Kingdon's Multiple Streams Theory Research Articles

Why Was the Policy Idea on the Health Benefits Package Advisory Panel Gazetted in Kenya? A Retrospective Policy Analysis.

In 2018, Kenya's Ministry of Health (MoH) gazetted the Health Benefits Package Advisory Panel (HBPAP) to develop a benefits package for its universal health coverage (UHC) programme. In this study, we examine the political process that led to the gazettement of the HBPAP. We conducted a case study based on semi-structured interviews with 20 national-level participants and, reviews of documents such as organizational and media reports. We analyzed data from the interviews and documents thematically using the Braun and Clarke's six step approach. We identified codes and themes deductively using Kingdon's Multiple Streams Theory which postulates that the successful emergence of a policy follows coupling of three streams: the problem, policy, and politics streams. We found that the problem stream was characterized by fragmented and implicit healthcare priority-setting processes that led to unaffordable, unsustainable, and wasteful benefits packages. A potential policy solution for these problems was the creation of an independent expert panel that would use an explicit and evidence-based healthcare priority-setting process to develop an affordable and sustainable benefits package. The political stream was characterized by the re-election of the government and the appointment of a new Cabinet Secretary for Health. Coupling of the problem, policy, and political streams occurred during a policy window that was created by the political prioritization of UHC by the newly re-elected government. Policy entrepreneurs who included health economists, health financing experts, health policy analysts, and health systems experts leveraged this policy window to push for the establishment of an independent expert panel as a solution for the issues identified in the problem stream. They employed strategies such as forming networks, framing, marshalling evidence, and utilizing political connections. Applying Kingdon's theory in this study was valuable in explaining why the HBPAP policy idea was gazetted. It demonstrated the crucial role of policy entrepreneurs and the strategies they employed to couple the three streams during a favourable policy window. This study contributes to the body of literature on healthcare priority-setting processes with an unusual analysis focused on a key procedural policy for such processes.

An Analysis of the Adoption and Implementation of A Sugar-Sweetened Beverage Tax in South Africa: A Multiple Streams Approach

ABSTRACT This paper describes a case study of the adoption and implementation of the sugar-sweetened beverage tax in South Africa, termed the Health Promotion Levy. Qualitative data extraction and analysis of institutional documents, such as policy proposals and parliamentary debate records, stakeholder submissions to Parliament and media reports, were guided by the Kingdon Multiple Streams Theory as adapted to study agenda setting, policy adoption, and implementation. We present the following key findings: First, consistent messaging from policy entrepreneurs, consisting of advocacy groups, health organizations, and research entities, was key to ensuring that a tax policy solution was proposed and passed. Second, the continuity of certain key policymakers contributed to the relatively expedient passage of the tax policy. Third, the use of an excise tax was, amongst others, an appealing policy solution because of its revenue-raising potential; however, uncertainty regarding the purpose of the tax negatively impacted public attitudes toward it. Fourth, industry arguments, relating to unemployment, were effective in restructuring the tax in favor of industry actors. Finally, regulatory action by sectors outside of finance and health impacted stakeholder perceptions of the tax and possibly obstructed regular annual adjustments for inflation.

Punctuating the equilibrium: A lens to understand energy and environmental policy changes

Punctuating the equilibrium: A lens to understand energy and environmental policy changes

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

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.

The Health Policy Process in Vietnam: Going Beyond Kingdon's Multiple Streams TheoryComment on "Shaping the Health Policy Agenda: The Case of Safe Motherhood Policy in Vietnam".

This commentary reflects upon the article along three broad lines. It reflects on the theoretical choices and omissions, particularly highlighting why it is important to adapt the multiple streams framework (MSF) when applying it in a socio-political context like Vietnam's. The commentary also reflects upon the analytical threads tackled by Ha et al; for instance, it highlights the opportunities offered by, and raises questions about the centrality of the Policy Entrepreneur in getting the policy onto the political agenda and in pushing it through. The commentary also dwells on the implications of the article for development aid policies and practices. Throughout, the commentary signposts possible themes for Ha et al to consider for further analysis, and more generally, for future research using Kingdon's multiple streams theory.

Introducing New Priority Setting and Resource Allocation Processes in a Canadian Healthcare Organization: A Case Study Analysis Informed by Multiple Streams Theory.

