WEBVTT 1 00:00:00.210 --> 00:00:01.043 Hi, everyone, 2 00:00:01.043 --> 00:00:04.353 and welcome to this modules lecture on health policy design. 3 00:00:05.550 --> 00:00:08.310 This module is designed to help health managers develop 4 00:00:08.310 --> 00:00:10.890 the knowledge and skills needed to understand, 5 00:00:10.890 --> 00:00:14.340 efficiently influence and adapt to global health policies. 6 00:00:14.340 --> 00:00:17.220 It focuses on key concepts in the design of health policies 7 00:00:17.220 --> 00:00:19.530 around the world that are particular in importance 8 00:00:19.530 --> 00:00:22.473 for health managers and organizational leaders. 9 00:00:24.900 --> 00:00:26.670 Global health policy can be described 10 00:00:26.670 --> 00:00:29.910 as the complex web of rules, both formal and informal, 11 00:00:29.910 --> 00:00:31.890 that police vested interests in the attainment 12 00:00:31.890 --> 00:00:34.540 of the highest level of health policy for all people. 13 00:00:35.460 --> 00:00:37.110 This description acknowledges the role 14 00:00:37.110 --> 00:00:39.630 of various stakeholders as key players in these systems 15 00:00:39.630 --> 00:00:42.180 that determine who gets what health services 16 00:00:42.180 --> 00:00:45.843 and with what level quality, length of wait, and cost. 17 00:00:46.740 --> 00:00:49.380 This description also goes beyond personal health services 18 00:00:49.380 --> 00:00:51.150 to include policies that directly 19 00:00:51.150 --> 00:00:54.900 or indirectly affect health, whether these policy are rules 20 00:00:54.900 --> 00:00:56.970 that allocate or reallocate important resources 21 00:00:56.970 --> 00:00:59.790 like food or medicine or regulations that control 22 00:00:59.790 --> 00:01:02.223 the behaviors of individuals and organizations. 23 00:01:05.190 --> 00:01:06.990 Now, let's discuss some of the key concepts 24 00:01:06.990 --> 00:01:08.463 in health policy and design. 25 00:01:09.420 --> 00:01:12.150 Policies are rules that can be either formal 26 00:01:12.150 --> 00:01:15.030 or informal, written or unwritten. 27 00:01:15.030 --> 00:01:18.063 Policymaking is the process of creating those rules. 28 00:01:19.020 --> 00:01:21.480 Finally, policy analysis involves examining 29 00:01:21.480 --> 00:01:24.390 those rules, the problems, the rules are meant to address, 30 00:01:24.390 --> 00:01:25.770 the goals of the rules 31 00:01:25.770 --> 00:01:29.640 and the criteria used to evaluate the efficacy of the rules. 32 00:01:29.640 --> 00:01:32.640 Typically, policy analysis also assesses alternatives 33 00:01:32.640 --> 00:01:36.060 to current policy and based on results of the comparisons 34 00:01:36.060 --> 00:01:38.643 makes recommendations from among the alternatives. 35 00:01:40.200 --> 00:01:43.170 Health policies have many sources with governance structures 36 00:01:43.170 --> 00:01:44.460 that vary depending on where in the world 37 00:01:44.460 --> 00:01:45.610 the policies originate. 38 00:01:46.470 --> 00:01:49.860 Policies can be made on different levels, including federal, 39 00:01:49.860 --> 00:01:53.310 state, provincial, and local, via legislative 40 00:01:53.310 --> 00:01:56.460 or elective bodies, administrative agencies, boards, 41 00:01:56.460 --> 00:01:58.653 commissions, courts, et cetera. 42 00:01:59.790 --> 00:02:03.000 Policy makers may include legislators, elected officials, 43 00:02:03.000 --> 00:02:05.790 agency members, border commission officials, 44 00:02:05.790 --> 00:02:07.353 judges, and others. 45 00:02:08.580 --> 00:02:10.920 Now let's discuss some of the key purposes 46 00:02:10.920 --> 00:02:12.840 of health policies. 