Mais conteúdo relacionado


Public Health Policy Analysis crash course..pptx

  1. PUBLIC HEALTH POLICY ANALYSIS CRASH COURSE By Dr Muhammad Arif MSPH, Diploma in GIS & Spatial Statistics, MBBS, FELTP, Certificate in Biostatistics
  2. Introduction to: 1) Policy 2)Health Policy By Dr Muhammad Arif MSPH, Diploma in GIS & Spatial Statistics, MBBS, FELTP, Certificate in Biostatistics
  3. WHAT IS POLICY? • (Brain Storming)
  4. A set of • Laws • Documents • Procedures • Guiding principles • Statement of Intent • Rules • Regulations (etc.) THAT GOVERN ACTIONS (Titmus 1974). Are considered as policy.
  5. Why do we need Policies? & What are their benefits? • (Brain Stroming)
  6. We need Policies mainly to  Avoid Conflicts. Allow to keep control on authorities. Coordination b/w daily decisions & general strategies. Ensure supervision, monitoring and accountability.
  7. What are different types of Policies? • ( Brain storming)
  8. There are several types of policies some examples are:  Public Policy ( made by Govt Authorities)  Public social policy ( to promote the welfare of public)  Health Policy ( to promote the health of citizens)  Organizational Policy ( made by organizations for their smooth running)
  9. Other types of Policies • Explicit Policies: “ Well written & documented Policies” • Implicit Policies: “ Un written policies”.
  10. So what is then Health Policy • ( Brain storming)
  11. Health Policy means The decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society. (World Health Organization)
  12. Common characteristics & attributes of any effective policy • Belongingness to masses. • Commitments.(Roles/responsibilities/time frame) • Backed by Public/influential entity. • Comprehensive. • Consistent with the communities ethical models. • Flexible to evidence/research based data driven suggested changes. • Clear & Logical. • Homogeneity (smoothness & Human rights ). • Laser focused at Vision, goals & objectives.
  13. Thanks
  14. HISTORY OF HEALTH POLICY & HEALTH PLANNING IN PAKISTAN By Dr Muhammad Arif MSPH, Diploma in GIS & Spatial Statistics, MBBS, FELTP, Certificate in Biostatistics
  15. • The history of Health Policy & Planning in Pakistan can be traced backed to initial public health measures taken by the British authories in the subcontinent before the independence. • At first Britishers started provision of health services to their employees & urban population. • Before that traditional medicine was practiced which is still in practice.
  16. 06 Major landmarks in the history of Health Policy making and Health Planning during “British raj” in the subcontinent. • 1859: Appointment of Royal commission to enquire into the health of the army of the united india. • 1880: Introduction of an act to delegate powers to vaccinate. • 1904: Report of plague commission following outbreak of plague in 1896. • 1919: Reforms introduced by the government of India act,1919. • 1935: Reforms introduced by the government of India act,1935. • 1943: Health Survey & Development committee ( Bohre committee).
  17. Major milestones in the history of Health Policy making and Health Planning after independence in Pakistan • Evolution of health planning in Pakistan can be traced back to British raj:  Pre-partition Health survey & development (1943-1946 Bhore committee report) kept on influencing the Health policy & planning for a number of years after Partition.  05 Year Plan (1955-1998) Alma Ata conference 1978 Efforts to formulate Health Policy ( 1970 - 2001) Social action Programme (1993-1996)
  18.  Millennium development goals.(2000)  Poverty Alleviation 1990 onwards  Devolution Plan 2001.  After 18th amendments Health is a Provincial subject.
  19. Assignment • Write a 2 to 3 lines for each major milestones in Health policy and Health Planning that took place after the independence of Pakistan. ( use google search ).
