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

It can be quite a challenge for the type of intersectoral
group necessary for formulating NCD policy to reach
agreement on aims, objectives and priorities, since the
members frequently have different levels of understanding
of the health issues and different agendas in their everyday
lives. On the other hand, when the importance of the task
in hand has been understood, it is clear that many planning
groups have worked well and innovatively, borne along by
the enthusiasm of identity with the group and their common
aim. Over the long term, however, a degree of ennui
can set in and in some countries studied, the effort and
time needed was said to lead to higher-level people dropping
out and their substitutes taking over.
It is worth noting that, on the whole, the way in which policy
formulation (and monitoring and evaluation) bodies are
constituted and function remains very much a black box.
Although WHO has for many years promoted the setting
up of such intersectoral bodies, there has been little analysis
of their modus operandi. For the core policy formulation,
implementation and monitoring group to work effectively,
in the United Kingdom it has been suggested (13) that they
should aim to achieve:
• a shared vision and common agenda;
• agreed objectives and priorities;
• agreed roles and policy instruments;
• openness about self-interests; and
• mutual respect, trust and ability for mutual learning, and
agreed methods of dealing with disagreements.
Achieving broader participation
Beyond the core group, participation is another of those
magic words easier said than done. Broad participation is
still an elusive element in many policy development processes
and often time is simply too short for any real consultation
and negotiation. In others, although an attempt is made
to distribute a draft document for comments and suggestions,
the effort already invested in reaching an agreed first
draft often means that there is little chance for the consultation
process to affect the main aims and objectives, but
only to make incremental changes on the details.
Transparency in the participatory process is essential if it is
not to become a mere formality. Countries such as Ireland
made clear reference in certain final policy documents to
comments made on previous versions. Some years ago,
Turkey published separately all comments made by institutions
and individuals on a draft health policy (14).
For broad participation in the planning process, one of the
problems is how to reach a wide target audience. The expansion
of the Internet has, of course, allowed draft policies
to be made available easily and cheaply to those who have
access, as was the case in the drafting of the Hungarian
National Heart Health Programme, and is the case for draft
legislation in most of the case-study countries. Unless a special
effort is made to reach them, however, this leaves out
many of those in poverty and other vulnerable groups. On
the other hand, lobby groups with well-organized NGOs
may have a stronger voice than is sometimes warranted,
influencing priorities to the benefit of their own interest
groups.
Attempts are made in a number of countries to organize
subnational discussions on national policies. Wales, for example,
has used a “cascade” approach involving a manageable
group of people in a first briefing and discussion, the
members of which undertake to carry out a similar effort in
their own regions, and so on down to the local level (15).
Despite the fact that effective involvement of the main
stakeholders is still rather a rhetorical aim in some countries,
there are innovative attempts to achieve wider and
more effective participation. In Ireland, there was at least
one case of evaluating the effectiveness of a consultation
process.
Chapter 5
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Reflections on experiences