Health Policy and PHC

Elizabeth Ekirapa Kiracho

0772408134
Ekky01@gmail.com
Ekky@musph.ac.ug
Moses Mukuru
0772878501, 0702878501
mmukuru@musph.ac.ug
 Outline
• Introduction to the course
• Exams
• Introduction to the course materials
• Assignment
• Feedback about the course and suggestions
 Why is health policy analysis important?
Many developing countries did not achieve their
health related MDG targets/ will not achieve SDG’s .
Why ?
• Lack of investment in weak health systems
• Insufficient or poorly coordinated national and donor
resources
• Lack of agreement on effective technical strategies
• Limited scale up of effective interventions that work
• Why national health policies – achieve less than
expected, perform differently from expected or even
fail
 Aim
Provide you with knowledge and skills to
understand, analyse and discuss
• Process of policy formulation and
implementation
• Approaches to Policy analysis
• Rationale for global and national level
policies - PHC, UHC
 Health Policy and Primary Health care

Course is organized into 5 units

• Unit 1: Concepts in PHC
• Unit 2: Implementation of PHC
• Unit 3: Health Policy Development
• Unit 4: Reforms in the Health sector
• Unit 5:Implementation of the National Health
Policy
 Mode of instruction
• Face to face
• Print material - Handbook
Encouragement to do the tasks, helps you to
learn, helps with revision, preparation of
notes
• Additional resources on Muelle
• Internet based discussions
• Independent study
 University Exam
• Exam contributes – 60% of marks
• Exam will be sat at the end of the semester
• Exam format – MCQ’s, short and long answer
Questions
Tips
• Approach to answering long answer questions
• Discussions
• Critical thinking
 Health Policy and Primary Health care
Course is organized into 5 units
Unit 1: Concepts in Primary Health Care (PHC)
• PHC is essential health care made universally accessible to
individuals and families in the community by means
acceptable to them, through their full participation and at
a cost that the community and the country can afford.
• It adresses the main health problems in the country –
promotive, preventive, curative and rehabilitative services

• Key principles of PHC – equity, self reliance, socio

economic development
 Health Policy and Primary Health care
Unit Objectives
• Outline the history of PHC and its subsequent development
• Discuss the principals and components of PHC
• Explain the relationship of PHC components to
determinants of health and their relevance to improving
health
• Explain the objectives of UHC and how it can be achieved
• Activity – Read core materials
• Problem and task – helps learning process pg 15
(Components of PHC and principles underlying)
 Health Policy and Primary Health care

Unit 2: Implementation of PHC

• Focuses on issues related to the
implementation of PHC
• Challenges in successful implementation of PHC
and constraints hence selective and
comprehensive PHC
• Pillars of PHC – community involvement,
political commitment, appropriate technology,
intersectoral collaboration)
 Health Policy and Primary Health care
• Unit 2: Implementation of PHC
Unit Objectives
• Discuss the advantages and disadvantages of
selective and comprehensive PHC
• Explain strategies used in PHC
Activities – visit to DHT
Task – exercise about selective and
comprehensive PHC
 UHC – Universal health care coverage

• “access to key promotive, preventive,

curative and rehabilitative health
interventions for all at an affordable cost”.
 Dimensions of UHC
• The scope of services covered
• Nature and number of people covered
(population coverage)
• The financial protection offered (WHO 2010).
• Health systems resilience
 Health Policy and Primary Health care
• Unit 3: Health Policy Development
Unit Objectives
• Outline the main approaches to policy
formulation Discuss the criteria for policy
analysis and evaluation
• Apply selected measures of health outcomes to
policy decisions
• Activity – Read National health policy
• Task - Read problem and answer questions
 Health Policy Development

