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- 1. MODULE 4 PART 2 The policy-making process 4 POLICY-MAKING AND HiAP
- 2. Define policy and describe the stages of the policy-making cycle Recognize the complex and political nature of the policy-making process 1 2 LEARNING OBJECTIVES 4 Identify the characteristics of a “window of opportunity” for policy change Frame a complex health issue and identify its policy challenges and opportunities 3 4
- 3. WHAT IS POLICY? 4 A policy is a principle or a plan to guide decisions, actions and outcomes. Policies can be laws, documents, procedures, guiding principles, statements of intent or working frameworks. Public policy refers to the policy of government. There can often be large (sometimes deliberate) discrepancy between policy as intent (what is planned, stated or written) and policy as practice (what actually happens).
- 4. THE POLICY-MAKING CYCLE 4 REVIEW Report Evaluate Monitor Stages of the policy cycle (Source: modified from http://www.geostrategies.com/images/policycycle.jpg) AGENDA SETTING Identify problem Research Set agenda FORMULATION Develop options and strategies Negotiate Formulate policy IMPLEMENTATION Enforce policy Implement policy POLICY
- 5. WINDOWS OF OPPORTUNITY 4 Alignment of problems, policies and politics in creating “windows of opportunity” Source: Leppo K et al. (2013) Health in All Policies: Seizing Opportunities, Implementing Policies. Finland, Ministry of Social Affairs and Health, p. 16. PROBLEMS POLICIES POLITICS Alignment of problems, policies and politics allows health to come through
- 6. POLICY PROCESS: THE PROBLEM STREAM 4 Regards public matters requiring attention. An issue needs to be recognized as a “problem” – Ad hoc basis – through events such as disasters, accidents or crises and media attention – More deliberate or planned avenues – research results, worrying changes in a situation, failures to meet previous goals, rising costs. Opportunities may arise from policy development within other sectors – Health policy-makers should identify such gateways for action. Not all problems are given attention to by the decision-makers.
- 7. FRAMING THE PROBLEM 4 Recognition of a problem can also be thought of as the agenda-setting stage of the policy cycle. The process of setting the agenda or getting a problem recognized is all about framing. Framing refers to how an issue is defined – – influences how the issue is viewed – who is considered responsible – the cause of the problem and possible solutions. Redefining or reframing the problem allows for new ways of understanding. This can encourage new stakeholders to engage in the policy process.
- 8. POLICY PROCESS: THE POLICIES STREAM 4 The policy stream regards proposals for change – “policies”. These provide alternative solutions for the problems and are developed by policy communities. To achieve success these policies should be – – Technically sound – Culturally and ethically acceptable – Financially reasonable. The search for solutions is the policy formulation stage of the policy cycle.
- 9. POLICY PROCESS: THE POLITICS STREAM 4 The politics stream is composed of political issues – E.g. election results, changes of administration, interest group campaigns or changes in public opinions. A policy change is possible only if the “politics” environment is right. Policy-makers need to be able to recognize appropriate moments in politics when a policy change would be most likely adopted. The negotiation of politics is part of both the policy formulation and policy implementation stages of the policy cycle.
- 10. 4 SEIZING WINDOWS OF OPPORTUNITY “Windows of opportunity” in policy formulation and implementation Source: Leppo K et al. (2013) Health in All Policies: Seizing Opportunities, Implementing Policies. Finland, Ministry of Social Affairs and Health, p. 19. TIME STARTING POINT WINDOW OPEN WINDOW CLOSED WINDOW CLOSED WINDOW OPEN DRAWBACKS MISSED OPPORTUNITY LONG-TERM HEALTH POLICY GOAL
- 11. POLICY CHAMPIONS / POLICY ENTREPRENEURS 4 In the context of ‘windows of opportunity’ and the complex, political nature of policy-making, Kingdon emphasizes the importance of policy champions. Policy champion: a person or team willing and able to lead and manage the policy process. Kingdon attributes policy entrepreneurs some vital resources: – Claim to a hearing – possesses expertise – Negotiating skills – political ‘know-how’ – Sheer persistence.
- 12. End of Module 4 Part 2 Please continue to Module 5 Part 1
Editor's Notes
- Title slide
- Briefly summarize the key objectives for this lecture. This lecture explains the policy-making process in relation to HiAP including topics such as the framing of issues, windows of opportunity, and managing complexity.
- To begin the discussion of the policy-making process, we first look at a general definition of policy. Broadly speaking, a policy is a principle or a plan to guide decisions, actions and outcomes. Policies may be written documents or unwritten practices. Often, there can be a difference between policy as intent and policy in effect. Policies are also highly context specific and influenced by social, cultural, economic and political structures.
