An innovative approach to participatory health policy development in Bulgaria: The conception and first achievements of the Partnership for Health

The Bulgarian Partnership for Health was established in 2015 as a new forum for health policy formulation and discussion. The Partnership presents a new approach of structured and sustained stakeholder involvement to overcome the lack of public participation in health policy development and implementation. Constituted as a permanent consultative body to the Council of Ministers, the Partnership engages a wide variety of stakeholders and professionals to shape and improve health policies. The shared governance of the Partnership between the Minister of Health and a patient organisation supports the elaboration of legislative acts based on the stakeholders' collaboration in priority areas. The governance and organisational structure of the Partnership assures capacity building, fast mobilisation of experts, continuity of stakeholder involvement, and increased responsibility in health policy development and implementation. This type of participatory approach may help reconcile initially opposing positions and foster reforms often impeded by political antagonism. Persisting challenges are a rather slow process of policy development and different perceptions of key concepts among the stakeholders. As policy-making in many countries in Eastern Europe suffers from political distrust, the Partnership's approach of involving experts - and not only politicians - could provide inspiration also to other countries, which have struggled with inconsistency of health policies pursued by different governments.     

Local health policy development processes in the Netherlands: an expanded toolbox for health promotion

Although much research has been done on the existence and formation of risk and issue based health policies, there is only little insight in health policy development processes in a broader context. This hampers intervention in these policy processes to adequately develop integrated and effective health policies. Legislation in the Netherlands requires municipalities to develop and implement local health policies. These policies are supposed to aim at the promotion of health across sectors and with a strong community involvement. Health policy development processes have been studied in four Dutch municipalities. For each case, we identified a range of stakeholders and monitored the change or stability of their characteristics over 3 years. In addition, for each case, three overlaying maps of networks were made addressing communication and collaboration actions within the defined set of stakeholders. We point out a number of barriers which impede integrated policy development at the local level: the importance given to local health policy, the medical approach to health development, the organizational self-interest rather than public health concern, the absence of policy entrepreneurial activity. Furthermore, this article advocates the use of complementary theoretical frameworks and the expansion of the methodological toolbox for health promotion. The value of stakeholder and network analysis in the health promotion domain, at this stage, is two-fold. First, mapping relevant actors, their positions and connections in networks provides us with insight into their capacity to participate and contribute to health policy development. Second, these new tools contribute to a further understanding of policy entrepreneurial roles to be taken up by health promotion professionals and health authorities in favour of the socio-environmental approach to health. Notwithstanding the value of this first step, more research is required into both the practical application as well as in the theoretical connections with, for example, Multiple Streams theory.     

基于利益相关者理论的农村县乡两级医疗服务整合作用机制分析

目的:分析利益相关者的利益诉求对农村县乡两级医疗服务纵向整合的影响机制。方法:通过对黔江、黄陂、扬中三地区的利益相关者访谈资料进行词频分析,确定各地区利益相关者的利益诉求;通过利益诉求调查问卷了解各地区利益相关者对各类诉求的重视程度和利益得失情况;借鉴综合评价和博弈论的理论方法分析各地区利益相关者的诉求得益情况对其行为反应的影响。结果:各地区的整合政策均在不同程度上反映了利益相关者的利益诉求;利益诉求效益评分越高的地区,其利益相关者对整合政策的行为配合意愿越强。结论:农村医疗服务整合的改革政策应综合考虑各利益相关者的利益诉求;利益相关者的利益诉求满足情况越好,其配合整合改革的动力越强,从而可在一定程度上影响当地整合改革的实施效果。     

Stakeholder perspectives towards implementing the national framework on palliative care in Canada

ContextIn 2018 Health Canada developed a national framework and subsequent action plan for palliative care. Collaboration and implementation by stakeholder organizations however continues to take place without coordination. Little is known about their attitudes toward national policy development and motivation to work together.MethodsWe employ a well-known stakeholder analysis framework to identify and understand the attitudes of key stakeholders. Organizations that have contributed to national palliative policy development over the past 25 years were identified and prioritized. In this paper, we survey key stakeholders to understand their attitudes towards collaboration and implementation of the 2018 Framework. A novel method to identify homogeneous stakeholder cohorts was developed.FindingsFifty-four out of 75 key organizations (72%) completed the survey. Organizations genuinely support the Framework. However, three-quarters of organizations were not confident in their abilities to strongly influence national palliative care policies. Barriers to collaboration include differences in governance models and funding arrangements, a lack of resources and divergent priorities. Homogeneous stakeholder cohorts and in-depth analysis of stakeholder characteristics resulted in recommendations to support targeted engagement strategies.ConclusionsImplementation of national palliative care policies requires a large-scale coordinated approach involving all stakeholders. Recommendations are centered on the premise that targeted and tailored stakeholder engagement needs to be coordinated and is superior to a one-size fits all approach.     