  20. THANKS
  21. SALIENT FEATURES OF VARIOUS NATIONAL HEALTH POLICIES OF PAKISTAN. By Dr Muhammad Arif MSPH, Diploma in GIS & Spatial Statistics, MBBS, FELTP, Certificate in Biostatistics
  22. Salient features of Health policy 1990. • High concern for health was presented in the first National Health Policy by enhancing the health expenses up to 5% of GNI. For the improvement of health, family planning and provision of clean water were given consideration . The focus of this policy was on the provision of health services in schools, malaria control programs, nutrition programs, family planning, control of infectious diseases (e.g. infective hepatitis and tuberculosis), clean drinking water, and sanitation for public health and health promotion.
  23. Salient features of Health policy 1997. In 1997, the second National Health policy was articulated. The concept “Health for All” (HFA) was its foundation. Road traffic accidents, HIV/AIDS, cancer, tuberculosis, violence, mental health, and diabetes were given attention. Under priority health programs, health education, and health promotion were given obvious place, and non-infectious diseases i.e. diabetes, cancer, and cardiovascular disease were highlighted for prevention and control measures (Ministry of Health, 1997). Under the District Health Government Initiatives, decentralization of the health (later on it was uncontrolled). Initiating of eradication of poliomyelitis (led by WHO), social action programs (led by the World Bank) and initiation of Lady Health Worker Program. Backing for vertical disease prevention and control programs (federally directed) with global share (Stop TB, Roll Back Malaria, GAVI Alliance, Global Fund to Fight Tuberculosis, AIDS, and Malaria).
  24. Salient features of Health policy 2001. • The National Health Policy’s Preface stated that “the new health policy provides an overall national vision for the Health Sector based on Health for All approach” (Ministry of Health, 2001).
  25. Salient features of Health policy 2009. The vision of the National Health Policy 2009 clearly indicates that a health system “is efficient, equitable & effective to ensure acceptable, accessible & affordable health services. It will support people and communities to improve their health status while it will focus on addressing social inequities and inequities in health and is fair, responsive and pro-poor, thereby contributing to poverty reduction” (Ministry of Health, 2009). The policy draft was drawn up in response to a country-wide discussion, but it could not be enforced due to the 18th Amendment. All the provinces have developed their own strategies as a substitute for it. The health system framework of WHO of six building blocks was followed by all provinces to develop their strategies (World Health Organization, 2020). All districts, provincial and federal governments are assigned very flawless roles and duties but in practical positions, they are overlapping. The federal government is responsible for the provision of technical backstopping, policymaking, coordination with various allies inside and outside the country, funding for health care, and control of the transmittable disease (Ministry of Health, 2009).
  26. 18th Amendment and Devolution of Power and Responsibility On 30 June 2011, the Ministry of Health was decentralized to the provinces by the Federal Government under the 18th amendment. Though in April 2013, it was reinstalled again but most of the responsibilities and programs of the Ministry of Health are assigned to the provincial health department .The ministry of health and the concurrent lists was abolished in 2001 after the promulgation of the 18th amendment. Different federal ministries were assigned the residual health allied duties included in the Federal Legislative Lists (Part I & II). In May 2013, the Cabinet agreed to establish a “National Health Services, Regulations and Coordination Division” (NHSR&C) for the management of the health functions in harmonize and effective way (Ministry of National Health Services, 2018). The formation of the New Ministry was with the directive of provision of mutual strategic vision, to attain Universal Health Coverage (UHC) through assessable, effective, affordable, and reliable health facilities programs, to coordinate the population welfare and public health at the international and national level, to deliver an oversight to regulatory bodies, to accomplish worldwide agreements and requirements, to legalize medical education and profession and to impose drug regulations (Ministry of National Health Services, 2018). After the decentralization of the health system in 2012, the provinces of Pakistan keep following similar procedures using the slight capability to produce evidence and include it into health policy as before 2012. Under the 18th constitutional amendment, the latest transition of power from the federal government to the provinces in the country has formed the chance and hopes to institutionalize reform . A challenging opportunity was provided by the political devolution in the country for the health care system to address the problems related to planning health care delivery structures, systems, services, and programs. This is of greater importance because that the objectives of health-related MDGs were not entirely accomplished and to meet the much more ambitious objectives of the Sustainable Development Goals more determinations are needed (Government of Pakistan, 2016).
