HARAMAYA UNIVERSITY

COLLAGE OF EDUCATION AND BEHAVIORAL SCIENCE

DEPARTMENT OF PSYCHOLOGY

Individual Assignment. II

Social Policy Analysis and Program Evaluation

(Spsy6042)

By: Ali Mummed ID..NO: K/PGP/418/11

Submitted to: Bahar Adam (PhD)

October, 2021
Table of Contents
page

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INTRODUCTION-------------------------------------------------------------------------------------------- 4

II) Individual Assignment. Policy analysis Take any social related policy in which you are interested and

analyses it focusing on the following-------------------------------------------------------------------------5

I. What is the policy? -------------------------------------------------------------------------------------5

A. Identify and briefly describe the policy. that has been introduced but not yet passed into law. social

problem or part of a problem this policy addresses---------------------------------------------------------6

B. What are the overt (stated objectives of this policy? ---------------------------------------------------7

C. What are the covert objectives (latent functions) of the policy----------------------------------------7

D. What value assumptions underlie this policy------------------------------------------------------------7

II. History of the Policy-----------------------------------------------------------------------------------------7

A. If this is an existing policy, when did it pass? Were there other policies addressing the same problem

prior to its passage? If this is a bill, when was it first introduced? What other policies were previously

passed to address the same problem? ------------------------------------------------------------------------9

B. What groups support this policy? What groups oppose it? Why? -----------------------------------14

C. How have social movements influenced policy responses over time? -------------------------------14

III. Who Does the Policy Affect? ----------------------------------------------------------------------------15

A. Identify the primary and secondary targets of the policy. Explain----------------------------------15

B. Does the policy increase or decrease oppression? How? For whom? -----------------------------15

C. Does the policy increase social control? How? Over whom? ---------------------------------------15

IV. Effects of the Policy---------------------------------------------------------------------------------------16

A. What have the short-term effects of the policy been (if an existing policy?) How do they compare with

the objectives or short-term goals of the policy? -------------------------------------------------------------16

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B. What are the long-term goals? -----------------------------------------------------------------------------16

C. What are some unintended effected/ consequences of this policy (if not yet in effect, what might they be---16

V. Feasibility--------------------------------------------------------------------------------------------------16

A. If this is still a bill, what are the chances of it being passed? Implemented? -------------------------16

B. What are the obstacles to the success of this policy? (Political, financial, Administrative, other) 17

VI. Alternative Policies--------------------------------------------------------------------------------------18

A. Can you suggest an alternative policy? --------------------------------------------------------------18

B. Do you have suggestions about changing some aspects of the policy you have analyzed? ---18

References----------------------------------------------------------------------------------------------------19

INTRODUCTION

Policies provide the framework within which the decision-makers are expected to
operate while making decisions relating to the organization. They are a guide to

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the thinking and action of subordinates for the purpose of achieving the objectives
of the business successfully. According to George R. Terry, "Policy is a verbal,
written or implied overall guide setting up boundaries that supply the general
limits and directions in which managerial action will take place." Thus, the
policies are a guide to thinking and action of those who have to make decisions.
Policies may be of different types. They can be classified on the following basis:
Some of them

Originated Policies. These policies are formulated by the managers. They tell
subordinates how to act in a given situation and the subordinates are expected to
follow them strictly. They are the basic policies and they have the support of
organisational authorities.

Appealed Policy. If, on any matter, the subordinate is not clear and a doubt about
his authority to handle a situation and if that subject matter is not already covered
by the existing policies, he may refer the matter for his superior's verdict.
Superior's verdict generates appealed policy and thus becomes a guide for the
future action of the subordinates.

External or Imposed Policy. Sometimes, outside agencies like government, trade

associations, trade unions etc. may also be instrumental in the formulation of a
policy by the enterprise. For example, if the government imposes a condition on
the enterprises to reserve a certain percentage of jobs for the backward sections of
society or for persons within the state, it becomes an external or imposed policy.

