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Introduction to Health Policy Development: Policy Making, Analysis, and Research

F. Marilyn E. Lorenzo, RN, MPH, DrPH University of the Philippines Manila College of Public Health Department of Health Policy Administration
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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.

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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 and Hanley, 1991)
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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. (Bryson and Crosby) Called policies, plans, programs, projects, decisions, actions, budgets, rules and regulations.
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Policy Types
Social Policy pertains to the directives that promote the welfare of the public. E.g. Magna Carta for Public Health Workers- law that could be viewed as a policy that promotes the 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 May be trade or economic policies that have impact on health
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Policy Types
Organizational Policies rules governing and positions taken by

organizations, such as the PNA or IRNUP.

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Policy Types
Institutional Policies are those governing workplaces What the institutions goals will be and how it will operate, how the institution will treat its employees, and how employees will work. E.g. sexual harassment policy

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Approaches to Policy Devt


Policy Making

Policy Analysis
Policy Research

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Initial Agreement (Plan for Planning) Issue

The Policy Change Cycle

Problem Formulation Creation Search for Solution

Policy of Plan or Formulation

Proposal Review and Adoption

Implementation And Evaluation

Policy or Plan Maintenance, Succession or Termination

Containment Triggering Mechanisms Mechanisms Public Agenda

Formant Agents

The Policy Environment

Approaches to Policy Development


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

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Policy Process:
A. Need Assessment 1. Identify the scope and limits of the problem 2. Identify the actors and stakeholders B. Policy Making 1. Conceptualize the causes of the problem 2. Collect information, procedures alternative solutions 3. Involve actors in choosing from policy alternatives

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Policy Process
C. Policy Implementation 1. Disseminate and publicize policy 2. Establish behavior changes based on the policy 3. Monitor and revise the policy

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Approaches to Policy Development


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
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Policy Development Approaches


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, they Y will result.

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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

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Policy Research
Different from bio-medical or

epidemiologic research in the following ways Multidisciplinary using multiple methods to analyze components, Inductive rather than deductiveproblem driven, not theory-driven.
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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.
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Policy Making Process


1. What is a Policy? Rules to establish, control or change the behavior of

institutions and/ or individuals in order to solve a problem. May be explicit or implicit Includes public policy as well as decision-making 2. Process of Policy development a. Problem identification/ clarification b. Decision that it is an important problem to study-policy research/ analysis c. Proposal of policy alternatives d. Selecting from policy alternatives e. Implementation of policy f. Evaluation
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Policy Making Process


3. World in which policies are made have 3 components: a. Institutions and mechanisms making or contributing to decision-making b. Information used in decision-making c. The values and beliefs held by institutions and beliefs a. Vested interest b. Beliefs c. Core values

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THE WORLD IN WHICH POLICIES ARE MADE

Evidence Data Research

Social Problem/ Issue


Knowledge CORE VALUES Ideologies

VALUES
BELIEFS Causal Assumptions

INTERESTS

Researchers and Universities FORMAL STRUCTURE Advocates Policy Brokers Media Executive Legislative Bureaucracy

INFORMAL SRUCTURE

Networks
Coalitions Stakeholders Citizens

Policies
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Selection from policy alternatives/ Implementation


1. Generating policy alternatives
Time frame short term, medium term, long term Extent of behavior change required by policy

incremental or fundamental Types of policy instruments used


Financial measures Regulatory or control measures Information-related Symbolic priority setting Research and development

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Selection from policy alternatives/ Implementation


2. Implementability of policy alternatives
Values of stakeholders Organizational structure for implementing policy Current political situation

3. Finalization of policy recommendations Revisions because of the political situation Revisions because of the value of stakeholders Revisions because the organizational structure is inadequate.
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Commitment
To search for the

COMMON GOOD
Through Health Policy Development

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Basic Preparation for Policy Analysts


