Welcome to our course on Understanding and Strengthening Health Systems for Global Health. During the course we will provide you with an overview of the main elements or building blocks of a health system based on the World Health Organization’s guidance. You will have the opportunity to explore four main areas of health systems in global health with particular reference to low and middle income countries. The first area focuses on understanding health service organizations, the challenges. Our second module looks at WHO’s six major building blocks or health systems components with particular reference to primary health care and the need for community participation in planning, delivery and assessment of these systems components. in our third module we examine the specific systems component of human resource development and capacity building. The fourth area consists of health policy making and advocacy with stakeholders. This course is geared toward learners who are already involved in managing health and development programs on the ground in low and middle income countries or who are preparing for such a management role. The main lectures will span a four-week period with approximately 2-4 hours of viewing learning materials per week. We have one peer graded essay wherein you will use skills in ‘organizational’ diagnosis to better understand a challenge in an organization where you are or have worked. There are also quizzes. We hope you will engage with your fellow learners in discussion forums to learn from each other.
Stakeholders
Loading...
来自 约翰霍普金斯大学 的课程
Understanding and Strengthening Health Systems
评分
从本节课中
Health Systems Policy Development and Advocacy Approaches
Health and development organizations and systems are created and funded through policy decisions. Within organizations there are policies that procedures that determine the actually functioning or the organization. This module looks at stakeholders in the policy process and helps the learner consider advocacy strategies to influence healthful policy change.
与讲师见面
William Brieger, DrPHProfessor, Health Systems Program of the Department of International Health
Bloomberg School of Public Health
In our previous modules,
we've emphasize the word, diagnosis.
We did an educational and behavioral diagnosis to find out why people became sick,
what behaviors they did,
seeking treatment or not seeking treatment,
and why they did these thing.
Was it something to do with their beliefs,
attitudes, resources, skills, social support?
We did a community diagnosis,
where we tried to find out how social economic, political, cultural,
and geographical forces influence the health of the community
and influence the community or the human response to these health problems.
We've recently talked about organizational diagnosis,
where we try to find out what factors
within the organization are functioning well and lead to
a healthy organization or where there may be problems in terms of the human dynamics,
the interaction with the environment,
the technical gaps that may influence the functioning of the organization.
At this point, we're in the process of making
a diagnosis to determine how policies are made,
who has a stake in these policies,
and if we are going to influence the policy process,
who should be involved,
how can we involve them?
Again, in the context of the ecological model,
we are concerned with human behavior at all levels so
policy makers can make decisions about drug distribution,
make decisions about essential drug lists,
make decisions about tariffs on bed nets,
make decisions about who can attend school if they're pregnant or not.
All of these kinds of policy decisions impact on the community and individuals.
So we should be concerned about the behavior of policymakers and
people who are trying to influence policy in the background, directly or indirectly.
And this is where we enter the phase of stakeholder analysis.
The example of HIV/AIDS control in developing countries will be used in this segment.
The stakeholders in HIV/AIDS include activist groups, community-based support groups,
government health departments at local, state, federal level,
international donor agencies that are providing funds and programs,
religious groups, and many others,
including pharmacy manufacturers that make anti-retroviral drugs,
condom manufacturers, professional and trade groups,
from the point of view of professional groups,
such as health workers and their concerns personally in terms of exposure and
their concerns professionally to prevent the disease in the community,
other kinds of trade groups and work groups,
such as dockworkers and transporters who may be at risk.
And, of course, the media has a stake in such a major health issue.
The stakeholder analysis tries to, first,
identify along six different variables,
how much investment concern interest a particular stakeholder has in the issue.
So in this slide,
the chart shows these six different elements: involvement,
interest, power, position, impact, and strategy.
And two examples are given,
the pharmaceutical companies and a national or state Ministry of Health.
The nature or type or level of involvement of
the pharmaceutical companies is there to protect their patents and promote sales.
They certainly have a high interest in any policy that deals with HIV treatment.
They have a lot of power because they do provide the lifeline to people.
They are basically opposed to any efforts,
any policies that would make treatment more universally accessible,
low cost using generics made in other countries.
Their ability to impact the condition,
the situation through manufacture of the drugs through their court actions to
prevent generics from entering the market because they have
a lot of money to hire their lawyers is high.
And the strategy that a group that wants to influence policy,
and assuming that they want to influence policy in
such a way that they guarantee treatment for even the poorest people in the community,
would be to defend against the onslaught of
the pharmaceutical company and their efforts to make drugs less accessible.
