making your voice count

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making your voice count!
A primer on health policy and how to influence it
Workshop Presented by Date
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Workshop Objective

• To help voluntary organizations working in
  health be more effective in policy development,
  and in policy dialogue when they choose to enter
  into discussion with one or more levels of
  government.

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Workshop History
VOICE in health policy Project (2002-2005)

• Funded by the Sectoral Involvement in
  Departmental Policy Development (SIDPD) Program,
  Health Canada
• Objectives were
• 1. to increase the policy capacity of Voluntary
  Organizations Working in Health (VOWHs), Health
  Canada and the Public Health Agency of Canada
• 2. to enhance individual and collective
  collaboration by VOWHs in Health Canadas and the
  Public Health Agency of Canadas policy
  development processes

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More Information on VOICE

• Hosted by
• Coalition of National Voluntary Organizations
  (NVO)
• 2002 - 2003
• Canadian Public Health Association (CPHA)
• 2004 2005
• Website

make your voice count!An on-line guide to
collaborative health policy development
www.projectvoice.ca
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Workshop Modules

• 1. Introduction
• Policy basics and health how the federal
  government makes decisions on health policy
• How to hear and be heard strategies and tools
  for connecting with government
• Putting it into practice developing a policy
  strategy
• Reflections on the workshop

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1. Policy basics and health
policy basicsand health
How the federal government makes decisions on
health policy
Material developed from How Government Works, a
workshop of the Institute On Governance
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Session Objectives

• To provide a clearer understanding of the
  structures, roles, processes and values of the
  federal government
• Who are the actors?
• What do they do?
• How do they do it?
• Where does health policy fit?

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What Has To Be Done?
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Working Together
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Shifting Roles of the Sectors
core government
non-profit voluntary sector organizations
quasi-government organizations, state-owned
enterprises
business
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What is Policy?

• Framework for action
• Set of decisions around a public issue
• Translates governments political vision into
  programs and actions to achieve results
• A set of inter-related decisions, taken by
  public authorities, concerning the selection of
  goals and the means of achieving them

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Who is Involved?

• Minister Ministers office
• Central agencies
• Deputy Minister
• Senior officials
• mid-level officials
• headquarters, regional local offices
• other jurisdictions
• international players

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Policy Development Process

• opportunity, problem, change
• identification of basic issue
• analysis
• development of policy program options
• decision department or Cabinet
• introduction of policy program or change
• delivery
• evaluation/monitoring

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Decision Making Cycle
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Cabinet

• Ministers appointed by Prime Minister
• Cabinet Committees, Full Cabinet
• Collegial, confidential decisions
• Ministers bring different views - not just
  departmental
• Privy Council Office controls agenda

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Influences on Policy
research timing (electoral, duration of
process) politics stakeholders
money global developments levels of government
technology existing policies opinion
polls lobby groups personalities of
leaders government priorities Supreme Court
decisions authority other related policies
programs other departments law international
agreements crises shuffles (Ministers,
Deputy Ministers, etc.)
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Possible Delays

• Complexity of issue
• Multiple players or jurisdictions
• Competing priorities
• Cabinet process
• Finding the money
• Legislative or regulatory process

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What are the Policy Priorities?

• Speech from the Throne
• www.pm.gc.ca/eng/sft-ddt.asp
• Budget
• www.fin.gc.ca/access/budinfoe.htmlyear
• Prime Ministers Ministers speeches
• http//pm.gc.ca/eng/feature.asp?featureId2
• Political party platforms
• www.politicswatch.com/parties.htm

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More Information?
How Government Works (on-line) -
www.campusdirect.gc.ca and click on -
free courses - campusdirect How
Government Works General Information on the
Federal Government - www.canada.gc.ca and click
on - about government... - structure of the
government of Canada Information on Public Health
Agency of Canada - www.phac-aspc.gc.ca Information
on Health Canada - www.hc-sc.gc.ca
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How health policy is made in Canada
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Division of Powers

• Federal economy, trade, security, national
  unity, etc.
• Provincial social policy, health, education,
  etc.
• BUTfunds lie with federal government

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Key Pieces of Legislation / Agreements

• The Constitution Act of 1867
• http//laws.justice.gc.ca/en/const/
• The Charter of Rights and Freedoms of 1982
• http//laws.justice.gc.ca/en/charter/
• The Canada Health Act of 1984
• http//laws.justice.gc.ca/en/C-6/

