PUBLIC HEALTH POLICY ANALYSIS
CRASH COURSE
By
Dr Muhammad Arif
MSPH, Diploma in GIS & Spatial Statistics, MBBS, FELTP, Certificate in Biostatistics

Introduction to:
1) Policy
2)Health Policy
By
Dr Muhammad Arif
MSPH, Diploma in GIS & Spatial Statistics, MBBS, FELTP, Certificate in Biostatistics

WHAT IS POLICY?
• (Brain Storming)

A set of
• Laws
• Documents
• Procedures
• Guiding principles
• Statement of Intent
• Rules
• Regulations (etc.)
THAT GOVERN ACTIONS (Titmus 1974). Are considered as policy.

Why do we need Policies? & What are their
benefits?
• (Brain Stroming)

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.

What are different types of Policies?
• ( Brain storming)

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)

Other types of Policies
• Explicit Policies:
“ Well written & documented Policies”
• Implicit Policies:
“ Un written policies”.

So what is then Health Policy
• ( Brain storming)

Health Policy means
The decisions, plans, and actions that are undertaken to achieve
specific healthcare goals within a society.
(World Health Organization)

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.

Thanks

HISTORY OF HEALTH POLICY
& HEALTH PLANNING IN
PAKISTAN
By
Dr Muhammad Arif
MSPH, Diploma in GIS & Spatial Statistics, MBBS, FELTP, Certificate in Biostatistics

• 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.

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).

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)

 Millennium development goals.(2000)
 Poverty Alleviation 1990 onwards
 Devolution Plan 2001.
 After 18th amendments Health is a Provincial subject.

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 ).

THANKS

SALIENT FEATURES OF VARIOUS
NATIONAL HEALTH POLICIES OF
PAKISTAN.
By
Dr Muhammad Arif
MSPH, Diploma in GIS & Spatial Statistics, MBBS, FELTP, Certificate in Biostatistics

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.

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).

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).

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).

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).

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.

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.

Thanks

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

POLICY CYCLE

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.

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.

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

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.

Class activity
• WHICH HEALTH RELATED GOVERNMENT POLICIES AND PROGRAMS
ARE GENERALLY REGARDED AS HIGHLY LEGITIMATE IN PAKISTAN?

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)

ACCORDING TO KINGDON’S MODEL
A PROBLEM CAN GET ONTO POLICY AGENDA ONLY WHEN THE THREE
STREAMS COMBINE.

HOW CAN WE DEVELOP A
PUBLIC HEALTH POLICY?

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)

ASSIGNMENT
• Getting TB onto policy agenda & formulate the DOTS Policy.

THANKS

HOW TO ANALYSE A HEALTH
POLICY
By
Dr Muhammad Arif
MSPH, Diploma in GIS & Spatial Statistics, MBBS, FELTP, Certificate in Biostatistics

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”.

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.

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.

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.

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.

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.

What do we mean by
4) Content:
Contents – of any policy literally mean
a) Text of the Policy.
b) Linguistics of the policy.

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.

• 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?

• 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?

• 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?

• 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.

Activity
• For self learning analyze Public health policy of any program and
generate report.

THANKS