Case 1: PHP: drivers of diversities across global health systems Flashcards
What is policy?
- broad statement of goals, objectives & strategies that enact frameworks for actions.
- Often in form of written dcouments, or can be unwritten social practices
What is policy environment?
Complex arena in which policy process occurs
Elements of policy environment are:
* government system
* political parties
* society
* organisation
* culture
* media
* public opinion
* etc.
What are policymakers?
- major players, elites of key stakeholders in the policy environment.
- Policy makers is not exactly policy actors but some of the policy actors can be included in policy making.
What is the definition of public health policy?
Health related policy that is instructed by public institutions (for the welfare of the society).
Explain public health policy
- can cover public & private policies about health.
- Can be a policy with ultimate goal to change law
- Policy can also be within an organisation (uni, school, etc)
- ‘big promises’ made by politicians are also policies
- inaction to something is also a policy
What is law?
- Rules that you have to follow, otherwise consequences
- Law goes above policy
- policy can lead to new law
What is the difference between law & policy?
law = formal
policy = informal
What is the focus of public health policy?
- promoting & safeguarding health of population
- Emphasises preventive measures, health education & creation of healthier environments.
What is the focus of law?
maintaining societal order & regulating various aspects of human behaviour, not limited to health.
What is the function of public health policy & law?
- PHP is proactive approach to improving public health through strategies & guidelines
- Law is reactive & broader tool for regulating behaviour & resolving disagreements in society.
What are the different processes/approaches for policymaking?
is this correct?
- Rationalist approach
- incrementalist approach
- Policy cycle (policy process)
What is the rationalist approach in policymaking?
- Decision making process linear & rational
- Based on information collected related to problems & alternative solutions.
What is the incrementalist approach in policymaking?
- Looks at existing situation & where to go from there
- More interactive process of mutual adjustment.
What are the steps of the policy process?
- Agenda setting
- policy formulation
- policy adoption
- policy implementation
- policy evaluation
*What is the health policy triangle/what does it show?
incomplete & dk it the answer fits here
- All components of health policy traingle combined outcome = content
- Actors in the policy environment - handle complex policy Context to conduct policy Process
What is health policy triangle a guiding tool for?
- Developing a policy → by rationalist or incrementalist approach
- Analysis of a policy → retrospective analysis/understanding an existing health policy
- Analysis for a policy → prospective analysis to anticipate outcome of a policy
What is a policy actor?
of actors can be more than # of policy makers. Actors can be policymakers but policymakers may not be the actors?
- individuals, organisations or state & their actions that affect policy.
- Some policy actors not directly involved in policy making but some have the appraises within the complex policy environemnt can effect making policy (lobbying groups, some companies?)
- # of actors can be more than # of policy makers. Actors can be policymakers but policymakers may not be the actors?
What is policy content?
written outcomes of a policy process.
What is policy process?
way in which policies are:
* initiated (making a case)
* negotiated
* communicated
* formulated
* implemented
* evaluated.
What is policy context?
Systemic factors such as political, economic, social or cultural, both national & international, which may have an effect on policy
What are drivers of diversities in global public health systems?
- situational (transient, impermanent, idiosyncratic)
- structural (relatively unchanging elements of the society and politics)
- cultural (value commitment of groups)
- environmental factors - events, structures & values that exist outside the boundaries of a political system, but which influences decisions within it (international /exogenous factors)
What are challenges with making policies?
- ensuring basic health services to all
- upholding & enforcing health ethics.
- reforms highly political & fiercely contested processes
- shortage of health workforces
- epidemiological transition: double/triple burden of diseases/ pandemics
- resource shortage with inefficient use of resources
- public private hybridisation with weak regulation and corruption
- lack of clarity and communication
What are opportunities with making policies?
- improved PH
- global collaboration
- social cohesion
- effective communication
- public engagement
- reducing inequities & inequalities between MS
Explain Bressers contextual interaction theory
- categorises context into three layers as specific, structural & wider
- highlights the dynamic relationship between the context & motivation, cognition & power of policy actors
- emphasizes importance of resources because resource availability could strengthen whereas shortages could weaken the power and motivation of a given policy actor
Explain specific context in Bressers contextual interaction theory
refers to previous policy decisions made & influence of geographical location on implemented policy
see diagram
Draw Bressers Contextual Interaction Theory
See summary q4
Explain geographical location in Bressers contextual interaction theory
refers to a facility in rural or urban areas.
Explain structural context in Bressers contextual interaction theory
refers to:
* actors’ position in governance,
* their interaction with other actors,
* actors’ roles & responsibilities
* availability of resources
Explain wider context in Bressers contextual interaction theory
Cultural, political & economic issues that influence the implementation
What influences the actors characteristics of motivation, knowledge & power according to Bressers theory?
context influences the actors’ characteristics of motivation, knowledge & power & these characteristics shape and re-shape the policy implementation process
What is cognition in Bressers contextual interaction theory
interpretation of reality by policy actors & their frames of reference
What is motivation in Bressers contextual interaction theory
refers to both the intrinsic and extrinsic motivation of policy actors
What is power in Bressers contextual interaction theory
refers to policy actors’ access to resources and/or possession of legal rights & their capacity to influence decisions & implementation
What is delegation?
specifies the transfer of the central government’s power to a lower level of the government.