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More Key Agreements

• The Social Union Framework Agreement of 1999
• http//socialunion.gc.ca/news/020499_e.html
• The Commission on the Future of Health Care in
  Canada
• http//www.hc-sc.gc.ca/english/care/romanow/index1
  .html
• The Health Accord of 2003
• http//www.hc-sc.gc.ca/english/hca2003/accord.html
  
• Health Care Renewal Health Canada 2004
• http//www.hc-sc.gc.ca/english/hca2003/index.html

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The Formulation of Health Policy in Canada

• Multiple actors shape health policy
• Health care delivery is provincial/territorial
  jurisdiction (with the exception of Aboriginal
  peoples on reserve)
• Input from voluntary health sector organizations

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How the Players Connect
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The Role of the Federal Government

• Leadership in
• developing implementing policies programs
• enforcing health regulations
• promoting disease prevention
• enhancing healthy living
• reducing health and safety risks
• providing health services to First Nations on
  reserve and Inuit communities
• international health

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Roles of the Provinces and Territories

• Management and delivery of health services
• Planning, financing and evaluating the provision
  of health care
• Public health infrastructure
• Health promotion
• Note The territories are ultimately under
  federal jurisdiction

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Health Canada in the North

• The Northern Secretariat at the First Nations and
  Inuit Health Branch plays a role in Health
  Canadas responsibilities in the North
• Some Health Canada programs are eligible to be
  administered by self-governing First Nations,
  where operationally viable
• At present, Health Canada, either directly or
  through a territorial government, continues to
  operate the Non-Insured Health Benefits (NIHB)
  program

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Municipal Governments and Regional Health
Authorities

• Detailed design and implementation of health care
  services
• Little or no tax base or constitutional authority

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Roles of voluntary health sector organizations
are to

• collaborate with other levels
• help identify analyze issues options
• put forward programming ideas
• deliver services programs
• monitor their effectiveness
• alert other players to concerns, opportunities,
  changes, problems

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About the Public Health Agency of Canada
Health Canada
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Public Health Agency of Canada (PHAC)

• Vision
• Healthy Canadians and communities in a healthier
  world
• Mission
• To promote and protect the health of Canadians
  through leadership, partnership, innovation and
  action in public health

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PHAC Mandate

• In collaboration with its partners, the PHAC
  leads federal efforts and mobilizes Pan-Canadian
  action in preventing disease and injury, and
  promoting and protecting national and
  international public health through the
  following
• Anticipate, prepare for, respond to and recover
  from threats to public health
• Carry out surveillance, monitor, research,
  investigate and report on diseases, injuries,
  other preventable health risks and their
  determinants, and the general state of public
  health in Canada and internationally
• Use the best available evidence and tools to
  advise and support public health stakeholders
  nationally and internationally as they work to
  enhance the health of their communities
• Provide public health information, advice and
  leadership to Canadians and stakeholders
• Build and sustain a public health network with
  stakeholders.

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Health Canada

• Vision
• Health Canada is committed to improving the lives
  of all of Canada's people and to making this
  country's population among the healthiest in the
  world as measured by longevity, lifestyle and
  effective use of the public health care system.

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Health Canada Contd

• Mandate
• Federal department responsible for administering
  the Canada Health Act
• Development of federal health policy in
  conjunction with provincial and territorial
  governments and other stakeholders

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Health Canada Contd

• Mandate (contd)
• Provides supplementary health benefits to First
  Nations on reserve and Inuit peoples
• Current Priorities
• Are updated annually and may be found in the
  Departments Reports on Plans and Priorities

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Taken from Health Canada Departmental Performance
Report, 2002-03
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Public Health Agency of Canada and Health Canada
Regional Offices

• Provide an important link with regional and local
  networks, including provincial and territorial
  governments, voluntary organizations, the private
  sector and the public
• Ensure PHAC and HC programs complement provincial
  priorities and suit local conditions
• Monitor and report on regional trends, issues and
  stakeholder perspectives
• Manage and deliver community-based programs,
  activities and services on behalf of the
  department.

