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KEYSTONE / Module 6 / Slideshow 2 / Policy Approach and Frameworks


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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:

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

Published in: Education

KEYSTONE / Module 6 / Slideshow 2 / Policy Approach and Frameworks

  1. 1. Building the HPSR CommunityBuilding HPSR Capacity KEYSTONE Inaugural KEYSTONE Course on Health Policy and Systems Research 2015 Policy Approach and Frameworks (POL)
  2. 2. KEYSTONE Policy Approach and Frameworks (POL) Kabir Sheikh Feb 26, 2015
  4. 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. 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. 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. 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. 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. 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. 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. 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. 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)
  14. 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. 15. KEYSTONE Stages of Policy POLICY PROCESSES Agenda setting Policy-making Implementation
  16. 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. 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. 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. 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. 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)
  21. 21. Open Access Policy KEYSTONE commits itself to the principle of open access to knowledge. In keeping with this, we strongly support open access and use of materials that we created for the course. While some of the material is in fact original, we have drawn from the large body of knowledge already available under open licenses that promote sharing and dissemination. In keeping with this spirit, we hereby provide all our materials (wherever they are already not copyrighted elsewhere as indicated) under Creative Commons Attribution-NonCommercial 4.0 International License. To view a copy of this license visit This work is ‘Open Access,’ published under a creative commons license which means that you are free to copy, distribute, display, and use the materials as long as you clearly attribute the work to the KEYSTONE course (suggested attribution: Copyright KEYSTONE Health Policy & Systems Research Initiative, Public Health Foundation of India and KEYSTONE Partners, 2015), that you do not use this work for any commercial gain in any form and that you in no way alter, transform or build on the work outside of its use in normal academic scholarship without express permission of the author and the publisher of this volume. Furthermore, for any reuse or distribution, you must make clear to others the license terms of this work. This means that you can: read and store this document free of charge distribute it for personal use free of charge print sections of the work for personal use read or use parts or whole of the work in a context where no financial transactions take place gain financially from the work in anyway sell the work or seek monies in relation to the distribution of the work use the work in any commercial activity of any kind distribute in or through a commercial body (with the exception of academic usage within educational institutions such as schools and universities However, you cannot: