Health Policy Development and Planning Session 3 & 4 PDF

HEALTH POLICY DEVELOPMENT AND PLANNING Session 3: Evolution of Public Health Policy: June 6, 2024 Session Objectives 1. Describe the evolution of public health policy. 2. Discuss the influence of determinants of health on health outcomes. 3. Describe the role of policies in the health sector....

HEALTH POLICY DEVELOPMENT AND PLANNING Session 3: Evolution of Public Health Policy: June 6, 2024 Session Objectives 1. Describe the evolution of public health policy. 2. Discuss the influence of determinants of health on health outcomes. 3. Describe the role of policies in the health sector. 4. Continue with group presentations on Policy development in different environments in our society. Evolution of Public Health Policy#1 Religious beliefs and superstition: These beliefs caused people to understand disease as an imbalance in the body due to sin or evil. Ancient Greeks believed the body is made of blood, phlegm, black bile and white bile- imbalance of these caused disease. Ancient Egyptians believed disease was caused by demons or gods and treatment involved appeasing these gods Ancient Chinese based their treatment by believing they must restore imbalances of elements of wood, fire, metal, earth and water. Biomedical approach: evolution of chemistry and laboratory sciences. Bacteriology and virology guided treatment. Involved mass vaccinations and development of new drugs Evolution of Public Health Policy #2 Sanitary environment approach. Entails people live and work in healthy conditions. Adequate housing-improvements in living conditions Proper sanitation Access to uncontaminated food and clean water-better nutrition A safe environment Health education Social behavioural approach: Based on psychological theories to improve lifestyles and behavioural change to reduce risk of disease. Advocacy campaigns against risky behaviours, substance and drug abuse, risky sexual behaviours, and reckless driving. Determinants of Health Physical environmental Social economic Health behaviours factors Health Service Factors factors factors Environmental quality Family & social Tobacco, drug & Access to care Buildings quality support substance abuse Quality of care Community support Diet & Physical exercise Political and commercial factors also determine health Genetics: Inheritance is a determinant of health & life span. Gender: Men and women are predisposed to different diseases in their lifespan  Influence of Determinants of Health on Health Outcomes Health outcomes Physical Morbidity and Mortality Environment (X%) Clinical Care (Z%) Health Factors Social-economic (P%) Personal characteristics and behaviours (Y%) Adapted from The WHO (2015): Health in all Policies. Training Manual. World Health Organization Press, Geneva, Switzerland Role of Public Health Policies in the Health Sector #1 1. Public health policies are necessary to address population health, health inequity, or health systems challenges that require intersectoral collaborations for policy solutions. The steps include: Knowledge of the complex problem Why it is a problem (definition of causes Perceived and actual) Potential solutions involving other sectors(especially technical feasibility) Potential costs and benefits of their intervention from a health perspective and society perspective. Example of complete public health issue could be health risks associated with changes of climate, exposure to technological waste. Food insecurity, NCDs Role of Public Health Policies in the Health Sector #2 2. External policies with high impact on health. Originators of such policies are external to the health sector and the policies have a high impact on health. For example, a health ministry may need a data protection policy to protect patient information. The ministry may formulate the policy to address issues of cyber security in collaboration with other actors and stakeholders. Steps for addressing the issue include: The Ministry prioritizes when to engage with other sectors because of the costs and time involved. Identifies key stakeholders and actors to engage Formulation of strategies to use in engaging them Taking the cycle of public policy formulation. Role of Public Health Policies in the Health Sector #3 3. Government priority affecting many sectors. The priority is a matter of national importance which requires multiple actors because of its national goal and the health impact provides the health sector with an opportunity to lead the intersectoral collaboration group. Policymaking provides an opportunity for: The health sector to steward the process and promote its agenda, gains visibility and respect for its expertise to lead the group The health sector to strengthen its reputation as a reliable sector and strengthen its ties with other sectors. Session 4: Health Policy Planning and Development Date: June: 13, 2024 Session Objectives 1. Describe the health policy triangle and related concepts. 2. Describe the health policymaking cycle and the role of stakeholders.  Health Policy Triangle CONTEXT Actors Individuals Groups Organizations CONTENT PROCESS Reference: Buse K, Mays N, Walt G (2005). Making Health Policy. Understanding Public Health Series Open University Press.  