POLICY PLANNING

POLICY PLANNING
Following three types of planning :
 Project planning

System planning

and Policy planning.

 PLANNING APPROACHES

 general to specific approach

 reverse .
A General - To - Specific Approach

 A general statement of policies

 establishment of goals
 statement of the objectives
 long range actions to achieve the
objectives
A General - To - Specific Approach

 begin by examining the health system

in very broad macro terms
 gradually increasing the level of detail
by subdividing the macro concepts into
smaller units;
 an analytical approach
Alternative Approach

 Begins at the bottom by identifying

discrete units
 gradually aggregating them into
somewhat larger groups
 until one finally has a small set of
categories that represent the
immediate subdivisions of the health
care system.
 The former approach is far more likely than the
latter to yield a comprehensive and exhaustive
plan .
 It is unlikely that any person or organization can
identify all of the possible components of a
health care system just by attempting to conduct
an inventory of what exists.
 such an approach has a great potential for many
oversights and omissions,
 On the other hand, beginning at the top and
breaking the system into smaller and smaller
subdivisions would render omission of any major
category of concern virtually impossible.
 Finally upon reaching the desired
level of analysis (the level of the
black box), one has ample
opportunity to examine the resulting
theoretical structure in the light of
what exists within the community
and to determine whether or not any
available services have been
omitted.
 The alternative, or reverse, approach to
developing a plan implies that, initially,
planners and decision makers are
incapable of going through such a process
and are simply unable or unwilling to state
explicitly the community’s values.
 They begin with immediate problems and
make very small-scale plans to solve
them;
 while doing so, they presumably learn and
use their new knowledge to expand the
scope of their planning effort.
POLICY MAKING
Three levels of policy
 meta policy,