Toward totally smokefree schools and beyond: the Crown Public Health Smokefree Schools Grant Program.

A three-year small grants scheme in Canterbury and the West Coast, New Zealand aims to influence the health promoting climate of schools by adopting totally smokefree policies. The Smokefree Environments Act of 1990 established the legal imperative for school policies. The principles of the Treaty of Waitangi and the strategies of the Ottawa Charter provide the programmatic and evaluation framework. Evaluation indicators include the organizational and policy context, status of school smoking policies, reasons for participation, stakeholder involvement, the value of additional funding, and the extent of media coverage. Partnerships among local smokefree partners, schools and whanau/communities, and between the health and education sectors are a priority. Interim findings indicate the Crown Public Health Smokefree Schools Grant program has positively influenced policy development toward totally smokefree schools. Based on these results and the changing environment, the smokefree efforts are being integrated into the broader context of health promoting schools.     

The process of social participation in primary health care: the case of Palencia,Guatemala

Background In 2008, the World Health Organization issued a callback to the principles of primary health care, which renewed interests in social participation in health. In Guatemala, social participation has been the main policy for the decentralization process since the late 1990s and the social development council scheme has been the main means for participation for the country’s population since 2002. Aim The aim of this study was to explore the process of social participation at a municipal‐level health commission in the municipality of Palencia, Guatemala. Methods Analysis of legal and policy documents and in‐depth interviews with institutional and community‐level stakeholders of the commission. Results The lack of clear guidelines and regulations means that the stakeholders own motivations, agendas and power resources play an important part in defining the roles of the participants. Institutional stakeholders have the human and financial power to make policies. The community‐level stakeholders are token participants with little power resources. Their main role is to identify the needs of their communities and seek help from the authorities. Satisfaction and the perceived benefits that the stakeholders obtain from the process play an important part in maintaining the commission’s dynamic, which is unlikely to change unless the stakeholders perceive that the benefit they obtain does not outweigh the effort their role entails. Conclusion Without more uniformed mechanisms and incentives for municipalities to work towards the national goal of equitable involvement in the development process, the achievements will be fragmented and will depend on the individual stakeholder’s good will.     

合理用药相关利益集团分析

目的:利用利益相关者(Stakeholder)分析方法对相关利益集团在合理用药政策落实过程中的动力和阻力进行综合分析,为确定我国合理用药的优先干预措施提供依据。方法:现场调查法、专家法和利益相关者分析法。结果:以政府为首的利益集团实施现有合理用药干预措施的意愿和能力较强,实施情况却不理想;以医疗机构为代表的利益集团实施意愿和实施情况较差,实施能力却最强;患者属弱势群体,实施能力最弱,实施意愿却最强。结论:对于以政府为首的政府利益集团,重点是要进行开发和协调;对以医疗机构为代表的利益集团,干预重点是要加强管理和管制,约束其行为;对于患者,重点是进行宣传和教育,提高对合理用药的认识和和维护自身权益的意识。     

定点零售药店纳入门诊统筹管理政策对利益相关者的影响分析

目的: 为完善定点零售药店纳入门诊统筹管理政策提供依据。方法: 基于利益相关者理论,结合文献综述、定性访谈分析定点零售药店纳入门诊统筹管理政策的实施对利益相关者的影响。结果: 理想层面,定点零售药店纳入门诊统筹管理政策的顺利实施能够缓解职工医保个人账户改革所带来的冲击,缓解医疗机构就诊压力,提升参保人购药的便利性。然而,受制于政策设计不完善、配套措施跟进不及时等因素,短期内政策产生的实际效果与理想状态存在差异。讨论和建议:医保部门持续收集政策实施的相关反馈,不断优化政策设计;完善政策时以参保人为核心,兼顾多方主体利益;充分了解相关主体的特点和利益关系,强化医保基金监管。     

新医改背景下利益相关者分析方法的应用现况

利益相关者分析方法作为一种政策分析方法,已广泛应用于西方国家的企业管理与卫生政策改革研究和实践,也为我国卫生改革政策的制定与实施提供新分析视角。文章对我国利益相关者分析方法在卫生领域的应用进行了回顾。     

