The political decision-making process BY Mrcheeks707 “The political decision-making process is so irrational that a completely rational approach to health policy-making can hardly be achieved. ” Support, debunk or provide alternative paradigms or approaches to this statement, focusing on the development of a particular policy area you are familiar with, and using analytic tools and frameworks in health policy analysis. This paper will begin by briefly examining the role of the state in health and how the state or political system is structured to meet this obligation.
It will then describe the types of policy, the stages of policy aking, and the uniqueness of health policy making. Having provided a solid foundation for understanding the political and policy making system, in the context of the Trinidad and Tobago scenario, it will delve into analyzing the policy making process, and directly answer the central question of the rationality of policy making in an irrational framework of government structure.
Weather policy is taught of as an intent, strategy, hypothesis, objective, goal, principle, or a learning process, it should include what governments say they will do, what they actually do and what they ecide not to do (Walt, 1994). Buse, Mays & Walt, (2005 cited in Gilson L, ed. 2012, p. 28) went on to say that health policy also includes decisions made by the private sector and other actions taken outside of the health system, which can have influence on diverse aspects of citizens’ health. Lipksy (1980 cited in Gilson L, ed. 2012, p. 8) also argue that Health public policy, the term used to differentiate from the broader public policy, is essentially the routinely daily practices of policy actors and their decisions that have been translated from the formal documents, which may ometimes be far removed from the original intent. Regardless of whether the broader objectives focused on in macro/systemic polices of high politics or the finer special interests objectives being met in micro- sectoral polices of low politics, there is a general public policy process that should be followed (Evans and Newnham, 1992).
To fully appreciate the impetus for health policy making in the public sector, one must understand the role of the state in formulating polices. As most develop and developing countries had been steered to accept the Keynsian philosophy, that f assuming the dominant responsibility in the provision of health services to the public amongst other social services (Walt, 1994), by the 1980’s most states were beginning to relinquish its role in the direct provision of services.
Despite governments continued attempts to divest the provision of health services to the private sector, urged in part by the World Bank, International Monetary Fund (IMF) and the diminishing resources of individual states, the critical health concerns of a nation will always mandate that some aspects of health care are treated at a central level. The complexities of health professionals training, controlling the spread of HIV and AIDS, and immunization of children, are too critical for a state to leave totally in the hands of private interest.
So who or what is this ‘state’ that has been entrusted with this responsibility of developing public policy, which ultimately impinges on every facet of citizens’ lives. This state, a subset of the wider political system, is composed of all the authoritative decision-making bodies of the society that maintains law and order while extracting and utilizing revenue, to provide services – ncluding health ).
Thus, based on the scarcity ot state resources, governments have no choice but to ration goods and services, even values, to varying and competing interest groups. This however, highlights the major flaw of the system model, in that it adopts the position that the state is impartial, and will distribute resources according to need rather than to the clout of interest groups. For one to fully understand the processes of policy making, one must examine it through the lens of policy theories.
As macro theories place heavy emphasis on power in political ystems, which its effects are more systemic in nature than micro theories. While the more obvious internal political structure of a nation can facilitate or hinder participation in the policy making process, exogenous factors are a major yet less discernible factor. Therefore, it is dependent on the particular aspect of control that policy health actors are faced with, will direct the type of policy development processes undertaken.
If the policy is within the control of Health, involves input to cross portfolio policy development, or involves input to intergovernmental policy evelopment. Amongst the many structures used to describe the policy processes Walt (1994) describes the most commonly used framework as a four step continuous cycle that moves through (1) problem identification and issue recognition/definition, (2) Policy formulation with clarification of policy issues and preferred options, (3) policy implementation (4) policy evaluation and review.
Consultation occurs throughout this cycle. This was expanded upon in the NSW Health Department State Health Publication (1998) to include; a release of formal discussion paper and the evelopment of final policy paper, as two separate activities coming after policy formation. These two additional steps have become necessary, as the intended policy must be available to the general public and special interest groups, to illicit their views before it is adopted and sent before cabinet for approval.
NSW Health Department State Health Publication (1998) provided twelve guidelines that will further assist in the rational process of a sound policy development process and promote the production of … ‘effective and high quality policy documents’. These ecommendations places emphasis on the need to have prompt Justification about the reason for the policy, unambiguity as to who holds power over the final document to initiate the policy development process, and selecting appropriate person(s) and resources to undertake the process effectively within the required timeframe.
There must also be consistency between micro and macro policies of the Government. NSW Health Department State Health Publication (1998) also urges that not only there should be timely participation of affected government stakeholders, there should be he lively discussion with Health Services and other key external stakeholders. Another area where Trinidad and Tobago can benefit greatly from is the recommendation that adequate testing be given for relevant options before implementation.
Head (2008) would argue that for a truly rational approach to health policy making to occur, it must be centered on Evidence-based policy (EBP) making. This concept of EBP sits squarely in the Rational or Synoptic model, and reflects more of an aspiration that a state should acquire, rather than an accomplished outcome hat could be examined. The only way decision makers can realistically and comfortably make sensible selections would be through adopting EBP as a measure to guarantee dependability ot intormation regarding the efficiency and ettectiveness of adopting a particular course of action over other possible alternatives.
It was under Prime Minister Blair, the then British Government saw the need for a more rational approach to policy making. They encouraged employing EBP as key trait in the new strategy to develop a logical method to policy development that will bring ncreased policy capability (UK Cabinet Office, 1999a cited in Head, 2008 p. 15). In Australia, Prime Minister Rudd (2008 cited in Head, 2008 p. 15-16) understood for there to be successful governance, decisions must hinge on ESP.
In his 2008 address to the Heads of Agencies and Members of Senior Executive Service, he stated … ‘The Government will not adopt overseas models uncritically. We’re interested in facts, not fads. … Australian policy development should be informed by the best of overseas experience and analysis. Other measures include identification and resolution of inancial and staffing implications of policy. Consideration and response to consultation, communication, industrial and implementation issues.
Provide for effective implementation and evaluation with performance targets, planning requirements and accountability arrangements identified. Effective use of Cabinet, Budgetary and Legislative processes of Government where required. Having reviewed these many components, hindrances, and best practices of rational policy making, tackling the fundamental question of the reality for there to be a rational approach to health policy-making?
And is evident in Trinidad and Tobago, the answer will have to be no. This has become clear as in many instances the required processes that need to be undertaken are not always available to the policy makers. Issues with fully adopting a rational approach begin to surface almost immediately. From simply identifying what exactly the health system is faced with, to defining goals to address those problems, a plethora of impediments already exists to derail the intended logical policy process.
Making rational decisions are also constrained by the decisions made by past administrations. This can be seen with the previous administration in Trinidad and Tobago, with the introduction of the CDAP. With such a program providing free prescription drugs for chronic diseases, often benefiting lower income groups, it would have been almost impossible for the new administration to reverse it, even after making negative statements towards such a program while in opposition.