  27. Conclusion To conclude, the country has had various five-year plans, health reform commissions, and health planning documents. The health policy of Pakistan does not alter itself entirely into an evidence-based, dynamic, comprehensive, feasible, and rational policy. The nature of the policy is highly centralized. It is based on estimations rather than dependable data which determine that it lacks the essential footing for implementation. Henceforth, implementation is not the only issue but planning and formulation as well. The planning and formulation are achievable and not cost-effective so, the implementation turns out to be further difficult. With the empowerment of the federal system in the country, the health system is in the procedure of regeneration. Although, opportunities, as well as challenges, have been created by the 18th constitutional amendment and improvement in the governing system is the imaginable mode for the improvement of the health sector. Seventy-five years history of health planning in Pakistan is labeled by numerous initiatives at various times but it always demanded a reliable and articulate procedure. The cherished level of health position has not been attained despite the development of a solid planning mechanism. An in-depth examination is mandatory to probe cases of the failure.
  28. NATIONAL HEALTH VISION OF PAKISTAN 2016 TO 2025. Class Activity: Plz Download the whole document from the google and together make a ppt and one of you will have to present it next week. Not More than 10 slides & 15 minutes.
  29. Thanks
  30. HOW TO DESIGN AND IMPLEMENT A PUBLIC HEALTH POLICY (Policy Making Process) By Dr Muhammad Arif MSPH, Diploma in GIS & Spatial Statistics, MBBS, FELTP, Certificate in Biostatistics
  32. What is Agenda & Agenda setting? AGENDA: “Any hot issue” . AGENDA SETTINGS: The Process by which certain issues come onto the Policy agenda from the much larger number of issues potentially worthy of attention by the policy makers.
  33. WHO SETs THE AGENDA? • Important Policy actors/stakeholders (government, mass media, donors & others) compete in attempt to persuade the government to put an issue onto policy agenda.
  34. Why do certain particular problems receive high priority & they get onto Policy Agenda? • This Question can be answered through: 1. HALL MODEL 2. KINGDON’S MODEL
  35. HALL MODEL LEGITIMACY SUPPORT FEASIBILITY Any issue which the government believes they should be concerned for and feel obligation to intervene is considered to be a Legitimate issue. Support means Public Support. Feasibility can be conveniently done. According to the Hall model things get onto Policy Agenda when they have: • Legitimacy • Support • Feasibility.
  37. KINGDON’S MODEL There are always Problems, Solutions & Politics. No magic Happens happen when These three streams are apart from each other. PROBLEMS SOLUTION POLITICS (Policy)
  40. AGENDA SETTINGS Develop Vision, Goals & Objectives Assess all possible Potential solutions using scientific evidence & Knowledge. Write Details of all possible potential solutions and prioritize them chose only those solutions which are cost effective & has higher Public Health Impact also fix time frame. Implementation inter-sectoral coordination will be require with legislations. Monitoring & Evaluations Public Health Policy Process.  Problem  Policy/Solutions  Political will ASSESS & ANALYSE THE POPULATION HEALTH NEEDS. (Problem Identification) (e.g. Study various Health Indicators Data from the PDHS)
  41. ASSIGNMENT • Getting TB onto policy agenda & formulate the DOTS Policy.
  42. THANKS
  43. HOW TO ANALYSE A HEALTH POLICY By Dr Muhammad Arif MSPH, Diploma in GIS & Spatial Statistics, MBBS, FELTP, Certificate in Biostatistics
  44. WHAT DO WE MEAN BY HEALTH POLICY ANALYSIS? Health policy analysis or for that matter any policy analysis means “ A systematic evaluation of the policy process (Policy making process), comparing Policy alternatives to the current policy & assessing the policy outcomes”.
