SUMMARY PMO BOOK “MAKING HEALTH
POLICY”
SUMMARY PMO BOOK “MAKING HEALTH POLICY”........................1
1. The health policy framework – context, process and actors............2
2. Power and the policy process.......................................................5
3. The state and the private sector in health policy.........................13
4. Agenda setting..........................................................................18
5. Government and the policy process............................................23
6. Interest groups and the policy process........................................28
7. Policy implementation................................................................33
8. Globalizing the policy process.....................................................39
9. Research, evaluation and policy..................................................45
,1. The health policy framework – context, process and
actors
Key terms
Actor: Short-hand term used to denote individuals, organizations or even the
state and their actions that affect policy.
Content: Substance of a particular policy which details its constituent parts.
Context: Systemic factors – political, economic, social or cultural, both national
and
international – which may have an effect on health policy.
Policy: Broad statement of goals, objectives and means that create the
framework for activity. Often take the form of explicit written documents, but
may also be implicit or unwritten.
Policy elites: Specific group of policy makers who hold high positions in an
organization, and often privileged access to other top members of the same, and
other, organizations.
Policy makers: Those who make policies in organizations such as central or
local government, multinational companies or local businesses, schools or
hospitals.
Policy process: The way in which policies are initiated, developed or
formulated, negotiated, communicated, implemented and evaluated.
Why is health policy important?
Decision making in health often involves matters of life and death which makes it
have a special position compared to other social issues. Health is also affected
by many decisions that have nothing to do with health care, such as poverty and
pollution. Economic policies may also influence people’s behavior. To tackle
major health problems, understanding the relationship between health policy and
health is important as well as how economic and other policies impact health.
Health policy guides choices about which health technologies to develop and
use, how to organize and finance health services, or what drugs will be freely
available.
What is health policy?
Policies are made in the private and public sector. In the private sector,
multinational conglomerates may establish policies for all their companies
around the world, but allow local companies to decide their own policies on
conditions of service. Private sector corporations have to ensure their polivies are
made within the confines of public law, made by governments. Public policy
refers to government policy, whatever they choose to do or not to do. Policies
may not arise from a single decision but could consist of bundles of decisions or
actions that lead to a broad courrse of action over time.
Health policy may cover public and private polivies about health. It is assumed to
embrace courses of action (and inaction) that affect the set of institutions,
organizatons, services and funding arrangements of the health system. Health
policy is synonymous with politics and deals explicitly with
,who influences policy making, how they exercise that influence, and under what
conditions. Politics cannot be seperated from health policy.
The health policy triangle
The framework for health policy acknowledges the importance of looking at the
content of policy, the processes of policy making and how power is used in
health policy. Exploring the role of state, nationally and internationally, and the
groups making up national and global civil society, to understand how they
interact and influence health policy. Also understand the processes through
which such influence is payed out and the context in which these different actors
and processes interact. The framework is simplified. In reality, actors are
influences by the context within they live and work; context is affected by many
factors; and the process of polivy making is affected by actors, etc.
The actors who make policy
Actors are individuals, organizations, or even the state or governent. However,
individuals cannot be seperated from their organizations or groups. Non-state
actors are actors outside the government. Civil society organizations are
organizations which fall between state and the individual or household. They
differ from governement or state actors by that they do not seek formal political
power for themselves although they do want to influence those who do.
Social/people movements are groups that get together to demonstrate strong
feelings about particular issues.
Actors may try to influence policy process at the local, national, regional, or
international level. Often they become parts of networks, partners, to consult
and decide on policy at these levels. Actors may seek to influence policy, but the
extent to which they will be able to do so will depend on their perceived or actual
power. Power may be characterized by a mixture of individual wealth,
personality, level of or access to knowlegde, or authority. However, it is strongly
tied up with the organization and structures they belong to. Interplay between
agency and structure.
Contextual factors that affect policy
Context refers to systemic factors – political, economic and social, both national
and international – which may have an effect of health policy.
- Situational factors: transient, impermanent or idiocratic conditions which
can have an impact on policy (e.g. wars, droughts). These may be a
specific one-off occurrence or much longer diffused public recognition of a
new problem.
- Structural factors: relatively unchanching elements of society. They may
include:
o The policitical system and extent to which it is open or closed and
the oppurtunities for civil society to participate in policy discussions
and decisions
o Type of economy and the employment base
o Demographic features or technological advance affect health policy
o A country’s national wealth
- Cultural factors: such as formal hierarchies, ethnic minorities, women’s
health, stigma, religious factors.
, - International or exogeneous factors: leading to geather interdependence
between states and influending sovereignity and international cooperation
in health. Some health problems need cooperation between national,
regional or multilateral organizations.
The processes of policy making
Process refers to the way in which policies are initiated, developed or formulated,
negotiated, communicated, implemented and evaluated. Most common approach
to understanding policy processes is the stages heuristic:
1. Problem identification and issue recognition: explores how issues get on
the policy agenda and why some do not.
2. Policy formulation: explored who is involved in formulating policy, how
policies are arrived at, agreed upon and how they are communcated.
3. Policy implementation
4. Policy evaluation: identifies what happens once a polcy is put into effect –
how it is monitored, whether it achieves its objctives and whether it has
unintended consequences.
In reality, this may not be as linear. It is seldom a rational process.
Using the health policy triangle
You can use the health policy triangle to help analyse or understand a particular
policy (analysis of policy) or you can apply it to plan a particular policy (analysis
for policy). Analysis of policy is generally retrospective and includes evaluating
and monitoring the policy. Analysis for policy is usually prospecive and it feeds
intr stategic thinking for the future and may lead to policy advocacy or lobbying.
