Question

What political resources are available for policymakers to implement a policy? (Health Policy)

Answer 1

The essence of public health, in the eyes of most researchers and practitioners, is a struggle to understand the causes and consequences of death, disease, and disability. Often an even greater struggle emerges when policy makers attempt to put that understanding to work, to translate knowledge into action for our collective well-being. Science can identify solutions to pressing public health problems, but only politics can turn most of those solutions into reality. Politics, for better or worse, plays a critical role in health affairs. Politics is central in determining how citizens and policy makers recognize and define problems with existing social conditions and policies, in facilitating certain kinds of public health interventions but not others, and in generating a variety of challenges in policy implementation. It is essential that public health professionals understand the political dimensions of problems and proposed solutions, whether they hold positions in government, advocacy groups, research organizations, or the health care industry. This understanding can help leaders to better anticipate both short-term constraints and long-term opportunities for change.

Health policy analysis, in general, tends to emphasize issues of policy design and adoption over questions of policy implementation. Although these policy cycle phases may overlap and share common challenges, a focus on policy implementation is still needed. This article seeks to correct this gap in the literature. We build on existing knowledge about health policy implementation in low- and middle-income countries to propose a way of both identifying and addressing some of the central challenges.

Policy implementation is a complex phenomenon and cannot be adequately covered in a short paper. We, therefore, focus only on certain aspects of health policy implementation using the lens of political science. Even this focus is not easy, however, in part because few political analyses have been conducted of health policy implementation in low- and middle-income countries (LMICs). The politics of policy implementation for the health sector—particularly the management of stakeholders in order to improve the chances of achieving policy objectives. We provide a characterization of stakeholder groupings that are relevant for all phases of policy reform, but we focus on the challenges for health policy implementation.

We conducted a literature scan of political analyses of health policy implementation in LMICs in PubMed and Google Scholar. Due to the limited available literature, we broadened the scope of the search to include descriptions of health policy implementation, including some articles that use an historic lens to discuss particular health policies, to draw insights and inferences about the politics of implementation. We decided to look at health policy implementation according to six major categories of actors that participate in health policy implementation in LMICs. These six categories are explained in the next section. Each category relates to a significant group of stakeholders involved in health policy implementation and also at a broader conceptual level, to a significant theoretical literature in political science.