医疗损害无过错补偿制度利益相关者分析

本文运用利益相关者分析法,对医疗损害无过错补偿制度构建中涉及到的利益主体的诉求、立场、权力和角色进行分析,认为政府包括卫生行政部门是政策的具体构建者和重要主导者,需利用其公权力主导该制度的构建和试运行;医方、患者及其家属是政策的直接受益者,但需要通过建立多元化筹资渠道、设定合理补偿范围等方式来保障制度良好运转;司法鉴定机构和专家团体是政策实施的重要保障方,但需统一鉴定制度,并引入专家团体评价机制;保险行业是政策实施的重要推进者,但需通过扩大筹资途径等方式提高其参与程度;新闻媒体对政策构建与推行具有重要影响,需进行适当引导以发挥其正面促进作用。     

Meeting report: national workshops for the communication of air pollution and health information: summary of four workshops in different regions of Europe

AIRNET was a thematic network project (2002-2004) initiated to stimulate the interaction between researchers in air pollution and health in Europe. As part of AIRNET's communication strategy, a standardized workshop model was developed to organize national meetings on air pollution and health (AIRNET network days) . Emphasis was given to tailor the national workshop information and related activities to the specific needs of a wider range of stakeholders (e.g., policy makers, nongovernmental organizations, industry representatives) . In this report we present an overview of the results of four workshops held in western, northern, central/eastern, and southern regions of Europe in 2004. Overall, workshop experiences indicated that by actively involving participants in the planning of each meeting, AIRNET helped create an event that addressed participants' needs and interests. A wide range of communication formats used to discuss air pollution and health also helped stimulate active interaction among participants. Overall, the national workshops held by AIRNET offered a way to improve communication among the different stakeholders. Because a broad stakeholder involvement in decision making can positively affect the development of widely supported policies, such meetings should be continued for Europe and elsewhere.     

Nutrition policies for schools

In Britain, Canada and the United States, the impetus for initiating school nutrition policies has come primarily from health, not education, agencies. These agencies define the nutrition problems of school students as both under‐ and over‐nutrition, and, to solve them, advocate the development and implementation of policies to combat health and learning problems associated with poor nutrition. Health, rather than educational, agencies are also more likely to formulate school nutrition policies; such policies commonly address the dietary principles of access, adequacy, and moderation. Within countries, the adoption of school nutrition policies varies considerably. Moreover, the degree to which such policies have been implemented is unclear, because of a lack of research to evaluate their process and impact. To enhance the successful development and implementation of school nutrition policies, greater partnership between health and education agencies is recommended throughout the policy process.     

Evidence based primary care? A multi‐tier,multiple stakeholder perspective from Chile

A new challenge in health policy is the implementation of evidence-based practice. It is useful to look at international experiences which go beyond the conventional USA and UK examples. Health sector restructuring in Chile has as its goals: using evidence-based decision-making to reduce variations of practice, contain costs and increase the effectiveness of clinical practice. A key area of change is within primary health care. But how does the implementation of evidence-based health care proceed in reality? In order to understand this, it was decided to assess the policy environment using stakeholder analysis. METHODS: Fifteen stakeholders from the public health sector were interviewed in depth using a snowball strategy for sampling. Material relating to perceptions, thoughts and aspirations about evidence-based innovations in primary health care was collected. Content analysis of the material produced a matrix of criteria and indicators of operational power. RESULTS: Concepts of evidence and effectiveness are different according to the role of each stakeholder in the health system. Most innovations proposed by government are related to management and stakeholders considered them as not being evidence-based. Informal mechanisms of decision-making predominated over the formal. Political issues are more important than formal evidence. All stakeholders felt they had power to define policy criteria but not to implement them. Implementation difficulties are related to how the system is organized and the culture within each organization. Most stakeholders indicated the need for human resources with appropriate knowledge and personal skills in order to implement these changes. These findings reveal again the importance of human factors within organizations. Policy-making should consider such processual aspects in order to implement changes in practices in Chilean health care system more effectively.     