II) Individual Assignment. Policy analysis

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Take any social related policy in which you are interested and analyses it focusing on the

following:

I. What is the policy? To analyses let lake Health policy.

The term ‘policy’ may refer to a field of activity, such as the government’s health or economic

policy, or to a specific proposal, such as ‘from next year, it will be university policy to ensure

students are represented on all governing bodies’. Sometimes policy is called a plan or a

programme, for example the government’s health sector development plan or the HEP, stating

what should be done to increase public access to primary health services and to improve health

Policy is often thought of as decisions taken by those with responsibility for a given policy area.

Policies may not arise from a single decision but could consist of bundles of decisions that lead

to a broad course of action over time. Policy may be made at many levels – in central or local

government, in a multinational company or local business, in a school or hospital. Specific

groups of decision makers who hold senior positions in an organization are sometimes referred

to as policy elites. The decision makers often have privileged access to other top members of the

same organization and of other organizations. For example, policy elites in government may

include the members of the prime minister’s cabinet, all of whom would be able to contact and

meet the top executives of a multinational company or of an international agency, such as the

World Health Organization (WHO).Health economists, managers, planners or policymakers

need to know the importance, concepts and principles of health policy, and the context, content,

process and actors to be considered in health policy development, implementation and analysis

A. Identify and briefly describe the policy. This may be an existing state or federal law, or a bill

that has been introduced but not yet passed into law. Indicate what social problem or part of a

problem this policy addresses.

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Health policy is a complex issue as health is by itself unpredictable and uncertain. Government

should develop a viable health policy document and devise health plans and programs to

implement it. Health policy is assumed to embrace courses of action (and inaction) that affect

the set of institutions, organizations, services and funding arrangements of the health system. It

includes policy made in the public sector (by government) as well as policies in the private

sector. Policies are made in the private and in the public sector. In the private sector,

multinational conglomerates may establish policies for all their companies around the world,

but allow local companies to decide their own policies on conditions of service. However,

private sector corporations have to ensure that their policies are made within the confines of

public law made by governments However, as health is influenced by many determinants

outside the health system, health policy analysts are also interested in the actions and intended

actions of organizations external to the health system that have an impact on health (for

example, the food, education, agriculture or pharmaceutical industries).Devising a framework

for incorporating politics into health policy needs to include consideration of the content of

policy. Many of the previous health policies focus on a particular policy, describing what it

declares to do, the strategy to achieve set goals and whether or not it has achieved them. Health

is also affected by many decisions that have nothing to do with health care: poverty affects

people’s health, as do pollution, contaminated water or poor sanitation. Economic policies, such

as taxes on cigarettes or alcohol, may also influence people’s behavior. Understanding the

relationship between health policy and health is therefore important and makes tackling health

problems, such as HIV/AIDS epidemics and drug resistance, as well understanding how

economic and other policies impact on health, easier. B. What are the overt (stated objectives

of this policy?

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the overt stated objectives of Health policy for the purpose of responding to social demands and

improving health and reducing the burden of disorders in a population and optimisation of

collective choices, the rationality of the decision-making processes and the behaviour of

‘bureaucrats’ It defines a vision for the future and helps to establish a model for action. Policy

also states the level of priority that a government assigns to health in relation to other social

policies. shortly, improving the health of the population, responding to people’s expectations

and providing financial protection against the cost of ill-health.

C. What are the covert objectives (latent functions) of the policy?

The covert objectives of policies are political dominance of the administrations of the country

by the government and developing an internal base of support; and aligning oneself with more

powerful than others. to get support of people. its accepted ideology or its certified expertise.

D. What value assumptions underlie this policy?

Values are the base on which governments set objectives and goals and develop strategies and

courses of action. Countries, regions and cultural and social groups within countries have their

own values associated with health and disorders. The professionals should refer consistently to

these values and principles in order to foster greater coherence, integrity, comprehensiveness

and continuity in the implementation of health policy.

