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Discuss how policy making and planning are the most important elements for

the health sector

Health has a significant influence on people's ability to cope with daily life, on the
social and economic contribution to the development of the country, and on general
success of the country. Therefore, health is a major national resource that deserves
consistent strategic development. In addition, right to health protection is one of the
fundamental human rights and everyone should be able to enjoy the best possible
state of health every person in Mauritius should have the opportunity to live in a
health-supportive environment and make healthy choices.
Policies, strategies and plans are not ends in themselves. They are part of the
larger process that aims to align country priorities with the real health needs of the
population, generate buy-in across government, health and development partners,
civil society and the private sector, and make better use of all available resources for
health- so that all people in all places have access to quality health care and live
longer, healthier lives as a result. (World Health Organisation). A few definitions are
given below.

Policy
There

are

numerous

Dictionary, Oxford

definitions

Dictionary,

of

policy(WHO/AFRO,

Wikipedia

Merriam

Encyclopaedia)but

Webster

taking

into

consideration the best elements from these definitions, policy can be defined as a
formal statement of intent which defines priorities and parameters for action in
response to needs and in context of available resources and other considerations
to guide and determine present and future decisions aimed at achieving rational
outcomes. Everything action is therefore expected to derive its rationale from this
policy.
Planning:

Planning is a systematic process of identifying and specifying desirable future


goals

and outlining

appropriate

courses

of

action

and

determining

the

resources required to achieve them.


Policy making encompasses a broad range of laws, approaches, prescriptions,
guidelines, regulations and habits. Some policies have implications across most or
all areas including the health sector. These are called macro-policies. One of these
guidelines has been implemented in the education sector but the implications are farfetched including the health sector is the inhibition of selling soft drinks and fast
foods in the school premises. Macro-policies with far reaching implications tend to
have a robust political character, even when they are advocated for their supposed
technical merits. Other policies, of strictly technical nature, address narrower issues,
such as the control of a communicable disease or drug quality control. The ways
services are delivered, allocative decisions are made, information is produced and
used, old practices are followed and new ones are introduced; all these elements
sum up into the policies governing the health sector.
Health policy and planning are closely related. Health policy development can be
considered at various levels. At the national level, national policies and legislation,
together with international policies ad financing agreements, govern the mediumand long- term viability of major health programmes in most developing countries
including Mauritius. At the facility level, policies determine how a service should be
run. Effective health planning relies on a clear understanding of health financing and
appropriate policy framework. The development of comprehensive, practical plan
needs to take both supply-side and demand-side issues into account, as research
has shown that health sector reforms focused primarily on improvement of supply of
services have limited impact on utilisation. An understanding of health financing
(budget) and the mechanisms by which services are financed should underpin the
development policy and the planning of service transformation.
According to numerous researches, numerous health issues are the consequences
of a wide variety of causes or multifactorial causes. The causes investigated have
been classified into the following:
1. Socio-economic circimstances
2. Educational
3. Work and work environmental

4. Nutrition
5. Water and sanitation6. Communicable and preventable diseases
The root causes have been identified that many policies and programs thought to be
unrelated to health may have important health consequences. Major health problems
such as obesity, diabetes mellitus, hypertension, bronchial asthma, allergies, cancer,
ischaemic heart disease and it its associated health and monetary costs, are
essentially unintended consequences of various social and policy factors related.
Policy factors like mass production and distribution of energy-dense foods and
introduction of transport facilities have powerful implications for individual behaviors
and public health. The prevention of todays major health problems requires
understanding and intervention to affect the root causes of ill health and to address
policies that shape and affect the root causes. To have effective results, a better
understanding of the possible health consequences of proposed policies and
planning decisions as they are being developed is required as adverse health effects
can be anticipated and minimized ad health benefits maximized.
Health planning and policy seek to create a group of mutually interacting bodies to
produce goods and services to meet the health needs of a population. Recent
developments in the health status of the human population are charactering by
continuous improvement in life expectancy, chronic diseases which absorb 90% of
total health care expenditure, differences in the causes of mortality (more than 70%
mortality from cancer, heart and brain, and external causes). The new trends in
health indicators define the current health policies and lead to the necessity of
adapting the health system so as to meet the changing health needs of the
population.
On the other hand, part of the world is facing wraths of civil war, natural calamities
like tsunamis like the ones in Japan recently and earth quakes like the ones last
week in Nepal. Greenhouse effect, deforestation and threat of biological warfare and
nuclear attacks are present all the time. In such circumstances, the healthcare sector
must be prepared or pro-active instead of reactive like we have been in the advent of
a flare of conjunctivitis recently in Mauritius. Healthcare should be prepared for
macro policies (at the national or international level) and micro policies at the
community or service level.

