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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health Johannesburg, May 2015 / Worldwide, an estimated 800 women die each day from preventable causes related to pregnancy and childbirth, the majority in low-and middle-income countries (WHO, 2014:1). The Safe Motherhood Initiative (SMI) aims to achieve safe pregnancies and childbirth, but maternal mortality remains a significant problem in Botswana. Aim and Objectives: The aim of this study was to analyse the implementation process of the SMI policy in Botswana, with specific reference to the training component. The specific objectives of the study were to: describe the context of policy implementation; analyse the content of the SMI policy guidelines; describe the process of implementation of the 2005 SMI policy guidelines; describe the key policy actors, their roles and their influence on the implementation of the policy; and describe the factors influencing the implementation of the SMI policy in Botswana. Methods: The study used a contemporary health policy analysis framework. During 2008, key informants were selected purposively in the southern health region of Botswana. Following informed consent, 12 in-depth interviews were conducted with key informants to obtain their views and perceptions of the content, context, process and the actors of the SMI policy implementation process. The data were analysed using thematic content analysis. Results: The study found that there was high level government commitment, with the SMI driven by the Ministry of Health. Key successes of the SMI policy included: the integration of the Prevention of Mother-to-Child Transmission (PMTCT) of HIV component into the SMI policy, the integration of SMI into the midwifery curriculum and the development, standardisation and distribution of reference manuals or protocols. However, legislative and health system barriers, as well as unsustainable funding, insufficient consultation with and support by stakeholders, and inadequate coordination of the policy process hindered the successful implementation of the SMI policy. Conclusion: The findings draw attention to the value of stakeholder involvement in policy formulation and implementation; the importance of addressing policy implementation barriers and resource availability; and the need for effective coordination and communication.

This thesis explores in which ways and why research informs and influences the public policy making process, and the extent to which existing theories and models add to our understanding of this. Since the late 1990s, the UK government has aspired to evidence-based policy making, particularly policy that is informed by research on what works. In practice, there are many barriers to this aspiration and the instrumental research use of 'what works' knowledge seems relatively rare. Existing research utilisation models offer some insights into why this is the case but they are not well supported by empirical evidence and they tend to underplay the complexities of the policy making process. Additional insights are provided by the literature on the policy process, but this does not pay much attention to research use. This thesis thus combines these perspectives. The thesis is guided by a conceptual framework that combines insights from the advocacy coalition framework (ACF), the stages heuristic, the research utilisation typology, practical rationality and the epistemic communities framework. Two qualitative case studies of Scottish national mental health policy making are considered using this conceptual framework: a suicide prevention policy and a review of mental health law. Data analysis combines 23 in-depth interviews and extensive document review. The ACF is used as a heuristic device to focus on aspects of the policy sub-system that are key to understanding research use. The findings demonstrate that despite limited research evidence on what works in mental health, research was used in the agenda setting and formulation stages of the policy making process, enriching the process and influencing policy sub-system dynamics. Five types of research use are identified; they do not occur in isolation but are layered and interlinked, and are at times contingent on one another. Research use is found to be bound up with the ways in which those involved in the policy making process work with others who share or oppose their policy beliefs, using similar or different knowledge bases. Research influenced policy beliefs, which in turn influenced policy making behaviour. Discussion of research enabled the inclusion, consideration and appreciation of new and different policy positions. It empowered weaker coalitions as well as cementing coalition dominance. It influenced policy direction and encouraged innovation and policy learning. The findings indicate that the current common usage of three categories of research use (instrumental, conceptual and political) may be too crude; real benefit was gained from applying Weiss' original seven research use types. Combining Weiss' research utilisation typology with the ACF deepened understanding of how research influences the policy making process. The findings only partially support the ACF hypotheses concerning research use, and they highlight weaknesses in a number of the ACF's assumptions and definitions. In terms of policy implications, the findings indicate a need to broaden governments' view of research use from an almost exclusive focus on the problem-solving use of 'what works' research knowledge to a wider appreciation of the ways in which research contributes to and enhances policy making.