By the end of this unit you should be able to

• Understand how policies are developed and
analysed
• Identify policy problems and suggest feasible
solutions to them
• Evaluate the implementation of policies and
suggest changes in implementation
• Understand the challenges faced during the
implementation of policies
 Different forms of policy
• Policy as intended process of change – policy
as intent – visions, goals plans etc
• Policy as reflected in the way things are done
– experience through what is done in practice
( routine decisions, activities, understandings
etc)
• Policy as written documents
• Policy as peoples understandings and actions
 Policy
• Think about the home situation?
• What kinds of policies are there?
• How did these policies develop? How where
they negotiated?
 Technical definitions of policy
• Courses of action (and inaction) that affect
the sets 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.
 Technical definitions of policy
• A more political and organizational approach
to policy analysis sees policy itself as a
process, the process of decision-making,
rather than focusing only on policy as the
output of that process or Commonly, health
policies are understood as the formal, as a
management input (Harrison, 2001; Thomas,
1998).
 What is Policy Analysis: Definitions
 The use of reason and evidence to select the best policy
among a number of alternatives to address a particular policy
problem. (MacRae and Wilde).
 “An applied social science that utilizes multiple research
methods, in argumentation and debate contexts, to create,
estimate critically, and communicate knowledge that is
relevant to the policies.” (Dunn)
 A process through which one identifies and evaluates
“alternative policies or programs that are intended to lessen or
resolve social, economic or physical problems” (Patton &
Sawicki)
Health policy analysis - Definitions
• Health policy analysis – a multi disciplinary
approach to public policy that aims to explain
the interaction between institutions, interests
and ideas in the policy making process ( Walt
et al 2008)
• Health Policy analysis – Retrospective studies
of policy during the development
/implementation process
 Policy analysis aims to support decision
making

 Determine whether a new policy is required to address

the problem
 If a policy/policies already exists, determine whether
it/they need to be modified or terminated
 Assess future implications of current or new policies

“Policy analysis is client oriented advice relevant to

public decisions to solve policy problems and informed
by social values”
Weiner & Vining
 Benefits/purpose of doing health policy
analysis
• Retrospectively – to understand what happened
• Prospectively – to Improve planned policies and
their implementation
• Help explain why certain issues receive political
attention
• Assist in identifying which stakeholders may
support or resist reform – used to develop
strategies to improve the prospects for pro-
reformist groups
 Benefits/purpose of doing health policy
analysis
• Help identify and address obstacles that
undermine policy implementation and
jeopardize national and global goals for
improved health
• Improve prospects that technical evidence is
considered during policy formulation leading
to evidence based policy
• Establish more realistic expectations
concerning incremental pro poor change
 Health policy analysis
• Policy analysis can assist decision makers
in choosing a preferred course of action
from complex alternatives and under
uncertain conditions.
• A good analysis or even a good decision
does Not Guarantee that the optimal
solution will be selected and / or
implemented.
 Scope of policy analysis
1.Policy analysis includes
 Analysis of policy – analytical and descriptive – attempting to
explain policies and their development and implementation
 Analysis for policy – Prescriptive – involved with formulating
policies and proposals
2. Policy analysis can include both
 The analysis of policy process and
 The analysis of policy content.
• The area of interest and the purpose of analysis
determines what type of analysis is conducted.
 Methodology
• Policy analysis uses a diverse range of
methodologies- quantitative and qualitative
• May include case studies, survey research,
statistical analysis, model building
• Area of interest and purpose of analysis
determines the type of analysis done
 Theories
Common theories in policy making
• Stages Heuristics
• Multiple stream theory ( Kingdon 1984)
• Punctuated equilibrium theory
• Policy triangle
 Theories and frameworks
• Use of frameworks and theories for the
analysis of policy is recommended
• Frameworks organize inquiry by identifying
elements and relationships among elements
that need to be considered for theory
generation
• Theories deepen understanding of causality,
postulate relationships that can be tested
 Theories of policy making
• Stages Heuristics ( Lasswell 1956)
• Policy making comprises of 4
 Agenda setting – issue sorting stage
 Policy formulation – decision makers make and
enact policy
 Implementation
 Evaluation
 Main criticism is that policy making is not linear,it
offers no explanation for casaulity
Theories of policy making – Agenda setting

