PMO: Summary Lectures and Book
Policy, Management and Organization in International Public Health
December 2023
Lecture 0 : Introduction 2
Lecture 1 : Puzzling and Powering - The Policy Process 5
Lecture 2 : The State and the Private Sector in Health Policy 11
Lecture 3 : Health Action International (HAI) 16
Lecture 4 : Governmental Arena - Government and the Policy Process 18
Lecture 5 : Agenda Setting, Role of the State and its Powers 23
Lecture 6 : Interest groups, NGO’s / Civil Society and the Policy Process 28
Lecture 7 : Globalizing Health Policy 36
Lecture 8 : Policy Implementation 41
Lecture 9 : Access to medicine, policy and practice 46
Lecture 10 : Research to Policy 51
,Lecture 0 : Introduction
Scandal in The Gambia 2022
- >70 children died of acute kidney failure due to over-the-counter medication, like
cough syrup because it had glycol in it = poisonous! Something is wrong with the
system because it happens over and over again.
- Who is involved? Local pharmacy, local hospital, Maiden Pharmaceuticals (Indian
factory producing cough syrup), WHO, Drugs Controller General of India, Medicine
Control Agency, Gambian Ministry of Health.
- This shows blurred distinctions between mechanisms for societal order.
- Who is responsible? Not clear to tell. From moral perspective = organized
irresponsibility.
3 mechanisms to organize society:
1. Self organization of societal actors → see how to do it as a community
2. Market → the idea is that in a free market, self-interest will inevitably result in a
beneficial situation for all, without central planning. But in many cases this does not
happen.
3. Hierarchy →
a. Citizens hive off some rights as free people to state organization in exchange
for safety and stability.
b. State = paramount organization for conflict management & coordination
(planning) with (de-)centralizing governmental arrangements that maintain a
monopoly on the legitimate use of force.
c. Within a certain geographical territory
d. Inhabitants share minimum cultural identity
Timeline
19th + 20th century: state formation. Territorial synchrony →
nation-state.
Something happened, synchrony between governance
arrangements, societal dynamics and identity of the citizenry
(cultural bind). This has been lost for the last 50 years, is an
ongoing process since then.
21st century: loss of territorial synchrony.
- Societal dynamics: increasingly seen to / perceived as transcending borders →
climate issues, migration, globalization of economy etc.
- Identity: one can have multiple identities → mother, expert, teacher, etc.
- Governing arrangements: on multi-level → multinational and international
arrangements. Example: mega-city region as relevant geographical space for
governance in relation to European Commission.
→ these have NO territorial boundaries.
Governance (of global health) arrangements: weakening of the ‘social contract’ between
citizens and governance.
- Governance = sustaining coordination & coherence among wide variety of actors
with different purposes and objectives
, - → political actors (and state institutions), corporate interests, civil society and
transnational organizations.
- [nation-state based] Political institutions no longer exercise a monopoly on the
orchestrations of governance
- Governance Is about the formal and informal rules that distribute roles &
responsibilities among governments, providers and beneficiaries + shape the
interactions among them.
Citizens = expression of trust in ‘voice’ in
voting and in paying taxes
Government = provides safety, in the public
interest
Accountability = in exchange for the
governments safety
Other implications:
- “No sovereign actor [is solely] able to
steer or regulate” (Rhodes, 1997,
p.57)
- Integration of the economy on the global level is coupled with an “increasing social
fragmentation on the local level” (Rosenaeu, 2000)
- Implies a loss of clear accountability
relations
Mismatches between governance arrangements
and the problems that we have in society.
Defining a concept = implying a course of action.
Example: ‘health’ as a concept → who acts /
determines what? Health can be defined as:
● Absence of any disease or impairment
● State that allows the individual to
adequately cope with all demands of daily
life (implying also the absence of disease
and impairment)
● State of balance, an equilibrium that an individual has established within himself and
between himself and his social and physical environment
“International health becomes global health when the causes or consequences of a health
issue circumvent, undermine or are oblivious to the territorial boundaries of states and thus,
beyond the capacity of states to address effectively through state institutions alone”
→ global health disregards boundaries!
Note: The move to global governance, does not imply the disappearance of state institutions,
yet detracts from the effectiveness and legitimacy of their policies.
Policy = a plan! Also ACTION. Many definitions ...
Public policy is a plan answering the question ‘what to do next?’ on behalf of society to
mitigate / resolve collective problems co-determined by a broad set of factors and actors.
Public policy is action “Constructive action that moves the community from a flawed present
toward an improved future”.
- Consists of a set of means chosen to reach the goals set
, - + implicit line of reasoning about how a means will help reach the goal
- Hence: problems serve as a point of departure
Health policy = courses of action or inaction taken to achieve specific health care goals
within society. By affecting:
- Sets of institutions
- Funding arrangements
- Organizations
- Services
- Agendas of key factors
→ of health care systems!