Childhood obesity is poisoning the future of Mauritius and in in order to curb it, the
previous Minister of Education and Quality implemented a policy whereby prohibition
of the sale of pastries and other high energy foods including soft drinks have been
banned in all school of Mauritius. At the international level, childhood obesity is
becoming highly concentrated in low income communities. Differential distribution of
three resources- food, physical activity opportunities, and health care- has been
identified as main drivers of inequalities in child obesity. These factors operate at the
global, national, regional, community and individual levels to produce differing rates
of obesity among different social groups. Unfortunately, market forces, public policies
and social factors interact to differentially distribute access to affordable healthy and
unhealthy food, opportunity for safe physical activity, and access to the primary and
preventive health services that can reduce risk of obesity.
As mentioned previously, be healthy has lots of correlations with other factors like
the food we eat, the place we live, the level of education we have, the work we do,
the activities we perform etc. higher educational attainment is related to better
health, possibly through the consequences of education for income, occupational
achievement, residential location, and other factors like self-efficacy and sense of
control ( Kawachi et al, 2010). Work environment are also predictors of health. The
adverse health consequences of physical and chemical exposures at work- such as
exposure to toxicants, noise, and heat- are well established (Rosenstock et al,
2005). There is plenty of evidence showing the impact of environmental factors, such
as air pollution, on causation and acceleration of respiratory and cardiovascular
diseases (Brook et al 2004, Dominici et al 2006). This is why the rate of asthma has
increased in the last few decades in countries like France and United Kingdom. Air
pollution is also related to an increase in the emission of carbon dioxide causing
global warming which in result causing a depletion in the ozone layer. Research has
also shown that the incidence of skin cancer has increased due to the exposure to
ultraviolet light.
As a matter of fact, numerous policies have been formulated for people to be healthy
in the medium or long term. A few of them are vaccination policies in most countries
including Mauritius to prevent communicable diseases as from the birth of our
children.

To address the problem of air pollution in Paris, a policy whereby car having either
odd or even numbers are not allowed to travel together when there is plenty of fog.
On one day, car having even number can drive and on the other those having odd
number. Similarly, the United Nations is holding global policies to encourage
countries to decrease their level of Carbon Dioxide release in the atmosphere. This
policy acts like a deterrent. Policies that blunt adverse consequences or ameliorate
health risks include housing, occupational safety and health, exposure to toxic
hazards, and the availability of nutritious food. Example of such policies include:
1. Environment
- Provide affordable housing ( the government has recently promised to provide
-

people with low income about 2000 houses per year)


Increase traffic safety ( to decrease comorbidity associated with fatal

accidents)
- Enforce lead abatement ordinances and reduction of asbestosis.
2. Work
- Limit exposure to physical hazards, chemicals and psychosocial strains in the
-

workplaces
Reduce disruptive shift changes and extended work hours
Provide working parents with sufficient leave time to attend to sick family
member. In the same hand, government has just extended the maternity leave

3.
4.
-

from 12 to 14 weeks to encourage breast feeding


Cigarettes and alcohol
Ban smoking in public areas,
Increase excise taxes on cigarettes and alcohol and junk food
Control advertising of tobacco and alcohol products
Limit the concentration and operating hours of stores selling alcohol
Recreation
Increase access to recreational facilities through construction support and
policies to open up school and other institutions evening or weekends for
people to make use of the gymnasium facilities. In the same hand, lightening
facilities in most of the football pitches is available for people to perform

5.
-

exercise after working hours and early in the morning.


