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This thesis is grounded in health policy analysis, which ‘seeks to provide descriptions of and prescriptions for specific decisions and policies’ and ‘is also concerned with the behaviour of actors in formulating and implementing policy and the context within which policies are promulgated’. The research was undertaken in Cambodia, Europe and Australia over the past decade.The aim of this research is to identify and analyse the actors, context and processes involved in the formulation and implementation of international health policy; to explore the way in which this policy brings about change; and to explore the interactions between actors and processes in its development and application. The methods selected for the research include document and discourse analysis, reflective praxis, participant observation, and in-depth interviews. Five case studies were used to explore specific aspects of international health policy development and implementation under the health sector reforms in Cambodia:• The first case study is based on the response of aid agencies to the 1997Cambodian coup. It examines the essential asymmetry of the political relationship between donors and recipient countries, despite the rhetorics of partnership, participation and local leadership. Interwoven with that analysis, however, is an examination of the conflict between two theoretical frameworks for understanding health policy – the rationalist and incrementalist approaches.• The second case study examines the international trend to more collaborative sectoral approaches to development assistance (specifically Sector-Wide Approaches to health development) and explores the process of development of policy rhetoric, and the way in which that brings about change, even in the absence of a strong evidence base.• The third case study examines the implementation of a key element of the health sector reforms in Cambodia: the Health Coverage Plan. It argues that rather than being merely a technical decision, the planning and implementation of the Health Coverage Plan are political acts, and shows the tensions between early acceptance of the plan, and resistance grounded in Khmer social, political and economic realities.• The fourth case study examines the impact of current trends in international development assistance on the donors themselves - in this case the German government, and its agency for technical cooperation, GTZ1. It shows that the new international development policy emphases – good governance, local leadership, collaborative approaches, policy reform, transparent processes, common procurement and accounting mechanisms and shared evaluation - impact on the policy and rganisational structures of donors as well as recipient governments.• The final case study addresses the competing agendas of three international health policies: Safe Motherhood, Reproductive Health and Sector-Wide Approaches to health development. The case study demonstrates the difficulties achieving the functioning health systems required for Safe Motherhood – despite their inclusion in the health coverage plan - given the total financial envelope available for healthsector reform under the Sector-Wide Management process.In the final analysis, the thesis shows that the solution to safe motherhood problems – or any of the multitude of health issues that burden developing countries - does not lie in financial mechanisms such as SWAps alone, but in the total financial package, and the capacity to structure a health system that can use it efficiently and effectively.
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