HEALTH POLICY

OTTAWA DECLARATION
Prerequisite to Health

peace, shelter, education, food, income, a stable eco-system, sustainable resources, social justice, and equity.

FIVE ACTION AREAS

Building healthy public policy Creating supportive environments Strengthening community action Developing personal skills Re-orientating health care services toward prevention of illness and promotion of health

THREE BASIC STRATEGIES

Advocate
Enable Mediate

PRIMORDIAL PREVENTION

prevention of risk factors themselves, beginning with change in social and environmental conditions in which these factors are observed to develop, and continuing for high risk children, adolescents and young adults. Amendable to policy

WHY IS POLICY IMPORTANT

WHY IS POLICY IMPORTANT

DEFINITIONS: POLICY
Principles that govern action directed towards given ends (Titmus, 1974) Consciously chosen course of action (or inaction) directed toward some end (Kalisch and Kalisch, 1982) Plan, direction or goal for action; authoritative decision making (Stimpson ands Hanley, 1991)

WHAT IS POLICY
ATTRIBUTES OF POLICY

Belongingness : it belongs to someone or somebody?

Government Department Party

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

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

POLICY COMES IN DIFFERENT FORMS

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

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

POLICY AS A PARTICULAR PROGRAM

Universal health screening (DEP ED) The TB DOTS program

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

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.

POLICIES COMES IN DIFFERENT FORMS

Embodied in plans,programs,projects,decision,actions,bud gets,rules and regulations

TYPES OF POLICY

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. (Bryson and Crosby)
Called

policies, plans, programs, projects, decisions, actions, budgets, rules and regulations.

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 promotes the welfare of health workers.

POLICY TYPES: HEALTH POLICY

Includes the directives and goals for promoting the health of citizens.
e.g.

Generic Drug Act, Tobacco Regulation Act

POLICY TYPES: ORGANIZATIONAL POLICIES

Rules governing and positions taken by organizations

i.e.

PNA, PMA, PHAP

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

WHAT IS HEALTH POLICY?

HEALTH POLICY

Public

health policy Health care policy

HEALTH POLICY
An

authoritative statement of intent adopted by government on behalf of the public with the aim of improving the health and welfare of the populations (centrally determined basis for action)

WHAT IS HEALTH POLICY

What

health agencies actually do rather than what governments would like them to do (Observing outcomes of decision making).

Health Policy

Contentious terms with many meanings

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

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

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.

Resources

Demands
Support Inbox

Policies are formulated, implemented and if necessary revised

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

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

Emergent Health System : healthcare iis viewed as an item of personal consumption

Insurance/Social security. Health care is seen as an insured . Guaranteed consumer good /service. Government role : central , but indirect

Socialized: Health care as a state provided service. States role in health is total

Pluralistic: Health care is viewed as a consumer good. Private and Public ownership of facilities, States role is minimal and indirect

National Health Service: health care is state supported, facilities are mainly publicly owned, payment for services is central and direct

A SOCIAL PROBLEM IS NOT A SOCIAL PROBLEM UNLESS THOSE IN POWER DECIDES THAT THE ISSUE IS WORTHY OF ATTENTION

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

POWER
a)

Authority whereas power concerns the ability to influence others, authority refers to the right to do so. When authority exits, personal judgement is surrendered to an authority on trust and acceptance.

b)

c)

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

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.?

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.

WHO DECIDES ? AND WHO ARE INVOLVED?

The consensus model -power granted to governments by people through periodic elections Pluralistic model no one group holds total power.

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.

POLICY NETWORK

Several organization collaborating in order to plan a co-ordinated assessment and provision of services.

WHO ARE THE ACTORS ?

National Congress POLITICS International MDGs,WH0 DOH PHILHEALTH Academe

Local Provinces, City , Municipalities

Policies

Problems Health needs and demands

PEOPLE in the Community

Pluralism :power is widely distributed in society Elitism: theory that power is concentrated in a minority group in society

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 all pressure groups STATE as a neutral referee adjudicating between competing demands Although society has an elite group, no elite group dominates at all times

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 existing elite 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

EXAMPLE

RH Bill???? Agarian Reform???? No balance billing

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...

Power and Political systems Power and the Health System

HOW ARE DECISIONS MADE

Rational models of decision making ( too idealistic) Incrementalism : more realistic but too conservative

Mixed scanning approach middle way

LEE AND MILLS (1985)

Policy making is concerned with what is politically feasible and technically desirable .

ROLE OF THE STATE AND INDIVIDUAL ?

Individual

and state responsibility Obligations or responsibility

Wearing

of helmets, Smoking in Public

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

ITEM FOR DISCUSSION

Which of the four dimensions of policy making 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 for various health services?

FOUR KEY CONSIDERATIONS

1. Political

pragmatism: 2. Ideological 3. Financial 4. Moral

DEFINITIONS: POLICY

Policy encompasses the choices that a society, segment of society, or organization makes regarding its goals and priorities and how it will allocate its resources.

POLITICAL

PROGRAMMATIC
An overarching course of action A series of objectives and how to reach them A statement of intent A long-term plan

What you are going to do about an issue How you are going to do it Who will do it

POLICY IS MAINLY DECIDING

POLICY PROCESS HOW ARE POLICY MADE?

