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Workshop Presented by: Date:

A primer on health policy and how to influence it

making your voice count!

To help voluntary organizations working in health be more effective in policy development, and in policy dialogue when they choose to enter into discussion with one or more levels of government.

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Workshop Objective

Workshop History

• Funded by the Sectoral Involvement in Departmental Policy Development (SIDPD) Program, Health Canada

• Objectives were:1. to increase the policy capacity of Voluntary

Organizations Working in Health (VOWHs), Health Canada and the Public Health Agency of Canada

2. to enhance individual and collective collaboration by VOWHs in Health Canada’s and the Public Health Agency of Canada’s policy development processes

VOICE in health policy Project (2002-2005)

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More Information on VOICE…

• Hosted by:• Coalition of National Voluntary Organizations (NVO) 2002 - 2003• Canadian Public Health Association (CPHA) 2004 – 2005

• Website:

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make your voice count!An on-line guide to collaborative health policy development

www.projectvoice.ca

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Workshop Modules

1. Introduction

2. Policy basics and health: how the federal government makes decisions on health policy

3. How to hear and be heard: strategies and tools for connecting with government

4. Putting it into practice: developing a policy strategy

5. Reflections on the workshop

1. Policy basics and healthpolicy basicsand health:

Material developed from How Government Works, a workshop of the Institute On Governance

How the federal government makes decisions on health policy

• To provide a clearer understanding of the structures, roles, processes and values of the federal government–Who are the actors?–What do they do?– How do they do it?–Where does health policy fit?

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Session Objectives

geopolitics

globalizationdemographics

technologicalinnovation

e-government

skills

borders

diversityhealth

fiscalcohesion

childrennorth americanintegration

security

culture &identity

families

environment

aboriginalpeoples

urban growth

innovation

unity

learning

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What Has To Be Done?

Working Together

Values

CivilSociety

PrivateSector

Governments

Traditions

History Culture

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Shifting Roles of the Sectors

core governmentcore government

quasi-government quasi-government organizations, state-organizations, state-owned enterprisesowned enterprises

non-profit & non-profit & voluntary sector voluntary sector

organizationsorganizations

businessbusiness

• Framework for action• Set of decisions around a public issue• Translates government’s political vision

into programs and actions to achieve results

• “A set of inter-related decisions, taken by public authorities, concerning the selection of goals and the means of achieving them”

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What is Policy?

Who is Involved?

• Minister & Minister’s office• Central agencies • Deputy Minister• Senior officials• mid-level officials• headquarters, regional & local offices • other jurisdictions • international players

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Policy Development Process

• opportunity, problem, change• identification of basic issue• analysis • development of policy & program options• decision: department or Cabinet• introduction of policy & program or

change• delivery• evaluation/monitoring

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Decision Making Cycle

Departments DefinitionAnalysis

Inter-Departmental or

Jurisdictional

Cabinet &Committees

DraftLegislation

The HouseFinalizeProgram

Minister -Announcement

ImplementationEvaluation

The Public

Environmentalscanning

Decision-MakingCycle

Program &Resourcing

Proposal

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Cabinet

• Ministers appointed by Prime Minister• Cabinet Committees, Full Cabinet• Collegial, confidential decisions• Ministers bring different views - not just

departmental• Privy Council Office controls agenda

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Influences on Policyresearch timing (electoral, duration of process)

politics stakeholders money global developments

levels of government technology existing policies

opinion polls lobby groups personalities of leadersgovernment priorities Supreme Court decisions

authority other related policies & programs

other departments law international agreements

crises shuffles (Ministers, Deputy Ministers, etc.) 2-11

Possible Delays

• Complexity of issue• Multiple players or jurisdictions• Competing priorities• Cabinet process• Finding the money• Legislative or regulatory process

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• Speech from the Throne- www.pm.gc.ca/eng/sft-ddt.asp

• Budget- www.fin.gc.ca/access/budinfoe.html#year

• Prime Minister’s & Ministers’ speeches- http://pm.gc.ca/eng/feature.asp?featureId=2

• Political party platforms- www.politicswatch.com/parties.htm

What are the Policy Priorities?

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More Information?

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How Government Works (on-line) - www.campusdirect.gc.ca and click on: - free courses - campusdirect: How Government Works

General Information on the Federal Government- www.canada.gc.ca and click on:

- about government...- structure of the government of Canada

Information on Public Health Agency of Canada

- www.phac-aspc.gc.ca

Information on Health Canada - www.hc-sc.gc.ca

How health policy is made in Canada

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Division of Powers

• Federal: economy, trade, security, national unity, etc.

