Policy analysis is an established discipline in the industrialized world, yet its application to developing countries has been limited. The health sector in particular appears to have been neglected. This is surprising because there is a well recognized crisis in health systems, and prescriptions abound of what health policy reforms countries should introduce. However, little attention has been paid to how countries should carry out reforms, much less who is likely to favour or resist such policies. This paper argues that much health policy wrongly focuses attention on the content of reform, and neglects the actors involved in policy reform (at the international, national sub-national levels), the processes contingent on developing and implementing change and the context within which policy is developed. Focus on policy content diverts attention from understanding the processes which explain why desired policy outcomes fail to emerge. The paper is organized in 4 sections. The first sets the scene, demonstrating how the shift from consensus to conflict in health policy established the need for a greater emphasis on policy analysis. The second section explores what is meant by policy analysis. The third investigates what other disciplines have written that help to develop a framework of analysis. And the final section suggests how policy analysis can be used not only to analyze the policy process, but also to plan.

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Reforming the health sector in developing countries: the central role of policy analysis

Any theory of the manner in which governmental policies get formulated and implemented, as well as the effects of those actions on the world, requires an understanding of the behavior of major types of governmental institutions (legislatures, courts, administrative agencies, chief executives), as well as the behavior of interest groups, the general public, and the media. The dominant paradigm of the policy process, the stages heuristic popularized by Jones (1970), Anderson (1975), and Peters (1986), has outlived its usefulness and must be replaced, in large part because it is not a causal theory. In the course of their empirical work, policy scholars have highlighted a number of phenomena that need to be incorporated into theories of the policy process. The development of such theories requires an integration ‘of both political scientists’ knowledge of specific institutions and behavior and policy scholars' attention to policy communities, substantive policy information, etc.Innovations by Policy Scholars in Understanding the Policy ProcessAt least since World War II, most political scientists have tended to focus on either a specific type of institution (legislatures, the presidency, courts, interest groups, administrative agencies, local governments, political parties) or on specific types of political behavior outside those institutions (public opinion, voting, political socialization). These have become the standard subfields within the discipline.In contrast, scholars interested in public policy have not been able to stay within these subfields because the policy process spans all of them. In the course of empirical work, policy scholars have highlighted a number of phenomena often neglected by political scientists without a policy focus:a) The importance of policy communities/networks/subsystems involving actors from numerous public and private institutions and from multiple levels of government;b) The importance of substantive policy information;c) The critical role of policy elites vis-a-vis the general public;d) The desirability of longitudinal studies of a decade or more;e) Differences in political behavior across policy types.

Toward Better Theories of the Policy Process

This paper presents a review of three decades of implementation studies and is constructed in the form of a personal reflection. The paper begins with a reflection upon the context within which the book Policy and Action was written, a time when both governments and policy analysts were endeavouring to systematize and improve the public decision-making process and to place such decision-making within a more strategic framework. The review ends with a discussion about how public policy planning has changed in the light of public services reform strategies. It is suggested that as a result of such reforms, interest in the processes of implementation have perhaps been superseded by a focus upon change management and performance targets. It is further argued that this has resulted in the reassertion of normative, top-down processes of policy implementation. The paper raises points that are important ones and indeed are reflected throughout all four papers in the symposium issue. These are: (1) the very real analytical difficulties of understanding the role of bureaucratic discretion and motivation; (2) the problem of evaluating policy outcomes; and (3) the need to also focus upon micro political processes that occur in public services organizations. In conclusion, the paper emphasizes the continued importance of implementation studies and the need for policy analysts to understand what actually happens at policy recipient level.

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Implementation Studies: Time for a Revival? Personal Reflections on 20 Years of Implementation Studies

Path dependency is an important notion in diachronic approaches to understanding social and political processes. The first section of this paper examines the application of path dependency to policy studies; the advantages of the concept in understanding policy development are highlighted by examples from pension policy and social housing policy in the UK, and the EU budget. The next section considers several criticisms of path dependency: (1) it is a fashionable label for the intuition that ‘history matters’ without a clear and convincing account of decision-making over time; (2) it explains only stability and not change; (3) its normative implications are confused and mostly left unexplored. The final section concludes that path dependency, despite being theoretically inchoate and difficult to operationalize empirically, is a valid and useful concept for policy studies. However, its proper application demands sensitivity from scholars to other temporal dynamics that may operate in policy development.

A Critique of the Use of Path Dependency in Policy Studies

Recent scholarly research into public policy has stressed the role of knowledge in the policy process. The variety of concepts and approaches to the study of knowledge seems puzzling. However, this article argues that the different theoretical approaches have some common ground and that a ‘knowledge perspective’ on the policy process has many advantages. It is suggested that such fields as evaluation research, epistemic communities, diffusion of economic policy paradigms, agenda‐setting and policy learning contribute to a new view of the policy process, in which power and knowledge perform complementary functions. The conclusions discuss the main implications for further research in the analysis of the policy process.

H. Hugh Heclo

Papers

Review Article: Policy Analysis