1. Introduction to Health Policy

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HEALTH POLICY


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OTTAWA DECLARATION

Prerequisite to Health

peace,

shelter,

education, food,

income,

a stable eco-system, sustainable resources,

social justice, and equity.


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FIVE ACTION AREAS

Building healthy public policy

Creating supportive environments

Strengthening community actionDeveloping personal skills

Re-orientating health care services

toward prevention of illness andpromotion of health


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THREE BASIC STRATEGIES

Advocate

Enable

Mediate


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PRIMORDIAL PREVENTION

prevention of risk factors themselves,

beginning with change in social and

environmental conditions in which these

factors are observed to develop, andcontinuing for high risk children, adolescents

and young adults.

Amendable to policy


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WHY IS POLICY IMPORTANT


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WHY IS POLICY IMPORTANT


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DEFINITIONS: POLICY

Principles that govern action directedtowards given ends (Titmus, 1974)

Consciously chosen course of action (orinaction) directed toward some end (Kalisch

and Kalisch, 1982)

Plan, direction or goal for action;

authoritative decision making (Stimpsonands Hanley, 1991)


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WHAT IS POLICYATTRIBUTES OF POLICY

Belongingness : it belongs to someone or

somebody?

Government

Department

Party

Source, Colin ,Palfrey , Key Concepts in Health Care Policy and Planning,2000


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ATTRIBUTE OF POLICY

Policy denotes commitment .

stated intention

Desire to make things happen

Policy has status

It has the backing of some influential entity

Source, Colin ,Palfrey , Key Concepts in Health Care Policy and Planning,2000


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POLICY COMES IN DIFFERENT FORMS


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HOGWOOD AND GUNN (1984)

Policy as an aspiration or general purpose

We believe that the health of the nation is the

first priority is terms of public spending

Example :

Corruption will not be tolerated by the PNOY

administration.

The programs of the new administration will

be primarily for the poor and the

marginalized


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HOGWOOD AND GUNN (1984)

Policy as one proposal or set of proposal

Government declaring that it shall reduce

maternal mortality by 2/3 by year 2015

Health sector declaring its support to

Universal Health Care


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POLICY AS A PARTICULAR PROGRAM

Universal health screening (DEP ED)

The TB DOTS program


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POLICY AS A FORMALLY AUTHORIZED ACTION

When government states its intention in a

piece of legislation ( white paper, charter )

Health care organization publishes its

prospectus

Magna Carta for Health workers

Cheaper medicines act

Reproductive Health Bill


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POLICY AS A PROCESS

Process as the progress of any policy from

its original appearance on the agenda to its

eventual implementation ,review and

evaluation.


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POLICIES COMES IN DIFFERENT FORMS

Embodied in

plans,programs,projects,decision,actions,bud

gets,rules and regulations


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TYPES OF POLICY


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POLICY TYPES: PUBLIC POLICY

Substantive decisions, commitments, and

actions made by those who hold or affect

government positions of authority as they are

interpreted by various stakeholders. (Brysonand Crosby)

Called policies, plans, programs, projects,

decisions, actions, budgets, rules andregulations.


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POLICY TYPES: SOCIAL POLICY

Pertains to the directives that promote the

welfare of a public.

e.g. Magna Carta for Public Health Workers- law

that could be viewed as a policy that promotesthe welfare of health workers.


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POLICY TYPES: HEALTH POLICY

Includes the directives and goals for

promoting the health of citizens.

e.g. Generic Drug Act, Tobacco Regulation Act


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POLICY TYPES: ORGANIZATIONAL POLICIES

Rules governing and positions taken by

organizations

i.e. PNA, PMA, PHAP


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POLICY TYPES: INSTITUTIONAL POLICIES

Policies that govern workplaces

What the institutions goals will be ;

How it will operate;

How the institution will treat its employees, and

How employees will work.

e.g. sexual harassment policy, contractualization

policy


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WHAT IS HEALTH POLICY?


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HEALTH POLICY

Public health policy

Health care policy


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HEALTH POLICY

An authoritative statement of intent

adopted by government on behalf of

the public with the aim of improvingthe health and welfare of the

populations (centrally determined

basis for action)


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WHAT IS HEALTH POLICY

What health agencies actually

do rather than what

governments would like themto do (Observing outcomes of

decision making).


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Health

Policy

Contentious terms with many meanings


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RATIONALIZATION OF VALUES

Heart of all political decisions is the allocation

of value.