  45. When & why Public Health Policy Analysis should be done? • To understand Policy making. • To plan a particular policy. • To research success and failure of a policy. • To explore reasons and learn lessons (Positive/Negative) from the policies. • To learn how to get things onto Policy agenda.
  46. Model/Tool commonly used for the analysis of Health policy is known as: “POLICY TRIANGLE” According to this model every policy has 04 components which are: 1) Actors/ Stakeholders 2) Context 3) Policy process 4) Contents.
  47. What do we mean by 1) Actor/Stake holder: Basically actors are International, Regional , National & Local individuals, groups, organizations & government – who formulate the policy, influence the policy, implement the policy & benefit from the policy. Some key International actors in health sectors are: • WHO, UN, World Bank, WTO, GATT, USAID, Milinda & Bilgate foundation, Rotary foundation etc.  Some National Level Key actors/stakeholders in health sector are: • Government, Subject Specialists, Mass media, Interested groups, Civil servants & Public/citizens.
  48. What do we mean by 2) Context (Policy Context): “ Context basically means – What were the political, Economical & social factors that led to the development of this story. ( The Background story)” What are the key factors that can lead to the development of Health policy? a) Situational factors – (wars, droughts, Epidemics). b) Structural factors – ( Political & Economical environments). c) Demography & Epidemiological Changes.
  49. What do we mean by 3) Process (Policy making Process ) Process basically mean- How this policy was initiated, developed, formulated , negotiated, communicated, implemented & evolved over time.
  50. What do we mean by 4) Content: Contents – of any policy literally mean a) Text of the Policy. b) Linguistics of the policy.
  51. How Policy analysis is done? • Step-01: Identify all the actors/stakeholders (International, Reginal, National & Locals) involved in this policy. Step-02: Develop stake-holder analysis chart/map according to the “Power & Influence” of the stake holders. Power: Power of a stakeholder is basically defined by its Wealth, Personality & Knowledge. Influence: Basically means Impact they can make.
  52. • Step-03: After developing stakeholder analysis map research these questions regarding each actor Q1:How potential actors were identified? Q2: What are the overall commitment by each stakeholder? Q3:What are potential gain and loses of each stakeholder from this policy? Q4: How closely or how many times each stakeholder has tried to mold or change the policy? Q5: How closely the policy design or process is matching the overall values and beliefs of each actor/stakeholder?
  53. • Step-04: For the analysis of Policy Context try to find answers to these questions Q1: How the problem was identified? Q2: What factors at time brought this problem to agenda settings. • Step-05: For the analysis of Policy process try to find answers to these questions: Q1: Who was involved during policy process? Q2: Whose agenda it was? Q3: How many current policy alternatives were identified through research & evidence? Q4: What time frame was fixed for this policy? Q5: How this policy was implemented & how its M&E was performed?
  54. • Step-06: Policy contents mostly comprises of: a) Policy Text. b) Language of the policy. For Policy Text analysis try to find answers for the following questions: Q1: Does policy text mentions clear policy goals & objectives? Q2: Does policy text mentions clearly how this policy will be implemented and which sectors or departments will work for it? Q3: Does Policy text clearly mentions about funding sources? (Structure, Scale able & Self sufficient). Q4: Does Policy text clearly mentions about Policy KPI and their bench marks & time frame. Q5: Does the policy text mentions about potential conflict with other existing policies?
  55. • For Policy Language analysis try to find answers for the following questions: Q1: What types of words are used while communicating this policy? Q2: Does all the stakeholders get to the same interpretation before implications. Q3: Any hidden message, ideas or associations conveyed? Q4: Any use of metaphors in the language? Metaphors can imply different course of actions.
  56. Activity • For self learning analyze Public health policy of any program and generate report.
  57. THANKS