OVERVIEW OF

HEALTH POLICY

LE HONG PHUOC
Dept. of Health Organization and Management
University of Medicine and Pharmacy, Ho Chi Minh City
 Objectives

1. To undestand basic concepts of policy, health policy,

policy types
2. To describe basic objectives of the health policy
3. To understand the policy process
4. To describe the factors influencing the health policy
process

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 What is policy?

• Policy is a set of ideas, or a plan of what to do in

particular situations, that has been agreed officially by
a group of people, a business organization, a
government, or a political party (Cambridge dictionary)

• Policy is a law, regulation, procedure, administrative

action, incentive, or voluntary practice of governments
and other institutions (CDC, 2017)

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 Policy science
(Khoa học chính sách)

• Multidisciplinary field
Politics
• Sensitive to the change of
Systems
time and environment analysis
Economics

• Study objects: policy system,

policy process Statistics Policy science Society

• Objectives: to fine causes,

solutions → policy
impvovements Philosophy Management

Psychology

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 Public policy
(Chính sách công)

• The term public policy always refers to the actions of

government and the intentions that determine those
actions
• Public policy consists of political decisions for
implementing programs to achieve societal goals.
• A public policy is an action which employs
governmental authority to commit resources in
support of a preferred value

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 Public policy
(Chính sách công)

• “Chính sách công là một chuỗi các quyết định hoạt

động của Nhà nước nhằm giải quyết một vấn đề hay
cải thiện một tình hình kinh tế xã hội theo mục tiêu xác
định”
• 3 basic roles of public policies
▪ To direct
▪ To stimulate developments
▪ To regulate/control

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 Basic features of public policy
(Đặc trưng cơ bản của chính sách công)

Issued by the government

To perform government authority

Institutionalized into decisions, circular etc. with

legal effects

Relying on the use of government power to conduct

policy implementations

Associated with the allocation of government resources

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 Policy level
(Cấp độ chính sách)

International
level
National level

Local level

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 Types of policies

• By impact level
▪ Macro policies (CS vĩ mô), systematic policies (CS có
tính hệ thống), High policies (CS có tính chính trị cao)
▪ Micro policies (CS vi mô), Sectoral policies (CS ngành),
Low policies (CS có tính chính trị thấp)
• By funtion: regulate, distribute, redistribute, etc.
• By criteria: economy, society, education, health etc.
• By issuing level: central government, local government
• Strategic policy and operational policy

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 High policies vs. Low policies
High policies
Policy type Macro policies
Systematic policies
Strategic policies
Policy level Central government
Provincial governments
Local governments
Ex. Policy to reform of public
administrative services, civil
servants' salaries,...
Policy on medical
socialization
Low policies
Micro policies
Sectoral policies
Operational policies
Ministry of Health
Local health management
Agencies/organizations
(hospitals, clinics, etc.)
Policy regarding Expanded
Program on Immunization (EPI),
cervical cancer screening
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 Macro policies vs. Micro policies

Macro policies Micro policies

To solve the great socio- Solve problems of sectors,
economic problems of the nation organizations or a target
polulation in society.
Impact on large population

Relate to long-term goals of the

nation

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 Strategic policy vs Operational policy
(CS chiến lược và CS tác nghiệp)

Strategic policy Operational policy

Features Results are difficult to reverse Results are relatively easy to
for many years change

Complexity, irreversible
increase with increasing
policy level
Ex. Strategic policies for Policies to support for women
economic development, after childbirth, health insurance
strategic policies for for the poor
healthcare systems
development

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Sources of public policy issuance

Depending on type and level:

- Constitution
- Resolution
- International commitment
- Strategy and planning for sectoral development
- etc.

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 What is health policy?

Health policy defines health

goals at the international,
national or local level and
specifies the decisions,
plans and actions to be
undertaken to achieve these
goals (WHO)

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 Features of health policy

• Health policy includes the characteristics of

politics and social regimes
• The government's decisive role

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 Health policy goals

• To enhance the efficiency of the health service

delivery system
• To ensure health equity

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 Heath equity
(Công bằng trong y tế)

Horizontal Vertical
Health Persons/population in Provide more health
service equal needs should services to
delivery be treated the same, communities/individuals
irrespective of their with greater health
income care needs

Health Charge people based Charge higher fees for

service on their ability to pay communities of
fees individuals who can
afford it (compared to
poorer communities)

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Policy process

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 Policy process
(Quy trình chính sách)

Policy agenda setting Policy

(Thiết lập chương trình formulation/adoption
nghị sự) (Xây dựng/Ban hành
chính sách)

Policy evaluation Policy implementation

(Đánh giá chính sách) (Thực hiện chính sách)
 Policy process
(Quy trình chính sách)