Easton(1965) : allocation of values is the

process by which government choose which

values to grant and which to deny the

process of making and altering policies


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POLICY AS A RATIONALIZATION OF VALUES

Competing demands on finite resources:

Demands made by individuals and groups

seeking particular policies

Resources help the government to respond

to the demands being made ( money ,

building staff , time )

Support relates to the extent to which any

government is authorised to pass legislation


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WHAT IS A POLICY

A policy is a plan or course of action

designed to define issues,

influence decision-making and promote broad community actions beyond

those made by individuals.


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Inbox

Demands

Resources

Support

Policies are formulated, implemented

and if necessary revised


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What is the level of involvement of

government?

Government may choose to do nothing.

(policy of inaction)

Example : abortion, euthanasia

Policies are usually made within a framework

of competing values


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POTENTIAL ROLE OF GOVERNMENT IN HEALTH

CARE

A regulator of health care agencies

A stimulator of research

A protector of deprived and disadvantaged

groups

A financier of health and health care

programmes

A purchaser of health care services

A direct provider of services


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Emergent Health

System :

healthcare iis

viewed as an itemof personal

consumption

Pluralistic: Health

care is viewed as a

consumer good.Private and Public

ownership of

facilities, States role

is minimal and

indirect

Insurance/Social

security. Health care is

seen as an insured .

Guaranteed consumer

good /service.Government role :

central , but indirect

National Health

Service: health

care is statesupported,

facilities are mainly

publicly owned,

payment for

services is central

and direct

Socialized:

Health care as a

state provided

service. States rolein health is total


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A SOCIAL PROBLEM IS NOT A SOCIALPROBLEM UNLESS THOSE IN DECIDES

THAT THE ISSUE IS WORTHY OF ATTENTION


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POWER

Power to decide

Power as non decision making

-non decision

-limiting the scope of actual decision to safe issues

by manipulating these dominant community

values, myths and political institutions and

processes


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POWER

a) Authority whereas power concerns the

ability to influence others, authority refers to

the right to do so.

b) When authority exits, personal judgement is

surrendered to an authority on trust and

acceptance.

c)


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POWER IS THOUGHT CONTROL

Power is a function of the ability to influence

others by shaping their eference....

Elections

The control of information , the mass media

and through the process of socialization

Mcdonalds? SMART


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WHO HAS POWER?

Role of the state?

Is the state independent of society? Or is it a

reflection of the distributive power in

society?

Does the state serve a common good or the

interest of the privilege few.?


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POLICY DEVELOPMENT,

therefore, is the process

by which society makes decisions,

selects goals and the best means for

reaching them,

handles conflicting views about what should

be done and

allocates resources to address needs.


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WHO DECIDES ? AND WHO ARE INVOLVED?

The consensus model -power granted to

governments by people through periodic

elections

Pluralistic model no one group holds totalpower.


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WHO DECIDES ? AND WHO ARE INVOLVED?

Elitist model -

government acts a honest brokers

reconciling the competing interest of different

groups towards agreed goals,

not all interest groups are equally powerful

or influential.


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POLICY NETWORK

Several organization collaborating in order to

plan a co-ordinated assessment and

provision of services.


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National Congress POLITICS International MDGs,WH0

Policies

DOH

PHILHEALTH

Academe

Local

Provinces, City ,Municipalities

WHO ARE THE ACTORS ?

ProblemsHealth needs and

demands

PEOPLE

in theCommunity


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Pluralism :power is widely distributed in

society

Elitism: theory that power is concentrated in

a minority group in society


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PLURALISM -FEATURES

Open electoral competition

Ability of individuals to organize themselves into

pressure groups and political parties

Ability of pressure groups to air their views freely

Openness of the state to lobby of neutral for allpressure groups

STATE as a neutral referee adjudicating

between competing demandsAlthough society has an elite group, no elite group

dominates at all times


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ELITISM

Policy is dominated by a minority

Political elite

Non elites may be induced in governing circles if

they accept the basic consensus of the existingelite

Public values reflect the values of the elite- not

necessarily in conflict with the values of the masses

The values of the elite are conservative, policy

changes are likely to be incremental


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EXAMPLE

RH Bill????

Agarian Reform????

No balance billing


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EXAMPLE:

International health financing reforms

Studied by Lee and Goodman (2002)

Contrary to pluralist claims that globalization

is opening up decisions to a wider range of

actors...


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Power and Political systems

Power and the Health System


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HOW ARE DECISIONS MADE

Rational models of decision making ( tooidealistic)

Incrementalism : more realistic but too

conservative

Mixed scanning approach middle way


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LEE AND MILLS (1985)

Policy making is

concerned with what is

politically feasible and

technically desirable .


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ROLE OF THE STATE AND INDIVIDUAL ?

Individual and state

responsibility

Obligations or responsibility

Wearing of helmets,

Smoking in Public


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ROLE OF THE STATE AND PRIVATE FOR PROFIT

SECTOR IN HEALTH POLICY

Privatization of publicly owned property

Regulations government interventions

enforcing rules and standards

Transnational corporations with branches in

more than one country


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ITEM FOR DISCUSSION

Which of the four dimensions of policymaking are likely considered when wealthy

countries offer AID to less wealthy countries?

Which rights and responsibilities might be

influential in determining a governments

commitment to providing public fund forvarious health services?


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FOUR KEY CONSIDERATIONS

1.Political pragmatism:

2. Ideological3.Financial

4.Moral


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DEFINITIONS: POLICY

Policy encompasses the choices that asociety, segment of society, or

organization makes regarding its goals

and priorities and how it will allocate its

resources.


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POLITICAL PROGRAMMATIC

What you are going to do

about an issue

How you are going to do it

Who will do it

An overarching courseof action

A series of objectives

and how to reach

them

A statement of intent

A long-term plan


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POLICY PROCESSHOW ARE POLICY MADE?


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RATIONAL MODEL

Step by step procedure

Highly logical and carefully sequenced

Does not allow for competing rationalities

Considered too prescriptive


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INCREMENTALISM (LINDBLOM,1959)

Muddling through a decision

Incremental change

Involves mutual adjustments and negotiation

Excludes options by accident

Policy is not made once and for all Proceeds through a series of incremental

changes


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INCREMENTALISM (LINDBLOM,1959)

The test of good decision is agreementrather than meeting of objectives

It involves trial and error


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OTHER MODELS

Appreciative setting ( Vickers 1965)

Policy choices are constrained by the cultural

and ideological horizon of individuals and groups

There are no built in priorities to guide them inthe multivalued choices so they must decide

what to place most value on in the concrete

situation of every decisions


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OTHER MODELS

Mixed scanning (Etzioni 1967)

Policy makers need to have regard to both

breadth and depth depending on how they

would distinguish between problems and

issues requiring detailed examination and

those needing more general overview


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OTHER MODELS

Planned bargaining ( Challis et al 1988)

combine and coordinate various interest

groups towards an agreed strategic set of

policies

Recognizes the importance of rationality and

the reality ofpolitics


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OTHER MODELS

Extra rationality (Dror,1989)

prescriptive account of how policy ought to

be made: a mix of rationality and inspiration

Notion of extra rationality : use of

judgement, creative intervention,

brainstorming , the brilliant idea that may

come unexpectedly


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POLICY ANALYSIS: RATIONALIST MODE

Problem Analysis

1. Understanding the Problem

a. Receiving the problem:

Assessing the symptoms

b. Framing the problem :

Analyzing market andgovernment failures

c. Modeling the problem:

Identifying policy variables

2. Choosing and explaining relevant

goals and constraints

3. Selecting a solution method

Solution Analysis

1. Choosing impact

categories for goals

2. Concretely specifying

Policy alternatives

3. Predicting impacts ofAlternatives

4. Valuing impacts of

Alternatives

5. Evaluating and

Recommending

Communication

Information Gathering

Identifying and organizingrelevant data, theories, and facts forassessing problems and predicting consequences of current and

alternative policies


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Policy Formulation

and Legitimation

Implementation Design and

Organizational Structuring

Resource

Mobilization

Progress/ImpactMonitoring

ConstituencyBuilding

Agendas

Decisions

Issues

= primary linkage

= secondary linkage


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AGENDA SETTING

What is an agenda? The list of subjects or problems to which government

officials (or several sectors) are paying some seriousattention to.

Process of agenda setting:

Getting an Issue recognized

Identification of a policy problem Nature of the problem affects how it gets into the

agenda and the course of action


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POLICY PROBLEM

A condition or situation that produces needsor dissatisfaction on the part of the people for

which relief and redress is sought


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WHAT IS AN ISSUE /PROBLEM

Widespread attention to , or at leastawareness of the issue

Shared concern of a sizeable portion of the

public that some type of action is needed toremedy the problem

A shared concern that the matter is an

appropriate concern of some governmentalunit and falls within the bounds of its

authority.


