การพัฒนานโยบายด้วยหลักฐานเชิงประจักษ์(Evidence-based policy development) ดร.ทพญ.ศิริวรรณ พิทยรังสฤษฏ์ Director, International Health Policy Program กระทรวงสาธารณสุข www.ihpp.thaigov.net

Good policy Good policy involves information gained from multiple sources, including expert knowledge, existing and new research, secondary sources, and stakeholder input. (Ridenour 2009)

Ref: Klein’s presentation on Evidence based policy development

Steps in Evidence Based Practice  Step 1: Formulating a well-built question  Step 2: Identifying articles and other evidence-based resources that answer the question  Step 3: Critically appraising the evidence to assess its validity  Step 4: Applying the evidence  Step 5: Re-evaluating the application of evidence and areas for improvement Ref: Klein’s presentation on Evidence based policy development

Policy adoption (Agenda setting theory) Hall et al. model Legitimacy Feasibility Support Kingdon 3-stream model Problems Policies (solutions) Politics (political will)

A Theory on agenda setting Used for academic purpose Presented by Siriwan Pitayarangsarit 21 July 2004 A Theory on agenda setting The Hall et al. model Legitimacy -those issues with which governments feel they should be concerned Feasibility technical knowledge, skills, infrastructure Support public support for the issue Legitimacy Issues where governments feel most people will accept state intervention. Issues range from high to low legitimacy. Examples: most people expect govts to keep law and order in the streets, to defend the country from external aggression Other areas, legitimacy not easily conferred: China’s one-child population policy; Russia what you could write about; Malawi – short skirts Feasibility Refers to the potential for implementing the policy, defined by prevailing technical and theoretical knowledge, financial and other resources. Example: Cannot integrate STD treatment into FP clinics until health workers can diagnose the diseases, and treat them (which may mean changing sorts of drugs available Support Elusive, depends on people’s trust in government, and support for issue Example: In 1980s not possible for Irish or Argentinian govt to introduce divorce law reform – implacable Church opposition

Agenda Setting Through Three Streams Used for academic purpose Presented by Siriwan Pitayarangsarit 21 July 2004 Agenda Setting Through Three Streams The Kingdon model Problem Stream indicators focusing events feedback Politics Stream (political will) visible participants hidden participants Policy Stream (solutions) window of opportunity Problem stream Indicators – routine information on health statistics (showing increase in heart disease or rising costs of particular programme) Focusing event – a crisis – cholera outbreak, or personal experience Feedback – programmes already in place – eg through evaluations Politics (political will) stream Visible participants – organized interests – interest groups – but may also be inside govt eg new president or PM; interest group with new data Hidden participants – specialists – academics, researchers, consultants Policy (solutions) stream Policymakers select from problems and politics streams and make public policy – ie find the political will to make the three streams come together (political will complex: made up of policymakers perceptions of public acceptability, financial & technical feasibility, etc) Ie policymaking doesn’t occur in linear stages, ie policymakers don’t necessarily proceed from identification of a problem, seek solutions for them.

Kingdon’s - 3 Stream model No Change Problem Policy (Solutions) Politics (Political will) Kingdon’s - 3 Stream model ACTION

Thank You Contact: siriwan@ihpp.thaigov.net