Kebijakan

Kesehatan

Amal C. Sjaaf

1
 What is
Policy ?
Anything a government chooses to do, or not to do. It
is about decisions of government, including the
decision to do.
General principles of right and wrong, which prevail
within the jurisdiction of a governmental entity laws,
plans, actions, behaviors of a government.
Policy is often distinguished from administration,
management, implementation or delivery. The
distinction is captured by the language of steering
ie. policy and rowing ie. doing.
2
 A broad statement regarded by the legislature or by the
courts as being of fundamental concern to the state
and the whole of society.
Covers government action, inaction, decisions and non-
decisions as it implies a very deliberate choice between
alternatives.
A complex phenomenon consisting of numerous
decisions or action made by government, individuals
and organisations that addresses problems and issues.
May be set by heads of government at any level of
government. Some levels may have formal or legal
precedence over others.
3
 The body of principles that underpin the operation of
legal systems addresses the social, moral and
economic values that tie a society together: values that
vary in different cultures and change over time.
An officially expressed intention backed by a sanction,
which can be a reward or a punishment. A course of
action (or inaction), a public policy can take the form of
a law, a rule, a statute, an edict, a regulation or an
order.
Policies are on-going and dynamic and therefore are
subject to change, particularly in response to problems
arising out of implementation of a decision.
4
 Policy as authoritative choice : policy is the exercise of
authority by those who legitimately have that capacity
conferred on them by the constitution and politics of the
country.
Policy as hypothesis : directs attention to the desirability
of seeing policy not as the final answer, but as a learning
process. There is always the possibility of unintended
consequences.
Policy as objective : a course of action by government
designed to achieve certain results. Public policy is
ultimately about achieving objectives. It is a means to an
end.

5
 Modernising
policy
Strategic looks ahead and contributes
to long-term government goals.
Outcome focused aims to deliver
desired changes in the real world.
Joined up operates across the
organisational boundaries of government.
Inclusive fair and takes account of
the interests of all.
Flexible and Innovative tackles cause,
not symptoms, and is not afraid of
experimentation.
Robust stands the test of time and
works in practice from the start.
6
 Types of Public Policy

Vertical policy :
developed within a single organizational structure and
generally starts with broad overarching policy
from broader policy as its starting point to specific policy
should maintain consistency with it.

Horizontal policy :
policy developed between or among organizational
components or sectors within government or the policy
community.
Categories : sectoral, multi-sectoral, integrated policy.
7
 Policy Context

Demographic trends :
Population trends with gender and geographical
disaggregation, outward migration and internal migration,
mortality and morbidity data.
Economic trends :
economic future/growth, level of income, income
distribution, unimployement rate
Fiscal trends :
budget for the current year, forecast 3-5 years ahead,
crisis that forces immediate and short term adjustment to
the spending plans.
8
 Kebijakan
Pemerintah
Sumber hukum adalah sumber yang dijadikan bahan untuk
penyusunan peraturan perundang-undangan,
Sumber hukum terdiri atas sumber hukum tertulis dan tidak
tertulis,
Sumber hukum dasar nasional adalah Pancasila
sebagaimana yang tertulis dalam Pembukaaan Undang-
Undang Dasar 1945, yaitu Ketuhanan Yang Maha Esa,
Kemanusiaan yang adil dan beradab, Persatuan Indonesia,
dan Kerakyatan yang dipimpin oleh hikmat kebijaksanaan
dalam permusyawaratan/perwakilan, serta mewujudkan
suatu Keadilan Sosial bagi seluruh Rakyat Indonesia, dan
batang tubuh Undang-Undang Dasar 1945.
 Tata urutan peraturan
perundangan
Tata urutan ini merupakan pedoman dalam pembuatan aturan
hukum dibawahnya :
Undang-Undang Dasar 1945
Ketetapan Majelis Permusyawaratan
Undang-Undang
Peraturan Pemerintah Pengganti Undang-Undang
Peraturan Pemerintah
Peraturan/Keputusan Presiden
Peraturan Daerah
Sesuai dengan tata urutan peraturan perundang-undangan ini,
maka aturan hukum yang lebih rendah tidak boleh bertentangan
dengan aturan hukum yang lebih tinggi
What is Health
Policy ?
Health policy may cover public and private policies about
health which is assumed to embrace courses of action
(and inaction) that affect the set of institutions,
organizations, services and funding arrangements of the
health system.
It includes policy made in the public sector (by
government) as well as policies in the private sector
which cover the actions and intended actions of
organizations external to the health system which have an
impact on health (for example, the food, tobacco or
pharmaceutical industries).
11
What is Health
Policy ?
An economist may say health policy is about the
allocation of scarce resources for health;
A planner sees it as ways to influence the determinants
of health in order to improve public health; and for a
doctor it is all about health services (Walt 1994).
Health policy is synonymous with politics and deals
explicitly with who influences policy making, how they
exercise that influence, and under what conditions
(Walt 1994).