47 00:02:12.840 --> 00:02:14.670 While there are many possible purposes, 48 00:02:14.670 --> 00:02:17.670 most fall into one of two broad categories. 49 00:02:17.670 --> 00:02:20.880 The first, allocative or redistributive policies 50 00:02:20.880 --> 00:02:23.130 are policies that determine the way public goods 51 00:02:23.130 --> 00:02:25.200 or resources are shared. 52 00:02:25.200 --> 00:02:28.500 Some policies typically give more resources to some groups 53 00:02:28.500 --> 00:02:30.240 and less to others. 54 00:02:30.240 --> 00:02:32.460 Examples include policies that provide free 55 00:02:32.460 --> 00:02:34.380 or reduce cost services only to people 56 00:02:34.380 --> 00:02:36.843 who fall under a specified income level. 57 00:02:38.250 --> 00:02:40.530 Regulatory policies on the other hand, are policies 58 00:02:40.530 --> 00:02:41.970 that are designed to affect the behavior 59 00:02:41.970 --> 00:02:44.820 or actions of others through rules that dictate 60 00:02:44.820 --> 00:02:46.293 what can and cannot be done. 61 00:02:48.630 --> 00:02:50.490 Next, let's turn to this diagram 62 00:02:50.490 --> 00:02:55.050 of the global health policy circuit that discusses 63 00:02:55.050 --> 00:02:58.800 some of the ways that global health policy is developed 64 00:02:58.800 --> 00:03:00.390 and some of the key actors 65 00:03:00.390 --> 00:03:02.223 in global health policy development. 66 00:03:04.440 --> 00:03:07.200 So this model provides a visualization of the complexity 67 00:03:07.200 --> 00:03:09.540 of global health policy processes. 68 00:03:09.540 --> 00:03:11.490 It highlights the following. 69 00:03:11.490 --> 00:03:13.530 The interconnectedness of public health policy, 70 00:03:13.530 --> 00:03:15.870 starting from the point of policy inception 71 00:03:15.870 --> 00:03:17.850 or the political initiative. 72 00:03:17.850 --> 00:03:22.080 The shaping of rules and regulations, governance policies. 73 00:03:22.080 --> 00:03:24.480 The introduction of policy premises 74 00:03:24.480 --> 00:03:27.870 subsequent to implementation and sector administration 75 00:03:27.870 --> 00:03:29.550 and renewed stakeholder initiatives, 76 00:03:29.550 --> 00:03:32.340 perhaps engaging in strategic ploys, drawing attention 77 00:03:32.340 --> 00:03:34.440 to a preferred revision potentially with the result 78 00:03:34.440 --> 00:03:37.773 of new political initiatives completing the policy circuit. 79 00:03:41.640 --> 00:03:45.330 So now let's think about the ways that health policy 80 00:03:45.330 --> 00:03:46.500 and health policy development 81 00:03:46.500 --> 00:03:49.110 might vary between different settings. 82 00:03:49.110 --> 00:03:51.720 As we know, governing structures 83 00:03:51.720 --> 00:03:54.420 and governments vary among countries. 84 00:03:54.420 --> 00:03:55.860 In social democracies, 85 00:03:55.860 --> 00:03:58.140 like those common and some western nations, 86 00:03:58.140 --> 00:03:59.880 policy initiation and implementation 87 00:03:59.880 --> 00:04:02.760 emerged following some level of national debate. 88 00:04:02.760 --> 00:04:04.980 Emerging policies commonly reflect the paradigm 89 00:04:04.980 --> 00:04:08.010 that governs knowledge development at a given time. 90 00:04:08.010 --> 00:04:10.380 Policies that break with established epistemology 91 00:04:10.380 --> 00:04:13.080 or generally accepted philosophy about a given topic 92 00:04:13.080 --> 00:04:15.630 may be seen as radical proposals setting the stage 93 00:04:15.630 --> 00:04:17.523 for intensified policy debates. 