[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-113381-en":3,"doc-seo-113381-105":29,"detail-sidebar-cat-0-en-105":90},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":4,"is_deleted":4,"is_public":20,"is_downloadable":20,"audit_status":20,"page_count":21,"language":22,"language_code":23,"site_id":24,"html_lang":23,"table_of_contents":25,"faqs":26,"seo_title":13,"seo_description":14,"update_tm":27,"read_time":28},113381,1099514067415,"Rowan","https://ap-avatar.wpscdn.com/avatar/100002539d78ffe74a7?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779092875211072502",8,"Research & Report","Generating Political Priority for Primary Health Care Reform in Romania - Research article","The paper analyzes how political priority emerged for comprehensive reforms to improve equitable access to high-quality primary health care (PHC) in Romania. It applies John Kingdon’s model of political agenda setting to trace how the convergence of problems, feasible policy solutions, and broader political developments supported adoption of a government program and a results-based funding instrument. Using gray and peer-reviewed literature, stakeholder consultations, and content analysis, it identifies themes aligned with Kingdon’s dimensions and distills three cross-context lessons for PHC reform.","Public Disclosure Authorized Public Disclosure Authorized  \nHEALTH SYSTEMS & REFORM  \n2021, VOL. 7, NO. 2, e1898187 (10 pages) [https://doi.org/10.1080/23288604.2021.1898187](https://doi.org/10.1080/23288604.2021.1898187)  \nRESEARCH ARTICLE     \nGenerating Political Priority for Primary Health Care Reform in Romania  \nHuihui Wanga, Adanna Chukwuma a, Radu Comsab, Tania Dmytraczenko a, Estelle Gongc, and Lidia Onofreid  \naHealth, Nutrition, and Population Global Practice, World Bank Group, Washington, DC, USA; bIndependent Researcher, Bucharest, Romania; cMount Sinai Health System, New York, New York, USA; dMinistry of Health, Bucharest, Romania  \nABSTRACT  \nThis paper examines how political priority was generated for comprehensive reforms to address inequitable access to high-quality primary health care (PHC) in Romania. We apply John Kingdon’s model of political agenda setting to explore how the convergence of problems, solutions, and political developments culminated in the adoption of a government program that included critical PHC reforms and approval of a results-based funding instrument for implementation. We draw on a review of the gray and peer-reviewed literature and stakeholder consultations, and use content analysis to identify themes organized in line with the dimensions of Kingdon’s model. We conclude this paper with three lessons that may be relevant for generating political priority for PHC reforms in other contexts. First, national PHC reforms are likely to be prioritized when there is political alignment of health reforms with the broader political agenda. Second, the availability of technically sound and feasible policy proposals makes it possible to seize the political opportunity when the window opens. Third, partners’ coordinated technical and financial support for neglected issues can serve to raise their priority on the political agenda.  \nARTICLE HISTORY  \nReceived 16 November 2020 Revised 4 February 2021 Accepted 26 February 2021  \nKEYWORDS  \nEquity; health reform; political agenda setting; primary health care; Romania  \nIntroduction  \nIn 2015, 193 countries in the United Nations General Assembly adopted the Sustainable Development Goals (SDGs), including the target of achieving Universal Health Coverage (UHC) by 2030. This goal of UHC commits countries to guaranteeing access to high-quality basic health services and providing financial risk protection to the entire population. As we enter the last decade before 2030, there are significant challenges in progressing toward UHC. Half of the world does not have access to a basic package of health services.1 An estimated 808 million people incur out-ofpocket payments for health care exceeding 10% of household consumption, pushing 97 million people into extreme poverty every year.2,3 Health reforms guaranteeing access to primary health care (PHC) are a cost-effective approach to comprehensively responding to population health needs, integrating services for communicable diseases, maternal and child health, and non-communicable diseases (NCDs), and ensuring access close to the community.4–7  \nThrough the 2018 Astana Declaration, countries have renewed their political commitment to investing in PHC asthe programmatic engine for accelerating progress toward UHC.7,8 However, in many countries, PHC is in crisis and subject to underdevelopment, underfunding, and lack of  \nhuman resources. Narrow scope and perceived low quality of PHC lead patients to bypass PHC for specialized care despite higher costs of and greater distances to the latter. These challenges are exacerbated by the health financing patterns that prioritize expensive but politically visible hospital reforms.  \nRomania is an example of a country where hospital spending has increased for conditions that are preventable and treatable by timely and effective PHC. Wagstaff and Moreno-Serra9 found that the adoption of social health insurance in Romania increased total health spending and hospital activit","cbCaif0Gn5SRBtFW","https://ap.wps.com/l/cbCaif0Gn5SRBtFW","pdf",520036,1,10,"English","en",105,"# Introduction\n## Universal Health Coverage and PHC challenges\n## Romania’s hospital spending and gaps in access\n# Abstract","[{\"question\":\"What framework does the paper use to explain political priority for PHC reform?\",\"answer\":\"The study applies John Kingdon’s model of political agenda setting to examine how problems, solutions, and political developments converge to enable PHC reform adoption.\"},{\"question\":\"What policy outcomes does the paper focus on in Romania?\",\"answer\":\"It examines adoption of a government program including critical PHC reforms and approval of a results-based funding instrument for implementation.\"},{\"question\":\"What three lessons does the paper conclude for generating political priority for PHC reforms?\",\"answer\":\"First, priority increases when health reform aligns with the broader political agenda. Second, technically sound and feasible proposals help seize political opportunities when a window opens. Third, coordinated technical and financial partner support can raise neglected issues on the political agenda.\"}]",1784503766,25,{"code":4,"msg":30,"data":31},"ok",{"site_id":24,"language":23,"slug":32,"title":13,"keywords":33,"description":14,"schema_data":34,"social_meta":85,"head_meta":87,"extra_data":89,"updated_unix":27},"generating-political-priority-for-primary-health-care-reform-in-romania-research-article","",{"@graph":35,"@context":84},[36,53,67],{"@type":37,"itemListElement":38},"BreadcrumbList",[39,43,47,50],{"item":40,"name":41,"@type":42,"position":20},"https://docshare.wps.com","Home","ListItem",{"item":44,"name":45,"@type":42,"position":46},"https://docshare.wps.com/document/","Document",2,{"item":48,"name":12,"@type":42,"position":49},"https://docshare.wps.com/document/research-report/",3,{"item":51,"name":13,"@type":42,"position":52},"https://docshare.wps.com/document/generating-political-priority-for-primary-health-care-reform-in-romania-research-article/113381/",4,{"url":51,"name":13,"@type":54,"author":55,"headline":13,"publisher":57,"fileFormat":60,"inLanguage":23,"description":14,"dateModified":61,"datePublished":61,"encodingFormat":60,"isAccessibleForFree":62,"interactionStatistic":63},"DigitalDocument",{"name":9,"@type":56},"Person",{"url":40,"name":58,"@type":59},"DocShare","Organization","application/pdf","2026-07-19",true,{"@type":64,"interactionType":65,"userInteractionCount":4},"InteractionCounter",{"@type":66},"ViewAction",{"@type":68,"mainEntity":69},"FAQPage",[70,76,80],{"name":71,"@type":72,"acceptedAnswer":73},"What framework does the paper use to explain political priority for PHC reform?","Question",{"text":74,"@type":75},"The study applies John Kingdon’s model of political agenda setting to examine how problems, solutions, and political developments converge to enable PHC reform adoption.","Answer",{"name":77,"@type":72,"acceptedAnswer":78},"What policy outcomes does the paper focus on in Romania?",{"text":79,"@type":75},"It examines adoption of a government program including critical PHC reforms and approval of a results-based funding instrument for implementation.",{"name":81,"@type":72,"acceptedAnswer":82},"What three lessons does the paper conclude for generating political priority for PHC reforms?",{"text":83,"@type":75},"First, priority increases when health reform aligns with the broader political agenda. Second, technically sound and feasible proposals help seize political opportunities when a window opens. Third, coordinated technical and financial partner support can raise neglected issues on the political agenda.","https://schema.org",{"og:url":51,"og:type":86,"og:title":13,"og:site_name":58,"og:description":14},"article",{"robots":88,"canonical":51},"index,follow",{"doc_id":7,"site_id":24},{"code":4,"msg":5,"data":91},[92,96,100,104,109,114,119,122,127,130,133],{"id":20,"doc_module":4,"doc_module_name":45,"category_name":93,"show_sort_weight":94,"slug":95},"Story & Novel",90,"story-novel",{"id":46,"doc_module":4,"doc_module_name":45,"category_name":97,"show_sort_weight":98,"slug":99},"Literature",80,"literature",{"id":52,"doc_module":4,"doc_module_name":45,"category_name":101,"show_sort_weight":102,"slug":103},"Exam",70,"exam",{"id":105,"doc_module":4,"doc_module_name":45,"category_name":106,"show_sort_weight":107,"slug":108},5,"Comic",60,"comic",{"id":110,"doc_module":4,"doc_module_name":45,"category_name":111,"show_sort_weight":112,"slug":113},6,"Technology",50,"technology",{"id":115,"doc_module":4,"doc_module_name":45,"category_name":116,"show_sort_weight":117,"slug":118},7,"Healthcare",40,"healthcare",{"id":11,"doc_module":4,"doc_module_name":45,"category_name":12,"show_sort_weight":120,"slug":121},30,"research-report",{"id":123,"doc_module":4,"doc_module_name":45,"category_name":124,"show_sort_weight":125,"slug":126},9,"Religion & Spirituality",20,"religion-spirituality",{"id":125,"doc_module":4,"doc_module_name":45,"category_name":128,"show_sort_weight":125,"slug":129},"World Cup","world-cup",{"id":21,"doc_module":4,"doc_module_name":45,"category_name":131,"show_sort_weight":21,"slug":132},"Lifestyle","lifestyle",{"id":134,"doc_module":4,"doc_module_name":45,"category_name":135,"show_sort_weight":105,"slug":136},19,"General","general"]