| dc.description.abstract | There have been increased calls for low- and middle-income countries to develop community health systems (CHS)
policies or strategies. However, emerging global guidance brackets the inherent complexity and contestation of policy
development at the country level. This is explored through the case of Zambia’s 5-year Community Health Strategy (CH
Strategy), formulated in 2017 and then summarily withdrawn and reissued two years later, with largely similar content.
This paper examines the events, actors, and contexts behind this abrupt change in the Strategy, through an analysis of
documentary sources and interviews with 21 stakeholders involved in the policy process. We describe an environment
of contestation, characterised by numerous international partners weighing in on the CH Strategy, interfacing with
shifting loci of responsibility for the CHS in the Ministry of Health (MoH). Despite the rhetoric of participation,
providers and communities played no part in the policy process. These dynamics created the conditions for the abrupt
change in strategy, illustrating the inherently fraught and political nature of policy development on the CHS in many
countries. Going forward, we conclude that paying attention to processes of CHS policy development, and in particular
the interaction between events, actors, and contexts, is as important as ensuring meaningful policy content. | en_US |