Nutrition
Ban sale of soft drinks and junk foods in schools
Modify school lunch programs to improve nutrition
Availability of dispensers for fruits in schools and universities instead of
chocolates and sweets

Housing policies, education policy, labour regulations (Working for 40 hours per
week and getting off from work after night duty) are critical to determining the

conditions that lead to patterns of disease and mortality. They are in other words
health policies.
Policies are indeed essential and of utmost importance in the healthcare. Be it a
macro-policy like thermal checking of travellers at airports for fever to prevent
propagation of diseases like dengue, avian flu, H1N1 virus or the simple hand
hygiene policy done at all levels to prevent cross contaminations. However, policy
without planning is very difficult to implement. From the very beginning stage of
problem or situational analysis whereby different problems concerning people and
their health to the implementation and reviewing of policies, planning is essential.
The situation analysis should be systematic and comprehensive and could use the
following as a check list:
Understand the population and service environment
-

Scan the environment


Profile the population
Profile and understand the health status of the population
Profile the geographical context
Profile the health status
Profile current service arrangement
Profile service activity ( current and projected)

Identify the health needs


-

Identify health issues (current and projected)


Identify health service issues (current and projected)
Develop an approach to categorise and analyse needs

However this is not possible without planning. The relationship between policy and
planning has been shown in the following diagram. As shown below, a policy provide
only overall direction to an issue. Strategic planning on the other hand translates the
policy into objectives and strategies while the operational plan looks into the small
actions for the implementation and checking of the problem.

POLICY

OPERATIONA
L PLANNING STRATEGIC
PLANNING

PROVIDES OVERALL
DIRECTION
OPERATIONA
L PLANNING

TRANSLATES
POLICY
INTO
TRANSLATES
STRATEGIES
BROAD
OBJECTIVES,
INTO
ACTIONS
STRATEGIES

Strategic Plan
A strategic plan can be defined as a document that portrays the vision of the desired
future. It is usually translated into medium to long term goals and objectives, set
priorities, expected results and targets as well as the vehicle to be used to achieve
them. In other words, it is about setting a direction for the organisation (Health care
sector in our case) by devising objectives and goals and also looking into strategies
to pursue for the organisation to achieve the desired goals. The strategic plan in no
way deals with the day to day running of the organisation or institution.

Operation plan
Operation plans, more commonly known as the implementation plans, are the
detailed actions which are identified to achieve the goal of the strategic plan. It gives
us an idea of:

What is to be done

Who will do it

How will it be done

When will it be done

It also looks into it how the above will be implemented.

The budget or finance is also part of the operation plan.

Planning takes place at any level in health system. It takes place continuously and it
is a spiral or cyclic process. The importance of planning as an element of healthcare
management process is universally accepted. It brings prosperity and stability to any
organisation including healthcare as a unit. Through planning, unity of purpose is
achieved. It diverts all efforts in one direction for the achievement of any well
established and well defined objectives. Without planning, there will be disorder,
confusion, inefficiency, wastage of human efforts and material resources.
The healthcare sector is an ever growing organisation with the number of patients
attending health care institutions increasing daily. The demands and expectation of
the population also in increasing and patients are becoming more exigent. The
emergence of new diseases and the propping of health institution here and these is
putting a lot of pressure of the management of health care systems. To be more
efficient and effective the need of planning is vital.
Once strategic planning has given the broad objectives, the operation plans are used
to execute these objectives. Planning unity of purpose and direction before the
organisation as a whole for achieving a well-defined goal. It does so by diverting all
resources in one direction for achieving well defined objectives. This can be
achieved by effective and judicious use of available human and material resources.
While so doing, wasting in any type of resource (human or material) is minimized.
Through planning, inconsistency in efforts is avoided. In other words, through
effective planning, conflicts are either minimized or resolved the sooner possible. In
so doing, the organisation keeps solutions for possible problems and enable the
organisation to function with confidence. Through planning, no hasty decision are
made. It facilitates effective delegation of authority, removes communication gaps
and thereby raises overall efficiency.
A healthy population is an essential asset for the progress of a country or nation and
this can not be achieved without proper functioning of its healthcare sector be it

