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Health Policy and Financing Module

Public policy and health policy

Sudarshan Paudel
School of Public Health
Patan Academy of Health Sciences
Lalitpur

2079 Falun 4

Public Policy

WHAT IS PUBLIC POLICY?

• Public policies are those policies developed by governmental
bodies and officials, and thus focus on purposive action by or for
governments.
• Policy - involves the decision to act on some particular problem
includes subsequent decision relating to its
implementation and enforcement
represents what government actually do what
government not to do
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Public Policy
What is Health policy?
It embraces courses of action that affect the set of institutions,
organizations, services, and funding arrangements of health care
system. It goes beyond health services, however, and includes
actions or intended actions by public, private and voluntary
organizations that have an impact on health.

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Sustainable Development Goals(SDGs) 2030

Structure of SDGs: 17 Goals, 167 targets, 247 indicators

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What is meant by Sustainable Development?

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Are SDGs a Public Policy?

• YES

• NO

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Overview of global and regional health situation

•Life expectancy around the world
•Estimated main causes of mortality
•Causes of mortality
•Global risk factors

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Life expectancy at birth, men and women, by WHO region, World Bank income
groups and global, 2000–2019

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Source: WHO Global Health Estimates, 2019 (file:///D:/Drive%20C/Downloads/9789240051140-eng.pdf)

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Composition of causes of death, by WHO region, World Bank income group and
global, 2000 and 2019

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Source: WHO Global Health Estimates, 2019 (file:///D:/Drive%20C/Downloads/9789240051140-eng.pdf)

Why Is Global Health Important?

• Security (Threats of disease globalization; emerging infectious diseases)
• Diplomacy (Citizens, civil society, and corporations can perform when politics fail; serve as
ambassadors of good will)
• Science (Build knowledge of global value and conduct research that is critical to scientific
advancement)
• Sustainable Development (Health is central to economic development and good health is directly
linked to both higher life expectancy and economic improvement)

Global health is an area for study, research, and practice that places a priority on improving
health and achieving equity in health for all people worldwide.
It emphases:
• transnational health issues, determinants, solutions
• multidisciplinary collaboration
• synthesis: population bases prevention & clinical care

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Health System Development: What is it?

Health system framework – The WHO System Framework

Propose modify WHO framework

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The level of health system

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Public Policy in Health System Context

•is the principled guide to action taken by the administrative
executive branches of the state with regard to a class of issues, in a
manner consistent with law and institutional customs. (Wikipedia)
•is a course of action adopted and pursued by government. (Henry, N.,
2013)
• is the means by which a government maintains order or
addresses the needs of its citizens through actions defined by its
constitution.(David White; study.com)

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Public Policy in Health System Context

• Where do we want to be?
• How did we get here?
• How well are we doing delivering services?
• What other alternatives are available throughout the world?
• What is likely to work in the future given our political process?
• What roles should professionals and ordinary citizens play in this
process?
• How can we become better prepared for such roles?

McLaughlin, C.P.&McLaughlin, C.D.,2019

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Current Issues of Health Policy

•Pandemic of COVID-19 •Ageing Population
•Air pollution and Climate •Antimicrobial Resistance
change •Disaster
•Communicable Disease •Unequal distribution of
•Global warming resources
•Motor vehicle accident •Quality and Safety of healthcare
•NCD system
•Occupational hazards •unplanned Cities
•Affordable healthcare Services • Unhealthy life style

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Current Issues of Public Health Policy

•Discuss the health policies and programs related issues in Nepal
in the verge of COVID-19.

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Some health policy focus narrowly on the health care

system only.

“Healthy public policy” has been used to differentiate the

broader definition from the narrow.

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Types of Policies
• High politics: the maintenance of core values – including
national self-preservation and the long-term objectives of
the state
• Low politics: are issues not seen as involving fundamental
or key questions relating to a state’s national interests, or
those of important and significant groups within the state.

