|
|
|
The starting point for clarifying the problem in a policy brief is to indicate how the problem was described when the decision to prepare a policy brief was taken. This should include a description of how the problem came to attention and the motivation for preparing a policy brief about this particular problem. As a rule, this information should be provided in the first background paragraph of the problem description, which should share some of the same characteristics of a lead in a newspaper article. It should be short (a couple of sentences); it should summarise what the problem is and why the policy brief is needed; it should contain only information necessary for the reader to understand the content of the policy brief; and it should motivate the target audience to continue reading.
Subsequent iterations and analysis of the problem can lead to clearer descriptions of the problem, a better understanding of its size and causes and, possibly, a better way of framing the problem that will facilitate the identification of appropriate solutions.
It is not uncommon for health system problems to be unclear when
they first come to attention. Sometimes a solution rather than a
problem is brought to attention by policymakers or advocates
without it being made clear what exactly the problem is that the
solution is intended to address. For example, while the issue of
task shifting may appear on a political agenda, it may not be clear
whether the problem is in fact the shortage of health workers, the
distribution of health workers, the use of health workers, the
performance of health workers, or a combination of these issues.
Therefore before appropriate options can be identified, it is
necessary to clarify what the problem is.
Sometimes a diagnosis rather than a problem may be brought to
attention, but it may not be clear that the right diagnosis has
been made. Many countries have implemented health reforms to
address the poor coordination of care. This may have been
done because uncoordinated care was thought to be the cause of
inefficiency and high costs; of ineffectiveness and poor health
outcomes; of patient dissatisfaction and long waiting times; or of
other problems. Without knowing what the problem is, it is
difficult to know if a correct diagnosis has been made or whether
the policies targeted at improving the problem are likely to
address it. In such cases, before appropriate policy options can be
identified, it will be necessary to ascertain what the problems are
that a lack of coordination is thought to be causing.
Thus, when clarifying a problem, it is important to ensure that a
problem has in fact, been identified (rather than a solution or a
diagnosis). Interactions with policymakers and other stakeholders
may be needed to uncover what the problem is before proceeding. In
other cases, it may be helpful simply to flag uncertainty about
what the problem is in the background section and to facilitate
subsequent discussions of this.
Knowing how the problem came to attention can help to clarify both what the problem is and the extent to which it warrants attention. A problem may come to attention as a result: of a specific event (e.g. an avoidable death that is widely reported in the media); of a change in an indicator (e.g. an increase in treatment failures for malaria or tuberculosis); of a lack of progress towards established goals (e.g. the Millennium Development Goal for maternal mortality); of advocacy (e.g. for improvement in anti-retrovirals coverage); of public dissatisfaction brought to attention through polls and the mass media; of political consensus (e.g. to increase insurance coverage); of a political event (e.g. the appointment of a new Minister of Health who has a personal interest in a particular issue); pressure from donors or international agencies (e.g. to reduce corruption); or of a priority-setting process.