Conceptual underpinnings: Health policy, policy formulation, and policy implementation

Managing hypertension and diabetes calls for the adoption of appropriate health policies. Health policy, an aspect of public policy, is used to denote “ courses of action that affect that set of institutions , organizations, services and funding arrangements of the health care system in a country” (Palmer & Short, 1994 p.23). Health policies therefore encapsulate actions or desired actions taken by public, private or voluntary organizations that impinge on the health of a population. According to Palmer and Short (1994), health policy differs from other policies because of the distinctive role and influence of the medical profession, the complex nature of providing health care, and the difficulty in differentiating good health services from poor services. These features make health policy a crucial aspect of the public policy of a state. To understand health policy though, regard should be given to understanding social and economic policy since clear linkages exist and forms an important part in fashioning a robust health policy and system.
Formulation of health policies is an important consideration in the management of disease conditions. However, policy formulation has been conceived as a “highly diffuse, and complex, process which varies by case….as nuances in particular instances can be grasped only through empirical case studies” (Howlett, Ramesh, 1995 p.123). However, no matter how complex the process might be, the basic conception is that policy formulation starts when governments realize a need and thinks of a course of action to address that need by exploring various options. Consequently, policy formulation involves elimination of policy options, until one or only a few options amongst which policy makers make their final decision (Howlett and Ramesh, 1995 p.123).
In addressing health needs, options selected must be implemented in order to realize the benefits of such decisions. Translating health programs into practice (implementation) is a complex phenomenon. Key issues to be taken into account include the nature of the health problem and the context, and the organization of the administrative mechanism in charge of the task of implementation (Howlett and Ramesh, 1995). Implementation of health policies may be influenced by socio-economic conditions, political circumstances, technological issues as well as the administrative apparatus (Sabatier and Mazmanian, 1980; Brownson et al ., 2003).