Context Situational factors: transient, Political factors: political will or lack impermanent conditions which can thereof, leadership attributes have an impact on policy (e.g. wars, conducive or not conducive to policy droughts) making. Structural factors: relatively Economic factors: unchanging elements of society (e.g. Adequacy/inadequacy of budget, the political system, type of economy, non-observance of budget cycles, demographic features, climate poor health financing policy etc change) Environmental factors: heavy disease Cultural factors: religion, traditions, burden, external influences on health customs/mores, ethnicity, gender outcomes etc International or exogenous factors: Social factors: Illiteracy levels, some policies require cooperation inadequacy of human capital, between national, regional or unchanged, weak social support multilateral organizations systems  Actors ❖ These are the individuals, organizations or the state (government) whose actions influence health policy. ❖ All actors have their interests, stakes, power, and influence in policymaking. ❖ Actors bring their cultures, orientations aspirations in policy agendas which have implications for policy options.  Content ❖ The policy content is the substance of a particular policy which details the subjects and topics to be covered. ▪ Policy content may be complex or straightforward. ▪ The content may cover a specific area of health service delivery e.g. policy on UHC, policy on Malaria Management ▪ The content may guide the vision of the health sector i.e. a national policy framework.  Process ❖ Process in policy development means how policies are initiated, developed or formulated, negotiated, communicated, implemented and evaluated. ▪ Policy making is a process of negotiation and bargaining to satisfy various interests and build a coalition of support. ▪ Policy making varies according to the nature of the policy and the organizational structure in which it is made (i.e. actors, content, and context) ▪ The process often includes assembling information, developing arguments, developing alternatives, and persuading others.  Health Policy: Definition of Terms#1 ❖ Health policy is a plan guide to guide decisions, actions and outcomes in the health sector. The plan contains written or unwritten practices or behaviours. ❖ A policy is a written or unwritten intent of what is envisaged to be done or it can be a policy in effect (under implementation). In the health sector, policies are written.  Health Policy: Definition of Terms#2 ❖ A health policy is context- specific and is influenced by social, economic, political, cultural/religious, and environmental factors. These factors have global, regional, national and local consequences. ❖ Health policies are formed through the complex inter-relationship of context, process and actors.  A Health Policy Framework: Components Policy Purpose: A health policy is developed with a focus to improving people’s health and wellness through provision of healthcare services and ensuring the health system is managed effectively and efficiently. Policy Goal: Overarching intent and the impact the policy is intended to have in the lives of the targeted population. Policy objective: Policy directions related to the health outcomes that need to be attained to achieve the policy goal. Policy orientations: How the sector will organize itself to facilitate the achievement of it objectives. Policy principles: Factors for consideration that will guide future investments. Policy strategy: key areas of interventions that the policy focuses on to achieve the policy objectives. Policy targets: Measurable parameters that demonstrate impact of the policy strategies.  A Health Policy Framework: example Kenya’s framework Policy Orientations & Principles Policy Objectives Policy Goal Eliminate Efficiency Research & ”Attaining the Equity Development Communicable diseases Health highest Health Systems Sbuilding Blocks Leadership Halt & reverse NCDs possible Multi-sectoral People-oriented Health Products & Technologies Reduce the standard of burden of violence Health & injuries health in a Workforce Provide essential responsive Healthcare Health manner” Social accountability Financing Minimise Exposure Participation Service Delivery to health risk Systems factors Health Strengthen collaboration Infrastructure with private and health care  Health Policy Cycle Monitor Evaluate Identify Problem Report Conduct research Set the Agenda Window Policy Review Agenda Setting Policy Policy Implementatio formulation n Implement Develop options and policy strategies Enforce policy Policy Adoption : Negotiate Validate Formulate policy Iterate Phases in Policymaking Cycle Consists of five phases; 1. Agenda setting: Involves identifying the problem, conducting policy analysis and setting the agenda. 2. Policy formulation: Develop policy options and strategies, negotiate, and formulate policy. 3. Policy adoption: Stakeholders validate and adopt the policy 4. Policy implementation: implement and enforce policy. 5. Policy monitoring and evaluation (monitoring, review and report). Social problems in the policy process:#1 1. Complex problems are ill-defined, ambiguous, and laced with political and moral issues. They require multi-stakeholder groups to address the complex solutions. The mindset of stakeholders is to ensure: ❖ A range of trade-offs through negotiations ❖ A tolerance of uncertainties or ambiguity ❖ An opportunities-driven approach Social problems in policy process: #2 2. Simple problems: Have predictable cause and effect and solutions can be defined and operationalised in a standard operating procedure to drive intervention. 3. Chaotic problems: interventions for such problems can only be used for learning. Cause and effect is not predictable and it is derived by looking back at events, and cannot be confirmed. 