Why is decentralisation relevant?
- essential process for strengthening democratic practices in many countries
- Decentralisation enhances service delivery & economic efficiency
What are 3 forms of decentralisation?
- Devolution
- Deconcentration
- Delegation
What is devolution of authority & responsibility?
- from the central government to local government agencies in political and administrative areas.
What is deconcentration?
- Deconcentrate the functions from higher to lower levels within the administrative apparatus of the countries.
What is delegation?
- give power to institutions under the government (delegating certain things) → goes toward devolution but does not go as far
Why does decentralisation improve service delivery?
- Decentralisation mechanism facilitates good governance = local people are empowered.
- Sub-national governments are closer to the people & can assist in improving efficiency of central governments.
What are factors influencing decentralised service delivery performance?
- political framework
- transparency in government actions
- people’s participation in public service delivery
- efficiency of the civil society
- aspects of the social structure
What service delivery pillars is the government based on?
(i) citizen satisfaction
(ii) trust
(iii) reliability
(iv) legitimacy
check diagram q5
What is a health system reform?
fundamental change of processes in policies & institutional arrangements of the health sector, usually guided by the government designed to improve performance of the health system, and ultimately health status of the people.
What are the key areas of health system reforms?
- Regulation
- Service delivery / provision
- Financing
- Resource generation and allocation
what are components of a health system?
- interconnections
- purpose/goals of the health system
Explain interconnections as a health system component
compliance, collaboration & coordination (i.e. relationships) among health system & non-health system actors for effective functioning of their roles
Explain purpose/goals of the health system components
Primary goal is to improve health through ensuring:
* “Goodness” (i.e. responding to people’s expectation - satisfaction) - responsiveness
* “Fairness” (i.e. equitable access to healthcare) - equity
* “Generating resources” with their efficient use - efficiency
What are actors/stakeholders in a health system?
- Ministry of Health
- Local managers
- Medical professionals & academics
- Healthcare providers (individuals or facilities; public/private); formal (for-profit or not-for-profit) / informal (drug venders, traditional healers)
- Health service organisation - national & international (WHO, social marketing companies, etc)
- Pharmaceutical companies
- Health financing agents & sources
- Communities, families, students
What are the dimensions of decentralisation?
- Political decentralisation PD
- Administrative decentralisation AD
- Fiscal decentralisation FD
- Market decentralisation MD
- Asymmetrical decentralisation AsD
What is PD
citizens or elected representatives are given more powers to make public decisions (decision-making power given to sub-national level)
What are the requirements for PD?
(i) constitutional reforms
(ii) development of pluralist political parties
(iii) strengthening of the legislatures
(iv) creations of local political units
(v) encouraging active public interest groups.
In many countries, devolution of power is performed under political decentralisation.
What is AD?
Grants administrative responsibilities &
government services various levels of institutions from central to peripheral
What ways of distributing the government’s administrative responsibilities is possible for AD?
Deconcentration & delegation
What is FD?
allocation of resources to the sub-national levels of the central government
What are the major components of FD?
- allocation of expenditure responsibilities by the central government and local layers of governments
- assignment of taxes for the government layers
- the design of an intergovernmental allowances system
- formulation & monitoring of fiscal flows budgeting different government layers.
What is market decentralisation?
formal permission of the private sector for the functions of the government.
Explain privatisation as a concept under MD
Privatisation is one type of concept under market decentralisation.
Privatisation →
* “sale of public assets to private investors”
* “transfer of assets in ownership, management, finance, or control to the private sector from the public sector”
The government’s role is reduced as privatisation is permitted.
What are 2 ASD methods?
political asymmetry & constitutional asymmetry.
What is political asymmetric decentralisation?
creates impact of cultural, economic, social & political conditions that affect different regional units.
What is constituional asymmetry?
Who is in control of implementation of law?
Judiciary institutions of state
Who is in control of implementation of policy?
Government/private agency
What is the purpose of policy?
Guidance for disciplined working of any organisation
Who are lawmakers and who are public policy makers?
- Law is enacted by law makers (parliamentarians)
- Policy is made by public, private or mixed agencies
What is agenda setting in policy process?
- Public attention focuses on a public problem/issue.
- officials words & acitons help focus attention
What is policy formulation in policy process?
- who is involved in formulating processes, how policies are arrived at, agreed upon & communicated & role of State
- create legislative, regulatory or programmatic strategies to address the problem
What is policy adoption in policy process?
policy makers formally adopt a policy solution, usually in form of legislation or rules
What is policy implementation in policy process?
government agencies begin job of making policy work by:
* establishing procedures
* writing guidance documents
* or issuing grants-in-aid to other governments
What is policy evaluation in policy process?
- policy analysis inside & outside government determine whether policy is addressing problem & whether implementation is proceeding well.
- may recommend revisions in agenda, in formulation of policy or in its implementation.