II. History of the Policy

Ethiopia’s health system first emerged as Haile Selassie’s imperial regime (1930–74) created

Ethiopia’s modern national institutions, including the Ministry of Public Health, established in

1947, referral hospitals and medical and health universities such as Addis Ababa University

medical school and Gondar Public Health College (1952) (International Institute for Primary

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Health Care – Ethiopia, 2019). These early health structures were mostly in urban centers and

were focused on curative care (Kloos, 1998, p. 509) and, as a result, reached relatively few

Ethiopians. After the 1974 revolution that overthrew the imperial regime, the avowedly Marxist

Derg regime had ambitious plans for primary health care, including a community health worker

programme, but implementation of these plans was undermined by the Derg’s harshly

repressive tactics and disproportionate military spending (Kloos, 1998). As a result, when the

Tigray an People’s Liberation Front overthrew the Derg and took power in 1991, health services

were dramatically underprovided in Ethiopia, even by regional standards. Health was not the

immediate priority for the new regime, which first focused on creating a governing coalition

incorporating ethnic parties from across Ethiopia (the Ethiopia People’s Revolutionary

Democratic Front, EPRDF), developing a new constitution and reorganizing the federal

structure of the country. Despite the lack of major health programs at this point, important

initial steps in the first decade of EPRDF rule included the first National Health Policy in 1993

and the first Health Sector Strategic Plan in 1997. Despite this initial progress during the first

decade of the EPRDF regime, at the time of the first Demographic and Health Survey (DHS) in

2000, just 5% of deliveries took place in health facilities. In the World Health Organization’s

(2000) World Health Report, Ethiopia’s health system was ranked 180 out of 189 in the world.

Ethiopia began its national expansion of primary health services in the second decade of the

EPRDF regime, starting circa 2003. The most well-known component of this was the Health

Extension Program (HEP), in which over 42 000 HEWs were trained to deliver basic primary

care (Assefa et al., 2019). This health worker programme was implemented together with large-

scale construction of primary hospitals and health centers and health posts to house HEWs. In

addition, the Ministry bolstered the higher-level health workforce (doctors, health officers and

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midwives); including by creating a cadre of junior clinical staff trained specifically for rural

service and then the broader ‘flooding’ policy, i.e. a policy to ensure adequate public sector

workforce by flooding the market with clinical staff. For the HEW programme, two female

secondary graduates, given 1year pre-service training, were deployed to each newly constructed

health post to serve a kebele (nearly 5000 people). The programme was launched in 2003 in

agrarian areas and adapted in following years to pastoralist and then urban areas. Care was

largely preventive, with 4 major areas of activity (family health, disease prevention and control,

hygiene and environment and health education and communication) and 16 service packages.

An important part of each HEW’s responsibility was to train ‘model families’ in each kebele

who would demonstrate good health behavior to their communities. After 2010–11, this aspect

of the programme was expanded into the ‘Women’s Development Army’, in which this

structure was massively extended, such that a model household was identified for every five

households (Health Policy and Planning, 2020)

A. If this is an existing policy, when did it pass? Were there other policies addressing the same

problem prior to its passage? If this is a bill, when was it first introduced? What other policies

were previously passed to address the same problem?

Ethiopia began its national expansion of primary health services in the second decade of the

EPRDF regime, starting circa 2003. The most well-known component of this was the Health

Extension Program (HEP), in which over 42 000 HEWs were trained to deliver basic primary

care (Assefa et al., 2019). This health worker programme was implemented together with large-

scale construction of primary hospitals and health centers and health posts to house HEWs. The

programme was launched in 2003 in agrarian areas and adapted in following years to pastoralist

and then urban areas. Care was largely preventive, with 4 major areas of activity (family health,

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disease prevention and control, hygiene and environment and health education and

communication) and 16 service packages. The four barriers synthesized from the secondary

literature on primary care (distributional politics, state capacity for implementation, financing

and ideology) are addressed in turn.

1.Structural challenges: distributional politics

Primary healthcare programs in developing countries require directing scarce resources to poor

rural areas. This is often resisted by political and economic elites, the middle classes and the

medical professions, especially when rural citizens are already politically and economically

marginalized. Underinvestment in primary care had characterized Ethiopian health budgets in

earlier periods: Kloos (1998) reports that circa 1972, 92% of health expenditures was on

hospitals.

Ethiopia under the EPRDF sought the opposite strategy, investing in rural priorities such as

agriculture, safety nets and rural services (De Waal, 2013; Tadesse, 2015; Lavers 2019;

Clapham, 2017) while limiting investment in urban areas.

