Policy Analysis and Decision- -Making Making Policy Analysis and Decision with Emphasis on Chronic Non- -communicable Diseases communicable Diseases with Emphasis on Chronic Non Bridgetown, Barbados Bridgetown, Barbados October 15 October 15- -17, 2007 17, 2007 Policy Options Policy Options Cristina Puentes-Markides Health Policies and Systems Strategic Health Development Area PAHO/WHO Key points Key points Policy Options Policy Options Generating policy options Generating policy options Evaluation criteria: types, methods, matrices. Evaluation criteria: types, methods, matrices. AG Assessing Policy AG Assessing Policy Economic evaluation: An Introduction (A. Economic evaluation: An Introduction (A. Gordillo Gordillo) ) PAHO-CPM-HSS/HP/07 2
Before defining options of solution to the Before defining options of solution to the policy problem, evaluation criteria related to policy problem, evaluation criteria related to the results of the selection of these the results of the selection of these alternatives need to be defined. alternatives need to be defined. PAHO-CPM-HSS/HP/07 3 Policy goals are established. (Reduce CVD among xxx, Policy goals are established. (Reduce CVD among xxx, increase levels of physical activity, etc.) increase levels of physical activity, etc.) These goals express what the policy should achieve in These goals express what the policy should achieve in terms of the solution of the problem. (outcome) (outcome) terms of the solution of the problem. These goals are translated into objectives, more These goals are translated into objectives, more concrete statements about the future results that are concrete statements about the future results that are desired. desired. PAHO-CPM-HSS/HP/07 4
Goals, Objectives, Criteria and Measures Goals, Objectives, Criteria and Measures Goals: formal, broad statement about desired long Goals: formal, broad statement about desired long- -run achievements run achievements reduce poverty reduce poverty Objectives: focused, concrete statement about end states Objectives: focused, concrete statement about end states reduce % pop on welfare reduce % pop on welfare Criteria: dimensions of the objectives used to evaluate alternative ive Criteria: dimensions of the objectives used to evaluate alternat policies policies cost; political viability cost; political viability Measures: tangible operational definitions of criteria Measures: tangible operational definitions of criteria cost per 1% reduction cost per 1% reduction PAHO-CPM-HSS/HP/07 5 In the field of policy analysis… ….. .. In the field of policy analysis Criteria are evaluative standards that guide the processes of Criteria are evaluative standards that guide the processes of decision making. decision making. They allow They allow ranking policy options in ranking policy options in order of preference order of preference. . The most important evaluative criterion is that the projected The most important evaluative criterion is that the projected outcome will solve the policy problem to an acceptable degree. outcome will solve the policy problem to an acceptable degree. Criteria can be measures, rules, standards, and all those attributes utes Criteria can be measures, rules, standards, and all those attrib considered relevant by the decision maker (individual or group) in a considered relevant by the decision maker (individual or group) in a given situation. given situation. PAHO-CPM-HSS/HP/07 6
More on criteria Evaluation criteria are measurable dimensions that serve Evaluation criteria are measurable dimensions that serve to compare and rank the policy alternatives. to compare and rank the policy alternatives. They are used to judge the They are used to judge the outcomes outcomes of implem of implem enting enting the the alternatives. alternatives. For each alternative you list, project all of the outcomes For each alternative you list, project all of the outcomes (or impacts) that you or other interested parties might (or impacts) that you or other interested parties might reasonably care about. reasonably care about. PAHO-CPM-HSS/HP/07 7 A good criterion should be A good criterion should be Clear Clear Consistent Consistent Supported by measures Supported by measures PAHO-CPM-HSS/HP/07 8
