ArticleBMC health services research2021
Synergies and fragmentation in country level policy and program agenda setting, formulation and implementation for Global Health agendas: a case study of health security, universal health coverage, and health promotion in Ghana and Sierra Leone.
Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- Reframing preventive health communication: from individual compliance to collective action.Frontiers in public health · 2026Article
- Political prioritization of prevention of mother-to-child transmission of HIV and syphilis: a qualitative comparative policy analysis in Ghana, Mozambique, and Sudan.Frontiers in public health · 2026Article
- Synergising universal health coverage and global health security in the Western Pacific Region.Journal of global health · 2025Article
- Identifying the opportunities and barriers: a cross-sectional review of the health development coordination mechanisms in the World Health Organization African Region.Frontiers in public health · 2025Article
- Synergies and dis-synergies between universal health coverage and global health security: A case study of Cambodia.Journal of global health · 2024Article
- Politics-evidence conflict in national health policy making in Africa: a scoping review.Health research policy and systems · 2024Article
- Expert Opinions about Barriers and Facilitators to Physical Activity Participation in Ghanaian Adults with Type 2 Diabetes: A Qualitative Descriptive Study.Sports (Basel, Switzerland) · 2023Article
- A critical look at synergies and fragmentations of universal health coverage, global health security, and health promotion in delivery of frontline health care services: A case study of Bangladesh.The Lancet regional health. Southeast Asia · 2022Review
- Beyond Lassa Fever: Systemic and structural barriers to disease detection and response in Sierra Leone.PLoS neglected tropical diseases · 2022Article
- Exploring system drivers of gender inequity in development assistance for health and opportunities for action.Gates open research · 2022Article
- Critical barriers to sustainable capacity strengthening in global health: a systems perspective on development assistance.Gates open research · 2022Article
- On the resilience of health systems: A methodological exploration across countries in the WHO African Region.PloS one · 2022Article
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Authors and funding
6 authors.
Funding
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Abstract
backgroundGlobal health agendas have in common the goal of contributing to population health outcome improvement. In theory therefore, whenever possible, country level policy and program agenda setting, formulation and implementation towards their attainment should be synergistic such that efforts towards one agenda promote efforts towards the other agendas. Observation suggests that this is not what happens in practice. Potential synergies are often unrealized and fragmentation is not uncommon. In this paper we present findings from an exploration of how and why synergies and fragmentation occur in country level policy and program agenda setting, formulation and implementation for the global health agendas of Universal Health Coverage (UHC), Health Security (HS) and Health Promotion (HP) in Ghana and Sierra Leone. Our study design was a two country case study. Data collection involved document reviews and Key Informant interviews with national and sub-national level decision makers in both countries between July and December 2019. Additionally, in Ghana a stakeholder workshop in December 2019 was used to validate the draft analysis and conclusions.
resultsNational and global context, country health systems leadership and structure including resources were drivers of synergies and fragmentation. How global as well as country level actors mobilized power and exercised agency in policy and program agenda setting and implementation processes within country were also important drivers.
conclusionsThere is potential in both countries to pull towards synergies and push against fragmentation in agenda setting, formulation and implementation of global health agendas despite the resource and other structural constraints. It however requires political and bureaucratic prioritization of synergies, as well as skilled leadership. It also requires considerable mobilization of country level actor exercise of agency to counter sometimes daunting contextual, systems and structural constraints.
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