2.Structural challenges: state capacity for implementation

Even if distributional politics poses no obstacle to shifting health resources to primary care, a

second major challenge is building the capacity of the state to deliver services in rural areas.

Key elements of state capacity include the ability to extract taxation, coordinate the activities of

multiple social groups and elicit compliance from both citizens and front-line agents of the state.

With respect to delivery of primary health, the state must mobilize resources and then hire,

train, deploy, motivate and monitor a large front-line workforce conducting complex tasks in

geographically dispersed settings. These are what Andrews et al. (2017) refer to as high

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transaction intensity, high discretion activities, which require relatively high levels of state

capacity.

A. Historical origins

Despite Ethiopia’s low governance ratings as of 2000, the country benefitted from a unique

heritage of ‘stateness’ due to the continuous existence of a centralized state, which had

originally been cantered in Axum in northern Ethiopia. The implementation capacity of this

early state was limited by its feudal organization (Markakis, 2011), but it generated enough

centralized military power to repulse Italian attempts to colonize Ethiopia in 1896. Unlike the

rest of the continent, therefore, Ethiopia did not have its indigenous political development and

state formation process derailed by colonization. This is the foundation upon which later state-

building experience rests.

Despite this history, when the EPRDF took power circa 1991, the Ethiopian state was in many

ways little better prepared to deliver primary care at national scale than other countries in the

region, which lacked Ethiopia’s ancient state tradition. While the imperial regime built national

institutions like the civil service, universities, and public schools and hospitals, these state-

building efforts were limited and ultimately halted by the 1974 revolution. The Derg regime’s

(1974–91) efforts to further strengthen the state were limited by their repressiveness, infighting

and massive diversion of resources into the military. The poor performance of the massive Derg

military against lightly armed rural insurgencies and the regime’s inability to address the 1984–

85 famine both demonstrate low Ethiopian state capacity through the 1980s.

B. Insurgent experiences

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While the state that they inherited had been weakened, the TPLF could contribute valuable

governing and state-building experience that they had accumulated in Tigray over the course of

the insurgency period. As mentioned above, the TPLF benefitted from successful governance of

the territory they controlled; a capability developed out of necessity, since the movement had

limited economic resources and no external sponsor. As described in Barnabas and Zwi (1997),

TPLF health leaders iterated, via trial and error, towards a functional PHC programme. Rather

than a process of ‘isomorphic mimicry’ where external donors and experts prescribe externally

generated models for health service delivery (Andrews et al., 2017), the TPLF went through a

difficult but ultimately productive experience of learning how to deliver primary health services

in ways that made sense for the Ethiopian context. State-building strategies: centralization, mass

mobilization and top down accountability. TPLF leaders made several strategic state- and

nation-building choices, which ultimately shaped their ability to implement PHC and other

national programs. Having staffed this structure, administrators and new cadres such as the

"kebele manager" were then managed through top down accountability mechanisms, including a

detailed performance management system, which each level of the administrative hierarchy was

ranked based on their performance. These ratings mattered for promotions and were taken

seriously. These state-building reforms, supported by donor funding, strengthened national

institutions focused on development implementation. Initial planning for the national HEW

programme dates to this period, and implementation was shaped by these state-building

strategies and dynamics.

C. Mass mobilization and incorporation

This state-building effort was then shaped by electoral developments. In the period before the

2005 election, the EPRDF, confident in their popularity, allowed relatively open competition.

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They lost urban areas badly and faced unusually strong opposition showing, although the final

election results remain disputed. After an initial period of direct repression (with several

hundred killed in the immediate aftermath by security forces), this threat to the regime spurred a

massive programme of expanding party and state structures at lower administrative levels to

incorporate mass participation, coopt potential opposition and ensure regime support. ese

emerging political needs of the regime fit well with the organizational needs of the HEP. Initial

evaluations of the programme highlighted the need for more fundamental mobilization of

communities, building on the model family structure, particularly in light of continued high

levels of maternal mortality.