Commonly Used Evaluative Criteria Commonly Used Evaluative Criteria Legal Feasibility: Consistency with current constitutional/legal framework, Legal Feasibility: national/federal/state/local mandates as appropriate. Political Viability: Acceptability of the policy option to various relevant stakeholders that Political Viability: hold political power (voters, legislators, president’s cabinet, etc.) Sustainability: Ability of the policy option to maintain its beneficial effects in the longer Sustainability: term. Social/Cultural Feasibility : Social/Cultural Feasibility : Consistency with national/local traditions, policies and institutions; acceptable for the local population. Technical Feasibility : Technical Feasibility : Availability of necessary resources and competencies. Administrative Feasibility : Administrative Feasibility : Degree of ease of implementation, financial/managerial factors. Cost Effectiveness: Achieving policy goals at the least cost. Cost Effectiveness: Economic Efficiency : Economic Efficiency : Maximization of satisfaction by society. PAHO-CPM-HSS/HP/07 9 : In public health, additional criteria may include : In public health, additional criteria may include Equity ( fair social allocation (distribution) of burdens (may be costs) and benefits among Equity social groups Economic and social costs of a disease/injury; loss of productivity, medical costs, Economic and social costs etc... Need to act quickly (e.g. to mitigate a disaster, to control the spread of a disease). Need to act quickly Burden of disease ( Burden of disease (e.g. measured by the relative number of people dead – mortality-; measured by the relative number of people affected –morbidity, other). Effect of the problem on special populations ( Effect of the problem on special populations ( lower income, women, children, lower income, women, children, the disabled, aged, etc.) or on the physical environment. the disabled, aged, etc.) or on the physical environment. Safety Safety Privacy Privacy PAHO-CPM-HSS/HP/07 10
Examples of Different Types of Criteria Examples of Different Types of Criteria Criteria Concept/Meaning Illustration Criteria Concept/Meaning Illustration Effectiveness Has a valued outcome been achieved? Units of service Effectiveness Has a valued outcome been achieved? Units of service Efficiency Efficiency Maximize the net benefits for all individuals. Maximize the net benefits for all individuals. Unit cost, net benefits, Unit cost, net benefits, cost cost- -benefit ratio benefit ratio [ [ Equity Equity Value judgment. It refers to the fair social Value judgment. It refers to the fair social Various/ Various/Pareto criterion, Pareto criterion, allocation (distribution) of burdens (may be allocation (distribution) of burdens (may be Kaldor Kaldor- -Hicks criterion, Hicks criterion, costs) and benefits among social groups costs) and benefits among social groups Rawls criterion Rawls criterion Responsiveness Responsiveness Policy outcomes satisfy the needs, Policy outcomes satisfy the needs, Consistency with citizen Consistency with citizen preferences or values of particular groups. preferences or values of particular groups. surveys. surveys. Appropriateness Desired outcomes (objectives) are worthy and Public programs should Appropriateness Desired outcomes (objectives) are worthy and Public programs should valuable. valuable. be equitable as well as be equitable as well as efficient. efficient. PAHO-CPM-HSS/HP/07 11 An Example: Priority Setting Criteria for Research at the An Example: Priority Setting Criteria for Research at the National Institutes of Health, USA National Institutes of Health, USA Public health needs Public health needs Scientific quality of research Scientific quality of research Potential for scientific progress (e.g. existence of Potential for scientific progress (e.g. existence of promising pathways and qualified researchers) promising pathways and qualified researchers) Diversification of the portfolio expand research Diversification of the portfolio expand research Adequate infrastructure support (e.g. human capital, Adequate infrastructure support (e.g. human capital, equipment, instruments, facilities). equipment, instruments, facilities). PAHO-CPM-HSS/HP/07 12
Example (Cont.) Example (Cont.) Each criteria is operationalized Each criteria is operationalized, see example for public , see example for public health needs health needs Public health needs Public health needs • N Number of people that suffer from a • particular disease. Scientific quality of research Scientific quality of research • Number of deaths caused by the disease. Potential for scientific progress. Potential for scientific progress. • Degree of disability caused by the Diversification of the portfolio to Diversification of the portfolio to disease. • Degree in which the disease expand research expand research shortens a normal, productive and Adequate infrastructure support. Adequate infrastructure support. comfortable life • Economic and social costs of the disease. • Need to act quickly to control the spread of the disease. PAHO-CPM-HSS/HP/07 13 Defining Policy Options Defining Policy Options
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