 The Policy Analysis Triangle is a simple model for understanding the various sets of factors that

are at work within any policy process.

 It emphasises the central role of policy actors, but also highlights the links between actors and
three other factors that influence decision making: context, content and process.

1. ACTORS

Policy actors are those who:

► Identify problems or issues as worthy of attention;

► Prevent problems or issues being considered;

► Shape the design of proposed policies; membentuk desain kebijakan yg diusulkan

► Block the implementation of proposals; menghalangi implementasi proposal

► Develop the strategies through which policies are developed and implemented; and

► Shape the practice of implementation and so influence the impacts achieved through policy
changes.

 Actors are at the center of the health policy framework.

 Actors can be used to appoint

» Individuals e.g. a statesman - Nelson Mandela, former President of South Africa

» Organizations such as World banks or multi-national companies such as Shell

» A State or government

Social movements or community movements.

 It is important to identify the full range of actors in policy processes and the roles they play,
including those who are less obvious and how they may influence policy by their ‘non-action’.

Penting untuk mengidentifikasi berbagai aktor dalam proses kebijakan dan peran yang mereka
mainkan, termasuk mereka yang kurang jelas dan bagaimana mereka dapat mempengaruhi
kebijakan dengan 'non-aksi' mereka.

 These actors seek to influence political processes at the local, national or international level.

 They are part of a network that is often referred to as a partner, to consult and decide on
policies at all these levels.

 To understand how much influence these actors have in the policy process also means
understanding the concept of power, and how that power is used

 Power can be categorized based on

 → Personal wealth

→ Personality

→ Level or access to knowledge

→ Authority

→ Organization and structure

2. CONTEXT

 Context refers to systematic factors - political, economic and social, national and international -
that may have an influence on health policy.

 Context can influence policy in a number of ways, then  It can affect the perceptions and
understanding of current problems, as well as actors’ policy concerns and their decision making
power.

 Contextual factors can influence the feasibility of policy implementation policy

» e.g. through affecting the resources that are (made) available or people’s willingness to provide
or use a service.

 There are many ways to classify these factors, but Leichter (1979) describes a way that is quite
useful:

SITUATIONAL FACTORS

• Conditions that are not permanent or specific that can have an impact on policy (example: war,
drought).

These are often known as 'focusing events’  event is only one event, such as: an earthquake that
causes changes in hospital building rules, or too long the public's attention about a new problem.

STRUCTURAL FACTORS

• Part of a society that is relatively unchanged.

• These factors include the political system, including the openness of the system and the
opportunity for citizens to participate in policy discussions and decisions

• Structural factors include the type of economy and the basis for labor.

• Structural factors that will affect a community's health policy are demographic conditions or
technological progress.
CULTURAL FACTORS

• Cultural factors, can affect health policy.

• In societies where the hierarchy occupies an important place, it will be very difficult to ask
questions or challenge high officials or senior officials.

• Positioning as a minority or language difference can cause certain groups to have inadequate
information about their rights, or receive services that do not meet their specific needs.

• In some countries, where there is a stigma about an illness (eg TB or HIV), the authorities must
develop a system of home visits or door-to-door visits.

• History and tradition also need to be considered as they can influence the environment in which
a policy is developed or implemented.

• Religious factors can also greatly influence policy,

» President George W. Bush’s was inconsistency in the early 2000s in terms of sexual rules with
increasing use of contraception or access to abortion.

» This affects policy in the United States and other countries, where NGO reproductive health
services are severely restricted or funding from the US government is reduced if they fail to
carry out President Bush's cultural traditions.

INTERNATIONAL OR EXOGENOUS FACTORS

• International or exogenous factors, which cause increased interdependence between countries

and affect international independence and cooperation in health.

• Although many health problems are related to national governance, some of them require the
cooperation of national, regional or multilateral organizations.

• Example  the eradication of polio has been carried out almost all over the world through
national or regional movements, sometimes with the help of international bodies such as WHO.

