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HPI4009 Health Systems Governance Case 3
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Summary HPI4009 Health Systems Governance Case 3
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Health system governance (HPI 4009)Tutorial group 3 22-11-2019
Case 3: Health policy: puzzling and/or powering?
Overall health policy: Triangle model + actors
(Broad) Policy: broad statement of goals, objectives and
means that create the framework for activity. Refers to the
decisions taken or not taken by those with responsibility for
a particular policy area. The set of institutions: rules of the
games. Organisation services and funding arrangements:
hospital/health care institutions + the way how they deliver
the healthcare.
You make choices on when, where, how many times, to
change or not to change something.
Health policy: may cover public and private policies about
health. It embraces courses of action (and inaction) that affect the set of institutions, organizations,
services and funding arrangements of the health and health care system. Because health is influenced
by many determinants outside the health system, health policy analysts are also interested in the
actions and intended actions of organizations external to the health system which have an impact on
health.
The four factors influence each other.
- Actors are influenced by the context within which they live and work.
- Context is affected by many factors such as political instability or ideology, by history and
culture.
- The process of policy making is affected by actors, their position in power structures, their own
values and expectations.
- The content of policy reflects some or all of these factors.
Actors
Individuals (e.g. the minister of Health), organizations (e.g. WHO, Shell, government). Non-state
actors and state actors.
Actors may seek to influence policy, but the extent to which they will be able to do so will depend
on their perceived or actual power. The organisation in which the actor is involved also decides
how much influence the actor has. This actor is more broad than the last one (case 2); it is more
focused on the policy within the health system, not only the health care (as in case 2). Here you
also have power, so not everybody has the same amount of power.
Context
Factors that affect policy – systemic factors (political, economic and social, local, regional, national
and international)
Situational factors
Transient (voorbijgaand) or unusual conditions which may influence policy (e.g. wars).
Structural factors
Relatively unchanging elements of the society (e.g. political system(open/closed), type of
economy).
Cultural factors
In societies where formal hierarchies are important, it may be difficult to question high officials or
elder statesmen. Religious for example
International or exogenous factors
Factors leading to greater inter-dependence between states and influencing sovereignty and
international cooperation in health may affect health policy.
1
, Content
Substance of specific policy.
What the policy entails.
Process
How the policy is made.
The way in which policies are initiated, formulated, developed, negotiated, communicated,
implemented and evaluated. Stages heuristic= breaking down the policy process into a series of steps,
(not necessarily reality and not linear)
1. Problem identification and issue recognition
Explores how issues get on to the policy agenda, while others do not even get discussed.
2. Policy formulation
Explores who is involved in formulating policy, how policies are arrived at, agreed upon, and how
they are communicated.
3. Policy implementation
Often the most neglected, but most important phase: if policies are not or wrongfully
implemented, the policy outcomes may not be those which were sought.
4. Policy evaluation
Identifies what happens once a policy is put into effect. How it is monitored, whether it achieves
its objectives and whether it has unintended consequences.
These stages all occur, but not in the linear way.
Stages of the process
1. Recognition that the problem must be known and that solutions must be available to engender
prioritisation.
Problem
Local level indicators: the health care issue is globally noted, but not locally and that is why is
does not get on the agenda.
No resources: knowledge alone is not enough to prevent/treat patients, especially in low- and
middle-income countries there are no resources to provide treatment.
Infrastructural and training challenges
High costs: vaccination for prevention does not require infrastructural development, but for
example HPV vaccines are expensive.
In summary, policy frameworks commonly note the necessity of both a clear problem and a viable
solution to raise the priority of an issue.
CONNECTION WITH MODELS feasibility + problem stream and policy stream + issue
characteristics.
2. Conceptualise the importance of the level of support for an issue in terms of actors and
resources (human and financial).
Look at the power of actors and human resources. There is also a range of other central elements of
actor power, such as the mobilisation of wider civil society actors and key influential leaders. Finally
there is a persistent challenge face in achieving priority for (in this article specific) women’s health
issues, so overall awareness for the issue to take it more generally.
CONNECTION WITH MODELS support + politics stream (but more background) + power of
actors
3. Conceptualisation or framing the issue: why and how issues arise on the policy agenda.
When applied in public health work, typically framing is taken to represent the key issues associated
with a health condition, or the other political issues it is linked to in the broader discourse around it.
CONNECTION WITH MODELS legitimacy + policy stream + power of ideas
2
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