review was conducted using 2 databases: PubMed and Google scholar. Search terms included: maritime doctors, maritime medicine, occupational health, and skills and competencies. Literature published between 1990 and 2018 was prioritised. Thirty-five articles that discussed the skills, competencies, and education of maritime doctors and health professionals were retrieved, reviewed, and discussed, plus 8 reports and documents from relevant International Organisations webpages. We explored policies in relation to training using i) the health triangle and ii) the Kingdon model. Doctors who serve in the sector should have extensive knowledge about medical practice, but also about the environment of seafaring. The complexity of their roles, coupled with the provision of a high quality of services in global shipping, call for high quality accredited training and harmonisation of maritime health practices. The analysis of policy, using 2 policy models, showed that a window of opportunity appears to be in favour of a policy regarding the recognition of maritime medicine as a medical specialisation. International stakeholders, together with the International Maritime Health Association, should actively advocate such a perspective which will be in favour of seafarers, who will enjoy better health and wellbeing, with higher income while avoiding ill-health, as well as the shipping industry, which will employ satisfied and loyal employees, and will enjoy a higher reputation.

How do Problems get on to the Political Agenda and get Taken Seriously by Policymakers? An Analysis of Climate Change Policy in the US

The issue of climate change is not of the recent past. However, it was late in the nineteenth century in the US that the phenomenon was defined and framed as an issue of public interest by those who say it mattered. The reason was the occurrence of indicators such as a rise in earth temperature and prolonged summer season. The mass displacement of people from their places of inhibits and damages to their properties forced the government to take the issue seriously. A change in the administration in the federal capital, along with pressure from civil society and demand from various groups to resolve the issue of climate change, proved to be something that ultimately led to the resolution of the issue and taken seriously by the government of the day. While answering the question of how the issue of climate change made its way to the agenda-setting stage of policymaking, Jhon Kingdon model of agendasetting has been applied, which is more relevant and acceptable in terms of conceptual logics and the issue at hand.

Our Bodies Our Voice: A case study on utilization of governance streams to change the policy for prevention of sexual violence in universities and the role of grassroots organizations

Sexual violence (SV) is an issue of global importance, with significant prevalence in the EU generally and the Netherlands in particular. Stigma and taboo often result in underreporting and exacerbate the already substantial mental health consequences of SV. Universities are recognized as high-risk settings, but in general awareness, response and prevention in Dutch universities have been limited. This article analyzes a case study of key events over a number of years resulting in policy change and active response in one university in the Netherlands, focusing on the impact and role of the Our Bodies Our Voice foundation, which started as a grassroots student initiative, using the Kingdon model of policy change. The aim is to make explicit how governance streams need to be aligned to place the issue of SV on the agenda of higher educational institutions, and findings highlight the importance of media coverage, advocacy, awareness raising and perseverance on the part of initiatives like OBOV, while building towards a policy window.

A Successful implementation of an idea to a nationally approved plan: Analyzing Iran's National Health Roadmap using the Kingdon model of policymaking.

Introduction: Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking. Methods: Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model. Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described. Results: The followings were done to accomplish the goals of each step: collecting experts’ viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation). Conclusion: In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran’s health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework.