Gaining health : analysis of policy development in European ...

Chapter 5
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a formal stakeholder analysis to ensure that important
partners are not forgotten, as were the nurses in Finland in
the 1980s, for example
Establishing the process
In Finland, in preparation for the policy formulation process,
it is usual to organize seminars and conferences to discuss
related concepts and ideas with a wide group of stakeholders,
and also to organize smaller, in-depth discussions
among experts. This acts not only as a means of advocacy
and of boosting the process but to some extent as training
for policy formulation. In the case of Kyrgyzstan, those
participating in the first preparatory meeting had not been
given an adequate understanding of the expected process.
At the second meeting, when participants from the different
ministries received a detailed draft strategy paper and
were briefed on intersectoral cooperation, the activity and
quality of involvement of the same people changed in a
spectacular way. Preparation for participation in intersectoral
policy-making bodies appears to be practically nonexistent
in many countries.
The way in which the work of the various steering groups
and subgroups is meshed together to avoid creating a
series of vertical packages is not clear. For the latest policy
formulation process in Hungary, for example, all subgroups
were given the same template to work from. They were
aware of the common WHO values but not always aware
of the overall goals, with the result that the 19 subgroups
in this complex process were said to operate in isolation.
Careful preparation of the NCD policy process, including a
clear understanding by all participants of the concepts and
values and of their own expected input, has been shown to
vastly improve the effectiveness and efficiency of the policymaking
process.
In countries dependent on outside funding, and with little
experience of this type of policy-making, the role of external
experts can sometimes dominate. This has the advantage
of bringing in foreign experience and examples of good
practice, and may speed up the process of policy formulation
when external deadlines are to be met. Nevertheless,
it does little to enhance national capacity building or ownership
and may completely miss the potential of national
specificities and assets, as was the concern in Albania.
For the first broad health policy after independence in
Lithuania, it was only because local experts were so firmly
entrenched in international networks and convinced of the
right way to go that they were able to stand up to the international
funding organizations and insist on following the
Health for All path. They also brought in WHO and outside
experts to reinforce this position. Other countries, such
as Finland and Hungary, have successfully utilized foreign
experts to legitimize positions that domestic experts might
have had difficulty in getting accepted.
Policy formulation can be a time-consuming process. Indeed,
it should be if the main stakeholders are to be identified,
their views taken into consideration, and where there
are differences of opinion, opportunity be given for a level
of agreement to be reached. In the cases examined, the
time allowed for policy drafting, consultation and redrafting
varied from as little as three months to well over a year. In
an external review of the first Finnish Health for All policy
(12), one of the criticisms made was that insufficient time
and support had been given to the core group of officials,
who were expected to carry out the heavy policy development
tasks at the same time as their normal work.
Countries starting from scratch do not have the advantage
of accumulated experience enjoyed by those with a long
history of NCD policy development, and must learn everything
from the beginning. Support in policy development
and planning methods, with examples of good practice and
potential pitfalls, could help those now embarking on the
process.
Reflections on experiences