Background

Making health policy decisions typically requires both formal discussions and careful consideration. Deliberative processes are a valuable means of providing contextualised ‘decision support’ to health policymakers and giving stakeholders – both patients and the public -  a voice.^1,2,3 While some attention has been given to the use of deliberative processes in clinical practice guideline development,^1,4,5,6 less attention has been paid to the use of such processes in facilitating evidence-informed health policymaking.^1,2,4

In this guide, the term ‘policy dialogue’ refers to a deliberative process (i.e. a structured discussion) which is focused on a policy brief (further details related to policy briefs are described in the previous guides in this series). Structured discussions of a policy brief can help to contribute to the development of evidence-informed health policies in a number of ways including by:

• Providing a check on the quality and contents of the policy brief
• Clarifying judgements that are made in the policy brief
• Introducing relevant evidence not incorporated in the policy brief
• Helping to ensure that the contents of the policy brief are understandable and understood
• Helping to ensure that the policy brief is taken into account and used in the development of a policy

They can also help to clarify the problem and solutions and the development of a shared understanding by:

• Further clarifying the problem and its causes
• Developing a shared understanding of the problem and its causes
• Further clarifying options for addressing the problem
• Developing a shared understanding of the pros and cons of different options
• Identifying and clarifying barriers to implementing these options
• Identifying and clarifying strategies for addressing these barriers
• Developing a shared understanding of the pros and cons of relevant implementation strategies
• Clarifying important uncertainties
• Developing a shared understanding of uncertainties and needs related to monitoring and evaluation

Further, structured discussions can contribute to the development and implementation of effective policies by:

• Facilitating dialogue between people with different types of expertise and different perspectives
• Bringing potential opposition into the policy development process
• Exposing, clarifying, or resolving disagreements regarding the evidence
• Clarifying judgements that need to be made based on the policy brief
• Clarifying the values used in judgements related to the balance between the pros and cons of the options and implementation strategies; and exposing, clarifying, or resolving differences in these values
• Allowing policymakers and stakeholders to generate ideas and actions that can help to expedite the development and implementation of effective policies
• Giving credibility to the policy development process and the policies that evolve

Finally, structured discussions can contribute to good governance and democracy by:

• Involving people in their own governance
• Helping to ensure transparency
• Helping to ensure accountability
• Building capacity for evidence-informed policymaking
• Providing a learning opportunity for stakeholders and the public

Designing policy dialogues to achieve their objectives

Health policy decisions require a large number of judgements, including:

• The importance of the problem and its causes
• Which options to address the problem should be considered
• The likely impacts of these options
• Barriers to implementing these options
• Which implementation strategies should be considered to address these barriers
• The likely effects of these strategies
• Priorities for monitoring and evaluation
• The balance between the advantages and disadvantages of the options and the implementation strategies that are considered viable

Most of these judgements need to be made by those preparing a policy brief and should be open to discussion by those using the policy brief. The last judgement needs to be made by those using the policy brief and requires a careful consideration of the values attached to the expected advantages and disadvantages.

The judgements that are made are complex and require input from people with different types of expertise and different perspectives. Bringing people together to discuss a policy brief is an activity based on the understanding that the participants will all have something to contribute. It is essential that policy dialogues are designed in such a way that an appropriate group of people is brought together. The process should also ensure that all participants will be heard and have the opportunity to influence the outcome of the process. A structured approach to deciding on the participants and the process can help to ensure that a policy dialogue is appropriately designed and able to achieve its objectives.

This page was last updated November 2011.