The basis of this study was my belief that the introduction of the present privacy legislation had been done in such a "try and see" manner. To me, the whole process "begged" for a much closer look to try to understand the rationale behind successive governments' decisions on this policy initiative. I begin my look at the process from the 1960s as this is when general public concern for the security of personal information was high. I then move to the introduction of the proposed Australia Card and its demise and then to the present. Then, with reference to the "classic" policy analysis authors, I show that the implementation of federal privacy laws in Australia was an excellent example of how not to go about convincing the public the new laws would offer the protection they, the public, sought. I also explore the reasons behind negative lobbying by certain non-government sector interests to demonstrate how this sector has influenced government thinking. As an example of the study of a policy issue this thesis shows the effect a lack of planning, and a terrible lack of communication, can have on the introduction of any new legislation. Much of this is due to the fact that the real issue behind the introduction of privacy legislation was that of increasing taxation revenue and not the protection of individuals' privacy. The privacy legislation was the "sweetener" the government believed was needed to satisfy the general public's concerns so that the government could achieve the desired result for its taxation revenue policy.

Presidential policy making in Congress is a lengthy, difficult process that involves developing a policy initiative, proposing it to Congress, and winning the legislature’s support. Recent empirical findings indicate that, although centralizing the policy making process eases a president’s managerial burdens, it may also decrease the likelihood of presidential policy success in Congress. Alternatively, decentralizing the process increases the likelihood of policy success, but constrains the president’s discretion over policy substance and incurs greater administrative burdens in the form of managing differing viewpoints, contradictory interests, and increased information flow. Such findings present an intriguing puzzle: how can presidents balance their managerial and information needs and costs to maximize their policy success in Congress? Solving this presidential dilemma can have substantial payoffs for the White House. I argue that agency input provides presidents with a degree of bureaucratic expertise and objectivity, process transparency, and agency support, which imbues presidential proposals with bureaucratic legitimacy and aids their passage into law. To test my hypotheses, I conduct a series of empirical analyses of pooled cross-sectional logistic regression models using a dataset on presidential legislative proposals over the period of 1949-2007. I find that agency input and presidential signaling are key components to increased presidential policy success in Congress. I also find that the employment of agency input for policy development decreases the number of changes made to the substance of a presidential initiative from its proposal stage to its passage into law. Because the substance of a proposal matters, sending a stronger signal for a proposal developed with agency input should have a stronger, positive influence on legislative success. To explore this possibility, I also incorporate the role that voluminous presidential signaling plays at high levels of agency input and find that it has a particularly potent, positive influence on legislative success and on lowering the extent of change to policy substance in the Senate. In light of these findings, I prescribe a new policy making strategy with agency input at its core. My conclusions should also provide an impetus for scholars to reconsider conventional wisdom regarding presidential-bureaucratic management and legislative policy making.