Stakeholder analysis: a review

The growing popularity of stakeholder analysis reflects an increasing recognition of how the characteristics of stakeholders--individuals, groups and organizations--influence decision-making processes. This paper reviews the origins and uses of stakeholder analysis, as described in the policy, health care management and development literature. Its roots are in the political and policy sciences, and in management theory where it has evolved into a systematic tool with clearly defined steps and applications for scanning the current and future organizational environment. Stakeholder analysis can be used to generate knowledge about the relevant actors so as to understand their behaviour, intentions, interrelations, agendas, interests, and the influence or resources they have brought--or could bring--to bear on decision-making processes. This information can then be used to develop strategies for managing these stakeholders, to facilitate the implementation of specific decisions or organizational objectives, or to understand the policy context and assess the feasibility of future policy directions. Policy development is a complex process which frequently takes place in an unstable and rapidly changing context, subject to unpredictable internal and external factors. As a cross-sectional view of an evolving picture, the utility of stakeholder analysis for predicting and managing the future is time-limited and it should be complemented by other policy analysis approaches.     

Utilizing the school health index to build collaboration between a university and an urban school district

BACKGROUND: Insufficient attention has been paid to the process of conducting the Centers for Disease Control and Prevention's School Health Index (SHI) to promote collaboration between universities and urban school districts when developing adolescent health promotion initiatives. This article provides an overview of the real‐world contextual challenges and opportunities this type of collaboration can pose. METHODS: The SHI and selected collaboration principles were used to facilitate partnership and increase stakeholder buy‐in, which led to developing and implementing an 8‐year health promotion campaign. RESULTS: The focus on planning brought together key stakeholders to allow for health promotion programming to take place, despite the competing demands on the schools. The SHI allowed for input from stakeholders to develop campaign activities and inform school‐ and district‐wide policy. Universities and school districts desiring to develop and implement school‐based, adolescent health promotion programs should (1) identify the hierarchical structure of the school district, (2) establish credibility for the program and the university staff, (3) emphasize the benefits to all partners, (4) maintain a cooperative partnership with teachers and administrators, (5) appreciate the need for planning, and (6) provide as many resources as possible to aid an already overburdened school system. CONCLUSIONS: Promoting healthy behaviors among students is an important part of the fundamental mission of schools. The significance of collaboration using the SHI, with direct input from students, teachers, administrators, and university partners, is critical in the development of institutional support for implementation of adolescent health promotion initiatives.     

Workplace health promotion and stakeholder positions: a Finnish case study

Modern workplace health promotion (WHP) requires collaboration, partnerships, and alliances with both internal and external stakeholders. However, the identification of the key stakeholders as well as the systematic mapping of their views has barely been covered in the existing research literature. This article describes the stakeholders and stakeholder positions in WHP in Finland. In this study, the stakeholders were classified as internal, interface, and external stakeholders. Furthermore, based on the authors' research, stakeholders and their positions were represented on a stakeholder map as well as by the power-interest matrix of the stakeholders. The governmental authorities play a key role in driving the strategic change toward WHP by preparing the required legislation and regulatory measures. However, both active employers and active employees can through their own work accelerate the development of new WHP services. Close collaboration between employers and employees is required at the individual workplaces. Some stakeholders, such as pension funds and occupational health services (OHS) providers, can act as important driving forces and support the strategic implementation of WHP in the workplaces. However, alone they have only limited opportunities to organize the WHP activities. Understanding the various stakeholders and the systematic mapping of their positions is essential for the successful planning and implementation of WHP activities.     

Health impact assessment.

There is growing concern about the environmental, social and health consequences of development projects. Environmental impact assessment (EIA), which aims to address this concern, is often conducted with little input from the health sector. Quantifying the health benefits and risks of a project or policy requires an innovative synthesis of socio-demographic, environmental health, epidemiological and health systems data. This article provides a simple framework for health impact assessment (HIA), a method for describing and measuring the impact of a project or policy on health and wellbeing, and designing appropriate interventions. The key components of HIA are: review of available data; research and identification of priority health issues through the use of rapid assessment methods; design of a health action plan with stakeholder consultation; implementation of interventions and the monitoring of long-term health impacts. HIA can assist in ensuring that development and policies are 'health promoting' and that the health sector plays a meaningful role in EIA.     

Enacting sustainable school-based health initiatives: a communication-centered approach to policy and practice

Communication plays an important role in all aspects of the development and use of policy. We present a communication-centered perspective on the processes of enacting public health policies. Our proposed conceptual framework comprises 4 communication frames: orientation, amplification, implementation, and integration. Empirical examples from 2 longitudinal studies of school-based health policies show how each frame includes different communication processes that enable sustainable public health policy practices in school-based health initiatives. These 4 frames provide unique insight into the capacity of school-based public health policy to engage youths, parents, and a broader community of stakeholders. Communication is often included as an element of health policy; however, our framework demonstrates the importance of communication as a pivotal resource in sustaining changes in public health practices.