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Policy types and policy levels

High politics Low politics

Policy types • Macro policy • Micro policy

• Systemic policy • Sectoral policy

• National government • Ministry of Health

• State government • Local health authority
Policy level • Regional authority • Institution (e.g. HP, Hospital)

• Regulation of • Introduction of breast

Policy example private sector screening
• Reform of civil service • Change in vaccine policy
salaries and conditions
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Another way of Policy types

• Distributive policies

• Regulatory policies

• Self-regulatory policies

• Redistributive policies

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1. Distributive policies

consist of the provision of services or benefits to particular

groups which do not result in any obvious disadvantage or
reduction in benefits to other groups, e.g. Social Health Security
policy

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2. Regulatory policies

… involve the imposition of limitations or restrictions on the

behavior of individuals or groups, e.g. forbidding private
practice among nurses and unlicensing physician.

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3. Self-regulatory policies

… are generally sought by an organization as a means of

controlling its own interests, and may be introduced to
avoid interest group activity, e.g. labeling of drug among
Pharmaceutical Association.

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4. Redistributive policies

… consist of deliberate government attempts to change the

distribution of income or wealth, e.g. means of progressive
taxation.

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Health Policy

low-politics
distributive or regulatory
pluralist > elitist

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Policy-Making Process
3-Phases,
8-Steps

Policy-Making Process for

Developing a (Healthy) Public Policy

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Policy analysis

Is a value laden enterprise

It is a process of evaluating and assessing public policies and programs to

understand their goals, impacts, costs, and benefits. It involves examining
the problem, the proposed solution, and the expected outcomes to inform
decision-making and improve the effectiveness and efficiency of policies. It
draws on various tools and techniques, including data analysis, cost-benefit
analysis, stakeholder engagement, and policy simulation, to provide
evidence-based insights and recommendations to policymakers and
stakeholders.

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Policy analyst

• Is viewed as just another actor with his/her own set of values and
biases.
• Use an incrementalist approach
(it emphasizes making small, gradual changes to policies or programs, rather than trying to implement large-
scale reforms all at once. Incrementalism recognizes that policy change is often complex and difficult to achieve, so it
aims to make gradual improvements over time, building on what already exists. This approach typically involves making
changes through small, iterative steps, based on ongoing feedback and evaluation. It contrast with the "big bang" or
radical approach of policy changes all at once, without necessarily considering the practicalities of implementation or the
potential unintended consequences.)

“Policy analyst to be useful to policy-makers must incorporate

their values and speak to them in their language”
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A Policy Analysis Framework

A policy analysis framework is a structured approach that can be used to evaluate and
assess public policies and programs. While there are several policy analysis frameworks
available, a common one is the following three-step framework:

Context

• Actors as individuals
• Actors as members of groups

Content Process
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A Policy Analysis Framework

A five-step policy analysis framework consist:

1. Define the problem: Identify and clarify the policy issue, including the objectives,
stakeholders, and affected populations.
2. Develop policy options: Generate a range of potential policy options to address the
problem, drawing on research, expert opinions, and stakeholder consultations.
3. Evaluate policy options: Assess the advantages and disadvantages of each policy
option, including their costs, benefits, feasibility, and potential unintended consequences.
4. Make recommendations: Based on the policy analysis, identify the most effective policy
option, or combination of options, and provide recommendations to stakeholders and decision-
makers.
5. Monitor and evaluate: Implement the policy and monitor its effects, including its impacts
on the target population and whether it achieves its intended outcomes. Evaluate the policy's
effectiveness and make adjustments as needed.
Using a 5-step policy analysis framework can help ensure that policies are
evidence-based, effective, and sustainable over the long term.
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Policy Analysis Strategies

Area of analysis Planning action

Macro-analysis of the Change will be easier if there is: a single
case with which policy implementing agency; clear goals, one
change can be objective; simple technical features;
implemented marginal change; short duration

Making values underlying Identify macro and micro level values

policy explicit underlying policy decisions. If values
conflict with policy, it may be determined.

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Instrument in Policy Analysis

•IMR
•DALYs
• Stakeholder
• Risk analysis
•Cost-effectiveness
•Cost-benefit
• Comparative analysis
• Scenario analysis
etc.

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Policy Analysis Functions

• Policy analyst can examine characteristics of a society that may
account for difference in policy outcome

• Policy analyst showed focus on policy process and policy

environment not only on policy

“OPTIONS FOR SOLUTIONS ARE TOOLS TO MAKE POLICY CHOICES MORE INFORMED,
MORE RETIONAL” So analysis will be used.