- This slide articulates theoretically the process of policy-making. There are a range of conceptual frameworks to describe the stages of the policy-making process or policy cycle. Generally speaking, the policy cycle consists of the following stages: Agenda setting (identify the problem, conduct the research, set agenda); Policy formulation (develop policy options and strategies, negotiate, formulate policy); Policy implementation (implement and enforce policy); and Policy review (monitoring, evaluation and reporting). Policy-making is complex, highly political and a continual process. It can stretch over long periods of time and usually involves many actors and interests, which may vary over the course of time. It is almost never straight forward and often feels more like a tangled web or an ongoing ‘juggling’ process. Often, the completion of one stage does not guarantee movement to the next. Nor is progress in one stage dependent on completion of all tasks in the previous stage. HiAP is premised on the kind of strategic and collaborative approach required to build and deliver effective policy, also recognizing that many contemporary health issues are complex and influenced by factors outside the health sector so collaboration is critical. This also makes HiAP an inherently political process that involves the reallocation of resources including power and responsibilities. Understanding the policy-making processes and contexts that support consideration of health and equity in the policies of non-health sectors is critical to the success and maintenance of HiAP. Given the complex, political nature of policy-making, it is essential to seize “windows of opportunity” that arise from changing economic, social and political realities.
- Given the complex, political nature of policy-making in health, it is essential to seize “windows of opportunity” that arise from changing economic, social and political realities. This concept of windows of opportunity comes from political scientist Kingdon who proposes the existence of three non-linear streams in policy-making – problems, policies and politics – which interplay to open windows of opportunity for policy decisions. He proposes that policy action requires a ‘policy window’ to become available through linkage of three streams: problems, policy and politics. When the three streams couple, i.e. when simultaneously a problem is recognized, a solution is available, and the political climate is positive for change, a window of opportunity, a policy window, opens to facilitate policy change. Windows of opportunity are short periods of time in which, simultaneously, a problem is recognized, a solution is available and the political climate is positive for policy change. This slide illustrates this alignment of problems, policies and politics. These are critical opportunities for policy entrepreneurs or policy champions to address important policy problems. In Kingdon’s model, policy entrepreneurs may act to bring the three policy system streams together creating a policy window of opportunity. Thus, policy entrepreneurs must act rapidly before the opportunity passes by, or they will have to wait until the next chance comes along. Windows of opportunity can sometimes coincide with political campaigns, changes in the government’s balance of power as well as crises and disasters. We will now delve deeper into the three streams in policy-making to gain a better understanding of policy processes. Here we will discuss the importance of framing a policy problem in order to get it recognized.
- We have begun to explore the policy-making process and have touched on Kingdon’s theory of policy formation as the result of three kinds of processes, or the flow of three ‘streams’ – the problem stream, the policy stream and the politics stream. Let’s now discuss these in more detail. The problem stream regards public matters requiring attention. Firstly, an issue needs to be recognized as a “problem” by politicians, policy-makers and the overall community before it can be raised in the policy-making agenda. This is most easily achieved on an ad hoc basis through focusing on events such as disasters, accidents or crises and the linked media attention. Fortunately, more deliberate or planned avenues are also possible. For instance, research results showing key information on the magnitude of the problem; worrying changes in the situation; failures to meet previous goals; or rising costs, can be very effective in raising awareness. International efforts also provide opportunities for the health sector to raise HiAP on national agendas – for example, the work of the WHO Commission on Social Determinants of Health or the 2011 United Nations High-Level Meeting on the Prevention and Control of Non-communicable Diseases. It is important to bear in mind that opportunities may also arise from policy development within other sectors and it is essential that health policy-makers identify such gateways for action. Ideally, policy processes across sectors would be screened for major impacts on health, health equity or health systems and those of high priority would be analyzed further. The rising cost of health care provision is proving to be an important factor for motivating governments to adopt a HiAP approach as one response to the perceived crisis. Obviously, a long list of problems could be advocated to national governments or municipal administrations. Far from all problems are, however, given attention to by the decision-makers. Some conditions are not even defined as problems until there is something to do about it, i.e. there is a solution (policy) available and recognized by the politicians.
- This recognition of a problem can also be thought of as the agenda-setting stage of the policy cycle, viewed earlier. This process of setting the agenda or getting a problem recognized is all about framing. Essentially, framing refers to how an issue is defined, which can in turn influence how the issue is viewed (non-issue, problem, crisis, etc.), who is considered responsible and the cause and possible solutions. Policy stakeholders can own or disown a public problem through the way they define it. Owning a problem can be an advantage to groups and organizations – it may allow for increased credibility, funding and legitimacy. Health problems often remain defined in purposely “fuzzy” terms because no stakeholder can see a benefit of owning complex problems. This often means that the ownership falls onto the “default” health actor: the ministry of health or other institutional arrangement that has a statutory requirement to deal with health. Redefining or reframing the problem allows for new ways of understanding, which can encourage new stakeholders to engage in the policy process.
