Course Outline

I. Objectives
II. Definition of Terms
III. Types of Policy
IV. Policy Development
 Policy Making Cycle
 Standard Components of a Policy
 Criteria of a Good Policy
 Qualities of a Good Policy
V. Health Policy Analysis
 Approaches to Policy Analysis
 Importance of Policy Analysis
 Conducting A Policy Analysis
 The Eight Fold Path
VI. Words to Ponder
VII. References

Objectives:
 Know the different terminologies used in policy process
 Define policy development and policy analysis
 Identify the cycle of policy development and its important elements
 Be acquainted on how to conduct policy analysis

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Policy
Is an essential part of every human being. Day-in-day-out policies are formulated,
relinquished, replaced, and revised among other things. It is a deliberate system of
guidelines to guide decisions and achieve rational outcomes. A statement of intent and
is implemented as a procedure or protocol. It is used to assist in both subjective and
objective decision making. It serves also as a blueprint of the organizational activities
which are repetitive/routine in nature. Policies are typically instituted to avoid some
negative effect or to seek some positive benefit.
Healthcare policy is an integral aspect of a healthcare system. It helps shape
and protects the health and well-being of our population. It consists of the
principles and regulation that guide and promote people’s health and well-being.
It is created to influence health achievements and goals. Legislation directly or
indirectly impacts health framework that manipulates socioeconomic status, social
and physical environments, behaviors and ease of access and ease of use to medical
services.

The World Health Organization (WHO) defined health policy as an agreement or

consensus on the health issues, goals and objectives to be addressed, the priorities
among those objectives, and the main directions for achieving them. Policy impacts
issues as fundamental as healthcare access, cost, delivery methods and privacy. It
involves the rules and regulations set forth by lawmakers on a local, state and national
level. It refers to the decisions, goals and actions that determine how care is
administered and accessed. It also refers to the policies set on national level in terms of
access to healthcare, coverage and cost. It helps establish guidelines that benefit
patients, healthcare organizations and our healthcare system. Having protocols can help
in avoiding human error and poor communication around medical decisions.
For nurses and health administrators, understanding and following policies can
help ensure that best care to patient will be delivered while using our knowledge.

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Moreover, when patients take the time to understand healthcare policy, they learn more
about their rights.

Policy development
Is an analytical process that begins with the occurrence or observation of an issue
that requires the attention of those affected and or those who represent those impacted.
It requires consultation and research in order to thoroughly understand the dimensions
of the problem. It is a long strategic process that produces a plan that the whole
organization should follow as closely as possible in the future.
Healthy public policies can improve the physical, social, economic and
environmental conditions, in which people live, learn, work and play.
Policy development often occurs in three types of settings: government, public
institutions (such as hospitals, daycare centers or schools) or organizations/workplaces.

Policy analysis
Is the process of identifying potential policy options that could address the
problem and then comparing those options to choose the most effective, efficient, and
feasible one. Conducting a policy analysis ensures you have gone through a systematic
process to choose the policy option that may be best for the situation.
Health policy analysis is a multi-disciplinary approach to public policy that aims
to explain the interaction between institutions, interests and ideas in the policy process.
It is useful both retrospectively and prospectively, to understand past policy failures and
successes and to plan for future policy implementations. The main concern of policy
analysis is the outcomes of health policies or the effects that the policy has on people

Types of Policy.

1) Distributive/Allocative Health Policy

Distributive policies target society as a whole to provide benefits. It spread
benefits throughout society. It is the allocation of resources to improve healthcare
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provision. An example of a distributive policy is the funding of hospital
infrastructure, health authorities, and medical research. The funds come from the
government to work on improving health services.

2) Regulatory Health Policy

Regulatory health policies are used by the government to standardize and
control types of behavior of specific groups. The government does this by monitoring
and enforcing consequences when policies are not followed. An example of a public
regulatory health policy is requiring medical professionals to be licensed in order to
work. An example of a private regulatory health policy is the accreditation process
that hospitals follow through various organizations to ensure standards are being met.