 mega policy,

 specific policy
 META POLICY
 The first can be defined as policy on
policymaking itself. In other words, it sets the
rules by which decision makers will establish all
the policies within an organization. Metapolicy
includes such generic components as the
policymaking system’s mode of operation (e.g.,
board/staff relationships), policymaking methods
(e.g., modes of policy analysis), and methods
and criteria for evaluating policymaking.
 Meta policy is important, but because it is quite
complex and falls outside the scope of this book,
it will not be discussed further here.
 MEGA POLICY
 Consists of a set of master policies which provide general
guidance for the more discrete specific policies. This guidance is
essential because the number and complexity of discrete policies
tends to be very great, and presenting all of those specific policies
to a community is not in keeping with the principle of
accountability in a public decision-making body
 Vast majority of citizens have neither, the time nor inclination to
monitor or participate in all the collective decisions required in a
modern community. Each, decision may have a significant effect
on many citizens and values of all affected.
 The solution to this dilemma is to delegate decision-making
responsibility to a small group which presumably is responsive to
the values of the community as a whole. In the health field,
accountability means that the health systems agency (HAS)
governing body or board indicate approval or disapproval of all
action taken.
 CONTENTS OF A MEGA POLICY
DOCUMENT
 The following possible components are listed:
 Organizational roles
 Basic values and their priorities (e.g, quality compared to cost)
 Theory of health on which a plan will be based
 Health system bounded.
 Change of topics to be considered
 Type of change sought
 Time values applied to decisions
 Level of acceptable risk and controversy
 Assumptions about availability of resources
 Assumptions about the future
 Acceptable instruments for implementing decisions
 Threshould values (e.g., will the goal levels set be the minimum
acceptable or the idea?)
 POLICY
 On the other hand, is a further specification of the general values held
about the health service system. Policy will address, for instance, the
critical characteristics of that system . Six characteristics of health services
– are mandated for consideration by P.L. 93-641, and some communities
may wish to add to this list, specific policies also have a key role because
they become the basis for establishing goals and goal levels. To be
discussed later.
 The offers some useful insights into the nature is policies and the following
discussion is based on her paper.
 The conditions for establishing a policy are as follows: An authorizing
agent directs an implementing agent (they may be the same personal to
act according to some conditional imperative The imperatives in effect,
that if a certain condition prevails a specified action should be taken. The
authorizing anticipates that the conditions requiring actions will occur
repeatedly, and the may revise the responded those will conditions without
violating the original imperative. This distinguished a policy from a
promise, which is unalterable.
 Policy making contributes greatly to efficiency in the planning process
without policies, the decision makers will be engaged in repeated debate of
crucial issues which wastes time and adversely affects an organization’s
ability to carry out its mission. Furthermore, general policies provide
guidance so the staff of a planning organization can proceed in the plan
development process without waiting for decision makers to ratify each
step along the way.
 Consumer Input: Key Factors
 Consumer input is a key policy issue., community input played a
valid role in the planning process., consumer needs have been
considered only to the extent that they were known and accepted
by professionals as valid criteria for establishing objectives;, At
one extreme is the implicit assumption that consumers simply do
not know their own needs and therefore cannot evaluate the
health services provided . At the others extreme is the assumption
that individuals are the best judges of their own welfare. Even
thought they cannot perform the services required they do know
when and how much service should be provided.
 Poor health persists in some areas because resources are applied
in a manner that is inappropriate to a given situation.
 Dissatisfaction leads to avoidance, Thus services predicated on
inappropriate assumptions about the benefits and desirability of
medical care become even less appropriate when those services
are used only in crisis of last-resort situations. As a result, this
use of resources tends to be ineffective even from the viewpoint
of professional designers of the system.
 The obvious solution to this problem is to decentralize control so ,
there are six dimensions of medical care; quality, continuity,
availability, accessibility, cost, and acceptability, in the traditional
health care system within this country, the first dimension has
been adequately dealt with by the system of licensure and peer
review. The others generally have been left to economic
regulation by the mechanism of the free market,
 SETTING GOALS AND
OBJECTIVES
 The guidelines for plan development under P.I 93-641
define goals as follows:
 Goals provide the basic framework for the plan by focusing
directly on particular health issues or areas of concern.
They are unconstrained by the present planning horizon
and are not stated in terms of community or provider
action. Goals are expressions of desired conditions of
health status and health systems. , expressed as
quantitiable, timeless aspiration, Goals, should be both
technically and financially achievable and responsive to
community ideals.
 The reference to community ideals makes it clear that, in
fact, goals, are derived from policies that represent
community value statements, thus goal setting becomes
the second major step in the plan development process.
Goals, however, do not establish specific thresholds which
tell decision makers the level or range of acceptable status
or system performance. Consequently, another term-goal
levels-must be introduced.
 The guidelines for p.L 93-641` define goal levels as “quantified
targets set to indicate the achievement of specific goals, Once
again, a process of deriving the goal level from earlier policy
statements should exist. For instance, a mega policy statement
might assert that a community will strive to achieve system
performance equivalent to the national average, and a policy
statement might indicate that one measure of health status is
infant mortality. In this case, the national average, as reported by
the National Center for Health Statistics, would be used as the
normative goal level against which the community’s actual
experience would be compared.
 The normative statement is then contrasted with the current and
projected status for the issue of concern, and that comparison
becomes the basis for establishing an objective. An objective is
defined in the within a specified time period.”. The level set for an
objective may or may not be identical with the goal level; this will
depend on the decision makers’ expectation of a system’s ability
to reach and/or maintain the goal level within the planning
horizon.
 GOAL INDICATORS
 A key issue in establishing goals and objectives is the
selection of appropriate indicators. Adete Hebb, indicators
must be measurable, must permit comparisons over time
and across geographic areas, and must be clear with
respect to the desired direction of change.
 Hebb suggests several specific indicator criteria, relevance,
clarity, direction of improvement, precision of definition,
data availability and established for each service, setting,
and characteristic within the taxonomy adopted by a health
planning agency.
 Indicators are essentially criteria for decision making; that
is they are measures of the factors to be considered by
decision makers, Indicators do not represent a total or
complete description of the subject under consideration.,
but are, instead, those elements deemed particularly
important.
 Indicator levels serve a number of purposes. First, they
describe the health system , Second , they inform providers
of what is expected of them. Third, they guide the planning
decision makers-for example, in project review-in
determining objectives and setting priorities. Fourth, they
are used to evaluate the performance of the health system
and of the planning agency itself. In other
 Regardless of the method used, there are five phases or
steps in the process of developing indicator levels. Phase I
is the establishment of general values, accomplished in the
policy development phase. Phase 2 is the conversion of
these values into operational measures-the selection of
indicators. Phase 3 relates to determining a feasible range
of outcomes for each operational measures. Phase 4
involves selecting an acceptable outcome threshold for
each measure. Phase 5 involves validating measures and
thresholds in terms of community values.
 THE ACTION PHASE
 Define actions as a “comprehensive collection of proposed
changes in health and community systems, aimed at
achievement of health status and health system goals and
objectives. They describe the broad actions that were
selected after consideration of possible alternative means
of improving health and health systems performance of
desired levels. “This definition makes it clear that actions
are derived from objectives as another sequential step in
the plan development process. An objective identifies a stat
of status to be achieved, whereas an action relates to some
step taken to achieve that state or status.
 That some actions may affect numerous objectives; on the
other hand, a single objective may generate multiple
actions,
 First step is problem recognition, achieved by analyzing the
data that might result from comparing goal indicator levels
and the forecast status of a community population or from
compiling information on publicity expressed discontent.
 Once the problem has been identified, the next step is to
analyze it is terms of causes and risk factors.
 After the risk factors have been identified, the areas of
potential intervention must be examined.
 The next step in this process is determing the preferred
potential intervention, which might be done on the basis of
a cost-benefit analysis