The study was to explore the degree of involvement of teacher union in the policy decision ¡Ðmaking process of the education authorities at the central and local level, to analyze the strategies the unions adopted during the participation, and to identify the viewpoints of these involvement from the related people, including policy decision-makers, legislators, and union leaders. Then, a theoretical model of teacher union¡¦s involvement in the decision-making process was testified against the cases in Taiwan. Finally, through the consultation with the experiences of UK and USA, an ideal operational model would be proposed for teacher unions around the island. To achieve the above aims, the researcher adopted documentary analyses and questionnaire survey as the major research methods. The questionnaire was developed by the researcher based upon the literature review and documentary analyses. Surveyed sample of the central level included standing members and executive staff of the National Teacher Union(NTU), congressmen belonging to the Education and Culture committee of the country¡¦s Congress, employees of the Ministry of Education. Surveyed sample of local level included standing board members and executive staff of eight local teacher unions, county councilors belonging to the county council¡¦s education section, local PTA members, and employees of local education authorities. The following 13 findings have been concluded: 1. Staff of the NTU cited the budgeting and management of education finance and the enactment of educational personnel regulations the most-often involved topic by the staff. 2. The perception of NTU¡¦s staff regarding the organization¡¦s involvement was ¡§high level of involvement, low degree of satisfaction,¡¨ which could lead to the more radical approach by NTU while dealing with the education authority in the future. 3. A more radical embarrassmen approach and a mild information approach were considered suitable measures by the NTU¡¦s staff while negotiating with the central education authority. 4. Much more policy makers than NTU¡¦s staff considered the NTU¡¦s role in the policy making process active. 5. All sample agreed that NTU use the information approach to influence the policy making most frequently. 6. Either central or local level, all sample regarded information approach and the alliance approach the two most appropriate measures. 7. All local sample considered the involvement of local teacher union was restricted to those sphere relating to the teacher¡¦s rights and privileges. 8. Local teacher union staff expressed ¡§low level of involvement, low degree of satisfaction¡¨ of their participation in the local policy decision-making process. 9. Compared with NTU, local teacher union showed limited use of different approaches of lobbying. 10. Alliance approach and information approach were considered by all sample the most used measures by the local teacher unions. 11. Local teacher union staff considered information approach the most appropriate measure in lobbying the policy makers, nevertheless, they showed willingness to utilize other approaches. 12. There were significant difference between the perceptions of PTA and local union staff concerning the teacher union¡¦s involvement in the policy making process. 13. County councilors¡¦ needs for educational information was extremely high, as a result, they showed support for the local teacher union¡¦s use of information approach in lobbying. Finally, 12 suggestions were provided to teacher unions at both central and local level as well as the education authorities by the researcher.

Depuis les années 1990, un changement semble être intervenu dans les politiques du risque inondation en France. Les aménagements de protection qui prévalaient depuis le XIXe siècle ont été remis en cause et l'inondation a été requalifiée comme un phénomène inévitable voire bénéfique pour l'environnement. Les discours de politique publique relatifs à la culture du risque ont remplacé ceux présentant le risque inondation comme un enjeu de sécurité publique. Les instruments d'action publique ont également changé. Les aménagements visant à inciter les riverains à vivre avec le risque inondation ont succédé à la construction de digues de protection. Notre thèse questionne la portée de ce changement d'action publique dans le domaine du risque inondation à travers l'étude d'une politique territoriale sur le Rhône. À cette fin, nous retraçons la genèse d'un instrument d'action publique, la restauration de zones d'expansion de crues, dans les forums internationaux et européens. Nous rendons compte de la traduction de cet instrument opérée sur le Rhône par une coalition de réformateurs promouvant une nouvelle problématisation des inondations. Nous suivons les controverses qui se sont déployées autour de la mise en œuvre de cet instrument localement, qui sont autant de traductions concurrentes de ce dernier. Enfin, nous questionnons les effets de l'abandon de cet instrument sur la politique territoriale, sur l'institution qui l'a porté, et sur le changement d'action publique annoncé. / Since the 1990s a shift occurred in the policies of flood risk in France. The protection structures that had been prevailing since the 19th century were questioned, and flooding was redefined as an unavoidable and beneficial for the environment. Public policy discourses about risk culture have replaced those of flood risk as an issue of public safety. The policy instruments have also changed. Facilities to encourage residents to live with flooding replaced major dykes building. The thesis questions the extent of this policy shift in the field of flood risk through the study of a local policy on the Rhône River. To that end, we retrace in international and European fora the origin of a policy instrument typical of this policy shift: the restoration of floodplains. We analyze the adaptation of this instrument to the Rhône as an opportunity for a coalition to support a new definition of floods locally. We follow the controversies and conflicts that developed around the implementation of this instrument. Finally, we question the impact of the abandonment of this instrument on the local policy itself, on the legitimacy of the coalition and on the policy shift announced.