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Who Does What and Why an Example

• Fetal Alcohol Spectrum Disorder

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FASD Federal Provincial Roles

• Federal To develop policies, programs and
  strategies that address awareness and prevention
  of FASD in a sustainable national framework
• Provincial/Territorial Develop, coordinate and
  promote FASD education, training and development
  of resources

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FASD Intergovernmental and Interdepartmental
Strategies

• Early Childhood Development (ECD) Agreement in
  2000
• Four key areas for action
• promote healthy pregnancy, birth and infancy
• improve parenting and family support
• strengthen early childhood development, learning
  and care
• strengthen community support

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The Role of the Voluntary Health Sector

• Types of Groups
• Role of Groups
• Multiple opportunities to influence the FASD
  Initiative

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How the FASD Players Connect
Provincial Territorial Governments -
initiatives and implementation at
provincial/territorial level
Federal Government - national policies,
programs, strategies
Health Voluntary Sector Organizations - policy
dialogue, collaborative initiatives,
implementation
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Questions?
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2. How to hear and be heard
how to hear and be heard
Strategies and tools for connecting with
government
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Session Objectives

• To reinforce the importance and power of your
  organizations voice in the policy debate
• To illustrate how you might build a strategy for
  policy dialogue with government

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Why Get into Policy?
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Start with Attitude

• Voluntary health sector government are natural
  allies
• Voluntary health sector has been source of many
  new public policy ideas and has many strengths
• Voluntary health sector the Government of
  Canada have broad agreement on best practices

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The Voluntary Sectors Value

• A healthy and active voluntary sector plays an
  important role in helping the federal government
  identify issues and achieve its public policy
  objectives. By its very nature and particularly
  because of its connection to communities, the
  voluntary sector brings a special perspective and
  considerable value to its activities, including
  those it undertakes with the Government of
  Canada.
• from A Code of Good Practice on Policy Dialogue,
  Voluntary Sector Initiative, 2002, p.6.

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Build Relationships

• Facts arguments persuade, but people make
  decisions
• Before a major issue arises, get to know key
  players in
• government(s)
• voluntary sector
• communities
• business
• Recognize you share the same goals - the health
  and well-being of Canadians

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The Strategy

• 1. Develop your position
• 2. Find your allies
• 3. Decide who you need to persuade
• 4. Decide who you need to involve
• 5. Identify opportunities
• 6. Develop messages and a story-line
• 7. Develop your approach
• 8. Determine your costs and milestones
• 9. Implement and evaluate
• 10. Success!

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1. Develop Your Position

• Recognize the problem
• Define the problem
• Get the facts
• Do the analysis
• Assess the options
• Assess and manage risk
• Charitable status
• Create a statement of what you want

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Recognize the problem
1. Develop your position

• How do you know you have a problem?

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1. Develop your position
Define the problem
Getting to the Root
Perceived Problem Possible Causes Proposed
Goals/Objectives Perceived Issue Possible
Action
Real Problem Actual Cause(s) Set
Goals/Objectives Issue Game Plan/Action
ANALYSIS
VERIFICATION
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Get the facts
1. Develop your position

• Get them all and get them right
• Keep them up-to-date
• Share them with partners (and government)

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Do the analysis
1. Develop your position

• Program / Policy Contextual Analysis
• Quantitative Approaches
• Stakeholder Analysis
• Political Contextual Analysis
• Is it do-able?

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Where to look locally
1. Develop your position

• For information and analysis
• Organizations that scan the environment
• Knowledgeable people
• Sources of written material

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Assess manage the risk
1. Develop your position

• Do a realistic assessment of risks and
  opportunities before engaging in the policy
  development process.
• Monitor the risks and opportunities throughout
  the process
• Consult the VOICE projects Risk and Opportunity
  Assessment Engaging in the Health Policy
  Process, July 2003

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Questions to ask about risk
1. Develop your position

• Ask questions related to your organizations
• mandate
• resources
• policy knowledge
• collaborative strengths
• commitment
• other relationships
• the public good

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Charities political activities
1. Develop your position

• Policy statement (CPS-022) from the Canada
  Revenue Agency (CRA) applies to registered
  charities
• www.cra-arc.gc.ca/tax/charities/policy/cps/cps-022
  -e.html
• Policy statement narrows what CRA interprets as
  political activities to no longer include many
  attempts to inform public opinion on an issue.