3) Redistributive Health Policy

Redistributive policies are an essential component of strategies for reducing
inequality and promoting sustainable development in its three dimensions: economic,
social and environmental. It is the system of taking money (tax) or power from one
group and gives it to another. This system often creates visible beneficiaries and
payers. Example of Redistributive policies includes the Medical Aid Program which
takes tax revenue from the public and spends it on the poor in the form of free health
insurance.

The Policy Development Cycle

Is a tool used for analyzing the development of a policy item. It can also be
referred to as a “stagiest approach”, “stages heuristic” or “stages approach”. It is thus a
rule of thumb‫ قاعدة اساسية‬rather than the actual reality of how policy is created. The
word “process” is replaced by “cycle” when the activity is always used each time a
similar outcome is desired.
These are critical steps that policymakers follow when drafting any form of policy. It is
an idealized process that explains how policy should be drafted, implemented, and

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assessed. It serves more as an instructive guide for those new to policy than as a
practical strictly-defined process.

Hi Policy Cycle

1) Agenda setting
This step identifies new issues that may require action. If multiple areas are
identified they can all be assessed, or issues may be given priority . Those under the
salient issues are the ones discussed and thoughts, ideas, and solutions are organized in
an agenda. This is the troubleshooting stage.

2) Policy formulation
This step defines the structure of the policy. It answers the questions: What
goals need to be achieved? Will there be additional implications?

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It involves exploring a variety of options or alternative courses of action available for
addressing the problem (appraisal, dialogue, formulation, and consolidation).

3) Decision making
In this step, leaders decide on a particular course of action whether to

maintain the policy status quo or alter it. The decision could be 'positive', 'negative', or
'no-action‘. Ideally, it is the course that will best address the problem for most
members of the public.
4) Implementation
In this step, the ultimate decision made earlier will be put into practice.
Requirements of that policy must be put into action, administered, and enforced to bring
about the desired change sought by the policy-makers. Involve creating an external
organization to carry out actions.
Monitoring to ensure correct policy implementation is also necessary.
5) Evaluation
This step assesses the effectiveness and success of the policy; they determine
whether or not the policy is bringing desired results. Policy actors attempt to determine
whether the course of action is a success or failure by examining its impact and
outcomes. These assessments can be quantitative and/or qualitative.

Standard Components of a Policy‫مكونات السياسة‬

1) Purpose Statement
The purpose of a policy or procedure is the reasoning that led to its creation.
These purposes may relate to a common problem that the organization hopes to solve.
It outlines why the organization is issuing the policy.
2) Applicability and Scope Statement
It describes who the policy affects and which actions are impacted by the policy
3) Effective Date

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 Indicates when the policy comes into force.
4) Responsibilities
It describes the role that individual employees have in ensuring that they
follow the policy. These responsibilities may list specific positions within the company
and how those positions contribute to the completion of a policy or procedure.
5) Policy Statements
Indicates the specific regulations, requirements or modifications to organizational
behavior that the policy is creating.

Additional Components of a Policy

1) Background
Indicating any reasons, history, ethical background statements, and /or intent that
led to the creation of the policy, which may be listed as motivating factors.

2) Definition
Providing clear and unambiguous definitions for terms and concepts found in the
policy document.

Criteria of a Good Policy

Criterion 1: Present the purpose of the policy document
A policy document should explain the reasons for the policy paper, the nature and
scope of the issue/problem for which a policy response is being sought and the desired
outcome that a policy or set of policies is intended to achieve

Criterion 2: Provide Evidence

A policy document should provide data/facts to support the various arguments
and recommendations put forth. Data/facts can be qualitative and quantitative.

Criterion 3: Identify and Evaluate Options

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 A policy document should identify the range of options available to address the
issue/problem described and should identify the framework of principles or objectives
that guided the selection of options to be considered. A common set of criteria should
be used to evaluate the pros and cons of each of the options considered. Where a
review of options is not considered relevant or suitable in relation to the policy question
at hand, a policy document should include a statement to this effect with reasons.