RATIONAL MODEL
Step by step procedure Highly logical and carefully sequenced Does not allow for competing rationalities Considered too prescriptive

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

INCREMENTALISM (LINDBLOM,1959)
The test of good decision is agreement rather than meeting of objectives It involves trial and error

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 in the multivalued choices so they must decide what to place most value on in the concrete situation of every decisions

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

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

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

POLICY ANALYSIS: RATIONALIST MODE

Problem Analysis
1. Understanding the Problem
a. b. Receiving the problem: Assessing the symptoms Framing the problem : Analyzing market and government failures Modeling the problem: Identifying policy variables

Solution Analysis
1. 2. 3. 4. 5. Choosing impact categories for goals Concretely specifying Policy alternatives Predicting impacts of Alternatives Valuing impacts of Alternatives Evaluating and Recommending

Communication

c. 2.

Choosing and explaining relevant

goals and constraints 3. Selecting a solution method

Information Gathering
Identifying and organizing relevant data, theories, and facts for assessing problems and predicting consequences of current and alternative policies

POLICY PROCESS FRAMEWORK

Issues Agendas Decisions
Policy Formulation and Legitimation

Progress/Impact Monitoring
Implementation Design and Organizational Structuring

Constituency Building
Resource Mobilization

= primary linkage = secondary linkage

AGENDA SETTING

What is an agenda?

The list of subjects or problems to which government officials (or several sectors) are paying some serious attention 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

POLICY PROBLEM

A condition or situation that produces needs or dissatisfaction on the part of the people for which relief and redress is sought

WHAT IS AN ISSUE /PROBLEM

Widespread attention to , or at least awareness of the issue Shared concern of a sizeable portion of the public that some type of action is needed to remedy the problem A shared concern that the matter is an appropriate concern of some governmental unit and falls within the bounds of its authority.

POLICY ANALYSIS: RATIONALIST MODE

Problem Analysis
1. Understanding the Problem
a. b. Receiving the problem: Assessing the symptoms Framing the problem : Analyzing market and government failures Modeling the problem: Identifying policy variables

Solution Analysis
1. 2. 3. 4. 5. Choosing impact categories for goals Concretely specifying Policy alternatives Predicting impacts of Alternatives Valuing impacts of Alternatives Evaluating and Recommending

Communication

c. 2.

Choosing and explaining relevant

goals and constraints 3. Selecting a solution method

Information Gathering
Identifying and organizing relevant data, theories, and facts for assessing problems and predicting consequences of current and alternative policies

How do issues get on to the policy agenda?

Problem Policy (Solutions) Politics (Political will)

No Change

No Change

No Change

No Change

ACTION

FRAMEWORKS OF POLICY DEVELOPMENT

Policy Making Policy Analysis Policy Research

THE POLICY CHANGE CYCLE

Initial Agreement (Plan for Planning) Issue Policy of Plan or Formulation Proposal Review and Adoption Policy or Plan Maintenance, Succession or Termination

Problem Formulation Creation Search for Solution

Implementation And Evaluation

Containment Triggering Mechanisms Mechanisms Public Agenda

Formant Agents

The Policy Environment

POLICY MAKING

Concerned with maintaining and developing the polity- the condition of civil order, form and process of civil government, organized society and state with the adoption of courses of action by political parties, governments and other important social organizations, and with issues in the science and art of governing

THE WORLD IN WHICH POLICIES ARE MADE (LOMAS)

Social Problem/ Issue
Knowledge CORE VALUES
Researchers and Universities FORMAL STRUCTURE

Evidence Data Research

VALUES
BELIEFS Causal Assumptions INTERESTS

Ideologies

Advocates Policy Brokers Media

Executive
Legislative

Bureaucracy

INFORMAL SRUCTURE Networks Coalitions

Stakeholders

Citizens

Policies

POLICY ANALYSIS

Client- oriented advice relevant to public decisions and informed by social values
Emphasize

professional mind set rather than skill

mastery Emphasize 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

POLICY ANALYSIS
Systematic Comparison and evaluation of alternatives available to public actors for solving social problems Client Specific person or institution as decision maker Involves synthesis of existing research and theory to predict consequences of alternative policies

Time constraints strong deadline pressures because completion of analysis usually tied to specific decision Weakness - myopia resulting from client orientation and time pressure

POLICY RESEARCH

Focuses on relationships between variables that 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.

POLICY RESEARCH

Iterative by recognizing that there are no perfect solutions to policy problems and therefore that the impact of one solution will lead to the need for new solutions either in the same or in a different policy

POLICY RESEARCH
Pragmatic by taking account of the policy environment 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 and taking account of their values.

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

Problem Analysis
1. Understanding the Problem
a. b. Receiving the problem: Assessing the symptoms Framing the problem : Analyzing market and government failures Modeling the problem: Identifying policy variables

Solution Analysis
1. 2. 3. 4. 5. Choosing impact categories for goals Concretely specifying Policy alternatives Predicting impacts of Alternatives Valuing impacts of Alternatives Evaluating and Recommending

Communication

c.

2.

Choosing and explaining relevant

goals and constraints 3. Selecting a solution method

Information Gathering
Identifying and organizing relevant data, theories, and facts for assessing problems and predicting consequences of current and alternative policies

QUICK AND DIRTY POLICY ANALYSIS PROCESS

Verify, Define, Detail the PROBLEM

MONITOR the implemented policy

Establish EVALUATION CRITERIA

DISPLAY and DISTINGUISH among alternatives

Identify ALTERNATIVE POLICIES

EVALUATE alternative policies

Source: Patton and Sawicki, 1993

COMMITMENT

To search for the COMMON GOOD Through Health Policy Development