Instructor: Hi, everyone,
and welcome to this modules lecture on health policy design.
This module is designed to help health managers develop
the knowledge and skills needed to understand,
efficiently influence and adapt to global health policies.
It focuses on key concepts in the design of health policies
around the world that are particular in importance
for health managers and organizational leaders.
Global health policy can be described
as the complex web of rules, both formal and informal,
that police vested interests in the attainment
of the highest level of health policy for all people.
This description acknowledges the role
of various stakeholders as key players in these systems
that determine who gets what health services
and with what level quality, length of wait, and cost.
This description also goes beyond personal health services
to include policies that directly
or indirectly affect health, whether these policy are rules
that allocate or reallocate important resources
like food or medicine or regulations that control
the behaviors of individuals and organizations.
Now, let's discuss some of the key concepts
in health policy and design.
Policies are rules that can be either formal
or informal, written or unwritten.
Policymaking is the process of creating those rules.
Finally, policy analysis involves examining
those rules, the problems, the rules are meant to address,
the goals of the rules
and the criteria used to evaluate the efficacy of the rules.
Typically, policy analysis also assesses alternatives
to current policy and based on results of the comparisons
makes recommendations from among the alternatives.
Health policies have many sources with governance structures
that vary depending on where in the world
the policies originate.
Policies can be made on different levels, including federal,
state, provincial, and local, via legislative
or elective bodies, administrative agencies, boards,
commissions, courts, et cetera.
Policy makers may include legislators, elected officials,
agency members, border commission officials,
judges, and others.
Now let's discuss some of the key purposes
of health policies.
While there are many possible purposes,
most fall into one of two broad categories.
The first, allocative or redistributive policies
are policies that determine the way public goods
or resources are shared.
Some policies typically give more resources to some groups
and less to others.
Examples include policies that provide free
or reduce cost services only to people
who fall under a specified income level.
Regulatory policies on the other hand, are policies
that are designed to affect the behavior
or actions of others through rules that dictate
what can and cannot be done.
Next, let's turn to this diagram
of the global health policy circuit that discusses
some of the ways that global health policy is developed
and some of the key actors
in global health policy development.
So this model provides a visualization of the complexity
of global health policy processes.
It highlights the following.
The interconnectedness of public health policy,
starting from the point of policy inception
or the political initiative.
The shaping of rules and regulations, governance policies.
The introduction of policy premises
subsequent to implementation and sector administration
and renewed stakeholder initiatives,
perhaps engaging in strategic ploys, drawing attention
to a preferred revision potentially with the result
of new political initiatives completing the policy circuit.
So now let's think about the ways that health policy
and health policy development
might vary between different settings.
As we know, governing structures
and governments vary among countries.
In social democracies,
like those common and some western nations,
policy initiation and implementation
emerged following some level of national debate.
Emerging policies commonly reflect the paradigm
that governs knowledge development at a given time.
Policies that break with established epistemology
or generally accepted philosophy about a given topic
may be seen as radical proposals setting the stage
for intensified policy debates.
In a top-down approach to policymaking
on the other hand, policies are formalized at the more
central health system levels
and then passed down to peripheral government
responsible for implementation.
The ultimate performance or output of any policy
will be shaped by how these peripheral government
structures actually translate the policy into programs.
Their actions and inactions, decisions and non decisions
can effectively shape the public face of a policy.
Finally, ministries of health in many countries
may have a hierarchical structure with a central
or national level ministry responsible for agenda setting,
policy formulation, and health sector coordination,
and more peripheral levels, especially district levels
and below, responsible for policy implementation.
Plans, budgets and programs for health services, education,
and other areas may or may not completely reflect
the established policy premises
depending on the extent
to which centrally designed policies are modified
peripherally in implementation.
So now let's turn to the importance
of the analysis of health policy.
Health policy design and analysis are inherently social
and political exercises.
The environmental context in which policies play out
may be shaped by a variety of changing conditions,
including such factors as the economy, public opinion,
election budget cycles, and organizational interests.
All of these factors can influence the shape, pace,
or direction of a particular policy at a given time.
Throughout the world,
the condition shaping policy environments,
including governance structures
and the power of stakeholder influences very widely.
One way that health policies are analyzed
and developed is through the use of a white paper.
A white paper is a comprehensive, yet concise report
that summarizes the position on a complex
and often controversial or difficult issue.
It aims to increase stakeholders understanding of the issues
for the development of policy.
This figure lays out some of the key steps
of policy analysis using white paper,
including formulating a problem statement
and underscoring its relevance,
recognizing budgetary implications,
identifying financial options,
identifying all resources considered necessary
to determine the capacity to enact, following an assessment
of critical prerequisites, reflecting on the policies
presume credibility with regard to key stakeholders,
and concluding its analysis the policy initiative
as summarized in a model acceptance.
Great.
So now after learning about some of the methods
for policy analysis, it's clear that policy analysis
is a necessary skill for health managers to have.
Policy analysis is important
to helping managers foster organizational decision making
and strategic planning,
and managers should select a method that's tailored
for their country and organization.
One approach to health policy analysis
is to use the STEP method.
This method follows a systematic sequence
of logical activities that comprehensively examine
a problem, the policy designed to address it,
the intended consequences of the policy,
the policy's outcomes,
and the variance of the policy
that could potentially improve the results.
The analysis may include a recommendation for a quote
best choice for among the suggested alternatives,
plans for advocating for the preferred variant
and plans for evaluating the outcomes
of the policy alternative.
The number of steps included in the model can vary
depending on the source, but it typically includes
five to eight steps.
The core of the analysis, without including advocacy
or evaluation plans generally includes the five actions
laid out on this slide.
So why is it important to conduct policy analysis?
Well, policy analysis are iterative.
At any point in the analysis
if the results are unclear,
the analyst can and should return to earlier steps
and repeat the processes
until the results enable a move to the next step.
Given the complex and time consuming nature
of policy analysis,
most analyses in reality are incomplete
or at some point deemed to be good enough for now.
Analysts may be forced to cut short
or skip entire steps in the process
if faced with time or resource constraints,
meaning that a decision has to be made based on information
that's less than ideal.
So now we'll turn to this figure
which uses an example from a major capital city
in Western Europe,
and this table illustrates one way in which
a policy analysis might be set up.
In this example, the problem that was analyzed was related
to the city's hospitals receiving large numbers
of pregnant migrant women who present for delivery
without having received adequate prenatal care,
resulting in costly complications
and adverse outcomes for infants and mothers.
The policy alternatives represent ways in which
the hospitals might provide prenatal care free of charge
for pregnant migrant women
who come to onsite outpatient clinics.
Based on the comparison presented in the exhibit,
the fourth policy alternative appears to be the best choice
among those presented.
It's evaluated to have a good cost,
a good time to implement,
and a good effectiveness.
The only alternative contained on this table
that ranks good in all three categories.
As we've discussed previously,
cultural competence is a crucial aspect
of effective leadership,
but the concept is equally important
in the context of global health policy.
Policies that do not take into consideration
the community's unique social and cultural needs
and characteristics
risk underperforming are failing to meet their goals.
Policies that are culturally incompetent might, for example,
result in intended beneficiaries losing interest
in a program or failing to use services
intended to help them.
Finally, in summary, we learned in this module
that global health policies has a complex web of rules.
We examined the health policy landscape on macro-level
transnational policies, country level government policies,
and micro-level policies in smaller units of governance
or in individual organizations.
We also discussed some methods for analyzing health policy
and looked at sources of various health policies.