2. Prerequisite to Health
• peace,
• shelter,
• education,
• food,
• income,
• a stable eco-system,
• sustainable resources,
• social justice, and equity.
3. Building healthy public policy
Creating supportive environments
Strengthening community action
Developing personal skills
Re-orientating health care services
toward prevention of illness and
promotion of health
7. prevention of risk factors themselves,
beginning with change in social and
environmental conditions in which these
factors are observed to develop, and continuing
for high risk children, adolescents and young
adults.
Amendable to policy
8.
9.
10. Principles that govern action directed
towards given ends (Titmus, 1974)
Consciously chosen course of action (or
inaction) directed toward some end (Kalisch
and Kalisch, 1982)
Plan, direction or goal for action;
authoritative decision making (Stimpson
ands Hanley, 1991)
11. Belongingness : it belongs to someone or
somebody?
Government
Department
Party
Source, Colin ,Palfrey , Key Concepts in Health Care Policy and Planning,2000
12. Policy denotes commitment .
stated intention
Desire to make things happen
Policy has status
It has the backing of some influential entity
Source, Colin ,Palfrey , Key Concepts in Health Care Policy and Planning,2000
13.
14. Policy as an aspiration or general
purpose
“ We believe that the health of the nation is the
first priority is terms of public spending”
Example :
“Corruption will not be tolerated by the PNOY
administration. “
“ The programs of the new administration will be
primarily for the poor and the marginalized”
15. Policy as one proposal or set of proposal
Government declaring that it shall reduce
maternal mortality by 2/3 by year 2015
Health sector declaring its support to Universal
Health Care
17. When government states its intention in a piece
of legislation ( white paper, charter )
Health care organization publishes its
prospectus
Magna Carta for Health workers
Cheaper medicines act
Reproductive Health Bill
18. Process as the progress of any policy from its
original appearance on the agenda to its
eventual implementation ,review and
evaluation.
21. Substantive decisions, commitments, and
actions made by those who hold or affect
government positions of authority as they are
interpreted by various stakeholders. (Bryson
and Crosby)
Called policies, plans, programs, projects,
decisions, actions, budgets, rules and regulations.
22. Pertains to the directives that promote the
welfare of a public.
e.g. Magna Carta for Public Health Workers- law
that could be viewed as a policy that promotes the
welfare of health workers.
23. Includes the directives and goals for promoting
the health of citizens.
e.g. Generic Drug Act, Tobacco Regulation Act
24. Rules governing and positions taken by
organizations
i.e. PNA, PMA, PHAP
25. Policies that govern workplaces
What the institution’s goals will be ;
How it will operate;
How the institution will treat its employees, and
How employees will work.
e.g. sexual harassment policy, contractualization policy
29. An authoritative statement of intent
adopted by government on behalf of
the public with the aim of improving
the health and welfare of the
populations (centrally determined
basis for action)
30. What health agencies actually
do rather than what
governments would like them
to do (Observing outcomes of
decision making).
32. Heart of all political decisions is the allocation
of value.
Easton(1965) : allocation of values is the
process by which government choose which
values to grant and which to deny – the
process of making and altering policies
33. Competing demands on finite resources:
Demands made by individuals and groups
seeking particular policies
Resources help the government to respond to
the demands being made ( money , building
staff , time )
Support relates to the extent to which any
government is authorised to pass legislation
34. A policy is a plan or course of action
designed to define issues,
influence decision-making and
promote broad community actions beyond
those made by individuals.
36. What is the level of involvement of
government?
Government may choose to do nothing. (policy
of inaction)
Example : abortion, euthanasia
Policies are usually made within a framework of
competing values
37. A regulator of health care agencies
A stimulator of research
A protector of deprived and disadvantaged
groups
A financier of health and health care
programmes
A purchaser of health care services
A direct provider of services
38. Emergent Health
System :
healthcare iis
viewed as an item
of personal
consumption
Pluralistic: Health
care is viewed as a
consumer good.
Private and Public
ownership of
facilities, States role
is minimal and
indirect
Insurance/Social
security. Health care is
seen as an insured .
Guaranteed consumer
good /service.
Government role :
central , but indirect
National Health
Service: health
care is state
supported, facilities
are mainly publicly
owned, payment
for services is
central and direct
Socialized:
Health care as a
state provided
service. States role
in health is total
39.
40. Power to decide
Power as non decision making
-non decision
-limiting the scope of actual decision to safe issues by
manipulating these dominant community values,
myths and political institutions and processes
41. a) Authority – whereas power concerns the ability
to influence others, authority refers to the right
to do so.
b) When authority exits, personal judgement is
surrendered to an authority on trust and
acceptance.
c)
42. Power is a function of the ability to influence
others by shaping their eference....