94 00:04:18.420 --> 00:04:20.640 In a top-down approach to policymaking 95 00:04:20.640 --> 00:04:22.890 on the other hand, policies are formalized at the more 96 00:04:22.890 --> 00:04:24.540 central health system levels 97 00:04:24.540 --> 00:04:26.790 and then passed down to peripheral government 98 00:04:28.740 --> 00:04:30.363 responsible for implementation. 99 00:04:31.500 --> 00:04:33.720 The ultimate performance or output of any policy 100 00:04:33.720 --> 00:04:36.450 will be shaped by how these peripheral government 101 00:04:36.450 --> 00:04:39.720 structures actually translate the policy into programs. 102 00:04:39.720 --> 00:04:44.490 Their actions and inactions, decisions and non decisions 103 00:04:44.490 --> 00:04:46.990 can effectively shape the public face of a policy. 104 00:04:48.240 --> 00:04:50.640 Finally, ministries of health in many countries 105 00:04:50.640 --> 00:04:52.890 may have a hierarchical structure with a central 106 00:04:52.890 --> 00:04:55.860 or national level ministry responsible for agenda setting, 107 00:04:55.860 --> 00:04:58.350 policy formulation, and health sector coordination, 108 00:04:58.350 --> 00:05:01.290 and more peripheral levels, especially district levels 109 00:05:01.290 --> 00:05:04.920 and below, responsible for policy implementation. 110 00:05:04.920 --> 00:05:08.130 Plans, budgets and programs for health services, education, 111 00:05:08.130 --> 00:05:10.380 and other areas may or may not completely reflect 112 00:05:10.380 --> 00:05:12.330 the established policy premises 113 00:05:12.330 --> 00:05:13.200 depending on the extent 114 00:05:13.200 --> 00:05:15.210 to which centrally designed policies are modified 115 00:05:15.210 --> 00:05:16.760 peripherally in implementation. 116 00:05:19.920 --> 00:05:21.480 So now let's turn to the importance 117 00:05:21.480 --> 00:05:23.130 of the analysis of health policy. 118 00:05:24.210 --> 00:05:27.210 Health policy design and analysis are inherently social 119 00:05:27.210 --> 00:05:29.250 and political exercises. 120 00:05:29.250 --> 00:05:31.620 The environmental context in which policies play out 121 00:05:31.620 --> 00:05:34.530 may be shaped by a variety of changing conditions, 122 00:05:34.530 --> 00:05:37.560 including such factors as the economy, public opinion, 123 00:05:37.560 --> 00:05:41.220 election budget cycles, and organizational interests. 124 00:05:41.220 --> 00:05:43.590 All of these factors can influence the shape, pace, 125 00:05:43.590 --> 00:05:46.653 or direction of a particular policy at a given time. 126 00:05:47.910 --> 00:05:48.960 Throughout the world, 127 00:05:48.960 --> 00:05:50.790 the condition shaping policy environments, 128 00:05:50.790 --> 00:05:52.620 including governance structures 129 00:05:52.620 --> 00:05:55.413 and the power of stakeholder influences very widely. 130 00:05:59.100 --> 00:06:01.710 One way that health policies are analyzed 131 00:06:01.710 --> 00:06:04.860 and developed is through the use of a white paper. 132 00:06:04.860 --> 00:06:07.650 A white paper is a comprehensive, yet concise report 133 00:06:07.650 --> 00:06:09.720 that summarizes the position on a complex 134 00:06:09.720 --> 00:06:12.270 and often controversial or difficult issue. 135 00:06:12.270 --> 00:06:14.880 It aims to increase stakeholders understanding of the issues 136 00:06:14.880 --> 00:06:16.380 for the development of policy. 