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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?
1. Develop your position
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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1. Develop your position
Do the analysis
• Program / Policy Contextual Analysis
• Quantitative Approaches
• Stakeholder Analysis
• Political Contextual Analysis
Is it do-able?
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1. Develop your position
Where to look locally
For information and analysis:
• Organizations that scan the environment
• Knowledgeable people
• Sources of written material
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1. Develop your position
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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1. Develop your position
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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1. Develop your position
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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1. Develop your position
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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1. Develop your position
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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1. Develop your position
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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3. Decide who you need to persuade
More Key Players
• Minister’s staff
• Public Servants
And, factor in personality
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3. Decide who you need to persuade
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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7. Develop your approach
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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7. Develop your approach
Communications material
• Create a plan
• Consider timing
• Web-site, media, print, advertising/public service announcements
• Consider getting expert help
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7. Develop your approach
Meetings and correspondence
• The personal touch:
– meetings with key decision-makers and people with influence
– correspondence
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7. Develop your approach
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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