Background
Rural health contexts are faced with unique challenges, which include long-term unfilled positions, high staff turnover, low job satisfaction, high levels of nurse burnout and minimal opportunities for career advancement (Cosgrave, Hussain, & Maple, 2015). As such, it becomes difficult to ensure access to affordable, quality healthcare for the rural population due to lack of personnel in critical units and low levels of service provision arising from a disenchanted and unmotivated workforce (Asante, Martins, Otim, & Dewdney, 2014). It is therefore important to develop a rural health policy that will attract healthcare providers to rural communities and ensure the provision of quality and affordable healthcare to the residents.
The Policy Process
Evaluation Stage
The evaluation stage in the policy process has been defined as the phase through which policymakers develop a comprehensive understanding of the merit, worth and utility of a policy by applying various evaluation principles and techniques to scrutinize the content, implementation or impact of the policy to the intended audience or population (Luck et al., 2015). It is important to note that evaluation is a “systematic way of learning from experience and using the lessons learned to improve current activities and promote better planning by careful selection of alternatives for future action” (Spassoff, 1999, p. 182). This phase not only checks the policy in terms of necessity, efficiency and validity, but also evaluates its impact on the problem or issue at hand (Houston, Brigmon, & Parsons, 2008).
There are many methods that can be used to determine if the stated policy objectives of attracting healthcare providers to rural communities and ensuring the provision of quality and affordable healthcare can be successfully met. In this paper, a cost-benefit analysis (CBA) of the rural health policy is used to evaluate whether the policy succeed in accomplishing the stated objectives. The CBA framework provides a method of economic assessment that values all benefits against all costs and uses the resulting cost-benefit ratio to offer a more quantitative indication of whether the benefits outweigh the costs of a policy intervention (Houston et al., 2008). As such, it will be important to provide a monetary value of all the costs related to implementing interventions that will reduce staff turnover and enhance their motivation and satisfaction. Such interventions may include the provision of monetary incentives, promotion opportunities, work-family balance programs and more personnel.
Next, a monetary evaluation of all the benefits arising from the policy intervention will be undertaken. Such an evaluation may aim to quantify several indicators, such as level of community health status, changes in the number of health personnel providing healthcare services in rural hospitals, quality of care provided to the population after the policy intervention, as well as satisfaction level for health professionals and community members. The objectives of attracting health providers to rural settings and ensuring the provision of quality and affordable care will be perceived as being met if the benefits of the policy intervention outweigh the costs (Houston et al., 2008). It is also important to evaluate other alternative interventions that could be used to achieve the stated objectives to determine if the policy is more or less costly relative to other alternatives that can be implemented to attain similar benefits.
Analysis Stage
Health policy analysis has been defined in the literature as “a multi-disciplinary approach to public policy that aims to explain the interaction between institutions, interests and ideas in the policy process” (Walt et al., 2008, p. 308). Drawing from this description, the policy analysis stage can be defined as a collection of methodologies and techniques that are applied to determine or evaluate if the policy has the capability to achieve the stated objectives. Available literature demonstrates that policy analysis is not only comprehensive in nature by virtue of encompassing cause-and-effect relationships, outcomes and impacts of the policy, but also multifaceted by virtue of examining and weighing available alternatives for achieving the goals and objectives of the policy (Houston et al., 2008).
One of the factors that could prevent the stated policy objectives from being achieved is inability or unwillingness to engage all stakeholders, including those who oppose the policy. Lack of stakeholder engagement can lead to resistance to ongoing initiatives aimed at attracting healthcare providers to rural communities and ensuring quality and affordable healthcare in rural settings (Using Evaluation, 2014). Another factor relates to the use of unreliable or invalidated data to inform the policy process. It is always important to use valid and reliable quantitative or qualitative data collection methods to ensure that the results achieved from the policy analysis process reflect the true situation on the ground (Houston et al., 2008). The inability to include vested and often conflicting interests and opinions may also jeopardize the successful attainment of the stated objectives. Lastly, the incapacity to capture and quantify levels of resources, values, beliefs and power of different actors within the rural health context may serve as a hindrance to the achievement of the stated policy objectives (Walt et al., 2008).
The factors that may ensure the rural health policy meets its stated objectives include (1) incorporating relevant government health agencies and other stakeholders in the decision making process, (2) establishing a criterion for the inclusion of alternative interventions that add value to the stated objectives, (3) developing effective mechanisms for the successful implementation of the policy, and (4) ensuring the inclusion of community members and healthcare professionals as important stakeholders by virtue of their position as beneficiaries of the rural health policy (Houston et al., 2008; Walt et al., 2008). It is also important to ensure the availability of monetary and nonmonetary resources that will be used to drive the desired changes and health outcomes (Using Evaluation, 2014).
Revision Stage
The revision stage in the policy process entails making changes to an existing policy depending on the findings of the ongoing evaluation and analysis (Subruto, 2011). The main revision arising from the factors identified in the analysis stage is to include the positions of important stakeholders to ensure minimal resistance. It is also important to relook at the data used in informing policy interventions to ensure their accuracy and ability to address the real issues on the ground. Additionally, the policy should be revised so that it reflects the vested interests of local political actors and other stakeholders in rural health, such as private practitioners, drug providers, and community-based organizations. Lastly, it is important to revise the policy to ensure the inclusion of alternative interventions that have been depicted as feasible and less costly in achieving the stated policy objectives. The inclusion of such alternatives must be based on their capacity to meet the policy objectives better and more efficiently than the initial interventions.
References
Asante, A.D., Martins, N., Otim, M.E., & Dewdney, J. (2014). Retaining doctors in rural Timor-Leste: A critical appraisal of the opportunities and challenges. Bulletin of the World Health Organization, 92(4), 277-282.
Cosgrave, C., Hussain, R., & Maple, M. (2015). Factors impacting on retention amongst community mental health clinicians working in rural Australia: A literature review. Advances in Mental Health, 13(1), 58-71.
Houston, J.G., Brigmon, P.B., & Parsons, W.W. (2008). Criminal justice and the policy process (2nd ed.). Lanham, Maryland: University Press of America.
Luck, J., Yoon, J., Bernell, S., Tynan, M., Alvarado, C.S., Eversole, T.,…Beathard, C. (2015). The Oregon public health policy initiative: Building competencies for public health practice. American Journal of Public Health, 105(8), 1537-1543.
Spassoff, R.A. (1999). Epidemiological methods for health policy. Oxford: Oxford University Press.
Subruto, A. (2011). Understanding complexities in the public policy-making process through policy cycle model: A systematic dynamics approach. Web.
Using evaluation to inform CDC’s policy process. (2014). Web.
Walt, G., Shiffman, J., Schneider, H., Murray, S.F., Brugha, R., & Gilson, L. (2008). ‘Doing’ health policy analysis: Methodological and conceptual reflections and challenges. Health Policy and Planning, 23(2), 308-317.