D. Structural challenges: the role of ideas

Another common challenge for primary healthcare programs is ideological The 1978 Alma Ata

declaration is widely cited in Ethiopian policy documents, suggesting that international ideas

about PHC were influential. However, several Ethiopia-specific ideologies and currents of

thought were more important, most notably former PM Meles Zenawi’s distinctive

conceptualization of the developmental state (De Waal, 2013; Gebregziabher, 2019). More

directly, the idea of a national community health worker programme was modelled on previous

initiatives, in the health sector as well as from the agriculture sector. A historical account from

the International Institute for Primary Health Care – Ethiopia argues that ‘the ideation of HEP

began from the “Model Family” approach initiated in 1997 by the Tigray Regional Health

Bureau’, while others emphasize the earlier wartime community health worker programme, also

in Tigray region. To a lesser extent, the idea of PHC as the organizing principle of the health

system started in the Derg years, including with focus on prevention and on primary

interventions delivered by community workers. Finally, Dr Tedros himself has pointed to

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Ethiopia’s agricultural extension programme as a model that policymakers drew on for the

HEW programme (Witter and Awowsusi, 2017; International Institute for Primary Health Care

–Ethiopia, 2019).

3.Structural challenges: financial barriers

In many developing countries in the post-Alma Ata period, largescale primary healthcare

programmes fell apart due to fiscal pressures, as governments faced economic crises and cut

health budgets. Ethiopia certainly faced financial challenges with respect to its PHC

investments: The primary healthcare investment programme (including the HEP) required an

estimated $1.2 billion in start-up costs over 5 years. The government’s assumption of this

responsibility was critical; it avoided reliance on volunteer labour for this critical cadre, which

had contributed to the demise of many other community health worker programmes

B. What groups support this policy? What groups oppose it? Why?

The Groups Those support this policy Health stakeholder are group that support this policy who

are Persons and organizations with some interest in the improvement of the health of a

population. They include people with disorders, family members, professionals, policymakers,

funders and other interested parties are all Group that support the policy.

The Groups Those Oppose Private health institutions like private hospitals and health centres as

well as pharmaceutics factory may opposed groups because they are profitable institutions in

low cost they are not ready to serve people. Political opposition parties and within government`s

denied Personnel’s as well as those people who are not benefited from these policies are among

oppose of the policy C. How have social movements influenced policy responses over time?

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policies are introduced on a smaller scale in the beginning and then they are expanded

gradually. policies are expanded slowly and steadily, after knowing the workability and

feasibility of the policy as Incremental Model says. So we have to formulate, implement, adopt

and evaluate one policy on people who live permanently in one area. So social movements

influenced policy responses over time. III. Who Does the Policy Affect?

Stakeholder any individual or group who can affect or is affected by the actions, decisions,

policies, practices, or goals of the government or an organization Policy typically affect a large

group of people or even an entire population rather than simply one individual.

A. Identify the primary and secondary targets of the policy. Explain the primary targets of the

policy

Primary targets the policy are those individuals with direct authority to make policy change.

Secondary targets are those people who can influence the decisions of primary target.

Secondary target of policy are important because they can provide away to reach the primary

target of policy

The primary targets of policy are the person, group of people within a decision making

institution, with authority make or change policy. Example, President or Prime Minister,

Minister of Health Ministry. B. Does the policy increase or decrease oppression? How? For

whom?

when policy has not been implemented in accordance with the policy guidelines issued at the

time of policy-making and when the policy does not serve the people the policy can increase

oppression

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when the policy improving population health outcomes promoted and implemented in aimed

and directed at the appropriate and specific target group or target area and people may have

benefited in this case may be the policy can decrease oppression

C. Does the policy increase social control? How? Over whom?

the policy increase social control by policy interventions which intended to stop social problems

by means of controlling the people who are seen as problems (juvenile delinquents, drug takers,

thieves, terrorists).as being in ‘the best interests’ of the person being punished or ‘treated’: they

need a ‘bit of discipline’, they respect ‘toughness’, and so on.