12
UNDANG-UNDANG REPUBLIK INDONESIA
NOMOR 9 TAHUN 1960
TENTANG
POKOK-POKOK KESEHATAN

KETENTUAN-KETENTUAN UMUM
TUGAS PEMERINTAH
ALAT-ALAT PERLENGKAPAN
PEMERINTAH
USAHA SWASTA
PERATURAN PERALIHAN

13
 Sistem Kesehatan
Nasional
SK Menkes No.
99a/SK/MenKes/III/1982

Pemikiran RPJPK Bentuk Pokok

Dasar SKN s/d 2000 Penyelenggaraan

14
 Sistem Kesehatan
Nasional
SK Menkes No.
Pemikiran 99a/SK/MenKes/III/1982
dasar
Pendahuluan
Landasan
Pokok-Pokok Penyelenggaraan
Penutup

Rencana Pembangunan Jangka Panjang (2000)

Pendahuluan
Keadaan dan Masalah serta Kecenderungan Tahun
2000
Kebijaksanaan dan Langkah-Langkah
Pokok-Pokok Upaya Kesehatan
Penggerakan Pelaksanaan Upaya Kesehatan
Sumber Daya
Penahapan Pelaksanaan
Pengendalian dan Penilaian
Penutup
15
 Sistem Kesehatan
Nasional
SK Menkes No.
99a/SK/MenKes/III/1982
Bentuk Pokok
Pendahuluan
Keadaan dan Masalah Penorganisasian Upaya
Kesehatan
Dasar Bentuk Pokok Sistem
Bentuk Pokok Penyelenggaraan Sistem
Pelaksanaan dan Pengembangan Upaya Kesehatan
Manajemen Upaya Kesehatan
Sumber Daya Upaya
Peraturan Perundang-undangan
Penahapan Pelaksanaan
Penutup

16
UNDANG-UNDANG REPUBLIK INDONESIA
NOMOR 23 TAHUN 1992
TENTANG
K E S E H A T A N

K E T E N T U A N U M U M
ASAS DAN TUJUAN
HAK DAN KEWAJIBAN
TUGAS DAN TANGGUNG JAWAB
UPAYA KESEHATAN
SUMBER DAYA KESEHATAN
PERAN SERTA MASYARAKAT
PEMBINAAN DAN PENGAWASAN
PENYIDIKAN
KETETUAN PIDANA
KETENTUAN PERALIHAN
KETENTUAN PENUTUP
17
 TAP MPR No X Tahun 1998 tentang
Pokok-pokok Reformasi
Garis2 Besar Haluan Negara 1999-2004
Undang-Undang No 22 Tahun 1999
tentang Pemerintahan Daerah
Undang-Undang No 25 Tahun 1999
tentang Perimbangan Keuangan Antara
Pemerintahan Pusat dan Daerah
Undang-Undang No 25 Tahun 2000
tentang Program Pembangunan Nasional

