Implementing Policies Effectively: The way forward

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Implementing Policies Effectively The way
forward

• Jennifer Frances dela Rosa, MSc
• Fely Marilyn Lorenzo, DrPH
• Institute of Health Policy and Development
  Studies, NIH- UPM and
• College of Public Health, UPM
• 4th Public Health Convention on the Prevention
  and Control of Non-Communicable Diseases

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Policies

• MTPPAN
• Food Fortification Act
• Asin Law
• A0. 88-B s. 1994 (Rules and regulations governing
  the labeling of prepackaged Food Products
  Distributed in the Philippines)
• Price Act
• Consumers Act
• Tobacco Regulation Act 2003
• Tobacco Control Ordinances
• Memorandum No. 362 s. 2004 Kineti-kids
• LGU policies on sidewalks, parks and bike lanes
• Memo Circular No. 38, 1992 (Physical and Mental
  Fitness Program for Government Personnel)

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Recommendations

• Policy Agenda
• Research Agenda

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Policy Agenda

• 1. Mandate fast food chains and restaurants to
  keep public informed of the nutritional value of
  food offerings (e.g. in grams and calories,
  stipulation of nutritional value of food
  offerings including fat and salt content)
• 2. Monitoring of fat and salt content of fast
  food and restaurant offerings

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Policy Agenda

• 3. Stipulate Incentives
• Schools with a healthy student profile
• Business entities with a healthy human resource
  profile (eg. California Fit Business Award)
• Fast food outlets and restaurants complying with
  keeping public informed of the nutritional value
  of food offerings and fat and salt acceptable
  levels
• 4. Pursue the NNC policy agenda
• Amend PD 1569 (Barangay Nutrition Scholars)
• Amend RA 8976 (Food Fortification Law)
• Pass ordinances in support of the ASIN law

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Policy Agenda

• 5. Integration policies
• Focus prevention and health promotion
  interventions
• Young persons in schools
• To promote provision of healthy food, prevention
  of uptake of smoking and longer periods of
  exercise for all levels with the inclusion of
  early screening through the Stepwise surveillance
• Adults in the workplaces
• To promote provision of healthy food, tobacco
  control and regular exercise

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Research Agenda

• Review MTPPAN implementing guidelines (NNC)
• Determine the effectiveness and efficiency of
  food fortification as an intervention (NNC, DOH)
• Evaluate implementation of the effectiveness of
  the policy on labeling (AO 88-B s. 1994) (BFAD)
• Review the criteria to determine what food to
  fortify and what level of fortificant to use
  (Food Fortification Act) (BFAD)

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Research Agenda

• Review information/ messages disseminated to the
  public through quad media to correct
  misconceptions that fortified food is healthy
  food (Food Fortification Act) (BFAD, PIA)
• Review implementation guidelines for possible
  revisions and updating of the Consumers Act
  (DTI, DOH, DFA)

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Research Agenda

• Review curriculum re Kineti-Kids-Fitness Program
  for School Children (Memorandum No. 362 s. 2004)
  (DepED)
• Review implementation guidelines re sale and
  consumption of healthy food (Memorandum No. 373
  s. 1996) (DepED)
• Review implementation guidelines re physical and
  mental fitness program (Memo Circular No. 38 s.
  1992) (CSC)
• CEA/ CBA of NCDPC strategies (DOH)

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Next Steps

• 1. How can the NCDPC coalition and the DOH
  prioritize policy and research directions?

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Priority Setting

• Legislative agenda
• Legitimacy
• Feasibility
• Support
• Time frame
• Desired policy impact

• Research agenda
• Funding
• Expertise
• Rigor - methodology
• Urgency - would the results of the study lend to
  the creation/ revision of the policy?

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Next Steps

• 2. How can these priority policies and research
  directions be implemented?

