1. Final Stages of Formulating and Implementing Health Policies
Policies are basically a body of principles governing decision making. Thus health care policies can be defined as collaborative measures by the government and other stake holders directed at maintaining and improving the populations’ health status. This basically states long and short term goals as far as the health sector is concerned. It is thus clear that formulation and implementation of health care policies is multispectral and is a concerted effort of many professionals working collaboratively. Any policies (health policies included) generally have the following cycles: first is recognizing, defining and identifying of issues. At this stage, assessment of the need for a specific policy is also done. The other cycles of policy include preparation, formulation, development, implementation and evaluation. This thesis shall focus on the final stages of the health policy cycle; implementation and evaluation.
Another crucial stage in the making of health policies is the revision stage. This too can be carried either at the formulation stages or at the evaluation stages. Revision is basically amendment of health policies to make sure they are in line with prevailing health and economic conditions, needs of various stakeholders and to ensure that they are implementable. In health policy cycles, this stage usually comes after the analysis stage. Thus, health policy analysis is a precondition to revision. Analysis creates the basis for revision of health policies. The purpose of reviewing health policies is to make sure that the need for which they were proposed is met regardless of the changing health and economic conditions. Amendments also ensure that technical issues that arise from the either formulation or implementation of health policies are ironed out as soon possible. This includes loopholes that exist within the specific health policies. Generally, review of health policies is meant to improve their quality and positively impact on the beneficiaries while minimizing negative impacts of health policies.
Implementation of health policies basically refers to the translation of enacted policies into health measures that can be executed. This stage involves translation of law into stipulations and requirements that are to be enforced by specific federal agencies. Thus, this stage effectively translates health policies from a theoretical state to a practical one. This includes the use of all available resources to ensure that both the short and long term goals of the enacted health policies are to be met. For this to be possible, health policies must have the support and full backing of a majority of the stakeholders. This implies, the political class, the target group, health practitioners amongst other stakeholders must show the necessary good will for health policies to be implemented.
Evaluation of a health policy refers to the process usually carried out by the ministry of health or any other regulatory bodies to ascertain how effectively a health policy was implemented and its after effects whether expected or unexpected. Just like other stages of the health policy cycle, this stage is highly politicized. This implies the proponents and opponents of specific health policies are bound to be subjective in the evaluation stages of health policy cycles. The purpose of evaluating health policies is to improve on formulation and implementation processes through analysis of already enacted health policies within a dynamic health environment. This changing environment includes, political (changes in the countries leadership) and financial (budgetary cuts or increases) factors. This is because; all these factors have a very huge bearing on how effective health policies are. Evaluation is also supposed to ensure that the health policy is phrased in a manner that is easily implementable. To emphasize this, the thesis shall now examine a case study of how the Canadian government implemented, monitored and evaluated the 1999 policy-expansion of the Healthy Babies Healthy Children (HBHC) program.
2. The Healthy Babies Healthy Children (HBHC) Program
This program provided women with an opportunity of staying in hospital an extra 60hours after an uncomplicated delivery for further check up and follows up measures. The policy was based on the 1996 recommendation of the Canadian Pediatric Society and the Society of Obstetricians and Gynecologists of Canada to allow women flexible lengths of stay (LOS) after child birth. HBHC in its implementation strategy directed that all women call the public health units 48hours after postpartum discharge and that all women get a home visit regardless of their location, the LOS and demographic profile. Though, hospitals were at liberty to use their own predetermined mechanisms to determine the LOS before postpartum discharge. Many scholars foresaw challenges in the implementation of the program due to the manner in which the policy was formulated and the motives behind the formulation. Theoretically, the policy had sound basis but practically, the goals of the program were not easily attainable for the following reasons.
For starters, implementation of the HBHC program was the responsibility of two different sectors of the health system; hospitals and public health units. Though these two sectors are significantly related, each of the sectors is run by different professionals charged with different mandates. This implies that the government intended that the policy be implemented in two phases; at the hospital level and at the public health units’ level. Second, the government did not consult health professionals in the formulation process of the policy. Thus the result is that most doctors were against the HBHC program. In addition to this, the beneficiaries of the policy (women) were also not given an opportunity to voice out their concern as far as the policy was concerned. Also, the timing of this policy change did not make its implementation easy. The HBHC program was formulated and implemented in a period where by the Canadian health care system was marred by a lot of challenges. To this effect, the Canadians had lost faith in their health care system. Clearly, though the program seemed medically harmless and demonstrated empathy on the government’s side, it was bound to have a hard time based on this background.
