Introduction to Health Policy Development: Policy Making,
Analysis, and ResearchF. Marilyn E. Lorenzo, RN, MPH, DrPH
University of the Philippines Manila College of Public Health
Department of Health Policy AdministrationHealth Policy and
Administration 1
Definitions: POLICYPolicy encompasses the choices that a
society, segment of society, or organization makes regarding its
goals and priorities and how it will allocate its resources.
Health Policy and Administration
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Definitions: POLICY 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 and Hanley, 1991)Health Policy and Administration
3
Policy Types Public Policy 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.Health Policy and Administration
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Policy TypesSocial Policy pertains to the directives that
promote the welfare of the public. E.g. Magna Carta for Public
Health Workers- law that could be viewed as a policy that promotes
the welfare of health workers.
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Policy TypesHealth Policy includes the directives and goals for
promoting the health of citizens. E.g. Generic Drug Act May be
trade or economic policies that have impact on healthHealth Policy
and Administration 6
Policy TypesOrganizational Policies rules governing and
positions taken by
organizations, such as the PNA or IRNUP.
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Policy TypesInstitutional Policies are those governing
workplaces What the institutions goals will be and how it will
operate, how the institution will treat its employees, and how
employees will work. E.g. sexual harassment policy
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Approaches to Policy DevtPolicy Making
Policy AnalysisPolicy Research
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Initial Agreement (Plan for Planning) Issue
The Policy Change Cycle
Problem Formulation Creation Search for Solution
Policy of Plan or Formulation
Proposal Review and Adoption
Implementation And Evaluation
Policy or Plan Maintenance, Succession or Termination
Containment Triggering Mechanisms Mechanisms Public Agenda
Formant Agents
The Policy Environment
Approaches to Policy DevelopmentPolicy Making- 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
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Policy Process:A. Need Assessment 1. Identify the scope and
limits of the problem 2. Identify the actors and stakeholders B.
Policy Making 1. Conceptualize the causes of the problem 2. Collect
information, procedures alternative solutions 3. Involve actors in
choosing from policy alternatives
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Policy ProcessC. Policy Implementation 1. Disseminate and
publicize policy 2. Establish behavior changes based on the policy
3. Monitor and revise the policy
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Approaches to Policy DevelopmentPolicy Analysis- 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 analysisHealth
Policy and Administration 14
Policy Development Approaches Policy Research 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, they Y will result.
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Policy Research 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
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Policy Research Different from bio-medical or
epidemiologic research in the following ways Multidisciplinary
using multiple methods to analyze components, Inductive rather than
deductiveproblem driven, not theory-driven.Health Policy and
Administration 17
Policy Research 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.Health Policy and Administration 18
Policy Making Process1. What is a Policy? Rules to establish,
control or change the behavior of
institutions and/ or individuals in order to solve a problem.
May be explicit or implicit Includes public policy as well as
decision-making 2. Process of Policy development a. Problem
identification/ clarification b. Decision that it is an important
problem to study-policy research/ analysis c. Proposal of policy
alternatives d. Selecting from policy alternatives e.
Implementation of policy f. EvaluationHealth Policy and
Administration 19
Policy Making Process3. World in which policies are made have 3
components: a. Institutions and mechanisms making or contributing
to decision-making b. Information used in decision-making c. The
values and beliefs held by institutions and beliefs a. Vested
interest b. Beliefs c. Core values
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THE WORLD IN WHICH POLICIES ARE MADE
Evidence Data Research
Social Problem/ IssueKnowledge CORE VALUES Ideologies
VALUESBELIEFS Causal Assumptions
INTERESTS
Researchers and Universities FORMAL STRUCTURE Advocates Policy
Brokers Media Executive Legislative Bureaucracy
INFORMAL SRUCTURE
NetworksCoalitions Stakeholders Citizens
PoliciesHealth Policy and Administration 21
Selection from policy alternatives/ Implementation 1. Generating
policy alternatives Time frame short term, medium term, long term
Extent of behavior change required by policy
incremental or fundamental Types of policy instruments used
Financial measures Regulatory or control measures
Information-related Symbolic priority setting Research and
development
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Selection from policy alternatives/ Implementation 2.
