The health policy process
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The Health Policy Process. Gaston Sorgho, Harvard School of Public Health. Health sector reform requires. Technical Analysis Ethical Analysis Political analysis. What you are going to do about an issue How you are going to do it Who will do it Political. Policy is mainly deciding .

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The health policy process l.jpg
The Health Policy Process

Gaston Sorgho,

Harvard School of Public Health

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Health sector reform requires

  • Technical Analysis

  • Ethical Analysis

  • Political analysis

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What you are going to do about an issue

How you are going to do it

Who will do it


Policy is mainly deciding

  • Programmatic

  • An overarching course of action

  • A series of objectives and how to reach them

  • A statement of intent

  • A long-term plan

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Health sector reform is a policy reform

Policy reform is a profoundly political process

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Why is policy reform political?

  • Reform represents a selection of values

  • Distinct distributional consequences

    ( benefits / looses)

  • Reform promotes competition among groups

  • The enactment or non-enactment related with political events / crisis

  • Significant consequences for a regime’s political stability or longevity

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Why is reform so difficult?

  • Winners:

    not well organized, less powerful

  • Losers :

    well organized, powerful groups

    Risky process

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Reform may be desirable issue.but not necessarily feasible

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Political feasibility of reform issue.

  • Policy needs to be adopted and implemented in order to produce the expected results

  • Political feasibility is critical for Policy success

  • Political feasibility is not given itshould be created.

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What matters for reforms’ political feasibility? reforms’ political feasibility?

  • Actors

  • Content

  • Context

  • Process

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  • Why do issues reach the agenda?

  • Who formulates policy?

  • How is policy implemented?

  • How policy is evaluated?

  • Structural factors

  • Situational factors

  • Cultural factors

  • International factors


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To mention that… reforms’ political feasibility? We discussed health policy Actors in the previous session andContent of Health sector reform is discussed towards the 2 weeks.

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POLICY CONTEXT reforms’ political feasibility?

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Contextual factors reforms’ political feasibility?

  • Structural factors:

    • political system, economic or demographic structure

  • Situational factors:

    • violent events, change in government or political leadership

  • Civil Servants:

    • Size, quality and organization

  • International factors:

    • conditionality, globalisation

Examples will support each point

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Contextual factors reforms’ political feasibility?

  • For both retrospective and prospective policy analysis it is essential to contextualise the background

  • Political, economic and social factors will influence the way policies are developed and implemented

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POLICY PROCESS reforms’ political feasibility?

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Policy process framework reforms’ political feasibility?

= primary linkage

= secondary linkage




Each box to be discussed, but I do not

intend to develop the monitoring

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Issues reforms’ political feasibility?



Policy Formulation

And Legitimation

Progress/Impact Monitoring

Constituency Building

Implementation Design and

Organizational Structuring



= primary linkage

Policy process framework



Technically led

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Problem reforms’ political feasibility?

Policy (Solutions)

Politics (Political


No Change

No Change

No Change

No Change


How do issues get on to the policy agenda?

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Policy decisions reforms’ political feasibility?

  • Players

    • Individuals, groups , institutions entering the debate

  • Power

    • Political model

    • Political resources

  • Position

    • Position taken

    • Willing to spend resources on the policy

  • Perception

    • Definition & solution of the problem

    • Measures & symbolic consequences

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Policy formulation reforms’ political feasibility?

  • New Ideas vs Dominant paradigms

    • International learning

    • Policy innovation outside the health sector

    • Theory

  • Should be looking forward

    • Ahead to political decision: acceptability

    • Ahead to implementation: administrative capacity, civil servant attitude toward government, etc..

  • Design process

    • As much political as analytical

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Constituency building reforms’ political feasibility?









Political strategy

Coalition building

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Resource mobilization reforms’ political feasibility?

  • Substantial financial, human and technical resources needed

  • Support from constituencies and networks

  • Continue advocacy to maintain resources required: sustainability of sources of funds.

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What Influences implementation? reforms’ political feasibility?

  • Top-down or bottom-up approaches

  • Types of policy

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Implementation in practice reforms’ political feasibility?

  • Top-down approaches

    • Rational, prescriptive

    • Implementation is part of managing a sequential process

  • Bottom-up approaches

    • Incremental, iterative

    • Implementers are active participants

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Types of policies influence implementation reforms’ political feasibility?

  • Simple technical features

  • Clear goals

  • Implementation by one actor / structure

  • Marginal change from status quo

  • Rapid implementation

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Types of policies influence implementation reforms’ political feasibility?

  • Marginal change from status quo

    • Incremental change is easier to get agreed

    • Risks of error are less

    • Amount of information needed is smaller

    • Capital and other costs are lower

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Types of policies influence implementation reforms’ political feasibility?

  • Rapid implementation

    • Short duration of the execution of policy is less likely to encounter

      • organized resistance,

      • leadership changes,

      • distortions in policy.

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SUMMARY reforms’ political feasibility?

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  • Policy process involves both success

    • Technical expertise to produce analytical recommendations

    • Political acumen to create the right environment that allows for

      • Policy discussion

      • Policy change

  • Less a sequential move than a simultaneous one.

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Commitment to the reform success

  • An agency must be designated or created

  • Endowed with authority to implement the course of action,

  • An adequate budget must be appropriated to enable the agency to carry out its mandate.

    The absence of any one of these elements, especially the budget, suggests there is not yet full commitment to the policy.

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The Health Policy Process success

Gaston Sorgho,

Harvard School of Public Health