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‘DOING’ HEALTH POLICY ANALYSIS: METHODOLOGICAL AND CONCEPTUAL REFLECTIONS AND CHALLENGES
It is important to contextualize the health policy environment in order to understand the challenges to methodology and theory. While drawing on ideas and concepts from general policy analysis, most of which is derived from studies on high income countries, this paper focuses on health policy, and on low and middle income countries. Much of the theory from policy analysis in high income countries has resonance for health and developing countries, and can usefully inform research in those areas. However, transferring such concepts needs to be undertaken with caution. It is generally fair to say that the health sector has specific characteristics which affect the policy environment (and that differentiate it from other social sectors). The state may be both provider and purchaser of services, but also is involved in regulation, research and training among other functions. In service provision, it may be in competition or partnership with a private sector that it is also regulating. In undertaking its health care purchasing and regulatory functions, the state is usually heavily reliant on — and may lack — essential information that can only be provided by the sectors it is overseeing. Information asymmetry is often a bigger problem than with the other social sectors. Health issues are often high profile and demand public responses. Health interests, ranging from professionals to the pharmaceutical industry, have traditionally been perceived to influence the policy process significantly. They are uniquely placed to do so because of their knowledge, technology, access to political processes and stake in life and death issues.
However, while these characteristics are generally typical, all scholars point out that they have to be contextualized in both place and time. Health policy environments in middle and high income countries will therefore differ from those in low income countries, where, for example, there are weaker regulations, regulatory capacity and monitoring systems; lack of purchasing power as a leverage to influence types and quality of services delivered; more patronage in political systems, and more reliance on external donor funds, among many other differences.
In spite of differences between high and low income countries, however, it is increasingly recognized that policy processes are changing everywhere.
(from http://heapol.oxfordjournals.org/content/23/5/308.full, retrieved on April 4th, 2012)