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Health policy in Turkey: from a thriving past to an uncertain future
Purpose
The purpose of this study is to examine the development and current status of Iran’s biopharmaceutical industry, focusing on the evolution within the industrial, academic and policy sectors and to provide insights that may benefit other developing countries.
Design/methodology/approach
This study uses a qualitative exploratory-descriptive methodology. Data was collected through 18 semi-structured interviews conducted in 2021–2022 with experts from academia, industry and government in the biopharmaceutical field. Furthermore, a review of relevant documents supplemented the interviews, providing a comprehensive analysis of the growth and development of Iran’s biopharmaceutical sector.
Findings
This study reveals significant progress in Iran’s biopharmaceutical industry, characterized by advancements in infrastructure, institutional development and technology. Key findings include effective government policies supporting biopharmaceuticals, increased activity from private knowledge-based companies and the establishment of specialized accelerators. The sector has made notable strides in acquiring and transferring technology, enhancing networking among companies and pursuing export opportunities.
Research limitations/implications
The findings of this study suggest that other developing countries can learn from Iran’s approach to biopharmaceutical development. Emphasis on government support, technology transfer and the creation of supportive institutions can guide similar efforts elsewhere. The focus on networking and export strategies provides practical insights for growing biopharmaceutical sectors in other developing regions.
Originality/value
This research contributes to the understanding of biopharmaceutical industry development in the context of a developing country. This study highlights Iran’s unique strategies and offers a framework for other nations to consider in advancing their own biopharmaceutical sectors. This study’s insights into effective policies and practices provide valuable guidance for both policymakers and industry stakeholders.
This article focuses on how the Turkish state has been responding to limit the public health effects of COVID-19 pandemic to date. It aims to explain and understand the introduction, implementation and effect of health policy instrument mixes. It argues that although ‘presidentialisation’ of executive, and ‘presidential bureaucracy’ under presidential system of government are critical to introduce policies and implement their instrument mixes without delay or being vetoed or watered down which would otherwise occur in the parliamentary system of government, these features of impositional and exclusive policy style pose risks of policy design and implementation failures when the policy problems are poorly diagnosed, their policy solutions are wrong and/or complementary policy instrument mixes implemented ineffectively. However, a temporal, albeit temporary divergence from a dominant administrative tradition and policy style is most likely when a policy issue is esoteric (i.e. technical, scientific and expert-led) and framed as an existential crisis under high uncertainty that require scientific, expert-led, inclusive, early, quick and decisive responses to pressing policy problems.
Motivation
Turkey has been acknowledged as a “successful” example of Universal Health Coverage (UHC) reforms and has recently gained donor “darling status”. While the literature on UHC and health reforms in various countries has increased significantly in recent years, there is still little research on the political dynamics of the rise of UHC in national and global development agendas.
Purpose
This study examines the politics of UHC in Turkey's Health Transformation Program (HTP). It investigates how various policy actors, such as international organizations, policy experts and national political leaders, use UHC framing for different purposes.
Approach & Methods
The paper develops an interdisciplinary conceptual framework that combines elements of ideational scholarship and critical policy analysis. The analysis is based on a review of the secondary literature and primary sources. Qualitative content analysis is used to identify major themes and analyse patterns of interactions across the various policy levels.
Findings
The paper's main findings demonstrate the ways in which international actors and national policymakers engage in policy work and use their relationships, global policy ideas and experiences to build legitimacy and support for their respective agendas. Reforms in Turkey were proposed and implemented before the rise of UHC in the global agenda, suggesting an ex post facto rebranding of its reforms as UHC. For Turkey's policymakers, rebranding worked to tie their policy solutions, summarized in the HTP, to UHC as a widely accepted cultural symbol. The Ministry of Health's deliberate strategy to encourage data collection and monitoring was also a key part of its efforts to construct a success narrative in collaboration with global policy actors. For the global‐level advocates of UHC, Turkey provided evidence that UHC works. Before it became a target under the health‐related Social Development Goals (SDGs), advocates needed to demonstrate that they had the right framing and metrics for a UHC agenda. After 2015, successful examples have served as strategic tools for building support and political momentum as the agenda was diffused, and as these diverse agendas and interests overlapped.