private or public. With rising demands from the population and cuts in financial
allocations from the state, the health sector has to see to it how effectively and
efficiently it can cope with the rising demands of the population and the decreasing
financial assistance. Planning is what can be of any help here. As mentioned earlier,
the population globally is an ageing one and with the increase in the number of
people attending health institution due to war, natural calamities, stress, malnutrition
and social instability it is high time that the health sector plans itself to accommodate
what is awaiting it.
The corporate plan is for the day to day running of the health institution. The day to
day running in the health care sector involves lots of other economic sector. The
health sector cannot survive alone. There is not medicine without medications. There
can be no hospitals without beds, chairs and other furniture. Without technology,
high medicine which is proving its worth so much nowadays. No technology and
medication can reach a health institution without any form of transport be it via air,
sea or land. To achieve all of these, the most important thing is finance .Nothing can
be done without money. So first of all, the health sector needs a budget. And a good
budget can be made through proper planning.
Financing of food, furniture, transport, equipment, medication, infrastructure and
human resource can be efficiently done by proper planning. From the local
dispensary to the tertiary hospitals, all need planning. Planning has to be done for
the daily running of the institutions for example cleanliness of the wards, allocations
of beds, provision of food, medication etc. Forecasting is imperative in the healthcare
sector. A provision for medications to be used for lets say in winter is important. In
winter, respiratory infections are more common. As a matter of fact, provision has to
be made to cater for medication for such diseases.
Strategic planning has to cater for the future needs of the health sector- an ageing
population, increase in obesity, increase in sexually transmitted disease, increase in
pandemics and epidemics, increase in non-communicable disease and vector borne
diseases. Means to tackle all them can only be achieved through well thought
planning. Planning to decrease the incidence of obesity, transmissible diseases and
non-transmissible disease has to be done.

To conclude, planning and policy making are vital in the health sector. With emerging
new needs and increase in the already known priorities of the health sector and
global economic crises, the health sector has to learn and prepare itself to cope with
all these. Policy making is essential to plan ways to decrease or prevent the
incidence of obesity and other associated disease, and also to decrease the
incidence of sexually transmitted disease and teenage pregnancies. Planning has to
be done for the implementation of all these and preparing the health care for the
challenges awaiting. As the saying goes one Prevention is better than cure, the
health sector must prepare itself to minimize all the risks awaiting rather than cure it
which will be a big financial burden for the state. As a matter of fact, planning and
policy making has a huge financial implication in the health sector. it is imperative for
cutting the cost in the health sector but still provide top class health facilities and
service.

References
1. Public Health Policies in European Union: An Innovation Strategy
Horizon 2020
2. M. Marmot Social determinants of health inequalities Lancet, 365
(2005), pp. 10991104
3. Urban energy, carbon management (low carbon cities) and co-benefits
for human health by James Milner, Michael Davies, Paul Wilkinson
4. Does more equitable governance lead to more equitable health care? A
case study based on the implementation of health reform in Aboriginal
health Australia by Margaret Kelaher, Hana Sbanovic, Camille La
Brooy, Mark Lock, Dean Lusher
5. Health, policy and geography: Insights from a multi-level modelling
approach by Adriana Castelli, Rowena Jacobs, Maria Goddard, Peter
C.Smith