4. Complicated problems: Cause and effect can be inferred from data, analysis and expert knowledge. Once the problem is understood, interventions are then defined and planned for action. Agenda Setting in Health Policymaking 1. Policy-making is a complex process involving many actors and stakeholders who have diverse interests. 2. It is a political process requiring policymakers to seize the right opportunity (the policy ‘’window’’) arising from changing social, economic and political situations. The window of opportunity means; Short periods, and simultaneously a problem is recognized a solution is feasible and the political climate is conducive/positive for policy change. Policy champions help frame (define) the problem, the cause and the solutions. They support policy reforms and support from others. They attract resources and rally stakeholders and actors around the policy process to move forward. Agenda Setting in health policymaking ❖ Framing a problem influences the stakeholders’ ownership or dis-ownership of the problem. Ownership creates credibility, funding, legitimacy, redefining of the problem, and new ways of stakeholder understanding of the problem. ❖ Policy windows enable policy stakeholders to define the problem and influence how the problem is perceived i.e. whether it is a non-issue, a crisis or a problem and whether it is a complex, chaotic, simple, and complicated problem  Policy Formulation ❖ Proposals for solutions are discussed at this stage. All necessary stakeholders in policy-making form a technical working group ( represents the stakeholders). ❖ The policy formulation stage is the search for solutions and the policy briefs are documents that recommend policy options/ alternatives or choices on an ongoing policy debate that will be adopted for implementation.  Policy Brief: What is it? #1 ❖ Policy brief is a 1-2 pager document, which gives the rationale for choosing a policy option/alternative or choice in an ongoing policy debate. ❖ The Stakeholder TWG develops a policy brief, which is technically, culturally, ethically, and politically sound. ❖ Policy briefs are acceptable to key stakeholders, and the executive/authority and is backed up by a feasible budget.  Policy Brief: What is it?#2 ❖ Since policy briefs are influential to stakeholders, they must: ▪ Be focused and limited in scope (only agreed options) ▪ Be professional and not academically written. ▪ Be evidence-based- concrete and verifiable facts or supported by hard data. ▪ Concise, brief, understandable and accessible. ▪ Have a strong health argument (intrinsic to the health sector), ▪ Have a strong health-to-other sectors argument ▪ Have a strong health-to-societal goal argument.  Policy Brief Template ❖ Executive summary: an overview of the brief with key sentences (1-2), which encourage,/motivate the readers to go on reading ❖ Introduction: ▪ Why is the topic of the policy important or why is it important? ▪ What were the goals of the policy? ▪ Tie the ending of the policy with interesting content that embodies parts of the policy. ❖ Approaches and Results ▪ Briefly state the context, concrete facts, examples, and issues the policy is addressing only as you deem necessary to your audience.  Policy Brief Template ❖ Conclusion ▪ Base your policy on the results/outcomes of the policy, making strong and concrete assertions/declarations. ❖ Implications and Recommendations ▪ State clearly what and how the policy may influence beyond the jurisdiction of the policy ▪ Make suggestions on what should happen next. Policy Formulation: Role of Stakeholders ❖ Government: Is the main actor in policy making and provides the leadership and stewardship roles in the policymaking process. The government has various roles (see notes) ❖ Non- Governmental stakeholders are beneficial to policymaking; Assess support and opposition to policy Create visibility to government actions and legitimacy of the policy Empower the marginalized. Strengthen and increase collaboration with government, mobilise and ensure efficient use of resources Ensure sustainability of interventions Support technical implementation, monitoring and evaluation of interventions.  Stakeholders Analysis ❖ This is the process of identifying stakeholder groups which could be interested in, influenced or affected by the policy option and how the stakeholders react to the power/ interest, influence/interest continuum. ❖ A stakeholder analysis template maps the stakeholders according to their Influence/Power and Interest/Stake along a matrix. Stakeholder Analysis Template Name of Type(NGO, Influence Interest/stake in Engagemen Stakeholder Company, FBO, /Power the Issue t Government agency, (High or Low) (High or Low) (high, Individual, medium, Foundation etc) low) Stakeholder 1 Stakeholder 2 Stakeholder 3 Stakeholder 4  Stakeholder Analysis Matrix HIGH Stakeholder 3: Stakeholder 4: Type: Influencer Type: Key Players Strategy: Keep Satisfied Strategy: Manage closely Influence/ Power Stakeholder 1: Stakeholder 2 : Type: Crowd Type: Observer Strategy: Monitor Strategy: Keep Informed LOW LOW HIGH Interest/ Stake in the Issue Challenges of stakeholders in policy-making Process ❖ Policymaking can take long- lengthy negotiations to accommodate interests. ❖ Costs of interventions may increase when all stakeholders demand to have a role to play ❖ Polarizing interest groups- groups who stick and demand their interests to be heard and met. ❖ Can demand untenable expectations.  Thank you Course Code: HMD 132: Credits: 3 Semester: MAY-AUG 2024 Lecturer: Dr Anastasiah Kimeu [email protected]