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What are good policies?

What is thought of as an Improved Policy? or Better Policy?
•Family Doctor in Japan
•Universal healthcare coverage in Canada
•Carbon tax in Sweden
•Gun control in Australia
•Paid family leave in Norway
•30 Bhat Health Insurance Scheme in Thailand
•Health Decentralization in Indonesia
•Public Private Mixed in U.K.
•Free Health for All in Sri Lanka
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What are good health policies?

There are many examples of health policies that have been successful in improving public health outcomes
in different countries. Some examples from around the world are:
• National Health Service (NHS) in the UK: … a publicly funded healthcare system that provides universal
coverage for all citizens and legal residents of the UK.
• Tobacco control policies in Australia: … high taxes on tobacco products, plain packaging, smoke-free policies.
These policies have been successful in reducing smoking rates and tobacco-related health problems.
• HIV/AIDS prevention and treatment policies in Brazil: … free access to antiretroviral therapy for all patients. It
has successful in reducing HIV transmission rates and improving the health outcomes of people living with HIV.
• Universal health coverage in Thailand: … provides access to healthcare services for all citizens and legal
residents. The program has been successful in improving health outcomes and reducing health inequalities.
• Healthy eating policies in Japan: … a range of policies to promote healthy eating habits, including mandatory
nutrition education in schools, food labeling requirements, and subsidies for healthy foods. These policies have been
successful in reducing rates of obesity and related health problems.
• Seat belt while Driving:
• No Drink n Drive:

These policies demonstrate a range of approaches to improving public health outcomes, including universal
coverage, prevention-focused policies, and comprehensive approaches to specific health issues.
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Who cares about the policy process

3 groups concern
1. Policy maker
2. Collaborators, Funders, International organization
3. Policy analyst

POLICY ANALYST
• Develop theories about how the policy process works
• Make the content of policy more consistent, more meaningful, more rational
• Assist policy-makers

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(Four) Stages of Policy Making

1.Problem identification and issue recognition
• How do issues get on to the policy agenda?
• Why do some issues not even get discussed?

2. Policy Formulation
• Who formulates policy?
• How is it formulated?
• Where do initiatives come from?

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(Four) Stages of Policy Making

3. Policy Implementation
• What resources are there available?
• Who should be involved?
• How can implementation be enforced?

4. Policy Evaluation
• What happens once a policy is put into effect?
• Is it monitored?
• Does it achieve its objectives?
• Does it has unintended consequences?

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Policy-making model

1. Rational or Synoptic
2. Incrementalist
3. Mixed scanning

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1. Rational or Synoptic
a) Goals or values or objectives that guide policy makers are
clarified and ranked according to their importance.
b) Various alternatives for dealing with the problem are
considered.
c) Consequences following from the selection of each alternative
are investigated.
d) Each alternative, and its consequences, are compared with other
alternatives.
e) Policy maker chooses the alternative that maximizes the
attainment of the goals, values or objectives.
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1. Rational or Synoptic
Problems!

1. A loss to know where to start analysis.

2. Unrealistic, policy makers have no time.
3. Value-free, not objective, have favorite types of solutions,
4. Past policy determines present policy.

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2. Incrementalist Model
a) Selection of goals or objectives and the means of implementation
are closely allied.
b) Look at a small number of alternatives for dealing with a problem.
c) Each alternative only the most important consequences are
considered.
d) No optimal policy option not necessarily the “best” decision.
e) Incremental policy making is essentially remedial, and focus on
small changes to existing policies rather than considering future
major policies (e.g. national environmental policy).

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2. Incrementalist Model
Strengths:
• It concentrates the policy maker’s analysis on familiar, better known experience.
• It sharply reduces the number of different alternative policies to be explored; and
• It reduces the number and complexity of factors policy makers have to analyse.

Weaknesses:
• Content to make such small changes that they reinforce inertia all the status quo.
• Where significant social changes are sought, incrementalism would not be
appropriated.
• Conservative

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3. Mixed scanning (and Normative optional models)

• A macro (fundamental)
• A micro (small) classification

1. Broad review of the field of policy (no details)

2. More in-depth examination if require

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How to write policy brief?