POLICY”
SUMMARY PMO BOOK “MAKING HEALTH POLICY”........................1
1. The health policy framework – context, process and actors............2
2. Power and the policy process.......................................................5
3. The state and the private sector in health policy.........................13
4. Agenda setting..........................................................................18
5. Government and the policy process............................................23
6. Interest groups and the policy process........................................28
7. Policy implementation................................................................33
8. Globalizing the policy process.....................................................39
9. Research, evaluation and policy..................................................45
,1. The health policy framework – context, process and
actors
Key terms
Actor: Short-hand term used to denote individuals, organizations or even the
state and their actions that affect policy.
Content: Substance of a particular policy which details its constituent parts.
Context: Systemic factors – political, economic, social or cultural, both national
and
international – which may have an effect on health policy.
Policy: Broad statement of goals, objectives and means that create the
framework for activity. Often take the form of explicit written documents, but
may also be implicit or unwritten.
Policy elites: Specific group of policy makers who hold high positions in an
organization, and often privileged access to other top members of the same, and
other, organizations.
Policy makers: Those who make policies in organizations such as central or
local government, multinational companies or local businesses, schools or
hospitals.
Policy process: The way in which policies are initiated, developed or
formulated, negotiated, communicated, implemented and evaluated.
Why is health policy important?
Decision making in health often involves matters of life and death which makes it
have a special position compared to other social issues. Health is also affected
by many decisions that have nothing to do with health care, such as poverty and
pollution. Economic policies may also influence people’s behavior. To tackle
major health problems, understanding the relationship between health policy and
health is important as well as how economic and other policies impact health.
Health policy guides choices about which health technologies to develop and
use, how to organize and finance health services, or what drugs will be freely
available.
What is health policy?
Policies are made in the private and public sector. In the private sector,
multinational conglomerates may establish policies for all their companies
around the world, but allow local companies to decide their own policies on
conditions of service. Private sector corporations have to ensure their polivies are
made within the confines of public law, made by governments. Public policy
refers to government policy, whatever they choose to do or not to do. Policies
may not arise from a single decision but could consist of bundles of decisions or
actions that lead to a broad courrse of action over time.
Health policy may cover public and private polivies about health. It is assumed to
embrace courses of action (and inaction) that affect the set of institutions,
organizatons, services and funding arrangements of the health system. Health
policy is synonymous with politics and deals explicitly with
,who influences policy making, how they exercise that influence, and under what
conditions. Politics cannot be seperated from health policy.
The health policy triangle
The framework for health policy acknowledges the importance of looking at the
content of policy, the processes of policy making and how power is used in
health policy. Exploring the role of state, nationally and internationally, and the
groups making up national and global civil society, to understand how they
interact and influence health policy. Also understand the processes through
which such influence is payed out and the context in which these different actors
and processes interact. The framework is simplified. In reality, actors are
influences by the context within they live and work; context is affected by many
factors; and the process of polivy making is affected by actors, etc.
The actors who make policy
Actors are individuals, organizations, or even the state or governent. However,
individuals cannot be seperated from their organizations or groups. Non-state
actors are actors outside the government. Civil society organizations are
organizations which fall between state and the individual or household. They
differ from governement or state actors by that they do not seek formal political
power for themselves although they do want to influence those who do.
Social/people movements are groups that get together to demonstrate strong
feelings about particular issues.
Actors may try to influence policy process at the local, national, regional, or
international level. Often they become parts of networks, partners, to consult
and decide on policy at these levels. Actors may seek to influence policy, but the
extent to which they will be able to do so will depend on their perceived or actual
power. Power may be characterized by a mixture of individual wealth,
personality, level of or access to knowlegde, or authority. However, it is strongly
tied up with the organization and structures they belong to. Interplay between
agency and structure.
Contextual factors that affect policy
Context refers to systemic factors – political, economic and social, both national
and international – which may have an effect of health policy.
- Situational factors: transient, impermanent or idiocratic conditions which
can have an impact on policy (e.g. wars, droughts). These may be a
specific one-off occurrence or much longer diffused public recognition of a
new problem.
- Structural factors: relatively unchanching elements of society. They may
include:
o The policitical system and extent to which it is open or closed and
the oppurtunities for civil society to participate in policy discussions
and decisions
o Type of economy and the employment base
o Demographic features or technological advance affect health policy
o A country’s national wealth
- Cultural factors: such as formal hierarchies, ethnic minorities, women’s
health, stigma, religious factors.
, - International or exogeneous factors: leading to geather interdependence
between states and influending sovereignity and international cooperation
in health. Some health problems need cooperation between national,
regional or multilateral organizations.
The processes of policy making
Process refers to the way in which policies are initiated, developed or formulated,
negotiated, communicated, implemented and evaluated. Most common approach
to understanding policy processes is the stages heuristic:
1. Problem identification and issue recognition: explores how issues get on
the policy agenda and why some do not.
2. Policy formulation: explored who is involved in formulating policy, how
policies are arrived at, agreed upon and how they are communcated.
3. Policy implementation
4. Policy evaluation: identifies what happens once a polcy is put into effect –
how it is monitored, whether it achieves its objctives and whether it has
unintended consequences.
In reality, this may not be as linear. It is seldom a rational process.
Using the health policy triangle
You can use the health policy triangle to help analyse or understand a particular
policy (analysis of policy) or you can apply it to plan a particular policy (analysis
for policy). Analysis of policy is generally retrospective and includes evaluating
and monitoring the policy. Analysis for policy is usually prospecive and it feeds
intr stategic thinking for the future and may lead to policy advocacy or lobbying.
