Policy, Management & Organization
THE HEALTH POLICY FRAMEWORK
Chapter 1
Why is health policy important? because understanding the relationship between
health policy and health, and the impact that other policies have on health, may help to
tackle some of the major health problems of our time, e.g. obesity.
The health sector is a major part of the economy: it needs national fnancial resources,
the drives the economy through innovation and investment in bio-medical technologies or
production and sales of pharmaceuticals, and the health sector is used by patients and
providers. Policy has an efect on peoplees health e.g. taxes, insurance, rules, access,
etc.).
Concepts:
Actor = any participant in policy process that afects policy, e.g. individuals,
organizations, groups, government etc.
Content = substance of a particular policy which details its constituent parts, e.g.
objectives.
Context = systemic factors, e.g. political, economic, social or cultural, both national
and international, which may have an efect on health policy.
Epistemic community = policy community marked by shared political values, and a
shared understanding of a problem and its causes.
Ideas = the values, evidence, anecdote and argument that shape policy, including
the way a policy problem or solution is presented.
Interest = what an actor or group will gain or lose from a policy change.
Institutions = rules of the game. Determining how government and wider state
operate. Institutions can be formal structures and procedures, but also informal norms
of behaviour that may not be written down.
Policy = broad statement of goals, objectives and means that create the framework
for activity. Often takes the form of explicit written documents, but may also be
implicit or unwritten.
decisions that are taken, or not taken, by those with responsibility for a particular
policy area.
o Public policy = policies made by the state or the government and/or by those in
the public sector e.g. in agencies of government).
o Private policy = policies made by companies, corporations, multinational
conglomerates etc., in which the policy needs to made within the confnes of public
law made by the government. E.g. Heineken introducing ART for employees with
HIV in Africa in 2000s.
o Health policy = the combination of public and private policies about health. It
embraces courses of action and inaction) that afect the set of institutions,
organizations, services and funding arrangements of the health care) system.
Policy elite = specifc group of policy makers who hold high positions in a policy
system, and often have privileged access to other top members of the same, and
other, organizations.
Policy maker = those who make policies in organizations such as central or local
government, multinational companies or local businesses, clinics or hospitals.
Policy process = the way in which policies are initiated, formulated, developed,
negotiated, communicated, implemented and evaluated.
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,Governance = the most) important factor for:
Poverty alleviation and development
Ensuring that priorities for health and well-being of people are realized
Operationalized in diferent ways
Consensus set of processes, formally or informally applied to distribute
responsibility or accountability among actors of a given health) system.
Important questions:
o Who can participate
o Who gets an equal voice
o How is a system organized
o Who has the power to distribute resources
o Who decides?
16 Governance frameworks:
Theories:
o New institutional economies
Role of institutions shaping interactions
Institutions are formal and informal rules: norms, values and behaviour
E.g. principal- agent theory
o Political science and public management
o Development literature
o Multi- disciplinary
Area of focus interactions, rules, power, accountability, incentives, trust,
legitimacy.
o Incentives: why you should or shouldnet do something. Is it more important for a
health provider to provide good quality care, or that staf gets paid enough
money?
Core dimensions of governance:
Fundamental values: Control of corruption, Democracy, Human rights, Ethics and
integrity, Conflict prevention, Public good, Rule of law.
Sub-functions: Accountability, Partnerships, Formulating policies/ strategic
direction, Generating information/ intelligence, Organizational adequacy/ system
design, And more…
Outcomes: Efectiveness, Efciency, Equity, Quuality , Responsiveness ,
Sustainability, Financial and social risk protection, Improved health.
Governance = about formal/ informal rules that distribute roles and responsibilities
among governments, providers, and benefciaries and that shape the interactions among
them.
Governance encompasses authority, power, and decision making in the institutional
arenas of civil society, politics, policy, and public administration power asymmetry,
providers know more than receivers, e.g. best medication through bonus from
pharmaceutics).
Decision making
Regulation
Distribution of power
Shaping the health system
Lobby group
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,Health Governance model:
Clients: citizens, patients), have a voice, can sometimes) make a choice,
depending on the context access, SES, availability etc.) have to make clear what
they want have not much to say, but can vote etc.
State makes services compact: accountability of expectations
Providers: provide services, but can also report back on activities or request
more/other resources lobbying).
Social accountability is important. When this is not present, someone else needs to
be elected.
Governance issues/ core problems:
Lack of resources
o Low salaries
Mismatch of regulations
o Government has regulations that do not match the needs of citizens
Strikes providers needs versus patientse needs
No participation or consensus medical doctors are very powerful and can strongly
make their stand, so without consensus…
Many problems regarding the fundamental values and sub-functions. It is all about
power, and resource distribution, lobbying, standing for own values and norms. It
depends on where you are and where you come from, which decisions are made and how
it impacts you.
1. Participation in diferent actors in decision-making, power and politics
2. Role of state, private sector, NGOs, civil society in policy making and implementation
Institutional arrangements: incentives to not) do something.
3. Use of evidence and data
4. Accountability and oversight
5. Rules, regulations and regulatory frameworks -
Policies:
Public sector
o Vaccinations
o Compulsory Health insurance
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, o Seatbelts
Private sector
o Harassment policies
o Wage management
o Life style
Policy instruments:
Means series of intended activities with certain consequences instruments
o Judicial: Legislation not allowed in kindergarten when not vaccinated, no smoking
in cafes)
o Economic: Subsidies/ taxes e.g. raise sugar/ tobacco prices to discourage people)
o Communication: Persuasion health advertising, government billboards/tv/radio,
advertisements on cigarettes with horrible pictures)
o Modern: Self-regulation change norms, e.g. it is not cool to smoke).
Video about Iran Population Control:
Goals: Population control
Means:
o Increase population:
Aim: army
Policy: restriction & rules
Communication strategy using dating websites promotion
Legislation: ban on vasectomies
o Decrease population:
Policy: house/ employment
Promotion of birth control
Economic subsidies
What is health policy?
It refers to decisions, plans and actions
o To achieve specifc health care goals
o Within a society
Health policy =
o Defnes visions for the future e.g. all children vaccinated)
o Which helps to establish targets and points of reference
o For the short and medium term
Health strategy =
o Strategic direction and scope of work for 3-5 years
o Answers the question how are we going to successfully achieve the policy?
o Framework for division of tasks etc.
Health plan =
o Details on implementation and activities
o For a relatively short time frame e.g. annual plans)
o At all levels of the health sector
Health Policy Triangle highly simplifed representation of complex set of inter-
relationships.
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