18
 Visi Indonesia Sehat 2010
(KepMenKes No. 574/Men.Kes/SK/IV/2000 tentang
Pembangunan Kesehatan Menuju Indonesia Sehat
2010)
Kebijakan
1. Peningkatan KS Lintor
2. Peningkatan perilaku dan
pemberdayaan dan
kemitraan
3. Peningkatan Kesling
4. Peningkatan Upaya MISI: Visi 2010
Kesehatan 1. Pembangunan berwawasan kesehatan Masyarkat sehat dg:
5. Derajat Kesehatan 2. Kemandirian Masyarakat Lingkungan sehat,
3. Peningkatan Yankes yang bermudtu, Perilaku sehat,
merata, dan terjangkau Yankes bermutu,
Strategi adil dan merata
1. Pembangunan Was Kes
2. Desentralisasi
3. Profesionalisme DAN P POKO
K PRO
4. JPKM R OGRAM
K
ESEH
GRAM
ATAN
SASARAN
UNGG 1. Perilkau hidup sehat
UL AN
2. Lingkungan Sehat
3. Upaya Kesehatan
4. Manajemen Bangkes
5. Derajat Kesehatan
19
Undang-Undang No 25 Tahun 2000 tentang Program
Pembangunan Nasional (November 2000)
Sistematika Program Pembangunan Nasional (PROPENAS) Tahun
2000-2004 :
BAB I : PENDAHULUAN
BAB II : PRIORITAS PEMBANGUNAN NASIONAL
BAB III : PEMBANGUNAN HUKUM
BAB IV : PEMBANGUNAN EKONOMI
BAB V : PEMBANGUNAN POLITIK
BAB VI : PEMBANGUNAN AGAMA
BAB VII: PEMBANGUNAN PENDIDIKAN
BAB VIII : PEMBANGUNAN SOSIAL DAN BUDAYA
BAB IX : PEMBANGUNAN DAERAH
BAB X : PEMBANGUNAN SUMBER DAYA ALAM DAN
LINGKUNGAN HIDUP
BAB XI : PEMBANGUNAN PERTAHANAN DAN KEAMANAN
BAB XII: PENUTUP
20
 Garis-garis Besar Haluan Negara 1999-2004
Amandemen UUD 1945

Undang-Undang No. 20 Tahun 2003 tentang

Sistem Pendidikan Nasional
Undang-Undang No. 40 Tahun 2004 tentang
Sistem Jaminan Sosial Nasional
Undang-Undang No. ?? Tahun ???? tentang
Sistem Kesehatan Nasional (???)
21
 KERANGKA PIKIR SISTEM KESEHATAN NASIONAL (2004)

POLEKSOSBUDHANKAM Pembangunan
Nasional, Regional Dan Global Nasional

Landasan Kualitas SDM

Pember
Sumber dayaan
Daya Masy
Kesehatan
Bang. Kes Derajat kes.
Kecenderungan Upaya yg bermutu & masy yg
dan Isu Kes berkeadilan setinggi-
strategis
tingginya
Pembiayaan
Kesehatan
Manajemen
Kes
Prinsip
Dasar

Umpan balik
22
KepMenKes No. 131/MENKES/SK/II/2004
TENTANG SISTEM KESEHATAN NASIONAL

PENDAHULUAN
PERKEMBANGAN DAN MASALAH PEMBANGUNAN
KESEHATAN
POKOK-POKOK SISTEM KESEHATAN NASIONAL
SUBSISTEM UPAYA KESEHATAN
SUBSISTEM PEMBIAYAAN KESEHATAN
SUBSISTEM SUMBER DAYA KESEHATAN
SUBSISTEM PEMBERDAYAAN MASYARAKAT
SUBSISTEM MANAJEMEN KESEHATAN
PENYELENGGARAAN SISTEM KESEHATAN NASIONAL
PENUTUP
23
 UU 23/1992

KETENTUAN UMUM
ASAS DAN TUJUAN
UU 9/1960 SKN 1982 HAK DAN KEWAJIBAN

KETENTUAN-KETENTUAN TUGAS DAN TANGGUNG

UMUM Pemikiran dasar JAWAB
UPAYA KESEHATAN
TUGAS PEMERINTAH
Rencana SUMBER DAYA
ALAT-ALAT PERLENGKAP-
Pembangunan KESEHATAN
AN PEMERINTAH
Jangka Panjang PERAN SERTA
USAHA SWASTA MASYARAKAT