In this article, we analyze one case instance of how proposals for change to the priority setting and resource allocation (PSRA) processes at a Canadian healthcare institution reached the decision agenda of the organization's senior leadership. We adopt key concepts from an established policy studies framework - Kingdon's multiple streams theory - to inform our analysis. Twenty-six individual interviews were conducted at the IWK Health Centre in Halifax, NS, Canada. Participants were asked to reflect upon the reasons leading up to the implementation of a formal priority setting process - Program Budgeting and Marginal Analysis (PBMA) - in the 2012/2013 fiscal year. Responses were analyzed qualitatively using Kingdon's model as a template. The introduction of PBMA can be understood as the opening of a policy window. A problem stream - defined as lack of broad engagement and information sharing across service lines in past practice - converged with a known policy solution, PBMA, which addressed the identified problems and was perceived as easy to use and with an evidence-base from past applications across Canada and elsewhere. Conditions in the political realm allowed for this intervention to proceed, but also constrained its potential outcomes. Understanding in a theoretically-informed way how change occurs in healthcare management practices can provide useful lessons to researchers and decision-makers whose aim is to help health systems achieve the most effective use of available financial resources.

Understanding Policy Reform in Colorado's Domestic Violence Offender Treatment Standards

AbstractThis study examines the perceived conditions leading to Colorado adopting revised Standards for treating domestic violence offenders from the perspective of Kingdon's multiple streams theory. A within‐case analysis of ten semi‐structured interviews explores the Domestic Violence Offender Management Board in Colorado's process for revising Colorado's 2001 Treatment Standards. Findings suggest a benign political stream, supported by technically feasible and value‐accepted policy ideas, feedback and indicators of the problem, promoted a favourable setting for change. At least two policy entrepreneurs championed the decision‐making process. Agenda setting and policy formulation depended on three elements: feedback from existing programmes, indicators of continued difficulty in effectively treating offenders, and the existence of a suitable policy alternative. This study contributes a rare application of multiple streams theory to a criminal justice context in a sub‐national government. Future research should explore whether the presence of a benign political stream influences the development and revision of domestic violence policy in other policy environments.

The application of Kingdon's Multiple Streams Theory for human papillomavirus-related anal intraepithelial neoplasia.

This paper presents a discussion of the advantages and disadvantages of redefining human papillomavirus-related anal intraepithelial neoplasia as a problem of sexually active people by using Kingdon's Multiple Streams Theory to examine possible policy solutions for increasing anal cancer screening. Human papillomavirus is the most common sexually transmitted infection worldwide. Anal cancer associated with human papillomavirus infections is increasing in incidence in both men and women. The prevalence of anal cancer does not decrease with age. Pubmed was searched for articles and internet references from 1995-2012. Although a large body of literature suggests that human papillomavirus-related anal intraepithelial neoplasia is a problem, no effective policy solutions have emerged. However, as almost the entire sexually active population is exposed to human papillomavirus, it should be thought of as every person's problem. This suggests that human papillomavirus-related anal intraepithelial neoplasia calls for different types of problem definitions and policy solutions to address the disease. The issue of anal cancer is typically defined as a problem of HIV-positive individuals. Nurses are focused on improving patient outcomes. We play a key role in helping to identify problems, moving problems onto policymaker's agendas, and influencing the creation of new healthcare policies. Human papillomavirus-related anal intraepithelial neoplasia demands attention and the development of national level policies to ensure public health and safety. Kingdon's Multiple Streams Theory has provided a pragmatic framework to evaluate the problem.

Conceptual Innovation and Public Policy: Unemployment and Paid Leave Schemes in Denmark

The Danish paid leave schemes of the early 1990s are an important innovation in labour market policy because they not only directly reduce unemployment but also contribute to achieving other economic and social goals. In this article we investigate why they were brought into being by tracing their development to identify the salient causal influences on the crucial decisions from a historical point of view, then evaluate the extent to which contemporary policy-making approaches can account for these results. Our analysis shows that a number of factors influenced the development of the schemes, including the rise in unemployment, public opinion, parties, institutions and policy learning. The role of conceptual innovation was especially important. Overall the policy-making process can be best understood in terms of John Kingdon's multiple streams theory.