Health Policy Analysis
Conceptual Framework
Shahaduz Zaman
Newcastle University, UK
What does a health policy analysis involve?
Explains the interaction between
Institution
Interest
Ideas
Not just what happened
•BUT
What explains what happened?
We need a conceptual framework for that
What is then a conceptual framework?
 Conceptual frameworks provide a particular
perspective, or lens, through which to examine a
topic.
 Frameworks organize inquiry by identifying elements
and relationships among elements that needs to be
considered for theory building. ( Ostrom 2007)
 Health policy framework helps to contextualize the
‘health policy environment.’
Three major health policy analysis frameworks
Stages
framework
(Lasswell 1956, Brewer,
Deleon 1983)
Triangle
Framework
(Walt, Gilson 1994)
Network
Framework
(Thatcher 1998)
•Agenda setting
•Formulation
•Implementation
•Evaluation
•Content
•Actor
•Context
•Process
•Interactions
•Interconnectedness
Policy Triangle Framework
Content
Process
Actor
Context
Policy
Documents
Research
papers
Content
Guidelines
Strategies
Public
Sector
Donor
agency
People
Actors
Media
Private
Sector
Insurance
Company
NGO
Political
Environm
ental
Context
Cultural
Historical
How agenda is
set?
How policies
are executed
and assessed?
Process
How policies are
communicated ?
Who is
consulted?
 An Example of using Policy triangle framework
 Mediterranean studies of Cardiovascular diseases and
Hyperglycaemia: analytical Modelling of Population
Socio-economic transitions (MEDCHAMPS)
MEDCHAMPS objectives
 Developing a CVD and diabetes model for use
within the project countries, in order to
explain trends and predict likely future impact
of diseases
 Defining the national policy context and
characterising the health system for
developing policy options
Situation analysis (1)
Translating recommended interventions to
different cultural settings
Health
policies
Analysis
of:
Health
services
Health
beliefs
influence
Health outcomes
Gaps
Qualitative
data from key
stakeholders
Barriers
Opportunities
for
implementing
change
Informs
policy
options
National situation analysis of current policy
and health systems context
• Objectives:
– Using established schematic frameworks of potentially
effective policy measures and health system
interventions for the prevention of CVD and Type 2
diabetes in order to guide data collection and analysis
– Identify, collating and systematically reviewing all
relevant documentary materials on policies and health
services provision
– Exploring perception and knowledge of relevant
national policies through interviews with key informant
from relevant organisations, including government, the
health sector, private sector and non governmental
organizations (including patient group)
– Exploring health beliefs with potential target groups,
and determining whether these differ by population
group. Including by gender and socio economic group.
Two focuses
 A. Situation analyses of current policy:
 National/Regional/District overview
 B. Health system contexts:
 Local orientation alongside the national orientation
The project therefore envisages appraising existing
situations in partner countries on three different levels:
Level of
conceptualization
Level of
awareness and
commitment
Level of practice
Level 1: Situation on the level of
conceptualization
To know how
the combating
of CVD and
diabetes is
currently
conceptualized
in national
health policies?
What are the policies for
treatment and prevention of
CVD and diabetes in each
country?
What are the strategies
undertaken to fulfill the
policies?
What are the types of health
sectors functioning in the
country and their relative
prominence ?
Who are the stakeholders/interest groups, and what are their
roles?
How are CVD and Diabetes prevention and intervention
integrated within the wider health care system
What is the role of non health sectors in preventing CVD and
Diabetes?
Source of information
• Documentary materials on national policies, strategies, health
systems and financing concerning CVD and diabetes, including
policy relevant to smoking, diet, physical activity and alcohol use.
• Relevant documents on pricing and taxation, agricultural and
transport policies.
• Documentary materials on policies regarding national and local
health service provisions, prescribing , prevention and risk factor
management.
• National and international guidelines on policy measures and health
care structures and interventions developed by WHO, World Bank,
World Heart Foundation, International Diabetes Care Interventions.
• Method: Document analysis
Level 2: Situation on the level of Awareness
and Commitment
To know
whether the
implementers
and
practitioners of
health services
are aware of
and committed
to the existing
policies and
strategies
concerning CVD
and Diabetes?
Are the implementers and practitioners of health
informed about existing CVD and Diabetes
policies and strategies of their country?
What are their views about these policies and
strategies? Are they committed to what has been
recommended in these policies?
Do they have suggestions for acceptable and
feasible policy options?
Source of information
• Implementers and practitioners from:
–
–
–
–
Government
Private sector
NGOs at national, regional, provincial
Community level
• Method: Key informant interviews
Level 3: Situation on the level of practice
To know how
these policies
and strategies
concerning
CVD and
Diabetes are
practiced in
reality, and
how
practitioners
and patients
understand
these
practices?
What are people’s experience of living with CVD
and Diabetes, and how do they seek and access
treatment?
What cultural values regarding diet, physical
activity, and body size influence these practices?
What is the level and quality of CVD and Diabetic
care provided in formal or informal medical
settings?
Source of information
– Patients
– Care givers, medical practitioners
• Accessed through sample of health care facilities in (a)
urban and (b) rural settings.
• Method : In depth interviews, Illness narratives,
Observations.
Reference
 Merson, M., Black, R., Mills, A. (Eds) (2012) Global Health: Diseases,
Programs, Systems and Policies. London: Jones & Bartlett Publisher
 Ostrom, E. (2007) Institutional rational choice: as assessment of the
institutional analysis and development framework. In Sabatier PA (ed)
Theories of the policy process. Boulder, CO Westview Press pp 21-64.
 Walt, G. et al. (2008) Doing’ health policy analysis: methodological and
conceptual reflections and challenges. Health Policy and Planning
23:308–317