Implementability of policy alternatives Values of stakeholders
Organizational structure for implementing policy Current political
situation
3. Finalization of policy recommendations Revisions because of
the political situation Revisions because of the value of
stakeholders Revisions because the organizational structure is
inadequate.Health Policy and Administration 23
CommitmentTo search for the
COMMON GOODThrough Health Policy Development
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Basic Preparation for Policy Analysts1. Analysts must gather,
organize and communicate information in situations where deadlines
are strict and access to relevant people are limited.Develop
strategies for quickly understanding the nature of policy problems
and the range of possible solutions. Identify, at least
qualitatively, the likely costs and benefits of alternative
solutions and communicate these 2. Analysts need a perspective for
putting perceived social problems in context. Market failure
Government failure Sufficiency requires that the form of the
intervention does not involve consequences that would inflict
greater social costs than social benefits.-
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Basic Preparation for Policy Analysis3. Analysts need technical
skills to enable them to predict better and evaluate more
confidently the consequences of alternative policies - Micro-
Economics - Public Finance - Statistics - Organizational Behavior -
Political Behavior - Evaluation Research - Especially Benefit Cost
Analysis
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Basic Preparation for Policy Analysis4. Analysts must understand
political and
organizational behavior in order to predict, and perhaps
influence, the feasibility of adoption and successful
implementation of policies. - Understand worldviews of clients and
potential opponents
5. Analysts should have an ethical framework that explicitly
takes account of their relationships to clients.Health Policy and
Administration 27
Figure 1. Determinants of Health Major Factors and Intervention
PointsUnderlying Socioeconomic Demographic and Cultural Factors
Proximate Factors
Health Outcomes
IndividualAge, sex, education Occupation, health beliefs,
attitudes Household Income/wealth Age-sex composition Social
networks Community Ecological climate Markets and prices
Transportation Population size, structure and distribution Social
structure and organization
Health care service utilization
Mortality
Environmental contraindicators
Morbidity
Nutrient/ dietary intake Nutritional status Fertility
Disability
Injury
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A. INDIVIDUAL Health Status Bio-Medical Factors Psychological
Factors
B. SOCIETY Political Structure Socio-Cultural Patterns Economic
Development Demographic Structure
C. Institutions Health Services Health Organization Health
Planning
D. Larger Systems Environment
Health Care Sector General economic resources (A) Economic
resource specific to health (B) Supply of health care services (C)
Health care service utilization (E) Demand for health care services
(D)
A. B.
Land, labor, capital, technology Physicians, nurses, other
health workers, hospitals, RHU, BHS, clinics, pharmaceuticals,
medical equipments Institutional services, physician services,
hospital services (in-patient care, outpatient care), treatment for
specific health conditions, e.g. diarrhea, ARI, TB, tropical
diseases, chronic disease Demand for institutional services or
specific treatments Actual use of various types of services in
various institutional setting Outputs of other health-related
sectors, e.g. water supply, housing, etc.; and of social and
economic sectors, e.g. education, food supply, employment and
income, transportation Health outcomes, mortality, nutritional
status, disability
C.
D. E. F.
Health status (G)
G.
Other health-related and socio-economic sectors (F) Adapted from
Andreano and Helminlak (1988)
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7, g, i 5, e 6, f 2, b, h 4, d 3, c 1, a
Health Care SectorGeneral economic resources (A) Economic
resources specific to health (B) Supply of health care services (C)
Health care services utilization (E) Demand for health care
services (D)
Health status (G) Other health-related and socio-economic
sectors (F) Policy Areas, Issues and Questions of the 1.
Interpersonal resource allocation 2. Health care service structure
3. Health care service focus 4. Health care service utilization 5.
Health care service resource mix 6. Management and operational
procedures 7. Organization of the health care sector (i.e.,
private-public sector mix in service delivery and finance). Health
Policy and Administration 32 Criteria for Assessing the Economic
Performance Health Care Sector a. Intersectoral allocative
efficiency b. Service structure efficiency c. Service focus
efficiency d. Service utilization efficiency e. Production
efficiency
Towards Health Policy Development in the Philippines Figure 1.
Determinants of Health Major Factors and Intervention
PointsUnderlying Socioeconomic Demographic and Cultural Factors
Individual Age, Sex Education, Occupation Health Beliefs, attitudes
Household Income/wealth Age-sex composition Social network
Community Ecological climate Markets and prices Transportation
Population size, structure and distribution Social structure and
organizationHealth Policy and Administration 33
Proximate Factors Health care services utilization
Health Outcomes Mortality
Environmental contamination
Morbidity
Nutrient/ dietary intake Fertility Injury
Nutritional status
Disability