Kingdon's multiple stream model used to analyze health policies: applicability, contribution and limits

Abstract

This study aimed to identify the scientific production on health policy analysis that use Kingdon's model of multiple streams, and to examine the model's contributions and limits in the study of public health policies, in the SUS context. An integrative review of publications using the keywords Model Kingdon, multiple streams model "modelode múltiplos fluxos" and health public policy was made at the following databases: ProQuest, Portal de Periódicos and Banco de Teses e Dissertações (from CAPES) and Scientific Electronic Library Online. Inclusion criteria were: complete studies in Portuguese and English, available online in the databases; analysis of public health policies using the Kingdon model in national or international experiences. Review studies and experience reports were excluded. We identified 4 doctoral thesis, 6 articles and 2 master dissertations published from 1994 to 2009. The Kingdon's model proved to be applicable for analysis of health policies in different national and international political systems, in long periods of time and in the practice of governments. The contributions of this model for SUS analysis include: a - the incorporation of ambiguity in the decisions; b -appreciation of the consistency of the ideas contained in the proposals; c - an analysis of different interpretations of decision makers about the complex problems of Brazilian health. Concerning its limits, we point out its emphasis in the action of actors at the expense of the institutional framework that delineates their decisions.