Elections
The control of information , the mass media
and through the process of socialization
Mcdonalds? SMART
43. Role of the state?
Is the state independent of society? Or is it a
reflection of the distributive power in society?
Does the state serve a common good or the
interest of the privilege few.?
44. therefore, is the process
• by which society makes decisions,
• selects goals and the best means for reaching
them,
• handles conflicting views about what should be
done and
• allocates resources to address needs.
45. The consensus model -power granted to
governments by people through periodic
elections
Pluralistic model – no one group holds total
power.
46. Elitist model -
government acts a honest brokers reconciling
the competing interest of different groups
towards agreed goals,
not all interest groups are equally powerful or
influential.
47. Several organization collaborating in order to
plan a co-ordinated assessment and provision
of services.
48. National Congress POLITICS International MDGs,WH0
Policies
DOH
PHILHEALTH
Academe
Local
Provinces,
City ,
Municipalities
Problems
Health needs and
demands
PEOPLE
in the
Community
49. Pluralism :power is widely distributed in society
Elitism: theory that power is concentrated in a
minority group in society
50. Open electoral competition
Ability of individuals to organize themselves into
pressure groups and political parties
Ability of pressure groups to air their views freely
Openness of the state to lobby of neutral for all
pressure groups
STATE as a neutral referee adjudicating
between competing demands
Although society has an elite group, no elite group
dominates at all times
51. Policy is dominated by a minority
Political elite
Non elites may be induced in governing circles if they
accept the basic consensus of the existing elite
Public values reflect the values of the elite- not
necessarily in conflict with the values of the masses
The values of the elite are conservative, policy
changes are likely to be incremental
53. International health financing reforms
Studied by Lee and Goodman (2002)
Contrary to pluralist claims that globalization is
opening up decisions to a wider range of
actors...
54. Power and Political systems
Power and the Health System
55. Rational models of decision making ( too
idealistic)
Incrementalism : more realistic but too
conservative
Mixed scanning approach – middle way
56. … Policy making is
concerned with what is
politically feasible and
technically desirable . “
57. Individual and state responsibility
Obligations or responsibility
Wearing of helmets,
Smoking in Public
58. Privatization of publicly owned property
Regulations government interventions
enforcing rules and standards
Transnational corporations with branches in
more than one country
59. Which of the four dimensions of policy making
are likely considered when wealthy countries
offer AID to less wealthy countries?
Which rights and responsibilities might be
influential in determining a governments
commitment to providing public fund for
various health services?
61. Policy encompasses the choices that a
society, segment of society, or
organization makes regarding its goals
and priorities and how it will allocate its
resources.
62. POLITICAL PROGRAMMATIC
What you are going to do
about an issue
How you are going to do it
Who will do it
• An overarching course
of action
• A series of objectives
and how to reach
them
• A statement of intent
• A long-term plan
63.
64. Step by step procedure
Highly logical and carefully sequenced
Does not allow for competing rationalities
Considered too prescriptive
65. Muddling through a decision
Incremental change
Involves mutual adjustments and negotiation
Excludes options by accident
Policy is not made once and for all
Proceeds through a series of incremental
changes
66. The test of good decision is agreement rather
than meeting of objectives
It involves trial and error
67. Appreciative setting ( Vickers 1965)
Policy choices are constrained by the cultural and
ideological horizon of individuals and groups
There are no built in priorities to guide them in the
multivalued choices so they must decide what to
place most value on in the concrete situation of
every decisions
68. Mixed scanning (Etzioni 1967)
Policy makers need to have regard to both
breadth and depth depending on how they
would distinguish between problems and
issues requiring detailed examination and
those needing more general overview
69. Planned bargaining ( Challis et al 1988)
combine and coordinate various interest
groups towards an agreed strategic set of
policies
Recognizes the importance of rationality and
the reality ofpolitics
70. Extra rationality (Dror,1989)
prescriptive account of how policy ought to be
made: a mix of rationality and inspiration
Notion of extra rationality : use of judgement,
creative intervention, brainstorming , the
brilliant idea that may come unexpectedly
71. Problem Analysis
1. Understanding the Problem
a. Receiving the problem:
Assessing the symptoms
b. Framing the problem :
Analyzing market and
government failures
c. Modeling the problem:
Identifying policy variables
2. Choosing and explaining relevant
goals and constraints
3. Selecting a solution method
Solution Analysis
1. Choosing impact
categories for goals
2. Concretely specifying
Policy alternatives
3. Predicting impacts of
Alternatives
4. Valuing impacts of
Alternatives
5. Evaluating and
Recommending
Communication
Information Gathering
Identifying and organizing relevant data, theories, and facts for
assessing problems and predicting consequences of current and
alternative policies
72. Policy Formulation
and Legitimation
Implementation Design and
Organizational Structuring
Resource
Mobilization
Progress/Impact
Monitoring
Constituency
Building
Agendas
Decisions
Issues
= primary linkage
= secondary linkage
73. • What is an agenda?