137 00:06:22.290 --> 00:06:26.100 This figure lays out some of the key steps 138 00:06:26.100 --> 00:06:28.950 of policy analysis using white paper, 139 00:06:28.950 --> 00:06:31.140 including formulating a problem statement 140 00:06:31.140 --> 00:06:33.090 and underscoring its relevance, 141 00:06:33.090 --> 00:06:35.160 recognizing budgetary implications, 142 00:06:35.160 --> 00:06:37.800 identifying financial options, 143 00:06:37.800 --> 00:06:39.810 identifying all resources considered necessary 144 00:06:39.810 --> 00:06:42.660 to determine the capacity to enact, following an assessment 145 00:06:42.660 --> 00:06:45.930 of critical prerequisites, reflecting on the policies 146 00:06:45.930 --> 00:06:49.050 presume credibility with regard to key stakeholders, 147 00:06:49.050 --> 00:06:51.510 and concluding its analysis the policy initiative 148 00:06:51.510 --> 00:06:54.723 as summarized in a model acceptance. 149 00:06:57.120 --> 00:06:57.953 Great. 150 00:06:57.953 --> 00:07:01.050 So now after learning about some of the methods 151 00:07:01.050 --> 00:07:05.340 for policy analysis, it's clear that policy analysis 152 00:07:05.340 --> 00:07:09.543 is a necessary skill for health managers to have. 153 00:07:10.830 --> 00:07:12.660 Policy analysis is important 154 00:07:12.660 --> 00:07:15.390 to helping managers foster organizational decision making 155 00:07:15.390 --> 00:07:16.593 and strategic planning, 156 00:07:18.360 --> 00:07:21.000 and managers should select a method that's tailored 157 00:07:21.000 --> 00:07:22.833 for their country and organization. 158 00:07:25.620 --> 00:07:28.380 One approach to health policy analysis 159 00:07:28.380 --> 00:07:29.823 is to use the STEP method. 160 00:07:30.690 --> 00:07:32.580 This method follows a systematic sequence 161 00:07:32.580 --> 00:07:34.680 of logical activities that comprehensively examine 162 00:07:34.680 --> 00:07:37.440 a problem, the policy designed to address it, 163 00:07:37.440 --> 00:07:39.780 the intended consequences of the policy, 164 00:07:39.780 --> 00:07:41.100 the policy's outcomes, 165 00:07:41.100 --> 00:07:42.210 and the variance of the policy 166 00:07:42.210 --> 00:07:45.060 that could potentially improve the results. 167 00:07:45.060 --> 00:07:47.370 The analysis may include a recommendation for a quote 168 00:07:47.370 --> 00:07:50.760 best choice for among the suggested alternatives, 169 00:07:50.760 --> 00:07:53.190 plans for advocating for the preferred variant 170 00:07:53.190 --> 00:07:54.750 and plans for evaluating the outcomes 171 00:07:54.750 --> 00:07:56.050 of the policy alternative. 172 00:07:56.910 --> 00:07:59.040 The number of steps included in the model can vary 173 00:07:59.040 --> 00:08:02.460 depending on the source, but it typically includes 174 00:08:02.460 --> 00:08:03.813 five to eight steps. 175 00:08:05.250 --> 00:08:07.950 The core of the analysis, without including advocacy 176 00:08:07.950 --> 00:08:11.940 or evaluation plans generally includes the five actions 177 00:08:11.940 --> 00:08:13.143 laid out on this slide. 178 00:08:15.540 --> 00:08:18.930 So why is it important to conduct policy analysis? 179 00:08:18.930 --> 00:08:21.360 Well, policy analysis are iterative. 180 00:08:21.360 --> 00:08:22.710 At any point in the analysis 181 00:08:22.710 --> 00:08:24.330 if the results are unclear, 182 00:08:24.330 --> 00:08:26.580 the analyst can and should return to earlier steps 183 00:08:26.580 --> 00:08:28.200 and repeat the processes 184 00:08:28.200 --> 00:08:30.650 until the results enable a move to the next step. 185 00:08:31.860 --> 00:08:33.930 Given the complex and time consuming nature 186 00:08:33.930 --> 00:08:34.920 of policy analysis, 187 00:08:34.920 --> 00:08:37.860 most analyses in reality are incomplete 188 00:08:37.860 --> 00:08:40.770 or at some point deemed to be good enough for now. 189 00:08:40.770 --> 00:08:42.450 Analysts may be forced to cut short 190 00:08:42.450 --> 00:08:44.250 or skip entire steps in the process 191 00:08:44.250 --> 00:08:46.560 if faced with time or resource constraints, 192 00:08:46.560 --> 00:08:49.080 meaning that a decision has to be made based on information 193 00:08:49.080 --> 00:08:50.313 that's less than ideal. 