Here are some steps to follow when writing a policy brief:
• Define the problem: Clearly define the problem that the policy brief aims to address. Use data and evidence to show
the magnitude and impact of the problem.
• Identify the policy options: Identify and evaluate different policy options that can address the problem. This should
be based on a thorough analysis of the relevant literature, best practices, and stakeholder perspectives.
• Assess the options: Evaluate each policy option in terms of its feasibility, effectiveness, and potential impact. Use
evidence to support your assessment, and consider the potential unintended consequences of each option.
• Recommend a course of action: Based on the analysis, recommend a preferred course of action. This should be a
clear and specific policy recommendation that is aligned with the policy goals and objectives.
• Develop a concise and engaging executive summary: Write a concise executive summary that summarizes the key
findings and recommendations of the policy brief. This should be clear, engaging, and tailored to the target audience.
• Present the evidence: Present the evidence using graphs, tables, and other visual aids to illustrate key points. Use
data and statistics to support your arguments, and provide references for any sources cited.
• Write in a clear and concise style: Write in a clear and concise style that is accessible to a non-technical audience.
Avoid jargon and technical terms, and use plain language wherever possible.
• Tailor the brief to the target audience: Tailor the policy brief to the target audience.
• Proofread and edit: Have someone else read the brief to provide feedback and suggestions for improvement.
By following these steps, you can create a policy brief that is clear, concise, and persuasive, and that effectively
communicates your policy recommendations to the target audience.
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Examples of policy brief

Title: "Investing in eHealth: A Strategy for Improving Healthcare Delivery and Outcomes“
Context: The policy brief is aimed at policymakers in a developing country that is facing significant challenges in delivering quality healthcare services to its
citizens. The country has limited resources and is grappling with high rates of chronic diseases, inadequate health infrastructure, and a shortage of trained
healthcare professionals.
Key Points:
The policy brief argues that investing in eHealth technologies and services can help address some of the healthcare challenges faced by the country.
EHealth refers to the use of electronic information and communication technologies to support healthcare delivery and management.
The brief highlights several examples of successful eHealth interventions in other countries, such as telemedicine, mHealth applications, and electronic
health records. These interventions have been shown to improve access to care, increase efficiency, and reduce costs.
The brief outlines a three-pronged strategy for investing in eHealth in the country:
– Develop a national eHealth strategy that is aligned with the country's broader health and development goals. The strategy should involve a range of
stakeholders, including government agencies, healthcare providers, and technology companies.
– Build the necessary infrastructure to support eHealth, such as broadband internet connectivity, electronic health record systems, and secure data
storage and transmission.
– Invest in capacity-building and training to ensure that healthcare providers and other stakeholders are equipped with the skills and knowledge to use
eHealth effectively.
The policy brief emphasizes the importance of a coordinated, evidence-based approach to eHealth investment and implementation. This requires robust
monitoring and evaluation mechanisms to assess the impact of eHealth interventions and ensure that they are meeting the needs of the population.
Conclusion:
The policy brief concludes that investing in eHealth is a promising strategy for improving healthcare delivery and outcomes in the country. It is a cost-
effective and scalable approach that has the potential to address some of the systemic challenges facing the healthcare system. However, it requires a
strategic and coordinated approach, and a commitment to evidence-based investment and implementation. By following the three-pronged strategy
outlined in the brief, the country can realize the benefits of eHealth and improve the health and well-being of its citizens.
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In conclusion,

• Public policy and health policy are closely related but distinct fields of study and
practice.
– Public policy refers to the broad range of policies and programs implemented by
governments to address social, economic, and political issues affecting society.
– Health policy, on the other hand, focuses specifically on policies and programs related to the
health sector, including healthcare delivery, financing, and regulation.
• Health policy is a subset of public policy, it is an increasingly important area given the
growing recognition of the critical role of health in promoting overall well-being and
social and economic development. Health policies can have a significant impact on
population health outcomes and can contribute to reducing health inequalities.
• Effective public policy and health policy require a comprehensive understanding of the
complex issues and systems involved, as well as careful analysis, stakeholder
engagement, and political will. By working together, public policy and health policy can
help create a healthier, more equitable, and more prosperous society.
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THANK YOU
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