1. Analysts must gather, organize and communicate information in situations where deadlines are strict and access to relevant people are limited.
Develop strategies for quickly understanding the nature of policy problems and the range of possible solutions. Identify, at least qualitatively, the likely costs and benefits of alternative solutions and communicate these 2. Analysts need a perspective for putting perceived social problems in context. Market failure Government failure Sufficiency requires that the form of the intervention does not involve consequences that would inflict greater social costs than social benefits.
-

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Basic Preparation for Policy Analysis


3. Analysts need technical skills to enable them to predict better and evaluate more confidently the consequences of alternative policies - Micro- Economics - Public Finance - Statistics - Organizational Behavior - Political Behavior - Evaluation Research - Especially Benefit Cost Analysis

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Basic Preparation for Policy Analysis


4. Analysts must understand political and

organizational behavior in order to predict, and perhaps influence, the feasibility of adoption and successful implementation of policies. - Understand worldviews of clients and potential opponents

5. Analysts should have an ethical framework that explicitly takes account of their relationships to clients.
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Figure 1. Determinants of Health Major Factors and Intervention Points


Underlying Socioeconomic Demographic and Cultural Factors

Proximate Factors

Health Outcomes

Individual
Age, sex, education Occupation, health beliefs, attitudes Household Income/wealth Age-sex composition Social networks Community Ecological climate Markets and prices Transportation Population size, structure and distribution Social structure and organization

Health care service utilization

Mortality

Environmental contraindicators

Morbidity

Nutrient/ dietary intake Nutritional status Fertility Disability

Injury

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A. INDIVIDUAL Health Status Bio-Medical Factors Psychological Factors

B. SOCIETY Political Structure Socio-Cultural Patterns Economic Development Demographic Structure

C. Institutions Health Services Health Organization Health Planning

D. Larger Systems Environment

Health Care Sector General economic resources (A) Economic resource specific to health (B) Supply of health care services (C) Health care service utilization (E) Demand for health care services (D)

A. B.

Land, labor, capital, technology Physicians, nurses, other health workers, hospitals, RHU, BHS, clinics, pharmaceuticals, medical equipments Institutional services, physician services, hospital services (in-patient care, outpatient care), treatment for specific health conditions, e.g. diarrhea, ARI, TB, tropical diseases, chronic disease Demand for institutional services or specific treatments Actual use of various types of services in various institutional setting Outputs of other health-related sectors, e.g. water supply, housing, etc.; and of social and economic sectors, e.g. education, food supply, employment and income, transportation Health outcomes, mortality, nutritional status, disability

C.

D. E. F.

Health status (G)

G.

Other health-related and socio-economic sectors (F) Adapted from Andreano and Helminlak (1988)

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7, g, i 5, e 6, f 2, b, h 4, d 3, c 1, a

Health Care Sector


General economic resources (A) Economic resources specific to health (B) Supply of health care services (C) Health care services utilization (E) Demand for health care services (D)

Health status (G) Other health-related and socio-economic sectors (F) Policy Areas, Issues and Questions of the 1. Interpersonal resource allocation 2. Health care service structure 3. Health care service focus 4. Health care service utilization 5. Health care service resource mix 6. Management and operational procedures 7. Organization of the health care sector (i.e., private-public sector mix in service delivery and finance). Health Policy and Administration 32 Criteria for Assessing the Economic Performance Health Care Sector a. Intersectoral allocative efficiency b. Service structure efficiency c. Service focus efficiency d. Service utilization efficiency e. Production efficiency

Towards Health Policy Development in the Philippines Figure 1. Determinants of Health Major Factors and Intervention Points
Underlying Socioeconomic Demographic and Cultural Factors Individual Age, Sex Education, Occupation Health Beliefs, attitudes Household Income/wealth Age-sex composition Social network Community Ecological climate Markets and prices Transportation Population size, structure and distribution Social structure and organization
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Proximate Factors Health care services utilization

Health Outcomes Mortality

Environmental contamination

Morbidity

Nutrient/ dietary intake Fertility Injury

Nutritional status

Disability

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