PERATURAN PERALIHAN Bentuk Pokok PEMBINAAN DAN

PENGAWASAN
PENYIDIKAN
KETETUAN PIDANA
KETENTUAN
PERALIHAN
KETENTUAN PENUTUP

24
 SKN 2004 SKN 2009
INDONESIA SEHAT
2010 PENDAHULUAN PENDAHULUAN
PERKEMBANGAN DAN PERKEMBANGAN DAN
Kebijakan MASALAH PEMBANGUNAN MASALAH PEMBANGUNAN
KESEHATAN KESEHATAN
Peningkatan KS Lintor
POKOK-POKOK SISTEM POKOK-POKOK SISTEM
Peningkatan perilaku
dan pemberdayaan KESEHATAN NASIONAL KESEHATAN NASIONAL
dan kemitraan SUBSISTEM SUBSISTEM
Peningkatan Kesling UPAYA KESEHATAN UPAYA KESEHATAN
Peningkatan Upaya SUBSISTEM SUBSISTEM
Kesehatan PEMBIAYAAN PEMBIAYAAN
Derajat Kesehatan KESEHATAN KESEHATAN
SUBSISTEM SUBSISTEM
Strategi SUMBER DAYA SUMBER DAYA
Pembangunan Was Kes KESEHATAN KESEHATAN
Desentralisasi SUBSISTEM PEM- SUBSISTEM PEM-
Profesionalisme BERDAYAAN BERDAYAAN
JPKM MASYARAKAT MASYARAKAT
SUBSISTEM SUBSISTEM
Pokok Program MANAJEMEN MANAJEMEN
dan Program KESEHATAN KESEHATAN
Kesehatan PENYELENGGARAAN PENYELENGGARAAN
Unggulan SISTEM KESEHATAN SISTEM KESEHATAN
NASIONAL NASIONAL
PENUTUP PENUTUP
25
 RUU Ttg Tenaga Kesehatan

