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Table 2 Summary of factors playing a role in policy-development process for Syrian refugees

From: The governmental health policy-development process for Syrian refugees: an embedded qualitative case studies in Lebanon and Ontario

Factor Policy: Lebanon’s Health Response Strategy (2016) Policy: Phase 2 of Ontario’s Health System Action Plan (2016)
Policy development Institutions Government structures
• The Health Response Strategy fell under the sole jurisdiction of the MoPH because of is technical nature (e.g., analysis of health needs, MoPH guidelines for health institutions, budget allocations), which meant that it effectively faced no opposition in decisions about supporting Syrian refugees
Policy networks
• MoPH convened a National Health Steering Committee, that comprised of major international and local partners, to inform the policy-development process
Policy legacies
• Past Palestinian refugee camp policies resulted in an interpretive effect among the Lebanese where by camps were perceived as sources of insecurity, radicalisation and armed groups, and as places to be avoided. In order to avoid these problems, Syrian refugees have been integrated into communities; however, this has placed a strain on the health system, necessitating this strategy to help address their health needs
Government structures
• Ontario’s first-past-the-post system meant that a majority Liberal government, elected in 2014, was able to act on the federal Liberal government priorities of accepting Syrian refugees without significant chance for derailment from opposition parties (i.e., it faced no veto points)
Policy networks
• Liberal government convened round-table discussions with key societal actors (e.g., Canadian Red Cross, Canadian Centre for Refugee and Immigrant Healthcare, and Crossroads Clinic for Refugees) to inform the policy-development process
Policy legacies
• Past restrictive Federal government Conservative Party immigration policies resulted in an interpretive effect among Ontarians that a more balanced immigration policy was needed for vulnerable refugees in need of assistance, especially given Canada is comprised of many immigrants who immigrated to Canada in search of a better life
Interests Societal interest groups
• Some actors drew on their practical experiences in Syria and in Lebanon to lobby government about their preferred approaches to addressing the health needs of Syrian refugees
Societal interest groups
• Some actors drew on their practical experiences in Syria and in Canada to lobby government about their preferred approaches to addressing the health needs of Syrian refugees
Ideas Values about ‘what ought to be’
• Lebanese values of providing safety for displaced people underpinned the policy-development process
Knowledge/beliefs about ‘what is’
The government drew on inputs from a variety of sources, many of which were informed by research evidence and other types of information, such as
• Lessons were drawn about how to prevent and manage future infectious disease outbreaks among Syrian refugees from prior management of measles, hepatitis A, and Leishmaniasis disease outbreaks in 2015
• Data was obtained from two main sources: first, MoPH databases (e.g., Maternal Neonatal Mortality Notification System) that included data on service utilization, human resources, immunization coverage, and disease prevalence related to displaced Syrians. Second, reports from other organizations (e.g., Johns Hopkins’ Syrian refugee’s health access survey (2015), UN Vulnerability Assessment of Syrian Refugees, and World Bank assessments) about the health needs of Syrian refugees (e.g., access to PHC services, etc.)
• Analysis of NGOs’ funding initiatives demonstrated that 45% of donor funds were spent on organizational overhead costs, prompting the policy-development process to appropriately align funds and human resources and reduce overhead costs
• Information from the Lebanon crisis response plan (2015–2016) helped inform sections of the Health Response Strategy (e.g., Primary healthcare (PHC) budget that included funds allocated to support mental health needs of Syrian refugees, etc.)
• Tacit and experiential knowledge obtained from addressing health needs of the Palestinian refugees
Values about ‘what ought to be’
• Ontarians values such as inclusion and fairness underpinned the policy-development process
Knowledge/beliefs about ‘what is’
The Ontario government drew on inputs from a variety of sources, many of which were informed by research evidence and other types of information, such as
• Lessons were drawn about how to manage the health needs of Syrian refugees ‘within routine practices’ from the implementation of Phase 1 Ontario’s Health System Action Plan (2015) that primarily focused on addressing the health needs of Syrian refugees upon arrival in Ontario (e.g., primary-care provision at Toronto Pearson International Airport, which acted as the point-of-entry for refugees)
• Existing research evidence were drawn that included cross-sectional disease prevalence studies among Syrian refugees in other contexts (e.g., Jordan, Lebanon, Turkey), Canadian-adapted Sphere emergency social-services guidelines about shelter and about transportation to healthcare facilities, and medical guidelines from ‘on the ground’ organizations (e.g., at Médecins Sans Frontières, United Nations High Commissioner for Refugees)
• Tacit and experiential knowledge obtained through direct contact with field personnel in Jordan and Syria was used in specific and direct ways to learn about health needs and how best to provide linguistic services (e.g., Arabic interpretations) and culturally appropriate services (e.g., dietary needs)
• Data about the humanitarian response plans inside of Syria was obtained from reports from other organizations (e.g., International Organization for Migration)
• Insights on culturally appropriate ways of providing healthcare was obtained from conversations with newly arrived Syrian refugees
External factors International donors
• International donors (e.g., the European Union) targeted priorities (e.g., maternal & child health) influenced the focus of the strategy. The policy-development process was intended to increase and align donor funds to specific health outcomes
Media coverage
• Photo of Alan Kurdi, a 3-year-old Syrian boy who drowned on 2 September 2015 in the Mediterranean Sea when his family was escaping Syria into Europe, became a focusing event among Ontarians and the governing Ontario Liberal party that accelerated the policy-development process