Multiple stream theory ( Kingdon 1984)

 Problem stream – problems that society faces
 Policy stream – policy makers, varouis options
 Politics stream – political transitions and national mood,
• Occasionally they merge and a policy window is created
for dealing with particular issues
• Eg TB Dots accepted due to advocacy during HIV epidemic
with open global policy opportunities
 Kingdom Model (1984)
• Policy entrepreneurs inside and outside
government take advantage of policy windows
to move issues on to the formal agenda of
government
• Policy window that allows an issue to be put
on the policy agenda arises when the three
separate streams converge problem stream,
politics stream and the policy stream
 The policy triangle

Context

Actors
• Individuals
• Groups
• Organization

Content Process

Walt and Gilson 1993 34

 Policy Triangle

Context
Situational factors
Structural factors
External factors

Actors
Individuals
Groups
Orgs
Content
Process
Objectives of policy
Problem identification
Beneficiaries
Policy implementation
Benefits
Policy evalaution
Methodology for policy analysis- Eight fold
Path (Bardasch et al)
• 1.Define the problem
• 2. Assemble the evidence
• 3. Construct the alternatives
• 4. Select the criteria
• 5.Project the outcomes
• 6.Count the trade offs
• 7.Decide
• 8.Tell your story
 Other topics to read about
• Stake holder analysis
• Agenda setting
• Street level bureacarcy theory
• Approaches used to influence policies
 Unit 4: Reforms in the Health sector

Objectives
• Outline the main elements of reforms in the
health sector
• Describe main features of the minimum health
care package
• Discuss the rationale and objectives of
decentralization
• Discuss country experiences in decentralization of
health services with particular focus on Uganda
 Health sector reform - definition
• Health sector reform deals with fundamental
change of processes in policies and
institutional arrangements of the health
sector, usually guided by the government.

• The success of health sector reforms depend

on several factors -
 Reasons for health sector reform
• Fragmentation and duplication of funding and
services
• Poor management systems and organizational
capacity
• Poor efficiency in service delivery
• Poor quality of services
• Lack of responsiveness in services delivered
• Improve accountability and local "ownership”
 Changes that may occur
• Changes in financing mechanisms

• Changes in priority setting mechanisms

• Changes in organizational mechanisms

 Health Policy and Primary Health care
• Unit 5:Implementation of the National Health Policy
Objectives
• Describe the main features of a national health policy
( Uganda as an example)
• Outline the main components of a health sector strategic
plan
• Discuss implementation of a HSSP with particular focus on
the sector wide approach ( SWAP ) covering rationale and
issues arising
• Apply burden of disease approach to a concrete public
health situation
 Assignment 1
• The world over countries are striving to achieve
Universal health care coverage and the sustainable
development goals.
(A) Outline the key approaches that countries can
use to achieve the key components of UHC
(B) Outline and explain the health related SDG’s
(C) Review existing health related policies and
documents and discuss two key challenges that
Uganda is facing in addressing each of the key
components of Universal health care coverage.
 Assignment 2
• Uganda is currently considering a bill on national health
insurance. You have been asked as a policy expert to do a
policy analysis of National Health Insurance.
A. Review policy frameworks/ theories that you could use to
conduct the policy analysis. Write a critical analysis of two
theories/ frameworks that you could use to conduct the
analysis.
B. Briefly outline how you would go about doing the policy
analysis . Clearly outline the methodological approach that you
would take , the data collection methods that you would use and
the key issues that you would investigate ( Based on one of the
two frameworks in B above).
 Assignment
• Assignment contributes 30% to final mark
• Date to submit assignment
• Deadline April 15th 2020
• Word limit (3000 words)
• Submit through Muelle
• Last resort - Email to Max Walusimbi and
Evans Nalule( mwalusimbi@musph.ac.ug)
• enalule@musph.ac.ug