November 1, 2018

An introduction to stakeholder and policy analysis

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It is sometimes difficult to understand the difference between policy and programmatic and/or intervention goals. Specifically, a policy is a plan for future action adopted by a governmental entity and formulated through the political process.

For example, a programmatic action that focuses on engaging with women’s groups to change local perceptions around HPV vaccination is not, by itself, a public policy change, as it does not necessarily have to be adopted by a governmental entity and does not touch the political process. Similarly, for road traffic accidents, training emergency providers in better treatment or transport of trauma patients also does not necessarily intersect with the government or need to be formulated through the political process.

In contrast, enacting a law to increase the drinking age from 18 to 21 to control road traffic injuries or instituting taxes on tobacco products for cardiovascular disease prevention are examples of policy changes as they necessitate engaging government structures within the political process. Similarly, for HPV vaccination campaigns, creating legislation that requires all girls who attend school to be vaccinated is also a policy change. However, even local efforts to work with women’s groups to change perceptions regarding HPV vaccines could be re-framed into a policy change. Perhaps the government could enact a guideline requiring that all public clinics hire community outreach workers focused on HPV vaccination messaging. While this might still mobilize women’s group to engage with HPV vaccination campaigns, it would do so via a government guideline or law.

Health leadership around the world frequently need to prioritize one potential policy change over another. Often “implementation feasibility” or “cost of enacting the policy change” are primary considerations, but there are many other factors to include in this decision making process. One available resource for weighing one intervention against another is the Disease Control Priorities Project, which provides a table of different common interventions and their cost-effectiveness.

During the comparison process, scoring proposed policy changes by developing standardized criteria within a matrix can be a great way to be open and transparent. A transparent policy selection process can be very compelling to stakeholders who want to understand why you are advocating for a certain policy change over another.

In stakeholder and policy analysis, it is critical to identify appropriate stakeholders and understand their influence on the policy process, their motivators given the proposed policy change, and strategies for engaging the stakeholder in the policy process. It can be tempting to focus on stakeholders who are champions of the proposed change and to frame their motivators in positive/supportive terms rather than identifying stakeholders who might be opposed to a given policy change. However, it is often the opposed stakeholders that you need to work hard to understand and reach out to. One successful strategy is to engage dissenting stakeholders in coalitions with other stakeholders who you have identified as supportive.

Lastly, be sure to think critically about the motivations for all stakeholders. For example, a policy change of increasing taxes on cigarettes or alcohol may address a public health issue by decreasing disease burden, but it is important to understand if the general population (which includes both people who smoke and/or drink) would be supportive of the policy change. Many people in the community might be opposed to this policy because they might see themselves as at low risk of associated diseases, but impacted by the increased financial burden. Individuals who are alcohol dependent or addicted to cigarettes will see the price of their addiction increase, and while many of them may want to quit, there are systemic and structural issues that can make this difficult. Be sure you consider all stakeholders and how you could develop strategies to engage broad groups with diverse interests, many of which may not be explicitly or publicly stated.

Authors: Dr. Arianna Rubin Means & Dr. Brad Wagenaar