Although all steps are equally important in the process of making a health policy, the initial step of issue identification is the one that determines the issue being processed as an agenda for the formulation of policy. (Buse et al., 2012, p. 15).
Hall et al. model define, legitimacy, feasibility, and support as three criteria that qualify a health problem as a policy agenda. An issue only gets to the agenda table when the government believes that its responsibility to solve it and if it has the feasibility to be solved in terms of resources like manpower, budget, and technology. The issue should also get the support of the public and interest groups. But sometimes despite the lack of feasibility, some issues get into the agenda because of the foreign or international aid that the country is receiving (Buse et al., 2012, pp. 68-74)
Whereas, according to the Kingdon model, when the three streams: problem stream, the policy stream, and the political stream run together or intersect, a policy window opens, and the matter is put as an agenda. This window opens when there is a clearly defined problem followed by policy entrepreneurs linking a solution to it and there is a political opportunity for action. Policy actors like media, civil society, I/NGOs, pharmaceuticals, etc. also play an important role in framing a problem, proposing a solution, and creating a favorable condition (Buse et al., 2012, pp. 68-74).
Problem stream demands discussing and framing an issue in a specific way to grab the attention of policymakers. Focusing on certain events like an epidemic outbreak or crisis can also bring focus to agenda setting as it needs immediate solutions like the Ebola outbreak. Feedback from the policy evaluation stage also contributes to pushing an issue onto the agenda when the current policy either do not meet the objective or is producing any unintended side effects (Sabatier, Weible, Herweg, Zahariadis, & Zohlnhøfer, 2018, pp. 21- 22). Policy stream whereas consists of the analysis of the health problems and their possible solutions with the possibility of success (Buse et al., 2012, p. 69). The issue and its probable solutions must pass the survival criteria like technical feasibility, acceptability, public acquiescence, and financial viability. If not, the issue is not taken further as an agenda (Sabatier et al., 2018, pp. 23-24)In the political stream majorities of the proposal are sought, and thus the stream consists of bargaining and powering. National mood, interest groups, and the government are the three core elements of this stream which mostly is affected by elections, budgeting, and alike (Buse et al., 2012, p. 70). One example can be countries like China, Costa Rica, Cuba, and Sri Lanka helping people to achieve good health despite the lack of extensive financial resources to invest in health as a result of strong political will (Skolnik, 2016, p. 14).
Let’s take unsafe abortion, responsible for 1 in 12 maternal deaths globally, as an example. Every year 7 million are either injured or disabled and 22000 yearly deaths occur due to unsafe abortion (Médecins Sans Frontières, 2019), making unsafe abortion a severe issue. Solutions like free legal safe abortion, sex education, and family planning can be bought by the stakeholders to address and solve the issue. But the best solution to this can be free legal safe abortion through medication as not only it can be easily administered by trained midwives and nurses but is also less invasive and can be completed with privacy (Médecins Sans Frontières, 2019). Whereas, termination of pregnancy through surgeries are comparatively expensive and can have complications like infection, excessive bleeding, and injuries (Better Health Channel, 2018). Sex education might be useful but takes a longer time to create an impact. So, here the issue of unsafe abortion has a possible policy solution of abortion via medication. It, however, is not enough that we identified a problem and a probable solution, the political context too should be appropriate for the availability of resources (easy production of abortion drugs), trained health personnel, acceptance from the society, and preference of women and government’s focus to improve women’s health. These lining of events or conditions then can trigger policy development and can put unsafe abortion as the agenda. So, an issue is defined as agenda only after it goes through a series of criteria from being framed as a problem, have the most effective and feasible solution aligning with the context of the country.
References
- Better Health Channel. (2018). Abortion procedures – surgical. Retrieved from https://www.betterhealth.vic.gov.au/health/healthyliving/abortion-procedures-surgical
- Buse, K., Mays, N., & Walt, G. (2012). Making health policy (2nd ed.). Maidenhead: McGraw-Hill.
- Sabatier, P. A., Weible, C. M., Herweg, N., Zahariadis, N., & Zohlnhøfer, R. (2018). Theories of the policy process. In (Fourth ed. ed.). New York: Routledge.
- Médecins Sans Frontières. (2019). Unsafe abortion: a forgotten emergency. Retrieved from https://www.msf.org/unsafe-abortion-forgotten-emergency-womens-health
- Skolnik, R. L. (2016). Global health 101 (Third ed. ed.). Burlington, Massachusetts: Jones & Bartlett Learning.