KEYSTONE HPSR Initiative // Module 6: Policy Analysis // Slideshow 2: Policy Approach and Frameworks This is the second slideshow of Module 6: Policy Analysis, of the KEYSTONE Teaching and Learning Resources for Health Policy and Systems Research To access video sessions and slides for all modules copy and past the following link in your browser: http://bit.ly/25vVVp1 Module 6: Policy analysis This module focuses on the policy analysis approach to understand who makes policy decisions (power) and how and why these decisions are made (process). As a field primarily preoccupied with understanding decision-making, contemporary policy analysis approaches place actors at the heart of systems, problematize policy content, are attentive to context, and can see implementation as a series of social relationships rather than as an obvious consequence of policymaking. There are 5 slideshows in this module. Module 6: Policy analysis -Module 6 Slideshow 1: Introducing Health Policy -Module 6 Slideshow 2: Policy Approach & Frameworks -Module 6 Slideshow 3: Researching Health Policy -Module 6 Slideshow 4: Group work -Module 6 Slideshow 5: Group work The other modules in this series are: Module 1: Introducing Health Systems & Health Policy Module 2: Social justice, equity & gender Module 3: System complexity Module 4: Health Policy and Systems Research frameworks Module 5: Economic analysis Module 7: Realist evaluation Module 8: Systems thinking Module 9: Ethnography Module 10: Implementation research Module 11: Participatory action research Module 12: Knowledge translation Module 13: Research Plan Writing KEYSTONE is a collective initiative of several Indian health policy and systems research (HPSR) organizations to strengthen national capacity in HPSR towards addressing critical needs of health systems and policy development. KEYSTONE is convened by the Public Health Foundation of India in its role as Nodal Institute of the Alliance for Health Policy and Systems Research (AHPSR). The inaugural KEYSTONE short course was conducted in New Delhi from 23 February – 5 March 2015. In the process of delivering the inaugural course, a suite of teaching and learning materials were developed under Creative Commons license, and are being made available as open access resources. The KEYSTONE teaching and learning resources include 38 videos and 32 slide presentations organized into 13 modules. These materials cover foundational concepts, common approaches used in HPSR, and guidance for preparing a research plan. These resources were created and are made available through support and funding from the Alliance for Health Policy & Systems Research (AHPSR), WHO for the KEYSTONE initiative

1. https://twitter.com/KeystoneHPSR
Building the HPSR CommunityBuilding HPSR Capacity
KEYSTONE
Inaugural KEYSTONE Course on Health Policy and Systems Research 2015
Policy Approach and Frameworks (POL)

2. KEYSTONE
Policy Approach and
Frameworks
(POL)
Kabir Sheikh
Feb 26, 2015

3. KEYSTONE
I. CONCEPTS

4. KEYSTONE
Policy Studies
IS NOT
• A quantitative science (for the large
part)
• Centrally concerned with facts and
proving them
• Does not provide ready blueprints
and solutions for problems
IS
• A subjective social science
• Concerned with concepts and their
application
• Helps to frame and address questions
about real life problems

5. KEYSTONE
Multi-disciplinary Orientation
• Political Science
• Public Administration
• Sociology
• Economics
• Law
• Management Science
• Organizational Studies
• Psychology
• Ethics
• Cybernetics
• Public Health, Education,
Environment, Commerce, etc.
POLICY STUDIES

6. KEYSTONE
Scale of Policy
• ‘High politics’ policy: concerned with the maintenance of core values – including national self
preservation – and the long term objectives of the state
• ‘Low politics’ policy: concerned with issues not seen as involving fundamental or key
questions relating to a states’ national interests, or those of important or significant groups
within the state
Evans and Newnham 1984
High Politics Low Politics
(‘politics as usual’)
Policy type •Macro policy
•Systemic policy
•Micro policy
•Sectoral policy
Policy level •National government
•State government
•Regional authority (e.g. SEARO)
•Ministry of health
•Local health authority
•Institution
from Walt 1994

7. KEYSTONE
Ideas Vs Interests
Ideas
Norms, beliefs and values
• Principles: beneficence, equity,
justice
• Norms and values: cultural,
social, religious
‘Rational’ solutions
• Disease burden estimates
• Health needs assessments
• Economic evaluations
Interests
Economic
• Direct financial gain or
maximization of self-interest
Political
• Obtaining political power or
manipulating it for gain
Social
• Standing and prestige, social
accomplishment