- After recognizing or framing problems, proposals for solutions are required, in other words – “policies”. Before a problem can reach the decision agenda, decision-makers must be given at least one alternative solution, worked out and ready to put in place. Politicians concerned with an array of problems will prioritize to act on the ones where the administration, the scientific community, or somebody else, could provide a constructive solution, often worked out in advance. Often developed by policy communities (including public institutions, universities, think-tanks, and/or private bodies) these provide alternative solutions for the problems. To achieve success, these policies should be technically sound, culturally and ethically acceptable and financially reasonable. Such solutions are accepted more readily if they do not conflict with other interests, and therefore, it is often worth studying other interests and pursuing such solutions. The search for solutions is the policy formulation stage of the policy cycle. We will focus on this more when we look at policy briefings in a later lecture, which explores and recommends policy options (Module 6).
- Finally, a policy change is possible only if the “politics” environment is right. Policy-makers need to be able to recognize appropriate moments in politics when a policy change would be most likely to be adopted. Suitable opportunities often arise in election campaigns; during the establishment of a new government; or during a change in the balance of power in parliament, such as the rise of a new coalition. A financial crisis can also provide an opportunity if, for example, raising taxes on harmful products is viewed as an appropriate option. There is also a need to identify relevant actors and policy-making processes. The political process involves negotiations between all the parties involved and the more conflicting interests there are, the more difficult the process to find a common solution. The negotiation of politics is part of both the policy formulation and policy implementation stages of the policy cycle.
- In the context of policy-making, a long-term vision is essential to guide the policy process over the course of a longer time span and allow policy-makers to seize windows of opportunity. Progress is made by taking opportunities as they arise but, at a given political time, some windows might be closed or missed because of lack of awareness of policy processes in other sectors. There can also be drawbacks that worsen the situation. Example: Ecuador’s introduction of restrictions and taxes on the sale of alcohol is an example of seizing a window of opportunity. The policy community had long identified Ecuador as a country with high binge-drinking rates in Latin America. But nothing was done until 50 people died and 14 were left blind due to bootleg liquor in June 2011. In response, the authorities introduced a three-day ban on alcohol sales and bought back any contaminated alcohol still in circulation. Since then, Ecuador has seen great progress: an intersectoral alcohol policy was launched in April 2012; a tax reform increased excise tax for imported alcohol significantly; and several local districts have banned alcohol sales and consumption on the streets during public festivities.
- We briefly touched on the concept of policy champions/policy entrepreneurs in our opening lecture. We will now discuss this in more detail. Policy entrepreneurs are individuals who introduce and promote their ideas in many different avenues and invest time and energy to increase the chances for an idea to be placed on the decision agenda. Policy entrepreneurs are active both in the problem stream and the policy stream. While decision-makers often shift their attention from one problem to another, policy entrepreneurs keep to their issue. Even good policy proposals may, however, fail to be taken seriously if they are presented before the policy community is ready. ‘Softening up processes’, implying to prepare and educate both the public and the specialists, are often driven by the policy entrepreneurs. Therefore, both the problem recognition and the suggested solutions could be results of policy entrepreneurs’ efforts. In the context of discussing windows of opportunity and the complex, political nature of policy-making, Kingdon emphasizes the importance of policy champions. A policy champion is a person or team willing and able to lead and manage the policy process. Policy champions proactively promote policy reforms, publicly support the policies and foster the support of others. They frame discussion of the issue, build consensus, attract resources, and seize and create opportunities to move the reform forward. Kingdon attributes policy entrepreneurs some vital resources. The first resource is claim to a hearing, which means that an actor has an ability to speak for others, hold a decision-making position or possesses expertise. The second resource regards political connections or negotiating skills, implying a combination of technical expertise and political know-how. The third, and by Kingdon labelled the most important resource, is sheer persistence. This means that actors promote their ideas in all ways and in several avenues, and are willing to invest large resources in order to promote their solutions. Change agents and policy entrepreneurs are similar terms for this concept that highlights the creative dimension of breaking with existing ideas and initiating new policies. The ultimate aim of this course is to help you, as the participants, feel enabled to become policy champions or policy entrepreneurs. Effective policy-making is about the people – the policy champions – being able to look for windows of opportunity and make positive change for the good of the community and broader society.