Comparison of health policy processes in India, Vietnam and China –Findings from HEPVIC project

BackgroundThe HEPVIC project aims to understand the interplay of key aspects of health policy development and implementation in Vietnam, India and China: context, evidence, the role of civil society and the way in which human resources, service delivery and the wider health system are considered. This session compares the key elements of, and influences on, health policy processes in the three countries. 
Methods:This study compared qualitative data on the development and implementation of three maternal policies, which were collected and analysed in each country. The comparative analysis described and explained patterns (commonalities and differences) in policy development and implementation, relating them to their different contexts and to existing policy theory.
Findings
Formal policy development tended to be top-down and closed, but with clear trends of greater civil society participation. Triggers for agenda-setting included international evidence and events, media events, and individual policymakers’ experiences.  Multisectoral policy processes, as in domestic violence, were slower, with more implementation barriers, than ‘health technical’ issues, such as safe motherhood. The role of the private sector in implementation was growing, but often not considered explicitly during policy design. Human resource issues considerations generally focussed on inservice training needs, rather than HR management and workload implications. International actors were influential, providing funds and evidence for agenda setting and policy design. Changing national political contexts were key influencers, as were cultural issues and economic pressures.  Policy theories were helpful in explaining policy processes, but can be amplified through these findings.
Conclusions
Either an integrated design or sequential phasing of policy development can result in a well thought-out policy.  Key aspects for policy implementation were not consistently considered, especially the role of the private sector, HR aspects and financing. Policy processes are messy and difficult to research, but are essential to understand for improved policy.