Policy agenda setting Policy

(Thiết lập chương trình formulation/adoption
nghị sự) (Xây dựng/Ban hành
chính sách)

Policy evaluation Policy implementation

(Đánh giá chính sách) (Thực hiện chính sách)
 Policy agenda
(Chương trình nghị sự)

• Policy agenda is the list of demands, issues that policy

makers choose or feel obliged to act on at a given time
• Why do issues get onto the policy agenda?
Models to explain:
- The Hall model: legitimacy, feasibility, support
- The Kingdon’s model: agenda setting through three
streams (problem, politics and policies)

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 The Hall model
(Hall et al, 1975)

When an issue falls high in relation to 3 concepts it

becomes on the government agenda
1. Legitimacy: the issue is legitimate for the government
to act on, its right or even obligation to intervene
2. Feasibility: refers to the potential for implementing
the policy
3. Support: refers to the public support or public trust in
government

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 Kingdon’s Model
(John Kingdon’s, 1984)
Considers policy as being made of three streams of processes; the
“problem”, the “policy” and “politics” streams
• Problem stream (Dòng vấn đề)
An issue need to be perceived as problem and get the attention of
officials
• Policy stream (solution) (Dòng chính sách/giải pháp)
Consists of the ongoing analysis of the problem and their proposed
solutions together with the debates surrounding these problems and
possible responses.
• Politics stream (political will) (Dòng chính trị)
The visible and invisible participants those who bring attention to the
issue, bringing the streams together
- Visible participants: president, prime minister, minister or from outside
the government who highlight the issue…
- Hidden participants: academics, health professionals, researchers etc
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 Kingdon’s model
(John Kingdon’s, 1984)

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 What issues initiate a policy?

• Problems existing in
the community
• Weaknesses in the
implementation of
policies → Policy
makers initiate a
policy

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Sự thay đổi cơ cấu dân số

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Top 10 causes of death in Vietnam

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 Mô hình phân phối dịch vụ y tế tại Việt Nam
Công lập Tư nhân
(311.226 giường bệnh) (21.122 giường bệnh)

47 CSYT
tuyến TW
149.542 CBYT 303 bệnh viện tư nhân
470 tuyến
tỉnh

947 tuyến 113.513

quận/huyện CBYT 35.000 phòng khám tư nhân

69.373
11.100 tuyến xã CBYT

39.172 nhà thuốc

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Nguồn: Niên giám thống kê y tế, 2018; Cục Quản lý Khám chữa bệnh, BYT, 2021
 Policy process
(Quy trình chính sách)

Policy
Policy agenda setting
(Thiết lập chương trình
formulation/adoption
(Xây dựng/Ban hành
nghị sự)
chính sách)

Policy evaluation Policy implementation

(Đánh giá chính sách) (Thực hiện chính sách)
 Policy formulation/adoption
(Xây dựng/Ban hành chính sách)

• Policy formulation is the development of effective and

acceptable courses of action for addressing what
has been placed on the policy agenda.
• Policy adoption is a phase of the policy process in
which policies are adopted by government agencies
for future implementation

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Health policy formulation/adoption

• The research to propose a policy on health care with

goals, solutions and resources to achieve the set
goals.
• Approved by government agencies and issued in the
form of a legal document.

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Perspectives in health policy formulation

Political
Humanity
class
(Nhân văn)
(Giai cấp)

Historicity Systematic
(Lịch sử) (Hệ thống)

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Principles in health policy formulation

Compliant with politics

Compliant with current law

Suitable for country conditions

Suitable for domestic and international context

Applying advances in science and technology

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Progcess of health policy formulation

Identifying health needs and issues

Developing goals, objectives

Strategy

Setting policy intervention/

strategies
Study
Setting priotities and selecting policy
intervention

Policy adoption
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 1. Identifying health needs and issues

• The origins:
- “Conflicts” appear in the practice
- Needs to change or maintain policies and
protect people's health

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 2. Developing goals, objectives

Foudations
• Government’s strategy
• Results of researchs on health policy
• Future forecast

Principles
• Choose priority for each stage
• Realism of the goal
• Balance the benefits and harms

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 Requirements for health policy
goals/objectives

• Policy goals are clear, credible and reflect the vision of

citizens and policy makers
• Policy objectives are attainable, feasible, credible,
technically sound, consistent with central government
priorities and socially as well as politically acceptable

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 3. Setting policy intervention

Foudations
• Policy goals/objectives
• Resource capacity
• Theoretical models
• National and international experience

Principles
• Fit to goals/objectives
• Compliant with political and social orientations
• Acceptability, feasibility, ease of implementation

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 4. Setting priotities and selecting
policy intervention

• Do the interventions fundamentally solve the

determined health problems?
• Do the interventions bring the desired effect?
• Does the solution have any unexpected effects?
• Are the interventions possible? Are interventions
suitable with the current conditions?