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Problem Analysis





Analyzing market and

government failures






Solution Analysis

1. Choosing impact



Policy alternatives



Alternatives

5. Evaluating and

Recommending

Communication

Information Gathering

Identifying and organizingrelevant data, theories, and facts forassessing problems and predicting consequences of current and


How do issues get on to the policy agenda?


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Problem Policy (Solutions)

No Change

No Change

No Change

Politics (Political

will)

ACTION

No Change


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FRAMEWORKS OF POLICY DEVELOPMENT

Policy Making

Policy Analysis

Policy Research


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Initial

Agreement(Plan for

Planning)

Issue

Problem

Formulation

Creation

Search for

Solution

Policy of

Plan orFormulation

Proposal

Review andAdoption

Implementation

And Evaluation

Policy or Plan

Maintenance,Succession or

Termination

Triggering

Mechanisms

Containment

Mechanisms

Public Agenda Formant Agents

The Policy Environment


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POLICY MAKING

Concerned with maintaining and developingthe polity- the condition of civil order, form

and process of civil government, organized

society and state with the adoption ofcourses of action by political parties,

governments and other important social

organizations, and with issues in the scienceand art of governing


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Evidence DataResearch Knowledge

ResearchersandUniversities

Advocates PolicyBrokers Media

BELIEFS

CausalAssumptions

COREVALUES

Ideologies

INTERESTS

FORMALSTRUCTURE

Executive

Legislative

Bureaucracy

INFORMALSRUCTURE

Networks

Coalitions

Stakeholders

Citizens

SocialProblem/

Issue

Policies

VALUES


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POLICY ANALYSIS

Client- oriented advice relevant to publicdecisions and informed by social values

Emphasize professional mind set rather than skill

masteryEmphasize the importance of social values in

policy analysis

By looking at consequences of policies beyond

those that affect client, places a value on the

welfare of others

Good policy analysis takes a comprehensive

view of consequences and social values


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POLICY ANALYSIS

Systematic Comparison and evaluation ofalternatives available to public actors for

solving social problems

Client Specific person or institution asdecision maker

Involves synthesis of existing research and

theory to predict consequences of alternativepolicies


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Time constraints strong deadlinepressures because completion of analysis

usually tied to specific decision

Weakness - myopia resulting from clientorientation and time pressure


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POLICY RESEARCH

Focuses on relationships between variablesthat reflect social problems and other

variables that can be manipulated by public

policy.Desired product of is a more-or-less verified

hypothesis of the form: if the government does X,

then Y will result.


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POLICY RESEARCH

Iterative by recognizing that there are noperfect solutions to policy problems and

therefore that the impact of one solution will

lead to the need for new solutions either inthe same or in a different policy


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POLICY RESEARCH

Pragmatic by taking account of the policyenvironment and arriving at solutions that are

feasible given existing institutional structures

Focuses on malleable variables i.e.variables that are under the control of and

can be changed by the policy makers.

Responsive by involving stakeholders andtaking account of their values.

O C O OC SS


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POLICY DEVELOPMENT PROCESS

Problem identification/ clarification

Decision that it is an important problem to

study-policy research/ analysis

Proposal of policy alternatives

Selecting from policy alternatives

Implementation of policy

Evaluation

POLICY ANALYSIS RATIONALIST MODE


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Problem Analysis





Analyzing market and

government failures






Solution Analysis1. Choosing impact



Policy alternatives



Alternatives

5. Evaluating and

Recommending

Communication

Information GatheringIdentifying and organizingrelevant data, theories, and factsfor assessing problems and predicting consequences of

current and alternative policies

QUICK AND DIRTY POLICY ANALYSIS PROCESS


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QUICK AND DIRTY POLICY ANALYSIS PROCESS

Source: Patton and Sawicki, 1993

Verify, Define, Detail

the PROBLEM

Establish

EVALUATIONCRITERIA

Identify

ALTERNATIVE

POLICIES

EVALUATE


MONITOR the

implemented policy

DISPLAY and

DISTINGUISH

among alternatives

COMMITMENT


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COMMITMENT .

To search for the

COMMON GOOD

Through Health Policy Development

1. Introduction to Health Policy

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