RPP Ttg FasYan Kes

UU 36 thn 2009 PerPress 72 thn 2012 Ttg SKN

````
Ttg Kesehatan RPP Ttg Standar Mutu Yankes

RPPres Ttg BPKN dan BPKD

RPP Ttg Pendayagunaan

Tenaga Kesehatan Asing

UU 44 thn 2009 RPP Ttg Subsidi atau Bantuan

Ttg Rumah Sakit Pemerintah dan Pemda

RPP Ttg Badan Pengawas RS

Indonesia dan Daerah26
Pengembangan Kebijakan
Publik
Policy making is the process by which governments
translate their political vision into programmes and actions
to deliver outcomes desired changes in the real world.
Merupakan hasil dari interaksi dari aktor/pelaku dan
lingkungan kebijakan dengan memanfaatkan model-model
tertentu,
Aktor/pelaku kebijakan disini adalah mereka yang terlibat
aktif (langsung dan tidak langsung) dalam proses, baik
dalam bentuk orang perorang, lembaga non pemerintah,
dan badan pemerintah yang dapat mempengaruhi dan
dipengaruhi oleh kebijakan yang dikembangkannya.
27
 Pejabat resmi di kalangan pemerintah, pimpinan partai,
tokoh masyarakat non partisan, lembaga swadaya
masyarakat, organisasi profesi, kelompok intelektual,
mahasiswa, dll. merupakan sebagian dari aktor/pelaku
dalam proses tersebut.,
Lingkungan kebijakan adalah setiap aspek kehidupan
masyarakat yang dapat atau perlu dipengaruhi oleh
pelaku kebijakan untuk dikembangkan menjadi lebih
baik dari sebelumnya.

28
 Policy-making is the 'authoritative allocation of values' by those
in positions of authority making choices that have a special
status within the group such as : (Hanney et al, 2003)
government ministers and officials,
local health service managers, or
representatives of a professional body.
Results take many forms ranging from national health policies
made by the government to clinical guidelines determined by
professional bodies.
Policy-making identifies at least three broad areas of activity:
policy agenda setting, policy formulation, and policy
implementation (Lavis et al, 2002 dan Gilson et al, 2002].
 Kebijakan pelayanan kesehatan dikembangkan mengacu
kepada kebijakan fundamental global, nasional dan kebijakan
turunan/derivatif dari kebijakan fundamental nasional
Kebijakan fundamental global:
Declaration of Human Rights
WHA WHO
ASEAN Charter
Kebijakan fundamental nasional:
UU Dasar Tahun 1945
UU No. 39 Tahun 1999 ttg Hak Asasi Manusia
UU No. 11 Tahun 2005 ttg Kovenan Internasional tentang
Hak-Hak Ekonomi, Sosial dan Budaya
UU No. 12 Tahun 2005 ttg Kovenan Internasional tentang
Hak-Hak Sipil dan Politik
30
 Kebijakan turunan/derivatif terkait sektor kesehatan
UU No. 20 Thn 2003 ttg Sistem Pendidikan Nasional
UU No. 32 Thn 2004 ttg Pemerintah Daerah
UU No, 39 Thn 2004 ttg Praktik Kedokteran
UU No, 40 Thn 2004 ttg Sistem Jaminan Sosial Nasional
UU No. 25 Thn 2009 ttg Pelayanan Publik
UU No. 36 Thn 2009 ttg Kesehatan
RPJP 2005-2035
RPJMN II 2010-2014

31
 Models of policy-making
Rational models
Policy-makers identify problems, gather and review all the data
about alternative possible solutions, and their consequences, and
select the solution that best matches their goals.
Rationalist model is the ideal - an orderly progression of stages.
or steps : (Howlett and Ramesh)
identification of objectives - agenda setting
evidence gathering - formulation of options
decision-making - weighing the options in terms of cost and
benefit
policy implementation - putting the chosen solution into effect
 policy evaluation - monitoring results
policy termination / adaptation / confirmation.

Incrementalist models
A series of small steps in a process of 'muddling through or
'decision accretion in the absence of clear movement
towards predetermined goals.
It involves scientific knowledge and a range of other factors
including interests, values, established positions within
institutions, and personal ambitions.
Can be undemocratic and exclusive and is often captured
by the most powerful players, in health sector policy making
may include:
 community-based organisations and advocacy groups
organisations providing supplies and health services
organisations of professional and other health workers
consumer and supporter organisations
funders - including government, insurance and development
partners
other government agencies with health related interests and
responsibilities.
Stakeholders are able to exert power and influence over the
health system.
Ensure that all legitimate interests are assessed and
weighed in the policy development process.
 The success of a policy initiative depends upon the extent to
which the key stakeholders have been involved and are
committed to support the implementation.
Networks Model
A generic label for long term relationships between influential
interest group, leading experts ('epistemic community'),
professionalised policy network with a government
officials/policy makers.
Requires that policy be democratically legitimate, implies an
open, inclusive, interactive and highly politicised approach.
Mechanism of representative democracy are almost sufficient
to engage citizens in understanding issues, and in policy
making on issues which concern them directly.
 Difficult to establish an informed and sustainable policy
dialogue with citizens on substantive policy issues and
citizens Involvement is usually episodic
Often takes the form of protest against existing or proposed
policy, and is difficult to manage constructively without
political conflict. Typically the process is long on debate and
comes up short on decision-making.

Garbage can' model (idiosyncratic model)

Looks at the issues in an idiosyncratic way whereas garbage
solutions, occasionally with problems attached, remain in the
policy-making system which make it becomes a most untidy
process.
 The market supersedes all other considerations. Government
involvement should be minimal. Neo-liberals favour market
approaches towards the provision of goods and services,
including health services.
Consumers - rather than technical experts, interested groups
or citizens - as the most legitimate participants in the policy
making process.
No one-best-way to organise policy-making, Different
approaches are more effective in different settings and at
different times. This has lead to what are calling
predominantly pragmatic rationality in policy-making
Health policy making requires:
