Presentation by Kadidiatou Kadio (Université de Montréal). Global Health Workshop: Methods For Implementation Science in Global Health. http://www.equitesante.org/implementation-science-methods-in-global-health/

1. Multiple streams framework to analyze the
health social protection program implementation
in Burkina Faso
METHODS FOR IMPLEMENTATION SCIENCE
IN GLOBAL HEALTH
April, 20th. 2017
McGill University
Workshop co-organised by REALISME Chair and McGill Global Health Programs
Kadidiatou Kadio,Ph.D c.

2. Context
 To improve health service access for the poor, a solidarity program was implemented.
 Government gave subsidies to the Community-Based Health Insurance (CBHI )
 CBHI : Community members pool their resources to share the financial risks of
health care, own the scheme and control its management.
 Intervention implementation should make to identify the poor, facilitate joining the
CBHI and provide access to health care

3. Objectives of the study
Major implementation difficulties in relation to access to services, for the program
beneficiaries (the poor).
The implementation of intervention did not take place: The exemption from the
payment of health services was not organized
Why the implementation of the program failed?

4. Method
Multiple Stream Framework (Kingdon's theory): to study public policy agenda-
setting.
Other authors applied MSF to all stages of the policy process
Problems
Politics
Policy
Emergence Formulation
Problems
Politics Policy
Implementation of the intervention is explained by the coupling of the policy stream and
problems stream, by the action of political entrepreneurs who exploit windows of opportunity
Problems
Politics
Policy
Implementation

5. Method
Implementation is defective
Politic stream
Universal health
coverage and
universal health
insurance scheme
Problems stream
The situation of
the exclusion of
the poor and
destitute from the
health services
Policy stream
Abolition out of
the pocket / poor
people to be
affiliated to CBHI
No coupling

6. Results
Why No stream
coupling?
No Policy entrepreneurs to support the removal of any
payment
 Chose to operationalize the solution in the direction of
their interest: to maintain co-payment
Policy window
 Opportunity opened up in the course of the solutions
could not be exploited
Solution of the suppression has not been put in place
 Implementation / operationalization of the solution did
not remove the financial barrier
 Destitute have become members of CBHI but had to
support a co-payment to use the services

7. Lessons learned for
implementation
science in global
health
Strengths
 The MSF is flexible
 Taking into account both national and
international contextual factors,
 Cognitive factors i.e. beliefs, values, and ideas.
 Analytical perspective, helps to understand the
difficulties of implementation.
Limits
 Politics stream subcomponents
 Politics stream more generally.

8. To go further
1. Herweg, N. (2017). Theoretical Approach to the Policy Process: The Multiple Streams
Framework. In European Union Policy-Making (pp. 23-72). Springer International Publishing.
2. Howlett, M., McConnell, A. et Perl, A. (2014). Streams and stages: Reconciling Kingdon and
policy process theory. European Journal of Political Research.
3. Jones, M. D., Peterson, H. L., Pierce, J. J., Herweg, N., Bernal, A., Lamberta Raney, H., &
Zahariadis, N. (2016). A River Runs Through It: A Multiple Streams Meta‐Review. Policy
Studies Journal, 44(1), 13-36.
4. Kingdon, J. W. (1984). Agendas, Alternatives, and Public Policies. Boston, MA: Little, Brown.
5. Lemieux, V. (2002). L'étude des politiques publiques: les acteurs et leur pouvoir.
6. Ridde, V. (2009). Policy Implementation in an African State: An Extension of Kingdon's
Multiple‐Streams Approach. Public Administration, 87(4), 938-954.
7. Zahariadis, N. (2014). Ambiguity and Multiple Streams. Theories of the Policy Process, 25-58.

9. Let’s discuss this together!
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