• Provincial: social policy, health, education, etc.

• BUT…funds lie with federal government

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• The Constitution Act of 1867- http://laws.justice.gc.ca/en/const/

• The Charter of Rights and Freedoms of 1982- http://laws.justice.gc.ca/en/charter/

• The Canada Health Act of 1984- http://laws.justice.gc.ca/en/C-6/

Key Pieces of Legislation / Agreements

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More Key Agreements

• The Social Union Framework Agreement of 1999- http://socialunion.gc.ca/news/020499_e.html

• The Commission on the Future of Health Care in Canada- http://www.hc-sc.gc.ca/english/care/romanow/index1.html

• The Health Accord of 2003- http://www.hc-sc.gc.ca/english/hca2003/accord.html

• Health Care Renewal – Health Canada 2004- http://www.hc-sc.gc.ca/english/hca2003/index.html

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• Multiple actors shape health policy• Health care delivery is

provincial/territorial jurisdiction (with the exception of Aboriginal peoples on reserve)

• Input from voluntary health sector organizations

The Formulation of Health Policy in Canada

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How the Players Connect

Federal Government -

national policies, programs, strategies

Provincial & Territorial Govt -

initiatives & implementation at

their level

Municipalities & Regional Health

Authorities - detailed implementation with province & Health

Voluntary Sector Orgs

Health Voluntary Sector Orgs - policy dialogue,

collaborative initiatives & implementation

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• Leadership in:– developing & implementing policies &

programs– enforcing health regulations– promoting disease prevention – enhancing healthy living– reducing health and safety risks– providing health services to First Nations

on reserve and Inuit communities– international health

The Role of the Federal Government

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• Management and delivery of health services

• Planning, financing and evaluating the provision of health care

• Public health infrastructure

• Health promotion

Note: The territories are ultimately under federal jurisdiction

Roles of the Provinces and Territories

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Health Canada in the North

• The Northern Secretariat at the First Nations and Inuit Health Branch plays a role in Health Canada’s responsibilities in the North

• Some Health Canada programs are eligible to be administered by self-governing First Nations, where operationally viable

• At present, Health Canada, either directly or through a territorial government, continues to operate the Non-Insured Health Benefits (NIHB) program

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• Detailed design and implementation of health care services

• Little or no tax base or constitutional authority

Municipal Governments and Regional Health Authorities

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Roles of voluntary health sector organizations are to:

• collaborate with other levels

• help identify & analyze issues & options

• put forward programming ideas

• deliver services & programs

• monitor their effectiveness

• alert other players to concerns, opportunities, changes, problems

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About the Public Health Agency of Canada & Health Canada

Public Health Agency of Canada (PHAC)

Vision• Healthy Canadians and communities in a

healthier world

Mission• To promote and protect the health of

Canadians through leadership, partnership, innovation and action in public health

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In collaboration with its partners, the PHAC leads federal efforts and mobilizes Pan-Canadian action in preventing disease and injury, and promoting and protecting national and international public health through the following:•Anticipate, prepare for, respond to and recover from threats to public health;•Carry out surveillance, monitor, research, investigate and report on diseases, injuries, other preventable health risks and their determinants, and the general state of public health in Canada and internationally;•Use the best available evidence and tools to advise and support public health stakeholders nationally and internationally as they work to enhance the health of their communities;•Provide public health information, advice and leadership to Canadians and stakeholders;•Build and sustain a public health network with stakeholders.

PHAC Mandate

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Health Canada

Vision• Health Canada is committed to

improving the lives of all of Canada's people and to making this country's population among the healthiest in the world as measured by longevity, lifestyle and effective use of the public health care system.

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Health Canada Cont’d

Mandate:

• Federal department responsible for administering the Canada Health Act

• Development of federal health policy in conjunction with provincial and territorial governments and other stakeholders

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Mandate (cont’d): • Provides supplementary health benefits to

First Nations on reserve and Inuit peoples

Current Priorities• Are updated annually and may be found in

the Department’s Reports on Plans and Priorities

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Health Canada Cont’d

Taken from Health Canada Departmental Performance Report, 2002-03

Public Health Agency of Canada and Health Canada Regional Offices:

• Provide an important link with regional and local networks, including provincial and territorial governments, voluntary organizations, the private sector and the public;

• Ensure PHAC and HC programs complement provincial priorities and suit local conditions;

• Monitor and report on regional trends, issues and stakeholder perspectives;

• Manage and deliver community-based programs, activities and services on behalf of the department.