Policy Implications
This article contributes to the current debates on policy diffusion, translation and implementation of the UHC agenda. It unpacks the use of success stories to navigate the political dynamics among national governments and global policy communities. Success stories, alongside an emphasis on country ownership, may serve to encourage the co‐production of policy across local, national and global levels.
Purpose
The purpose of this paper is to investigate physicians’ response to reforms in Turkey on the basis of their experience of the changes in the daily work environment. It aims to bridge the gap between health policy and sociology of professions literatures to explain why some public-sector physicians have opposed the recent reforms.
Design/methodology/approach
The research adopts a qualitative methodology including semi-structured interviews and content analysis. The fieldwork involves collecting information through written documents and interviews with 23 physicians working in public tertiary hospitals in one large city.
Findings
Physicians’ response combines a concern with material interests, previously conceptualized in terms of erosion of autonomy, with anxiety over damage to their professional image and social status. The particular reform discourse adopted by policymakers disrupts the existing constructions of harmony in the professional discourse between the public and professional interests, and between social value and material interests.
Research limitations/implications
One major limitation of this paper is its exploratory nature and analysis based on one case study. Future studies that adopt a cross-country comparative approach could help addressing concerns of limited generalizability.
Originality/value
Earlier social science literature on health reforms has explained physicians’ opposition in terms of protecting their professional self-interest and fighting against any regulation that could limit their income or autonomy. The paper adopts a broader definition of interests that goes beyond this materialist conception and includes subjective ideas about interests such as values and beliefs about how they serve the public interest. This definition allows us to unpack the relationship between interest and autonomy.
Turkey has maintained liberal contraception and abortion policies since the 1980s. In 2012, the government proposed to restrict abortion; a bill limiting abortion was later drafted but never passed into law. Since the proposed restriction, women have reported difficulty accessing abortion services across Turkey. We aimed to better understand the current availability of abortion and reproductive health services in Istanbul and explore whether access to services has changed since 2012. In 2015, we completed 14 in-depth interviews with women and 11 semi-structured interviews with key informants. We transcribed all interviews and completed content and thematic analyses of the data. Key informants had good knowledge about the political discourse and the current abortion law. In contrast, women were familiar with the political discourse but had mixed information about the current status of abortion and were unsure about the legality of their own abortions. There was consensus that access to services has become more limited in the last five years due to the political climate, thus advocacy to prioritize reproductive health services, and abortion care in particular, in the public health system are needed.
This study focuses on the institutional history of family planning in Turkey and the ways it shaped the discursive trends to state ends. Family planning has been used to this day for different purposes under changing socio-economic circumstances, from the establishment of the Turkish Republic until the present day. The state policy has utilized family planning for promoting reproduction, thus maintaining a certain population growth in the early decades of the Republic, while the emphasis changed over time from pronatalist policy to the anti-natalist policy making, especially after the 1960s. In all periods, feminist sensitivities and gender specific considerations have never been granted their due importance. With the contemporary focus on neo-liberal health reforms, family planning has been further marginalized in state discourse. © 2014 The Editor(s) (if applicable) and the Author(s). All rights reserved.
Turkey is undertaking comprehensive reforms in its healthcare sector which bring about a major transformation in the boundaries between the public and private sectors. As in many transition and late-developing countries reforms seek to universalize coverage, increase efficiency and improve quality of healthcare services. The Turkish case is interesting as it draws attention to the balance that is being struck between two major components of the reforms, namely marketization and universalism. Expansion of coverage and improvements in equity are taking place alongside state-induced market and managerial reforms. This article assesses the extent of marketization and argues that while market elements have been limited to the provision dimension, in the long run they may lead to some erosion in universalism. The Turkish case serves as an example of transformations in developing countries where market reforms have to be accompanied by a strong and active state for universalism to be achieved.
This article presents a comparative analysis of the social role of two voluntary associations of Turkish businessmen: TUSIAD (The Association of Turkish Industrialists and Businessmen) and MUSIAD (The Association of Independent Industrialists and Businessmen). These associations are approached both as mechanisms of interest representation and as agents of two different class strategies. Hence, the article highlights two types of organizational activities that accompany interest articulation and representation: first, the activities which seek to bind the “bearers of interest” or “members of class” into coherent communities, and second, those aimed at the promotion of particular macro-level social projects.
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