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The Policy Change Cycle
Policy or Plan Maintenance, Succession
or Termination
Policy of Plan or Formulation
Proposal Review and Adoption
Implementation And Evaluation
Containment Mechanisms
Triggering Mechanisms
Public Agenda
Formant Agents
The Policy Environment
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Policy Implementation

• Translation of Policy to Action
• What occurs between policy expectations and
  (perceived) policy results
• Common to observe a gap between what was
  planned and what occurred as a result of policy
• Government reforms are currently focused on
  devising systems that increase the likelihood
  that governments policies will be implemented
  in the way that ministers intended and that
  provide information on policy impact

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Policy Implementation

• Drafting of legislation or regulations
• Negotiation of agreements
• Allocation of resources
• Development of programs to achieve policy
  objectives
• Policy formulation and implementation are 2
  elements that exist in a continuous loop both
  are political in nature

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Implementation Strategy (Spasoff, 1999)

• Policy implementation is enhanced through the
  development of and implementation strategy
• Goal Setting
• Vision, Goals, Objectives and Targets
• Allocating Health Resources
• Information systems
• Monitoring and evaluation

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1. Goal Setting

• Emerged as part of strategic planning
• Key contributions to implementation
• Ability to focus attention on a topic
• Maintain a sense of direction
• Guide resource allocation and programming
• Measure progress.

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1. Goal Setting

• Usually done by a credible task force with wide
  representation
• Vision Statement
• Towards goals point to set of guiding principles
  and values
• Goals
• Broad statements of desired states or directions
  to move to
• Generally not quantitative and not necessarily
  attainable but should be statements against which
  policies/ programs could be tested
• Objectives
• Make goals realizable SMART
• Targets
• Specifies the amount of progress and the time by
  which it is do be made
• Definitive

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1. Goal Setting

• Achievement of goals require
• Substantial SUPPORT and ACTION from the many
  agencies whose activities influence health
  (hardest step)
• Systems must be established to monitor progress
  toward achievement of goals

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2. Resource Allocation

• Most definitive step in policy making
• Explicit or active
• Resources are allocated according to a formula
• Implicit or passive
• Allocation can be described in retrospect as
  things just happen
• Includes allocation for targeted populations,
  specific diseases or health problems, providers,
  specific treatments and technologies

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3. Information Systems

• Must be used not only for administrative purposes
  but also for planning, evaluation and research
• Essential information
• Target population
• Key indicators for implementation
• Cost of program
• Outcome indicators
• Adverse outcomes
• Other events

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3. Information Systems

• Individual information
• Demographic data
• Provider information e.g. Individual physicians
• Services provided
• Outcomes

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4. Monitoring and Evaluation

• Gathering of relevant information
• Measurement of data
• Feedback mechanism

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Strategies Coordination, Collaboration and
Networking

• Vital activity of the Coalition
• Coordination Assemble and synchronize
  differentiated work efforts harmonize of
  individual efforts
• Collaboration and Networking inter-organizationa
  l interactions of exchange, concerted actions and
  joint production

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Advocacy

• Organization and deliberate use of information to
  persuade a specific audience to take action or to
  influence decision making
• Done to change policies and programs
• To expand organized efforts of partners and
  mobilize them
• To convince/ get commitment of target audience to
  act on the problem or issue

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Key Points in ensuring effective policy
implementation
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Necessary and Sufficient Conditions for Effective
Policy Implementation (Buse et al, Hogwood etal)

• Adequate causal theory
• Clear and logically consistent objectives
• A structured implementation process to enhance
  compliance by implementers
• Adequate time and significant resources are
  available
• Required combination of these resources is
  available

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Necessary and Sufficient Conditions for Effective
Policy Implementation

• Presence of a committee with skillful officials
  tasks are fully specified in correct sequence,
  perfect communication and coordination those in
  authority can demand and obtain perfect
  compliance dependency relationships is minimal
• Support from interest groups and legislature
• No changes in socio-economic conditions that
  undermine political support or the causal theory
  underlying the policy (e.g.calamities)

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Maraming Salamat po!
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2. Nature of Cooperation

• Assembly of factors for successful implementation
  
• What are essential elements ?
• Who controls the essential elements?
• Availability of policy brokers fixers?