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Develop assess the options
1. Develop your position

• Part of normal routine for any organization
• Generally important to do before entering into
  dialogue with government
• Explore opportunities to develop and assess
  options alongside government colleagues

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Create a clear statement
1. Develop your position

• Reduces risk of misunderstanding, confusion or
  omission of important elements
• Proposing a decision can be helpful in framing
  discussions

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2. Find Your Allies

• other organizations - create or join a coalition
• media
• decision-makers
• their advisors
• the prominent and quotable
• etc.

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3. Decide Who You Need to Persuade

• The decision-makers
• Those who influence decision-makers
• Those who could derail you

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Perspective ofthe Key Players
3. Decide who you need to persuade

• Senators
• Members of Parliament (MPs)
• Ministers

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More Key Players
3. Decide who you need to persuade

• Ministers staff
• Public Servants
• And, factor in personality

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4. Decide Who You Need to Involve

• Staff
• Volunteers
• Your Board
• Your members and community

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5. Identify Opportunities

• Governments have many priorities
• - be prepared to answer Why Now?
• What presents an opportunity?
• Crises
• Transition change of government, change of
  leadership, an election, a Speech from the Throne
  etc.
• Decision Points consultations on new issues,
  new programs introduced, the Budget etc.
• Events

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6. Develop Messages Story

• Messages should be drawn from clear statement of
  position
• Story-line should be pyramidal

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7. Develop Your Approach

• Creating policy documents
• Convening policy events
• Communication materials
• Personal contact - meetings and correspondence

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Creating policy documents
7. Develop your approach

• A statement of the issue or challenge
• Background information
• Analysis
• A position statement on how the issue should or
  could be addressed

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Convening policy events
7. Develop your approach

• Consider organizing a meeting and inviting
  government to collaborate and/or attend
• Policy events come in many different shapes and
  sizes
• Many benefits of policy events

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Communications material
7. Develop your approach

• Create a plan
• Consider timing
• Web-site, media, print, advertising/public
  service announcements
• Consider getting expert help

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Meetings and correspondence
7. Develop your approach

• The personal touch
• meetings with key decision-makers and people with
  influence
• correspondence

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8. Determine the Costs

• Look at the range of potential costs financial,
  human resources, level of service to clients
• Consider additional sources of funding
  government, foundations, donated services
• Set milestones

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9. Implement Evaluate

• Implementation - The strategic plan is not an end
  in itself
• Evaluation - Your strategy and the impact of the
  policy change

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10. Success!

• Give credit where credit is due
• Thank those who made the changes and supported
  your cause

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Questions?
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3. Putting it into Practice
putting it into practice
Developing a policy strategy
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Session Objectives

• To apply the knowledge and skills learned in the
  previous sessions to a relevant issue.
• To have participants share ideas on best
  practices for policy dialogue with government.

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Case Study Instructions

• 1.Work in your small group to assess the case
  study, or your local health issue, and taking the
  role of the Executive Directors of the lead
  organization, develop a strategy for engaging
  government. (60 - 75 minutes)
• 2. Choose one person to present your strategy to
  the larger group (the group will be acting as
  your Board of Directors). Each presentation
  should be no more than 10 minutes. Be prepared
  to answer questions!

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Small Group Questions

• Using the information either provided in the case
  study or based on what you know of your local
  issue, develop the following elements of a policy
  strategy
• define what your position is
• determine who can help you - your allies
• decide who you need to persuade and who you need
  to involve
• identify opportunities of when to present your
  position
• develop messages which indicate your position
• choose the tools to communicate your message

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Reporting Back

• Present the results of your strategy to the Board
• Some time will be allowed for questions
• What did we learn from the process of developing
  a policy strategy?
• Where do we go next?

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making your voice count!
Reflections on the workshop
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Decision-Making Cycle
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Build Relationships

• Facts arguments persuade, but people make
  decisions
• Before a major issue arises, get to know the key
  players
• Assume you share the same goals - the health and
  well-being of Canadians

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Have A Strategy

• 1. Develop your position
• 2. Find your allies
• 3. Decide who you need to persuade
• 4. Decide who you need to involve
• 5. Identify opportunities
• 6. Develop messages and a story-line
• 7. Choose your approach
• 8. Determine your costs milestones
• 9. Implement and evaluate
• 10. Success!

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The Voice of the Voluntary Sector Matters.Hear
and Be Heard!
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