Lecture 7_20240626.pdf

Policy in Health Care and Public Health 26 June 2024 Public Policy ❏ “[Public policies] confer advantages and disadvantages, cause pleasure, irritation, and pain, and collectively have important consequences for our well-being and happiness.” (Anderson 1984) ❏ “Public policy is w...

Policy in Health Care and Public Health 26 June 2024 Public Policy ❏ “[Public policies] confer advantages and disadvantages, cause pleasure, irritation, and pain, and collectively have important consequences for our well-being and happiness.” (Anderson 1984) ❏ “Public policy is whatever governments choose to do or not to do.” (Dye 1984) ❏ “A statement by the government of what it intends to do with a particular problem.” (Birkland 2019) Which building block of the health system is public policy under? Health Governance ❏ “The careful and responsible management of the well-being of the population” (WHO 2000) ❏ Leadership, stewardship, regulation, oversight ❏ The premise is that ‘good’ governance will ultimately lead to improved health outcomes (Barbazza and Tello 2014) ❏ Challenges: ❏ Changing population demographics and epidemiology, widening social inequalities, and a context of financial uncertainty ❏ Health systems moving toward increasingly decentralized structures, engaging diverse and heterogeneous networks of actors for generating resources, delivering services and financing care Health Governance & Public Policies ❏ Characterizes a set of processes (customs, policies or laws) that are formally or informally applied to distribute responsibility or accountability among actors of a given [health] system (Barbazza and Tello 2014) ❏ Policies “guide decisions, actions and outcomes”, but can come in various forms (e.g., laws, procedures, even frameworks) and can be formal/informal or implicit/explicit. ❏ Consider policies related to: access and equity, health promotion and disease prevention, regulation and safety, health information systems, health financing, health research and innovation, etc. Multiple Streams Approach ❏ A theoretical framework used to explain how policy agendas are set and how policy change happens (Kingdon 1984) ❏ Three Streams: ❏ Problem Stream – issues or perceived problems that policymakers and the public view as needing attention and action ❏ Policy Stream – various potential solutions or policy proposals that experts, researchers, interest groups, and policymakers have developed over time ❏ Politics Stream – encompasses the political climate, including public opinion, elections, interest group pressure, changes in government priorities, and the overall political context within which decisions are made John Kingdon’s Multiple Streams Approach (MSA) Multiple Streams Approach Policy change happens when these three streams come together during a "policy window": 1. A problem gains significant attention or becomes seen as urgent. 2. A viable policy proposal or solution exists that can effectively address the problem. 3. The political climate is favorable or conducive to adopting the proposed policy solution. Republic Act 10354 Responsible Parenthood and Reproductive Health Law of 2012 RA 10354 (RH Law) ❏ Problem Stream ❏ One of the key problems that the RH Law aimed to address was the high maternal mortality rate in the Philippines. Unsafe abortions and lack of access to contraception were contributing factors to maternal deaths. ❏ The Philippines has a high population growth rate, which posed challenges for economic development, poverty reduction, and social services delivery. RA 10354 (RH Law) ❏ Policy Stream ❏ Various policy proposals and solutions had been developed over time by advocates, health professionals, and NGOs. ❏ Although the law was passed in 2012, it has been in limbo for about 13 years and has been in political consciousness since 1967. ❏ Policy has taken on different framings (“recurring ambiguity”): ❏ FM - population control ❏ CA - women, health, responsible parenthood ❏ FR/JE - population, women, modern contraception ❏ GMA - population, family planning as a health intervention, responsible parenthood RA 10354 (RH Law) ❏ Politics Stream ❏ BA mentioned of support for the RH Bill in his 2012 SONA ❏ Various NGOs and civil society organizations mobilized ❏ Various personalities in the halls of the Congress and the Senate have followed suit and publicly declare their support for the RH Bill ❏ RH issue was highly mediatized Nature of the Policy Process: non-linear, follows stages model (Laswell  The Policy Analysis Triangle What is the economic, political, socio-cultural context that justifies your proposed policy? Who are the stakeholders in your proposed policy? What are the objectives, mechanisms for implementation, resource availability, indicators for monitoring and evaluating progress of your proposed policy?