Which policy options should be presented?

The selection of policy options to be presented in a policy brief often flows logically from the description of the problem, and particularly from the analysis of the cause of the problem or underlying factors, as described in SURE Guide 3: Clarifying the problem. The rationale for deciding which policy options to present in a brief should be provided at the beginning of the section in the brief in which the options are described. When relevant, this should include a statement of why any other options that were considered were excluded. If several potential options were considered and excluded, or the reasons for selecting the particular options that were included cannot be explained in one or two short paragraphs, more detailed information about the reasons for excluding or including specific options could be included as an appendix.

A number of strategies can be used to identify potential policy options, including:

• A consideration of different delivery, financial, and governance arrangements that address the problem or its underlying causes
• Using frameworks developed to address the specific problem
• Considering interventions described in systematic reviews
• Considering ways in which other jurisdictions have addressed the problem
• Consulting key informants
• Brainstorming

Because the causes of health system problems are complex, solutions to these problems may also be complex. In addition, it may be necessary to consider bundles or packages of different delivery, financial and governance arrangements to address a problem.

Deciding which policy options should be described in a policy brief may be relatively straightforward if, for example, the policy brief is being prepared to describe a specific solution that has already been proposed. But in other instances, deciding on which options to present may require several iterations. Decisions may need to be reached in different ways, such as:

• First considering a broad range of options, then narrowing the selection down to the most viable ones by appraising each on the basis of evidence and acceptability, and then examining what additional changes in delivery, financial, and governance arrangements might be needed in conjunction with these options; or by
• First considering potential delivery, financial, and governance arrangements as potential elements of policy options; and then appraising the evidence for those elements; and then determining whether and how to bundle or package viable elements into policy options

A framework can be used to structure the consideration of potential solutions to a problem. Sometimes the framework used to clarify the causes of a problem can also be used to identify potential solutions. For example, a broad framework for health system problems might be used both to clarify the causes of a problem and to identify potential solutions.¹ More specific frameworks may facilitate a consideration of the potential solutions to some types of problems. The process of finding frameworks and examples of them is described in SURE Guide 3: Clarifying the problem.  Further guidance is provided in the SUPPORT Tool on using research evidence to frame options to address a problem which is in the ‘Additional resources’ section of this guide.

Systematic reviews or overviews of systematic reviews may describe options for addressing a particular problem. These can be used to provide a framework, as well as providing an inventory of interventions and evidence of their impacts. Strategies for finding systematic reviews can be found in the ‘Additional resources’ section of this guide.

A consideration of how other jurisdictions have addressed similar problems may also be helpful when identifying potential solutions. While there is no simple method of searching for descriptions of policies tried in other jurisdictions, the most efficient way to find them may simply be to talk to people with expertise in the specific areas. Contacting people in other countries with similar problems may also be particularly useful. Consultation with key stakeholders may also be helpful, as well as with people with relevant expertise who may be able to provide information about which solutions they consider viable, based on their experience, knowledge and perceptions.

Brainstorming or creative thinking (Box 4.1) may be important when deciding which policy options to present as viable alternatives for addressing a problem. This may be done in a structured way, using a framework, or in an unstructured way. 

Involving people with different perspectives and those with a broad knowledge of the health system during the brainstorming process is useful. A brainstorming process may be best done in two or more stages. The first stage, for example, could be the generation of potential solutions - and ideas about where and how to identify other potential solutions - after considering a description of the problem and its causes. This could be followed by locating and appraising evidence of the likely impacts of potential policy options (or components of options), and, finally, meeting again to discuss the viability of potential options and to decide which options to present in the policy brief.

The policy options that are presented in a policy brief may be mutually exclusive where it is necessary to make a choice between them. In such cases, the options should be described in a way that facilitates comparison and a well-informed assessment of the pros and cons of each option should be presented. But, if the options presented are not mutually exclusive, a policy brief should make clear if there are any potential benefits of combining the different options and include a list of the pros and cons of each option.

This page was last updated November 2011.