Factors influencing policy formulation, implementation and outcomes

The literature identifies several key factors that influence the success of pro-poor health policies.

• The context in which the policy operates is important. Formulating a policy requires a good understanding of local needs, opportunities and constraints (population needs, capacities and commitment of local actors).
• A variety of stakeholders must be taken into account. Health systems depend among others on support from donors, adhesion from the population and commitment of the health workers. It calls respectively for a convincing attitude from the government, specific measure to empower the population and civil society, and complementary measures on the supply side to foster quality and accountability (regulation, incentives and norms).
• No single health assistance scheme is sufficient to meet the needs of entire populations and it is often better to target specific groups. Policy development must be seen as a search for complementarities and synergies between health financing and health assistance mechanisms
• Political commitment is of key importance for nationwide strategies. The strategy must integrate a wider arena than only the health sector, as caring for the poor is more than a technical issue. Others ministries (e.g. social welfare) may be involved.
• Finally, there are no universal solutions, as the strategy depends and impact on the whole institutional setup. It is important to know which conditions made a policy possible, and how this policy changes its environment. It is always the result of a sustained approach that allows adaptation over time in response to experience and changing environment.

A similar set of principles is developed in a recent report of the WHO Commission on Social Determinants of Health: Challenging inequity through health systems: final report of the Knowledge Network on Health Systems. It takes a wider look at the health systems and provides recommendations to public and civil society health actors on how to better address equity considerations. It is organised along the lines of mobilising intersectoral relationships; facilitating social empowerment; building up universal health coverage; and strengthening processes of developing and implementing policies. The report also stresses that international actors must support national led health system transformation and action.