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Fetal Alcohol Spectrum Disorder

Who Does What and Why – an Example

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• Federal: To develop policies, programs and strategies that address awareness and prevention of FASD in a sustainable national framework

• Provincial/Territorial: Develop, coordinate and promote FASD education, training and development of resources

FASD Federal & Provincial Roles

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• Early Childhood Development (ECD) Agreement in 2000

• Four key areas for action: promote healthy pregnancy, birth and

infancy improve parenting and family support strengthen early childhood development,

learning and care strengthen community support

FASD Intergovernmental and Interdepartmental Strategies

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• Types of Groups

• Role of Groups

• Multiple opportunities to influence the FASD Initiative

The Role of the Voluntary Health Sector

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How the FASD Players Connect

Federal Government - national policies, programs, strategies

Provincial & Territorial Governments - initiatives and implementation at provincial/territorial level

Municipalities & Regional Health Authorities - detailed implementation in collaboration with province & Health Voluntary Sector Orgs

Health Voluntary Sector Organizations - policy dialogue, collaborative initiatives, implementation

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Questions?

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2. How to hear and be heardhow to hear and be heard: Strategies and tools for connecting with government

Session Objectives

• To reinforce the importance and power of your organization’s voice in the policy debate

• To illustrate how you might build a strategy for policy dialogue with government

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Why Get into Policy?

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Start with Attitude

• Voluntary health sector & government are natural allies

• Voluntary health sector has been source of many new public policy ideas and has many strengths

• Voluntary health sector & the Government of Canada have broad agreement on best practices

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The Voluntary Sector’s Value

“A healthy and active voluntary sector plays an important role in helping the federal government identify issues and achieve its public policy objectives. By its very nature and particularly because of its connection to communities, the voluntary sector brings a special perspective and considerable value to its activities, including those it undertakes with the Government of Canada.”

from A Code of Good Practice on Policy Dialogue, Voluntary Sector Initiative, 2002, p.6.

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Build Relationships• Facts & arguments persuade, but people make

decisions• Before a major issue arises, get to know key

players in:– government(s)– voluntary sector– communities– business

• Recognize you share the same goals - the health and well-being of Canadians

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1. Develop your position

2. Find your allies

3. Decide who you need to persuade

4. Decide who you need to involve

5. Identify opportunities

6. Develop messages and a story-line

7. Develop your approach

8. Determine your costs and milestones

9. Implement and evaluate

10. Success!

The Strategy

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• Recognize the problem• Define the problem• Get the facts• Do the analysis• Assess the options• Assess and manage risk• Charitable status• Create a statement of what you want

1. Develop Your Position

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• How do you know you have a problem?


Recognize the problem

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“Perceived” Problem

Possible Causes

Proposed Goals/Objectives

“Perceived” Issue

Possible Action

“Real” Problem

Actual Cause(s)

Set Goals/Objectives

Issue

Game Plan/Action

ANALYSIS

VERIFICATION

Getting to the Root

Define the problem 1. Develop your position

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Get the facts

• Get them all and get them right

• Keep them up-to-date

• Share them with partners (and government)

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Do the analysis

• Program / Policy Contextual Analysis

• Quantitative Approaches

• Stakeholder Analysis

• Political Contextual Analysis

Is it do-able?

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Where to look locally

For information and analysis:

• Organizations that scan the environment

• Knowledgeable people

• Sources of written material

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Assess & manage the risk

• Do a realistic assessment of risks and opportunities before engaging in the policy development process.

• Monitor the risks and opportunities throughout the process

• Consult the VOICE project’s Risk and Opportunity Assessment: Engaging in the Health Policy Process, July 2003

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Questions to ask about risk• Ask questions related to your

organization’s:–mandate– resources– policy knowledge– collaborative strengths– commitment– other relationships– the public good

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Charities & “political activities”

• Policy statement (CPS-022) from the Canada Revenue Agency (CRA) applies to registered charitieswww.cra-arc.gc.ca/tax/charities/policy/cps/cps-022-

e.html

• Policy statement narrows what CRA interprets as political activities “to no longer include many attempts to inform public opinion on an issue.”