During implementation of the HBHC program, the following happened. At the hospital levels, most providers did not picture extension of LOS as part and parcel of service delivery. In fact most physicians did not inform newly delivered mothers of the 60hours LOS at their disposal. The physicians were surprised to find out that most women knew of the extended LOS policy and voluntarily opted for it regardless of the recommendation of the doctors. Thus, what culminated is bed space shortage. This is so because though the hospitals had anticipated severe pressure to the available resources, they did nothing to resort the issue because of the operating costs. Increasing the resources to cater for more mothers that were now opting for the extended LOS would mean increasing the operating costs. Given the fact that government funding was limited to the public health units, hospitals refrained from using their own funds to implement government directives. Besides, according to the doctors, the LOS was a clinical issue left to the discretion of mothers and physicians. Thus, policy makers had no business meddling in that issue. Also, based on empirical studies, a direct relation between infant health and the LOS is yet to be established.
The hospitals that unwillingly complied with the government directive had no choice but to charge more for these services to cover up their operating costs. This is because the policy still gave the hospitals lee way to determine best applicable approaches as far LOS was concerned. This meant that most hospitals viewed this policy suggestively rather than prescriptive. Thus, the hospitals recommended that there were other factors in play that marred effective implementation of the HBHC policy. At the hospital level, the implementation of the policy was affected by reluctance of the doctors to inform women of the extended LOS and their strong support for shortened LOS. Since the doctor’s decision is final and supreme, their analysis of the situation is what prevailed. Women also viewed the LOS in terms of the health of their infants. Most women whose infants were perceived to be healthy by the medical practitioners opted for shorter LOS. In fact, according to most women involved in the study, their health was subordinate to that of the infants. If the baby was fine, then they were strong enough to go home. Thus, this evaluation and analysis of the HBHC policy implementation indicates that for effective execution of health policies, it is a pre-requisite that all stakeholders be involved at all stages of the policy cycle.
At the public health units’ level, the case was a bit different. The HBHC requirements were followed to the latter. The nurses made follow-ups as prescribed by the program, because of the steady government funding and prior intent to do so even before the policy was implemented. However, at this level the policy failed to determine the intent and purpose of the home visits. Also, the public health units experienced a challenge in compliance with this directive. There was a shortage of nurses to conduct home visits specifically during the weekends. This shortage of personnel was also responsible for the lengthy duration between phone calls and follow-up visits. Though, ultimately the nurses made the follow up visits. Success of the HBHC program at this level indicates that the requirements of the policy were in line with the mandate of the public health units. Though, as usual women reacted to the home visits variedly. Acceptance of the offer for home visits was based on whether the women felt that the specific visit was adequate enough to meet their postnatal health needs. This implies that acceptance of the home visits was solely dependent on individual perceptions of the women.
Hanney, S. R., Gonzalez-Block, M. A., Buxton, M. J., & Kogan, M. (2001). The Utilisation Of Health Research In Policy-Making: Concepts, Examples And Methods Of Assessment. Health Research Policy and Systems 2003, 1:2 .
Htwe, D. M. (2006). Formulation, Implementation and Evaluation of Health Research Policy. Regional Health Research Forum WHO-South East Asia Region(Volume 5, Issue2).
Sc.D, R. J., & M.A., J. M. (2009). The American Public and the Next Phase of the Health Care Reform Debate. The New England Journal Of Medicine.
Walt, G., Shiffman, J., Schneider, H., Murray, S. F., Brugha, R., & Gilson, L. (2008). "Doing" Health Policy Analysis: Methodological And Conceptual Reflections And Challenges. Oxford Journals, 308-317.
Watt, S., Sword, W., & Krueger, P. (2005). Implementation Of A Health Care Policy: An Analysis Of Barriers And Facilitators To Practice Change. BMC Health Services Research 2005, 5:53 .