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A challenge in applying this model to a programme change such as the ETA is identifying the appropriate level at which to consider the influences of the political climate (the politics stream).
The politics stream describes the political context in which health policy is set.
In the politics stream, no clear political transitions were discussed by stakeholders that could present a window of opportunity for reform.
The so-called streams consist of (1) a problem stream – linked to identification or recognition of problems, (2) a policy stream – encompassing feasible policy solutions, and (3) a politics stream – reflecting the political will to address an issue [ 50].
The politics stream consists of political developments, in this case a trend of increasing energy imports and prices, along with enlargement of the EU to include NMS which felt their national security was undermined by dependence on gas imports (particularly from Russia).
The politics stream refers to the broader political context within which policy is made, including changes in public mood and within government agencies.
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In the next section, extension of Kingdon's Multiple Streams (Problem, Policy and Politics streams) framework [41] is used to discuss the utilization of RSBY and MSBY MDR-TB benefit packages in terms of equity in benefitting the poor from these packages.
However, applying the "three-streams" framework proposed by Kingdon [ 5], we showed that there are obstacles in the policy and politics streams that hinder substantial policy change.
Kingdon argued that only once there is convergence across the problems, policies and politics streams can a problem or an issue emerge on the policy agenda [ 14].
According to Kingdon, policy entrepreneurs play the key role in 'softening up' the system and linking the problem, policy and politics streams.
The softening up process can take many years but is an important preparatory phase in creating readiness for policy change when the 'problem, policy and politics' streams align and a policy window opens.
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