Policy analysis and health policy analysis
Policy analysis is a descriptive attempt to explain policies and their development and is a special kind of research. Although policy analysis has been used since 1960s, its application in developing countries has been limited.5 The importance of policy analysis is widely acknowledged in the health sector5, however most nurses are not yet familiar with or able to understand the importance of being involved in health policy development or analysis. Health policy analysis (HPA) serves as an approach to explain the interaction among institutions that create policy, and their interests and ideas in the processes of public policy.10 Moreover, HPA helps us to understand: the why and how of policy makers’ interests and their decision-making regarding matters like health problems and funding; how context influences the policy process and its outcomes; what are the important processes of a policy; and who are the significant actors in those processes, and how they use their power, position and influence in the various processes of policy making.
Policy analysis draws on concepts from economics, political science, sociology, public administration, and history.5 There are two types of policy analysis: ‘analysis of policy’ which refers to the understanding of policy consequences after a policy is made, and ‘analysis for policy’ which refers to the generation of solutions for solving policy problems.11In the former, there is argument that the traditional policy analysis focuses on the content of policy while neglecting the actors who were involved in policy- making processes, therefore this study sought to address this shortcoming, as well as describe the contexts of the policy process. In this study, actors are individuals or groups at national and local levels who are affected by the context in which they live and work, who use power and position to influence policy- making processes; power is defined as the ability, authority, strength, or force to drive policy, and position indicates the status of actors in the policy- making process. Contexts include both stable and uncertain events influencing actors who set up policy. The process of policy-making refers to how an issue gets on to a government agenda and how that issue proceeds. Content of policy refers to details of policy reflecting all previous dimensions.
Examples of policy analysis: In low and middle income countries, like Thailand, HPA is in a stage of infancy and studies tend to be diverse and fragmented, an indication of efforts to build policy analysis capacity within these countries.12 Many HPA studies use an analytical model13-15 like that described above. For example, in an analysis of mental health reform in Bosnia, Herzegovina, and Kosovo13 data was collected from documents and articles relating to health policy and key informant interviews. The contexts of mental health reform were collected, including the history of politics and mental health services, psychiatric epidemiology, and foreign influences on mental health reform. The content was also examined, including underlying principles and implementation characteristics of mental health reform. The process included the timing and pace of reform. Lastly, the actors and their positions and power were analyzed using political mapping16, which was later included in the Policy Maker software. Political mapping was considered very useful to structure different and extensive qualitative data, and was a suitable method to analyze health reforms in post-conflict areas. Political mapping proved a useful research strategy in the present study.
Another HPA study involved the nursing workforce14 and analyzed the implementation of a policy for rural allowances in North West province hospitals of South Africa where there were health professional shortages. Here a case study design was used for: document reviews; interviews with seven policy-makers selected by purposive and snowball sampling; and in-depth interviews with 33 hospital managers and health professionals. The study found that there were geographic inequities in health personnel distribution in the country because health workers tend to move to cities. Policy content included the intention of the policy to attract and retain health professionals, including RNs, to work in public health services in rural areas. The process of policy implementation showed problems with the implementation of the rural allowance policy, including lack of evidence to guide policy formulation, restricting eligibility for allowance to doctors and professional nurses, lack of clarity in the definition of rural areas, weak communication, and the absence of a monitoring and evaluation framework. Actors involved came from various government departments.14
While nurses are in an ideal situation to understand and recognize the policy determinants of health17, globally they are less likely to be involved in policy determination18, hence the focus on analysis of an important policy document in this study in Thailand.
Study questions: With regard to the PIPDEMN this study’s questions were:
• What were the contexts that influenced its development?
• Whatweregoalsandstrategies?
• What were the policy formulation processes? and
• Who were the actors involved in its development and what were their roles?
Policy analysis and health policy analysisPolicy analysis is a descriptive attempt to explain policies and their development and is a special kind of research. Although policy analysis has been used since 1960s, its application in developing countries has been limited.5 The importance of policy analysis is widely acknowledged in the health sector5, however most nurses are not yet familiar with or able to understand the importance of being involved in health policy development or analysis. Health policy analysis (HPA) serves as an approach to explain the interaction among institutions that create policy, and their interests and ideas in the processes of public policy.10 Moreover, HPA helps us to understand: the why and how of policy makers’ interests and their decision-making regarding matters like health problems and funding; how context influences the policy process and its outcomes; what are the important processes of a policy; and who are the significant actors in those processes, and how they use their power, position and influence in the various processes of policy making.Policy analysis draws on concepts from economics, political science, sociology, public administration, and history.5 There are two types of policy analysis: ‘analysis of policy’ which refers to the understanding of policy consequences after a policy is made, and ‘analysis for policy’ which refers to the generation of solutions for solving policy problems.11In the former, there is argument that the traditional policy analysis focuses on the content of policy while neglecting the actors who were involved in policy- making processes, therefore this study sought to address this shortcoming, as well as describe the contexts of the policy process. In this study, actors are individuals or groups at national and local levels who are affected by the context in which they live and work, who use power and position to influence policy- making processes; power is defined as the ability, authority, strength, or force to drive policy, and position indicates the status of actors in the policy- making process. Contexts include both stable and uncertain events influencing actors who set up policy. The process of policy-making refers to how an issue gets on to a government agenda and how that issue proceeds. Content of policy refers to details of policy reflecting all previous dimensions.Examples of policy analysis: In low and middle income countries, like Thailand, HPA is in a stage of infancy and studies tend to be diverse and fragmented, an indication of efforts to build policy analysis capacity within these countries.12 Many HPA studies use an analytical model13-15 like that described above. For example, in an analysis of mental health reform in Bosnia, Herzegovina, and Kosovo13 data was collected from documents and articles relating to health policy and key informant interviews. The contexts of mental health reform were collected, including the history of politics and mental health services, psychiatric epidemiology, and foreign influences on mental health reform. The content was also examined, including underlying principles and implementation characteristics of mental health reform. The process included the timing and pace of reform. Lastly, the actors and their positions and power were analyzed using political mapping16, which was later included in the Policy Maker software. Political mapping was considered very useful to structure different and extensive qualitative data, and was a suitable method to analyze health reforms in post-conflict areas. Political mapping proved a useful research strategy in the present study.Another HPA study involved the nursing workforce14 and analyzed the implementation of a policy for rural allowances in North West province hospitals of South Africa where there were health professional shortages. Here a case study design was used for: document reviews; interviews with seven policy-makers selected by purposive and snowball sampling; and in-depth interviews with 33 hospital managers and health professionals. The study found that there were geographic inequities in health personnel distribution in the country because health workers tend to move to cities. Policy content included the intention of the policy to attract and retain health professionals, including RNs, to work in public health services in rural areas. The process of policy implementation showed problems with the implementation of the rural allowance policy, including lack of evidence to guide policy formulation, restricting eligibility for allowance to doctors and professional nurses, lack of clarity in the definition of rural areas, weak communication, and the absence of a monitoring and evaluation framework. Actors involved came from various government departments.14While nurses are in an ideal situation to understand and recognize the policy determinants of health17, globally they are less likely to be involved in policy determination18, hence the focus on analysis of an important policy document in this study in Thailand.Study questions: With regard to the PIPDEMN this study’s questions were:• What were the contexts that influenced its development?• Whatweregoalsandstrategies?• What were the policy formulation processes? and• Who were the actors involved in its development and what were their roles?
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