440 From intentions to impact: analysing the agenda-setting process for India’s national burns program

<h3>Background</h3> Burns is a major public health problem in India with high burden of mortality, disability, and catastrophic health expenditure. In response, the union government of India started a national program on prevention and management of burn injuries (NPPMBI). However, after a decade of NPPMBI, health systems and policy response to burns is still limited. <h3>Objective</h3> This study analyses agenda-setting for India’s national burns program, to understand the factors contributing to program design, implementation, and outcome. <h3>Policy Analysis</h3> We conducted a retrospective policy analysis of burn program agenda setting using qualitative methods. The study was conducted in India involving the stakeholders in the national policy response to burns. The data was derived from two sources: document reviews and key informant interviews with purposively selected stakeholders. The READ (Readying material, Extracting data, Analysing data and Distilling findings) approach was used for document reviews, and qualitative thematic analysis was done to analyse both, documents and interviews. A combination of the policy prioritisation and issue-framing framework formed the basis for the final analysis. <h3>Policy Implications</h3> The findings suggest three critical features of burns care policy prioritisation in India: challenges of issue characteristics and framing, divergent portrayal of ideas as social or health issues, and overt centralisation of the health policy agenda and process in a federal governance structure. First, lack of credible indicators on the magnitude of the problem and evidence on interventions as well as limitations in framing, limited advocacy, and agenda-setting. Second, policy response to burns has two dimensions in India: response to gender-based intentional injuries and healthcare response. While intentional burns have received policy attention, the healthcare response was limited until the national program was initiated in 2010 and scaled up in 2014. Third, overt centralisation of actors and policy process and the vertical nature of policy implementation, contributed to program limitations. <h3>Conclusions</h3> These findings suggest new dimensions to analyse health policy prioritisation, especially when health issues with significant burdens do not get priority, even with a national program. Based on this analysis, we recommend a bottom-up approach for a national program process in India from the outset.