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Challenges and reflections on the analysis of health policies

By Gabriela Lamarca & Mario Vettore (ENSP/FIOCRUZ)

Many researchers and practitioners have been conducting analysis of health policies. It represents a stage of the process as important as any others, like implementation or evaluation. However, despite of its importance, little attention has been placed on how to conduct appropriate research projects focusing on political analysis, what research designs, theories or methods best inform and fit to this aim. In fact, there is little guidance, particularly in low and middle-income countries. It is rare to find an academic work that explores the methodological challenges for researchers in this area.
Health policy analysis is a multi-disciplinary approach to public policy that aims to explain the interaction between institutions, interests and ideas in the policy process. However, it is important to contextualize the health policy environment. Health policies in countries of middle and high income differ from those in low-income countries, where, for example, there are weaker regulations, poor regulatory capacity and little or no system of monitoring; lack of purchasing power which influences the types and quality of services; among many other differences. Health policy environments, therefore, can be considered a barrier to overcome, at least an issue to take into consideration in order to understand the challenges to methodology and theory.
To advance on the analysis of health policy, researchers need to use structures and the existing theories of policy process more broadly, making it more explicit in their research project and paying more attention on how their own power and positions influence the knowledge they generate. According to Hajer and Wagenaar (2003), policy analysis should be more deliberative, less top down, involving expanded networks, and more interpretive, taking into account people's stories, experiences, their understandings, values and beliefs expressed through language and behaviour.
The success or failure of any public health policy initiative can be measured in terms of differences in a given population and across the gradient. However, the analysis of a health policy should be considered an important step to go beyond advocacy to understand and address some of the political barriers to reform, mainly because health issues are often high profile and demand public answers.

‘Doing’ health policy analysis: methodological and conceptual reflections and challenges
Hajer MA, Wagenaar H, editors. Deliberative policy analysis. Cambridge: Cambridge University Press; 2003.

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