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 4. Setting priotities and selecting
policy intervention (cont.)

• Which solution achieves the goal?

• Which solution works to the root cause of the problem?
• Which solution has the lowest cost?
• Which solution brings the greatest benefit, with the
smallest disadvantages in terms of politics and
society?
• Which solution creates a positive response of the
people?

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 5. Policy adoption

• Submit the selected policy option to the government

agency.
• Government agencies evaluate
• Policy adoption at the official conference
• Decision on policy in legal documents

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 Policy process
(Quy trình chính sách)

Policy
Policy agenda setting
(Thiết lập chương trình
formulation/adoption
(Xây dựng/Ban hành
nghị sự)
chính sách)

Policy evaluation Policy implementation

(Đánh giá chính sách) (Thực hiện chính sách)
 Policy implemention

The process by which policies enacted by government

are put into effect by relevant agencies

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 Policy implementation (cont.)

• Policy implementation: a science and an art

• To detecte policy weaknesses → to adjust the policy
• Stakeholders need to be involved
• Solutions should be published

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 Policy implementation steps

• Develop a policy implementation plan

• Policy dissemination
• Assign and coordinate policy implementation
• Maintain policy
• Adjust policy
• Monitor and supervise policy implementation
• Review

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Factors influence to the implementation of
health policy

Objective
Subjective factors
factors

Medical
socialization

Policy implementation
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 Objective factors

• Problem characteristics
- Complex problem
- Involving many sectors
- Involving varied populations
• Policy environment
• Position of policy target
groups
- Policy target groups
- “Power” groups

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Dimensions of policy environment and
the policy cycle

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 (2) Subjective factors

Communication

System organization for health policy implementation

Administrative procedures

Resources for policy implementation

Community's attitudes and actions

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 (3) Medical socialization

Two aspects
• Government authority and responsibility in health care
• Strengthening the responsibility of society, the
community and citizens for health care

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 Policy process
(Quy trình chính sách)

Policy
Policy agenda setting
(Thiết lập chương trình
formulation/adoption
(Xây dựng/Ban hành
nghị sự)
chính sách)

Policy evaluation Policy implementation

(Đánh giá chính sách) (Thực hiện chính sách)
 Lượng giá Đánh giá
VS
(Evaluation) (Assessment)

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 What is policy evaluation?

• Policy evaluation applies evaluation principles and

methods to examine the content, implementation or
impact of a policy.
• Evaluation is the activity through which we develop an
understanding of the merit, worth, and utility of a policy

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 Policy evaluation
• The process of the collection and analysis of
information/feedback:
- During implementation
- After implementation
→ compare with objectives

Implementation Objectives

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 Why Is Policy Evaluation Important?

• Documenting policy development

• Documenting and informing implementation
• Assessing support and compliance with existing
policies
• Demonstrating impacts and value of a policy
• Informing an evidence base
• Informing future policies
• Providing accountability for resources invested

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 Health policy evaluation

Objectives Methods Data collection

- To adjust policy - Before–after (pre– Interviews, group

- To propose a new post) studies discussions
policy - Feedback from Quesionairre
- To evaluate the affected population Secondary data
policy - Feedback from Reports
implementation interest groups,
etc.
- To determine the stakeholder groups
necessary - Comparison
resources to between different
effectively regions
implement the policy

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Steps for evaluation in health policy

• Identify the problem, the goal

Prepare for • Determine on the scope of the
assessment assessment
• Determine the evaluation model

Do
evaluation

Write a
report, use
the results

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59
Two-groups pretest-postest design

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 Information in health policy

• Information is data that is received and evaluated as useful

for decision making or performing a certain task in the policy
process.
• Sources: policy makers, implementing agencies, stakeholders
• Information form: reports, internet, media, etc.

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 Information for all stages of the policy

Policy agenda - Policy formulation Policy

setting - Policy adoption implementation

Policy evaluation

High quality information

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 Information in health policy

• Big data
• Diverse data
• General and
comprehensive information
→ Turing data into
information

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 Information for health policy process

• Systematic
• Completeness
• Accuracy
• Timeliness
• Specificity, logic
• Quantity and quality
• Ability to collect
• Economic efficiency

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Source: Health Metrics Network (2008)

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 Objectives

1. To introduce concepts of policy, health policy, policy

types
2. To describe basic objectives of the health policy
3. To understand the policy process
4. To describe the factors influencing the health policy
process

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 Team work activities

• Please choose a health policy, and then

➢ Identify target group(s) and stakehoders
➢Analyze the factors influencing the implementation of
this policy.
• Presentation time: 15-20 minutes

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Thank you for your attention.

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