– The list of subjects or problems to which government
officials (or several sectors) are paying some serious
attention to.
Process of agenda setting:
• Getting an Issue recognized
• Identification of a policy problem
– Nature of the problem affects how it gets into the
agenda and the course of action
74. A condition or situation that produces needs or
dissatisfaction on the part of the people for
which relief and redress is sought
75. • Widespread attention to , or at least awareness
of the issue
• Shared concern of a sizeable portion of the
public that some type of action is needed to
remedy the problem
• A shared concern that the matter is an
appropriate concern of some governmental unit
and falls within the bounds of its authority.
76. Problem Analysis
1. Understanding the Problem
a. Receiving the problem:
Assessing the symptoms
b. Framing the problem :
Analyzing market and
government failures
c. Modeling the problem:
Identifying policy variables
2. Choosing and explaining relevant
goals and constraints
3. Selecting a solution method
Solution Analysis
1. Choosing impact
categories for goals
2. Concretely specifying
Policy alternatives
3. Predicting impacts of
Alternatives
4. Valuing impacts of
Alternatives
5. Evaluating and
Recommending
Communication
Information Gathering
Identifying and organizing relevant data, theories, and facts for
assessing problems and predicting consequences of current and
alternative policies
77. How do issues get on to the policy agenda?
Problem Policy (Solutions)
No Change
No Change
No Change
Politics (Political
will)
ACTION
No Change
80. Concerned with maintaining and developing the
polity- “the condition of civil order, form and
process of civil government, organized society
and state” – with the adoption of courses of
action by political parties, governments and
other important social organizations, and with
issues in the “science and art of governing”
81. Evidence Data
Research Knowledge
Researchers
and
Universities
Advocates Policy
Brokers Media
BELIEFS
Causal
Assumptions
CORE
VALUES
Ideologies
INTERESTS
FORMAL
STRUCTURE
Executive
Legislative
Bureaucracy
INFORMAL
SRUCTURE
Networks
Coalitions
Stakeholders
Citizens
Social
Problem/
Issue
Policies
VALUES
82. Client- oriented advice relevant to public
decisions and informed by social values
Emphasize professional mind set rather than skill
mastery
Emphasize the importance of social values in policy
analysis
By looking at consequences of policies beyond
those that affect client, places a value on the
welfare of others
Good policy analysis takes a comprehensive view
of consequences and social values
83. Systematic Comparison and evaluation of
alternatives available to public actors for
solving social problems
Client – Specific person or institution as
decision maker
Involves synthesis of existing research and
theory to predict consequences of alternative
policies
84. Time constraints – strong deadline
pressures because completion of analysis
usually tied to specific decision
Weakness - myopia resulting from client
orientation and time pressure
85. Focuses on relationships between variables
that reflect social problems and other variables
that can be manipulated by public policy.
Desired product of is a more-or-less verified
hypothesis of the form: if the government does X,
then Y will result.
86. Iterative by recognizing that there are no
perfect solutions to policy problems and
therefore that the impact of one solution will
lead to the need for new solutions either in the
same or in a different policy
87. Pragmatic by taking account of the policy
environment and arriving at solutions that are
feasible given existing institutional structures
Focuses on malleable variables i.e.
variables that are under the control of and can
be changed by the policy makers.
Responsive by involving stakeholders and
taking account of their values.
88. Problem identification/ clarification
Decision that it is an important problem to
study-policy research/ analysis
Proposal of policy alternatives
Selecting from policy alternatives
Implementation of policy
Evaluation
89. Problem Analysis
1. Understanding the Problem
a. Receiving the problem:
Assessing the symptoms
b. Framing the problem :
Analyzing market and
government failures
c. Modeling the problem:
Identifying policy variables
2. Choosing and explaining relevant
goals and constraints
3. Selecting a solution method
Solution Analysis
1. Choosing impact
categories for goals
2. Concretely specifying
Policy alternatives
3. Predicting impacts of
Alternatives
4. Valuing impacts of
Alternatives
5. Evaluating and
Recommending
Communication
Information Gathering
Identifying and organizing relevant data, theories, and facts
for assessing problems and predicting consequences of
current and alternative policies
90. Source: Patton and Sawicki, 1993
Verify, Define, Detail
the PROBLEM
Establish
EVALUATION
CRITERIA
Identify
ALTERNATIVE
POLICIES
EVALUATE
alternative policies
MONITOR the
implemented policy
DISPLAY and
DISTINGUISH
among alternatives
91. To search for the
COMMON GOOD
Through Health Policy Development
Editor's Notes
There may be one pure form . In real life health care –may include more than one type as in Belgium and Spain
