Introduction to policy making processes

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Introduction to policy

making processes

Dr Arash Rashidian, MD PhD

Director of Science, Information and Dissemination

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Outline

Challenges in understanding,

developing and

implementation policies

Key policy making processes

Interaction between processes,

context, content and key policy

actors

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Health Policy as

a Social/Public

Policy

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

What is a social/public policy

• Challenge starts from defining policies!

• Policies are sometimes likened to “elephants”

“Defining policy is rather like the elephant – you know it

when you see it but you cannot easily define it” (Cunningham, 1963)

• Overlapping terms used interchangeably in different

contexts!

• Policy, planning, strategy, management, politics

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

What is a social/public policy

• Courses of action adopted by governments and other

important social organizations

• “Public policy is whatever governments choose to do or not to do” (Dye, 1972)

• Adoption or maintenance of an existing course of action

• Policy intention: “Health and health inequalities tell us a great deal about the

good or bad effects of social policies” Michael Marmot

• Policy decisions in one sector interact with those in another

• e.g. Health and environment; health and housing ….

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Approaches in defining policy

• Policies are developed at different levels

• “High” and “low” politics

• International, national and sub-national (e.g. provincial) levels

• And not sedentary

• Important to note policy-making processes

• more than “outputs” of decisions, or “inputs” of management

• Defining policies:

• How policies should occur …“prescriptive”

• How policies occur in reality …“descriptive”

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Policy making stages

essentially there are four stages

• Problem formation /

agenda setting

• Policy formulation

• Policy implementation

• Policy evaluation

Stages Activities

Problem identification and issue

recognition

Understand the challenge or problem

• What precisely is the problem?

• What evidence is there?

• Who has an interest in the issue?

• What do we want to achieve?

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Policy making stages

essentially there are four stages

• Problem formation /

agenda setting

• Policy formulation

• Policy implementation

• Policy evaluation

Stages Activities

• Review and evaluate research evidence

• Identify options

• Assess national data and evidence

• Consult stakeholders

• Identify risks and barriers and

opportunities

• Identify what works well

• Evaluate options, identify pros and cons

• Incremental changes or radical reforms?

• Achieve consensus and ownership

• Develop recommendations

• Make decision (s)

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Policy making stages

essentially there are four stages

• Problem formation /

agenda setting

• Policy formulation

• Policy implementation

• Policy evaluation

Stages Activities

• National policies often requires

“translation” to programmatic of those

responsible for implementation

• They may also require adaptation to the

context

• Draw implementation strategies and plans

• Develop manageable pieces of work

• Define timelines and deadlines

• Allocate responsibilities

• Keep stakeholders informed / involved

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Policy making stages

essentially there are four stages

• Problem formation /

agenda setting

• Policy formulation

• Policy implementation

• Policy evaluation

Stages Activities

• Establish performance measures

(quantitative and qualitative)

• Key performance indicator

• Develop plan for measurement and

reporting

• Monitor progress / ensure accountability

• Give feedback to those involved with the

tasks

• Report on performance

• Evaluate the outcomes of the policy

• Adapt and amend the implementation

plan in light of evaluation results

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Policy making stages

• Using stages to understand policy-making

• “descriptive” or “prescriptive”?

• The “stages” imply policy making steps are sequential or

cyclical

• Policy-making does not necessarily follow a rational process

• It often involves incremental decisions that result in small gains

• Policy processes are very context specific, policy actor

dependant and vary over time in a country

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Policy content is not the only important

element in policy-making!

• “ … health policy means different things to different people. For most

people, health policy is concerned with content … . For me health

policy is about process and power. … it is concerned with who

influences whom in the making of policy, and how that happens.”

Gill Walt, 1994

• Example of efforts to reduce alcohol consumption in Hungary (Varvasovszky &

McKee, 1998)

• Different stakeholders – relative power and position

• Those who wanted it reduced lacked power - i.e. MoH

• Those who didn’t have the will to reduce consumption were in power

positions - i.e. MoF; MoC

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Approaches in defining policy …

• The World Health Organization defined health policy as

• “an agreement or consensus on the health issues, goals and objectives

to be addressed, the priorities among those objectives, and the main

directions for achieving them.” (WHO/EURO, 1999)

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Descriptive policy

analysis can be used

for prescriptive policy

recommendations

• A good example: John Kingdon’s 3

streams’ model (1984, 1995)

• Agenda setting opportunities

• windows of opportunity for policy

making

problem

Policy (solution)

Politics (political will)

no change

Action – policy window

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Important note

• The strong interaction between policy formulation and policy implementation

• Policy making encompasses both

• Think of “top down” and “bottom up” approaches to policy making

• Despite the widespread misconception:

• ‘A good policy that is badly implemented’

I call this “the chained elephant”

fallacy

Capacity Building for Development of Policy Briefs: General Principles for NEDtP Members

25-26 October 2021

Cairo, Egypt

Social

values

Complexities policy-making objectives,

processes, and interactions

Policy-maker

questions

What are the main

priority

issues/problems

for

decision-

making?

What are the

potential e

ffective

and safe policy

options?

Are the policy

options cost-

effective and

affordable?

Are the policy

options

easible to

implement and

sustainable?

Policy making is influenced by a variety of factors

Context

Content

Process

Policy triangle

Walt & Gilson, 1994

Actors

Study of health policy

makers in a LMIC

(Mostafavi, Rashidian et al)

Lobbyism

Conflict of

interests

Social

cohesion

Illness

severity

Burden of

disease

Equity in

physical

access

Equity in

financial

access

Freedom

choice