Criterion 4: Logical Sequence

A policy document should contain a logical flow in terms of presenting the
various arguments and recommendations put forth. The linkage between one section of
a policy paper and the next should be clear. The reader should have an overall sense of
the organizational structure of the policy document.

Criterion 5: Present the Results of Consultations

A policy paper should identify who has been consulted in the process of
developing the policy paper and should identify the feedback received from those
consulted. Where consultation is not deemed appropriate or timely under the
circumstances, the policy paper should provide a statement to this effect with reasons.

Criterion 6: Clear Presentations

A policy paper should present each section in a direct, straightforward fashion
that is as brief as possible without compromising comprehensiveness and
comprehension.

Qualities of a Good Policy Writing

 Timely
It is ready when other decision-makers need it; has been prepared based on
adequate consultation with stakeholders inside and outside healthcare organizations;
clearly articulates the purpose for which it has been prepared;

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  Has a sound logical basis
There is a clear description of the facts and assumptions upon which the advice is
based, and a clear articulation of the links between fact and assumptions on the one
hand, and conclusions and recommendations on the other.

 Has a sound evidentiary basis

The underlying evidence is accurate and complete.

 Balanced 
It presents a representative range of viewpoints; presents an adequate range
of viable options for action.

 Well presented 
The prose is concise; the text is well organized.

 Relevant
It takes into account current realities (including political realities) and anticipates
related developments

 Pragmatic 
It bears in mind implementation issues.

Health Policy Analysis

 META ANALYSIS
It is often used to assess the clinical effectiveness of healthcare interventions. It
combines data from two or more randomized control trials, provides a precise
estimate of treatment effect,
 MESO ANALYSIS

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 Is a middle-range or bridging level of analysis which is focused on the linkage
between the definition of problems, the setting of agendas and decision-making and
implementation processes.
Considered at the level of patient care (micro) healthcare organization (meso) and
health policy (macro).

 DECISION ANALYSIS
Is a formalized approach to making optimal choices under conditions of
uncertainty. The goal of decision analysis is to ensure that decisions are made with all
the relevant information and options available.

 DELIVERY ANALYSIS
Is the analysis of implementation, evaluation, change and impact.

Two Major Fields of Health Policy

1) Analysis of existing policy
Is analytical and descriptive i.e., it attempts to explain policies and their
development
2) Analysis for new policy
Is prescriptive i.e., it is involved with formulating policies and proposals (for
example, to improve social welfare).

Type of Approaches Primary Objective

 Process Approach  To examine part of the policy
process

 Logical-positivist approach  To examine the causes and

consequences of policy using
scientific methods.
 Econometric approach  To test economic theories

 Phenomenological (Post positivist)  To analyze events through an

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 approach intuitive process
 Participatory approach  To examine the role of multiple
actors in policymaking
 Normative approach  To prescribe policy to decisions
makers or others
 Ideological approach  To analyze from a liberal or
conservative point of view
 Historical approach  To examine policy overtime

Importance of Policy Analysis

Its purpose is to assist policymakers in choosing a course of action from among
complex alternatives under uncertain conditions. Conducting policy analysis ensures
you have gone through a systematic process to choose the policy option that maybe best
for the situation.

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Conducting a Policy Analysis
1) Research and identify possible policy options
It is done by reviewing research literature, conducting an environmental scan, and
surveying best practices to understand what other communities are doing.

2) Describe the possible policy options

Pay attention to the health impact, cost of implementation, and feasibility of each
option.

3) Rank the possible policy options and pick the best one
Compare the policy options , in some cases, the review may reveal a clear winner
a policy that is:
a) Feasible,
b) Has a strong, positive impact on public health
c) Is economically and fiscally viable

The Eight-Fold Path in Policy Analysis

1) Define the problem
First, in health policy analysis, primary care researchers must define the problem.
Defining the problem is critical in policy analysis because it guides the research method
and helps establish the structure used in communicating the results.