8. KEYSTONE
Understanding policy decision-
making
• Rational choice theory: Predicts behaviour, based on
economic theories of maximisation of self-interest
• Group and network theories: Decisions in policy are
the result of interplay of allegiances and affiliations,
ideas and interests
• Discourse theory: The language of formulating a
policy problem is not value-neutral, and is a(n often
covert) way of shaping policy agendas and processes
INTERESTS
-BASED
IDEAS-
BASED

9. KEYSTONE
Rational and Incremental Policy-making
Rational model
• Linear sequence from problem
identification to resolution
• Solution-focused
• (Often) wholesale changes
• Driven by objectivity and
scientific reasoning
Incremental model
• Non-linear “muddle” of processes
• Process and context-focused:
emphasize consensus,
participation
• Small changes to existing positions
• Driven as much by pragmatics,
interests, relationships as by
scientific reasoning

10. KEYSTONE
Power
Types of Power
Decision making
Non-decision making
Thought control
Coordinative/communicative
Rational-legal
Traditional
Charismatic
Instruments of Power
Coercion Inducement Co-optation
Stick Carrot Hug

11. KEYSTONE
Systems ‘Software’
Ideas and interests, Values
and norms Relationships
and power,
Systems ‘Hardware’
Human Resources, Finance,
Medicines & technology,
Organizational structure,
Service infrastructure,
Information systems
Socially Constructed Health Systems
 Policy and systems are
shaped by particular
politics, culture,
discourse (and not
others)
(Gramsci, Foucault)

12. KEYSTONE
Affinities
• Kinship
Community affinities are crucial for rural workforce
retention in India (Sheikh et al. 2012)
• Empathy
Greater responsiveness and attentiveness is cited as a
major reason for private provider preference in LMIC
globally (Limwattanon 2008)
• Trust
Trust between employers and health providers
improved patient provider relations in South Africa (Gilson
et al. 2005)

13. KEYSTONE
II. FRAMEWORK: POLICY TRIANGLE

14. KEYSTONE
Policy Actors
Governments
Lawmakers Executive Judiciary
Ministries and
bureaucracy
Institutions, firms and organizations
Technical and professional bodies
Donor agencies
Civil society and interest groups
‘Networks’
‘Street level bureaucrats’
Laity / electorate
Multilateral / bilateral organizations
NON-STATE
STATE

15. KEYSTONE
Stages of Policy
POLICY
PROCESSES
Agenda setting
Policy-making
Implementation

16. KEYSTONE
Process: Agenda Setting and
Policymaking
1. Punctuated equilibrium: issues
compete to shift from “low
politics” to “high politics” status
(Baumgartner and Jones 1993)
2. Hall model: legitimacy,
feasibility and support (1989)
3. Kingdon’s multiple streams
(1984)
Problem
No change
No change
No change
Policy
(solutions)
Politics
(political
will)
ACTION
Policy agendas are set through the interplay of ideas and interests

17. KEYSTONE
Process: Implementation
Instruments of implementation
• Legal: compelling people and organizations to do things
• Financial: allocating funds to encourage or penalize actions
• Organizational: through the application of bureaucratic power
• Personal: through persuasion and instruction
Theories of implementation
• Top-down - planner’s perspective, linear execution, separate from policy
formulation
• Bottom up or action-centred: decisions at all levels, focus on service
provision

18. KEYSTONE
Top-Down and Bottom-up
Approaches
Top Down
• Focus on execution of policy-
makers’ intentions
• Starts with a statement of intent
• Implementation with clear lines
of authority and enforcement of
norms
Bottom Up
• Subordinate actors (e.g. service
providers) also seen as decision-
makers
• Starts with statement of behavior
• Implementation seen as
relationships between actors

19. KEYSTONE
Policy Context
Contextual factors (adapted from Leichter1979):
• Situational: a transient, impermanent or idiosyncratic condition or event that has
an impact on policy-making
• Structural: the relatively unchanging elements of a system or polity, e.g. its
economic and administrative base
• Cultural: the value commitments of prevalent within the polity or system
• External: events, structures and values outside the boundaries of the health
system or country, but that influence decisions within it

20. KEYSTONE
The Policy Triangle
CONTENT
• Ideas for policy
• Type and scale of policy
ACTORS
• Who makes and influences decisions
(power), and how?
• Whose interests?
• Whose ideas?
PROCESS
• Agenda Setting
• Policy Formulation
• Implementation
CONTEXT
• Situational, structural, cultural,
environmental
CONTENT
ACTORS
•as individuals
•as members of groups
PROCESSCONTEXT
(Walt and Gilson 1994)

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