Angel E. Alvarez, Ph. D.
Research-Consultant-Training 

Political negotiation of policy reforms

In contemporary pluralistic societies, new policies may spark dissent among stakeholders. In these societies, building consensus is a must for successful adoption and implementation of regulations and interventions. Consensually adopted regulations tend to be more successful than those authoritatively imposed. They are almost always the product of delicate negotiations to avoid hindrances during the implementation.

The likelihood of approval of the policy proposal hangs on a great deal on the quality of problem formulation and policy design. Ill-defined problems lead to vaguely defined and therefore defective agreements. Nevertheless, the power to approve the proposal belongs to the legislature and top leaders of the executive branch. Decisions on whether or not to support the proposed policy are generally preceded by public or private conversations and debates among proponents, stakeholders and decision-makers.

Negotiation should not be confused with a loosening of authority and the laws and regulations. The main strength of the proponents of the policy is their technical preparation and cohesiveness as a team. Policies end up being defined by influential stakeholders and interest groups—which should be avoided by any means—where there are institutional weakness and lack of technical preparation. Nevertheless, the lack of political consultation and dialogue may result in unnecessary conflict escalation.  The existence of barriers to participation cast doubts on the legitimacy of the policy and policy-makers—specially if the excluded are those without the power or the skills to express by themselves in the political arena.[i]

Those policy beneficiaries who live in poorly organized communities are among the most powerless groups within society.[ii] The empowerment and involvement of powerless stakeholders can have a positive influence on the implementation effectiveness. On the other hand, policy experts and advocates must be aware and able to respond appropriately to influential stakeholders and government agencies that assign a lower priority to public health programs for drug user or disagree with details of the proposed policy. Disagreement and resistance to change may come from different public and private stockholders. Those who benefited from previous policies and those others who hold wrong perceptions about the policy impacts can resist the change. Established organizational routines, government budget constraints, conflicts of interest, and different commitment levels can also hinder the implementation of policy changes. Furthermore, misinformation and prejudices can lead some stakeholders and decision-makers to question the necessity, efficacy, appropriateness, and effectiveness of public health programs for drug users.

Policy promoters should encourage negotiations with stakeholders to reach agreement on the formulation of the problem. Such an understanding will serve as a basis for the policy to become more feasible in the approval phase. The effort should be focused on forming a coalition of committed and influential interested parties (see Fig. 1, to achieve the highest level of cooperation among the most significant possible number of supporting stakeholders.

Effective negotiation requires leading efforts to engage interested parties in consultations and win-win negotiations to put pressure on decision-makers to approve and endorse the implementation of evidence-based drug policies. The milestone of this stage is maximizing support and minimizing opposition to the public health policy propodeal. Politics, as the aggregation of citizens’ preferences into government policies, becomes explicit at this point of the policy cycle. 

Figure 1. Map of stakeholders

The ultimate consequence of policy promotion and advocacy actions should be the approval and budgeting of the policy and programs. Public health and drug experts must be aware of the procedures for the formal adoption of policies, programs and procedures, and be prepared to cooperate with the legislators and executive leaders to help them to make informed decisions. In some countries, policy proposals must be approved by the executive cabinet or the legislature before they can be implemented. In others, the proposals become administrative documents that serve as guidelines for plans and programs. In some other countries, drug abuse governed by legal restrictions and controls. However, policies expressed in laws may include too many operational details, which may make future adjustments more difficult. [iv] 

To encourage cooperation and agreement, the spokespersons or leaders of the team that proposes the policy are firmly committed to the public health approach and have political skills of negotiation and persuasion. Policy professionals with no political training need to develop the following capacities to deal with the politics of policy-making:

1.    First and foremost, always stand for the evidence-based approach and do not compromise on the core values and goals of the policy.

2.    Engage in constructive dialogues and negotiations aimed at achieving a balanced and consensual formulation of the plan.

3.    Make an exhaustive and consistent map of interested parties and identify their preferences and level of influence on the policy-making process (see Figure 2).

4.    Determine the stakeholders’ alignment with the policy framework.  

5.    Create a network of influential supporters and generate opportunities for adequate consultation and participation.

6.    Support and endorse evidence-based advocacy activities.

7.    Provide manageably and motivating information, address the concerns, and favour the empowerment of powerless supporters.

8.    Assess the rationale of the opposition to the policy proposal and facilitate communication to reduce resistance and promote change among primary and secondary opponents.

9.    Develop strategies for efficient and ethical negotiation and conflict management, taking the win-win approach instead of confrontational tactics. However, under exceptional conditions, policymakers have no other option but to impose the technically superior and socially most relevant policy designs.

10. Monitor uninvolved parties for early detection of concerns.

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[i] Patient empowerment and efficient health outcomes. Financing sustainable healthcare in Europe. 2007: 139–162. [accessed 26 February 2009]; http://www .sustainhealthcare .org/The_Cox_Report.pdf.

[ii] Jie Chen, C. Daniel Mullins, Pricila Novak, Stephen B. Thomas, “Personalized Strategies to Activate and Empower Patients in Health Care and Reduce Health Disparities.” Health Education and Behavior. Published online 2015 April 6. doi:  10.1177/1090198115579415

[iii] Health promotion glossary. Geneva: World Health Organization; 1998. Angelmar R, Bermann BP. Lyons M. Should patients have a role in patient safety? A safety engineering view. Quality and Safety in Health Care. 2007; 16: 140–142. 

[iv] World Health Organization. How to develop and implement a national drug policy. 2nd ed. Malta: 2001.