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Influencing Policy..??? Tarun Dua

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Influencing policy | 27 August 2010 3 |3 | Influencing Health Policy What is health policy? Why do we need to influence health policy making? Who can influence it? ACTORS How we can do it? PROCESSES AND INPUTS Lessons for the epilepsy world

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Influencing policy | 27 August 2010 4 |4 | What is health policy? A set course of action (or inaction) undertaken by governments or health care organizations to obtain a desired health outcome Putting policy into action: plan/programme Public health related policies: from local, state, or federal legislation, regulations, and/or court rulings

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Influencing policy | 27 August 2010 5 |5 | Health policy Part of economic, social or political structure Influenced by government development priorities In many countries, health sector remains a neglected entity Health, population and development are interlinked

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Influencing policy | 27 August 2010 6 |6 | Understanding policy making process Lack of priority? OR Lack of power and influence Understanding the policy making process is the first step in strategizing how to activate power and influence changes Three phases formulation phase implementation phase evaluation phase/modification phase Policy development is neither linear, simple nor always coherent

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Influencing policy | 27 August 2010 7 |7 | Understanding policy making process Formulation of new policies: more difficult Modification: in incremental fashion; less controversial Example: changes in the Medicare Program since its enactment in 1965 Policy and Politics are closely interconnected Different group of people can influence it but often have competing interests In these cases, policy making relies on political process

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Identifying the Problem and the Desired Outcome Identifying and Analysing the Stakeholders and Networks Understanding the Contextual Environment Understanding the Policy, Political and Decision- Making Processes Managing Communication and the Change Process Monitoring and Evaluating the Project

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Influencing policy | 27 August 2010 9 |9 | Actors Media NGOs Special interest groups Businesses and Industry Professional lobbyists International field: donor agencies, United Nations can assist It is the local actors that guide the policy agenda

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Influencing policy | 27 August 2010 10 | Media Three important roles played by media Policy makers are under constant scrutiny Educates public by reporting facts and conducting independent analysis Provides a forum for discussion Independence of media critical for them to play an important role in policy making

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Influencing policy | 27 August 2010 11 | Reporting done by Walt Bogdanich and colleagues at The Wall Street Journal in February 1987 Documented the way poorly trained or overworked laboratory technicians were misreading Pap smear tests, misleading many women as to whether they did or did not have cervical cancer. The expose not only won a Pulitzer Prize but, far more importantly prompted congressional passage in 1988 of the Clinical Laboratory Improvement Amendments, prescribing minimum standards of training, testing, and workloads for laboratory technicians.

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Influencing policy | 27 August 2010 12 | New e-tools that can help in generating policy discussions

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Influencing policy | 27 August 2010 13 | Civil Society (NGOs, special interest groups) Educating public officials and their staffs about the positive or negative effects of policy proposals Conducting advertising campaigns and public relations initiatives supporting their views Arranging for expert opinions and providing facts, data, and opinion polls to support their positions Arranging for witnesses to testify before parliament Encouraging their members to vote, communicate with their elected officials, and write letters to the media supporting their positions

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Influencing policy | 27 August 2010 14 | Examples of civic influences on health policies Drug prices and treatment access Tobacco control Patient rights Promotion of breastfeeding and control of infant formula Rights of people with HIV/AIDS Primary health care Trade agreements

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Influencing policy | 27 August 2010 15 | Promotion of breast feeding and control of infant formula Public health practitioners moving the issue into the public domain Referral of the issue to the UN opened up active industry and civic lobbies IBFAN, Oxfam and War on Want played an important role

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Influencing policy | 27 August 2010 16 | Promotion of breast feeding and control of infant formula Industry legal suits against civic lobbies Drafting of the code for breast- milk substitutes Example of a very reactive intervention

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Influencing policy | 27 August 2010 17 | WHO Framework Convention for Tobacco Control

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High levels of industry investment in challenging scientific evidence, advertising, public information campaigns and both direct and indirect funding of research "Industry not only seeks to sell cigarettes, but to actively undermine public health measures."

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Influencing policy | 27 August 2010 19 | Civil Society initiatives Balancing corporate interest in policy making Positive effect of strengthening the public accountability of business and government However sometimes there are policy changes but no real changes on the ground due to unwillingness of states to implement such decisions Sometimes companies set their own business funded CSOs

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Influencing policy | 27 August 2010 20 | Does the doormat really influences the boot? Reasons of failure of NGO's advocacy efforts overall absence of clear strategy failure to build strong alliances failure to develop alternatives to current orthodoxies the dilemma of relations with donors.

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Influencing policy | 27 August 2010 21 | Public policy/Professional research organizations Also known as "think tanks" Professional health organizations carry research that can help in influencing policy

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Influencing policy | 27 August 2010 22 | Steps in Health Policy Research Assessment of health needs Production and distribution of health resources in terms of manpower, facilities, supplies and knowledge Broad definition of the organization structure of the health system Management of health services at community, primary, secondary and tertiary levels Economic support of both public and private health systems Evaluation and feedback of the results of health activities

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Influencing policy | 27 August 2010 23 | Research inputs to making Mali's essential medicines list Improving the transfer of research into policy: collaboration between researchers and policy-makers, increased production and dissemination of relevant and useful research, and continued and improved technical support from networks and multi- national organizations.

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Influencing policy | 27 August 2010 24 | WHO MENTAL HEALTH POLICY AND SERVICE GUIDANCE PACKAGE Purpose: develop policies and comprehensive strategies for improving the mental health of populations Countries: Gambia, Guyana, Lesotho, Namibia and Sri Lanka, Ghana, Chile

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Influencing policy | 27 August 2010 25 | Lessons for epilepsy world Identifying the problem and the desired outcome Supply of antiepileptic drugs? Changing the legislation? Rights of people with epilepsy? STAYING FOCUSED Rights of people with disability Litigation protecting the right of people who lack capacity to agree to hospital admission Advocating for the Implementation of the UN Convention on the Rights of Persons with Disabilities in Croatia Advocating across Europe for Independent Living for People with Disabilities Establishing Community-Based Supported Housing in Serbia.

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Influencing policy | 27 August 2010 26 | Role of different ACTORS Importance of local actors Convergence of interests is critical Joining of efforts Involvement of media and use of innovative tools BREAKING DOWN WALLS MAXIMISING INCLUSION

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Influencing policy | 27 August 2010 27 | PROCESSES Policy making is a long drawn process Requires political skills and influence Inputs Evidence Information exchange Technical expertise Advocacy and public lobbies Resources THINK OF NEW WAYS OF DELIVERING MESSAGES TO THE POLICY MAKERS ALIGNING RESOURCES AND OBJECTIVES