Government leadership from ministers and other politicians;
Bureaucratic leadership from government officials - managers
and policy advisors;
Professional leadership from doctors, nurses and other clinical
and public health leaders;
Community leadership by people who directly represent
community interests.
Leadership :
Broad visionary leadership to look and see ahead;
Competent executive leadership manage policy making and
implementation;
Integrating and networking leadership to get and keep the
stakeholders together; and
Hands on leadership at the front line carry out the basic tasks.
 Policy-making is the 'authoritative allocation of values' by those
in positions of authority making choices that have a special
status within the group such as : (Hanney et al, 2003)
government ministers and officials,
local health service managers, or
representatives of a professional body.
Results take many forms ranging from national health policies
made by the government to clinical guidelines determined by
professional bodies.
Policy-making identifies at least three broad areas of activity:
policy agenda setting, policy formulation, and policy
implementation (Lavis et al, 2002 dan Gilson et al, 2002].
40
41
1. IDENTIFY, ANALYZE AND DESCRIBE
THE PROBLEM
Describing the problem:
What is the extent of a problem? How
big a problem is it?
What and who is involved?
What are the limits of the problem?
What are the origins of the problem?
Is there a starting point to your
problem? When did it first become
apparent?
Are you looking at a real problem or
a symptom of a larger problem or
issue? 42
Analyzing the problem:
What is it about the situation or condition
that is unacceptable or wrong? What events
or incidents illustrate this?
What factors in the community affect the
problem (e.g., community attitudes,
traditional values, conflicting agendas,
economic difficulties, cultural
differences)?
What has been done to try to resolve the
problem?
What is the cost of the problem (human and
financial)? What is the cost of doing
43
nothing about the problem?
Identifying and understanding
stakeholders:
Who will be positively or negatively
affected if the problem was resolved?
Who else sees this as a problem?
What exactly do some stakeholders stand to
gain from resolving the problem? How
important is it to them?
Are the stakeholders reasons for wanting
the problem solved the same as yours? If
not, what are their reasons?
Are there others who you might bring on
side if the matter was brought to their
attention?
What exactly do other stakeholders stand 44
Gathering data about a problem or issue:
Community service directories can help
you identify the groups, agencies and
organizations that have an interest in
your issue and/or have taken action in
response to your issue.
Population health status data is
available from your local public health
unit, district health council or health
research organizations.
Socio-demographic data can include key
social and economic variables, such as
household income, education level, health
status level, age distribution or
occupational categories. 45
 Other studies about the problem or
issue, such as needs assessments,
research reports, and journal articles
are good sources.
Newspaper or magazine articles may have
relevant information about the problem
or issue. Pay particular attention to
articles that refer to controversy
surrounding the issue or indicators of
support.
Interviews with key individuals or
groups such as heads of community
agencies, elected officials or informal
community leaders, can provide valuable
information about a problem or issues. 46
Remember that they can only give you
2. ASSESS COMMUNITY SUPPORT, CAPACITY
AND READINESS TO DETERMINE IF POLICY
IS AN APPROPRIATE STRATEGY

Community support and capacity :

Are there educational and awareness
programs in your community that focus on
your problem? How long have they been
running? How successful have they been?
How popular are they?
What kinds of environmental support for
your issue exist in your community?
Has the problem been a recent focus in
the media (radio, TV, newspaper
editorials, etc.)?
47
 If similar issues have arisen in the
past, what kind of actions were taken?
Is there valid and representative survey
data measuring public opinion about the
problem?
Are there signs in the community that
indicate a need for change (e.g.,
dissatisfaction with the status quo or
interest in a new idea)?
What general capacities to deal with the
problem exist (assets, organizational
infrastructure, community leaders, social
capital)?
48
Decision makers
Important to consider of the role of
decision makers, those people with the
power to implement policy.
Some have actual decision making power;
others are extremely influential but may or
may not have official power.
Need to consider who in your community has
both official and influential power.
Need to assess their views about the
problem and the likelihood they will
support policy as a potential solution.
Force field analysis: assessing the climate
for change
The climate for change refers to the
49
combination of attitudes, values,
 To predict how well a policy proposal
will be received, it can be useful to
determine the forces likely to support
and oppose the policy.
Force field analysis is particularly
useful for identifying and responding to
potential counter-arguments against the
adoption of a policy.
To conduct a force field analysis, you
need to ask yourself the following
questions:
What will help us to take action on the
problem? What are the driving forces?
What will hinder us? What are the
50
negative or restraining forces?
Determining if policy is an appropriate
strategy
Determine if a policy is the most
appropriate way of addressing the health
problem.
Is there more than one solution to your
problem
What does each solution require in terms of
time, people, money and/or additional
resources?
Which solution offers the greatest benefit
at the least cost
Do any of the solutions involve policy
development?
Are you willing to do the work required to
develop policy? 51
 To predict how well a policy proposal
will be received, it can be useful to
determine the forces likely to support
and oppose the policy.