194 00:08:54.120 --> 00:08:56.550 So now we'll turn to this figure 195 00:08:56.550 --> 00:08:58.800 which uses an example from a major capital city 196 00:08:58.800 --> 00:08:59.823 in Western Europe, 197 00:09:00.660 --> 00:09:02.700 and this table illustrates one way in which 198 00:09:02.700 --> 00:09:05.133 a policy analysis might be set up. 199 00:09:05.970 --> 00:09:09.360 In this example, the problem that was analyzed was related 200 00:09:09.360 --> 00:09:11.700 to the city's hospitals receiving large numbers 201 00:09:11.700 --> 00:09:13.860 of pregnant migrant women who present for delivery 202 00:09:13.860 --> 00:09:16.590 without having received adequate prenatal care, 203 00:09:16.590 --> 00:09:18.480 resulting in costly complications 204 00:09:18.480 --> 00:09:21.450 and adverse outcomes for infants and mothers. 205 00:09:21.450 --> 00:09:23.640 The policy alternatives represent ways in which 206 00:09:23.640 --> 00:09:25.950 the hospitals might provide prenatal care free of charge 207 00:09:25.950 --> 00:09:27.540 for pregnant migrant women 208 00:09:27.540 --> 00:09:31.170 who come to onsite outpatient clinics. 209 00:09:31.170 --> 00:09:33.690 Based on the comparison presented in the exhibit, 210 00:09:33.690 --> 00:09:36.600 the fourth policy alternative appears to be the best choice 211 00:09:36.600 --> 00:09:37.803 among those presented. 212 00:09:39.240 --> 00:09:44.070 It's evaluated to have a good cost, 213 00:09:44.070 --> 00:09:45.630 a good time to implement, 214 00:09:45.630 --> 00:09:47.763 and a good effectiveness. 215 00:09:48.840 --> 00:09:52.530 The only alternative contained on this table 216 00:09:52.530 --> 00:09:55.113 that ranks good in all three categories. 217 00:09:57.390 --> 00:09:58.500 As we've discussed previously, 218 00:09:58.500 --> 00:10:00.480 cultural competence is a crucial aspect 219 00:10:00.480 --> 00:10:01.920 of effective leadership, 220 00:10:01.920 --> 00:10:03.540 but the concept is equally important 221 00:10:03.540 --> 00:10:05.490 in the context of global health policy. 222 00:10:06.510 --> 00:10:08.550 Policies that do not take into consideration 223 00:10:08.550 --> 00:10:10.470 the community's unique social and cultural needs 224 00:10:10.470 --> 00:10:11.820 and characteristics 225 00:10:11.820 --> 00:10:15.270 risk underperforming are failing to meet their goals. 226 00:10:15.270 --> 00:10:17.730 Policies that are culturally incompetent might, for example, 227 00:10:17.730 --> 00:10:19.980 result in intended beneficiaries losing interest 228 00:10:19.980 --> 00:10:22.530 in a program or failing to use services 229 00:10:22.530 --> 00:10:23.643 intended to help them. 230 00:10:26.430 --> 00:10:29.850 Finally, in summary, we learned in this module 231 00:10:29.850 --> 00:10:33.060 that global health policies has a complex web of rules. 232 00:10:33.060 --> 00:10:36.090 We examined the health policy landscape on macro-level 233 00:10:36.090 --> 00:10:39.750 transnational policies, country level government policies, 234 00:10:39.750 --> 00:10:42.330 and micro-level policies in smaller units of governance 235 00:10:42.330 --> 00:10:44.373 or in individual organizations. 236 00:10:45.570 --> 00:10:48.930 We also discussed some methods for analyzing health policy 237 00:10:48.930 --> 00:10:53.553 and looked at sources of various health policies.