IV. Effects of the Policy

A. What have the short-term effects of the policy been (if an existing policy?) How do they

compare with the objectives or short-term goals of the policy?

the results of public action and its effect on society from the viewpoint of the objectives pursued

and/or in terms of indirect or undesirable effects. seeks to maximize gains and minimize losses.

B. What are the long-term goals?

The government decisions which are political, it is influenced by influential groups in the

society having control over the political power and the response of the political system to the

changing demands and desires of the people

C. What are some unintended effected/ consequences of this policy (if not yet in effect,

what might they be?). Costs are measured in monetary terms, and health status outcomes may

include number of deaths averted and number of life years gained. Costs may be assessed as

cost to the provider or cost to society. For example, the cost of treating malaria from the

provider’s perspective considers the cost of laboratory tests, drugs given to the patient,

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personnel costs and capital costs – vehicles, buildings and equipment. cost to the society far

greater capturing indirect cost, opportunity cost and time preference (discounting) are

unintended consequences of the policy

V. Feasibility

A. If this is still a bill, what are the chances of it being passed? Implemented?

Planners must thus develop indicators to assess whether the strategy has been realised or not.

This often requires collection of information or data at the time that the strategy is devised.

Only if such information is available at the beginning of the plan it is possible to measure

whether the target has been reached at the end of the time period. While numbers or percentages

are often good indicators to use, not all outcomes can be measured quantitatively.

B. What are the obstacles to the success of this policy? (Political, financial, Administrative, other)

obstacles of the success of the policy political system in which the policy making takes place.

by which power is acquired and the existence of (or lack of) free media affect how policy is

framed. Free media bring issues to the attention of the public and popularize them. Political

instability, and bureaucratic bottleneck, the deliberate imposition of policy, complete alteration

to the plan if it is not favorable to the implementers or civil servants saddled with the

responsibility to implement it

Economic factors are also structural.

A country with a small gross domestic product (GDP) may find it difficult ensuring universal

health care. A mandatory health insurance policy would not occur when a large proportion of

people of working age are unemployed or underemployed. GDP growth may present an

opportunity to subsidies costly health policies. Cultural context: a domain term for the history,

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language, customs, norms and religion that make up a society. Cultural norms in most parts of

Ethiopia that dictate women as subservient to the wishes of men have hampered the utilisation

of modern contraceptives in that country.

• situational – increased awareness of the mixed disease burden with the rise of chronic diseases

requiring sustained treatment and care

• political – increased government commitment to the health of the population

• economic – increased GDP growth of Ethiopia

• cultural – increased demand for modern health care partly due to the shift away from

traditional medicine

• international – USAID assistance both technical and financial.

VI. Alternative Policies

A. Can you suggest an alternative policy?

Policies alternative are based on highly uncertain and fluid knowledge, and are in response to a

dynamic situation (ever-changing problems, and evolving contexts) the alternative might not be

acceptable by government or policy developer because there is risky for proposing an

alternative

B. Do you have suggestions about changing some aspects of the policy you have analyses?

No suggestions about changing some aspects of the policy that I have analyses because I`m not

elite of health policy developer. Public policy as elite preference, elites that have power, ability

to allocate values.

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References

1.FDRE (Federal Democratic Republic of Ethiopia) (2006) National Five-Year Strategic Plan For

Malaria Prevention and Control in Ethiopia 2006–2010, Addis Ababa, Federal Democratic Republic of

Ethiopia.

2. FMOH (Federal Ministry of Health) (1998) Policy on HIV/AIDS of the Federal Democratic Republic

of Ethiopia, Addis Ababa, Federal Ministry of Health.

3. FMOH (2005) Health Sector Development Plan III (HSDP III) 2005/6 – 2009/10, Addis Ababa,

Federal Ministry of Health

4.Andrews M, Pritchett L, Woolcock M. 2017. Building State Capability: Evidence, Analysis, Action.

New York: Oxford University Press

5. Assefa Y, Gelaw YA, Hill PS, Taye BW, Van Damme W. 2019. Community Health Extension

Program of Ethiopia, 2003–2018: successes and challenges toward

6. Barnabas G, Zwi A. 1997. Health policy development in wartime: establishing the Baito health system

in Tigray. Health Policy and Planning 12: 38–49.

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