2) Assemble some evidence

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 Is crucial in the solution of policy problems. This step is the data and
information gathering that can help in analyzing the problem. It involves assembling the
evidence by investigating the background, trends, and systematic, institutional,
interpersonal or financial barriers and facilitators to successful resolution
3) Construct the alternatives
It guides primary care researchers to consider the advantages and disadvantages
of each policy alternative and consider using alternative approaches to policy alone or in
combination with other alternatives. It is an explicit description of the assumptions and
positions being made for each policy alternative, is critical for successful
implementation of the policy.

4) Select the criteria

It explores how alternatives can be measured and evaluated. This is an
essential step to determine the effectiveness of current policy. Criteria can be
established based on prior research and can include the feasibility of each alternative
given local, epidemiological, political and socioeconomic conditions. Considerations
can also include primary health outcomes, cost-effectiveness, feasibility of
implementation, acceptability, political feasibility, sustainability and practicality.

5) Projecting the outcomes ‫توقع النتائج‬

Often considered the most challenging step, projecting the outcomes is an
opportunity to consider how realistic or viable each alternative policy outcome is
given resource constraints.
In order to project the outcomes, primary care researchers must consider both the
direction and the magnitude of the outcome.

6) Confronting the trade-offs ‫مواجهة المفاضالت‬

The primary care researcher needs to consider the trade-offs between and within
each policy alternative. The trade-offs need to be considered in terms of the criteria by
which they can be evaluated, and the criteria themselves need to be weighted.
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7) Decision making
Decision-making is an opportunity for primary care researchers to go through the
process of clarifying the costs and benefits in order to present a final decision to
stakeholders. This will ensure that, when they explain the costs and benefits, their
explanations are clear and the logic behind their choice is sound and easy to follow.

8) Tell the story

May take the form of a narrative, and primary care researchers need to clearly
understand the reasons behind their decision. Most importantly, primary care
researchers need to define the audience and ‘pitch’ the story to a target population,
keeping in mind both the larger political environment and the storytelling medium. It
can be done either in written or in oral form, but in any case, it should be
“communicated simply and clearly”

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 An actual sample of policy is attached to further understand the topic.
Highlighted parts are the standard components of a policy:

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References
September 27, 2022. Policy Analysis. Office of the Associate Director for Policy and Strategy. Centers for
Disease Control and Prevention. Retrieved from
https://www.cdc.gov/policy/polaris/policyprocess/policyanalysis/index.html
March 05, 2021. Strategy and Policy Development. Office of the Associate Director for Policy and Strategy.
Centers for Disease Control and Prevention. Retrieved from
https://www.cdc.gov/policy/polaris/policyprocess/strategy-development/index.html
March 15, 2022. CDC Policy Process. Office of the Associate Director for Policy and Strategy. Centers for
Disease Control and Prevention. Retrieved from https://www.cdc.gov/policy/opaph/process/index.html
12 October 2022.POLICY. Retrieved from https://en.wikipedia.org/wiki/Policy#Cycle

 2020.Redistributive Policies. United Nations Economic and Social Commission for Western Asia. Retrieved
from https://archive.unescwa.org/redistributive-policies
12 October 2022.POLICY. Retrieved from https://en.wikipedia.org/wiki/Policy#Cycle

 2020.Redistributive Policies. United Nations Economic and Social Commission for Western Asia. Retrieved
from https://archive.unescwa.org/redistributive-policies
Tawipa Kapisa. November 22, 2021. 5 Stages of the Policy Making Process. Guardian, Student Guide.
Retrieved from https://www.zambianguardian.com/stages-of-the-policy-making-process-2/
2022.The Policy Cycle. European Geosciences Union. Retrieved from https://www.egu.eu/policy/cycle

Definition of Public Policy Evaluation. The Pennsylvania State University. Retrieved from
https://courses.worldcampus.psu.edu/welcome/plsc490/lesson05_07.html

Policy NL. Newfoundland Labrador Canada. Retrieved from

https://www.policynl.ca/policydevelopment/ps.html

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