On the other hand, the Ministry of Health, again,
say that you're looking at this from the point of
view of an AIDS activist group that you want to
promote a policy that ensures people have access to care.
The Health Department is quite concerned.
Their involvement is influenced by the cost of care,
how much they can afford,
what their budgets are.
Health departments have a high interest in
the issue because there will be great demands made on their service.
They want to respond.
They have mandates to serve the public.
Their power and actually influencing policy,
most of them are civil servants,
they generally don't speak out.
They may, through some professional associations,
make their views known.
But as a Health Department,
as a Ministry of Health,
they usually are the recipients of
policy directives and don't have a lot of power in influencing them.
Sometimes they may be called on individually as experts to
testify before legislative bodies that do make the decisions.
Their position is that they would be strongly supportive, generally,
of anything that would provide care to people at affordable price
because the public sector is the major source of care,
not necessary the best but the major source of care in many countries.
They would have a high impact on the issue if
they were able to treat all the people they needed to.
Again, if you are the activist group trying to change policies,
you would involve them,
get them to contribute what they can to
formulating better policies towards speaking out as experts.
The next slide is based on news that came out of South Africa
last year and shows another important stakeholder in the process.
The Catholic bishops in South Africa spoke out officially,
condemning the use of condoms.
They were not concerned with the fact that it prevented
AIDS because it was seen as a birth control measure.
This was ironic because a few individual bishops a week before
the conference were talking positively that
community should be able to protect themselves.
But as a whole group,
the bishops came down specifically against,
their position was opposed to the preventive side of AIDS control programs.
In contrast, the level of involvement in donor agencies was actually to provide condoms.
Many different agencies, U.S. government,
British government, were providing condoms.
Activist groups were supporting the provision of condoms.
Ironically, pornographic movies made in Brazil
were actually showing their movie stars as role models using condoms,
and they had made that change over the years.
They were actually forced in the media that were promoting condom use.
So, again, when you have an issue,
you have a number of stakeholders.
You need to identify what is their position.
Are they powerful, are they influential with which groups of people?
It's important to classify
the characteristics of these different stakeholders to see who are more powerful,
who are on the side for certain policies,
who are against certain policies.
Want to rank their interest in the issue.
Is it high? Is it moderate?
Is it low?
Is there a power or influence high, moderate, or low?
Do they take a supportive position for the new policy?
Are they opposed to it or they're not mobilized,
they're disinterested, even though they might potentially have some impact?
Again, looking at the example of the Catholic bishops in South Africa,
they had a high-level of interest.
They had moderate to low power though to make influence in the sense that it depends
on the proportion of the population that would be Catholic or that would listen to them.
They were be clearly opposed to the promotion of condoms and
their impact though because of being quite vocal,
because of media coverage of their event may actually be disproportionate,
making people, policymakers, legislators more
embarrassed or more uncomfortable in terms of taking a stand themselves.
So, again, we need to be aware that some groups may have disproportionate influence
and that may be because of other stakeholders such as the mass media.
We need to look at policy even in a broader context.
We have now the World Trade Organization functioning,
and when we get to the areas of pharmaceuticals,
they make policies that may be
counterproductive to the policies that are made by WHO and international health agencies.
Their concern about protecting copyright may make it
difficult for AIDS patients to get cheap generic drugs.
Recently, in South Africa,
the government went to court, and fortunately,
they were able to succeed in getting generic drugs accepted in their country.
Countries like Brazil and India make their own drugs and are not
dependent on the international pharmaceuticals.
Again, having figured out who are stakeholders,
what are their positions on the issue,
what power and influence and potential impact they might have,
the next question is then,
what kind of strategy?
What would your organization want to do?
If their position, if the position of a stakeholder was supportive,
it would be important to involve them, develop coalitions,
where each organization, a member of
the coalition can contribute, whether it's expertise,
whether it's money, whether it's
volunteer strength to go out in the community and canvass.
If the position on the particular issue is mixed,
maybe a particular group is in favor of preventing HIV/AIDS,
but they're cautious about using condoms because of the family planning implications,
it might be useful to collaborate with them until they can
clarify their stand and maybe come around to your side.
There may be some groups that are marginal.
They're not directly concerned,
maybe in terms of the drug issue.
It may be the retail pharmaceuticals.
They may not have as major a role,
but eventually, they might take an interest.
You'd want to monitor what they're doing.
And again, the groups that are specifically
opposed to the policy you're trying to promote,
your group needs to come up with statements,
expert testimony, information, influential groups that can defend your position.
An important strategy that we'll talk about in
the next section for promoting news policies
and defending against opposition groups is the strategy of advocacy.