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Develop & assess the options

• Part of normal routine for any organization

• Generally important to do before entering into dialogue with government

• Explore opportunities to develop and assess options alongside government colleagues

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Create a clear statement

• Reduces risk of misunderstanding, confusion or omission of important elements

• Proposing a decision can be helpful in framing discussions

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2. Find Your Allies

• other organizations - create or join a coalition

• media

• decision-makers

• their advisors

• the prominent and quotable

• etc.3-19

• The decision-makers

• Those who influence decision-makers

• Those who could derail you

3. Decide Who You Need to Persuade

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Perspective ofthe Key Players

• Senators

• Members of Parliament (MPs)

• Ministers

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More Key Players

• Minister’s staff

• Public Servants

And, factor in personality

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4. Decide Who You Need to Involve

• Staff• Volunteers• Your Board• Your members and community

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• Governments have many priorities - be prepared to answer “Why Now?”

• What presents an opportunity?– Crises– Transition: change of government, change of

leadership, an election, a Speech from the Throne etc.– Decision Points: consultations on new issues, new

programs introduced, the Budget etc.– Events

5. Identify Opportunities

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6. Develop Messages & Story

• Messages should be drawn from clear statement of position

• Story-line should be pyramidal

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7. Develop Your Approach

• Creating policy documents• Convening policy events• Communication materials• Personal contact - meetings and

correspondence

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Creating policy documents

• A statement of the issue or challenge

• Background information

• Analysis

• A position statement on how the issue should or could be addressed

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Convening policy events

• Consider organizing a meeting and inviting government to collaborate and/or attend

• Policy events come in many different shapes and sizes

• Many benefits of policy events

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Communications material

• Create a plan

• Consider timing

• Web-site, media, print, advertising/public service announcements

• Consider getting expert help

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Meetings and correspondence

• The personal touch:

– meetings with key decision-makers and people with influence

– correspondence

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8. Determine the Costs

• Look at the range of potential costs: financial, human resources, level of service to clients

• Consider additional sources of funding: government, foundations, donated services

• Set milestones

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9. Implement & Evaluate

• Implementation - The strategic plan is not an end in itself

• Evaluation - Your strategy and the impact of the policy change

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10. Success!

• Give credit where credit is due

• Thank those who made the changes and supported your cause

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Questions?

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3. Putting it into Practiceputting it into practice: Developing a policy strategy

Session Objectives

• To apply the knowledge and skills learned in the previous sessions to a relevant issue.

• To have participants share ideas on best practices for policy dialogue with government.

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Case Study Instructions

1.Work in your small group to assess the case study, or your local health issue, and taking the role of the Executive Directors of the lead organization, develop a strategy for engaging government. (60 - 75 minutes)

2. Choose one person to present your strategy to the larger group (the group will be acting as your Board of Directors). Each presentation should be no more than 10 minutes. Be prepared to answer questions!

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Small Group Questions• Using the information either provided in the case

study or based on what you know of your local issue, develop the following elements of a policy strategy:

– define what your position is– determine who can help you - your allies– decide who you need to persuade and who you

need to involve– identify opportunities of when to present your

position– develop “messages” which indicate your position– choose the tools to communicate your message

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Reporting Back…

• Present the results of your strategy to the Board

Some time will be allowed for questions

• What did we learn from the process of developing a policy strategy?

• Where do we go next?

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Reflections on the workshop

making your voice count!

Decision-Making Cycle

Departments DefinitionAnalysis

Inter-Departmental or

Jurisdictional

Cabinet &Committees

DraftLegislation

The HouseFinalizeProgram

Minister -Announcement

ImplementationEvaluation

The Public

Environmentalscanning

Decision-MakingCycle

Program &Resourcing

Proposal

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Build Relationships

• Facts & arguments persuade, but people make decisions

• Before a major issue arises, get to know the key players

• Assume you share the same goals - the health and well-being of Canadians

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Have A Strategy

1. Develop your position2. Find your allies3. Decide who you need to persuade4. Decide who you need to involve5. Identify opportunities6. Develop messages and a story-line7. Choose your approach8. Determine your costs & milestones9. Implement and evaluate10. Success!

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The Voice of the Voluntary Sector Matters.

Hear and Be Heard!

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myvc trainer slides eng

Health & Medicine

creating policy

major issue

public health

butpeople

convening

regional health

voluntary

policy development