Force field analysis is particularly
useful for identifying and responding to
potential counter-arguments against the
adoption of a policy.
To conduct a force field analysis, you
need to ask yourself the following
questions:
What will help us to take action on the
problem? What are the driving forces?
What will hinder us? What are the
52
negative or restraining forces?
3. DEVELOP GOALS, OBJECTIVES AND
POLICY OPTIONS
Goal is a broad statement summarizing
the ultimate direction or desired
achievement of your policy (e.g., to
promote food security among low-income
families or to reduce the incidence of
alcohol-related harm among young
people).
Objective is a brief statement
specifying the desired impact or effect
of a policy (i.e., how much of what
should happen to (whom) by when).
Objectives can be viewed as directions
or building blocks towards the
53
achievement of policy goals.
 Objectives should be S = Specific, M =
Measurable, A = Attainable, R =
Realistic, T = Time limited
Setting policy objectives:
Consider the specific policy
components and time frame needed to meet
your goals.
Each objective should focus on one
desired policy change or result.
Remember that a comprehensive policy
will entail multiple objectives (both
long and short term).
Objectives must be measurable so the
impact of a policy can be evaluated. 54
Choosing Policy Options :
Policy options are choices regarding the
types of policies that can be put in
place to address health issues.
Should first consider the degree of
support for each policy option.
Interview a cross-section of people to
get their views.
Investigate how similar issues have been
handled in other communities.
May need to negotiate with decision
makers and accept less than you want in
order to move forward.
55
4. IDENTIFY DECISION MAKERS AND
INFLUENCERS

Pick your decision makers carefully,

those being approach depends on the
issue being addressed:
Status-oriented decision makers are
highly concerned about generating
positive media coverage and avoiding
unfavorable coverage.
Mission-oriented decision makers hold
strong beliefs and values that guide
their decision making.
Process-oriented decision makers are
most concerned with serving their 56
5. BUILD SUPPORT FOR POLICY

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6. WRITE AND REVISE THE POLICY

Written policies usually include the

following:
a preface or preamble describing the
purpose of the policy,
policy goals and objectives (often
incorporated into the preface),
a description of the policy components
(e.g., the associated activities,
regulations, sanctions, that constitute
the meat of the policy),
procedures for dealing with failure to
comply with the regulations specified in
the policy,
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a plan for promoting and disseminating
Review the Policy Draft
Which stage(s) in the policy-making process are
you trying to influence through your policy
paper?
Which stakeholders have been/are involved at
each stage of the policy making process?
Have you identified a clear problem to address?
Can you summarize it in two sentences?
Do you have sufficiently comprehensive evidence
to support your claim that a problem exists?
Have you outlined and evaluated the possible
policy options that could solve this problem?
What evaluation criteria did you use?
Have you decided on a preferred alternative?
Do you have sufficient evidence to effectively
argue for your chosen policy alternative over
the others?
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Policy options in HMP
(Thailand Case)
Policy issues in HMP
Regarding quality, efficiency, and
equity; three main policy issues were
raised from the literature reviews
and through interviews:
a.Financial responsibility
Who should pay for the cost of
production?
How to share costs among the public,
students, and beneficiaries?
60
b.Role of institutions
Who should own the production
institutes, production?
What private institutions would
be more appropriate, profit or
nonprofit making institutes?
c.Community and local
authority participation
How can the community and local
government participate in the
selection of students, education
management and manpower
management?
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Policy options in HMP
Option 1: Publicly financed and owned
Current situation of most HMP in Thailand
Option 2: Publicly financed but privately
owned educational institutions
Government may financially subsidize the
private educational institutions, as is
happening for private primary and
secondary education.
Government may provide scholarships for
contracted students to study in private
institutes (similar to the case where the
government sends students to study in
foreign private universities).

62
 Option 3: Privately financed in
public owned educational
institutes.
In this case the students
themselves have to pay the full
cost of their education in the
public colleges.
Option 4: Privately financed in
privately owned education
institutes.
This is the current situation for
most private higher education.

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7. IMPLEMENT THE POLICY
A policy is ready for implementation if the
following conditions are met:
Have you identified and analyzed the
issues your policy needs to address?
Do you have sufficient information about
these issues to support and justify the
implementation of your policy?
Are your policy goals reasonable and your
policy objectives measurable?
Do you have the required support and
approval of key decision makers? If not,
how will this be obtained?
Have you selected your policy components
and prepared a written policy that 72
describes these components and a strategy
 Do you have an accurate estimate of the
resources (time, money, person power
and expertise) needed to implement and
monitor your policy?
Is the timeline for implementation
realistic?
Does your policy specify who is
responsible for what
Have you identified the barriers to
implementation you are likely to
encounter?
Do you have a plan for dealing with
these barriers?
Have you shared your draft policy with 73
other key stakeholders who will be
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