Politics identification, development, and implementation process in

Politics is mainly defined by Lasswell, as
classically as who gets what, when and how, Lasswell define that who affects
the origins, formulation, and implantation of public policy in the health
sector, Politics in many dictates, for example who all the people entitled to
services, and who will provide services with what are the priority areas, who
all of them will be subsidized, and how the allocation of budget would be done
and the budget ought to be allocated and spent. The implementation of reforms
is basically associated with new administration and the political crises, while
reforms can also affect the stability of political administrations,

In spite of its acknowledged importance, there is also
broad agreement that politics and political issues are rarely analysed and
frequently ignored at all stages of the policy identification, development, and
implementation process in the health sector, particularly in the interactions
between international donor agencies, recipient developing country governments,
and their domestic political context. There is ample documentation that
politics frequently trumps evidence as a driver of policy priorities and
reforms and there are calls for both prospective and retrospective analyses of
the politics of public health policy to improve the probability of policy
implementation and impact and to understand more fully the political
environments in which reforms operate. The political will or
technocratic model assumes that decisions by political leaders or a reform
champion are necessary and sufficient for policy change and that these leaders
are rational actors maximizing the public interest (Alesina, 1992). Reform can
occur from outside the political system, it is a policy-making model that is
frequently referenced in the public health literature as the mechanism via
which to effect change in the sector. The political factions or partisan or
pluralist model assumes that politicians seek to serve the desires of different
groups, including interest groups, bureaucratic agencies, and political
parties. It encompasses the interest group approach to policy-making, with its
emphasis on the political competition of groups and ideas (Kingdon, 1984), as
well as the bureaucratic politics approach, with its emphasis on how government
organizations and employees seek to protect and promote their own narrow
sectarian interests. Reform occurs when incentives and benefits to preferred
constituencies are sufficiently large. The political importance of
health care is apparent today in the spate of clinics sponsored by movements
and parties. Some political groups use health services merely as a form of
patronage, but in most instances the motive is to mobilize popular support by
using health as an issue of popular empowerment.

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India, the persistent gap between promised proper policies such as the National
Rural Health Mission (an initiative to deliver primary care to the poor
intended to increase the national health budget by 1% of GDP) and budget
allocation and execution is attributed in part to the practices of the Indian
civil service, where frequent rotation among ministries is common, driven by
political party affiliation, and expertise in a particular area, such as
health, is infrequent, leading to poor follow-up and little ownership. If
governments make policies that are strongly disliked by the public or
particular groups, they know that these may well be resisted with the result
that their policies may not be implemented. In most countries, there are a
growing number of groups outside government, referred to as interest or
pressure groups, which want to influence government thinking on policy or the
provision of services in a direction favourable to their point of view, social
group, or material position. They use a range of tactics to get their voices
heard, including building relationships with those in power, mobilizing the
media, setting up formal discussions, or providing the political opposition
with criticisms of government policy. Although the existence of interest groups
indicates that political power is not the monopoly of any one group, it is
clear that some interest groups are far more influential than others. In the
health field, the medical profession is still the most significant interest
group outside government in most countries

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