title: Altogether now... understanding the role of international organizations in iCCM policy transfer.
abstract: BACKGROUND
  Policy transfer theories explain how policy ideas move across time and geography and offer an approach to understanding waves of policy change, a common phenomenon in global health. Four primary mechanisms for the transfer of policies from global to national levels are posited: learning, coercion, socialization and competition.
  
  
  METHODS
  We used six concurrent country case studies of policy change for child survival followed by a global study to analyse (1) mechanisms for policy transfer and (2) the roles of international organizations in promoting policy transfer. Our six country cases drew upon early adopters of integrated Community Case Management of Childhood Illness policy (Malawi, Niger), as well as countries that were slower to adopt due either to practical implementation challenges (Mozambique, Mali) and/or policy resistance (Burkina Faso, Kenya). In total, 145 semi-structured interviews and 283 document reviews were conducted across the six country cases, and 25 semi-structured interviews and 72 document reviews for the global study.
  
  
  RESULTS
  Three of the four diffusion mechanisms (learning, coercion and socialization) were important in these cases, but not competition. Multiple strategies were employed by multilateral organizations to support policy transfer, such as regional meetings or academic publications, frequently serving multiple diffusion mechanisms simultaneously (e.g. both learning and socialization). In just one country case, funding conditionalities were used to press for policy change. The emphasis of policy transfer mechanisms varied between early and later adopters. Early adopters, for example, were more likely to engage in learning. International multilateral organizations were active policy transfer agents, and national policy-makers perception of them as "trusted partners" made them well suited for this role. However, on occasion their role became more that of advocates than neutral facilitators.
  
  
  CONCLUSIONS
  International actors use multiple synergistic channels to promote uptake of global health policies in low- and middle-income countries, and tailor strategies employed to country contexts.
authors.affiliation: Health Systems Program, sbennett@jhu.edu.
authors.forename: Sara
authors.initials: S
authors.lastname: Bennett
authors.affiliation: Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD 21205, USA and.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Dalglish
authors.affiliation: African Population and Health Research Centre, Nairobi, Kenya.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Juma
authors.affiliation: Health Systems Program.
authors.forename: Daniela C
authors.initials: DC
authors.lastname: Rodríguez
mesh_terms: D019090:Case Management; D002648:Child; D000067576:Child Health; D003906:Developing Countries; D006291:Health Policy; D006801:Humans; D007391:International Cooperation; D007407:Interviews as Topic; D011050:Policy Making
keywords: iCCM; international organizations; policy transfer