• However, even though one region has succeeded in immunizing all of its infantry polio and still
maintaining its coverage, the polio virus can still enter the area brought by non-immunized
people who enter through the border.

3. PROCESS & STRATEGY

Every policy change process takes place over time, and understanding the chronology of the
steps within it is always important to thinking about and understanding the process of change.
Within any process of policy change, a range of specific processes and strategies may be
deployed (or overlooked) that will enable or support the decision making entailed in developing
the policy, as well as its implementation
 The specific process options include those regarding
 The style of decision making - which can range broadly from consensus-based to instructional
decision making;
 The information and knowledge available and used in decision making;
 The speed and timing of decision making;
 The way in which consultation takes place and the communication strategies employed;
 The extent to which attention is paid to managing actors in the process of policy change, and the
strategies used to do this;
 The venue or location of decision making – including the use of structures specially established
as fora for decision making (or non decision making), versus routine committees and meetings;
 The scale and timing of implementation of proposed changes, and the sequencing of different
activities and tasks.

The process refers to the way in which policies are initiated, developed or developed,
negotiated, communicated, implemented and evaluated.
The most commonly used approach to understanding the policy process is to use what are
called 'STAGES OF HEURISTICS’
(Sabatier and Jenkins-Smith 1993).
 To divide the policy process into a series of stages as a theoretical tool, a model and not
always show what actually happens in the real world.
 However, this set of stages helps to understand policy formulation in different stages:
- IDENTIFICATION OF PROBLEMS AND ISSUES
Discover how existing issues can be put on the policy agenda
Why other issues have never been discused
- POLICY FORMULATION
Find out who is involved in the formulation of the policy, how the policy is produced, agreed
and communicated.
The role of policy making in government
- POLICY IMPLEMENTATION
This stage is most often ignored and is often considered a separate part of the first two
stages.
However, this stage is argued as the most important stage in policy making because if the
policy is not implemented, or changed during implementation, something wrong might
happen - and the policy results are not as expected.
- POLICY EVALUATION
Find out what happened when the policy was implemented - how it was monitored,
whether its objectives were achieved and whether there were unintended consequences.
This stage is the time when the policy can be changed or canceled as well as the new policy
set.

FACTS PROCESSS & STRATEGY

1) The policy process looks like a linear process - in other words, it runs smoothly from one stage to
another, from problem discovery to implementation and evaluation.

2) Actually rarely seen clearly as a process, maybe when the implementation phase of a new
problem is found or the policy may be formulated but never reaches the implementation stage

3) Policy making is rarely a rational process - iterative and influenced by unilateral interests - i.e.
the actors.

4) The policy process is something that is jumbled by policy makers . Lindblom (1959)

4. CONTENT

Content  what has been agreed to

Content  is the substance of the policy which is embedded in legislation, policy documents,
regulations and guidelines.
 The text of a policy generally describes its objectives and may give various details, including the
structures or mechanisms for implementation, resource availability, indicators for monitoring
and evaluating progress.
 The policy content also represents a set of values – either overtly or in a less obvious way.
 Policy content only comes alive in the actual practices of implementing policy actors.
 The substantive content of policies is influenced by the actors involved in or shaping policy
formulation decisions as well as by the contexts in which it is developed and implemented, such
as levels of resource availability.
 Past policies influence current problems and current policies influence actors’ positions on
policy and the feasibility of implementation.
Iuran BPJS Batal Naik, Tarif Normal Berlaku 1 Mei 2020

Aktor:

-
- MA
- Kepala Humas BPJS
- Pemerintah?
- Para Menteri, Menteri Keuangan Sri Mulyani, Wakil Menteri Keuangan Suahasil Nazara,
Menteri Koordinator Bidang Politik, Hukum dan Keamanan (Menko Polhukam) Mahfud
MD

-
- Komunitas Pasien Cuci Darah Indonesia

Konteks:

Process:

Konten: