Breaking the Cycle of Policy Congestion: A Governance-Level Failure Undermining Public Health Coherence

This conceptual paper addresses a persistent but under-recognized governance challenge in public health: policy congestion. In many low- and middle-income countries, ministries of health and their partners face an overload of overlapping, contradictory, and poorly harmonized public health policies. These often stem from parallel efforts by multiple government departments, NGOs, NPOs, and international donors. Drawing from real-world examples in areas such as human immunodeficiency virus (HIV), non-communicable diseases (NCDs), and maternal health, the paper demonstrates how policy congestion creates fragmentation, weakens accountability, burdens health workers, and undermines the coherence of national priorities. It concludes by offering five governance-level policy reforms that could help break this cycle. This paper is especially relevant for public health officials, policy advisors, donor organizations, and implementation partners working across fragmented health systems.